Presidential Address: Lead With Optimism

In his 2007 presidential address at the Vascular Annual Meeting, Dr. K. Craig Kent, MD, looked to the past, raised a warning for the present, and painted an optimistic, if challenging, picture of the future.

"Vascular surgeons, until recently, have been the practitioners that have led the way," Dr. Kent. pointed out. "We were the leaders! We maintained this leadership role throughout many decades into the eighties and early nineties. ... God knows, nobody else wanted to perform an 8-hour femoral pedal bypass!"

But then there was a profound change. "In the late 90s, minimally invasive techniques matured, at first slowly, but then more rapidly. It was no longer an onerous task to care for a patient with vascular disease. The skill sets, with the advent of catheter techniques, crossed over with those of other interventionalists,"said Dr. Kent of New York Presbyterian Hospital, New York.

"In a matter of 10 years, the world changed dramatically for vascular surgeons. Instead of being leaders, in many ways we have become followers. Much of the new technology that we frequently use today was championed by others while we stayed on the sidelines fighting vehemently for the status quo. We let other organizations write the guidelines for vascular disease. . . . In sum, our position as leaders in the treatment of vascular disease has been, and continues to be, challenged."

To counteract this trend, vascular surgeons need to be leaders in vascular care in their local communities, he said. "It is the responsibility of every individual in this room to rise to a leadership role. If each of us takes on this mission. . . . Collectively we will be successful."

Dr. Kent outlined those qualities of leadership he felt were most important to this effort. The first was skill "to assure the world that we are also master physicians--that we can medically manage our patients with the latest pharmacy and with an in-depth understanding of the natural history of vascular disease. We need to perform catheter intervention with the same ability and skill as we do open surgery. Whatever the technique, we must be regarded as the best."

He addressed the need for passion and vision, as well as service, including continuity of care not commonly offered by other interventionalists. But, perhaps the most important attribute of a leader is optimism, he said. "The treatment of vascular disease will evolve. We can't control this evolution . . . but we can help it find its way. Medical students and residents follow an optimistic leader. Referring physicians want to hear that we are strong and positive about our profession. Patients need to hear our confidence. Optimism is a shining star that everyone follows."

Dr. Kent pointed out that SVS today has around 2,300 members, and an annual budget of 4.7 million dollars. "Our initiatives are numerous and in the areas of clinical practice, recruitment, education, research, branding, communications, international relations, advocacy and reimbursement," he declared.

He highlighted recent initiatives and successes: For example, in education--where a new committee has been established to create a program for comprehensive training in carotid stenting; in branding the profession, where SVS is using surveys of referring physicians and a communications committee to help understand the problem and take measures to correct it; in recruitment, where the SVS working in concert with the APDVS; and in advocacy and reimbursement, where initiatives in abdominal aortic aneurysm served as a model for "the first ever, preventative benefit available for patients with vascular disease, and SVS related efforts have saved vascular surgeons on a yearly basis over 60 million dollars in vascular testing revenue."

Dr. Kent ended with a call to every member of the SVS. "Each of us needs to return to our community with a mission . . . to let the world know that we are skilled surgeons and skilled interventionalists, that we are passionate about our specialty . . . that we are best at service. Most importantly . . . we are optimistic about the future. With this prescription, I am assured that the world will perceive vascular surgeons as leaders in vascular care!"