The AVF/ACP Merger: A Thoughtful Treatise

Several months ago I wrote an article espousing the advantages of the American Venous Forum and the American College of Phlebology merging into one national venous society. The article generated a great deal of interest by members of both societies and their industry sponsors. I was asked by VEIN Magazine to write a follow-up article outlining how the two groups might accomplish this task. As I stated in my previous article, I truly believe that any group of well-intentioned people striving for the same goals can accomplish anything. So let’s look at what some of the hurdles are and possible solutions towards achieving a merger.

Determining the cost of the AVF/ACP merger

As with any merger, there will be an analysis of each organization’s finances. Since both organizations are 501c3 charitable organizations, they are required by law to publish their tax returns. I went to Foundation Center's website and reviewed the 2013 tax returns of both organizations— 2013 is the most recent year available for review. An initial evaluation demonstrated several findings: For 2013, the ACP reported revenues of approximately $3.9 million and the AVF reported revenues of $1.85 million. Clearly the ACP’s ability to generate revenue is very good.

However, when you look at net assets, which are the key to any merger, the ACP reports assets of $755,000 compared to $1.5 million for the AVF. The reason for this discrepancy is related to the costs of running their prospective organizations and the cost of their annual meetings. The ACP spends approximately $980,000 for payroll expenses and $945,000 to run their annual meeting. Meanwhile, the AVF spends $318,000 for management fees and $419,000 for meeting expenses. The question that will need to be answered is what type of management support will the new organization require and why is the ACP’s annual meeting so expensive?

The ACP has chosen to hire full-time employees and contract out certain services, whereas the AVF has a professional management company. The combined organization would have between 1,500 and 2,500 dues paying members. An organization of this size is similar in size to the Society for Vascular Surgery. I would therefore suspect that an organization of this size will need a full-time executive director, chief financial officer and a foundation director. Other support staff will be determined based on the mission of the new organization. For example, will the organization need a marketing director, education director, social media and communications department, and a website manager? The support staff needs will be determined by the mission of the new society.

Tackling the major issues of an AVF/ACP merger

The second issue will be succession planning. To me, this is an easier task than the financial management. Currently, the ACP president is a two-year term versus a one-year term for the AVF. I suggest that both organizations look at the current composition of their executive committees and agree that these individuals will ascend to the presidency over the next seven years. The two groups would alternate every other year for seven years.

Alternatively, the AVF can nominate a president for the first two years and the ACP can nominate a president at year three. This would follow the annual and bi-annual process that currently exists. At the end of the seven years, the new organization would nominate a slate of leaders for the approval by the membership. A nominating committee should be developed and charged with this task. I also recommend that the presidency should be for one year only. Having served as president for one year and foundation president for two years, I can attest to the fact that a two-year term in a voluntary organization takes its toll on the president and limits his/her drive, as does it impact his professional practice. With an effective executive director and a five-year strategic initiative, a one-year presidency works very well.

The next issue relates to the American Board of Phlebology. The positions of both groups have been widely debated over the past several years. I applaud the ACP’s efforts to try and develop uniform standards for the practice of venous disease. For physicians who have not received formal graduate medical education venous disease training in their residencies, the board exam provides a measurement of cognitive competency. Unfortunately, it does not provide measurements of clinical competency. It is also clear that the American Board of Medical Specialties (AMBS) will never make phlebology a separate board. So what can be done to address this issue? Perhaps we should look at residency programs that are multi-disciplinary as a possible solution—specifically, I am referring to sports medicine and hand surgery. Physicians completing family medicine, emergency medicine and orthopedics residencies are eligible for training in sports medicine. Similarly, physicians completing general surgery, orthopedics and plastic surgery can receive additional training in hand surgery. I therefore recommend that the new venous organization ask the ABMS if a multi-disciplinary, GME-approved training program can be developed for phlebology. The phlebology residency would be viewed as a certificate of added qualification and complete the clinical competency requirement requested by the AVF. It would also provide a pathway for non-traditional venous physicians to pursue added clinical competency in phlebology. The new venous organization would develop the curriculum and training requirements. In this manner, we would ensure high quality venous care to our patients and credibility to physicians wanting to practice venous disease.

An important issue for me is developing a continual, diversified revenue stream and decreasing the new organization’s reliance on industry funding. In my opinion, to achieve this goal, the new organization needs its own journal. Today, the ACP supports the journal Phlebology. As per the 2013 tax returns, the ACP receives no revenue from the journal. The AVF, on the other hand, supports the Journal of Vascular Surgery, Venous and Lymphatic Disorder (JVS:VLD). This journal is currently a quarterly supplement, with plans on eventually becoming either a monthly or bi-monthly journal. The journal has also recently received Medline designation, increasing the likelihood of scientific submissions for publication. This journal is currently owned by the Society for Vascular Surgery (SVS). The AVF has initiated discussions on possible royalty sharing opportunities but currently receives no revenues from the journal. A new venous society with 1,500 to 2,500 members offering the JVS:VLD would increase subscription rates and stimulate advertising revenue. A society of this size should be able to negotiate a revenue sharing agreement with the SVS. Simultaneously, the new society should approach the journal Phlebology and explore revenue sharing opportunities with them as well. Associating with a high-quality journal is a key component to the growth and identity of a new venous organization. It provides credibility, visibility and legitimacy. Thus, a journal should be a top discussion point during any merger discussions.

The last issue for me is the name of the new venous organization. To avoid emotional discussions on this topic, I recommend the two organizations consider hiring a marketing firm to address this question. When the Society for Vascular Surgery and the American Association for Vascular Surgery (AAVS) were addressing this issue, a certain approach was taken. The recommendation of the marketing firm was to call the new organization the Society for Vascular Surgery for several reasons: The name SVS has large name recognition with the public and the government. It was also felt that the SVS’s constituency was primarily vascular surgeons and that the name should reflect this fact.

The assessment by the marketing firm made it easier for the members of both groups to accept this recommendation without the perception of favoritism to one group or the other. I suggest the two groups consider a name such as the American Society for Venous, Lymphatic and Thrombotic Disorders. This name clearly indicates the group’s mission, is understandable to the public and is inclusive of all physicians regardless of specialty training. As I am sure there are many other possible names, I recommend we let the marketing and branding experts present the new society with potential names and move forward from there.

Final thoughts on the AVF/ACP merger

In conclusion, I truly believe that a merger between the ACP and AVF is possible. I have outlined in broad strokes what I believe are some of the hurdles to this merger and possible solutions. I continue to believe that a single national venous society would represent the needs of clinicians and patients more effectively than the two societies separately. It is my continued hope that the leaders of the two organizations will consider a merger as being in the best interest of both societies.