What would Charles Darwin say about collaborating with and training other specialties?

In the Darwinian sense, vascular surgeons are competing with IRs and ICs for scarce food and resources. The likelihood is that we will soon be competing with cardiac surgeons whose food source (patients needing open procedures) is going away.

Vascular surgeons have certain assets such as specialized training and a focus on noncardiac vascular disease, knowledge of its medical treatment and natural history, and the ability to do open vascular operations when needed.

However, these may not be enough to ensure our specialty’s survival, since the other specialties interested in the same patients and lesions as we do also have assets that may counteract their intrinsic liability of not being focused primarily on these patients or lesions.

So what about the often-heard recommendation that we collaborate with these other specialties interested in caring for vascular patients – that we cooperate and help them in their training and practice on their vascular disease patients? In an ideal Utopian world, we should do so, and all interested specialties should work together harmoniously as I suggested in 1996.

But here is what Charles Darwin, if he were alive today, would likely say about this. The real world is not such a Kumbaya place. Experience has shown over and over that human nature with its affinity for competition, tribalism, and self-interest works against Kumbaya. These traits, especially self-interest, which accounts for problems in our politics, our legal profession, and Wall Street, also causes problems for our specialty.

Darwin would also say that our patients, a target of opportunity for other specialties, are limited. So are the resources to take care of them optimally, like dollars, vascular laboratories, angiography suites, hybrid operating rooms, hospital beds, etc.

So regarding our relationship with other specialties interested in caring for vascular patients, especially cardiac surgery, Darwin would say: Vascular surgeons and cardiac surgeons are closely related specialties (species) that are competing for limited resources and space. Vascular surgery adapted more quickly than cardiac surgery to the endovascular revolution and will likely survive and prosper. However cardiac surgeons are aggressive and talented and have open skills.

They can learn endovascular techniques as we did. We should not train them and give away our current competitive advantage.

Vascular surgery must maintain and enhance its niche, possibly by increasing its recognition as a separate specialty. Lastly Darwin would say: Vascular surgery should never forget that it is in a struggle to survive. It should do everything it can to maintain and enhance its competitive edge.

Dr. Veith is professor of surgery at New York University Medical Center and the Cleveland Clinic. He is an associate medical editor for Vascular Specialist.

The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or publisher.