SVS Clinical Practice Council's Survey Identifies Issues

By Keith D. Calligaro, MD

The Society of Vascular Surgery's Clinical Practice Council surveyed the membership to identify issues emerging in the practice environment that require attention from SVS.

The survey was conducted in February 2006 and emailed to 1,573 members. Disappointingly, only a total of 157 participants responded to the survey resulting in a 10% response rate.

The 21-question survey addressed the following areas:

• Endovascular techniques in practices
• Competition in the local marketplace
• Operating a vascular surgery business
• Professional liability and expert witness concerns

Demographics

A majority of survey participants were between 46-55 years old (70%). About 25% were between the ages 56-65, 22% were under 35 years of age and 8% were over 65 years old. Approximately 60% of survey participants characterized their practice as community-based while 40% characterized it as academic.

Endovascular Procedures

Regarding if survey participants personally perform specific endovascular procedures, 83% performed infrarenal AAA endograft, 80% peripheral arterial balloon angioplasty and stenting, 74% tibial angioplasty, 65% subintimal angioplasty, 64% renal artery stenting, 57% thrombolysis, 39% thoracic aortic aneurysm endograft, and 39% carotid stenting. Of note, 66% responded that their preferred approach to lower extremity occlusive disease was percutanous.

When asked if anyone in the practice does these procedures, 40% indicated carotid stenting and 34% indicated thoracic aortic aneurysm endograft procedures were performed by someone else. No physician performed carotid stenting in 22% of practices and none performed thoracic aortic aneurysm endografts in 26% of practices..

Survey participants also were asked if their practice does not provide the full-spectrum of endovascular interventions, why not? The top reasons included lack of training, the practice does ok without them or they were unable to get credentialed.

In 2001, about half (56%) of survey participants indicated that the majority (76-100%) of their personal operative caseload were open cases compared to only 16% in 2006.

In 2001, 42% of survey participants reported that 10% or less of their personal operative caseload were endovascular cases, while in 2006 it dropped to 11%. When asked if vascular surgeons should train cardiothoracic surgeons to do open vascular surgery procedures, only 34% were willing to do so compared to 48% who were willing to train them to perform endovascular procedures.

Competition in the Marketplace

Survey respondents were evenly divided regarding the question as to whether they were losing referrals from other physicians. Of those that indicated they were losing referrals, an overwhelming 88% said it was because of more competition from cardiologists. When asked: "What techniques does your practice use to generate more referrals?", 70% indicated that they use grand rounds/lectures.

Regarding marketing their practices, 67% indicated they marketed their practice directly to the public. The top techniques included vascular screenings, lectures/presentations and advertisements in newspapers, magazines, or radio.

Operating a Vascular Business

When asked what techniques they are currently using to reduce their practice's operating expenses, top reasons were modifying processes/protocols to improve efficiency, limiting the number of employees and outsourcing some work (e.g., typing, billing.).

Participants also were surveyed on techniques they are using to reduce the expense of operating a vascular lab. The top techniques indicated were modifying processes/protocols to improve efficiency and increasing the number of studies per hour.

When asked: "Do you need help in developing or managing a non-invasive vascular lab?", only 33% responded, "Yes." They indicated they needed help included marketing the lab, payment denials and developing a lab.

Liability and Expert Witness Concerns

About 62% of the survey participants indicated that fraudulent witness testimony is a problem existing in their community.

When asked: "Is professional liability insurance a problem for you?" respondents were fairly divided with 53% indicating "Yes" and 46% responding "No." Of those indicating, "Yes," an overwhelming 87% said the main problem is premiums.

Regarding how SVS can help address professional liability concerns, the top factors included working to decrease frivolous lawsuits, increasing visibility of existing SVS expert witness program to evaluate fraudulent testimony and working to decrease premiums.