After an evening of networking among vascular surgery trainees, the 2024 Society for Clinical Vascular Surgery Symposium began with an opportunity to acknowledge the value of private practice vascular surgery in the care of our patients.
The Sunday morning private practice session echoed the sentiments of our private practice colleagues. The conversation initially highlighted the symbiotic relationship between private practice and academic vascular practices. We are all promoting comprehensive care for patients with vascular disease.
Nevertheless, each of the invited speakers presented fundamental differences in practice. Over the last decade, the proportion of private practice vascular surgery physicians declined from 60% to 42%. Partly due to the COVID-19 pandemic, the “erosion of individual practice” has advanced steadily alongside health care centralization.
Academic hospitals have resources that are not afforded to the private sector — funding, resident support, legal backing, and a slew of others that have slowly increased the representation of larger academic practices within vascular societies and advocacy groups.
As reimbursement rates fail to keep pace with inflation and the expected rising cost of health care, exacerbated by the pricing and pooling strategies of device and pharmaceutical companies, we can expect a continued decline of the private model of providing vascular care.
Yet, these practices form the basis of frontline community vascular care and must be protected for the sustainability and perpetuation of our field.
Bridging the gap between academic and privatized vascular care is not a novel goal. Former society president Dr. William Brown opined on this during his 2007 address: “Medicine is the only profession in which a distinction is made between those who practice as the so-called academic surgeons and private practice surgeons.”
However, nearly 15 years later, this gap feels wider. Private practices have evolved to survive, adopting higher efficiency modalities outside of the hospital space — i.e., Ambulatory Surgery Centers and Outpatient Based Babs.
In light of recent publications regarding controversial atherectomy volumes at outpatient facilities, the podium presenters voiced their fear of a growing division within the vascular surgery community — feeling that maybe their concerns, perspectives, and viability are not adequately represented.
The engaging audience participation underscored the depth to which this subject permeates. Respondents called for increased representation and support for the Society for Vascular Surgery Political Action Committee. Others affirmed that despite the division in practice patterns, quality-driven outcomes and surgical training bind our field as the comprehensive caretakers for vascular disease.
Shuddered away from these difficult conversations, our bright-eyed future vascular surgeons partake in the annual top-gun surgical skills competition. This year, featuring an elimination bracket, the winner takes home a new set of fine surgical instruments.
Next year, many of these trainees will choose a side — academic or private practice. We must continue to foster an active relationship with our private practice partners and ensure unity with inclusivity to prevent alienating ourselves.
Dr. Patel is a vascular surgeon at WellSpan York Hospital in York, PA.
Image by BRO Vector / Getty
