Women in Phlebology Around the World

Helane Fronek, MD, FACS, FACPh, has been the true Pioneer Woman in phlebology here in the US. That’s not just my opinion, but the opinion of any and everyone who has had the opportunity to learn from this phenomenal woman. She’s a sort of big sister who is always working to advance her fellow female friends. And she has a lot of friends. She’s an exceptional caregiver and a selfless provider of support, education and advice — the combination of her skills makes her a superstar.

VEIN asked this superstar to help us understand what being a woman in phlebology means in 2013. She more than delivered with a composite snapshot of several leading female
phlebologists who work tirelessly to advance this specialty around the world.

Are men really from Mars and women from Venus? Stereotypical differences between the genders abound, but in phlebology we have seen a collaborative effort by both men and women who share a commitment to excellence in patient care and to the development of our specialty. This has resulted in the rapid advances in education, research, and therapeutic options in our field.

Medicine has historically been a male-dominated field. Although the first medical school in the United States opened in 1765, it was not until 80 years later that the first woman was admitted. Times have certainly changed since then, and the pace of change is increasing rapidly. In 2003, over half of medical school applicants and matriculants were women. While there are still more men than women practicing medicine, there are several fields in which women comprise large majorities: over 70% of current residents in pediatrics and OB-GYN are women. Since most patients with venous disease are women, phlebology is another field that might see a large number of women in its ranks in the future. These women will be happy to find that their trail has been blazed by an impressive group of women physicians from all medical specialties.

Recently, I spoke with these women about their decision to enter the field of phlebology, their own mentors, and how we might encourage young physicians to enter the field.

Dr. Felizitas Pannier

While a Resident in Dermatology at the University of Bonn, Dr. Felizitas Pannier became involved in the Bonn vein study with Professor Eberhard Rabe, who became an important mentor and instilled in her a great enthusiasm for phlebology. Felizitas was especially attracted to the field because it offered opportunities for both clinical and research activities. In fact, of her many accomplishments, she cites her papers on endovenous laser and sclerotherapy among her most significant contributions to the field. She finds the promising new treatments, including the new anticoagulants, to be great advances for her patients and is very enthusiastic about practicing in the field at this time due to the increasing therapeutic options.

Currently, Felizitas provides patient care in a private phlebology practice, as well as in the Department of Dermatology at the University of Köln. As one of only 279 women in the German Society of Phlebology (23.3% of its members are women), she is especially passionate about developing a research program to study the effects of venous disease in women and children. Felizitas is also committed to encouraging more young physicians to enter the field and enjoys sharing her enthusiasm for the field with students and physicians at all levels. To do this, she has been involved in the new Fellowship educational program of the German Society of Phlebology and was pleased that 20 physicians attended the two-day sclerotherapy course, which will be offered twice per year. She also promotes phlebology by presenting talks at the University of Köln, in Bonn, and in Maastrict, where she previously worked as an attending physician, and serves as the Vice President of the UIP.

Dr. Mary-Paula Colgan

Dr. Mary-Paula Colgan, the only female phlebologist in Ireland, “just fell into” the field of phlebology. An acquaintance had done a Vascular Surgery Fellowship with Dr. David Sumner in Springfield, IL, and encouraged Mary- Paula to apply. While the three-year program focused only on research and ultrasound diagnosis, Dr. Sumner became an important mentor for her and, over 20 years later, she remains “delighted with her choice” to practice in the field of phlebology. After the fellowship she returned to Ireland to run the veins unit and vascular lab at Trinity College in Dublin at St. James Hospital. Thus began her passion for leg ulcers. Mary-Paula believes that this group of patients remains under-served because ulcers are “unglamorous,” although there is so much that can be done to heal them.

In addition to her clinical work in Dublin, she is involved in research at the University of Milan and is working there with the group, VAS, to have angiology recognized throughout Europe. This is her biggest frustration, as the lack of recognition interferes with young physicians choosing phlebology for their career. Since there are so few phlebologists in Ireland, there are no training programs in the country. This deprives physicians who might be interested in obtaining education and certification that would support their phlebology practice in the country. She regrets that the ABPh (now the ABVLM) Diplomate designation is only available to those who have trained in the US or Canada. To satisfy her desire to promote education in the field, Mary-Paula participates in a Vascular Medicine training program at the University of Milan and presents talks on venous disease and venous ulcers throughout the country. She realizes that since phlebology is not a recognized field in Ireland, it is unlikely that a young phlebologist will find a government-recognized post. For this reason, she plans to “keep chipping away” at both the medical community and government in order to promote the recognition of phlebology as a medical specialty.

Terri Morrison, RN

Terri Morrison, RN, was initially approached along with her husband, Dr. Nick Morrison, by Dr. Charles Rogers, who suggested that they get involved in phlebology. Originally, Terri’s expertise focused on marketing and building a thriving phlebology practice in the Phoenix area, but she quickly became an expert on compression and cosmetic sclerotherapy. Now the ACP’s representative to the International Compression Club, Terri is a strong proponent of the use of compression and is always enthusiastic about the latest compression offering.

A regular attendee of national and international meetings, her early mentors were Joe Zygmunt, RVT, and Tracie Dauplaise, RVT, who were involved with me in the educational programs for allied health members of the ACP. Understanding that each member of the healthcare team contributes differently and thus has different educational needs, Terri was instrumental in developing a specific section of the ACP dedicated to developing the skills and elevating the knowledge base of its nursing members. A passionate educator, she has lectured on various topics, presented compression workshops, and continues to teach nurses in her practice at home. As a strong advocate for both the nursing community and phlebology, Terri finds it frustrating that there are so few avenues to reach nurses with information about venous disorders and available treatments. Terri is also very dedicated to the medical volunteer work she, Nick, and an international group of phlebologists perform each year in South America for Amigos de Salud, a charity that the Morrisons founded approximately 20 years ago.

Dr. Lisa Pavone

Originally a family physician, Dr. Lisa Pavone was introduced to Dr. Jack Pfeifer, a vascular surgeon and director of the University of Michigan Livonia Vein Center, and thus to phlebology, by her friend and colleague, Emily Cummings, MD. Lisa fondly remembers Dr. Pfeifer’s charisma and skill as a physician and appreciates Dr. Wakefield’s continued support of her role as a phlebologist at the University of Michigan. Lisa initially found that she enjoyed being a specialist and having a practice that included office procedures, but it is the relationships with her patients, who report they are incredibly appreciative of the care they receive, and the excitement of rapidly changing technology that keeps her interested in the field.

As part of the section of vascular surgery, Lisa sees patients in an outpatient setting at the University of Michigan, where she teaches vascular surgery and interventional radiology residents and fellows. She feels fortunate that the trainees she interacts with appreciate the exposure to the field of venous diseases and are interested in gaining the knowledge and experience of managing venous patients in an outpatient setting. She enjoys conveying her personal satisfaction with the field in an attempt to encourage other young physicians to consider treating this patient population.

The quintessential communicator, Lisa has contributed to phlebology as editor of the ACP’s online magazine VeinLine, and as a member of the ACP Board of Directors. In her local region, Lisa has served as a medical expert for media presentations. While she hopes that her greatest contribution is yet to come, as a member of the Board of Directors of the American Board of Venous and Lymphatic Medicine, Lisa hopes to further its mission of “setting educational standards for training in the field and to uphold the highest standards of knowledge and care.”

Dr. Pauline Raymond-Martimbeau

Dr. Pauline Raymond-Martimbeau was slated to do a fellowship in colposcopy and entered the field of phlebology when her fellowship director passed away. At that time, in the mid 1970s, ultrasound diagnosis and imaging did not exist and she felt fortunate to study with Drs. Raymond Tournay, Pierre Wallois, Jean Hardillier, Pierre Caille and Louis Vergoz—French physicians who had mastered the art of the clinical exam. Because of the blind nature of treatment and the lack of quality data on the effect of sclerotherapy, Pauline felt significant trepidation about the potential of this treatment to sclerose deep veins or cause pulmonary embolism. Drs. Gilles Cloutier and Helene Sansoucy helped her overcome these fears and together, they developed protocols for sclerotherapy of the great saphenous vein that used 6% iodinated iodine and 5% sodium tetradecyl sulfate. She found the variability of venous patterns intriguing and felt that phlebology represented “that unique mix of hands-on practical application combined to sound physiological principles, supported by a continually evolving evidence base.”

Pauline was clearly a trailblazer and her high level of energy allowed her to be “innovative and creative” throughout her decades in the field. She has treated thousands of patients with cutting edge treatments and dedication to excellence, and feels that the satisfaction of her patients has kept her going, along with her dedicated and loyal staff who has been with her for 29 years. However, her passion has always been to help others succeed. While she has created hands-on training sessions, mentored physicians, and presented numerous talks, Pauline is most proud of the fellowship program that the Canadian Society of Phlebology started a few years ago. Based on the UIP core curriculum, the program has allowed both new and established phlebologists to “get better training and share experience with colleagues” and has elevated the quality of phlebology practice in Canada, where 38% of phlebologists are women. She believes that implementation of a core curriculum in medical schools will be the best way to promote the field of phlebology.

Diana Neuhardt, RVT, RP hS, MBA

Diana Neuhardt, RVT, RP hS, MBA, entered the field of phlebology with a different perspective — that of a patient. Diagnosed with a DVT while a college student, Diana was frustrated that so little could be done. For this reason, she is a strong patient advocate and believes that an important part of her work as a venous sonographer is to help patients understand their condition. Her initial plan was to become a pathologist, as she likes the puzzle of medical diagnosis, and she has put this same love of exploration to great use in the both ultrasound, which she also sees as a puzzle, and in the field of phlebology. She feels fortunate to have had “the best mentors in the field” – Wolfgang Dahnert, a radiologist from Europe, and the vascular surgeon Max Johnson, who never discouraged any of her questions.

Inquisitive by nature, Diana has enjoyed being part of a “new frontier” and has reveled in exploring the areas of venous disease that weren’t previously understood. The potential each day to “learn what we don’t know” keeps her interested in the field, in addition to her commitment to help patients in ways that she wishes she could have been helped. However, she feels that her greatest contribution has been to teach ultrasound skills to both sonographers and practitioners, skills that have become increasingly crucial to both diagnosis and treatment in the field. She finds it easy to encourage young sonographers to enter the field simply by sharing the fun that she has each day, knowing that no two patients are the same. Diana also appreciates the multi-disciplinary aspect of phlebology and the sharing of knowledge among colleagues from a variety of backgrounds and has enjoyed the international nature of the field. In her role as Chair of the Public Education committee of the ACP, Diana spearheaded several important projects to increase awareness of vein disease among the public, including the PBS Special, Vein Health: Discoveries, New Technologies and Breakthroughs and the public educational book, Healthy Veins, Healthy Legs.

Stephanie Dentoni, MD

Stephanie Dentoni, MD, completed the Vascular Medicine Fellowship at the Cleveland Clinic, where she first encountered the procedure of sclerotherapy. However, it was the new technology of endovenous thermal ablation that caught her interest and inspired her to attend the 2003 UIP meeting in San Diego to learn more about these outpatient procedures that would allow her to help patients with a minimum of discomfort and downtime. It was there that she met Diana Neuhardt, RVT, RPhS and Nick Morrison, MD, FACS, FACPh, who helped her transition her practice to serve more phlebology patients. Since that time, Dr. Morrison has continued to mentor and encourage her and has been a “gold mine of knowledge and professionalism.”

Stephanie appreciates the variety of patients in her practice — from the more complicated vascular medicine and thrombophilia patients to the more straightforward superficial disease patients, and she enjoys the long-term relationships she develops with her patients, whose disease process is chronic and who seek her help over many years. She also believes that phlebology requires a certain finesse—many patients present with vague symptoms that require excellent listening skills and a consideration of other factors in the patient’s life in order to obtain the best clinical outcomes. This is another aspect of her practice that Stephanie feels brings a sense of challenge and satisfaction to her work. She is concerned about developing the new generation of phlebologists and stresses that we need to begin introducing people to the field even before they begin medical training. By educating the public, Stephanie asserts, we will enhance the appreciation of and interest in our field. Personally, Stephanie takes advantage of the fact that Stockton, CA, is a small community in which people know each other well. She uses her connections with other families to invite high school students interested in careers in medicine to her office, where she introduces them to the joys of a practice in phlebology.

Phlebology is fortunate to have attracted the talents of these dynamic and accomplished women, each of whom has come to the field with a different background and perspective and has made significant contributions to its rapid development. A common denominator in keeping them interested in the field has been the intrigue that phlebology provides—each patient presents a unique puzzle to be solved and there is still much to be learned in this new frontier. While the excitement of including research in her practice, the appreciation of venous patients, or the relationships with colleagues from around the world may appeal differently to each woman, each of them derives considerable satisfaction from practicing in a field that is continually changing and that provides new and more effective care for a large group of previously underserved patients.

Although the current percentage of women practicing in phlebology is still lower than that of some other specialties that care primarily for female patients, we can look forward to increasing numbers of women entering the field as these role models and mentors look to encourage more young physicians to join our ranks.