Some things vascular surgeons should know that they don’t learn in training

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All vascular surgeons want to be good doctors and to take the best possible care of their patients. They, therefore, train diligently and strive to keep up with new developments by reading vascular journals and attending cutting edge vascular meetings. They seek to optimize their judgment, communicate well and honestly with patients, perform their procedures with care, and follow their patients closely.

However, doing all these things does not ensure ascendancy in the profession. There are other factors which go into being a successful vascular surgeon. Many of these are not taught in medical school or residency training, and failure to recognize their importance can derail an otherwise prominent career. It is, therefore, important to highlight some of these factors which can be pitfalls to even the best trained and most committed vascular surgeon.

Dr. Frank J. Veith

Dr. Frank J. Veith

Vascular surgeons exist in a professionally competitive environment. We compete for patients with several other specialists including interventional cardiologists, interventional radiologists, and some general and cardiac surgeons as well as other lesser competitors.

All are hungry for patients and all consider themselves expert in all or some of the things we do. We also face competition from other vascular surgeons, few of whom feel busy enough to turn away patients. Therefore, it is important that vascular surgeons consider the competitive landscape when they are choosing a location or institution in which to practice. Is there an empty niche for the particular skills one brings to the area or the institution, and will other physicians in the area recognize those skills? Even then they must compete effectively not only by providing superior care but also by engaging in appropriate public relations and marketing of their assets.

Recognizing the importance of professional relationships with nonphysicians and other physicians outside our specialty and cultivating these relationships are other keys to success. The need for good relationships with referring physicians is obvious. Not so obvious is the need to have good relationships with hospital administrators who control essential resources, with other specialists like anesthesiologists and intensivists who can optimize the care our patients receive, with industry representatives, and even with other vascular surgeons. To make these relationships work to our advantage it is crucial to make them mutually beneficial. People are much more inclined to be helpful if what they are doing also helps them. Mutual self-interest can even improve interactions with competitors.

It is also important to avoid making enemies. This is particularly hard to do in the competitive environment in which we work. It is even harder to do in the present health care setting in which others who we do not control are unreasonable or incompetent. This is particularly true with those in positions of administrative authority like hospital executives or operating room supervisors. Making enemies of these individuals can be disastrous since they often control resources that determine our destiny. Keeping such individuals supportive or at least neutral, despite their possible serious flaws, is worth the sometimes painful effort required.

One must also be aware that nothing elicits hostility like success. If a young vascular surgeon/specialist has introduced a new technique or is particularly charming and hard-working and therefore has a booming practice, rest assured that his or her competitors – or even non-competitors – will be covertly or overtly hostile and take every opportunity to damage or bring down the successful individual. It does not matter that the hostility is unjustified and based on jealousy. It can still be unfairly damaging. All should realize that jealousy and greed are among the most powerful motivators of human behavior.

In view of all these considerations, it is apparent that all vascular surgeons, especially talented and successful ones, will at various times in their careers face battles. All cannot be fought. So one has to decide which ones should be avoided and which ones to engage in. Battles to fight should be picked carefully because they will consume energy and leave scars, no matter the outcome.

Most battles are best avoided unless victory is certain. Multiple simultaneous battles should be avoided. Battles in which one faces numerous opponents at the same time should also be shunned. Ideally in unavoidable conflicts, one should have as many allies as possible, although the loyalty of allies cannot always be counted on. Self-interest will determine the loyalty of presumed allies.

Never underestimate enemies, or overestimate allies. If the outcome of a battle is uncertain or to be determined by a board or other group, know how that group will vote before taking on the fight. Always remember the role of jealousy and greed in determining human behavior in battle. Defeated opponents do not forget and are forever dangerous.

Time is a vascular surgeon’s most important asset. Anything that one can do to enlist others to protect or expand this time is helpful. To this end, loyal nurses, physician’s assistants, or nonprofessional associates are invaluable. Their loyalty, which must be reciprocated, can be earned by recognizing their contributions and rewarding them intellectually and financially. This mutual loyalty is essential to success in practice and in the inevitable conflicts that will occur.

All these concepts and many others are not covered in medical school or residency training. Yet all are important in a vascular surgery career, whether it be in a practice or academic setting. Human nature is a constant and its elements may often work against one’s success. Being aware of some of these often noxious and little discussed elements will hopefully enable vascular surgeons to cope with them better and ultimately survive in what can be a difficult environment.

Dr. Veith is professor of surgery at New York University Medical Center and the Cleveland Clinic and an associate medical editor for Vascular Specialist.

 

The ideas and opinions expressed in Vascular 
Specialist do not necessarily reflect those of the Society or publisher.

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