Different Endovascular Referral Patterns Are Being Learned In Medical and Surgical Residency Training Programs

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Bart E. Muhs, MD, Thomas Maldonado, MD, Chaminda Jayanetti, MD, Mark A. Adelman, MD, Glenn R. Jacobowitz, MD, Caron Rockman, MD, Patrick J. Lamparello, MD, Paul J. Gagne, MD.
New York University School of Medicine, New York, NY, USA.

Background: Physicians in residency training will be the future referring physicians of tomorrow. We sought to determine the current surgical and medical trainees’ perception of vascular surgery’s endovascular qualifications. Methods: An anonymous survey was sent to all surgery and medicine residents at a single academic institution. Respondents answered the questions “Which specialty is the most qualified to perform IVC filter insertion, angiograms, angioplasty, and stenting of the carotid arteries, renal arteries, aorta, and lower extremity arteries.” For each question, respondents were asked to select either vascular surgery, interventional radiology, interventional cardiology, or don’t know. Results: 100 residents completed the survey (surgery, n=50; medicine, n=50). There was a significant difference between surgery and medicine residents when choosing the most qualified endovascular specialty (p<0.05). Surgery residents chose vascular surgery as the most qualified specialty for all listed procedures carotid (80%, n=40), IVC (56%, n=28), aorta (100%, n=50), extremity (86%, n=43), renal (78%, n=39). Medicine residents chose vascular surgery as the most qualified specialty less frequently; carotid (66%, n=33), IVC (6%, n=3), aorta (88%, n=44), extremity (72%, n=36), renal (16%, n=8). There was no significant difference in specialty selection based on PGY year. Conclusions: There is a large discrepancy between surgical and medical trainees’ perception of vascular surgery, particularly regarding IVC and renal artery interventions. If our own institution mirrors the nation, each passing year a significant portion of the 21,722 graduating internal medicine residents going into practice viewing vascular surgeons as second tier endovascular providers. A concerted campaign should be undertaken to educate medical residents regarding the skills and capabilities of vascular surgeons.