Creating the Nation’s First Phlebology Fellowship Program from the Ground Up

Despite the prolific nature of venous disease, patients seeking vein care may be hard-pressed to find physicians possessing the advanced clinical training to provide it. Physicians interested in receiving such training are often referred by the American College of Phlebology (ACP) to online CME courses, the ACP Annual Congress or individual physicians (preceptorships) who conduct informal training in their offices.

Though such training opportunities certainly are valuable, they are by no means all-inclusive or standardized. Although recognized by the American Medical Association and American Osteopathic Association, obtaining recognition of a board certification in phlebology by the American Board of Medical Specialties, which ensures consistency and quality across all programs, has been an ongoing challenge.

In 2003, the American College of Phlebology formed an ad hoc committee of 10 (eight physician participants and two ACP staff members) to discuss this very problem. In order to forge a path to an ABMS specialty and to help establish phlebology as a more prominently known field, it was clear that the first step would be to develop a true Phlebology Fellowship Training Program, with a comprehensive educational curriculum and formalized assessment methods.

But who would provide the training? How do you create such a fellowship program from the ground up, and continue to assure its quality? Over the next six years, the ACP committee embarked on the lengthy, complicated process of learning the answers to these questions and establishing what has become the nation’s first and only phlebology fellowship program.

The Long Road to Fellowship

The process began with extensive research into what topics ought to be covered, where the fellowship ought to be held, which procedures would be covered and by whom, how applicants would be solicited and selected, and what requirements fellows would be expected to observe.

An ACP curriculum committee was formed to establish the standardized curriculum, which would include principals of anatomy, physiology, pathology, pharmacology, medicine, surgery and research. Fellows would receive a combination of learning opportunities, including hands-on clinical work with patients in a broad spectrum of treatment for venous diseases and a strong research component.

The University of California at San Diego was the first to complete the criteria to host the fellowship program. Under the direction of UCSD’s John Bergan, MD, FACS, FACPh, FRCS, Hon (Eng.), the program was ready to accept applications.

In early 2007, a call went out to more than 2,000 people, including the entire ACP membership database, as well as several professional societies with members whose interests closely aligned with the study of phlebology. And in 2009, the first ACP Phlebology Fellow, Nisha Bunke, MD, FACPh, began her 2009-10 program in San Diego.

The Move to NYU

In 2009, when Dr. Bergan retired from his post at UCSD and as Director of the Fellowship Program, the program needed a new home. Dr. Lowell Kabnick, MD, FACS, FACPh, RPhS, who had been on the first ad hoc committee to establish the fellowship, stepped in as chair and continued to develop a quality program at New York University Medical Center, where he is director of the NYU Vein Center and a world-renowned surgeon-teacher.

As Dr. Kabnick explains, even though he had a history with the program and was able to expedite things, the process was lengthy and complex.

“The cost of a fellowship is expensive, and there are many different costs other than the fellow’s salary,” he says, explaining that a formal application had to be made to the ACP Foundation to fund the fellowship, and NYU approvals had to be secured from the chief of vascular surgery, the chair of the Department of Surgery, the medical education chair and the dean of the hospital. Once all this had been completed, applications could be solicited and a fellow selected.

Three fellows have, to date, participated in the program at NYU.

“It’s not an easy process,” Kabnick says. “It takes a fair amount of effort to bring in a fellow who may or may not know venous disease or have prior procedural skills and teach him or her what they need to know by the year’s end.”

An Unparalleled Phlebology Education

The one-year fellowship provides fellows with the opportunity to learn how to diagnose and treat the entire gamut of vein disorders, ranging from superficial venous issues to deep vein problems. Fellows are extensively trained, according to guidelines from the American Board of Venous and Lymphatic Medicine, in duplex ultrasound, venous ablation, phlebectomy, sclerotherapy, ultrasoundguided sclerotherapy, acute deep vein thrombosis and venous obstructive disease, with exposure to venous malformations as well.

Beyond clinical work, fellows each are responsible for a clinical research paper, to be presented at a national conference. NYU fellows attend vascular conferences and morbidity and mortality conferences with the Department of Surgery and are responsible for content and planning of venous lecture events held twice a month, as part of NYU’s continuing education program.

“It’s an exciting fellowship, and there’s certainly a lot of interaction with patients,” Kabnick explains. “We do over 3,000 procedures a year here in venous intervention…We’re excited to have it, we think we’re doing a very good job, and it’s supported by us all.”

Dr. Todd Jones, the 2013–14 Phlebology Fellow, calls the experience “excellent.”

“I’ve been getting a lot of experience seeing patients with all spectrums of venous diseases, and in some cases more than I’ve bargained for, which is a good thing,” Jones says. “Day to day, I see patients with venous diseases ranging from almost purely cosmetic to very severe symptoms. I get to see the benefits of the work we do directly, and I see all patients both pre- and post-operatively, which is unusual for a fellowship experience.”

Jones says the ability to attend conferences, coordinate lecture events, embark on important research studies and work closely with Dr. Kabnick to write medical textbooks has also been incredibly valuable as he prepares for his medical career.

“Definitely, in terms of practicing medicine,” Jones says, “the treatment of venous disease and researching better methods will be at the forefront of my practice.”

For more information about the ACP Phlebology Fellowship program at NYU, please contact ACP Membership Director, Caryl Tynan via email at [email protected] or by phone at 510.346.6800.