If you consider Dr. Peter Gloviczki’s skills—award-winning magician, amateur tie designer, notable vascular surgeon, editor, and proponent in the advancement of venous disease treatments—you might say he’s a man of multiple trades. Well, he is. But don’t let some of his unconventional knacks deceive you; Dr. Gloviczki is a force to be reckoned with.
The proclaimed perfectionist excels at everything he does. Now serving as the professor of surgery at Mayo Clinic College of Medicine in Rochester, MN, he is furthering the life path he had envisioned as a child living in Communist Hungary. In an interview with Vein Magazine, Dr. Gloviczki discusses what led to his present and what else is in store, not just for him, but for the future of vein disease treatment.
VEIN Magazine: Dr. Gloviczki, your life story is nothing short of amazing. Upon reflection, was your path systematically chosen as a means to achieve the goal you set as a youth to become a professor of surgery, or was it a culmination of calculated risks that, combined with hard work and good fortune, allowed you to achieve the success that you have earned? Can you share with us a few of your most poignant moments that led you to where you are today?
Peter Gloviczki, MD: What guided me from a very early time was a vision and determination that I wanted to be a physician. At age six, I articulated that I wanted to be a surgeon because my father had a friend who was a surgeon and his role in medicine appealed to me. My family was very supportive, especially my physician father, who was a tremendous role model. He continuously inspired me to follow this direction, although
I don’t ever recall him telling me that I should be a physician. He somehow developed that inspiration within me. Having my father as a role model, and then later having the professors that I worked with during my training, encouraged me to become a physician and ultimately a surgeon. One vascular surgeon, whom I worked with for eight years in Budapest, named Professor Lajos Soltesz, had such a charismatic and motivating personality that I felt there was no other choice for me than to go in the direction of vascular surgery.
I was a good student who strived for perfection. From age six, I never had less than ‘straight As’ on any of my exams (laughs)! This drive ultimately paid off for me because I graduated from Semmelweis University with the Gold Ring of the Hungarian Republic. I had a choice of where I wanted to go, and fortunately there was a position at a cardiovascular clinic in Budapest, where I was mentored by Professor Soltesz. I didn’t know much about vascular surgery at that time, but it appealed to me, so I applied for the position and received it.
Later on, I had an opportunity to get out of Communist Hungary because Professor Soltesz procured a fellowship exchange opportunity with France. This allowed me to do my residency in Paris from 1974-75. The time I spent in Paris pushed me further into the realm of vascular surgery, and ultimately is what motivated me to seek an opportunity at the Mayo Clinic.
VM: How so?
PG: I had a professor who would disappear twice a year and when he would come back, I would ask him, ‘Where did you go?’ He replied that he was at the Mayo Clinic. When I asked why, he told me the Mayo Clinic was the best in the world. That’s when I thought to myself, ‘What am I doing in Paris?!’ (Laughs)
VM: What was it about vascular surgery that was so appealing?
PG: I think that ultimately the type of comprehensive and continuing care I could provide to the vascular patient played a major role. When I chose this profession, I didn’t know much about it, but it only took a few weeks for me to love what I was doing. And given my desire to be as good as I can at what I am doing, my passion grew from there.
VM: I have read about your other passion for performing magic and that you are an accomplished magician. I understand that you performed abroad during your time in medical school and took these opportunities to also study abroad while you were outside of Hungary?
PG: Absolutely. Because of the communist system, there was no way for me as a resident or surgeon to attend international meetings. So, wherever I went, I traveled as a magician but arranged my trips so that my magic shows or lectures coincided with vascular surgery meetings.
VM: Was that a dangerous thing to do?
PG: No, Hungary was quite liberal after the 1956 Revolution. While it was closed for about a decade after 1956, it started to open up for artists, musicians, and athletes. You could travel if you were competing in a sports activity or doing something artistic. You had to use the state agency and pay 15% of your honorarium to them, and they would arrange the trip. I didn’t know whether they knew or cared if I went to medical meetings or not, but I certainly did.
"Anybody who is knowledgeable in venous disease realizes that there are multiple players, and what we should set as a goal is that venous disease management is performed at the highest level by all vascular and venous specialists who do this."
VM: I imagine that if they had objected, you would have known.
PG: Yes, I am sure of that. A regular citizen could get a Visa every second year at that time, so travel was very restricted until the wall came down.
VM: As a vascular surgeon, how did you come to include venous disease treatment as part of your practice? Was it a path that you always wanted to pursue, or did something happen during your career that led you to add venous disease treatment to your skill set?
PG: My professor in Budapest sparked my interest in venous disease, but the year I spent with Professor Servelle in Paris treating patients with vascular and lymphatic malformations and venous disease, cemented my interest. At the very beginning of my surgical career, I was interested in microsurgery, and one of the areas I worked on in Paris was microsurgical lymphovenous anastomosis to treat lymphedema.
Professor Servelle was very knowledgeable in venous malformations and venous disease, so what I picked up right from the beginning is the great diversity of vascular surgery. It deals with the arterial, venous, and lymphatic problems, all of which contribute to vascular disease. This variety is what truly appealed to me. I was always involved in venous disease and interested in lymphedema, and was fortunate to have great educators in arterial surgery.
When I came to the Mayo Clinic, my original research projects were lymphatic microsurgery, venous reconstructions, and arterial disease. I was so different than the people who trained in the United States, where vascular surgery focused on aortic and arterial reconstructions and venous disease was an absolute stepchild that no one wanted to deal with. My interest in veins was very welcomed at the Mayo Clinic because, at that time, the other vascular surgeons did not want to deal with venous ulcers or varicose veins, or even large vein reconstructions, which ultimately became one of my major areas of practice.
VM: It’s no secret that Europe has taken the lead with respect to treatment of venous disease. What did you do early on to try and advance the specialty?
PG: When I came out here, I quickly became involved with the American Venous Forum, which led me to editing, with James S. T. Yao, the first edition of the Handbook of Venous Disorders, of which I am now working on the fourth edition. It has become a successful handbook on venous disease. I am putting in the last chapters now, and it should come out in the second part of next year, very likely around the time of the VEITH meeting.
"I would like to see the Society for Vascular Medicine (SVM) and wound healing societies become more involved, as well as see increased collaboration between the SVS, AVF, ACP, and SIR."
VM: There is much discussion about the diverse societies who manage venous disease working more closely together. In your article in the Journal of Vascular Surgery, published January 6, 2014, you highlighted the formation of a joint foundation between the SVS and Society of Interventional Radiologists (SIR) and announced the upcoming PRESERVE study, the first large-scale North American multispecialty prospective study to evaluate the use of inferior vena cava filters. How has this initiative worked out?
PG: I think that the initiative has worked out very well. Both the foundation and the program are growing, and the study is ongoing. It is a visible collaboration between the SVS and SIR, which is very good.
VM: What are your thoughts on other organizations aligning?
PG: Anybody who is knowledgeable in venous disease realizes that there are multiple players, and what we should set as a goal is that venous disease management is performed at the highest level by all vascular and venous specialists who do this. There are vascular surgeons, cardiologists, interventional radiologists, phlebologists, and general surgeons. Though I could list several more specialties who treat venous disease, my point is that if we can create joint guidelines for how to improve the quality of venous disease care, we will all benefit—more importantly, the patients will benefit, too. I work at an institution where teamwork and a multispecialty approach have always existed.
I was a featured speaker at the ACP Annual Congress this year, and received an honorary membership, which I am very proud of. Although I was not a member of their society, I felt that they recognized I strongly support the highest quality care for venous disease. I very much promote the collaboration between multiple societies. The AVF, ACP, and Covidien have worked together to create a national campaign to increase awareness about venous disease, and as we update our SVS/AVF guidelines on venous disease and venous ulcers, we are looking for partners who will join us and be participants in this process.
VM: Which organizations do you see as being integral in aligning to ensure the future of quality venous disease treatment?
PG: I would like to see the Society for Vascular Medicine (SVM) and wound healing societies become more involved, as well as see increased collaboration between the SVS, AVF, ACP, and SIR.
VM: While vascular surgery training has experienced excellent growth, do you feel that the venous disease treatment training in vascular surgery programs are adequate?
PG: I don’t think it is adequate. Vascular surgery, as a specialty, includes the arteries, veins, and lymphatic systems when you read it on the vascular surgery board statement. But the fact is that there are still currently many vascular programs where there is a deficiency in the teaching of venous disease treatment. I think interest in venous disease has increased tremendously, both in superficial and deep venous disease, and what you will see is that venous disease treatment in vascular surgery training will improve. We are working on it, but there are deficiencies.
VM: How can training be improved?
PG: One of the recent collaborations of the SVS has been to re-strengthen the links with the AVF. The AVF was founded by members of the SVS, and it became a very strong academic venous organization run primarily by vascular surgeons. Obviously, I welcome that and I am a major supporter of the AVF. During my presidency, I pushed to strengthen these ties by launching the Journal of Vascular Surgery: Venous and Lymphatic Disorders as a joint venture of the SVS and AVF.
I am sure that this journal, launched in 2013, is going to be a very strong link between the AVF and vascular surgery, and will be a major educational and research forum for vascular surgeons and venous disease treatment. I know it will happen, because I am going to be the editor beginning mid next year. Peter Lawrence will be the other editor. So, there will be two editors with a strong venous background. Dr. Lawrence is the chair of Vascular Surgery at UCLA, a past president of the SVS, and is considered a leading venous disease expert.
Obviously, more fellowship programs will help training, and increasing interest by vascular surgeons in seeing patients with venous disease has and will continue to increase training. We published a study in the venous journal about the involvement of vascular surgeons participating in the treatment of venous disease, and we found that 86% of respondents perform both deep and superficial venous procedures and 92% do superficial veins. I think we are seeing a tremendous increase in interest in venous disease treatment by vascular surgeons as a result of the advancements of minimally invasive endovascular technology.
VM: Where do you feel today’s doctors are gaining knowledge and experience in the treatment of venous disease?
PG: The vascular surgeons get most of their exposure locally in the training programs and also at meetings of the SVS and AVF societies. There are also a good number of vascular surgeons who are members of the American College of Phlebology, and there are excellent national meetings like Jose Almeida’s International Vein Congress (IVC), the annual New York Venous Symposium and, of course, the VEITH Symposium, where this year four days were dedicated to venous disease.
VM: As an expert in complex open surgery, what isthe future of this type of surgery in the next decade? Given that they are performed in specialized centers, what type of doctors should receive this training, and how do you envision being able to teach them to achieve the level of care that you have achieved?
PG: You bring up a real problem. We can talk about complex aortic abdominal surgeries and complex open large vein reconstructions, which I do quite regularly, such as inferior vena cava reconstructions for malignant tumors or superior vena cava reconstructions for patients who are candidates after failed endovascular techniques. These are highly complex interventions that regular training programs will not be able to teach because of the low numbers. I think these procedures, whether arterial or venous, will be done in specialized centers.
There is no doubt in my mind that not everyone should do these reconstructions, and certain institutions will work together with multiple specialties to do aortic or large central venous reconstructions. The way I see it, especially as the 0 + 5 programs will increase and the 5 + 2 programs in vascular surgery will decrease, that the trainees who finish a five-year program will not be able to perform these types of surgeries unless they train at the few clinics that do these types of surgeries. I believe that there will be special fellowships, in both complex aortic surgery and complex venous surgery, at centers like the Mayo Clinic, Boston, UCLA, Houston, St. Louis, Northwestern, and other centers where there is complex surgery happening.
I’m not talking about just complex open surgery, but complex endovascular procedures as well. They also require expertise that you cannot learn in many 0 + 5 programs.
VM: I have read some of your comments and concerns regarding the state of reimbursement under the Affordable Care Act prior to its implementation. Citing your article in the Journal of Vascular Surgery mentioned above, two points you made continue to resonate with me: Dr. Veith’s comment in Vascular Specialist that ‘primary care physicians don’t get patients well,’ and that it is becoming necessary to ‘… learn how to be team players and leaders in big medical center environments.’ Can you share your thoughts on this topic with us? What do you feel are the major challenges facing doctors in the specialty today?
PG: We all see and feel the change. We can no longer provide the type of care that the patient may need. There might be a better way to treat a patient, but if that treatment is too expensive, we may not be able to provide it. The cost is becoming a major issue, and the way I see it is that we are changing our practice and we need to somehow find cost-effective care that still provides a high enough quality that should be provided.
I am concerned that the financial constraints will somehow decrease the quality of care and will promote physicians to perform those procedures that have the best reimbursement, even if that procedure may not be the best for the patient. I acknowledge the advantages of the ACA—coming from Europe I believe people should have access to care and insurance—but it will likely decrease the overall quality of care. I know the intention is good, but I do not think it will solve the problem of health care in the United States.
VM: You mentioned in an interview with Vascular News in January 2013, that your proudest professional moment was becoming president of the Society for Vascular Surgery in 2012. The SVS experienced tremendous growth during your presidency. What spurred this success? What are you most proud of accomplishing during your tenure as president?
PG: To be frank, the SVS is a tremendous organization, and I would be careful to tie any success of the society to any one president. It is a one-year term, and there is a leadership that includes the vice president, president-elect, and president—three people who define the direction of the SVS. I certainly wouldn’t tie it to my own presidency; I would tie it to the leadership of the society who 13 years ago were instrumental in getting the two major national vascular societies under one umbrella.
That has led to the buildup of both a local membership and international membership, and we now have over 5,000 members, making the SVS the largest vascular society in the world. This was achieved through the direction of multiple presidents. I was pleased to present the data, but I knew this was a team effort and it was great to be a part of it.
I was very proud to design the necktie for the SVS, and when I was AVF president, I also designed the necktie for the AVF (laughs)! I think what made me most proud as SVS president was contributing to establishment of the Journal of Vascular Surgery: Venous and Lymphatic Disorders. Under my editorship, I want to make it the number one academic journal in venous disease.
VM: I read a blurb on the local news station in Minneapolis that said you may be retiring in the near future. Hopefully not anytime soon for the sake of patients who need your care. But when you do, is there a renewed career in magic in your future?
PG: I never left magic. I still do a couple of shows at medical meetings. Ultimately, I see my editorship of the journal as a nice way to decrease my clinical work. The editorship term is for three years, renewable for another term. I am looking forward to the new edition of the Handbook of Venous Disorders coming out next year, and I will be working on that next year. But as I decrease my activities in medicine, I am going to increase my activities in magic (laughs). It’s a great hobby. I enjoy it and my wife Monika, my family, my friends, and my patients love it.