For many years, varicose vein disease and chronic venous insufficiency (CVI) have received inadequate attention from the medical community. Fortunately, this “service gap” seems to be closing because of two major changes in the last few years.
First, there have been several major technological breakthroughs that have greatly improved the treatment options available to patients with varicose veins. Second, phlebology (the study of veins) is now being recognized by organized medicine as a rapidly emerging subspecialty.
These developments in vein care have been important in attracting growing numbers of physicians to the exciting field of phlebology, not as a sideline, but as the sole focus of their professional practice. It now seems that the field is maturing to the point of obtaining recognition as a bone -fide medical subspecialty, recognized and respected by all the major entities of organized medicine.
Veins Chronically Neglected
Medical science has not done a great job in terms of service, teaching or research when it comes to the clinical management of advanced varicose veins and severe CVI. Varicose veins and CVI are poorly understood by most clinicians, mainly due to the fact that venous disease is under-represented in most clinical textbooks, medical school curricula and residency programs. Currently, there is a large population of patients who suffer from the pain or skin damage of CVI, and who have heretofore been bewildered, frustrated and underserved by the medical community at-large. Patients often find their vein care to be uncoordinated and full of conflicting (and often ill-informed) opinions, not facts.
The source of this neglect, in my opinion, is not that physicians are stupid or lazy, but that organized medical education has paid only a miniscule amount of time and effort to teaching about this very common disorder. In fact, there is no other condition that has such a high prevalence (25 percent of the adult population) but gets so little attention. Even among sub-specialists who should be trained in the areas of varicose veins and CVI, the neglect is obvious. For example, in two of the most widely recognized and comprehensive textbooks – “Vascular Surgery” (Rutherford) and “Obstetrics-Gynecology” (Dewhurst) – the number of pages that even mentions varicose veins in these otherwise excellent textbooks is only 7/2393 for Rutherford and only 1/579 for Dewhurst!
The lack of phlebology education in medical school and residency programs, coupled with the fact that the treatment options in the past were unattractive means that physicians have not felt comfortable selecting patients for treatment or referral. Furthermore, when patients insisted that the doctor “do something,” the “something” was often a vein stripping, from which neither the patient nor the physician derived much personal or professional satisfaction.
Over several generations, this has led to the feeling that the treatment of vein disease was something best avoided. By extension, it was not something worth studying or even asking patients about. Further frustrating this situation is the lack of any board recognition, formalized residency/fellowship training and a general feeling that phlebology could never become a legitimate, respectful or useful body of clinical knowledge.
As a consequence, the large population of patients who suffer from CVI remain bewildered, frustrated and underserved, and they are often told:
• “Just wear support hose”
• “The only thing that we can do is a vein stripping”
• “If we treat these, they will just come back.”
As part of our dedication to the relief of human suffering, the status quo with regards to phlebology cannot remain.
Phlebology and Organized Medicine
Since 2005, the American College of Phlebology (ACP) has had a major strategic initiative to obtain full recognition by the American Board of Medical Specialties. At present, such recognition is not a requirement for the practice, reimbursement or credentialing of phlebologists. Full recognition by the ABMS is one of the highest honors that a subspecialty can receive, and the ACP thinks the time has come for phlebology to be recognized as a separate and distinct subspecialty with its own formalized residency/fellowship training.
One of the most tangible recent pieces of evidence of phlebology’s evolution from a “hobby” to a profession was the 2006 decision by the AMA to approve the specialty of phlebology for inclusion in the AMA’s list of self-designated medical specialties. This occurred due to the efforts by the ACP, mostly under the leadership of Steven E. Zimmet, MD, FACPh, and past president of the ACP.
Dr. Zimmet1 said: “The ACP is by far the largest society in the United States, and one of the largest in the world, devoted to venous disorders. The tremendous growth in membership and the many significant initiatives of the ACP are reflections of the momentum in the field.”
The recognition of phlebology by the AMA has had a significant effect on postgraduate training in the specialty and has continued to motivate even more interest and involvement of physicians in this exciting and evolving subspecialty.
Also in 2006, the ACP created the American College of Phlebology Foundation. The ACP Foundation funded the first Fellowship Program in Phlebology in 2007 at the University of California, San Diego under the direction of Dr. John J. Bergan, an internationally recognized expert in the field and also a past president of the ACP. In its first year of operation, The ACP Foundation received contributions from individual physicians and medical corporations totaling more than $3.6 million and established research grants for faculty, research trainees and practicing physicians totaling about $140,000 per year2.
Perhaps the most exciting development in this initiative is the establishment of the Board Examination in Phlebology; the first Board Examination will be administered in April 2008.
With the first cohort of physicians scheduled to take this test in April 2008, there will be increasing numbers of physicians who will be able to claim that they have “passed the board exam” in phlebology and will further help to substantiate the maturity of this newest of fields, that for so many years has been treated like the unwanted step-child of medicine. As Dr. Bergan has so eloquently stated, “Cinderella has come to the ball.” VTN
About the Author
Dr. Barbara Zuniga is in the full-time, exclusive practice of Phlebology and is the medical director of the Midwest Vein Center in Orland Park, Ill. Dr. Zuniga may be reached at 877- 510- 8346.
References
1 Zimmet SE. Letter from Medical Director. Vein; Fall 2007; Vol 1, page 7.
2 Bergan, JJ. Foreword in: Fronek HS. Editor, The fundamentals of Phlebology: Venous Disease for Clinicians. San Francisco: American College of Phlebology, 2004:3.
|
