Phlebology for the Masses

Newly appointed ACP President Robert J. Min, MD, MBA, Aims to Increase Vein Disease Education, Awareness

The American College of Phlebology (ACP) is a non-profit educational organization that is dedicated to research and education about venous disease and up-to-date methods of diagnosis and treatments. The ACP was originally founded in 1985 as the North American Society of Phlebology by Dr. Anton Butie. The purpose of the College was to bring together physicians and surgeons from diverse specialties who share an interest in the diagnosis and treatment of peripheral venous disease. ACP Executive Director Bruce A. Sanders said, “It provides a forum for physicians and other health professionals to exchange medical knowledge and techniques related to the treatment of venous disorders and improve the standards of medical practitioners and the quality of patient care.”

Newly-appointed ACP President Robert J. Min is continuing that mission by devoting much of his time to studying the diagnosis and treatment of vein disease. He has pioneered the development of minimally invasive treatment alternatives such as Transcatheter Duplex-Guided Sclerotherapy and more recently developed the technique of Endovenous Laser treatment of varicose veins. In addition to serving as acting chairman Department of Radiology at New York Presbyterian—Cornell, Dr. Min is an assistant professor of Radiology at Weill Medical College of Cornell University, and an attending physician in Cardiovascular Interventional Radiology at New York Presbyterian Hospital. Previously, Dr. Min earned his medical degree from Weill Medical College of Cornell University before completing an internship in surgery and a residency in diagnostic radiology at New York Presbyterian Hospital-Cornell, where he served as Chief Resident. Dr. Min received additional subspecialty fellowship training in Cardiovascular Interventional Radiology at Stanford University Medical Center. Recently, Dr. Min discussed his new role at ACP with Vein Magazine Editor Claudia Schou.

Congrats on your new appointment as president of American College of Phlebology! Have you always seen yourself in this role?

Not necessarily. Although I’ve been involved in ACP for several years, including serving as faculty and on the Board of Directors, I never planned on becoming President of the society. But, because of a variety of unforeseen circumstances, the position became available and I was encouraged to consider taking the position, especially in light of all of the important initiatives the ACP is undertaking.

What types of trends are you seeing in vein treatments?

Doctors are becoming more interested in venous disease and patients are increasingly seeking treatments. Duplex ultrasound has given us a better understanding of venous disease and new treatments like endovenous laser and radiofrequency ablation, have been developed that deliver better results more safely and less invasively. It’s exciting to have contributed to the improvements in the care that we can now deliver. As people become more aware of these treatments—patients seeking physicians and physicians seeking to provide—it becomes increasingly important for a society such as the ACP to play a role in ensuring that these treatments are delivered in the best manner possible. The ACP has a long history as a multi-disciplinary society composed of both physicians and non-physician providers working together to advance our understanding and treatment of venous disease. For several years, the ACP has organized and provided scientific meetings to provide instruction to the many physicians who are interested in venous disease and these meetings have grown substantially in size and scope over the past couple of decades, particularly over the past five years. Membership in the ACP has grown at the same pace. Currently, we have more than 1,600 members in the ACP, and that has increased at a rate of 10 percent to 15 percent per year. We anticipate there will be more than 2,000 members very soon, largely because of the trends I described but also because of the new and exciting things that the ACP has been involved in.

Last year the ACP was successful in obtaining self-designated specialty recognition within the American Medical Association for phlebology, as well as raising in excess of $4 million for the ACP Foundation in its inaugural year. The foundation was created to support and promote education and research within phlebology. In particular we’ve been able to design and start a Phlebology Fellowship Program that will allow physicians to apply for and potentially get accepted to a phlebology fellowship that will be focused on learning about all aspects of venous disease. It is the first time that such a fellowship program has ever been established. There have been a variety of leaders within the ACP who have helped develop the program and that committee has been led by Dr. Tri Nguyen. Equally exciting has been the tremendous amount of progress in making Phlebology Board Certification a reality through the efforts of both ACP headquarters staff and the board certification committee chaired by Dr. Steven Zimmet. A curriculum has been developed, phlebology board certification requirements established, and we’ve made significant progress in developing a board certification examination in phlebology. It’s anticipated that the first board certification examination in phlebology may be delivered some time in 2008.

What plans do you have for the ACP?

I think that the ACP has already made important contributions by taking a leadership role as a medical society in assuring that physicians are properly trained to deliver the best care to the increasingly large number of people who are now seeking treatment for their vein related problems. What I’d like to accomplish during the remainder of this year and next year as the president of the ACP is to ensure that many of these efforts that I’ve described continue to move forward. The programs that I’ve talked about are largely focused on physicians and physician education. The ACP is also going to have to reach out to the public and make people aware of what phlebology is, including all the great potential treatments that are now available to help their condition and how to locate the best providers of the care they’re seeking.

What types of the challenges do you see?

One challenge is educating people, both the lay public and medical community, on what exactly is “phlebology.” Unfortunately, most people still are not aware that there is a medical specialty focused on venous disease. Another challenge is assuring that the medical services provided by phlebologists is appropriately reimbursed by insurance carriers, when medically appropriate. This will clearly benefit the providers but also the many people who are seeking care but don’t have the financial means to pay out of pocket. There is a misconception that venous disease including varicose veins are a purely cosmetic issue-when in fact they’re quite often associated with significant leg symptoms and can progress to cause more disabling venous disease-related complications. Much of the data that third-party payers are using to make their payment decisions is outdated. The ACP and other medical societies involved in venous disease could and should take a leadership role in providing such payers with both consensus documents and literature from scientific studies demonstrating both the safety and the efficacy of the modern treatments available. The ACP has committees currently working on this effort.

What are your thoughts on vein treatments at Medi Spas?

Because we can do a lot more for patients suffering from venous disease in terms of more accurate diagnosis and treatments, we are definitely seeing more patients seeking care and more physicians wanting to treat veins. This may be as part of their existing practice or in some cases the sole component of their practice. We’re also seeing in healthcare, decreasing reimbursements for the services physicians provide at the same time that the cost of providing these services is increasing. In many cases, this combination has forced physicians to seek new areas of revenue such as offering cosmetic procedures which typically are paid for “out of pocket” by patients. We’ve seen many physicians, not just dermatologists or plastic surgeons, getting involved in medi spas which provide a variety of cosmetic related procedures including the treatment of veins. Getting more physicians involved in the delivery and treatment of veins and thereby increasing access to potential patients could be a good thing but only if there is a way to ensure that those providing these treatments are properly educated and trained. I believe that the ACP, and in particular many of the exciting programs being developed and supported by the ACP, will lead this effort.