The role diversity played in the past, how it functions in the present, and where it might take vascular surgery in the future formed one of the central themes running through the Presidential Address delivered by outgoing Society for Vascular Surgery (SVS) President Ali AbuRahma, MD, during the 2022 Vascular Annual Meeting (VAM) in Boston (June 15–18).
AbuRahma is the 16th SVS president to be born outside of the United States—which were an important backdrop to his opening remarks in “SVS past, present and future: From being exclusive to more inclusive.”
He dipped into the Society’s storied three-quarter-century history—pulling out and highlighting the 15 past presidents before him who were born outside of the United States—to settle on an important question posed to him by members: “Are we inclusive enough, or are we still as exclusive as we were 50 years ago?”
Those international names represent important figures in vascular surgery, important advances in the specialty as a whole, and many contributions to the development of the SVS, he told the VAM 2022 audience. The contingent includes two SVS charter members: Hungary-born Geza de Takats, MD, president in 1953; and Robert Linton, MD, a Scot who followed de Takats as president two years later. AbuRahma spotlighted the major contributions of all 15, including more recent predecessors such as Anton Sidawy, MD, who hails from Syria and was SVS president in 2010; Peter Gloviczki, MD, also born in Hungary, and the 2013 SVS president; and Michel Makaroun, MD, who was born in Lebanon and led the SVS in 2019.
“At a time of unfortunate xenophobia in our culture, the SVS has always been an open international society, and this is no better reflected than in the backgrounds of so many of our past leaders,” he told attendees. The “unparalleled leadership of the SVS” in the field of vascular disease “reflects not only the wisdom of our past leaders,” but the organization’s commitment to evolution going forward, AbuRahma said.
The chief of vascular and endovascular surgery at West Virginia University School of Medicine/Charleston Area Medical Center in Charleston, West Virginia, highlighted how this evolution at the SVS has played out at the structural and committee levels.
“In the early SVS years, and during the first 50 years, there were very limited numbers of standing committees, including the membership, program, nominating [committees], and a committee on arrangements for VAM,” he said.
AbuRahma outlined how the membership has expanded and become more inclusive, and how new dedicated membership sections for women, young surgeons and physician assistants, and for areas such as community practice and office-based labs, have broadened discussion and educational offerings.
He also pointed out how changes at the SVS Nominating Committee level capture the essence of the Society’s evolution. “In the past, the SVS Nominating Committee consisted of three members appointed by the president one month before VAM, usually the three immediate past presidents, and its function was to compile a slate of officers to be presented to the Executive Council and members at the VAM,” AbuRahma informed attendees. “Currently, it consists of seven members—the three most recent and surviving and available past presidents with the most senior as chair, one member that is elected annually from and by the 11 representatives of the regional and vascular societies serving on the Strategic Board, one member-at-large elected from the SVS membership who is not currently serving on the Executive Board, the vice-chair of the Community Practice Section, and the chair of Leadership and Diversity Committee.”
Looking ahead, AbuRahma continued, the SVS must maintain focus on key areas, such as branding the specialty, continuing the fight for “fair and appropriate payment,” and continuing to provide support for those in community practice: “We must be united and have a common message across members and keep investing in embracing diversity and cultural change,” he said.
“We should keep investing in our health and wellness and our early-career members which is critical for our future. We must continue to embrace quality in vascular patient care and finally we must work towards finding a common pathway in working with other non-vascular surgeon providers who practice endovascular therapy based on acceptable dedicated training in endovascular intervention.”
That harkens back to AbuRahma’s chosen topic for last year’s E. Stanley Crawford Critical Issues Forum at VAM 2021 in San Diego. The then incoming SVS president focused on the role of multispecialty care in vascular and endovascular surgery, hoping to get at least some answers to the question: Can the competing specialties of the vasculature work together?
AbuRahma assembled a panel of physicians covering every specialty involved in the treatment of vascular disease for the event. During the forum, AbuRahma himself declared: “Vascular providers must have defined, dedicated vascular and endovascular training during their formal residency or fellowship. Multispecialty practice, if feasible, will enhance and improve vascular care.”
At VAM 2022, AbuRahma returned to the topic, and posed such questions as what strategy vascular surgery should deploy in order to ensure vascular procedures are carried out by appropriately trained specialists. “Many specialties are attracted to performing vascular procedures in light of workforce shortage, and mal-distribution creates access issues to vascular surgeons,” he said. “Advances in treatment and device technology make therapy for an increasing number of vascular conditions within the perceived scope of other specialists, some of whom are without adequate training. The current policies and incentives are rewarding the wrong behavior with consequences of quality challenges, increased complications landing in vascular surgery practices, payment inefficiencies with overutilization and unnecessary procedures.”
He once again raised the virtues of multispecialty practice, which traces its roots to his state—West Virginia—and the concept of a Vascular Center of Excellence model, such as the one developed at his institution, which includes eight board-certified vascular surgeons, two board-certified cardiologists/vascular interventionists, one board-certified vascular medicine interventionist, and one board-certified interventional radiologist.
In that vein, AbuRahma conducted a survey of SVS members to assess the level of interest in multispecialty models of practice. Among the results, he found more than 50% of respondents saw cardiologists/interventional cardiologists and interventional radiologists as a threat among non-vascular surgeon providers performing procedures for vascular disease, while 58% said they did not form part of a multispecialty group that includes non-vascular surgeons.
What, then, should the strategy be? AbuRahma asked: “How can the SVS best position itself to take the lead in shaping the future of vascular surgery care delivery, and optimizing patient outcomes? Can demonstrated competence and quality metrics be established and agreed upon across specialties? Who are the critical partners to engage in the dialogue?” And, he added, “Are there highly successful multispecialty models to be demonstrated? All of us know politics are local. Can we or should we influence and or impact training guidelines?”