Because They Can

Thirty-five thousand feet, a glass of Scotch whisky, reading ARTnews magazine, and I am wondering who has $50 million to spend on a work of art? Well, according to ARTnews, between 50 to 100 billionaires do. How many billionaires exist in this world? One thousand four hundred and twenty-six, according to Forbes. Not too many, but apparently they buy a lot of expensive art. Can 50 to 100 people actually support the art world? It is hard to comprehend spending $50 million on anything, let alone a piece of art. I collect art. Mostly original works by artists I like, most relatively inexpensive. Although, it may come as no surprise to some of our readers that I do own an original work of Bob Dylan’s entitled, "Sunday Afternoon." But $50 million? The royal family of Qatar had some extra cash back in 2011. They decided to buy Cezanne’s painting, "Card Players," for $250 million (a quarter of a billion dollars!). Let that sit in your mind as you pull out varicose veins from the leg of a patient with Medicare insurance. If they paid $250 million then someone else must have been willing to spend $240 million during the bidding.

What determines the “worth” of a work of art? What determines the “worth” of a venous procedure? In 1895, Cezanne’s art dealer, Ambroise Vollard, sold one of Cezanne’s paintings for $40 to another artist, Edgar Degas. Apparently, Degas was the only one who appreciated Cezanne’s work at the time. While the worth of art usually goes up, the worth — or should I say, the reimbursement — for a venous procedure usually goes down. There are a lot of artists, some dead and some alive, not all of them can command prices of $50 million, but no one is telling them that if their sculpture is 5 feet in height it will be sold for $1000, and if it is 6 feet in height it will be sold for $2000. We are told that if you do a phlebectomy using 10 incisions you will be paid “x dollars,” and if you use 20 incisions you will be paid “y dollars.” Ludicrous. The artist, the dealer, and the buyer ultimately determine the reimbursement for a work of art.

Have we missed the boat? If a billionaire would pay $50 million for art, would he pay me $500,000 for an endovenous ablation? I’d even throw in the phlebectomy or sclerotherapy for free. The point is, when do we, as vein specialists, become artists? We have been lulled into a false sense of security by third-party payors and others. Can increased volume-always make up for decreased reimbursement? Art world prices are based on talent, supply, demand and public perception. Why shouldn’t vein care be as well?

Most artists work from passion. Some succeed and some fail. Many vein specialists work from passion as well. Some do it for other reasons. We know the other reasons. We at VEIN want to fuel your passion. We also want to stimulate the idea of passion in those practitioners who may have entered the vein world for other reasons. It is okay if you entered it this way; we just don’t want you to continue to live in it this way. You won’t have fun. It will just become a job to you.

This issue of VEIN brings you passion on many fronts. Our featured physician is Joann Lohr, a person who cannot be accused of lacking passion. In fact, at times she has been accused of having too much passion. Some people are just like that. Her story is one to analyze and reflect upon. Another piece, “Understanding the Patient Experience,” gives another perspective of vein care. It reminds us why we do what we do and perhaps how we can do it better. Passion on a physician and institutional level is highlighted by a tour of Massachusetts General Hospital’s new Institute for Heart, Vascular, and Stroke Care. Most of us would like to practice with others who share common passionate goals. Passion is what drives many artists. Passion won’t always pay the bills. Passion doesn’t get every artist $50 million.

Most of the time they don’t see the money anyway because they have been long dead. Most wealthy people who buy art for ridiculous prices didn’t get where they are because they were driven by the pursuit of money. Most of the time the money was made by hard work and a passion for something. Not all of the time. Somehow I think the royal family of Qatar never really had to “work” to get the $250 million for Cezanne’s painting. It just so happened that a huge amount of oil was right where they had decided to live. We should all be so lucky. For me, right now at 35,000 feet, I’ll have one more glass of Scotch, close my eyes and dream about the Princess of Qatar asking me to fix her veins. More importantly, she has no insurance and it’s all cash pay. These are the rewards of passion. Seek them, even if only in your dreams.