On the Nature of Turf Wars: Disruptive Technologies Did It!

When offered the position of Editor-in-Chief at VDM, I was told that I would have a great deal of freedom to generate my imprint on this publication, and a few privileges; perhaps a little glamour as well. I was also given the “power” to over-rule (if necessary) manuscript reviewers and make some decisions of my own — provided they were rational and based on compelling reasons. Well, I finally found something worthy of such a stance! The article by Baerlocher, et al. on uterine artery embolization was submitted to VDM and put through the usual peer-review process. The assigned reviewer found it good and interesting, but concluded that the subject would not be of much interest to the VDM readership. When confronted with the issue, and after carefully reading through the paper, I said to myself, “The opportunity to act like an editor-in-chief has finally arrived!” So here we are. I don’t know just how you — the reader — will react to it, but I would encourage you to read the piece critically, and at least twice. It contains a plethora of rich and well thought-out concepts and definitions that are not readily available. Turf wars are a huge reality in 21st century vascular medicine, and I think Baerlocher et al. have very succinctly and with utmost clarity put their finger on the precise etiology! “Disruptive technologies” have done it, clearly! And it will continue to happen in the foreseeable future. This is especially true and likely as limited-skills specialists continue to populate the ranks — those are, specialists who possess, by training background and practice, a relatively “limited” set of skills. Surgeons in particular! Who would have predicted, even just a few years ago, that CT surgeons would be ever described (or defined) as specialists with limited skills?! Vascular surgeons are not far behind… What’s happened here?? Well, they’ve been “disrupted” by the emergence of new technologies that threaten to overtake the old standards of care. Technologies that require new and different skills and training which are a world apart from the “time-honored” conventional approaches and techniques used by specialists who continue to view such patients and pathologies as their “God-given domain.” What’s at stake? Everything! Self-respect, power, money… And it is an unbelievably ego-bruising thing to have happen. Some of you reading this piece may feel differently. You may say to yourself, “The writing was on the wall long ago! This thing is largely self-inflicted,” and I would agree! I started doing percutaneous transluminal angioplasty (PTA) [for superficial femoral artery (SFA) and iliac artery stenoses] in 1987 — as a vascular surgeon, that is! I don’t know what I would have done as a CT surgeon, but I sense that — at a minimum — I would have explored percutaneous transluminal coronary angioplasty (PTCA) and questioned the stand-by role in the 1980s! At the same time, I must recognize that each and every specialty brings a unique set of skills and patient treatment capabilities to the table. It is not possible (or even realistic) for everyone to be re-invented into an all-knowing, all-adopting vascular or cardio-vascular specialist. In closing, let me just state — in case any one is in doubt — that the future of vascular and endovascular medicine does not belong to any one group or specialty in particular. But it is undeniable that those physicians who have positioned themselves well, — through skills and appropriate open-mindedness will maximize their opportunities for predominance and success in the challenging and somewhat “hostile” new vascular world of disruptive technologies…