Portal de Periódicos da CAPES

Of strategies and chances

2014; Elsevier BV; Volume: 60; Issue: 6 Linguagem: Inglês

10.1016/j.jvs.2014.08.090

1097-6809

Julie A. Freischlag,

Cardiac, Anesthesia and Surgical Outcomes

Thank you for the wonderful honor of serving as your president during the past year and giving me the special privilege of addressing our members at the annual meeting. I have attended nearly every annual meeting since I was a fellow and owe much of my career to the friends I make, knowledge I gain, and inspiration I experience at the meetings. The Society for Vascular Surgery (SVS) is an important organization with tremendous responsibility to its members, patients, and the health of our nation. I deeply enjoyed the opportunity to help lead the Society in making a difference and advancing the education, training, and research that supports our profession. My presidential address included many firsts. I am the first woman president to deliver the address, I shared results of the Society's first Strategic Plan, and for the first time a patient told his story on stage. My mentors and family sat in the front, my family joined me at the podium so I could acknowledge their support, and my presentation theme was something we do not do in vascular surgery—take chances. I selected “Chances” because there is a positive aspect about chance that influences our lives. For example, I became president because you gave me the chance to serve and I took that chance. There are chances that we all should be giving to patients, colleagues, trainees, and even people we do not know. Most important, we need to take chances for ourselves. It is difficult to single out one undertaking in 2013 that was the most significant, yet I believe developing the Society's first Strategic Plan was of utmost importance to the future of our organization. The plan is similar to a basic instrument set for vascular surgery because it is an essential component of everything we do. Every day we are led by its purpose—promote vascular health through advancing the science and practice of vascular disease management—and guided by its values—integrity, commitment to quality, relevance to members, leadership, diversity and inclusivity, and professionalism. The Strategic Plan required hundreds of hours of meetings, phone calls, status reports, and—most of all—teamwork. The Society's staff went above and beyond to add the complex project to their already full plates, and many members volunteered their time and energy to help complete the plan. Together, we demonstrated the outstanding commitment and capability of the Society and its members. I am proud that we did more than complete the plan; we implemented it. In my address, I explained the plan's goals and described examples of progress for each goal. The Table summarizes the information.TableSociety for Vascular Surgery (SVS) Strategic Plan Goals and ProgressGoalsProgressHigh-quality vascular care•Participation in the Vascular Quality Initiative has grown to 282 sites, 2042 physicians, and 16 regional quality groups•13 practice guideline writing groups are under way, and five more are expected soon for creation of a centralized resource for data on cost, outcomes, and comparative effectiveness•SVS owns 13 quality measures, and the Centers for Medicare and Medicaid Services chose nine for the Physician Quality Reporting System (PQRS) program, further increasing SVS ownership of consensus documents and updates, with SVS creating and updating performance measuresEducation•SVS offered its first two online webinars•>100 scholarships were given to medical students and residents to attend the annual meeting and to stimulate interest in vascular surgery•VESAP3, which will be released September 2014, offers flexibility for meeting maintenance of certification self-assessment requirementsAdvocacy•SVS was among the few surgical societies to develop its own proposal for health care reform, which was well received by Congress•508 SVS members wrote letters to Congress about payment reform•SVS members donated $100,000 to the Political Action CommitteeBranding•The “Vascular Conditions, Tests, Treatments” section on VascularWeb has nearly 1 million unique visitors each year•Newly reinvigorated SVS Facebook page has nearly 2000 “likes”•New media outreach program was in place in Boston to generate interest in vascular surgery through coverage of the annual meetingDiscovery•SVS and the Society of Interventional Radiology are sponsoring a Food and Drug Administration–approved study of inferior vena cava filters•SVS Foundation supports young researchers through its collaboration with the National Heart, Lung, and Blood Institute on K08 and K23 awards•SVS collaborates with the American Heart Association on an annual Vascular Research Initiatives ConferenceSustainability•SVS has had a positive operating margin for the last 4 years and is on target to continue that trend•Positive operating margins have resulted in total assets more than doubling from 2007 to 2013 ($4M to >$8M)•International membership grew from 47 in 2007 to 699 in 2014 and continues to increase•First vascular leadership postgraduate course was held June 4, sponsored by the Leadership Development Team, and will become an annual event extended to a full-day course next year at the Vascular Annual Meeting Open table in a new tab I am excited about the Strategic Plan because it establishes priorities, directs resources, tightens operations, aligns everyone's efforts toward shared goals, and guides the Society's path during times of challenge and change. The concerted and disciplined project raised fundamental philosophical and operational questions that helped define the Society—who it serves, what it does, and why and how it measures success. Throughout the process, we learned more about where we are, where we need to go, and how we will get there. We discovered what works and what needs improvement. Most important, we saw vast opportunities for achieving further greatness. I look forward to continuing to help the Society seize its promising future. The Strategic Plan does more than help the Society; it also lays the foundation for creating and enhancing chances for our patients to lead healthier lives, students and residents to receive innovative education and training, researchers to make breakthrough discoveries, colleagues to develop rewarding and fulfilling careers, and each of us to open new windows of opportunity in our personal and professional lives. Giving chances to others and taking chances for ourselves helps move everyone from one step to the next. Giving chances demonstrates the humanity in our character, and taking chances improves our strength and resilience for achieving our dreams. Both are essential skills that help us lead others—and ourselves. Taking advantage of the power of chance requires focusing on three aspects of chance: (1) understanding the role that chance plays in shaping our careers and the careers of others, (2) contemplating the possible outcomes of taking a chance or giving a chance to another person, and (3) reflecting on successes that have occurred because of chance. My favorite quote about chance is, “In this world, we have to take chances. Sometimes they're worth it and sometimes they're not. But I am telling you now, you will never know until you try.” For example, two fantastic parts of my life involved taking chances. I took a chance on a dating service that introduced me to my husband, Phil, and it has been worth it now 21 years later! And I became president of the Society because you gave me the chance to serve and I took that chance. Taking chances is the key to an exciting and fruitful life, and giving chances is the secret to a rewarding and fulfilling career.•To give our patients a chance, we must become and continue to be excellent physicians. We need to listen to our patients, care about them, and fret about them before, during, and after surgery.•Giving colleagues chances means we must be good team members, do what we said we would do, and demonstrate integrity.•We must find, create, and give chances to the fellows, residents, and students who we teach and train.•And we must turn around and reach out to those coming up behind us, pull them to our side, mentor them as we were mentored, and cheer them forward. We must take the chance and give them a chance of a lifetime. We must keep in mind that we cannot effectively do for others what we do not do well for ourselves. We cannot be afraid to take chances in our own lives. I ponder whether I should take a particular chance, but I do not allow concerns about success or failure to prevent me from taking chances. Professionally, we can learn a new surgical or research procedure, take on new responsibilities, attend leadership courses (eg, those offered by SVS), or consider a new position—I did! We can take a chance by asking a colleague, resident, or student to partner on a project. For example, Kendall Likes has worked with me since she was 16. She recently graduated from college and presented my research paper the day after my presidential address. At home, we can ask a child, spouse, significant other, or friend to join us in the excitement of taking a chance on doing something new. Phil and I are now biking on the American River trails in Sacramento, which is something we never expected to do. This is an example of how taking a chance—I took a chance on a new position in Sacramento at the University of California—can unveil an invigorating world of chances that you did not know existed. I also believe there are chances in our everyday lives that we seldom embrace, such as character-building chances to meet someone new, to lend a helping hand, or to bring a smile to someone's day. My emphasis on the humanity of sharing chances is based on the quote, “To the world you may be one person; but to one person you may be the world.” Experience has taught me that life is a river of chances that stops for no one. We can watch it flow by from the shore, team with someone who can help us slowly get wet, or jump in on our own with full gusto and ride an adventure that welcomes whatever happens next! Wherever the river's turns have taken me, I have always had the same ultimate destination—be the leader that people want to follow more because of who I am than what I accomplish. I have a plaque in my office that states “Because Nice Matters”—because that is who I am. It is my promise, it is how I practice medicine, and it is how I direct my life's mission. My life has been full of amazing chances—chances I developed myself, chances that were given to me, and chances that I have taken. Most important, the chances that I embarked on have created more and better chances for those in my footsteps. My lifetime of chances began with going to college to become a high-school biology teacher, but the program closed because too many students wanted to be teachers. My love of science led me to the pre-med program with a goal of becoming a pediatrician. I did my surgery clerkship first to get it out of the way because I thought I would not like it. By chance, I enjoyed surgery, changed direction, and attended the University of California, Los Angeles (UCLA) to train to be the best vascular surgeon I could be. Dr Steven Economou gave me the pivotal chance by recommending that I do surgery. Drs Donald Morton, Wesley S. Moore, and Ronald Busuttil gave me many chances to expand my skills and knowledge in UCLA's general and vascular surgery departments; Drs A. R. Moosa, Bruce E. Stabile, Marc Sedwitz, and Robert J. Hye gave me the chance to be assistant professor at the University of California, San Diego; and Drs Michael J. Zinner, Wesley S. Moore, and Edward Passaro, Jr, provided the chance for me to join their team as assistant professor at UCLA. Developing my leadership career followed a road that was lined with excellent chances. Sometimes I had to create and seek out chances, and other times nice people presented them to me or pointed out the ones I might not have considered without their support and encouragement. Many chances also emerged as a result of my hard work, dedication, and enthusiasm. I have learned that chances come in all shapes and sizes and we have to be careful not to miss those that do not meet our preconceived expectations. I do not view chances as ends in themselves; instead, I assess each one for its potential to contribute to the ongoing journey of my life in new and exciting ways. For example, I whole-heartedly took chances on leadership roles serving as Chief of Vascular Surgery at the West Los Angeles VA, Chief of Surgery at Zablocki VA Medical Center in Milwaukee, Chief of Vascular Surgery at UCLA, and Chair of Surgery at Johns Hopkins. Many inspirational people influenced these chances for my career advancement, including Drs Robert E. Condon, Jonathan B. Towne, E. Carmack Holmes, Wesley S. Moore, and Edward Miller. I have experienced that you run out of chances only when you stop taking them. I did not fully appreciate the significance at the time, but I was the sixth woman to finish General Surgery at UCLA, the second woman vascular fellow at UCLA, the sixth woman in the United States to receive her vascular board certificate, and the first woman faculty on staff at the University of California, San Diego, and UCLA. I became the only woman serving as a Vascular Surgery Division Chief (from 1998 to 2003), the first woman Chair of the Department of Surgery and Chief of Surgery at Johns Hopkins, the first woman Chair of the Board of Regents of the American College of Surgeons, and the first woman president and immediate past president of the Society for Vascular Surgery. Looking in the rear-view mirror at the places I have been, the responsibilities I have had, and the people who helped make it all possible, I am surprised by the large number of chances—some serendipitous and others targeted—that came together as pieces of the puzzle. Combined, they prepared me to take a new position at the University of California, Davis, to serve as the Vice Chancellor for Human Health Sciences and Dean of the School of Medicine. Unfortunately, in the same rear-view mirror, I see the reality that most of the people who filled my career with chances are men. My current position is the first time that I can credit the power of chance to women in leadership roles. Not only did Linda Katehi, Chancellor of the University of California, Davis, give me a chance by hiring me, she also co-chaired the recruiting committee with Diana Farmer, Chair of the Department of Surgery—one of only six women chairs of surgery presently in the United States. I am proud and fortunate to be at an institution with a culture that improves chances for women to lead. I cannot adequately express the profound joy I experienced when all members of the surgery team for my first case at the University of California, Davis, were women! The men who gave me chances throughout my career—and continue to do so—are extraordinary role models for stepping forward to help women succeed. We know there are not enough women vascular surgeons, and too few are in leadership roles that enable them to champion enough chances for other women. More men need to follow my male mentors' lead—take a chance by giving chances to women, help them pursue those chances, and celebrate their successes. Men need to help women, women need to help women, and we all need to help each other access the chances that make a difference in our careers so we can go out and make a difference in our patients' lives. Advancing chances for women helps generate interest in our profession and maintains the prestige that our Society gained when members selected their first woman president. My personal and professional goal is to leverage the chances that I take to help improve chances for others. I accept the obligation to circumspectly view chances in the context of the impact that I can have on others by taking chances—not just look at chances through a lens that focuses only on the benefits to me. Taking full advantage of a chance depends on capturing its larger transformational power for the benefit of all. For example, I evaluate my chances in terms of how I can help encourage more women to become vascular surgeons. Our profession's recent milestones in this shared effort include the following:•The number of women vascular surgery trainees increased 437% since 2007.1ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2007-2008. Chicago: ACGME; 2008. p. 78 and ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2008-2009. Chicago: ACGME; 2009. p. 80 and ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2009-2010. Chicago: ACGME; 2010. p. 65 and ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2010-2011. Chicago: ACGME; 2011. p. 66 and ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2011-2012. Chicago: ACGME; 2012. p. 66 and ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2012-2013. Chicago: ACGME; 2013. p. 74.Google Scholar•The integrated vascular surgery program ranks seventh in the percentage of women residents (after obstetrics and gynecology, pediatrics, dermatology, medical genetics, internal medicine, and physical medicine and rehabilitation), and the number of women increased from 18% to 38% between 2008 and 2013.2ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2008-2009. Chicago: ACGME; 2009. p. 77 and ACGME Department of Applications and Data Analysis. ACGME Data Resource Book Academic Year 2012-2013. Chicago: ACGME; 2013. p. 75.Google Scholar•In 2007, there were 2426 male and 183 women vascular surgeons. In 2010, the number of men increased by 203 and women increased by 40. While the increase is good news, it should be better in light of data that show the number of active male surgeons (including general, neurologic, orthopedic, plastic, thoracic, and vascular surgery) decreased by 988 while women increased by 704.3AAMC Center for Workforce Studies. 2008 Physician Specialty Data Book. Washington, DC: AAMC; 2008. p. 13 and AAMC Center for Workforce Studies. 2012 Physician Specialty Data Book. Washington, DC: AAMC; 2012. p. 14.Google Scholar Progress has been made and more has yet to be achieved. As individuals and collectively as the Society for Vascular Surgery, we have an obligation to make a lasting difference that matters to each of us, to future generations of vascular surgeons, and to our patients. We all must take a chance to do our part in leading the way forward. As leaders of chance and change, we need to be real—act with authenticity and clarify what is important; we need to be whole—act with integrity and respect the whole person; and we need to be innovative—act with creativity and experiment with how things get done.4Friedman S.D. Total leadership: be a better leader, have a richer life. Harvard Business Review Press, Boston2008: 29-149Google Scholar Taking a chance to lead requires finding and knowing your inner voice, listening and attending to others, telling thought-provoking stories, nurturing a shared vision, energizing innovative thinking, and cultivating an organization's creative imagination. Effective leaders inspire through their hearts, as well as minds, by sharing the deeper purpose and meaning of doing good work and serving others. Poetry is an excellent guide for the inner journey that uncovers and strengthens the soulful qualities of truly great leaders.5Intrator S.M. Scribner M. Leading from within: poetry that sustains the courage to lead. Jossey-Bass, San Francisco2007: 1-256Google Scholar Most important, leaders must model the behavior they ask of others. When I was six, my grandfather told me that I could do anything I wanted to do even though some people would tell me I cannot. Every time I give someone a chance, I remember his words and make sure that the chance I provide will help the person do even more than they thought they could do. When I help people pursue chances, I ask them to close their eyes, imagine where they will be in 15 years, and contemplate how they will get there.6Pink D.H. Drive: the surprising truth about what motivates. Riverhead Books, New York2009: 129-152Google Scholar And then I ask them to think about the definitive factor—how do they want to be remembered? I also explain that taking chances involves choice. We can choose to ignore or to take chances for ourselves; we can choose to create chances for others or wait for them to ask; and we can choose to be exhilarated by chances or fear them. Whenever debating a chance, my strongest advice is found in Robert Frost's poem titled “The Road Less Taken.”Two roads diverged in a yellow wood,And sorry I could not travel bothAnd be one traveler, long I stood …I shall be telling this with a sighSomewhere ages and ages hence:Two roads diverged in a wood, and I,I took the one less traveled by,And that has made all the difference. Thank you for giving me the chance to be the first woman to travel the presidential road at the Society for Vascular Surgery. Thank you for creating the chance for us to be brave together in achieving another first for the Society. And thank you from the bottom of my heart for granting me the honor and privilege of being your president. Mark Buckovich assisted with conception and design, writing the article, and final approval of the article.