The Future of Vascular Surgery, Opportunity or Obituary?

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Abstract

Vascular surgeons must accept that their once core arsenal of open, peripheral surgeries can no longer sustain practices. Minimally invasive, endovascular and venous procedures are now routinely performed by far less qualified physicians, many of whom have had no more than an introductory seminar in minimally invasive procedures. This poses a serious threat to surgical practices whose survival now seems to depend on how quickly they can catch up.
The speciality of vascular surgeons has undergone a great deal of change. The question, however, is whether the surgeons themselves have changed enough. The advent of endovascular techniques has opened the door for treatment of all types of vascular disease, aneurysms, carotid disease and peripheral vascular disease. As non-invasive means for treating coronary artery disease have become more effective, cardiothoracic surgeons have increased the amount of non-cardiac vascular surgery they perform. Surgeons do not learn how to handle aortic aneurysms by only operating on ruptured aneurysms; they build experience with elective cases during daylight hours. If mortality rates are bad for low-volume surgeons doing elective cases, imagine the statistics for novolume surgeons doing emergency cases.

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Patients should be encouraged to enquire about their surgeon’s experience in performing procedures, especially complex ones. Primary-care physicians should also be familiar with the experience of the surgeons they refer to, as they share the liability of referring their patients to under-qualified surgeons.

Handling the Business Side
These are also difficult times for vascular surgeons trying to establish, maintain and grow their practices. Various factors, including rising malpractice premiums and increasing staff salaries and benefits and federal regulations, all seem to work against the business of medicine. In the face of these obstacles, helping a practice to thrive is a challenging task. A successful practice is dependent on the level of commitment that a physician is willing (and able) to contribute to increase revenues and minimise expenses.

There are some basic principles of practice management that can be implemented to control what might easily rise to being an uncontrollable beast. A written budget, based on prior fiscal year financial statements, can be used to microscopically examine each expense for targeting goals that support expense containment or reduction. Surgeons should also review all maintenance and service contracts for equipment; cost to benefit ratios should be compared and options for abandoning, extending or re-negotiating service contracts considered. Moreover, physicians must develop, publish and enforce operational strategies, such as implementing a system to advance confirm appointments for habitual ‘no-show’ patients, minimising the effect that they can have on a practice.

Surgeons should develop a plan to attract new patients and devote up to 2% of the practice’s total revenue to marketing. They should also retain attorneys, accountants and efficiency consultants who specialise in healthcare and can identify the time and expense weakness in the practice and who can recommend ways to improve workflow, decrease costs and increase revenue.

A truth regarding the practice of medicine is that it is a high-volume, low-profit business. Surgeons can no longer depend on operating room cases as their major source of revenue; they need to look for other sources of income. A superior practice will use ingenuity and persistence to raise revenue. To be successful, surgeons must be as interested and involved in the business side of their practices as in the clinical side. Any successful business must meet the bottom line to succeed – monies in must exceed monies out./>/>/>/>/>/>/>/>/>

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