GMO2003 said:
How does the referral pathway work...are vascular cases directly referred to vascular surgeons or do the pesky cardiologists 🙄 get in the way? Is treatment of PVD a team approach with cards, rads, and vascular surgery..who ultimately owns the patient? perhaps the good Dr. Cox can chime in 😍 😉
Referral patterns can vary geographically or even within the same zip code. Treatment of vascular disease can be handled, albeit in different ways, by family practitioners, internists, cardiologists, vascular, general and trauma surgeons. Surgical/procedural management obviously is generally referred to those that practice this on a routine basis (ie, vascular or general surgeons). I personally have not seen cardiologists referred patients that would be better treated by a surgeon, especially for peripheral or abdominal vascular problems. Any PCP can prescribe some Trental.
The choice of surgical specialist may be up to the referring physician, availability and patient. For example, patient with an expanding AAA goes to see his PCP in a smallish town without a vascular specialist. You know the local general surgeon has an interest in vascular disease and has treated these cases, effectively, in the past. Or maybe you went to medical school or belong to the country club with the local surgeon. You refer this patient to said local general surgeon.
Same patient but you do not feel the surgeon in town has the skills to effectively treat your patient. However, there is a university hospital two hours away with vascular surgeons on staff. You refer your patient there. He is seen in the vascular clinic and the decision is made that the patient would be a good candidate for an endovascular repair. The surgeon contacts the interventional radiologists and the two arrange their schedule to treat your patient.
Same patient but not a candidate for endovascular repair or patient not so sure about "newfangled" treatment. Patient does not want to travel or ask his family to do so. He requests to see surgeon in town and you arrange an appointment for him. Patient undergoes surgery locally.
Patient is a veteran. You see him in your primary care clinic at the local VA hospital. When you find his AAA on exam, you order a CT and send him to see the surgeons. The surgeon tells the patient that while he has done a AAA repair, he doesn't do them often and would refer the patient to an out of state VA which routinely does these, having vascular surgeons on staff. The transport is arranged and the patient gets his repair done.
Same patient but one with good extra insurance coverage. Patient inquires as to whether or not he can elect to have surgery locally with a private vascular surgeon. He asks you for a referral, and since this is the patient's preference and you know a good vascular surgeon, you are happy to help him.
Same patient but like other above, he takes care of his invalid wife and does not want to travel out of state for his repair. You insist that you do not feel comfortable repairing this man's AAA, and being the typical veteran, he argues with you, refuses to go and ends up in the emergency room 14 months later with a rupture.
Same patient, but you agree to do the repair. It has been awhile but you know the basics and the patient is treated and discharged home in good condition.
Different patient with a traumatic arterial injury who for some reason, comes to your office first. You live in a city with both trauma and vascular surgeons. The vascular surgeon oncall that day is an arrogant jerk and once hit on your wife at a hospital Christmas party. You send the patient to the local trauma center and suggest that his repair be done by one of the trauma surgeons.
Same patient but trauma surgeon "hates" peripheral vascular surgery and refers your patient to vascular surgeon on call.
And so on...
the point is that in any community there will be established referral patterns. As noted above, some of these are based on availability (is there a vascular surgeon in town?), good old boy network (ie, "I have not idea if Fred is a good surgeon, but boy we had some fun downing those beers in college so I'm sure he'll take good care of the patients I refer to him"), desire for connections (ie, "If I refer my vascular patients to Surgeon X, he in turn will give me...a) referrals for patients who need a primary care physician; b) a "finders fee"; c) a sponsorship for membership at the local exclusive gold club; etc, habit (ie, always refer patients to same surgeon, despite new vascular surgeon in town), etc.
If you're the only game in town, you need only to make your name and abilities known and generally you'll get patients and referrals for the local physicians, including cardiologists. You may come across some who prefer sticking to their referral patterns (ie, "I always send my patients to Hopkins for treatment"), but you may make some in-roads by offering good service and being a nice guy to work with who will see referred patients in a timely manner.
If you're a vascular surgeon in a town with multiple general surgeons who while not Vascular fellowship trained, have an interest in the field, and do lots of these procedures, and there are also interventional radiologists who also do a fair bit, then your ability to get referrals, will be a bit more difficult.
Since i have little information about the status of Vascular surgery and its practice patterns, this is a bit speculative and I don't know how much the cardiologists are doing. Our Vascular surgeons seem pretty busy. However, the above thoughts on referral patterns are essentially true for most any field. As long as you have a patient base and don't set your practice up in a saturated market (ie, trying to do Plastics in So Cal), then you should find enough cases to keep you busy.
