Vascular Surgery: Workforce Needs and Career Choices

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2 Vascular Surgery: Workforce Needs and Career Choices Peter R. Nelson, MD, MS Associate Professor of Surgery University of South Florida Morsani College of Medicine No relevant disclosures to the content of this presentation

3 Who Are Vascular Surgeons? The only medical specialists trained to provide comprehensive care of patients with all stages of vascular disease: prevention, diagnosis, all aspects of management, and follow-up Vascular disease includes arterial, venous, and lymphatic problems Vascular therapy includes risk factor modification, comprehensive medical therapy, and conservative approaches Vascular operations include the full spectrum of open and endovascular procedures Vascular surgeons run non-invasive vascular laboratories, do research in clinical, outcomes, and basic/translational science, and play a major role in education and simulation

4 Objectives Review current workforce data Projected specialty needs Current training production Is there a shortage? Different career templates Academic Private practice Big complex cases Bread and butter case load VA opportunities Lifestyle first

5 Workforce Needs in Vascular Surgery

6 Workforce Needs: Important Factors Baby Boomer generation is reaching senior age with an anticipated high prevalence of vascular disease Financial crisis with decreasing reimbursement for vascular procedures and the need for healthcare reform Technology is growing by leaps and bounds and as a result procedures, especially minimally invasive procedures, are seeing exponential growth Significant regional variation in the availability of vascular surgeons that leads to worse outcomes in underserved areas Large need for vascular specialists in smaller, rural communities Background estimates of a shortage of surgeons and surgical specialists of approx. 30,000 over the next 20 years

7 Workforce Needs: Demand 2008 population estimates were 300,000,000 By 2050, population estimates are 420,000,000 76,000,000 baby boomers will all be >65 years old by 2030 and will make up fully 20% of the population Prevalence of PAD in those over 65 years of age approaches 20% Severe critical limb ischemia (CLI) alone affects over 1 million Medicare beneficiaries with an associated cost > $3 billion Vascular surgical annual case estimates: , million million Hong, M, et. al. J Vasc Surg, 2009.

8 Workforce Needs: Supply Currently ~3000 board-certified vascular surgeons nationally Many general, cardiac, other surgeons still performing vascular procedures Currently graduating 150 vascular fellows and residents annually 2000 Dartmouth Atlas of Vascular Healthcare Santiani, et. al. J Vasc Surg October 2009

9 Workforce Needs: Is there a shortage? Conservative estimates of population growth and workforce needs Estimated that we will need: 2030 ~3500 vascular surgeons 2050 ~4000 Assume similar training numbers and balance between new and retiring specialists Gives an estimated shortage: (12%) (21%)

10 What is the Current Job Market Like? GREAT! Almost daily s announcing vascular surgery jobs all around the country Requests for locum tenens coverage for hospitals with vascular shortages Interest in hospital systems to establish networks of vascular surgeons similar to trauma networks Academic jobs are generally available but more word of mouth Resources: Journal of Vascular Surgery VascularWeb Job Bank Headhunters Referrals from mentors and friends

11 Experiences in the Job Market Colvard BD, Schanzer A, Rectenwald J, Shames M, Lee JT

12 Career Options in Vascular Surgery

13 Academic Career Broad definition More than just teaching residents and fellows Defined research program basic/translational science outcomes/health policy research clinical trials/device development education/simulation research extramural/industry funding regular publication University-based teaching hospital Balance of clinical and academic responsibilities Generally lower salary potential

14 Private Practice Career Either solo practice or joining a group of established partners Initial trial period prior to full partnership Salary may be supported initially through hospital employment General and vascular surgery? Need more business savvy May have teaching responsibilities for students or residents if affiliated Generally less research activity More control over your schedule, but will need to be available Better salary potential

15 Hybrid/Mixed Career Essentially an psuedo-academic private practice Large multispecialty group or integrated cardiovascular center Lots of resources Specialty care focus Hybrid OR facilities Sophisticated ancillary services Ability to do large complex open or endovascular cases Infrastructure for clinical trials May or may not be a teaching institution Good business plan with potential for significant reimbursement

16 Big Complex Cases Large open complex vascular cases will increasingly be done in tertiary/quaternary referral centers University faculty with referral base for complex pathologies Thoracic aortic emergencies Complex ruptured AAAs Graft infections/aortoenteric fistulae Complex LE revascularization Busy practice, heavy call load Regional/national reputation Comfort with higher M&M Increasingly higher demand as trainees are more endovascular focused

17 Bread and Butter Cases Straight forward cases in full spectrum of practice AAAs Carotid endarterectomy LE revascularization Dialysis access Venous cases High proportion of interventional cases Community hospital Ambulatory office-based interventional suite Build local reputation Refer complex cases to tertiary center

18 VA Opportunities Can be hired directly into the VA or can be part of a University package Generally salary is lower Supplement from University Responsibilities and work load are usually less Good benefits Complex, bread and butter practice No RVU pressure Time can be allocated to research and better protected VA MERIT, DOD funding Need to understand and tolerate the inertia within the federal system

19 Lifestyle First If your primary priority is life outside the practice/hospital Carve out a specific niche or area of expertise Vein Center Dialysis Center Ambulatory interventional suite Ambulatory cases Minimize inpatient census Minimize/eliminate call no emergencies generated by your elective practice Contribute significantly to the practice s and your own bottom line

20 Conclusions Plenty of jobs out there! Plenty of work to go around! Choose your fellowship so that you are well prepared for your specific ultimate career goals Almost every practice possibility is out there! Get the appropriate research training if relevant Get advanced education/degree in public health/health policy Get ample clinical training to fit your specific needs Be committed to and articulate in discussing your career goals Seek out the right group w/ partners who need what you offer, who have a similar career philosophy, and will support your personal mission Take FULL advantage of the resources here at VAM 2013

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