Brothers and sisters, unite!
In this month’s Vascular Specialist, there are two letters to the editor that seem to imply a division in the SVS membership. The letters indirectly suggest that the SVS comprises two camps, on the one hand, academics, and on the other, community-based physicians. Further, although the majority of the membership comprises primarily of nonacademic surgeons, the leadership is, and will remain, predominantly composed of University-employed physicians. Implicit also is that there may not be a common agenda.
However, many questions come to mind: Are we truly a house divided? If so, how did this come about? Do community and academic surgeons indeed have different concerns that split us into camps? If so, how can we come together because the aphorism “United we stand, divided we fall” will have critical implications for the future of our specialty.
Dennis Gable writes that “the SVS is often (and historically) thought of as a society reserved for academic surgeons” because it is regarded solely as a vehicle to arrange a national academic meeting (the VAM). However, he counters that incorrect assessment by describing many fundamentally important roles that the SVS plays in the daily lives of practicing vascular surgeons. He encourages members to go online (at www.vascularweb.org) and see for themselves all that the SVS is doing for vascular surgery, vascular surgeons and their patients. The Society’s strong advocacy efforts on reimbursement issues, for example, have prevented millions of dollars in payment cuts, something hugely important to members in community practice.
However, many older surgeons will recall a period when only a select few could join the Society for Vascular Surgery as it was then constituted. Entry was reserved for nationally recognized researchers or those with an extensive list of publications. At that time, it was even difficult to become a member of the International Society for Cardiovascular Surgery. Community surgeons who had limited or few current publications were almost totally excluded. That was the impetus for community surgeons to form the Society for Clinical Vascular Surgery. However, some years back the SVS expanded beyond just the meeting and sought to be inclusive rather than restrictive. Membership is now virtually guaranteed to all board-certified vascular surgeons in good standing. Even members of allied health groups such as nurse practitioners and physician assistants are encouraged to become affiliate members. The SVS inspires female and minority medical students to become vascular surgeons and future members.
Further, 7 years ago, current President Bruce Perler, then chair of the Clinical Practice Council, initiated the Community Practice Advisory Committee in an effort to address the concerns of community members. I had the privilege of being its first chairperson. The current chairperson of that committee, Richard Lynn, now serves on the Board of the Society. Additionally, the SVS has made a concerted effort to add community surgeons to all of its committees.
Even the annual meeting has increasingly added multiple sessions addressing topics of interest to community surgeons. As attendance at these session proves, academic and employed physicians have found them to be equally informative. This is the result of the changing economic and health care environment that has blurred the lines between academic and nonacademic practices. Is there, then, any real division that separates the university surgeon from his or her community counterpart? Personally I believe there is none. If there is, it is simply a historical memory that has failed to disappear when confronted with the reality of the present.
However, Carlo Dall’Olmo and Dennis Gable, community surgeons who have been very active in SVS leadership positions (Carlo as Chair of the PAC and Dennis as Membership Chair), both recognize the absence of community surgeons on the SVS Executive Committee. Does this imply a conspiracy? Of course not! Rather, it is a result of the many factors briefly outlined in their letters. I have had the benefit of discussions with both men, as well as current and past SVS Presidents, so perhaps I can paraphrase their thoughts on this issue.
Carlo suggests that it is a result of a governance structure that rewards leadership positions based not only on service to the Society but also on academic achievements. He, as well as many others, suggests that our leaders should be elected, based not only on their publications and research, but also they must have proven dedication to the Society as well as providing a manifesto or platform explaining their goals for its future. Indeed, most if not all current and past executive members have been some of the most prolific researchers and have also effectively served on multiple committees over many years. If not for their hard work (unpaid and purely voluntary), our Society would never be in the viable situation it is now. We certainly owe a great deal of gratitude to the many academics who have so effectively stewarded our organization.
