Vascular surgeons must present a unified front in order to address structural and financial challenges facing the specialty, Society for Vascular Surgery (SVS) President-Elect Keith Calligaro, MD, said in summing up this year’s E. Stanley Crawford Critical Issues Forum at the 2025 Vascular Annual Meeting (VAM) in New Orleans. This year, the annual forum explored ways to “empower” the vascular community to confront these head on and covered topics ranging from vascular surgery’s position within heart and vascular centers, to unionization and fair financial reimbursement.
First up, Malachi Sheahan III, MD, chair of surgery at the Louisiana State University Health Sciences Center in VAM host city New Orleans, addressed one of the thorniest topics: the issue of heart and vascular centers and vascular surgery’s position within them. Fundamentally, he asked whether the specialty’s role is being a peripheral part of the heart and vascular center?
“If we cohabitate heart and vascular, I just see no way we are going to come out on top,” he told those gathered. “For most of us here, we are at too much of a disadvantage for this to be a successful paradigm for our care.”
Next, Faisal Aziz, MD, the chief of vascular surgery at Penn State University in Hershey, Pennsylvania, contemplated the position of departments of vascular surgery in both academic and community hospital settings, ultimately asking, “Are they worth fighting for?” “The best interests of vascular surgery are not served by being a part of heart and vascular institutes, or by departments of surgery—I think it is about time that we declare our independence,” he said.
Sunita Srivastava, MD, assistant professor of surgery at Massachusetts General Hospital in Boston, addressed how vascular surgeons can attain fair financial reimbursement from a marketing and fair compensation perspective. Her talk, based on a report of the SVS Population Health Task Force, looked at outside pressures impacting fair compensation. “The financial advantage of a vascular surgeon to healthcare is severely underestimated and very difficult to measure,” she told VAM 2025 attendees. “We contribute the technical revenue to a service, we are not given credit for it. When our operative assistance is needed, we drive the complexity, we drive the financial value, and the contribution margin to the hospital.”
Last up, Enrico Ascher, MD, professor of surgery at New York University in New York City and CEO of the Vascular Institute of New York, tackled the question of potential unionization, asking, “How can vascular surgeons unionize when 95% of payments come from Medicare?” he said. “As issues with full time employees and patients increase, the topic of unionization is not going to go away, it is just going to become deeper and [more] robust.”
Calligaro, at the time SVS president-elect, now SVS president following the conclusion of VAM 2025, identified the need for vascular surgery unity. “The overriding theme from this whole session is that we need to be unified. There are disagreements on certain issues, but we really need to speak as one voice, get together and try to figure out what we can by working together.”
Calligaro, who as the incoming SVS president was responsible for organizing the forum, assembled the panel of four leading vascular surgeons to tackle some of the hottest topics of the day that speak to how vascular surgery is structured in hospitals and medical centers, as well as how vascular surgeons are reimbursed and organized.
“Fundamentally, we want to inform our SVS members what they can do to become better positioned with their hospital administrations and compared to other specialties, so that we are in a better position to take care of our patients for ourselves,” the chief of vascular surgery at Pennsylvania Hospital in Philadelphia told Vascular Specialist ahead of the event.
