‘Leveraging multiple teams and cardiovascular specialists’

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Young Erben

This quarter’s Leadership Corner features Young Erben, MD, interviewing Charles B. Ross, MD, chief of vascular and endovascular services at Piedmont Heart Institute, Piedmont Hospital, Atlanta, since 2012.

I am highlighting the innovative work of Dr. Ross, current medical leader of the Southeastern Vascular Study Group (SEVSG) and president of the Georgia Vascular Society. Dr. Ross is an advocate for vascular service providers and a well-respected vascular surgeon within his region. He understands the unique stresses placed on systems for vascular care and the providers and teams who must provide that care “in the trenches.” Many of us are certainly reminded when we highlight Dr. Ross of the daily challenges we face while trying to juggle the needs of the patient, hospital system and of all providers involved within a hospital system.

Dr. Ross was recruited from the University of Louisville to the Piedmont Heart Institute, Piedmont Hospital, in 2012. The Institute was experiencing tremendous growth and development of all facets of its cardiovascular service line. Dr. Ross recognized the synergistic advantages of development of a system to care for all non-coronary vascular emergencies for the institute, the hospital and the healthcare system, and introduced the concept of a level one cardiovascular emergency program. Dr. Ross was teamed with Dr. William Morris Brown, Piedmont Heart Institute chief of cardiac surgery, to lead this effort. Dr. Ross gives credit to Drs. Michael Dalsing, Gary Lemmon, Arthur Coffey and the team at IU-Methodist in Indianapolis who mentored the Piedmont team.

He said, “Basically, we adapted the groundbreaking IU-Methodist level one system to the needs of Piedmont and its metro Atlanta and north Georgia community—incorporating not just acute aortic syndromes, acute limb ischemia and ‘other’ vascular emergencies like acute mesenteric ischemia and venous catastrophes, but also acute pulmonary embolism response.” This required leveraging multiple teams and cardiovascular specialists as well as supporting consultants. The Piedmont Level I Cardiovascular Emergency Program went “live” on July 1, 2014, and has since served over 1,300 major emergencies.

Several questions come to mind when we encounter unique leaders like Dr. Ross.

Charles B. Ross

What inspires you?

CR: Patients and teammates inspire me. The bravery of patients facing life- and limb-threatening situations is never lost on me. Daily inspiration may also come from a special nurse who provides critical and compassionate care, a perfusionist incredibly tired from overwork who works extra hours to support the ECMO program, or an advanced practice provider (APP) who spots an important piece of data that meaningfully changes a plan. Or watching my partners plan a complex aortic endovascular reconstruction, or observing them develop a vascular service line at a satellite hospital—seeing progress in action. Everyone in the trenches being the best they can be—little things that sometimes no one else seems to see—inspire me.

What keeps you passionate about what you do?

CR: Vascular surgery as a specialty is the source of my passion. It is the history of vascular surgery, my everlasting appreciation of those who trained me, and my desire for the whole world to appreciate the miracles we produce, or contribute to, every single day. Turning passion to productive works, involvement with regional vascular societies, the PERT Consortium, and Society for Vascular Surgery (SVS) have been key for me. Failure pushes me forward as well. The present “fireman” struggle that all vascular leaders are facing has been particularly difficult for me. Piedmont is a large hospital with one of the highest acuity ratings of all “community hospitals” in this country. And, we have a large system of satellite hospitals unable to provide advanced vascular care much of the time. My partners and I live the role of “firemen of the hospital and system,” often multiple times daily. We do so in absence of resident and fellow support. Despite the attention offered by our SVS to this issue, I have been unable to achieve recognition and tangible support for my team for our contributions to the mission of the hospital and healthcare system as a whole. I am continuing to work with our administrative team to quantify and gain credit for our efforts.

What about collaboration—you are known as someone who values multispecialty involvement. Can you elaborate?

CR: Collaboration works best when there is mutual respect, concern and empathy among team members. This was highlighted by Drs. Ali AbuRahma and Mark Bates in a special session at the Vascular Annual Meeting (VAM) this year. I felt as if my Piedmont colleague in interventional cardiology-vascular medicine, Dr. Andrew Klein, and I could have given the same talk with the same message. If an acute pulmonary embolism presents to me on call and I am in a case, it is seamless for me to call Drew and ask him to take it, and vice versa. The taxonomy of our specialties does not matter.

The same is true for interventional management of acute limb ischemia. Another major example of Piedmont Heart and Vascular Institute collaborative effort is our cardiac and vascular surgery teamwork in offering comprehensive management of all acute aortic syndromes and complex aortic elective surgery.

Issues do arise that can be very destructive to collaboration, but they are imposed at higher levels than the trenches in which we provide patient care. Differential payment based on specialty taxonomy for identical work is demoralizing. Marketing that favors one specialty above another and provides misleading messages that can change practice patterns is also troubling. These actions undermine collaboration.

Multispecialty collaboration in absence of incentives to support such activities creates winners and losers. For example, a hospital may wish for its vascular surgeons to support other services. But, if the hospital fails to recognize the opportunity lost by having a vascular surgeon on standby for six hours, without any billable service, what it is really asking is for vascular surgery to underwrite the other service. Of course, the vascular surgeon wants nothing but good care for patients, and vascular surgery wants to contribute to programs that are good for the hospital. But, in relative value unit (RVU)-driven compensation plans, or, worse still, private practice, vascular surgeons personally take a loss for participation. There are innumerable such examples, and we cannot be “shamed” into not speaking up. In my experience, for complex reasons, including historic undervaluation for vascular procedures as compared to others, vascular surgery ends up on the short end of the stick much of the time.

What keeps you grounded?

CR: My colleagues and my family. I am so fortunate to have the most supportive and stable vascular partnership at Piedmont, and in the greater vascular surgical community in Georgia as a whole. Moreover, the national support I have felt has been so appreciated. The ability to pick up the phone, and call mentors and colleagues for advice on administrative problems and manpower has been a great advantage. SVS membership has been foundational for me. More than anything, my participation in the SVS reminds me that I am not alone. Colleagues in the PERT Consortium also represent important sources of counsel and gravitas for me. The PERT community, both here in metro Atlanta and nationally, basically defines a multispecialty, multi-institutional effort with a singular mission—to reduce mortality and morbidity of acute pulmonary embolism. The chance to be part of an effort to have a measurable, positive impact on a frequently fatal disease process has been one of the most rewarding activities in which I have ever engaged. But, most importantly, it is my wife of 41 years, Kim, who tolerates burdensome Epic activity, multiple conference calls resulting in late dinners, and other academic and nonclinical duties which tend to consume weekends.

It is also our children, all hard workers and successful in their own early careers. Everything hinges on Kim and family.

Young Erben participated in the 2020 Society for Vascular Surgery (SVS) Leadership Development Program and is one of the recipients of the 2021 Leadership Mastery Grant. She has been able to use her skills learned during the course to bring multi-disciplinary teams together to address several vascular needs in her community. The Mastery Grant permitted her to take the Career Advancement and Leadership Skills for Women in Healthcare course offered by Harvard Medical School and directed by Julie Silver, MD, a renowned innovator at supporting healthcare change and working to improve disparities in the medical workforce.

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