Vascular Surgeons Need Loyal Colleagues

By Frank J. Veith, M.D.

Many old-time vascular surgeons considered themselves to be flinty independent practitioners who could alone provide all aspects of care to vascular patients.

Such lone-wolf vascular surgeons may have been able to thrive in the past, but times have changed. Vascular surgery patients have become more complicated and generally sicker.

Vascular care has become substantially more complex and intricate. Regulatory, compliance, and legal pitfalls abound. Because of these changes, the need for round-the-clock involvement by the vascular surgeon has become more commonplace. Indeed, it has become almost routine.

Accordingly, the day of the independent solo vascular surgeon, who may depend on a general surgeon for "coverage," is over.

Vascular surgeons must develop close relationships with trusted, loyal colleagues on whom they can depend. Such close, formal collegial relationships include not only those with other fully-trained vascular surgeon-partners and physicians in other disciplines, but also with those who are not physicians but are trained in related fields such as nurses, physician's assistants, noninvasive laboratory technicians, and most importantly, administrative assistants who provide secretarial and other organizational services.

To be successful, the modern vascular surgeon must be part of a structured team.

Let us examine why all these loyal colleagues are so critically important to the present-day vascular surgeon's success in carrying out his or her many missions. First are the vascular surgeon's partners. In today's environment vascular surgeons will benefit from working in a group or a partnership. Up to 30% of vascular patients require urgent or emergent procedures, many requiring high-level judgmental, surgical, or interventional skills.

If one vascular surgeon is performing a lengthy procedure or seeing an office full of patients and another patient requires an emergent procedure or reintervention, it cannot and should not wait until the end of the day or be performed by a "covering surgeon" who may be less qualified and also busy.

Vascular surgeons who work in groups or partnerships of competent, compatible individuals can deal with such urgent situations optimally. The same considerations apply to nights, weekends, and vacations.

Trusted partners can also be essential to optimal care if a vascular surgeon finds himself in an unusually difficult or lengthy procedure. It is far better to call for help from a fresh and willing colleague than from a less well-trained surgeon who may also be a competitor.

In addition, fatigue is real and is well known to dampen performance. It is far more acceptable to ask for relief from a partner than from an outsider after a sleepless night or two, or during an overly lengthy procedure that is not going well. Vascular surgery cannot be practiced well as a part-time specialty. To do so places the surgeon and the public at risk.

Scholarly productivity also increases logarithmically if vascular surgeons work in collegial groups. Access to more patients, shared contributions, ability to engage in clinical trials, shared writing chores, and the availability of concepts and ideas are all enhanced greatly within a partnership or team of vascular surgeons. The solo vascular surgeon can no longer compete in the same league.

Next on the trusted, loyal colleague list are specialists from other disciplines such as anesthesiology, radiology, cardiology, and intensive care management. The benefits of working together regularly with the same individuals who are committed to the care of sick, complicated vascular patients are legion.

There is nothing better and more rewarding than working regularly with one or a team of "superspecialist" anesthesiologists who understand what vascular surgeons do and what vascular patients need.

There is nothing worse than working every day with a different "generalist" anesthesiologist who has little interest in and experience with vascular patients or procedures. The difference in quality of care and outcomes is enormous. The same is true with specialists from other disciplines.

Last, and possibly most important, in the list of loyal colleagues are the nonphysician, so-called ancillary individuals who are anything but ancillary. In my opinion, such individuals are the key to success in vascular surgery and the touchstone of all successful vascular surgery groups or services.

These individuals--nurses, a physician's assistants, executive assistants or supersecretaries--are the glue that holds groups or partnerships of vascular surgeons together and makes them work. They deserve to be rewarded accordingly in terms of respect, status, and income.

Since I have run a busy and productive vascular surgery service for years, I can say emphatically that it has been such individuals and their commitment, more than any of the vascular surgeons, that has led to the accomplishments and stature of that service. In our case, it was two supersecretaries (executive assistants), a nurse, a physician's assistant, and a vascular laboratory technician.

The qualities of these individuals that made them so essential to the overall group's success had nothing to do with their educational level, their background, their original job description or their title It related more to their native intelligence, their initiative and willingness to learn, and most important, their understanding of vascular patients and vascular surgery and their commitment to do whatever was necessary to complete the mission of the group.

One young vascular surgeon did not appreciate the overriding importance of these individuals to the group's success and indeed to his success. He regarded them as "old shoes" who "when they wore out could be replaced." He could not have been more wrong. The so-called ancillary staff, because of their character traits, loyalty, and commitment, were irreplaceable. He, the vascular surgeon, could easily be replaced without weakening the group. The other nonphysician loyal colleagues could not.

The message is that vascular surgery today is best practiced as a structured group of individuals which includes vascular surgeons and others who are equally important and committed to achieving the mission or missions of the group.

Vascular surgeons must recognize the importance of this group or team concept. They must also recognize the essential contributions of loyal colleagues who are neither physicians nor vascular surgeons. They must do everything they can to cultivate the qualities that make such individuals an integral part of their well-functioning team.

Finally, when they find such individuals, they must recognize their importance and reward them accordingly. Better vascular patient care will result.