Grounds For Appeal ABVS Application

January 2005

The grounds for the appeal based on procedural issues include the following:

1. The American Board of Vascular Surgery satisfies all the criteria for approval as a  member examining board of ABMS.  No specific information to refute this has been forthcoming.

On December 18, 2002, the LCSB held a meeting to hear from the ABVS and representatives of the ABS.  Subsequently, Vascular Surgery received a letter dated December 20, 2002 from the LCSB Secretary, Dr. Miller, stating that the application was denied.  No details regarding the basis for the LCSB’s actions were provided as to whether their conclusion was a result of a split or unanimous decision, or if failure to meet one or all twelve of the ABMS criteria to become an independent board were the basis for the application’s denial.  Subsequently, a written request was sent to Dr. Miller asking for an accounting of the decision that would allow a reasoned decision to be made regarding an appeal.  The following one paragraph written response from Mr. Miller, dated December 30, 2002, was received:

“I am unable to provide more specific shortcomings of the application of the American Board of Vascular Surgery.  The LCSB decision was based on a totality of criteria elucidated in the Eleventh Revision of Essentials for Approval of Examining Boards in Medical Specialties, Sections IV, Criteria for Approval of New Examining Boards.”

When minutes of the meeting were requested by the ABVS and reviewed they revealed an even briefer statement that the application was rejected (with no details).

This lack of openness by the LCSB committee is troubling and challenges the integrity of the process.  As an applicant for a new specialty board we were asked to expend thousands of hours and dollars for recognition by the two organizations through this AMA and ABMS committee.  We were asked to address in exquisite detail the twelve essentials for a new board.  In response we received the aforenoted two sentence answer that makes no specific reference to the essentials or any other criteria.  This process is flawed and inappropriate for any organization representing the public interest.

2. Basic fairness supports the appeal.  LCSB’s procedures have not resulted in basic fairness here.

a. The LCSB erred in failing to allow the ABVS the opportunity to know of the objectives lodged by opponents to the application, so that a meaningful assessment of issues could be forthcoming.  The rule of proceeding did not even allow ABVS representatives to attend the portion of the LCSB meeting where an incumbent board (the ABS) presented its opposition.  We had no opportunity to respond, or even to know of the objections.  The ABMS representatives to the LCSB included a general surgeon and past ABS Director who should have reused himself from the hearing to avoid what represents a major conflict of interest.

b. The LCSB has declined to provide us with a statement of the specific reasons for the denial of our application, so that we could frame a meaningful appeal.  The LCSB has thus failed to provide the notice required by the most basic due process.  A subsequent request to the executive committees of the AMA and ABMS resulted in no change in the lack of response from the LCSB.

c. The LCSB’s procedures protect incumbent boards and their certificants from competition at the expense of the public interest and thus violate federal and state antitrust law.

3. Our specialty supports the appeal.  The support for ABVS recognition is widespread.  In an independent poll conducted by Deloitte and Touche in 2001 of all American vascular surgeons, 66% of all respondents and 79% of all respondents in practice less than 10 years, affirmatively agreed to the question: “Should Vascular Surgery seek an ABMS approved independent specialty Board at this time?  This poll was undertaken upon the advice of a previous ABMS Executive Director, who stated that a less formal survey or individual correspondence would not represent an accurate measurement of professional opinion.

Furthermore a repeat poll in 2004 prepared by Deloitte and Touche resulted in confirmation of ABVS support.  Among all representatives 76% supported formation of an ABMS-ABVS, including 77% of Directors of Vascular Surgery Training Programs of the Association of Program Directors in Vascular Surgery.  Lastly, the Council of the major vascular surgery learned organization, the Society for Vascular Surgery, has confirmed its financial support of the ABVS.  We are aware of no evidence contradicting this showing.  Anecdotal and outspoken criticism of the ABVS by a minority of surgeons without regard to public needs does not rebut the showing of broad specialty support.

The ABVS believes the LCSB was unduly influenced by such criticism.  It is noteworthy that one-third of the current ABVS Directors have served as President of our major national vascular society, and all existing national and regional vascular societies have representatives as sitting Directors.

4. ABMS interests and tradition support the appeal.  There can be no doubt the ABVS is legitimate in every sense.  Its leaders are respected academicians and have many years of experience in testing the qualifications of surgeons.  Failure to include legitimate certifying boards under the ABMS umbrella will inevitably fuel the movement for non-ABMS boards to achieve recognition by state medical boards as an ABMS-equivalent.  The ABVS supports the ideals of the ABMS and would prefer to function within the ABMS.  It is noteworthy that all other surgical specialties having reached the maturity of Vascular Surgery have established ABMS Boards.

Approval of new specialty boards is one of the primary responsibilities of the AMA and ABMS as expressed through the LCSB.  The public has accepted the idea that medicine will be self-governing in this area.  This trust is predicated on the assumption that the organizations representing medicine will act in the public interest.  The AMA and ABMS have a responsibility to the public to demonstrate that the decisions they make on the public’s behalf are fair, objectives as possible, and based on clearly stated facts.

5. Science and the public interest support the appeal.  Medical evidence unambiguously supports the application.  Patients experience significantly better outcomes from surgeons with specialty training in vascular surgery.  Such specialty training requires an accessible career path that facilitates such training, like the paths established for many other ABMS approved surgical specialties.  The incumbent board opposing our application has not addressed the issue of training and certifying adequate numbers of vascular surgeons to care for the public.  General surgery’s attempts to head off the issue by restructuring its general surgery training programs have not been perceived as feasible by Program Directors in either general or vascular surgery, and will have no visible impact on workforce needs.  We believe it is likely that our detractor’s presentation did not appropriately inform the LCSM of this fact.

How can the public determine how decisions are made by medical organizations?  The primary means is by examination of the reasons given for their decisions.  Are they based on logical and factual assumptions?  Are they related to established criteria proclaimed by these organizations?  Are those criteria reasonable?  These questions raised by the ABVS are impossible to answer because the LCSB has not articulated the reasons for its recent decision.  We would assert that this is ethically and procedurally unacceptable.