Society News

Don’t forget how valuable the Vascular Educational and Self-Assessment Program can be in keeping with all things vascular-related.

The fourth edition – which will soon include a mobile app (Apple products only) for off-line – launched just two months ago. Besides the app, VESAP4 also offers syncing between the companion app and desktop version; expanded bookmarking and annotation, easier navigation and simplified tracking of CME/MOC certificates.

Costs is $450 for candidates, $550 for members and $650 for non-members. A total of 75 CME (7.5 for each of the 10 sections) will be available. For information, email [email protected] or call 800-258-7188. 

Don’t forget how valuable the Vascular Educational and Self-Assessment Program can be in keeping with all things vascular-related.

The fourth edition – which will soon include a mobile app (Apple products only) for off-line – launched just two months ago. Besides the app, VESAP4 also offers syncing between the companion app and desktop version; expanded bookmarking and annotation, easier navigation and simplified tracking of CME/MOC certificates.

Costs is $450 for candidates, $550 for members and $650 for non-members. A total of 75 CME (7.5 for each of the 10 sections) will be available. For information, email [email protected] or call 800-258-7188. 

Don’t forget how valuable the Vascular Educational and Self-Assessment Program can be in keeping with all things vascular-related.

The fourth edition – which will soon include a mobile app (Apple products only) for off-line – launched just two months ago. Besides the app, VESAP4 also offers syncing between the companion app and desktop version; expanded bookmarking and annotation, easier navigation and simplified tracking of CME/MOC certificates.

Costs is $450 for candidates, $550 for members and $650 for non-members. A total of 75 CME (7.5 for each of the 10 sections) will be available. For information, email [email protected] or call 800-258-7188. 

Despite affecting 25 million Americans, including two to six million with ulcer conditions, chronic venous insufficiency is relatively understudied compared to other vascular diseases. Yet for patients with venous leg ulcers, their condition is debilitating, painful and embarrassing.

Dr. Ulka Sachdev is studying the condition, hoping her “bench-side research” will develop “bedside” solutions. She received a five-year, National Institutes of Health K08 and SVS Foundation grants in 2012 and an SVS Foundation Clinical Research Seed Grant in 2017. “Their ulcers are very difficult to manage,” she said. “They are large, open, painful and wet. Patients’ daily routines are negatively affected by their wounds. It’s really sad.”

Since she regularly treats CVI patients, Dr. Sachdev wondered why some patients have benign venous insufficiency that ulcerates and why some ulcers recur. “If we could determine at an earlier stage how to mitigate the risk of new ulceration or recurrence, I think it would be worth it,” she said.

In her previous, K08-supported research she hypothesized that wound healing during ischemia is promoted by inflammatory proteins released by damaged tissue. She found that certain proteins known as danger signals can be released by damaged tissue and promote regenerative effects. 

“My hypothesis is that specific danger signals can be manipulated, ideally with an oral drug,” Dr. Sachdev said. “If it works, this could be a mechanism that allows a dying muscle cell to say, ‘Hey, I need help.’  This might mean that someone who cannot get a bypass or a stent might not have to face amputation.’”

Her recent grant is for studying study patterns of inflammation in chronic venous insufficiency. 

The goal of her studies is to determine whether patients with benign varicose veins and those with ulcerations express inflammatory mediators that predict their response to treatment. Later, perhaps, effective treatments will be found that change these patients’ lives.  

Despite affecting 25 million Americans, including two to six million with ulcer conditions, chronic venous insufficiency is relatively understudied compared to other vascular diseases. Yet for patients with venous leg ulcers, their condition is debilitating, painful and embarrassing.

Dr. Ulka Sachdev is studying the condition, hoping her “bench-side research” will develop “bedside” solutions. She received a five-year, National Institutes of Health K08 and SVS Foundation grants in 2012 and an SVS Foundation Clinical Research Seed Grant in 2017. “Their ulcers are very difficult to manage,” she said. “They are large, open, painful and wet. Patients’ daily routines are negatively affected by their wounds. It’s really sad.”

Since she regularly treats CVI patients, Dr. Sachdev wondered why some patients have benign venous insufficiency that ulcerates and why some ulcers recur. “If we could determine at an earlier stage how to mitigate the risk of new ulceration or recurrence, I think it would be worth it,” she said.

In her previous, K08-supported research she hypothesized that wound healing during ischemia is promoted by inflammatory proteins released by damaged tissue. She found that certain proteins known as danger signals can be released by damaged tissue and promote regenerative effects. 

“My hypothesis is that specific danger signals can be manipulated, ideally with an oral drug,” Dr. Sachdev said. “If it works, this could be a mechanism that allows a dying muscle cell to say, ‘Hey, I need help.’  This might mean that someone who cannot get a bypass or a stent might not have to face amputation.’”

Her recent grant is for studying study patterns of inflammation in chronic venous insufficiency. 

The goal of her studies is to determine whether patients with benign varicose veins and those with ulcerations express inflammatory mediators that predict their response to treatment. Later, perhaps, effective treatments will be found that change these patients’ lives.  

Despite affecting 25 million Americans, including two to six million with ulcer conditions, chronic venous insufficiency is relatively understudied compared to other vascular diseases. Yet for patients with venous leg ulcers, their condition is debilitating, painful and embarrassing.

Dr. Ulka Sachdev is studying the condition, hoping her “bench-side research” will develop “bedside” solutions. She received a five-year, National Institutes of Health K08 and SVS Foundation grants in 2012 and an SVS Foundation Clinical Research Seed Grant in 2017. “Their ulcers are very difficult to manage,” she said. “They are large, open, painful and wet. Patients’ daily routines are negatively affected by their wounds. It’s really sad.”

Since she regularly treats CVI patients, Dr. Sachdev wondered why some patients have benign venous insufficiency that ulcerates and why some ulcers recur. “If we could determine at an earlier stage how to mitigate the risk of new ulceration or recurrence, I think it would be worth it,” she said.

In her previous, K08-supported research she hypothesized that wound healing during ischemia is promoted by inflammatory proteins released by damaged tissue. She found that certain proteins known as danger signals can be released by damaged tissue and promote regenerative effects. 

“My hypothesis is that specific danger signals can be manipulated, ideally with an oral drug,” Dr. Sachdev said. “If it works, this could be a mechanism that allows a dying muscle cell to say, ‘Hey, I need help.’  This might mean that someone who cannot get a bypass or a stent might not have to face amputation.’”

Her recent grant is for studying study patterns of inflammation in chronic venous insufficiency. 

The goal of her studies is to determine whether patients with benign varicose veins and those with ulcerations express inflammatory mediators that predict their response to treatment. Later, perhaps, effective treatments will be found that change these patients’ lives.  

Don't let the federal government keep money -- in the form of Medicare reimbursements -- to which you are entitled!

Learn all about coding and reimbursement, from the essentials to modifiers to future initiatives, at the SVS Coding and Reimbursement Workshop, Oct. 13-14, in Chicago. Instructors are Teri Romano, RN, MBA, CPC, CMDP; Sean P. Roddy, MD; Robert M. Zwolak, MD, PhD; and Sunita D. Srivastava, MD.

Friday topics are: coding and reimbursement essentials, global surgical packages, getting paid the first time when applying surgical modifiers and the Medicare rule on non-physician practitioner billing.

Saturday topics include an overview of Current Procedural Terminology, coding for a number of procedures and information on MACRA, MIPS and APMs. Future SVS CPT coding initiatives also will be discussed.

An optional half-day workshop, from 9 a.m. to noon Friday, Oct. 13, will focus on codes for evaluation and management (E&M), which physicians continue to misunderstand and misuse.  

Cost is $880 for an SVS member or staff, $955 for a non-member and $250 for residents and trainees. Cost for the optional session is $100 for an SVS member or staff, $215 for a non-member and $50 for residents and trainees.

Learn more, register and access the full agenda here.

Don't let the federal government keep money -- in the form of Medicare reimbursements -- to which you are entitled!

Learn all about coding and reimbursement, from the essentials to modifiers to future initiatives, at the SVS Coding and Reimbursement Workshop, Oct. 13-14, in Chicago. Instructors are Teri Romano, RN, MBA, CPC, CMDP; Sean P. Roddy, MD; Robert M. Zwolak, MD, PhD; and Sunita D. Srivastava, MD.

Friday topics are: coding and reimbursement essentials, global surgical packages, getting paid the first time when applying surgical modifiers and the Medicare rule on non-physician practitioner billing.

Saturday topics include an overview of Current Procedural Terminology, coding for a number of procedures and information on MACRA, MIPS and APMs. Future SVS CPT coding initiatives also will be discussed.

An optional half-day workshop, from 9 a.m. to noon Friday, Oct. 13, will focus on codes for evaluation and management (E&M), which physicians continue to misunderstand and misuse.  

Cost is $880 for an SVS member or staff, $955 for a non-member and $250 for residents and trainees. Cost for the optional session is $100 for an SVS member or staff, $215 for a non-member and $50 for residents and trainees.

Learn more, register and access the full agenda here.

Don't let the federal government keep money -- in the form of Medicare reimbursements -- to which you are entitled!

Learn all about coding and reimbursement, from the essentials to modifiers to future initiatives, at the SVS Coding and Reimbursement Workshop, Oct. 13-14, in Chicago. Instructors are Teri Romano, RN, MBA, CPC, CMDP; Sean P. Roddy, MD; Robert M. Zwolak, MD, PhD; and Sunita D. Srivastava, MD.

Friday topics are: coding and reimbursement essentials, global surgical packages, getting paid the first time when applying surgical modifiers and the Medicare rule on non-physician practitioner billing.

Saturday topics include an overview of Current Procedural Terminology, coding for a number of procedures and information on MACRA, MIPS and APMs. Future SVS CPT coding initiatives also will be discussed.

An optional half-day workshop, from 9 a.m. to noon Friday, Oct. 13, will focus on codes for evaluation and management (E&M), which physicians continue to misunderstand and misuse.  

Cost is $880 for an SVS member or staff, $955 for a non-member and $250 for residents and trainees. Cost for the optional session is $100 for an SVS member or staff, $215 for a non-member and $50 for residents and trainees.

Learn more, register and access the full agenda here.

It seemed appropriate this month for me to step aside for the Editor’s commentary and provide a forum for one of our associate editors to talk about his experience during Hurricane Harvey.

John I. Allen, MD, MBA, AGAF
Editor in Chief

We knew that a powerful storm was coming, but very few anticipated the widespread destruction Hurricane Harvey would bring. Houston is no stranger to floods, but the amount of water that Harvey unleashed was record-breaking. Areas that had never flooded were underwater, evacuations were commonplace; the devastation was heart-breaking. In the midst of significant personal tragedy, Houston came together. Neighbors took in flooded colleagues, personal boats were used for rescues, and many braved impassable roads to donate clothes, food, labor and medical aid. Shelters across the city were assisted by volunteers; community groups collected and coordinated distribution of supplies. Medical teams were mobilized to treat chronically ill patients who evacuated without their medications or those injured while escaping the floods.

At one of the largest medical centers in the world, floodgates constructed after Tropical Storm Allison kept the waters at bay. And physicians, nurses, janitors, and other employees slept in hospitals for days to provide care to our patients during the worst of the floods. Those who relieved them worked long hours to see the many patients rescheduled in the aftermath of the storm. After-work crews of neighbors continue to go from house to house removing flooded floor boards and ripping out drywall. Houston came together.

Dr. Ketwaroo is an assistant professor in the division of gastroenterology and hepatology at Baylor College of Medicine, Houston, and an advanced endoscopist at the Michael E. Debakey VA Medical Center in Houston. He is an associate editor for GI & Hepatology News.

It seemed appropriate this month for me to step aside for the Editor’s commentary and provide a forum for one of our associate editors to talk about his experience during Hurricane Harvey.

John I. Allen, MD, MBA, AGAF
Editor in Chief

We knew that a powerful storm was coming, but very few anticipated the widespread destruction Hurricane Harvey would bring. Houston is no stranger to floods, but the amount of water that Harvey unleashed was record-breaking. Areas that had never flooded were underwater, evacuations were commonplace; the devastation was heart-breaking. In the midst of significant personal tragedy, Houston came together. Neighbors took in flooded colleagues, personal boats were used for rescues, and many braved impassable roads to donate clothes, food, labor and medical aid. Shelters across the city were assisted by volunteers; community groups collected and coordinated distribution of supplies. Medical teams were mobilized to treat chronically ill patients who evacuated without their medications or those injured while escaping the floods.

At one of the largest medical centers in the world, floodgates constructed after Tropical Storm Allison kept the waters at bay. And physicians, nurses, janitors, and other employees slept in hospitals for days to provide care to our patients during the worst of the floods. Those who relieved them worked long hours to see the many patients rescheduled in the aftermath of the storm. After-work crews of neighbors continue to go from house to house removing flooded floor boards and ripping out drywall. Houston came together.

Dr. Ketwaroo is an assistant professor in the division of gastroenterology and hepatology at Baylor College of Medicine, Houston, and an advanced endoscopist at the Michael E. Debakey VA Medical Center in Houston. He is an associate editor for GI & Hepatology News.

It seemed appropriate this month for me to step aside for the Editor’s commentary and provide a forum for one of our associate editors to talk about his experience during Hurricane Harvey.

John I. Allen, MD, MBA, AGAF
Editor in Chief

We knew that a powerful storm was coming, but very few anticipated the widespread destruction Hurricane Harvey would bring. Houston is no stranger to floods, but the amount of water that Harvey unleashed was record-breaking. Areas that had never flooded were underwater, evacuations were commonplace; the devastation was heart-breaking. In the midst of significant personal tragedy, Houston came together. Neighbors took in flooded colleagues, personal boats were used for rescues, and many braved impassable roads to donate clothes, food, labor and medical aid. Shelters across the city were assisted by volunteers; community groups collected and coordinated distribution of supplies. Medical teams were mobilized to treat chronically ill patients who evacuated without their medications or those injured while escaping the floods.

At one of the largest medical centers in the world, floodgates constructed after Tropical Storm Allison kept the waters at bay. And physicians, nurses, janitors, and other employees slept in hospitals for days to provide care to our patients during the worst of the floods. Those who relieved them worked long hours to see the many patients rescheduled in the aftermath of the storm. After-work crews of neighbors continue to go from house to house removing flooded floor boards and ripping out drywall. Houston came together.

Dr. Ketwaroo is an assistant professor in the division of gastroenterology and hepatology at Baylor College of Medicine, Houston, and an advanced endoscopist at the Michael E. Debakey VA Medical Center in Houston. He is an associate editor for GI & Hepatology News.

For the first time in history, four generations of physicians work side by side in the U.S. health care system. An expanding population, longer life expectancies, and later retirement ages all contribute to this phenomenon. Each of these generations has made significant contributions to modern surgery and how we practice it. For better and for worse.

Traditionalists, or the Greatest Generation, were true surgical pioneers. DeBakey, Cooley, Fogarty, their names now adorn everything from instruments to medical centers. They truly founded the modern system of surgery. Born between 1900 and 1945, Traditionalists were forged in the crucibles of the Great War and the Great Depression. Their core values were hard work, discipline, and sacrifice. A large number were combat veterans who valued conformity and adherence to the rules. Traditionalists set up our current hierarchical departments of surgery. Mirroring their values, they employed a military chain of command approach. Many traditionalists rose to positions of absolute power, and some were corrupted by this power. Gods became monsters. Abuse, both verbal and physical, came to be commonplace and accepted in the surgical work environment.
 

Born between 1946 and 1964, Baby Boomers were raised in the aftermath of a war none of them saw. More optimistic and idealistic than the Traditionalists, the Boomers valued success. Their goals became more individualistic. Chasing money, titles, and recognition, Boomers wanted to build a stellar career. Fifty-hour work weeks became 70, 80, or 90. Ambition led to wealth, dramatic successes, and remarkable careers. Their choices also led to divorce, drug abuse, and suicide. While burnout has become a modern concern, its roots are clearly tied to this era. Now serving as our deans and department chairs, the Boomers also made several notable contributions. Specific to our field, Boomers oversaw the development of vascular surgery as an independent specialty and the expansion of fellowship training programs. Coming of age in the 1960s, Boomers also led the integration of our field with the acceptance of both minorities and women.

When I first heard the term “Generation X” I thought “Dumb name, won’t last.” Not my best prediction. Born between 1965 and 1980, Generation X grew up during the home computer revolution. Quick to adopt new technologies, Gen Xers were far more adaptive to change than previous generations. Labeled as having short attention spans, most Gen Xers were task/goal oriented. While these attributes helped drive the endovascular revolution, they also may be the reason we have approximately 983 FDA-approved devices to treat SFA disease. Generation X entered surgical training eager to please the more senior Traditionalists and Boomers. This wouldn’t last. Children of divorce and latch-key kids, Generation Xers are eclectic, resourceful, and self-reliant. Most of all they value freedom. Watching their predecessors work themselves and others to near death, Generation X revolted. Uncapped duty hours, limitless call, and pyramidal residencies were all institutions in the 1980s, and they all fell. Generation X were portrayed as nihilistic slackers, but their true motivation was often distrust of institutions. Watching the Boomers descend into burnout, Xers tried to achieve a more reasonable work-life balance. Though they successfully fought for lessening the abuses of surgical training, few Gen Xers actually reaped the benefits. I vividly recall watching slack-jawed as an intern scrubbed out of a case to go home because he was post call. A Martian landing in the OR and offering to assist with the anastomosis would have brought no less amazement.

With their careers spanning the endovascular revolution, Generation X has seen perhaps the greatest era of transformation in our profession. Our competition is no longer general or cardiac surgery, but rather interventional radiology and interventional cardiology. Gen X is also the first generation to earn less than its predecessors. Throw in their obscene tuition payments and one can see how Gen Xers fell well short of the financial heights of the Traditionalists and Boomers. The Gen Xers are the masters of the work hard/play hard ethos. You will see them at VEITH entertaining their European colleagues at 3 a.m. and then running the 6 a.m. breakfast sessions. While the Boomers often seemed old by 40, Xers appear desperate to salvage their lost youth.

Born between 1981 and 2006, Millennials are already the most populous generation. Their chief attributes are confidence, sociability, and a realistic outlook. Knowing they can’t please everyone, they rarely try. They want work to be meaningful in and of itself. They also value teamwork over individual approaches. Millennials are civic minded and have a strong sense of volunteerism. Their parents often tried to shelter them from the evils of the world, and they were the first generation of children with schedules. Because of their upbringing, Millennials are far more likely to seek guidance than the independent-minded Gen Xers. Raised to believe their voice mattered, they are now often reviled for it. It is with some degree of awe that I watch our Millennial students brazenly march into the dean’s and chancellor’s office to discuss their “careers.” As a medical student I first saw my dean at graduation, and I certainly didn’t even know what a chancellor was. Generation X is often baffled by the self-interest Millennials exude. But we shouldn’t be, we have seen it before. Raised by Baby Boomers (The Me Generation), Millennials inherited their self-driven outlook. This is also the reason Boomers and Millennials struggle to work together. They are too alike. Boomers see Millennials as “snowflakes” who are scared of work and selfie obsessed. Millennials bristle at the authoritarian nature of Boomers.

For vascular surgery to advance as a field, we need to recruit, train, and mentor this new generation. If only there was some guide: “The Proper Care and Feeding of Millennials." As senior attendings, program directors, and section chiefs, Generation X must now serve as a bridge between two larger forces, the Boomers and their offspring, the Millennials. Of course, whatever generation you are from is the best, but we must confront our biases. It is easy to seek out the same personalities to be your trainees and partners. Don’t. This pool will shrink every year. Millennials are more self-aware of their capabilities and therefore of their limitations. We may become flustered by their need for hand-holding, but what if it is appropriate? Was all of the autonomy you were granted during training truly good for the patients? Graduated responsibility and roles that push their limits help Millennials grow. I know they don’t value punctuality or dress codes, but they are better team players and openly motivated by learning. I formed our integrated vascular residency with two positions per year specifically to foster the team building Millennials crave. Yes, this is the generation that got 8th-place trophies so you must constantly award progress. Fortunately, now that surgery is unencumbered by such things as massive salaries and status, Millennials enter our workforce with purer intentions.

Dr. Sheahan is a professor of surgery and Program Director, Vascular Surgery Residency and Fellowship Programs, Louisiana State University Health Sciences Center, School of Medicine, New Orleans. He is also the Deputy Medical Editor of Vascular Specialist.

For the first time in history, four generations of physicians work side by side in the U.S. health care system. An expanding population, longer life expectancies, and later retirement ages all contribute to this phenomenon. Each of these generations has made significant contributions to modern surgery and how we practice it. For better and for worse.

Traditionalists, or the Greatest Generation, were true surgical pioneers. DeBakey, Cooley, Fogarty, their names now adorn everything from instruments to medical centers. They truly founded the modern system of surgery. Born between 1900 and 1945, Traditionalists were forged in the crucibles of the Great War and the Great Depression. Their core values were hard work, discipline, and sacrifice. A large number were combat veterans who valued conformity and adherence to the rules. Traditionalists set up our current hierarchical departments of surgery. Mirroring their values, they employed a military chain of command approach. Many traditionalists rose to positions of absolute power, and some were corrupted by this power. Gods became monsters. Abuse, both verbal and physical, came to be commonplace and accepted in the surgical work environment.
 

Born between 1946 and 1964, Baby Boomers were raised in the aftermath of a war none of them saw. More optimistic and idealistic than the Traditionalists, the Boomers valued success. Their goals became more individualistic. Chasing money, titles, and recognition, Boomers wanted to build a stellar career. Fifty-hour work weeks became 70, 80, or 90. Ambition led to wealth, dramatic successes, and remarkable careers. Their choices also led to divorce, drug abuse, and suicide. While burnout has become a modern concern, its roots are clearly tied to this era. Now serving as our deans and department chairs, the Boomers also made several notable contributions. Specific to our field, Boomers oversaw the development of vascular surgery as an independent specialty and the expansion of fellowship training programs. Coming of age in the 1960s, Boomers also led the integration of our field with the acceptance of both minorities and women.

When I first heard the term “Generation X” I thought “Dumb name, won’t last.” Not my best prediction. Born between 1965 and 1980, Generation X grew up during the home computer revolution. Quick to adopt new technologies, Gen Xers were far more adaptive to change than previous generations. Labeled as having short attention spans, most Gen Xers were task/goal oriented. While these attributes helped drive the endovascular revolution, they also may be the reason we have approximately 983 FDA-approved devices to treat SFA disease. Generation X entered surgical training eager to please the more senior Traditionalists and Boomers. This wouldn’t last. Children of divorce and latch-key kids, Generation Xers are eclectic, resourceful, and self-reliant. Most of all they value freedom. Watching their predecessors work themselves and others to near death, Generation X revolted. Uncapped duty hours, limitless call, and pyramidal residencies were all institutions in the 1980s, and they all fell. Generation X were portrayed as nihilistic slackers, but their true motivation was often distrust of institutions. Watching the Boomers descend into burnout, Xers tried to achieve a more reasonable work-life balance. Though they successfully fought for lessening the abuses of surgical training, few Gen Xers actually reaped the benefits. I vividly recall watching slack-jawed as an intern scrubbed out of a case to go home because he was post call. A Martian landing in the OR and offering to assist with the anastomosis would have brought no less amazement.

With their careers spanning the endovascular revolution, Generation X has seen perhaps the greatest era of transformation in our profession. Our competition is no longer general or cardiac surgery, but rather interventional radiology and interventional cardiology. Gen X is also the first generation to earn less than its predecessors. Throw in their obscene tuition payments and one can see how Gen Xers fell well short of the financial heights of the Traditionalists and Boomers. The Gen Xers are the masters of the work hard/play hard ethos. You will see them at VEITH entertaining their European colleagues at 3 a.m. and then running the 6 a.m. breakfast sessions. While the Boomers often seemed old by 40, Xers appear desperate to salvage their lost youth.

Born between 1981 and 2006, Millennials are already the most populous generation. Their chief attributes are confidence, sociability, and a realistic outlook. Knowing they can’t please everyone, they rarely try. They want work to be meaningful in and of itself. They also value teamwork over individual approaches. Millennials are civic minded and have a strong sense of volunteerism. Their parents often tried to shelter them from the evils of the world, and they were the first generation of children with schedules. Because of their upbringing, Millennials are far more likely to seek guidance than the independent-minded Gen Xers. Raised to believe their voice mattered, they are now often reviled for it. It is with some degree of awe that I watch our Millennial students brazenly march into the dean’s and chancellor’s office to discuss their “careers.” As a medical student I first saw my dean at graduation, and I certainly didn’t even know what a chancellor was. Generation X is often baffled by the self-interest Millennials exude. But we shouldn’t be, we have seen it before. Raised by Baby Boomers (The Me Generation), Millennials inherited their self-driven outlook. This is also the reason Boomers and Millennials struggle to work together. They are too alike. Boomers see Millennials as “snowflakes” who are scared of work and selfie obsessed. Millennials bristle at the authoritarian nature of Boomers.

For vascular surgery to advance as a field, we need to recruit, train, and mentor this new generation. If only there was some guide: “The Proper Care and Feeding of Millennials." As senior attendings, program directors, and section chiefs, Generation X must now serve as a bridge between two larger forces, the Boomers and their offspring, the Millennials. Of course, whatever generation you are from is the best, but we must confront our biases. It is easy to seek out the same personalities to be your trainees and partners. Don’t. This pool will shrink every year. Millennials are more self-aware of their capabilities and therefore of their limitations. We may become flustered by their need for hand-holding, but what if it is appropriate? Was all of the autonomy you were granted during training truly good for the patients? Graduated responsibility and roles that push their limits help Millennials grow. I know they don’t value punctuality or dress codes, but they are better team players and openly motivated by learning. I formed our integrated vascular residency with two positions per year specifically to foster the team building Millennials crave. Yes, this is the generation that got 8th-place trophies so you must constantly award progress. Fortunately, now that surgery is unencumbered by such things as massive salaries and status, Millennials enter our workforce with purer intentions.

Dr. Sheahan is a professor of surgery and Program Director, Vascular Surgery Residency and Fellowship Programs, Louisiana State University Health Sciences Center, School of Medicine, New Orleans. He is also the Deputy Medical Editor of Vascular Specialist.

For the first time in history, four generations of physicians work side by side in the U.S. health care system. An expanding population, longer life expectancies, and later retirement ages all contribute to this phenomenon. Each of these generations has made significant contributions to modern surgery and how we practice it. For better and for worse.

Traditionalists, or the Greatest Generation, were true surgical pioneers. DeBakey, Cooley, Fogarty, their names now adorn everything from instruments to medical centers. They truly founded the modern system of surgery. Born between 1900 and 1945, Traditionalists were forged in the crucibles of the Great War and the Great Depression. Their core values were hard work, discipline, and sacrifice. A large number were combat veterans who valued conformity and adherence to the rules. Traditionalists set up our current hierarchical departments of surgery. Mirroring their values, they employed a military chain of command approach. Many traditionalists rose to positions of absolute power, and some were corrupted by this power. Gods became monsters. Abuse, both verbal and physical, came to be commonplace and accepted in the surgical work environment.
 

Born between 1946 and 1964, Baby Boomers were raised in the aftermath of a war none of them saw. More optimistic and idealistic than the Traditionalists, the Boomers valued success. Their goals became more individualistic. Chasing money, titles, and recognition, Boomers wanted to build a stellar career. Fifty-hour work weeks became 70, 80, or 90. Ambition led to wealth, dramatic successes, and remarkable careers. Their choices also led to divorce, drug abuse, and suicide. While burnout has become a modern concern, its roots are clearly tied to this era. Now serving as our deans and department chairs, the Boomers also made several notable contributions. Specific to our field, Boomers oversaw the development of vascular surgery as an independent specialty and the expansion of fellowship training programs. Coming of age in the 1960s, Boomers also led the integration of our field with the acceptance of both minorities and women.

When I first heard the term “Generation X” I thought “Dumb name, won’t last.” Not my best prediction. Born between 1965 and 1980, Generation X grew up during the home computer revolution. Quick to adopt new technologies, Gen Xers were far more adaptive to change than previous generations. Labeled as having short attention spans, most Gen Xers were task/goal oriented. While these attributes helped drive the endovascular revolution, they also may be the reason we have approximately 983 FDA-approved devices to treat SFA disease. Generation X entered surgical training eager to please the more senior Traditionalists and Boomers. This wouldn’t last. Children of divorce and latch-key kids, Generation Xers are eclectic, resourceful, and self-reliant. Most of all they value freedom. Watching their predecessors work themselves and others to near death, Generation X revolted. Uncapped duty hours, limitless call, and pyramidal residencies were all institutions in the 1980s, and they all fell. Generation X were portrayed as nihilistic slackers, but their true motivation was often distrust of institutions. Watching the Boomers descend into burnout, Xers tried to achieve a more reasonable work-life balance. Though they successfully fought for lessening the abuses of surgical training, few Gen Xers actually reaped the benefits. I vividly recall watching slack-jawed as an intern scrubbed out of a case to go home because he was post call. A Martian landing in the OR and offering to assist with the anastomosis would have brought no less amazement.

With their careers spanning the endovascular revolution, Generation X has seen perhaps the greatest era of transformation in our profession. Our competition is no longer general or cardiac surgery, but rather interventional radiology and interventional cardiology. Gen X is also the first generation to earn less than its predecessors. Throw in their obscene tuition payments and one can see how Gen Xers fell well short of the financial heights of the Traditionalists and Boomers. The Gen Xers are the masters of the work hard/play hard ethos. You will see them at VEITH entertaining their European colleagues at 3 a.m. and then running the 6 a.m. breakfast sessions. While the Boomers often seemed old by 40, Xers appear desperate to salvage their lost youth.

Born between 1981 and 2006, Millennials are already the most populous generation. Their chief attributes are confidence, sociability, and a realistic outlook. Knowing they can’t please everyone, they rarely try. They want work to be meaningful in and of itself. They also value teamwork over individual approaches. Millennials are civic minded and have a strong sense of volunteerism. Their parents often tried to shelter them from the evils of the world, and they were the first generation of children with schedules. Because of their upbringing, Millennials are far more likely to seek guidance than the independent-minded Gen Xers. Raised to believe their voice mattered, they are now often reviled for it. It is with some degree of awe that I watch our Millennial students brazenly march into the dean’s and chancellor’s office to discuss their “careers.” As a medical student I first saw my dean at graduation, and I certainly didn’t even know what a chancellor was. Generation X is often baffled by the self-interest Millennials exude. But we shouldn’t be, we have seen it before. Raised by Baby Boomers (The Me Generation), Millennials inherited their self-driven outlook. This is also the reason Boomers and Millennials struggle to work together. They are too alike. Boomers see Millennials as “snowflakes” who are scared of work and selfie obsessed. Millennials bristle at the authoritarian nature of Boomers.

For vascular surgery to advance as a field, we need to recruit, train, and mentor this new generation. If only there was some guide: “The Proper Care and Feeding of Millennials." As senior attendings, program directors, and section chiefs, Generation X must now serve as a bridge between two larger forces, the Boomers and their offspring, the Millennials. Of course, whatever generation you are from is the best, but we must confront our biases. It is easy to seek out the same personalities to be your trainees and partners. Don’t. This pool will shrink every year. Millennials are more self-aware of their capabilities and therefore of their limitations. We may become flustered by their need for hand-holding, but what if it is appropriate? Was all of the autonomy you were granted during training truly good for the patients? Graduated responsibility and roles that push their limits help Millennials grow. I know they don’t value punctuality or dress codes, but they are better team players and openly motivated by learning. I formed our integrated vascular residency with two positions per year specifically to foster the team building Millennials crave. Yes, this is the generation that got 8th-place trophies so you must constantly award progress. Fortunately, now that surgery is unencumbered by such things as massive salaries and status, Millennials enter our workforce with purer intentions.

Dr. Sheahan is a professor of surgery and Program Director, Vascular Surgery Residency and Fellowship Programs, Louisiana State University Health Sciences Center, School of Medicine, New Orleans. He is also the Deputy Medical Editor of Vascular Specialist.

The staffs of the Journal of Vascular Surgery and Journal of Vascular Surgery: Venous & Lymphatic Disorders are interested in creating a list of SVS members who have interest, expertise and resources to perform high-quality systematic reviews and meta-analyses.

If interested, please submit your name, institution and topics consistent with your area of expertise. Members may reach out directly via email to Dr. Cynthia Shortell, assistant editor of reviews for JVS-VL, and Dr. Ron Fairman, assistant editor of reviews for JVS. 

The staffs of the Journal of Vascular Surgery and Journal of Vascular Surgery: Venous & Lymphatic Disorders are interested in creating a list of SVS members who have interest, expertise and resources to perform high-quality systematic reviews and meta-analyses.

If interested, please submit your name, institution and topics consistent with your area of expertise. Members may reach out directly via email to Dr. Cynthia Shortell, assistant editor of reviews for JVS-VL, and Dr. Ron Fairman, assistant editor of reviews for JVS. 

The staffs of the Journal of Vascular Surgery and Journal of Vascular Surgery: Venous & Lymphatic Disorders are interested in creating a list of SVS members who have interest, expertise and resources to perform high-quality systematic reviews and meta-analyses.

If interested, please submit your name, institution and topics consistent with your area of expertise. Members may reach out directly via email to Dr. Cynthia Shortell, assistant editor of reviews for JVS-VL, and Dr. Ron Fairman, assistant editor of reviews for JVS. 

September is Peripheral Artery Disease Awareness Month. To help SVS members educate patients and to spread awareness about vascular surgeons, we have prepared several things you can share.

1. An infographic for patients and their families. We urge you to print it and post around the office or your institution.

2. A quick resource web page for patients, offering patients a PAD video playlist and links to articles and information on PAD.

3. The latest PAD research information for physicians, along with clinical practice guideline links. If you have contacts among primary care physicians or other referrers, please feel free to send them this link.

4. Two press releases on PAD, to share with your communications people, public relations departments and/or patients

•             Don't Fall for These 6 Internet Myths About Statins

•             Often misdiagnosed, PAD can be mild or deadly

September is Peripheral Artery Disease Awareness Month. To help SVS members educate patients and to spread awareness about vascular surgeons, we have prepared several things you can share.

1. An infographic for patients and their families. We urge you to print it and post around the office or your institution.

2. A quick resource web page for patients, offering patients a PAD video playlist and links to articles and information on PAD.

3. The latest PAD research information for physicians, along with clinical practice guideline links. If you have contacts among primary care physicians or other referrers, please feel free to send them this link.

4. Two press releases on PAD, to share with your communications people, public relations departments and/or patients

•             Don't Fall for These 6 Internet Myths About Statins

•             Often misdiagnosed, PAD can be mild or deadly

September is Peripheral Artery Disease Awareness Month. To help SVS members educate patients and to spread awareness about vascular surgeons, we have prepared several things you can share.

1. An infographic for patients and their families. We urge you to print it and post around the office or your institution.

2. A quick resource web page for patients, offering patients a PAD video playlist and links to articles and information on PAD.

3. The latest PAD research information for physicians, along with clinical practice guideline links. If you have contacts among primary care physicians or other referrers, please feel free to send them this link.

4. Two press releases on PAD, to share with your communications people, public relations departments and/or patients

•             Don't Fall for These 6 Internet Myths About Statins

•             Often misdiagnosed, PAD can be mild or deadly

The American Society of Hematology (ASH) is seeking feedback from SVS members by Oct. 2 on its draft recommendations for ASH guidelines on VTE in the context of pregnancy and Heparin-Induced Thrombocytopenia.

The guidelines have been posted for comment. Members can review the comment page here and download the draft recommendations. The page includes a link to the online survey where members can provide their comments.

The American Society of Hematology (ASH) is seeking feedback from SVS members by Oct. 2 on its draft recommendations for ASH guidelines on VTE in the context of pregnancy and Heparin-Induced Thrombocytopenia.

The guidelines have been posted for comment. Members can review the comment page here and download the draft recommendations. The page includes a link to the online survey where members can provide their comments.

The American Society of Hematology (ASH) is seeking feedback from SVS members by Oct. 2 on its draft recommendations for ASH guidelines on VTE in the context of pregnancy and Heparin-Induced Thrombocytopenia.

The guidelines have been posted for comment. Members can review the comment page here and download the draft recommendations. The page includes a link to the online survey where members can provide their comments.

Payment adjustments for Medicare reimbursement come in 2019 -- but the adjustments are based on data being collected now, in 2017. If you have not begun collecting data as yet, you MUST begin no later than Oct. 2, 2017!

You will be required to send in your performance data no later than March 31, 2018. If your practice is participating in a CMS-approved Alternative Payment Model (APM), MIPS participation is not required. For 2017 there is currently no APM specific to vascular surgery. The SVS has formed a Task Force to develop a vascular APM.

The first payment adjustments based on performance go into effect on Jan. 1, 2019. Those members who do not participate in 2017 will receive a 4 percent penalty from Medicare.

SVS has held four webinars recently helping members learn what they need to know for the changes. View the materials here.

Payment adjustments for Medicare reimbursement come in 2019 -- but the adjustments are based on data being collected now, in 2017. If you have not begun collecting data as yet, you MUST begin no later than Oct. 2, 2017!

You will be required to send in your performance data no later than March 31, 2018. If your practice is participating in a CMS-approved Alternative Payment Model (APM), MIPS participation is not required. For 2017 there is currently no APM specific to vascular surgery. The SVS has formed a Task Force to develop a vascular APM.

The first payment adjustments based on performance go into effect on Jan. 1, 2019. Those members who do not participate in 2017 will receive a 4 percent penalty from Medicare.

SVS has held four webinars recently helping members learn what they need to know for the changes. View the materials here.

Payment adjustments for Medicare reimbursement come in 2019 -- but the adjustments are based on data being collected now, in 2017. If you have not begun collecting data as yet, you MUST begin no later than Oct. 2, 2017!

You will be required to send in your performance data no later than March 31, 2018. If your practice is participating in a CMS-approved Alternative Payment Model (APM), MIPS participation is not required. For 2017 there is currently no APM specific to vascular surgery. The SVS has formed a Task Force to develop a vascular APM.

The first payment adjustments based on performance go into effect on Jan. 1, 2019. Those members who do not participate in 2017 will receive a 4 percent penalty from Medicare.

SVS has held four webinars recently helping members learn what they need to know for the changes. View the materials here.

In-district meetings with congressional representatives provide a great opportunity for AGA members to establish working relationships with legislators, and help make the voices of our profession and our patients heard.

Members of the Baylor College of Medicine gastroenterology division – Avi Ketwaroo, MD; Richa Shukla, MD; Yamini Natarajan, MD; and Jordan Shapiro, MD – had the opportunity to meet with U.S. Rep. Gene Green, a Democrat from Texas’ 29th Congressional District, as part of AGA’s efforts to link constituents with local representatives. The group discussed the importance of supporting increases in NIH funding to maintain similar levels based on biomedical research inflation, the importance of screening colonoscopy, and improving access to care by opposing the repeal of the Affordable Care Act.

Watch an AGA webinar, available in the AGA Community resource library for AGA members only (community.gastro.org) to learn more about how to set up congressional meetings in your district or contact Navneet Buttar, AGA government and political affairs manager, at [email protected] or 240-482-3221.



[email protected]

In-district meetings with congressional representatives provide a great opportunity for AGA members to establish working relationships with legislators, and help make the voices of our profession and our patients heard.

Members of the Baylor College of Medicine gastroenterology division – Avi Ketwaroo, MD; Richa Shukla, MD; Yamini Natarajan, MD; and Jordan Shapiro, MD – had the opportunity to meet with U.S. Rep. Gene Green, a Democrat from Texas’ 29th Congressional District, as part of AGA’s efforts to link constituents with local representatives. The group discussed the importance of supporting increases in NIH funding to maintain similar levels based on biomedical research inflation, the importance of screening colonoscopy, and improving access to care by opposing the repeal of the Affordable Care Act.

Watch an AGA webinar, available in the AGA Community resource library for AGA members only (community.gastro.org) to learn more about how to set up congressional meetings in your district or contact Navneet Buttar, AGA government and political affairs manager, at [email protected] or 240-482-3221.



[email protected]

In-district meetings with congressional representatives provide a great opportunity for AGA members to establish working relationships with legislators, and help make the voices of our profession and our patients heard.

Members of the Baylor College of Medicine gastroenterology division – Avi Ketwaroo, MD; Richa Shukla, MD; Yamini Natarajan, MD; and Jordan Shapiro, MD – had the opportunity to meet with U.S. Rep. Gene Green, a Democrat from Texas’ 29th Congressional District, as part of AGA’s efforts to link constituents with local representatives. The group discussed the importance of supporting increases in NIH funding to maintain similar levels based on biomedical research inflation, the importance of screening colonoscopy, and improving access to care by opposing the repeal of the Affordable Care Act.

Watch an AGA webinar, available in the AGA Community resource library for AGA members only (community.gastro.org) to learn more about how to set up congressional meetings in your district or contact Navneet Buttar, AGA government and political affairs manager, at [email protected] or 240-482-3221.



[email protected]