Venous & Lymphatic Medicine Subspecialty Task Force by Mark Meissner, MD, FAVLS, DABVLM
Dr. Mark Meissner
The American Vein & Lymphatic Society (AVLS) has long recognized the importance of developing Venous and Lymphatic Medicine as a medical sub-specialty. This significant patient population has been underserved by 20 years of technological advancement. Few training opportunities encompass the breadth of cognitive and procedural skills required of the venous specialist. With the goals of improving standards for patient care and eventual subspecialty recognition, the American College of Phlebology (now the AVLS) developed the American Board of Venous and Lymphatic Medicine (ABVLM) now an independent certification entity, in 2007. The ABVLM has accomplished a great deal in the last 14 years, including developing the core content for venous and lymphatic medicine; establishing program requirements for training programs; defining milestones in a trainee’s education; establishing fellowship programs in Venous and Lymphatic Medicine; and developing a rigorous, psychometrically validated certification examination with ongoing maintenance of certification. There are currently 884 diplomates of the American Board of Venous and Lymphatic Medicine and 5 fellowship programs training as many as 8 fellows per year.
knowledge and skills, the ABMS developed a Focused Practice Designation (FPD) pathway in 2017. Focused practice designations are developed under the supervision of individual specialty boards and require that the physician retain active board certification in that specialty. Focused practice designations generally require documentation of clinical practice experience as well as an examination. (board-certificationrequirements) Thirteen FPDs are currently offered by 9 ABMS boards. Although the FPD process may provide a valuable experiencebased pathway for recognizing venous and lymphatic medicine, it has the disadvantage of residing under an individual medical board and being available only to diplomates of that board. The AVLS strongly believes that venous and lymphatic medicine is a truly multidisciplinary specialty that benefits from cross-disciplinary skills found beyond the scope of any single specialty board. A specialist in venous and lymphatic medicine must have knowledge and experience in diagnostic and interventional ultrasound, venous thromboembolism, lymphatic disease, wound care, sclerotherapy, superficial venous disease, deep venous disease, and pelvic venous disorders, the entirety of which a single specialty rarely encompasses.
The pathway to the development of an American Board of Medical Specialties (ABMS) subspecialty is primarily a formal training-based pathway, generally requiring the existence of 20 to 40 training programs before consideration of an application. However, recognizing that medical practice evolves and that experience also has a role in developing specialized
A Focused Practice Designation in venous disease has been recently proposed to the American Board of Surgery. Both the AVLS and ABVLM view this as a valuable opportunity to establish a dialog with the ABMS regarding recognition of venous and lymphatic disease as a multidisciplinary subspecialty. Continued in page 6
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