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Home > Medical Professionals > Vascular Specialist newspaper > Vascular Specialist Volume 4 Number 1 > Vascular Specialist Volume 4 Number 1

As Tom Friedman recognized in his book, "The World is Flat," we now live in a globalized economy in a globalized world. The days of isolationism and an insular United States are over. Is this true also with medicine in general and vascular surgery in particular? You bet it is.

In times past, the United States was the dominant force and the engine for innovation in medical development and progress. The rest of the world looked to the United States for leadership in medicine and that certainly was true for vascular surgery. Then imperceptibly in the 1980s things began to change throughout the rest of the developed world. Important innovations, disruptive technologies, and paradigm shifts in vascular disease management were first introduced in Europe, South America, and Australia. Balloon angioplasty, stents, endovascular grafts, and fenestrated endografts are prominent examples. Development of these advances in vascular treatment often proceeded faster in these "overseas" or "out of U.S." countries in part because of a less restrictive regulatory environment, although a greater willingness to accept change may also characterize vascular surgery in some non-U.S. sites.

Why is all this of any concern to Americocentric U.S. vascular surgeons? Why should they care what is going on overseas, and why should they care that North America is no longer the center of the universe for advances in vascular surgery?

U.S. vascular surgeons are presently in a difficult environment. Payment for vascular procedures has not kept pace with inflation, and we face the threat of further decreases in compensation in the future. Endless paperwork as well as huge malpractice premiums increase the cost and pain of practicing vascular surgery. As vascular surgeons' incomes decrease, they are forced for financial reasons to increase their interest in venous disease and in some cases to do procedures for marginal or inadequate indications. On top of these problems, vascular surgeons face increasing competition from cardiologists, radiologists, and other interventional specialists who regard the care of almost all noncardiac vascular patients as fair game to augment their practices and incomes. And most recently, cardiac surgeons, who have seen erosion of coronary bypass surgery because of stents and statins, are seeking to expand their practices to include noncardiac vascular lesions throughout the arterial and venous systems. Many cardiac surgeons--and even some general surgeons--are now seeking endovascular training to facilitate their ability to attract patients with vascular lesions. Others are recruiting partners with recent vascular surgery training for the same purpose.

Unfortunately vascular surgery is not a clearly defined specialty. In this difficult free-for-all environment in which other specialists are competing vigorously for our patients, vascular surgeons must provide the highest quality care they possibly can to retain their practices. One way of doing this is to acknowledge the importance of overseas vascular surgery and the innovations and developments that are being introduced outside the United States. By keeping up with these and incorporating them into practice, American vascular surgeons can improve their quality of care over that of other specialists who are largely proceduralists. Educating the public about the benefits of going to a bona fide vascular surgeon for vascular care then becomes a major responsibility of our national and regional vascular societies--a responsibility to which they must devote more resources and attention than they have in the past.

Finally, how can vascular surgeons develop a better awareness of overseas progress so that they can incorporate new concepts and innovations into their day-to-day practice from outside? First, they must recognize the importance of non-U.S. progress in vascular disease management. Next they must begin to read non-U.S. vascular journals and become aware of material presented at non-U.S. vascular meetings and U.S. meetings featuring non-U.S. leaders in the vascular field. The Internet and Web-based versions of such meetings and journals can minimize the cost in time and travel expenses to achieve this awareness of beyond the U.S. progress in the field.

Vascular surgeons must be aware that their world is flat, too. They must embrace the importance of overseas vascular surgery and use it to retain a competitive edge over others who wish to provide vascular care as an add-on to primary practice in another specialty. Vascular surgeons need to survive in this globalized world, and this is one way to do so.