Presidential address: SVS and AAVS united☆

Article Outline

• History
• Division of responsibilities
• Review of governance and management
• Management committee
• Foundation merger committee
• Society merger committee
• Society merger proposal
• Rationale for society merger
• Addendum
• References
• Copyright

I am very grateful for the opportunity to have served as President of the Society for Vascular Surgery (SVS) this year. I have been fortunate to be on the SVS Council for the past 7 years, and I was privileged this year to work with Dr Thomas M. Riles, President of the American Association for Vascular Surgery (AAVS), who has served on that Council for the past 6 years. This has given us a useful perspective about the governance and function of our societies. Perhaps it was fated that we were charged by the Joint Council last year to evaluate our governance and management. As a result, hundreds of work hours were dedicated to this task by many members of the societies, and I would like to acknowledge all of the individuals who directly contributed to this process (Table). The result of their effort is the historic recommendation that the SVS and AAVS merge to form a single Vascular Society. To respond to this recommendation, we must understand certain details about our history, our current governance, and the process that led to this conclusion.

Table. Council and Committee members who participated in the Society review and planning process, 2002-2003

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History 

Our societies have a proud history since their founding more than 50 years ago.1 The SVS was founded in 1946 by 31 pioneers of what was then cardiovascular surgery. The first annual meeting was held in 1947 in conjunction with the annual meeting of the American Medical Association (AMA), which was always held in early June. Five years later a group of cardiovascular surgeons from several countries founded the International Society of Angiology, with three international chapters. The North American Chapter (NA-ICVS), which included nearly all of the SVS members, held its first annual meeting in 1952, and changed its name to the International Cardiovascular Society (ICVS) in 1957. For the next 15 years these two societies technically met separately, but always on adjacent days, at the annual meeting of the AMA. By 1966 it was clear that the two societies had a common purpose, with so much overlap of membership that a merger was considered.1 This did not occur, but the program committees were combined to develop a joint annual meeting, which began in 1967. Five years later, to improve communication between the societies' leadership, the President and Secretary of the NA-ICVS were made ex officio members of the SVS Council. By 1975 the societies had so much in common that a Joint Council of their officers was established to manage their mutual affairs. Joint registration was established for the annual meetings, and in 1977 Mr William Maloney and his firm, Professional Relations and Research Institute (PRRI), were hired to manage the business affairs of both societies. In 1981 the ICVS changed its name to the International Society for Cardiovascular Surgery (ISCVS), and in 1984 the SVS and the North American Chapter of the ISCVS (NA-ISCVS) jointly founded the Journal of Vascular Surgery. In 1986 the SVS established the Lifeline Foundation to begin charitable fundraising for vascular research, which was joined by the NA-ISCVS in 1994. In 1988 the SVS established the Crawford Critical Issues Forum to discuss the many emerging nonscientific issues affecting vascular surgery, which was soon expanded to involve members of the NA-ISCVS. In 1996 the leaders of both societies founded the American Board of Vascular Surgery (ABVS). In 2001 the NA-ISCVS changed its name to the American Association for Vascular Surgery (AAVS), and expanded its governing council to include representatives of regional and other national vascular societies.2 That same year the AAVS established both the Vascular Web and the AVA, and was joined in these efforts by the SVS.

From this brief recounting of history, it is clear that the SVS and AAVS have functioned as a single entity representing vascular surgery for many years. There have been joint annual meetings for the past 36 years, and for most members this is the most visible part of our societies. In considering the recommendation for formal merger, however, it is also important to understand some details of our governance structure. Since 1975 the Joint Council has coordinated the shared business of the two societies. Initially this business was simply the annual meeting, and the Joint Council included the combined 15 officers of both societies. Over the ensuing years the Joint Council expanded substantially as society activities became more complex, and new committees and representatives were added to the agenda. At the same time, the separate agendas of the individual councils shrunk proportionately, because they included only the business activities unique to each society. Thus, by the year 2000 the individual society council meetings lasted only 1 hour, but were followed by a 7-hour Joint Council meeting involving 45 persons, where all the important business of the societies was conducted.3 Of note, the Joint Council was never incorporated as a legal entity, does not have bylaws, and has no legal or membership authority to take action. As a result, it has made decisions only if a consensus of both societies' officers was achieved.

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Division of responsibilities 

Over time, there was growing frustration with the length and complexity of the Joint Council meetings, and the inefficiency of many informational reports compared with only a small number of action items. This inefficiency was variously attributed to the large size of the council, lack of an efficient business model for decision making, or overlap of responsibilities of the dual officers from two societies. Certainly the leadership challenges had become more complex, with success often dependent on the business skills and personal interaction of the two presidents. Because of these issues, a retreat of both councils was held in New Orleans in June 2000, to consider the governance structure of the societies. At this retreat 30 leaders of vascular surgery spent 2 days discussing methods to eliminate redundancy and streamline the responsibilities of the two societies and the Joint Council.4 Three basic options were considered: first, specific division of responsibilities between the societies; second, a merger to form a single society; and third, formation of a separate federation to represent all major vascular societies in North America. Ultimately, one third of the group favored merger of the societies, and two thirds favored division of responsibilities between two independent societies. In part this represented the political conclusion that “a single national society representing all of vascular surgery was not a viable alternative at the present time.”5 As a result, it was decided to divide the responsibilities between the societies so that the SVS would supervise activities primarily affecting academic surgeons and the AAVS would supervise activities primarily affecting surgeons in practice. As it turned out, activities designated for the SVS had largely been delegated to other organizations, namely, research to the Lifeline Foundation, Board certification to the ABVS and the American Board of Surgery (ABS), and fellowship training to the Association of Program Directors in Vascular Surgery. In contrast, the AAVS took on the major responsibilities of the previous Joint Council, namely, government relations, reimbursement, public education, the Vascular Web, and interaction with other vascular societies. While acknowledging that “any division of responsibilities would be extremely difficult inasmuch as neither Society wished to abrogate its role in certain activities to the other society,”4 the councils voted to try this method.

At that time it was also necessary to restructure the Joint Council. The SVS Council had been expanded by five members, to include representatives from the Association of Program Directors in Vascular Surgery (APDVS), ABVS, ABS, and the Lifeline Foundation. The AAVS Council had been expanded by 10 members, to include representatives from other vascular societies. Thus a true “Joint” Council would consist of 32 members, not including committee chairs and representatives, which was considered too large for efficient function. Because major responsibilities had now been assigned to the individual society councils, it was decided that the Joint Council should consist of a small group of the six elected officers from each society, whose function would be to try to resolve any differences that arose between the individual society councils.3 The Joint Council would also be responsible for allocating the great majority of net income that is derived from the annual meeting and the Journal, and is divided equally between the two societies (Fig 1). Traditionally, programs such as Government Relations with large budgets that required joint funding had been discussed at the Joint Council meeting, where funding decisions were made. Under the new division of responsibilities, discussions concerning Government Relations, the Vascular Web, and the AVA, which comprised 66% of program funding last year, were now confined to the AAVS Council. Common functions absorbed 24% of the funds, whereas the SVS supervised only 10% of program funding (Fig 2). As a result, SVS members of the Joint Council felt uninformed about many of the new initiatives that required joint funding decisions. After a year's experience with the new system, the SVS Council concluded that “the operating agreement, reached 2 years ago in New Orleans, appears to have overreacted to perceived problems with efficiency and organizational design and thereby left the individual councils too independent and placed too little authority with the Joint Council.”6 By June 2002 there were multiple perspectives about how to best achieve efficient governance and financial decision-making between the two societies, but no consensus had emerged. Accordingly, the Joint Council charged its current presidents to investigate the management and governance of the societies and to develop specific proposals to address these concerns. Thus began the year-long process that I would like to describe to you today.

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• Fig 1. 

  Source of combined income, minus direct expenses, for SVS-AAVS, fiscal year 2002.

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• Fig 2. 

  Program funding by SVS-AAVS, fiscal year 2002.

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Review of governance and management 

Our first step was to identify an external consultant to conduct a thorough assessment of the current operations, management, and leadership of the societies. We selected Mr Thomas Nelson, an experienced health care association manager with 35 years' experience in both a management firm and as an independent executive director. He interviewed vascular surgery leaders, conducted an on-site review of PRRI management, and presented his report to the Joint Council in October 2002.7 His conclusions were sanguine, but at the same time challenging. First, he concluded that our governance structure was based on a loose web of committees and councils, often with lack of continuity among the leadership from year to year, and, more important, with no strategic plan. He noted dysfunctional council meetings filled with informational reports about the current environment, but lacking action items to address these critical issues. He found a strong financial base for the societies, but noted that nearly all income was derived from the annual meeting and the Journal of Vascular Surgery. He was concerned that the societies did not have a business plan to diversify this financial portfolio. Perhaps most important, he urged our societies to identify the key roles and responsibilities for our various organizational entities and to develop a sound business plan to achieve effective outcomes. He made the following key recommendations. First, maintain a focus by identifying the key priorities for vascular surgery, and stay with this work plan on a continuing basis. Second, make planning a central part of every council meeting, and evaluate programs continuously to ensure their success and focus. Third, delineate clear roles and responsibilities for the society leadership and management staff, and maintain continuity of direction as leadership changes. Fourth, identify and articulate a clear vision for the future of vascular surgery, and create an efficient and effective structure to exceed these expectations. Finally, Mr Nelson concluded that we need a paradigm shift to move to a business model of decision packages and prioritization of programs and resources, with more continuity than the annual term of each president. He suggested that we could substantially grow our business with increased diversity in our educational offerings, such as self-assessment tools, Board review courses, practice management courses, new technology training, and a practice-oriented journal.

Perhaps most important, our consultant challenged the society leadership to think outside the box and to articulate a vision for vascular surgery for the next 10 years. In response to this challenge, the Joint Council met in November 2002, and voted unanimously to consider a move to independent management in a centrally located national headquarters, and an even bolder move of merging our two societies and our two foundations. To pursue this vision, three committees were appointed to develop specific proposals in these areas for presentation to a joint meeting of both society councils. I would like to describe the results of this effort and the actions taken by the councils that have brought us to the historic question that we face today.

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Management committee 

The Society Management Committee consisted of Drs G. Patrick Clagett, Jack Cronenwett (Chair), Peter Gloviczki, Lazar Greenfield, Joseph Mills, Thomas O'Donnell, Gregorio Sicard, and Rodney White. This committee reviewed Tom Nelson's report, and retained Dr Kathleen Henrichs, an experienced management consultant who worked with the Society for Thoracic Surgery during their transition to independent management. The committee recognized the hard work and dedicated efforts of Messrs William Maloney and David Cloud, and the PRRI group over the past 27 years in managing our societies, which provided an incentive to continue this relationship. However, the committee also saw many advantages of independent management, primarily the complete focus of an executive director and staff on vascular surgery issues, rather than sharing this team with multiple clients, some of whom might even have diverging agendas. Discussions with Dr Thomas Russell, Executive Director of the American College of Surgeons (ACS), indicated the desire of the ACS to partner with other surgical organizations, and the potential to lease office space within the ACS building. The Management Committee became convinced that the benefits of a dedicated, full-time executive director with a national vascular headquarters should be pursued. Chicago was selected as an ideal city for such offices, because of its central geographic location and the many other medical societies headquartered there. A feasibility study was then performed by our consultant, and discussions were held with leaders of the Society for Thoracic Surgery to gain insight from their move to Chicago last year.

A proposal for independent management was developed, which included the hiring of an executive director and three staff members for a Chicago office, with continued outsourcing of some current activities to PRRI.8 Under this arrangement PRRI would continue to manage the annual meeting, but would gradually transition other society functions, including accounting, data processing, and website management to the Chicago office. The proposed new management budget was within 10% of our current costs, including the new staff, leased office space, and a contract with PRRI for outsourced services. After thoroughly evaluating these options, the SVS and AAVS councils voted in February 2003 to recruit an independent executive director and to move the society offices to Chicago. Accordingly, a search committee was appointed, consisting of Drs Jack Cronenwett, Bruce Gewertz, Richard Green, Thomas O'Donnell, Thomas Riles, and Gregorio Sicard, and a professional search firm was retained to identify qualified candidates for the position of executive director. In addition, further negotiations were held with the ACS to lease office space. The search process identified an outstanding candidate, who was approved by the Joint Council in May. This led to the successful recruitment of Ms Rebecca Maron as the new Executive Director for our societies. Ms Maron received a Masters of Business Administration degree from the Kellogg School at Northwestern University, and is a Certified Association Executive. She has 30 years of management experience in health care associations. While working for the American Academy of Orthopedic Surgeons she successfully developed programs for change that quadrupled their annual operating budget. She has demonstrated ability to work effectively with surgeons, has important connections with other medical societies, and was an obvious choice for the search committee.

The Joint Council has also finalized a lease for office space on the 24th floor of the ACS building, which is a contemporary building in downtown Chicago, two blocks from Michigan Avenue. Our space is contiguous with offices of the ACS and one floor above the Society for Thoracic Surgery, which moved into its space in the building last year. The societies will initially lease 2000 sq ft, and can expand this space in the future as required. Ms Maron will assume all executive responsibilities for the societies beginning July 1, 2003, and will recruit additional staff during the summer so that our Chicago office will be operational by October 1, 2003. The SVS and AAVS councils were unanimous in taking this action as the first key step toward an efficient business model to manage the affairs of vascular surgery. It is anticipated that these offices could also provide executive services to other vascular societies in the future, and in so doing, better coordinate all of our activities.

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Foundation merger committee 

The Foundation Merger Committee consisted of Drs Thomas Riles (Chair), William Flinn, Thomas Fogarty, Richard Green, Robert Hobson, K. Craig Kent, Rodney White, and James Yao. To understand the issues surrounding a potential merger of our foundations, it is also important to review some of their history. Founded in 1986, the initial focus of the Lifeline Foundation was to promote basic vascular research through individual grants and research awards and by partnering with the National Institutes of Health and Prevention (NIH) to sponsor the Research Initiatives Forum. In recent years Lifeline also received substantial contributions for clinical research grants, and with industry support it developed the Lifeline Vascular Registry. In partnership with the NIH, Lifeline established two annual K-08 training grants reserved for vascular surgeons. The AVA was founded in 2001, also as a charitable foundation to promote research and education. Its initial focus has been public education, through development of a national screening program for vascular disease. It recently developed the American Vascular Research Organization to coordinate participation of vascular surgeons in industry-sponsored clinical trials involving relevant new technology. Thus, although they have similar missions, the specific programs of our two foundations do not directly conflict. Having two foundations, however, could lead to potential confusion among corporate and private donors about how to prioritize their contributions for basic research, clinical research, and public education. Maintaining two separate foundations also requires additional staff and management support. After considering these issues, the Foundation Committee agreed that a single foundation was desirable, provided that it preserve the programmatic function of both current foundations. This could be accomplished through committees for Basic Research, Clinical Research, and Public Education, with coordination of these activities and fund-raising through a single board of directors. It was ultimately decided that a merger of the foundations would logically follow a merger of the societies, and this activity was put on hold until the question of society merger is decided. It should be emphasized that the committee and both councils regard research and public education as critical continuing roles for a charitable foundation of the society, and want to enhance this function in our new structure.

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Society merger committee 

The Society Merger Committee consisted of Drs G. Patrick Clagett, Jack Cronenwett, Julie Freischlag, Peter Gloviczki, Richard Green, K. Wayne Johnston (Chair), K. Craig Kent, William Pearce, Thomas Riles, Gregorio Sicard, and Jonathan Towne. It was charged to consider alternative models of governance for our societies. It is clear that the SVS and AAVS are closely linked in both purpose and function, and in many ways have already merged functionally. In theory they serve different constituencies, with the SVS comprised largely of academic surgeons and the AAVS comprised of surgeons from both the academic and practice communities. As everyone understands, however, the economics of medicine have blurred many of these traditional distinctions. Furthermore, the leadership of both societies has been derived from academic centers, with the two presidents being indistinguishable by their heritage or credentials. It is not surprisingly, then, that both societies and their leadership are interested in the key issues affecting vascular surgery. Unfortunately, a structure of dual officers with overlapping responsibilities often leads to inefficient decision-making and difficult financial prioritization. After considering this background, the committee unanimously agreed that “Decision-making must be confined to one executive structure that has control of all major activities and associated finances.”9 This core principle was the basis for subsequent recommendations.

Based on this principle, the committee rejected the status quo, in which control of activities and finances is clearly divided. They also rejected complete separation of the societies, which would create even more duplication of effort and provide insufficient funding for either society to conduct major programs. The committee then explored three basic models that could meet the need for a single governance structure: (1) merge the SVS and AAVS to form a single society; (2) retain the SVS as an exclusive academic society, but cede financial authority and control of major activities to a new inclusive society; or (3) retain the SVS and AAVS, but incorporate a separate, supervising entity with financial authority for all major activities.

From the perspective of an efficient business model, a single society with clear responsibilities for a single set of officers had the most appeal. However, the political considerations involved in the merger of two societies, each with a 50-year tradition, initially seemed overwhelming. Option 2 would preserve two societies and focus financial authority, but would reduce the SVS to an honorific society with little function. Thus Option 3, which would preserve both societies but focus financial authority and decision-making within a legally incorporated but separate entity, initially seemed most plausible. The exact nature of this supervising entity has been variously proposed to be a foundation, academy, or federation, but the underlying principle is the same, and is illustrated in Fig 3 as the Vascular Council. After careful consideration of this model, however, the committee identified a number of substantial difficulties. First, fairness would require equal representation from both the SVS and AAVS. Because both councils have expanded in recent years, many current council members could not serve on the Vascular Council without it becoming too large for efficient governance. This would disenfranchise many representatives of other societies recently added to the AAVS Council. Second, selection of a chairperson for this group was judged to be problematic. Several different models were discussed, including election of a past president or other individual not on the councils, election or rotation of one of the two society presidents, or co-chairing by both society presidents. Each of these options was found to have substantial difficulties regarding bias, selection, or lack of a single leader. Finally, it was agreed that the Vascular Council would need to receive reports from all committees that required financing from our joint sources of income. This would leave the SVS and AAVS councils with little residual function, inasmuch as their only income would be derived from membership dues. It seemed most likely that the remaining SVS and AAVS councils would create new responsibilities for their officers, which would lead to the same dual governance problems that we have today. For these reasons, the councils rejected this option. Thus, even though the concept of society merger was considered politically difficult, it was ultimately selected as the best option to achieve effective governance for vascular surgery.

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• Fig 3. 

  Option for retaining both societies with a separate supervising entity, rejected by the councils.

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Society merger proposal 

The proposal for society merger was overwhelmingly approved by the SVS and AAVS councils at their meeting on February 7, 2003, and the details of this proposal have been widely distributed. It was carefully designed to select the best elements of both the SVS and the AAVS, but to create a single society with a single governing board. It also incorporates important new elements that do not currently exist in either society. The objectives of the new society encompass all the current objectives of both the SVS and the AAVS. Membership in the new society will be inclusive, consisting of all current SVS and AAVS members. The advantage of a large, inclusive membership has become obvious as we attempt to influence the federal government to improve reimbursement. In contrast to this inclusive strategy, membership in the SVS has come to represent an honor for surgeons who have distinguished themselves in research, teaching, and service to vascular surgery. In consultation with many SVS members, considerable thought was given to this question, namely, how to preserve this heritage of the SVS within a new inclusive society? Fortunately, an innovative solution emerged. Current SVS members will be awarded the title of Distinguished Fellows in the new society, and future members who meet the current criteria for SVS membership will be eligible to apply for this distinction. Fellows of the society will be represented by a four-member council, elected by the fellows, and will be responsible for evaluating and electing new candidates for fellowship. It is important to emphasize that fellowship in the new society is not a separate category or class of membership. Rather, it is designed to preserve the heritage of the SVS, to recognize distinctive achievement, and to have the same meaning as current SVS membership.

Likewise, considerable effort was devoted to the selection of a name for the new society. Although least important from a functional perspective, the society name carries huge emotional attachment. The councils considered a variety of options, and agreed that the name should have explicit meaning, wide “brand” recognition, and include the word “surgery,” despite the enlargement of our specialty to include many nonsurgical components. Ultimately, Society for Vascular Surgery was judged to be the optimal name for our new society.

The new SVS will be governed by an expanded board of directors, like the current AAVS Council (Fig 4). This board will consist of 23 members, including 7 elected officers, 11 representatives from other vascular societies, and 5 representatives from the councils. Also analogous to the current AAVS, a smaller executive committee will handle day-to-day activities between board meetings. Standing committees will report to the Board of Directors. The Nominating Committee will be enlarged to include four members, consisting of the two immediate past presidents and two at-large members elected annually by the board. The Nominating Committee report must be approved by the Board of Directors, as in the current AAVS by-laws. This represents a deliberate effort to expand and open the nominating process. The Fellows Council will be represented on the Board of Directors by its chair and vice chair, and members of this council will be elected each year by the fellows of the society during their annual luncheon meeting. An important new concept is the creation of councils for research, education, and clinical practice, to oversee and coordinate our activities in each of these areas. These councils will consist of four elected members, with staggered 4-year terms, with the chair serving as a voting member of the Board of Directors. This will provide a new opportunity for many society members to have an important role on councils that will develop and prioritize the key areas of our business. A 4-year term will ensure continuity, and the chair will serve as the spokesperson for research, education, or clinical practice on the Board of Directors. Appropriate committees will be organized to conduct the work of these councils.

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• Fig 4. 

  Organizational structure of new, merged society adopted by the councils.

The merger plan calls for the current officers and committee members of both societies to transition into these positions during the first several years of the new society, so that no one will be disenfranchised. Current AAVS members will receive a certificate of membership from the SVS, and current SVS members will receive a certificate recognizing them as Distinguished Fellows of the new society. The logo for the new society will be the current logo of the AAVS, which, combined with the SVS name, will symbolize the union of our two societies (Fig 5).

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• Fig 5. 

  Logo for new, merged Society for Vascular Surgery.

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Rationale for society merger 

Some have asked, “Why is this society merger so important?” The answer is really quite simple. The merger is not an end in itself. Rather, it is designed to create a more effective governance structure that will allow us to accomplish our goals more efficiently. There is universal agreement about these goals. We want to do everything possible to improve the care of patients with vascular disease. This goal has not changed since the founding of our societies. What has changed is the complexity of the health care environment, and this requires an efficient business model if we are to be successful.

Another way to consider the proposed society merger is to ask the question, “Why not merge?” The most frequent concern that I have heard is the potential loss of the grand traditions of two separate societies. I hope you will agree that the proposed new society not only incorporates the best of both the SVS and AAVS but adds substantial new value, which is the justification for substantial change. Some have pointed out that there will be fewer opportunities to be president of the new society, which would deprive some members of serving in this leadership role. Although there will be fewer presidents, the terms of the secretary, treasurer and recorder have been shortened to 3 years, a new office of vice president has been created, and, most important, 16 new elected positions have been created on the new working councils. So there will be substantially more total leadership opportunities. Finally, it has been suggested that we should delay consideration of society merger to allow another year for thought and deliberation. While it is often attractive to give more consideration to an important issue, I believe that it is critically important to establish an efficient business model for our societies now, with a governance structure that allows us to move forward at a time when our discipline is under significant external stress. If we delay our decision another year, this issue will distract the attention of our councils from the strategic planning that they must accomplish now. If we go forward, they can devote this year to formulating a business plan to accomplish our strategic initiatives. Finally, the new councils for research, education and clinical practice will provide a focal point for the construction, evaluation, and continuity of our mission, and we need this now.

As we consider this potential, I would like to point out ideas that our new councils will consider. We have improved our annual meeting to include not only cutting-edge research, but education in new technology. However, we must redouble our efforts in this area and grow our society through enhanced educational offerings. Not only will this provide added value for our members, it will provide alternative sources of income that can reduce our dependence on the Journal and the annual meeting. Other societies have found this to be an effective model for growth, and our new executive director has substantial experience with such efforts. These educational efforts must also include the public, our nonvascular physician colleagues, and medical students who will become our trainees. We must continue to expand training for new technology throughout the vascular surgery workforce, and in particular we must ensure that vascular surgeons are properly trained to use carotid stents when these become approved. The Vascular Web requires not only continued financial support but also the support of members, to provide timely content for ourselves and the public. I believe that there is also an opportunity to develop a parallel trade journal that could incorporate much of the web content in a print version. Finally, although our initial application for an independent ABVS was not successful, we cannot be deterred from our mission to create an efficient training and certification system to ensure an adequate number of qualified vascular surgeons in the future. These are all important topics for our Education Council to consider and from which to develop a strategic plan.

In research, we have a good base through our existing foundations, but we must be diligent to continue our efforts in all areas, from basic research through new technologies, and we must not neglect the noninvasive vascular laboratory. I also believe that it is important for our society to stimulate collaborative clinical research among the membership, and not restrict this to industry-sponsored trials. Our colleagues in the United Kingdom have repeatedly demonstrated the value of this approach, and we should not continue to ignore this opportunity. In the area of clinical practice, we must continue to support the excellent work of our Government Relations Committee, and work with them and the Political Action Committee to create legislation that will increase reimbursement. We must also continue to develop new practice guidelines, and take more of a leadership role where we interface with other specialties. Finally, we must provide our members with a mechanism to report their surgical outcomes to avoid the inherent flaws of volume-based criteria and to demonstrate the efficacy of our techniques. These are just examples of potential elements that we need to evaluate and prioritize in the strategic plan for our new society, and we need to do this now.

In closing, I would remind you of a prescient address delivered by our fiftieth President, Dr Frank Veith, concerning the evolution of vascular surgeons to develop endovascular and interventional skills.10 I suggest to you today that it is time for our societies to undergo an equally important evolution and in fact accomplish an evolutionary leap to form a single, unified society. I hope that I have convinced you that our current structure of duplicate officers with divided responsibilities and no formal mechanism for resolving differences is not sufficient for vascular surgery at this point in our history. We must cherish the traditions of both of our societies, but we must equally look to our future. All options for governance have been carefully and thoroughly explored by both councils during the past year. I believe that the councils have demonstrated outstanding leadership by recommending a politically challenging but critical step in our evolution. We have recruited an outstanding executive director to improve the management and advocacy for our societies. We have acquired office space for a national vascular headquarters in Chicago, which will increase our visibility and enhance our liaison with other medical societies. Today we have the opportunity to create a unified vascular society that preserves the functional heritage of both the SVS and the AAVS, but provides a governance structure that will allow us to effectively conduct the business that our specialty deserves. In a few minutes the membership of the SVS will make this historic decision, and tomorrow the AAVS membership will do the same. The time has come for us to recognize our responsibility and look to the future of our societies, our younger colleagues, and our patients. I urge you to join the current leadership of our societies in a grand vision for the future by merging our societies to create a united Society for Vascular Surgery.

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Addendum 

At their subsequent business meetings on June 9-10, 2003, the membership of the SVS and the AAVS voted overwhelmingly in favor of the proposed merger of the societies, which should take effect by October 2003.

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References 

1. Barker W. The Society for Vascular Surgery (then and now). J Vasc Surg. 1996;23:1035–1042
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2. Pearce WH. Presidential address. The American Association for Vascular Surgery (a tradition of imagination, innovation, and change). J Vasc Surg. 2003;37:2–7
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3. Minutes of the Joint Council, NA-ISCVS/SVS, Toronto, Ont, Canada, Jun 10, 2000
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4. Minutes of the Joint Council Retreat, NA-ISCVS/SVS, New Orleans, La, Feb 10-13, 2000
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5. Minutes of the Strategic Planning Committee, SVS/NA-ISCVS, Chicago, Ill, May 30, 2000
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6. Minutes of the SVS Council, New Orleans, La, Oct 7, 2001
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7. Nelson T. AAVS/SVS operations, management and leadership assessment; Oct 2, 2002
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8. Henrichs K. A transition proposal for vascular surgery; Feb 7, 2003
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9. Joint Council Committee on Merger of the Societies. Report to the AAVS and SVS Councils; 2003 Feb 7; Chicago, Ill
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10. Veith FJ. Presidential address. Charles Darwin and vascular surgery. J Vasc Surg. 1997;25:8–18
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