Welcome to VEIN Magazine with Dr. Steve Elias—Real discussions on venous disease and treatment.

Dr. Steve Elias joins Dr. Bill Marston and Dr. Mark Meissner to talk about the state of venous education meetings.

Are these meetings the best format for CME? Can online education be viable? Do the for-profit doctors treating veins attend these meetings?

Stay tuned for more, plus hard opinions on Bon Jovi.

Episode Transcript

Dr. Steve Elias: I thought this segment we can speak about one of the questions...are there too many meetings? Are there too many vein meetings? Are there too many wound meetings? Are we saturating the market, not just for us, as mostly faculty, but for attendees and also industry? Are there too many meetings? Bill-

Dr. Bill Marston: I think the question really is there too much education available to people that need it? I think that there is not a lot of the same people that go to all these meetings. People that go to say, the AVF aren't going to Venous Symposium or Jose's [Almeida] meeting, so I think probably in the venous world, we have a lack of meetings. There's not enough.

As Dan Monahan says, there's nothing regionally out on the West Coast, except for the West Coast [Vein Forum], which is sort of getting going. I think we may have too many meetings that the same people go to but not enough availability regionally.

Steve: Yeah, Mark. You're shaking your head about what he's saying.

Dr. Mark Meissner: That's exactly what I was gonna say. I think there are too many meetings localized within the same region of the country. In some ways, do compete for...it may not draw the same people, but it's competing for the same audience. Particularly, the IVC and the New York Venus Symposium.

There needs to be more, particularly on the West Coast. Medicine in general is very East Coast-centric, particularly the population growth is on the West Coast. There really are no, other than when the ACP or the AVF go to the West Coast every other year. There's no main meetings on the West Coast to speak of.

Steve: Do you think a New York Venus Symposium could also be held at another time on the West Coast and call it the LA Venus symposium, or wherever the heck it's gonna be held? The same type of thing? You don't think there's over saturation for industry support?

Mark: Well, I think the problem is equally the meetings on the East Coast are parasitizing each other. If you got rid of one East Coast meeting, you may have another East Coast meeting that's twice as big, but shifted to the West Coast.

Bill: I think what you need are regional meetings that are not supported by the national part of the companies. They're supported by regional budgets.

For instance, if there's not been a meeting in the Pacific Northwest that focuses on Venus Disease. Those regional people are happy to support something that's gonna bring their people that they can market to, so they don't have to travel to New York or Miami to do it. You're not gonna get most of those people to travel those distances.

Steve: No they don't. And that's been the problem with the, in the opposite direction, with the meetings that are held on the West Coast by the various societies, like you guys said, The AVF and ACP.

Bill: The difficulty for taking the New York and going out there is that it takes a while to build it. Those first few meetings you may not be as successful if your goal is to have a 500 person meeting. If your goal is to have 100 people and you do it that way, then it's more achievable.

But it's better also then, if it's done by local. If the experts at UW do that meeting and other people from that region. They then have an interest in getting referrals from those other people.

That's what we've done in a wound side. Where there's saturation with big meetings trynna have big boosts for industry. But those smaller regional ones, there's a real need for. That's been really successful for us. We have one every other year that we do like that.

Steve: So you do it every other year?

Bill: In the Carolinas and-

Steve: Yeah you do in the Carolinas. But how do you deal with The West Coast?

Bill: Well, there's one meeting that moves around to a couple different locations. Modern wound care meeting. It's in Seattle sometimes, it's been in New Orleans, Portland. And it's the same agenda essentially.

You tweak it. But similar faculty, so you can plug it in wherever you wanna go. The idea there is to be successful on 75-100, you know, the size of a meeting like this.

Steve: So Mark. First of all, there is a lot of people West of the Mississippi that are treating vein disease. Certainly a lot of people on the West Coast. A lot of significantly well-known people like you and others that can run meetings?

What's the problem there? Why is it that the West Coast has not really been a hotbed?

Mark: As you know, Steve. I think it takes somebody who has both the time and commitment to it to organize the meeting. Because putting on a meeting is a big project and I think it's sort of in that. Also, I think it lacks some of the industry impetus on the West Coast as well, old meetings on the West Coast.

Steve: Yeah, we've had this discussion with the industry. From the industry viewpoint, they would rather we consolidate meetings than have more meetings.

It's very expensive to them, it's not just the commitment of, oh I'll give you $10,000, or $15,000, or $20,000 for a meeting. It's then they have to ship their equipment, their people, and all that other stuff, and hotel rooms.

Maybe, what you're saying is not a bad idea. In other words, the regional people have their budget and it's a lower cost and lower expectation.

Bill: And it's different reps that go to that sort of a meeting then go to a bigger national meeting.

Steve: Yeah, because the ones that support the national, they would rather there be combined AVF/ACP meeting for instance.

Bill: But so here's another big problem. We've just talked about all these trans trained physician that come into the vein world. Where are they getting their education? I don't think they're going to any of these meetings.

So how do we create a mandate that if you create these kind of regional meetings that they would actually go? A lot of the messages that we're talking about need to get to the people at these vein centers.

Steve: I mean, yeah that's a problem. But those people and vein centers don't necessarily need significant amount of CMEs.

Bill: Well, if you're an accredited vein center you do.

Steve: Yes, well no, Bill is talking about companies that are running vein centers. He's talking about the for-profit people. The thing is that if they could say that you need to get CMEs in the vein world, the vein space, then maybe it can drive people. But people can get CMEs in their sub-specialty.

Bill: We do a lot of those folks from the wound world to our meeting. Because it's close, they'll drive. If it's close by for a 2-day meeting, get some CME. At least you're getting them somewhere but I think we don't see that kind of physician at many of the meetings at all.

Steve: No, no we don’t. You're absolutely right. There's not that many people that work for those kind of organizations that come to the meetings for education. They're getting it. I don't know where they're getting it.

Bill: Corporations, probably. Web-based-

Mark: Online.

Bill: Something, yeah.

Steve: Online, right. By a training video or something like that. I'm intrigued by you saying Bill, that there are not too many meetings. Don't you feel like you go too many meetings?

Bill: What I would say is that there's not too much education.

Steve: Education.

Bill: Then the question also gets into, yeah. Are meetings the right way to do it? Meetings are good for social interaction in a medical way. You're talking about cases. After the meeting it stimulates you and then you have discussions so that's great.

Are there other ways? The web is the web. How can you control how good that is?

Steve: Do you get your information on new technologies, new techniques, what people are thinking about, from the web? No.

Mark: No, that's not true. There is some good information. I will use the example of your Clarivein technique video, which is on the web. When I first started doing Clarivein, I'd watch that before every case. I think there can be useful stuff on the web and there is, but it's limited right now, but there is.

Steve: There is definitely useful stuff, but I agree with you it is limited.

Mark: We have an orthopedist who is a specialist in amputations. And he's created technique videos on every amputation you can think of and our residents use that regularly, before showing up to the case.

Bill: And here's the problem though. And that's a great case. But if you search amputation technique videos, there is probably dozens that come up. How does the resident- The resident at your place knows they're gonna look at their faculty, but if you're a resident in Iowa, how are you gonna decide what you're gonna use? If you're a resident in South America, you don't know these places or whatever.

Mark: Maybe, there's a need for that kind of content though. That is a series of, not that you have to pay a thousand dollars to get, but a series of lectures from the AVF, ACP, New York Venus symposium that you know are at least reputable groups. Realistically, it is some cost to generate those, but the cost for the intellectual talent is not much.

Bill: But there's actually an easier way to do that. Where you don't have to make them yourself but if you had a process where you screened the stuff that is out there. You said okay, we have our website. Our panel says it's really great. WE're gonna select you and we're gonna link from our, whatever it is, AVF, ACP educational website. You're in. They're gonna love it. Because they're gonna get a lot more hits.

Steve: It's almost like you're doing a meta-analysis of what's out there and then coming down, narrowing it down, to what you say are the good ones. I think that's actually a very good idea. For technique-

Bill: You know what made me think of that originally is closure devices and they have really nice instructional videos for those, but again, there's dozens of em. Rather than having to figure out which one you're gonna-

Steve: Right, you want some organization. You wanna say these are the ones. I think that's good. It can be through an organization. Or it can be through some private organization, not-for-profit that

Bill: Then the challenge is to get it to those that would use it.

Steve: Right, and that challenge can be gotten electronically and also, in print. Clearly, I'm gonna use just a baseline example, vein magazine we could say people who read it are interested in veins. WE could say here's what's available.

Bill: If there's a way to get it distributed through the program directors and to the president and all that.

Mark: I think the ACP and the AVF could link to it too.

Steve: I didn't think this is the direction we would be going in, but who knew when you sit with a Marstead and Meissen, you never know where you're gonna go.

Steve: What else? Do you guys have anything you wanna talk about? Anything? Doesn't have to be involved with veins or it can be involved with veins. What we spoke recently about at the meeting here which was our last thing, was the whole idea of appropriateness and ethics. We've had some discussions on this. I think it's still, it's all coming down in the end that the payers and insurers need to be involved in some way that they have the data as to who's doing how many and what procedures?

Bill: I think. And we were talking about this a little while ago. We heard the most clearly expressed indication of the fundamental reason we have a problem. It's because practitioners who didn't traditionally do Venus disease said Hey, its easy money. Until that simple fact is changed, we're gonna continue to have a problem. Those that view it that way will always stay ahead of any attempts to restrain them unless its no longer easy money. You have to make it hard money or not money. That's what's gonna help.

Mark: You do deserve to get paid for what you do appropriately.

Bill: Appropriate money. If it’s not easy money.

Mark: I think it’s also the problem that in particular in the past, vascular surgeons and to a lesser extent, general surgeons controlled vein care. I think the response of vascular surgery has been a little bit wrong because the reality of it is, most vein care is not provided by vascular surgeons anymore.

Bill: Vascular surgeons are just as guilty of doing the same thing.

Mark: True. But vascular surgery is sort of withdrawn and instead of saying, we recognize this is an issue. We wanna be engaged in this and be involved in educating people and have an opinion on who does it. It's turned into sort of an isolationist, protectionist thing. We're not gonna interface with everybody else and do nothing but criticize everyone else, which isn't a productive approach. Because the train has left the station that vascular surgeons don't do most vein care anymore.

Steve: No, and they probably never will.

Mark: And I think vascular surgeons who are well-trained and do a lot of it are in a good position to lead. Then sort of bring those that aren't up to speed. You gotta engage-

Steve: Other specialties-yeah.

Mark: And being isolationist isn't productive.

Steve: I think the isolationism is breaking down a little bit organizationally because of the pressures that have come with Medicare in terms of coverage and the ability to have to work together to try and refocus the payers as to what's appropriate care and also that a procedure should be reimbursed. I think that has helped. But I agree with you Mark that the idea with some vascular surgeons, we are the vein people. Even though we don't do most of it, we are the vein people.

And it's scary to me that in some places, a vascular fellow can finish, having done minimal vane cases, and go out and be able to do vein cases. Whereas someone who's been moved into it ten years ago, has a lot of experience that's great. But is not a vascular surgeon to IR, for instance in Massachusetts, they can't even do it.

Just because a vascular fellow finishes a vascular fellowship and did four vein cases. It's not right. I think we're gonna get more cooperation because we are all getting together to educate the insurers who are beginning to deny procedures that should be covered. Once you know your enemy, they all of a sudden, they're not such a bad person.

Keep your friends close and your enemies closer. Once you get to know them, they're not so bad. ACP, AVS, SIR, now they're realizing, nice people.

Mark: There are some people from the other specialties in the graph that's been shown that they do better vein care than the graduating vascular fellow who's done four cases.

Steve: Wanna talk about music? What music do you wanna talk about? O'Donnell thought I would know that song today and I did know that song.

Bill: I did know that song too. Have you been to the Bon Jovi concert?

Steve: No.

Bill: Don't go. It was awful. I just, the boys sitting there. The sound was bad. They didn't have a jumbo screen, so you couldn't really see. It was just very disappointing.

Mark: It was kind of the 70s era before jumbo screens.

Steve: That's right you had to just listen.

Bill: But I'm too old to rush the stage anymore.

Mark: But the good news is you're probably so old that you don't hear that well and it didn't seem too loud.

Steve: Anything else about music Mark? Anything else about Lululemon clothes Mark? I converted you.

Mark: The fabric is awesome.

Steve: Yeah, I converted you. Are you wearing the pants and a shirt today?

Mark: Yeah, I got the whole ensemble.

Bill: I hope he's wearing pants and a shirt.

Steve: He used to make fun of me. I finally converted him. First he made fun of my socks. Then he wears nice socks.

Bill: Despite the fact that I'd love to learn more about your Lulu Lemons, I've gotta run to the airport.

Steve: Yeah, okay. Thank you guys. That concludes another one.

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