Venous & Lymphatic Medicine Subspecialty Task Force

Venous & Lymphatic Medicine Subspecialty Task Force

by Mark Meissner, MD, FAVLS, DABVLM

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.

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

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.

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.

The AVLS has established a task force to advance this issue with goals including increasing awareness of venous and lymphatic medicine among the member boards of the ABMS and exploring options for eventual ABMS recognition of the specialty, whether through an FPD or a true subspecialty process. The task force is led by Dr. Jeff Schoonover, with members from most specialties represented by the AVLS, including general surgery, vascular surgery, vascular medicine, cardiology, internal medicine, family medicine, emergency medicine, gynecology, and dermatology.

This opportunity is significant for our specialty and should not be ignored. Not only would a recognized multidisciplinary process promote uniform, high-quality care for our patients, but it would also help avoid the specialtybased credentialing restrictions occasionally put in place to exclude otherwise qualified practitioners. Optimally, such a process would recognize and accept the high-quality work already done by the ABVLM.

The ABMS is most responsive to diplomates of its member boards, and the pathway toward recognition of venous and lymphatic medicine will require the efforts of our members to educate their respective boards regarding the importance of multidisciplinary recognition. Steps that you can take as an individual member include,

• Get involved in the dialog and volunteer to represent your specialty by contacting Robert White (rwhite@myavls.org) for more information.

• Coordinate efforts with your specialty representatives on the AVLS Subspecialty Task Force. They can provide further information about how to contact and discuss these issues with your respective medical board. Approaching each board in a structured manner will be key in educating the boards regarding the multidisciplinary nature of venous and lymphatic medicine.

• Maintain certification with your primary ABMS specialty designation.

• Demonstrate your support for recognizing venous and lymphatic medicine as a distinct area of medical practice by becoming a diplomate of the ABVLM.

• Promote the AVLS position that venous and lymphatic medicine is a multidisciplinary specialty involving knowledge and skills that come from diverse areas of medicine and are not confined to any single currently existing medical specialty. Patients are best served by a specialist who can incorporate the knowledge and skills of diverse specialty backgrounds into their practice.

AVLS SUBSPECIALTY TASK FORCE

Dermatology: Vineet Mishra, MD, Margaret Mann, MD

Emergency Medicine:Marlin Schul, MD, Satish Vayavegula, MD

Family Medicine: Jeff Schoonover, MD, Lisa Amatangelo, MD

Interventional Radiology: Robert Worthington Kirsch, MD, Ron Winokur, MD

Internal Medicine: John Fish, MD, Marcus Stanbro, DO

Surgery: John Blebea, MD, Stephen Daugherty, MD, Zoe Deol, MD, Nick Morrison, MD, Peter Pappas, MD

Obstetrics & Gynecology: Theresa Soto, MD

AVLS / ABVLM Leadership: Tony Comerota, MD, Terri Carmen, MD, Neil Khilnani, MD, Mark Meissner, MD, Julianne Stoughton, MD