Leaving Cleveland …better than LeBron

 

"No Love" in Cleveland

One has to ask, “Did anyone in Cleveland EVER like LeBron?” I would have to give him credit for showing up at a Heat/Cavs game without the Secret Service.  I have yet to meet someone here who doesn’t have an opinion about him.  Whew, tough crowd!  I hope my exit is not so celebrated.

Looking forward to my last few days here (after my last call this coming weekend).  I certainly feel like I have a whole different set of skills to work with, nascent as they may be.  What is also new is the perspective of practicing vascular surgery in a manner similar in some ways yet quite different from both how I trained and how I previously practiced. Understandably the practice climate is a little different when each one of the vascular services (three) has a Fellow who is at least a PGY 6.  It’s also interesting that Vascular Surgery is it’s own department with 20 surgeons throughout the network.  They run their own M&M and have very little interaction with General Surgery.  GS Residents do rotate through but I suspect they get a lot of their “vascular” cases at outside rotations.  At least 4 of the outside hospitals are used for Vascular fellow and Vascular Resident rotations.  Their endovascular practice is supported by 5 dedicated and outstanding radiology techs who work only in Vascular Surgery staffing the 4 hybrid OR’s (soon to be 6).  They are recruiting another Vascular Surgeon.

Part of the difference in the practice mix is the role of Vascular Medicine in the consult mix.  Many of the DVT consults we currently see are seen and managed by Vascular Medicine here.  Likewise for the coagulopathy patients. Anticoagulation management is the responsibility of Vascular Medicine. What I didn’t realize until just last week is that the staff here all see patients at one of the outside hospitals each week.  As in our practice, that makes sense.  The difference is that they don’t operate at the outside hospitals. In-Patient rounds are fairly quick and efficient leaving lots of details to the fellows and the NP’s.  The EMR facilitates discharges and follow up.

I have seen almost no interaction with trauma.  There is an IR service here but they have little or no cross over with Vascular Surgery with the exception of dialysis access lysis and catheter placement.  Cardiac Surgeons (Roselli and Soltesz) do EVARs on a regular basis.  Cardiologists (I think) are continuing to do Carotid stents here but the Vascular Surgeons have scheduled only 3 in my three months ( and Clair was a PI on the flow reversal trials).  There does not seem to be a competition between Departments and I suspect that this is because everyone is busy enough.  Of course, it doesn’t hurt to have the Greenberg effect on outside referrals for complicated stent grafts.

The vascular lab remains a big part of the practice but studies are also read by Vascular Medicine.  I think our lab is structured better.  They lack an organized protocol system for follow up here.  This may reflect the large proportion of remote patients in their practice.

What has become obvious to me (that wasn’t obvious at the beginning of this Fellowship) is that the power of this Department is the individual surgeons and their energy level for keeping this Department world-class.  The reputation of the Cleveland Clinic is merely a smoky veil that will dissipate quickly over time (and has in some areas) if the quality of the staff is allowed to diminish.  The institutional reputation is intimately tied to the surgeons who are driving the daily health care here.  Let the staff slide and the veil quickly vanishes.  The brilliance of the Cleveland Clinic is that it’s leadership has continued to recognize the critical nature of its staff and recruits outstanding individuals to care for it’s patients.  Norm Hertzer and Ken Ouriel built a juggernaut that has been steered forward by Dan Clair.  Picking the right people is what builds for tomorrow sometimes at a cost for today.

With my life situation both in and outside of Cleveland continuing to evolve without much control on my part I am not sure how many posts I will make in the future.  This journey has been difficult, fun, anxiety provoking, rewarding, enlightening, tiring, exhausting and energizing (often in one day).  I have made some very nice friends here both staff and fellows.  I am a different surgeon than I was 3 months ago.  I am so glad that Jay Fisher started this adventure and that we were able to take advantage of this incredible opportunity at an incredible institution.  And now we have to put it in play…hopefully better than LeBron did.