Profile The following information reflects responses from 46 vascular surgeons who completed the 2003 Pathway Physician's Survey.

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1 VASCULAR SURGERY Vascular surgery is a subspecialty within general surgery that addresses the diagnosis and treatment of diseases of the vascular tree, including arteries, veins, and lymphatic vessels, exclusive of those within the cranial cavity and the heart. The principle diseases treated involve those affecting the carotid arteries, the aorta, and those supplying the blood supply to the lower extremities, the kidneys, and the abdominal viscera. Common procedures performed include carotid endarterectomy, repair of abdominal aortic aneurysm, and revascularization of the lower extremities. Specialists in this discipline are also experts in performing and interpreting diagnostic studies including ultrasound and angiography. Currently the subspecialty emphasizes minimally invasive treatment, including endovascular treatment for abdominal aortic aneurysm and for relief of obstruction of blood flow to organs and tissues by means of angioplasty and deployment of intravascular stents.

2 Profile The following information reflects responses from 46 vascular surgeons who completed the 2003 Pathway Physician's Survey. A. Respondents by types of areas Rural 8.70% Large City 21.74% B. Respondents by gender Female 6.52% Small City 34.78% Metropolitan City 34.78% Male 93.48% C. Respondents by years in practice Number of Responses yrs 6-10 yrs yrs yrs yrs More than 30 yrs Perspectives A. Respondents' satisfaction with current specialty/area of work Number of Responses satisfied Somewhat satisfied Neither satisfied nor Somewhat

3 B. Would you choose this specialty again? Not Sure 17.39% No 4.35% Yes 78.26% C. Respondents by practice environment Number of Responses Academic instution Affiliated w/group Business/industry Hospital Community Acdemic med ctr Hospital other Managed care HMO IPA PPO Mgr care other Solo practitioner Practice other D. Respondents' satisfaction with practice environment 20 Number of Responses satisfied Somewhat satisfied Neither statisfied nor Somewhat

4 and of Critical Factors Critical Factors represent significant aspects of physicians experiences in their practices. The rating represents their assessment of their current practice characteristics, while the weighting represents the importance of each factor to physicians. A. Caring for patients: How much time do you spend directly seeing and caring for patients? 7.9 σ = 1.58 No time at all Most of my time σ = B. Continuity of care: How much continuity of care do you have with patients, (i.e., the length of patient relationships)? σ = Short Term Long Term σ = C. Autonomy: To what extent do you have the final word on the treatment of your patients? σ = limited autonomy Great deal of autonomy σ =

5 D. Diversity: How much routine (similar work) or diversity (different tasks/activities) is involved in your work? σ = Great deal of routine Great deal of diversity σ = E. Personal time: Does your work allow you to control the scheduling and amount of time you spend on personal activities, (i.e., family, leisure)? σ = little flexibility A great deal of flexibility σ = F. Expertise: How broad is the scope of your work? σ = Narrow expertise Broad Expertise σ =

6 G. Income satisfaction: Compared to all physicians, do you feel you are fairly compensated for the amount of time and effort you spend? σ = Highly satisfied σ = H. Creativity: To what extent does your work provide opportunity for creativity? σ = Little opportunity Great deal of opportunity σ = I. Certainty of outcomes: How much certainty of clinical outcomes does your work provide? σ = little, often "wait and see" A great deal, outcomes usually clear σ =

7 J. Clinical decision-making: On what basis are your clinical decisions made? σ = Application of theory to a situation Based on prior evidence of clinical outcomes σ = K. Patient decision-making: To what extent do your patients have input into decisions about their health care? σ = Little opportunity Great deal of opportunity σ = L. Interacting with other physicians/members of health-care team: To what extent does your work provide opportunities for you to interact with other physicians/ members of a health-care team? σ = little A great deal σ =

8 M. Manual/mechanical activities: How often do you use manual/mechanical activities for highly skilled tasks (i.e., following procedures, performing operations)? σ = Never Most of the time σ = N. Pressure: How much pressure do you have in your work (i.e., dealing with clinical crises, need for immediate decisions about patients, dealing with multiple patients simultaneously). σ = Minimal pressure High pressure σ = O. Responsibility: How much responsibility do you assume for patient outcomes in your work? σ = Limited responsibility Sole responsibility σ =

9 P. Schedule: What type of schedule do you have in your work? σ = Regular hours Irregular and unpredictable hours σ = Q. Security: How much professional security do you have in your position, (i.e., know where you stand and are certain of your future professionally, will there be a need for your services in the future)? σ = Little security Great deal of security σ = R. Sense of accomplishment: To what extent does your work provide the opportunity to see end results? σ = Little opportunity Great deal of opportunity σ =

10 Weekly distribution of time According to the survey, vascular surgeons spend their week as follows: Activity Patient care activities On-call(in contact) On-call(available) Administrative Professional travel Continuing education Community service Research Other professional Average Hours per week (may overlap) Patient profile A. Patient encounters per week Number of Patients Ambulatory Inpatient Nursing Home Telelphone Terminally Ill Other Encounters B. Patient characteristics By age Infants(0-2 yrs) Children(3-18 yrs) Adults(19-64 yrs) Older adults(65+ yrs) By race Underrepresented minority (URM) Non-URM % % By type of insurance % Medicaid/Medicare Uninsured Other Percentage of patient encounters that deal with: % Routine check-ups Acute illness Chronic illness Terminal illness 7.28 Percentage of time per patient encounter devoted to: Acute conditions Chronic conditions Preventitive health % C. Five types of illnesses/conditions most frequently encountered Number of responses Peripheral vascular disease 45 Abdominal aortic aneurysms 41 Carotid disease 33 Venous disease/insufficiency 40 Dialysis access 13

11 Specialty: Vascular Surgery Total survey responses: 46 Summary of comments for question: List up to three other factors, if any, you would advise students to consider carefully before selecting your specialty? Physicians who completed the Pathway Physician s Survey, 2003, submitted the following comments. The majority of comments are categorized by the Critical Factors that are rated and weighted in another section. Numbers in parentheses indicate the total number of responses for a particular comment. 1. Caring for Patients Dedication to patients 2. Continuity of Care Establish long-term relationship with patients 3. Autonomy Independence 4. Diversity Lots of variety Many new and exciting technological advances; dynamic field 5. Personal Time Lifestyle (2) Quality of life 6. Expertise broad range of diagnostic and therapeutic skills 7. Income Satisfaction Decreasing income (3) Medicare dependent for reimbursement (2) Indebtedness Income expectations (2) 8. Creativity 9. Certainty of Outcomes Can see outcomes well 10. Clinical Decision Making 11. Patient Decision Making 12. Interacting with Other Physicians/Members of Health-care Team

12 13. Manual /Mechanical Activities Technical dexterity 14. Pressure 15. Responsibility Responsibility for critically ill patients Responsible for life/death decisions 16. Schedule Schedule flexibility is less easy to achieve Willing to work long hours Long operations 17. Security Competition from other specialties Assess the likelihood of significant change in the specialty and whether or not you want to Evolve with the discipline Job security in the future (2) Fewer young surgeons 18. Sense of Accomplishment 19. Patient Characteristics What type of patient care do you enjoy? Many inpatients 20. Types of Illnesses Chronic illnesses 21. Practice Environment Variety of practice situations available today Rising malpractice costs (3) Beholden to Medicare In what type of environment would you choose to live? Medical liability problems are worsening at an alarming rate particularly for surgeons 22. Health Care Environment The political environment currently is not supportive of physicians in general and surgeons in particular Avoid managed care

13 23. Personality/Temperament Personality fit Attention to detail The ability to lead and assume responsibility Self confidence Commitment to exercise Tolerance of poor outcomes Willingness to deal with end-stage disease Sense of humor Ability to work long and hard Willingness of personal sacrifice Maturity Stamina/ fatigue tolerance/energy (3) 24. Miscellaneous Comments Ability to enjoy specialty for the long run (2) Commitment/time commitment (6) 7 or more years of residency is a lot No real medical equivalent specialty Student technology Changes in specialty are enormous (2) Location Interest Preference for O.R. Debt burden Make decisions based upon the specialty, not your teachers Board certification Rewarding Loss of volume to others Long and arduous duration of training (2) Satisfaction Family input Opportunities for research are superb Prestige Sick patients