The Advanced Venous Career

By Thomas Wakefield, MD - AVF Past President

I have been asked to write about opportunities that present themselves to academic venous surgeons as they become more senior in their career.  Many of these opportunities, for me, relate to the fact that I have focused my clinical practice to a specific area, venous disease, and that practice has grown and matured.   I have also had the great opportunity to have had both a clinical and research focus in a specific area, venous thrombosis and venous thrombogensis and I have had important mentors in these areas. In my top ten list of what it takes to be happy as a surgeon scientist, number one and two relate to this topic:

1.  Find an area that you are passionate about and a Mentor.

2.  Focus on that area and keep it in your sights.

Approximately 10 years ago, I became head of Vascular Surgery at the University of Michigan and have led a wonderful group of surgeons.  I have some of the best partners in Vascular Surgery in the country, and we have a special group and a great staff. We also have outstanding  support from the Department of Surgery at Michigan.  As part of that responsibility, I have had the ability to be involved in many strategic planning activities and to be part of mentoring of junior faculty, faculty from other disciplines, students (undergraduate, graduate and medical), and trainees (residents and fellows).  As part of that mentoring, schorlarship and writing are very important.  My third and fourth items in my top ten list to be a happy surgeon scientist includes:

3.  Learn to Write and Enjoy Writing.

4.  Read widely in your area, especially from disciplines outside your own.

            At Michigan, we have both a long-standing successful Vascular Surgery Fellowship program and we have one of the first Vascular Surgery Residency programs.   As part of my responsibilities, I have also served on many important search committees and one learns a great amount about leadership while serving on these committees to choose new leaders. Just one year ago, I was honored to be asked to serve as one of the Directors of the University of Michigan Samuel and Jean Frankel Cardiovascular Center.  This appointment has provided me with the opportunity to think and act on a much larger scale, taking into consideration all of the specialties that deal with cardiovascular diseases and to take a much more global approach to medical and surgical care.  Michigan is a unique place, and the Cardiovascular Center at the University of Michigan Medical Center leads the way with values of:  Respect and Compassion: We honor and care for one another as individuals; Collaboration: We honor the synergy of team, built on trust; Innovation: We honor individual and collective creativity; Commitment to Excellence: We honor the intrinsic desire to be “Leaders and Best”.  We live these values daily.  Regarding my top ten list, these three items are important to my role as a leader in the Cardiovascular Center:

5.  Keep an open mind, but stay skeptical about easy and quick answers to problems.

6.  Understand that there will be as many failures are successes, and that you learn as much or more from your failures.

7.  Appreciate that advances mostly come in little steps – the huge ah-ha moments are few and far between.

      On a regional level, I served on the Council and then became the President of the Michigan Vascular Society.  I am past president of our Michigan surgical alumni society, the Frederick A Coller Surgical Society and I am currently President of the Alumni Association of my college and medical school alma mater, the University of Toledo.  On a national level, I was involved for over 11 years in the leadership of our most important venous organization, the American Venous Forum, first on the Council, then as Secretary, President-elect, President, Past-President, and then on the American Venous Forum Foundation.  I have also served our national vascular surgery organization, the Society for Vascular Surgery and most recently I was a member of the Society for Vascular Surgery Guidelines Committee.   All of these positions have allowed me to grow in many aspects of leadership and team building, and have provided new friendships and collaborations.  Specifically with the American Venous Forum, I have also been involved with the formulation of specific practice guidelines regarding venous ulcers and varicose veins.  It is not until one is in a position of responsibility that the intricies and importance of organizations, such as the American Venous Forum, becomes truly apparent.  Additionally, the importance of venous awareness in the country is shown by the growth in size and importance and the emphasis on venous topics at the yearly Veith symposium.   Just a few years ago, there might be one 2 to 3 hour session about veins for the entire Veith meeting. Last year, we had three entire days of the five day meeting devoted to venous topics and we expect a similar emphasis this year.  I have been fortunate to be part of the organization of this meeting.   

Another area of involvement of a senior academic surgeon is on editorial boards of major journals and as an expert reviewer in topics of one’s expertise.  For me, this has meant positions on many important journals such as the Journal of Vascular Surgery (Venous and Lymphatic), Annals of Vascular Surgery, Surgery, European Journal of Vascular And Endovascular Surgery, Thrombosis Research, to name a few. Peer review is an extremely important part of the advancement of science and it is an area we need to support and mentor our junior colleagues to continue to support.  Number eight in my top ten list:

8.  Participate in peer-review, a process which is not perfect but important.

As a senior surgical scientist, I also have had the opportunity to be involved with NIH study sections, special emphasis panels, and even part of the Surgeon General’s Call to Action against Venous Disease in 2008.  I have led an NIH T32 program in Vascular Biology at the University of Michigan now for over 10 years (co-PI for the current 5 year cycle) and my laboratory has been funded for approximately 20 years from NIH.  These interactions with NIH are critically important as surgeon scientists are very important to the advancement of knowledge.  As clinicians, we see the problems that need to be solved and we bring this knowledge to the field.  We cannot allow the surgeon scientist to become irrelevant in biomedical research of the future.  As funding becomes more competitive and the funds available are more limited, surgeon scientists must still be encouraged to compete and succeed for funding if our fields are to advance.  It is only through good research, both basic/translational and outcomes, that we will grow and continue to mature as vascular surgeons (both venous and arterial) and vascular biologists. There are also many other great research organizations and meetings to participate in, such the programs with the American Heart Association (such as Atherosclerosis, Thrombosis and Vascular Biology), American Society of Hematology, Society for Interventional Radiology, etc.  Number nine in my top ten list reflects this truth:

9.  Understand and practice the scientific method.

      So I believe you can see that as a senior vascular surgeon focusing on venous disease, there are multiple opportunities that present themselves.  I have been very fortunate in my career, and if my experience can serve as a stimulus to others to see and seize the opportunities that present themselves, then I have been successful in this short paper.  For my final item in my top ten list of what it takes to be a happy surgeon scientist:

10.  Have fun and remember that every day is a gift and every day counts.

   Thank you for the opportunity to share my experience.  Life as an academic vascular surgeon with an emphasis on venous disease has been very fulfilling, and I highly recommend it to others.

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