A second historical reality that impacted the progress of the ABVS was the fragmentation of the governance of vascular surgeons on both a local and national level. Locally, university surgeons, assuming that vascular surgery was an intrinsic part of general surgery, may have been concerned that their leadership roles would be diminished if they were relegated to division heads rather than department chairs. Nationally, there existed three bodies representing vascular surgeons, each with its own leadership and motivations. These were the Society for Vascular Surgery (SVS), the North American chapter of the International Society for Cardiovascular Surgery (NA-ISCVS) which later changed its name to the American Association for Vascular Surgery (AAVS) and the Society for Clinical Vascular Surgery (SCVS).
The SVS at the time was predominantly an academic association with its primary goal being the annual meeting. The SCVS was a casual community of predominantly private practice surgeons. The AAVS was the most representative but it did not have the infrastructure to be a dominant force. Further, there also existed the Association of Program Directors in Vascular Surgery (APDVS). This division was compounded by the formation of the ABVS. Despite three polls of vascular surgeons, the majority of which supported an independent specialty, the divided leadership of these various organizations refused to abide by the voice of their respective memberships. The destructive internecine arguments that developed are detailed in the Annals manuscript, and this disunion of the vascular community and its leadership clearly hampered a collective identity.
Thirdly, the members of the ABVS argued that an independent specialty was necessary in order to train vascular surgeons in the evolving field of endovascular procedures. However, many established leaders balked at this proposal and resisted incorporating such training into their programs. Their refusal to assist in the education of endo-competent vascular surgeons and the development of an independent specialty allowed cardiologists and interventional radiologists to infiltrate the field. Now, the argument for an independent specialty of vascular surgery is not so much with general surgeons but rather with Cardiologists and interventional radiologists.
Fourth, the ABS at the time still considered itself an authoritative Board protective of an all-encompassing General surgery. Its leaders feared that separation of vascular surgery would lead to a stampede with other subspecialties such as pediatric and hand surgery clamoring for independence.
It is not surprising that there was little chance that the ABVS would succeed. However, much can be learned from this historical review that predicts a new initiative in today’s healthcare environment will likely be successful and benefit not only vascular surgeons but also their patients.
In this modern era the practice of vascular surgery involves multiple disciplines and various forms of therapy. As I have frequently claimed, vascular surgeons “operate, medicate, and dilate”. When so much of what vascular surgeons do is beyond the realm of open surgery, wouldn’t most agree that vascular surgery should not be controlled by a governing body, the ABS, whose primary motivation remains operative therapy?
On the other hand, the current ABS recognizes all its subspecialties are similarly morphing away from general surgery and so the ABS is evolving into a Federation of quasi-independent boards. Accordingly, it is likely to be less resistant to a fully independent vascular specialty board existing under its umbrella organization.