The majority of more than 300 vascular surgeons who responded to a recent survey indicated that they perceive the management of venous disease to be of less value than that of arterial disease. Investigators Misaki M. Kiguchi, MD, of MedStar Washington Hospital Center in Washington, D.C., and colleagues share this and other key findings in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.
The authors note that biases and gender disparities influence career pathways in medicine, with vascular surgery being no exception. They continue that, despite venous disease comprising an estimated 1–3% of total healthcare expenditures, its value among vascular surgeons is ill defined. It was the aim of the present study to address this, by investigating the factors that influence vascular surgeons’ current perceptions of superficial and deep venous disease treatments.
Kiguchi et al share that an anonymous survey was distributed electronically to practicing vascular surgeons in December 2021, with respondents stratified by gender and practice breakdown. They detail that a venous-heavy practice was defined as one with venous work comprising ≥25% of the total volume.
The investigators note that a total of 315 practicing vascular surgeons responded to their survey, with a majority of 81.5% from the U.S. The respondents had a mean age of 46.6±9.6 years, the authors detail, and almost two-thirds (63.3%) identified as men.
In terms of race and ethnicity, Kiguchi and colleagues state that 63% of respondents identified as White (non- Hispanic), 17.1% Asian or Asian Indian, 8.4% Hispanic, Latinx, or Spanish, 1.6% Black. The remaining 9.9% selected ‘unknown’ for this category.
Nearly half of respondents (47%) shared that their practice setting was academic, compared to 26.5% private practice, 23.3% hospital employed, and 3.2% ‘other’.
The investigators also note that the female respondents were “significantly” younger than their male counterparts (p<0.0001). In addition, they had fewer years in practice (p<0.0001) and were more likely to perceive a gender bias within a career encompassing venous disease compared with the male respondents (p=0.02).
Of the 315 participants in the survey, Kiguchi et al relay that 143 (45.4%) had a venous-heavy practice, with no differences found in age or gender between the venous-heavy and venous-light practices. They continue that those with a venous-heavy practice had significantly more years in practice statistically (p=0.02), had sought more venous training after graduation (p<0.0001), were more likely to be in private practice (p<0.0001), and were more likely to desire a practice change (p=0.001) compared with those with a venous-light practice.
Kiguchi and colleagues report that, overall, 74.3% of respondents indicated that venous work might be less “valued” than arterial work in the field of vascular surgery. On multivariable regression, they detail, the predictors for the perception of venous work being less valued were female gender (odds ratio 2.01, 95% confidence interval 1.14–4.03) and completion of a vascular surgery fellowship (odds ratio 2, 95% confidence interval 1.15–3.57).
In their conclusion, Kiguchi et al state that vascular surgeons perceived the management of venous disease to be of less value than that of arterial disease, particularly by women and fellowship-trained vascular surgeons. “The prevalence of venous disease, as measured by its proportion of the U.S. healthcare budget, cannot be overstated,” the authors state. As a result, they stress that “efforts to elevate the importance of chronic venous disease within the scope of vascular surgery practices are essential to ensure patients are provided with appropriate specialty care.”