Watch: Knowing Your Value as a Vascular Surgeon

Linda: Hi and welcome back to Sisterhood in Surgery. Happy holidays, it’s the month of December and today’s topic is Knowing Your Personal Value As A Vascular Surgeon. And this topic really is so relevant, especially in the hospital setting in the November, December months. People have reached a deductible, they want their elective knee surgery, their elective back surgery – all these elective surgeries, and many times we as vascular surgeons get called for complications and post-op care. It really is something that we need to talk about as vascular surgeons, as a society, and within hospitals – that we have an underestimated value.

Really we are the firemen of the hospital and that is not something that you can really put a number on, but today we’re going to try. So Palma Shaw is here, my co-host of course, and we’re so excited to welcome Dr. Michael Dalsing who is the current president of the Society for Vascular Surgery as well as Dr. Randy Green who is the co-founder of Phairify, which we’ll hear more about, as well as Dr. Stephen Thomas, the other co-founder of Phairify.

So remember, today’s a live show so you can send your questions in by web. Go to PollEV.com enter DeBakey or join by text, text DeBakey to 37607 to send in your questions and we’ll get them answered.

Palma, do you want to start with introductions?

Palma: Sure. Thanks Linda, appreciate it. I’d like to welcome our guests and all those that are watching. Our hope today is to explore these important issues for the modern vascular surgeon. We’ve already run a show on Recruitment and Retention of vascular surgeons in October and we now will take a deeper dive today exploring the groundwork for the society for vascular surgery and what they’ve done and the future project with Phairify.

I’d like to introduce Dr Michael Dalsing, who’s a professor Emeritus at the Indiana University School of Medicine and a full-time faculty with the IU Health Physicians. He was born and raised in a small world Southwestern Wisconsin village, where many of his large family still reside. He attended St Mary’s College and then got a BA Bachelors of Arts in Biology in Minnesota with regulation to the Medical College of Wisconsin, where he got his MD in 1978.

Palma: He did his General surgical training followed by Vascular surgical fellowship at Northwestern University and he’s board certified in general surgery, vascular surgery and Surgical Care. He spent time with the Indiana University faculty as an Assistant Professor, rising up to become Professor of Surgery.

He also developed a vascular surgery training program and the integrated vascular training program at that institution. He’s had a long and distinguished career in academic surgery and he’s been the President of the Indiana chapter of the American College of Surgeon, The American Venous Forum, the Midwestern vascular surgical society, and the Association of Program Directors of Vascular Surgery, and currently is President of Nebraska vascular surgery.

He also recently completed his masters of Business Administration from the Indiana University Kelley School of Business in May this year, and he’s given over 200 medical presentations throughout the world including Japan, Australia, South America and Europe. He has published more than 160 peer-reviewed Journal articles and written over 40 book chapters. Welcome Dr. Dalsing.

Dr. Dalsing: Thanks Palma.

Linda: He’s an Adult Cardiac Surgeon and Transactional Health Care attorney representing Physicians and their practices. He received his MD from Northwestern University Medical School and then went on to train in General Surgery at Stanford. He completed a thoracic surgery fellowship at UVA and, as if practicing cardiac surgery wasn’t enough at the same time, he obtained a JD at Syracuse University College of Law and an MBA at the Johnson school at Cornell University. He is licensed to practice medicine and law in the state of New York. Welcome Dr. Green.

Dr. Green: Thank you.

Palma: And Dr. Thomas is an Infectious Disease Physician at SUNY Upstate Medical University where I work. He’s a Professor of Medicine and Professor of Microbiology and Immunology, and he was the chief of the SUNY Upstate infectious disease division from 2016 through 2021, and it will mention he was one of our saving leaders through the COVID pandemic. I know it must have taken its toll in his position. He then recently transitioned from ID Division Chief to become interim chair of the Department of Microbiology and Immunology, and was appointed the Frank E Young MD and Leanne Young endowed chair of Microbiology and Immunology this past October. Prior to joining Upstate, he spent 20 years in the U.S army serving at the Walter Reed Army Institute of Research and completing his career as the Institute’s Deputy Commander for Operations of Chief Operating Office.

He also served as the Infectious Disease consultant to the U.S Army Secretary General in the U.S Central command’s Regional Infectious Disease Expert during deployment in the Middle East. He earned his Bachelor’s of Arts with honors in biomedical ethics from Brown University and his medical degree from Albany Medical College, completing Internal Medicine in residency and infectious diseases fellowship at Walter Reed Army Medical Center. Welcome Dr. Thomas.

Dr. Thomas: Thank you very much.

Linda: So Dr. Dalsing do you want to go into why this topic is so important for us and knowing our true value as a vascular surgeon in 2023? I know, being part of the Branding Committee, how important it was to really distinguish talk about the SVS to distinguish us from other interventionalists that we are the complete doctor. We have both open and intravascular skills as well as not always having to treat the patient with surgery, but also with optimal medical optimization. If you could just briefly tell us your thoughts on this.

Dr. Dalsing: Sure. So the SVS, the leadership was actually contacted by a number of our members – both the DEI Committee, the Community Practice committee and a number of other people – who were just interested in surveying our membership on different aspects of this overall picture about compensation for vascular surgery. I think it’s extremely important to have data that has statistical validity behind it, so we were looking for that kind of a partner that we could use to see if we could actually have our own vascular surgery specific compensation database. If you go to the c-suite you have to be able to talk the same language as people that are in that Suite, and if you don’t have it, you really are at a disadvantage. You know, a lot of data in the past has really been general surgery, maybe cardiac surgery, and then vascular surgery was kind of the other surgery which put us in a bad position. So I think having this kind of data is very important.

As you know we tend to go about our daily activities trying to take care of the patients the best way we can every day, and we tend to forget all the things that we do. Our views are really a very small part of what we do. We kind of enable a lot of other specialty groups to do what they need to do in the hospital, we take care of the emergencies that come in. We help the trauma service be able to be a level one trauma system and I think these things have been kind of forgotten in evaluating vascular surgeons, so that’s why I think it’s important and that’s why the SVS thinks it’s so important.

Palma: So that’s why I believe the SVS has been working now with Phairify and what we’d like to hear a little bit about that organization and the two of the co-founders are with us today. We’ve been on their website – they’ll help us know one’s true value in the position, how we’re going to define ourselves and identify opportunities to match one’s skill set. So I’d like Dr. Green to introduce Phairify to you. He’s going to show a few slides to give us some background.

Dr. Green: Thank you very much Palma, and thanks again Dr. Dalsing and Dr. Lee as well for having us here. It’s really an honor. It’s a great conversation. I think to pick up on some of Dr. Dalsing’s comments: Setting up the problem has been something that Dr. Thomas and I have realized we need to do a little better because most of the people on this call are not a stranger to the frustration that goes with how we are valued as clinicians or how our work every day is valued. But I think it’s important to understand the Paradigm for how we’re valued. I think that’s what we’re getting at with Phairify and specifically with vascular surgery – being able to pick up on the most impactful drivers of value that fall outside of work or our views, so I’m just going to share a few slides here.

Physicians typically use very low reliability tools to understand our values so typically talking to colleagues and friends at the national meeting, calling an old friend about an old AMGA or MGMA page, and even some online resources that help us understand our value – unfortunately those are very low reliability, they don’t give us a good impression and they’re not reproducible. When we think about how hospitals and Health Systems or our employers understand our value it’s pretty clear that we are Revenue Generating Machines or cost avoidance tools and most of the compensation that we are paid is directly tied to our productivity. This is some great research done by two of the best sort of physician compensation valuation experts out there, Tim Smith and Mark Dietrich. What they tried to do is understand the validity of paying Physicians based on productivity because that’s really how it is, the market research determines what our value is, so they look back for the last nine years and they tried to understand the correlation between the compensation we’re paid and our productivity. And you’ll see that this has an {R} squared of 0.29 on average over nine years, so really these productivity methods of compensating us just based on what we do, fails to account for as much as seventy percent {70%} of physician compensation. So really all those other things that we do like, you talked about Dr. Dalsing and you did too as well, Palma, about escaping from a busy Clinic to go down and save a life in the OR – it seems like those categories of value we bring to employers are actually compensated but they’re not appropriately valued, they’re not understood by us. They’re certainly not understood by our employers.

This is what happens next, it’s really the wild west of market research used to value our services. These four columns represent quartiles of productivity and each number in each of the boxes is the difference between the 10th and the 90th percentile of dollar per work RVU payment so you can see like for Diagnostic Radiology there’s a $210 difference between the 10th and 90th percentile of dollar per work RVU payment for the same level of productivity. Really it just doesn’t make any sense.

And this is why; it’s right now this is how physician compensation is valued. Linear interpolation of market research data, where if you do the 75th percentile of productivity, somehow somebody believes you deserve the 75th percentile total compensation or compensation ratio matching where if you’re in the 50th percentile of productivity base and work our views you should be earning 50th percentile work or dollar per work RVU. The problem here, is that the basic tenacity of this practice is that physician compensation is a single Factor economic model driven by productivity, but Tim Smith’s research shows that’s totally invalid, and it also requires a belief that there’s some connectedness between the tables of productivity and the tables of product of compensation, which isn’t the case and further that these market research studies that are out there are constitute a definitive picture of the entire physician Marketplace and that’s not actually true. None of these surveys presently available do that. There’s a great deal of bias – most of these large market research studies are taken from large multi-specialty practices. They have very small sample sizes, the timeliness of the studies is off, data is collected for a very short period of weeks, analyzed later that year and released the following year. They’re not sub-specialty specific. So the same tools used to value a vascular surgeon’s practice and academics as a rural pediatric practice in Wisconsin, fail to pick up on the important drivers of value and many of them are not sufficiently detailed. It’s not just compensation, it’s hours worked, it’s time put into management, it’s how much your practice is endovascular versus open, Etc.

They need to be far more detailed to generate the comparability as a data set to any subject transaction to be of any value and then finally just the general information asymmetry that exists because these are expensive and many of them are not available to all surgeons.

And this is what I think is really happening. This is a typical income distribution in the United States. There’s a long right-sided skewer tail of very few high earners and this is I think what we’re seeing with many of the market research studies right now is that the gray oval of high earners are underrepresented in the sample by virtue of who participate in these market research studies and we see an oversampling of the green oval that then becomes a new curve and that curve has this systemic effect of driving down all the central measures of value. The median in a very narrower variability is a systemic sort of undervaluation of work by virtue of these market research studies and how the data are collected.

But this is the real problem – that any study like this has to be a sufficiently powered random sample to have any inferential capability. All the market research that I’ve talked about so far right now, these are convenient samples and they provide great descriptive statistics of the sample itself but they can’t be used for inference. Unfortunately that’s how they are used right now – without any inferential capability, it’s possible that some of the market research studies that are out there right now that say that the 90th percentile of vascular surgery compensation at $750,000 a year could really be the mean.

We have no way of knowing, but that’s how 300 billion dollars of physician compensation is actually valued in the United States right now, and the reason I spend a little bit of time on that is just that’s what Phairify and the SVS hope to correct by curing all those. We can’t control how valuation is done but if we can control the quality of the data they use then maybe we can be more impactful in getting to a more accurate valuation for each of us individually.

Palma: So Randy, do you think that this is going to be helpful regardless of where you live, is it going to be able to be broken down by, ‘I live in the southwest’ or ‘I live in the Northeast?’ Whether it’s gender, like ‘I’m a woman’, am I really getting paid ten percent {10%} less than my partner and is that even valid or is it appropriate?

Randy: That’s exactly what we’re going after here Palma. I think that what’s important about Phairify in terms of our relationship with SVS is that we’re sort of a blank slate. We really rely on you, the society leadership, the thought leaders to tell us what are the important determinants of value. What are the important characteristics of the membership you want to tie to that line of data so you can do very important things like gender pay disparity studies? Looking at ethnicity and race on productivity, maybe on career advancement – I mean when you collect enough of a robust set of data that span academic practices, private practices, and we can generate enough participation through the SVS – it makes it more like a census as opposed to a three percent sample.

Now there’s enough data in there for you to do the important things, like not just Regional, right? Regional is the most granular breakdown of many of the market research studies, but think about the Northeast for us right now. That includes Boston, Philadelphia, New York City – that has nothing to do with us up here in sleepy Syracuse, New York right? What you really want to know is show me 10% above and below cities like Syracuse based on cost of living, on cost of services – there’s a whole bunch of different ways we put that together to show you comparative cities.

Randy: The whole point of Phairify is to make it comparable. Collect the right information and provide a platform so that you can use the data the way you see fit. Save your report, print your report out, look at issues not just of compensation, but of call frequency, PTO – whatever variable of interest you have. All the other questions can become terms that you use to narrow it to a cohort that’s just like you.

Palma: So you’re embarking upon this with vascular surgery but what successes have you had with other Specialties? Maybe Dr. Thomas can comment. I think you did something with Nephrology. Is that correct?

Dr. Thomas: Right, so that’s been the largest Society to date that that we’ve worked with – the American Society of Nephrology and we’ve been very pleased with them because, as Randy was mentioning, part of the onboarding process we are going to get into great detail with SVS leadership on what exactly you care about, what exactly your members care about. Because it’s not just that vascular surgery is a different business than general surgery or cardiac surgery. There could be different businesses within vascular surgery. We’re finding this as we work with groups like ASN or as we work with American geriatrics society, and so we’re going to spend a lot of time figuring out which questions need to be asked of your members so that the data is available in a filterable form. That way, people can do exactly what Randy was just saying, which is lesser than an academic and ‘I have this percent of my portfolio is Clinical Care’ or ‘this much is teaching’, ‘this much is research’… and they can compare across one another and know exactly where they stand.

So you know the standard response rate, as Randy mentioned, for some of these other surveys is anywhere between one to three percent. We’ve just started with ASN and we’re already almost at 10%, which is really kind of unheard of, so we’re hoping that SVS is going to do much better than that.

Palma: Maybe Dr. Dalsing can tell us what’s the magic secret and how are we going to engage our membership, who’s going to be your cheerleader and how are we going to pull this off?

Dr. Dalsing: Really our biggest ask is that we’ve sent out letters to all the regional and National societies that are vascular surgery based, asking them to encourage their members to join when we send out the survey. That’s because the more robust the data, the more granular it can be, and the more we’ll be able to use it in our daily lives and our daily practice. The nice thing about the SVS is that we started to look at this year ago. We had a Workforce valuation group that published already in 2019, so we knew that vascular surgery had a lot of components that were being missed or undervalued; so we kind of have a little template to help in this process already that was headed up Dr. Powell, and we can certainly get anybody the reference who wants to look it up, but it was at JVS 2019.

So we’ve been working on this a while and this just seemed like a nice dovetail of a group that could help us do this with a template that we kind of have in place. We’re discussing the members of the task force to help verify already to have members that can help them make these granular decisions.

Linda: So Randy, just to review – I guess long term, how do we bring this up to our Administration? I mean, because they’re going to go by the standard traditional ‘well this is your MGMA percentile and you fall in this percent range’, and how do we approach them with this information that will value us more as vascular surgeons and therefore a higher compensation? Because they’re going to say well you’ve only billed this much – or is the thought that with this information, we can lobby for better compensation on a national Medicare level therefore that kind of trickles down to us in terms of RVU?

Randy: I wouldn’t be so bold as to say that our data set’s going to ever generate more revenue on the clinical side for you. But I would say that I flipped the question, we get that one pretty frequently – will the data be accepted when I walk into the department chair or the administrators of the Dean’s office? The truth is, it’s going to be difficult to reject a society third-party data source that has three, five, ten times the amount of data than some of the commercially available studies. When they look at perhaps the bias that may be presumed in a study of this kind, I typically push that back and say, well you know all the currently available market research that you’re used to calculate Dr. Green’s total cash compensation at the end of the year is generated by employers. A prudent practice based on sort of FMV and Commercial reasonableness analysis through Stark and the anti-kickback statute – prudent practice is to use multiple surveys. Wouldn’t it be nice to have one survey that may have a physician biased among all the employer surveys that are presently used? Because one does not exist out there right now.

I will say that there’s a pretty interesting article written by a guy named Kevin Rinz at the Census Bureau. What he did, he looked at our NPI numbers, physician NPI numbers and he was able to access our tax forms in from the IRS – creepy, I know. So he got this sort of IRS reported physician compensation line and then was able to look at the American Community survey, which is a self-reported study of compensation that they do of one percent of all Americans and was able to find the physicians in there.

So it looked at Physician Reported, Income Tax Reported, Physician compensation – and guess what? There is a bias. We report 20 percent less when we report it, we do not over report. So I think those findings can be more persuasive when you use the Phairify information generated through SVS to walk in there and do battle for a fair salary.

I think the problem right now is they’re assuming a lot right when they come in and they pull out the book and they blow the dust off it and they say,” you know here’s what we think your value is”. They’ve got to understand that is an invalid practice. We have no idea what median compensation for vascular surgeons is in the United States right now. Those data do not exist. Stop asserting you know that and maybe believe in a more powerful tool which is Phairify and SVS’S data at some point.

Dr. Dalsing: I think you have to look at where the data comes from, too, don’t you Randy? Because you know for most of the status actually being generated from the people who are paying us, it comes from the Administrators, the CEO’s. If you look at their Directors on the MGMA, for example – and I did go back and look up a little bit about what universities are actually using for this, and I’ll just mention a number of them. There’s ACM, the AAP, the AARAD, the AMTA, the Gallagher report, the MGMA and both academic and community – they’re already using a lot of databases. You just don’t even know exactly which ones they’re using or what combination they’re using. So it’s like a moving target, you can’t even figure out how you’re being compensated and so knowing that it’s kind of been generated by vascular surgeons in large numbers and supported by a society that maybe can get the message out to our own members that this data is available, it will have more power.

Stephen: So it’s a low sample size, it’s biased, it’s low quality and it’s four to five years old. And as was mentioned earlier you can’t get it.

Stephen: You can’t get it right, unless you’re an Administrator. It’s tragic to think that people are taking screenshots of some online aggregate a survey of compensation. So this is what motivated us and our partners to form this company and to develop what we believe is the solution to the problem, because it’s going to make it transparent. It’s going to have equivalency of access so the administrators and the docs are going to all be looking at the same data from a high sample size study, and then they can have real conversations about value and what appropriate compensation and benefits are associated with that.

Palma So Stephen, when they come to you and say MGMA from 2021 – was this because you said it’s four to five years old? So where’s that data from, when they have every year or they say last year?

David: Well, when I’ve asked people to kind of characterize the time frame of the data, they don’t tell me this is last year’s data. They pulled the Elder Scroll off the table, off the bookshelf; they open up the book, they blow the dust away, and they say this is what you know you’re worth. And if you don’t take the time to look at the sample size, you don’t take the time to see the Geographic area. As Randy mentioned, for those of you who have not been to Syracuse – it’s not like New York City, it’s not like Austin. And so unless you do that and then you read the small print about how they got the data which was again going to administrators, getting downloads of data sets from administrators you won’t know all of these nuances and so this is why we believe going through a trusted medical specialty societies, going at some point direct to Doc and a combination of the both. This is where the most truthful information is going to come from in our opinion.

Palma: So it sounds like this is a slow and steady climb, right? We’re like climbing, rock climbing, right? You’re going with the strongest foothold to get the accurate data and then move forward and then engender support from the membership. So what hurdles do you encounter in the short term and long term bringing this to fruition for the SVS? Because I mean I’m all excited to have this data the next time I negotiate with my boss. What’s going to get us there and what’s going to stop us?

Randy: If I could, Stephen, jump in I will say that in my opinion it’s getting representative samples from all the various subgroups within SVS right. So there are first year, second year, third year members who encounter sort of early stage career issues. They’re mid-career people; there are people that are getting ready to make the jump to Chief chair. There’s really a palm of the long tail of vascular surgeons, the guys that are really in the objective world making above 90th percentile. Look, if we don’t get them to participate, we’re no better than anything else out there, right? We’re going to be subject to the same sample bias and it will do you no good. So what we’ve really tried to do is understand, and we’re going to have I think a great deal of luck using Society committee structures to make aware and bring people in all those subgroups onto the platform. ASN has about 20 work groups of early career work groups. The academic work group so we’re going to engage all the leaders of those work groups to bring to their committees the importance of understanding for that committee of certain aspects of the practice of nephrology or in this case practice of vascular surgery. We can use them to again drive participation in these groups and there’s one point about Phairify so, everybody takes one study that’s the core study but we also break it down into what we call modules. So each of these modules can be anywhere from three to five questions, but there’ll be questions that are germane to a subset of vascular surgeons. So there may be an early career module and that may ask how many jobs did you interview? What was the range of starting sellers? Any number of questions that may be important for that small group of vascular surgeons to understand. There may be an academic module, maybe there’s a research module. We leave that totally up to the society – but we think doing that is going to bring all these despair groups onto the platform and provide the richest data set to answer all the questions you guys have.

Palma: So Dr. Dalsing are we just going to take this one approach or are we going to do a multi-prong approach with social media? I mean, with the foundation SBS is great about engaging everybody right a lot of media blasts. Will you do this as well with Phairify?

Dr. Dalsing: Yeah absolutely. First of all we have to decide what basic package we’re going to have out there. What our task force evaluated, all those things that are important and we’re developing the task force to do that this week actually, and so we’ll give Steve and Randy some help in what Randy’s asking for really. What are those important modules? And then yeah the only way this is going to work is having total engagement. So the SVS is asking every member and every Vascular surgeon, because not every vascular surgeon is a member to participate. So that’s why we’re reaching out to all the regionals, all the local vascular surgery groups – any group that we can think about, we’ve sent letters to; certainly before the first survey goes out, we’ll try to do a mass media announcement with whatever tool we have. We have people who are on Twitter, we have people who use the SVS connect. There are a lot of social media people out there that use different platforms and we have to get them all engaged. It’s a big project.

Palma: We’re really happy to be the first ones to help you do that, Dr. Dalsing.

Linda: We have a question.

Dr. Dalsing: I think that’s very important.

Linda: We have a question from the audience. What is the time frame for this data and how will it be accessed by SVS members?

Randy: So the time frame is something we spent a lot of time on. We are not of the opinion that you collect data for four weeks and then if you don’t get your data in that four weeks, you can’t have access to the study – your only other opportunity is to buy it for several thousand dollars. So our studies run all year long from the launch date till the end of the next year, at which point we launch the next year’s study.

We try to start them right around tax time because that’s when Physicians have access to their tax documents. They know what their earnings are and have them aggregate using a PDF that they can download all the important information to make the exercise of filling out the crowd-sourcing study really easy. How do you access it? The SVS will send you an email with a link, the link brings you in. We collect no personally identifiable information so that you can have confidence that this is entirely private and secure. We totally disconnect every respondent’s identity which is just a made up username from their line of data. Once your data is entered into the system – and again it’s designed to be about a 15-minute exercise – then you have access to the information anytime, anywhere, on your phone, on your tablet, on your computer, anytime you log in it’s there. You can see the information for each question in aggregate or you can use this powerful filtering tool that we’ve developed as part of the application to designing these cohorts to look at any dependent variable that’s a question in the study.

Dr. Dalsing: So you really have to be engaged, right, Randy? You actually have to input data to get data out and that’s an important aspect I think, because it’s sort of like a pay for and you know it’s not a money paid for, it’s an engagement pay for in this case. But then you have pretty powerful data, and as the years go by more and more – but the initial push is what’s always most difficult because people have to realize it’s important and that it can be used so that’ll be something that we’ll have to work on a lot to make sure it happens.

David: Yeah so I mean crowd-sourcing platforms can be incredibly powerful but it needs the crowd, right? It needs people to get onto the platform and to put their information in and again just to kind of highlight what Randy was saying, it’ll take about 15 minutes and it is completely anonymous. We do not collect any of that information. We don’t need it and your access to the data – unlike some of these other groups that we’ve talked about – it’s immediate. As soon as you hit submit, you can immediately go and look at the national level data and then filter and do all those kinds of things.

Linda: And that’ll be on the website, the link that you get?

Randy: Yeah, it will. You’ll be able to access it ideally through the SVS website, so if you go to the ASN, ASN has a drop down and offers Phairify. You click Phairify and you can learn a little bit about it. You can access the application through the society’s website. You can also go to phairify.com and enter and access the application there as well. But as Steven said, just as soon as your data’s in you have access to it forever.

Palma: So is there going to be an app did I miss that, will there be an app on your phone?

Randy: Yeah, soon. But Palma you bring up something actually that it’s really something we’ve tapped into in the last year where we want to – it’s in the tech world, I sound like I’m 20 – but we want to gamify it. We want this to be something that becomes a living database, because remember if you’re able to put it on a native app on your phone, this can be done at O’Hare while you’re waiting for the shuttle. It can be entered, you can use the information if you need to, but also remember it’s changing all year long. As this thing grows, there’s new data points entered. It’s not a static database – the time course of data may be static but as it’s accumulated you learn more and more throughout the year about your specialty.

One last point I want to make, one of the hurdles. I think one of the hurdles is getting enough data on the platform in the beginning for it to entice others onto the platform. Here’s something super important. There are two issues as I said, how do you get the long tail on the platform and how do you get enough on the platform initially to entice more on? And I think we solved it and it’s got to be senior leadership. Senior leadership has to be their leaders for a reason. They have to have their shoulder in it from the beginning. We love every senior leader, every committee lead, every executive, executive Board member. Everybody gets their information right in the outset. We know where they fall on the total cash comp curve. We know that they’re going to be working their butts off because they’re senior people, that sort of sets the tone for the whole study and I think that’s how you pre-load it to get more people on as well.

Palma: SPS has allowed us to start a women’s section so on the steering committee for that and I help them form that section, so I’m sure the women will be pushing for Phairify and filling out our information because I think that it’s going to give us really good Solutions on how we can get better compensation. We’ve been looking for that for such a long time. Did you have any thoughts about that?

Linda: I think this is exciting. Obviously it’s going to take time to get all the data that you need, but I mean the end result should pay for all the weight since you’re right – I mean most of us, we get a contract and we’re like okay, I guess, I believe you when you say that I’m in this whatever percentile MGMA, even though I can’t look at the actual numbers myself. At least this can either confirm – most likely negate – that number, but give us some more fighting info to bring to the table and say,” hey, look no that’s not true, look at this information”. And this is like on a national level.

David: We don’t prescribe an aspirin unless there’s like three randomized control trials that say aspirin is good, but we will take guidance on our finances – which we just don’t think is appropriate certainly in 2022.

Linda: And there’s a question from the audience. So what is the plan for Phairify long term, is it to license to hospitals / providers or create a subscription model?

Randy: Good questions. So we offer Phairify exclusively through societies as a free member benefit to the society and to the members. We don’t plan to ever charge Physicians or societies. What we do is we make the data available in a de-identified way to hospitals and health systems – and you may think, ‘oh boy that sounds a little strange’. Well the truth is, for this information to be useful to fulfill the criteria again in Stark and the anti Kickback statute, particularly around FMV Fair Market Value Calculation, that information that is used to understand value must be made available to both sides of the of the deal so that when we de-identify it and make this available to the people that employ us, we fulfill that criteria. We would love nothing more than Phairify to be recommended by the OIG and the Department of Justice as the tool we use to understand and what is fair market value. And we can charge for that and so we do charge for the data and in fact we provide some of that Revenue back to our partnering societies as well.

Dr. Dalsing: There’s one other way to kind of think about this. So if the c-suite doesn’t know that the data exists and they have no ability to get it, let’s look at it one way. So about a third of hospitals out there are looking for vascular surgeons; there’s not nearly enough of us there for everybody to have one. Everybody is fighting to get us even though we don’t realize it. We kind of undervalue ourselves and we’re kind of accepting what we get in terms of compensation. but since there is a supply and demand issue here and we’re actually the supplier that has increased demand, if you have the data out there the hospitals can use that to maybe get the vascular surgeon that they want and would and the infrastructure that they also need to hire that guy.

What would you know, the SVS has another product that works with the SG2 on helping hospitals upgrade to the point where they actually get a vascular surgeon, so I think sometimes we look at ourselves wrong? We’re actually a valued commodity who aren’t using our leverage to get what we could or what we actually deserved. Let’s put it that way it’s not good, it’s deserved. So I look at this on a different spin than just having our competitors although there actually are partners and all this, to understand what the data is it’s important

Palma: It seems like this is going to be much more successful if we all stand together. I think if we stand unified as a group of vascular surgeons whether you’re a member of SVS which we all should be I think but or if you’re not, we all need to come together to stand strong, to get the data, to walk into those c-suites into different offices and know ourselves and we can go up against these people and over time I think it will evolve.

David: And it won’t be it won’t be SVS just doing it for vascular surgeons. It’s the entire Health Care System in the United States which you don’t, you just have to pick up the paper to see where we’re headed. We’re looking at 140,000 doctor shortage in the next eight years. One in five docs is leaving the profession post pandemic. We continue to have, as you’ve already mentioned, issues with disparity in terms of gender within certain Specialties, as well as underrepresented minorities in certain Specialties, and we’re a country that spends more than 13 percent of our GDP on health care. About eight percent of that is physician salaries, but unfortunately if you compare it to about the other 30 wealthiest countries in the nation, our health care outcomes – we’re at the bottom of that list unfortunately. People ask, they say well, wasn’t there this huge Healthcare hiring thing back in the 90s in the early 2000s to say?

Yeah it was – and for every one physician that entered into the health care system, 10 Administrators entered into health care. So there needs to be course correction and we believe that fair compensation for the value that is delivered is a key component of that. It’s not just about, well what’s my paycheck? It’s a much bigger issue which in the end I think does drive outcomes. So we’re really glad that we’re partnering with you all to solve a very big problem.

Dr. Dalsing: We’re very interested in our members right? They’re so valuable to us but we think this is such a big problem. We want every vascular surgeon to be involved. Hopefully they will become members because they see that we can help them do things – but boy this is something that every vascular surgeon ought to be able to do when he goes for his first job or his third job with data that he can use. I think it’s important that we’re all speaking the same language because then it becomes powerful right but if they’re one-offs you don’t make much of a difference.

Randy: One of the one of the important things you know about that really hasn’t come up that we recommend – we like when the societies make the data available to residents, medical students because if you can remember before I went to you general surgery and cardiac surgery, I really had no idea what the job was going to be like and I’m not talking about compensation. I mean call frequency, clinical hours and management. I had no idea but I jumped into it because I just loved it. I’m not saying I would have made a different choice, but I think today how medical students choose their specialty really is dictated a lot by not just comp but all the Contours of what they’re getting into. Imagine being able to give that as we talked about before the show to the medical students and really inform their decision of what a great way to drive diversity in the specialty to drive you know just this desire to become a vascular surgeon.

Linda: Great points about that startup. Start early.

Palma: When you say to break this all down, I was thinking, you know, there are times in your career when you maybe can’t work 100 percent of the time. Let’s say, I had a child and I want to go back slowly and I want to work 80 percent of my time. I think this will help us and anybody for whatever reason you wanted to step out – maybe you did your MBA or maybe you did a research, a two-year research Endeavor or something like that – and now we can maybe get better compensation and get a better proportion of the payments for what we do.

David: Right, that is a perfect example of what could be a module, right? So everyone takes that course Study Answers, the core questions, and then there could be a module for those types of Life circumstances. I mean this is why we work with specialty societies – because you know the issues that your members are thinking about and that they’re confronting and it’s a very flexible platform so that’s a great idea for a module right there.

Palma: Well when my kids were small, now they’re grown, but when they’re small we just have a lot more time dedicated to managing the kids and all these different things. But then once they get more self-sufficient, well then I’m more engaged with work – but we lose too many women or too many people in the process at that one part where you just kind of have to carry them that five years if they work 75 percent time or something. Instead, we lose them all together which is really very unfortunate.

Dr. Dalsing: That’s a real mistake, right – we have Workforce issues and we’re not flexible enough to keep people that we know we’re going to need. It makes no sense at all. But this may be a way to at least give people the knowledge that there are other people out there that have these same stresses and this is how they were able to take care of it by really dovetailing into that module so I can see how it could help a number of people. And certainly for the new person coming out, the fellow that’s going to come out – having data like this invaluable. Because essentially when I went and it was a handshake, and nobody does that anymore, you’d have to be crazy but that’s the way it was back then. But now, they go out and get a lawyer. They get a contract lawyer because that’s what people tell them to do, but that lawyer doesn’t have data so it could be just invaluable if we can make it happen – but that’s going to take everybody to be involved.

Linda: Well, we’re excited to start.

Palma: I don’t know if you had any closing comments or any last thoughts you’d like to impart.

Dr. Dalsing: Oh, I did want to say one thing. I would like to push our SPS branding tool kit.

Palma: Please do.

Dr. Dalsing I don’t think people use it enough. I mean it’s a turnkey process to advertise to have patient information out there you know and our members want us to educate patients because they don’t know who we are sometimes. So I just wanted to put a plug in there for something that’s Turnkey for you. All you have to do is get it, use it, put your name on and run with it. There are a number of other programs that the SDS has that I think are just not used enough, but that’s one that would be important for this conversation we’re having because it can show you how to separate yourself from everybody else in the community. So that’s just a different twist, nothing to do with Phairify – sorry.

Palma: No, it’s important and I think the membership and others have to understand how much the SVS generally cares about its members. I’m a little bit on the biased side since I’m on the Executive Board this one year and have done other things, but I think it’s just important. I’m always admiring the leadership and how much you care about making vascular surgery the best field possible, so I thank you for that Dr. Dalsing.

Linda: Thank you everybody.

Palma: Any closing comments Randy?

Randy: Yeah. I’d like to, you know, we’re at The Sisterhood in Surgery talk and we haven’t touched on anything Sisterhoodish. I will say that I read the article from Dr. Lynn from 2021 and there were two points that I thought were important. One was Transparency around pay and I think what the article is talking about is institutional transparency, right? Everybody at X you know surgeon {A] through {M}. But that’s important but I think it needs to be contextualized again with National Data or even Regional data for that kind of academic Medical Center and that kind of metropolitan area. So I think that transparency is important, but a benchmark for that transparency is a big component of how we can solve the gender pay disparity. Number two is Pay Equity audits. Really big you know really and I love the article. I know you’ve read it but even just refreshing what was said in the article was under the pay Equity audits done in a department all these different variables that are collected to understand compensation in terms of some measure of productivity, maybe clinical hours worked, being the Program Director of The Residency right. All that work has been done. Imagine having a Pay Equity audit but also having access to a National Database of the same terms to be able to again contextualize that sort of institutional data and then being able to really draw some conclusions about what’s going on in your institution. I think it’s an important augment to what should be done as recommended by Dr Lynn in the article to solve a vaccine problem which is the gender pay disparity. It also affects diversity in your specialty and all of us ultimately.

Dr. Dalsing: Must admit from SVS leadership we have a women’s section. We have a DEI Committee and we try to listen to them, they face challenges that not all the SBS EB leadership have to. So I think we rely a lot on other people in our in our society to tell us what’s important to them and I know that Palma will tell me at any time but I think it’s very it’s critical for us to have that feedback because without it we miss things and that’s what you don’t want to do especially when you start a project like this.

Palma: David, any comments?

David: I would just say thank you very much for the invitation. This has been great. We really look forward to working with you and your members and we are hoping and confident there will be maximal participation.

Palma: I’m going to be your big cheerleader up here and Linda will be down there.

Dr. Dalsing: Thank you for the invitation as well Palma. Linda, thanks so much. It was enjoyable. I enjoyed the conversation and all the things that we can maybe bring to your listeners.

Palma: It’s wonderful. We appreciate it and we wish you all a happy holiday and happy New Year 2023.

Linda: We’ll see y’all in January. Good night

Palma: Thank you very much.