From birth, he hated change. The situation he was in was always better than the situation he could be in--no matter how bad the current situation was or how good the future situation could be. This was my middle son, the change hater. As you can imagine, this unique and presumably rare personality trait made for challenging parenting—permanently remaining in preschool was not a realistic option. In bemoaning my fate as the parent of a “change hater,” my friend chided me for my cynical disposition. He said, "Do not think of your son as a hater of change, but as a lover of inertia."
As the years have passed, I have discovered “inertia lovers” are not as unique as I once thought. In fact, this trait is common among individuals and volunteer organizations. Medical societies, such as the ACP and the AVF, share this trait. Each society develops its unique character and operational methods that carries it along its path. Often this path is a successful one and when looking from within, there is never reason for change.
ACP/AVF merger has been long discussed
The concept of a merger is not a new idea. Leadership of both organizations has met (often in secrecy) to discuss this. Nonetheless, the inertia-loving aspect of each society seems to have resisted such a dramatic change. Our good judgment to move forward seems to be governed not by reason and logic but by Newton’s first law of motion. The best we have been able to accomplish is to develop several collaborative initiatives. In doing so, members of both organizations have come to know and respect each other, which further underlines the question of why we are not a single society.
However, each medical society exists within the larger environment of medicine and this environment is changing dramatically. Clinical decision making is being taken out of the hands of physicians and placed in the hands of third-party payers. Ever-mounting documentation requirements dominate and overshadow each clinical encounter. Decreasing reimbursements are threatening the viability of many physician practices. Societies can no longer just educate their members, they must advocate for their very survival. A strong, unified voice could be an infinitely more effective advocate than two smaller voices that are—at times—discordant. These issues are the impetus behind the interest in merging the American College of Phlebology and American Venous Forum.
Last year, Dr. Pappas took the initiative to bring this issue into the open, penning an article titled “Speaking with One Voice.” In his article, Dr. Pappas highlighted the potential accomplishments that a single, larger, more influential organization could accomplish. He envisioned an organization that could educate and advocate for both patients and physicians; he envisioned an organization that could really make a difference. He also acknowledged barriers to such a union—the loss of organizational identity, leadership ascension and ideological differences.
At first glance, overcoming these obstacles and the many others that exist may appear to be daunting, particularly when viewed through the lens of a merger. A potentially better way to view this concept is not as a merger but as the creation of a new organization containing the best elements of their original societies; a new organization with the same mission as its parents, which is to advance vein care.
Choosing a stronger, more reflective name
This new organization would need to have a new name that reflects our collective areas of interest in venous and lymphatic disease. Phlebology—well recognized overseas as pertaining to venous disease—in America is often confused with phlebotomy, the act of placing a needle into a vein. Efforts to change this perception have failed, and maybe it is time to give up on trying.
“Forum” as part of the AVF’s name, connotes a discussion group where ideas are exchanged. The AVF is currently much more than this and the new society I envision would certainly be much more than this. There are many potential new names—The Society for Venous and Lymphatic Disease (SVLD), The American Society for Venous and Lymphatic Disorders (ASVLD), The American Venous and Lymphatic Society (AVLS) are just a few that come to mind. It would not take long for representatives of both organizations to select an enduring name that would bring pride to all.
Financial assessment for the ACP/AVF merger
Each of the current society’s members would automatically receive membership in this new society, representing the collective strength of approximately 2,500 health care professionals. The money these individuals have invested through dues and other fees would be merged. As of June 30, 2015, the ACP reported $1,312,224 in net assets and a cash position of $1,879,962 on their most recent 990 tax documents. As of August of 2015, recent staff reports establish the current cash position of the ACP has increased to $2.3 million, with net assets of approximately $1.6 million. The AVF has also reported very healthy net assets of $1.5 million. A combined organization would have net assets in a surplus of $3 million, potentially permitting expansion of meaningful programs to further the collective mission of the new organization.
In addition to merging assets, the combined organization would have access to the successful programs each has invested in individually. The ACP has made extensive investments in programs that have led it to greater independence and stability. The ACP has become a provider of AMA CME credits and has recently received an independent four-year ACCME accreditation for its educational programming. The learning management system has realized a 489.2% revenue growth in online education since June 2013. The ACP has increased its advocacy activities by becoming active in the American Medical Assoication, with representatives serving on the House of Delegates, RUC Committee and CPT Advisory Committee. Collectively, these programs will pave the way to a better financial position for this new society, giving it greater influence and respect.
A promising future for ACP/AVF
The imbued vigor of this new society, built upon the foundation of the current organizations, will be well-positioned to develop new programs to enhance and preserve its future. For example, a new journal can be established to serve as the authoritative source for research in the area of venous and lymphatic disease. The revenue stream from this publication could significantly enhance the future success of the organization and its overall mission.
An organization of the size and scope I envision would need to be self-managed. In 2008, the ACP’s Board of Directors decided that becoming a self-managed organization with its own headquarters and staff yielded many benefits over being managed by an outside organization. Although maintaining a stand-alone headquarters comes at a cost, the benefits of doing so greatly outweigh the expense. The number of programs that are supported are exponentially larger. The institutional expertise and control that such staffing provides leads to greater stability and enhanced organizational knowledge. A new larger organization with new programs, such as a dedicated journal, will require a committed and experienced administrative staff. The ultimate nature and size of the administrative staff is a detail that should be left to the architects of this new organization.
New merger, new leadership, new president
Leadership succession can be a complex issue. Both organizations have spent years grooming individuals to ascend to leadership positions. Individuals currently in line to become leaders may bristle at the thought of losing an opportunity they had worked so very hard for. However, it is certainly possible to create a succession plan incorporating those in current leadership roles. The first thing that will need to be done is to expand the board of directors to allow for equal representation from each of the parent organizations. Once this is done, I can envision several models for equitable leadership succession. One model would have a president and two vice presidents.
Each vice president would be a leader, representing one of the two parent organizations and the first president could be chosen by the new board of directors. The two vice presidents would then alternate in their succession to the role of president. Alternatively, one of the current AVF or ACP presidents could take on the role of president and alternate. In the end, a new constitution will need to be drafted and the membership should have the opportunity to vote to give new leadership a mandate to lead.
In my experience as a past president of the ACP, the leadership term should be two years. Each president places their unique stamp on an organization by transforming their vision into initiatives that make a difference. The momentum needed to carry these ideas forward does not start immediately upon taking office; it takes time to become familiar with the complexities of the position and it takes a good six months to get things in gear. With a one-year term, the achievement peak is far too close to the next leadership transition, reducing the productiveness of the organization.
As one can see, leadership succession is not really an obstacle; it is just a matter of negotiating a model acceptable to both societies. In the well-chosen words of Dr. Pappas, “I do believe that well-intentioned, good-hearted people at a negotiating table can come to some compromise.”
Avoiding conflict with existing relationships
There are other obstacles to moving this idea forward that I have not mentioned. I believe each of these can be easily overcome through earnest and sincere negotiation. However, there is one obstacle beyond our ability to negotiate—the outside influence of other societies who may view this union as a potential threat. For example, the Society for Vascular Surgery (SVS) has always had a close affiliation with the AVF, as many of its members are also members of the SVS. The SVS may not welcome a new venous society and could lobby members to reject this concept.
It would be a shame if this transpired, as a new venous and lymphatic society would only compliment any of the other societies that might share members with the ACP and AVF. The ACP and the Society of Interventional Radiology (SIR) have collaborated very effectively in the past when need arose. I envision the new society would do the same with the SVS, SIR, or any other society sharing a common interest.
In summary, the establishment of a new venous and lymphatic society could create an organization more influential and effective than the sum of the parts creating it. Having spoken with them personally, a single, stronger organization would be welcomed by Industry and be a more effective advocate for its membership. The ACP Board of Directors has embraced this concept and is interested in beginning negotiations to make this a reality. In this article, I have given a sparse outline of my personal views on how this could be done. My views are limited by an incomplete understanding of the AVF’s inner workings as compared to my greater knowledge of the ACP and its workings.
However, like Dr. Pappas, I have no doubt that this idea could be turned into reality, if leadership is willing to invest the energy needed to overcome the inherent inertia within both societies.