Different medical professionals can treat veins. But they do not all carry the same qualifications, capability, and experience. Many patients come to our office asking about a relatively new specialty called phlebology. A phlebologist is someone who treats a specific subset of vein disorders mainly in the legs. The difference between a phlebologist and a vascular surgeon is very significant. Patients seeking vein treatment should understand the differences as they define what a doctor is and is not qualified as well as trained to do.
Areas of practice (Vascular surgery vs phlebology)
The vascular system consists of arteries and veins. They work together like opposite sides of the same coin. A phlebologist typically only works with veins in the legs and only treat one type of disease (venous disease). They are also limited to only certain vein treatments. For example, a phlebologist may treat basic deep vein thrombosis (DVT) using oral medication. However, a phlebologist is not qualified or sanctioned to perform thrombolysis to treat more serious DVT because it requires special radiology imaging and credentialing in a hospital or surgery center. Essentially, a doctor who is only credentialed in phlebology can only perform simple treatments for varicose veins, spider veins, DVT, and some types of wound care.
A vascular surgeon is an expert with the entire vascular system (veins and arteries) throughout the entire body. She or he is skilled and trained in treating all venous and arterial disease. This includes invasive and non-invasive surgeries like vein harvesting, arterial bypass, carotid artery surgery, vein and artery grafting, angioplasty, stenting, open aortic aneurysm surgery, dialysis access surgery, all vein surgeries, and complex wound care. The significance is that a vascular surgeon has a broader perspective and understanding by working with the entire vascular system and is qualified to perform more than just superficial or cosmetic vein treatments.
Training (Vascular surgeon vs phlebologist)
Vascular surgeons require extensive training. They must attend medical school for 4 years followed by a 5 to 7 year residency program for surgery. Vascular surgeons must then take a specialized 2 year fellowship in vascular surgery. Only after such training does a surgeon qualify to take the vascular surgery board exams. Vascular surgeons rarely start practicing independently after completing formal training and board certification. They typically join a group or hospital and work closely under the wing of other senior vascular surgeons until they are proficient to practice on their own.
A phlebologist, on its own, has no training as a surgeon. To be a board certified phlebologist, a doctor only needs to have a medical license, take a written test, and show certain experience in venous treatment. However, it is possible to waive the experience component with approval by the board. It is important to understand that simply taking a written test does not mean a phlebologist has sufficient training in a surgical specialty or care.
- Training to be a phlebologist should not be confused with training to be a surgeon. Plebology is not a surgical specialty.
- Doctors can obtain training in phlebology through a program or course. But typically, doctors train through an online course or seminar.
- Phlebology, in itself, only trains to treat the most basic symptoms of venous disease and typically only in the legs.
- Phlebology training, in itself, does not provide the training or qualifications to address post operative complications that require invasive intervention or hospital admission.
Certification
Board certification in phlebology is very different than board certification in vascular surgery. In fact, the difference can be confusing and sometimes misleading. Phlebologists utilize the title of “board certified” to claim a certain level of professionalism and training. However, the phlebology credential is provided by a relatively new corporation created in 2007 called The American Board of Venous and Lymphatic Medicine (ABVLM). It should not be confused with The American Board of Medical Specialties (ABMS). ABMS is a well established not-for-profit organization created in 1933 which is the “gold standard” for medical specialist certification. It is the authority that provides board certification for commonly accepted medical specialties like cardiology, radiology, surgery, emergency medicine, and vascular surgery. The ABMS does not recognize phlebology as a specialty.
Summary of phlebology certification requirements
- Phlebology board certification does not require the physician to have any surgical experience.
- A physician can be certified in any of the 24 ABMS specialties to qualify to take the phlebology board certification exam. For example, a psychiatrist or a family medicine doctor may become a phlebologist.
- A doctor simply needs to pass a written exam and show a case log of involvement in any kind of vein treatment to become “board certified” in phlebology.
- Phlebology board certification does not require the physician to be able to admit patients to a health care institution.
- Training to pass the phlebology board certification exam is typically provided via online courses or multi day in-person courses.
- Any of the ABVLM requirements above may be waived if approved by a review committee.
Summary of vascular surgery certification requirements
- Must complete rigorous residency training in surgery. No other residency will qualify to become a vascular surgeon.
- Must serve as a chief resident for 12 months during vascular surgery training.
- Must complete a 2 year fellowship that is accredited by The American Board of Medical Specialties (ABMS).
- Must have performed at least 250 major vascular reconstructions. There are no exceptions or exclusions.
- Must pass a series of multi-day exams. The first exam is an all day written exam. The second exam is an oral exam where a panel of peers evaluate the candidate through a series of questions. The panel evaluates their competency against a national database of other vascular surgeons.
- Must hold full surgical privileges at an accredited health care institution.
Surgical Capability and License
The qualifications and requirements for a vascular surgeon are vastly different than those of a phlebologist. However, this does not mean that a phlebologist is not skilled at treating some vein disease. Capability becomes an issue when phlebologists are limited because they are not surgeons. They are unable to take complex cases to the operating room. This can create pressure to perform procedures in the office when it may be better to perform them in a hospital or surgery center. Because phlebologists are not licensed or trained to fully manage post operative care on their own, they must send patients with complications requiring invasive intervention to the emergency room where a vascular surgeon or other qualified surgeon can attend to the patient.
Other specialists that treat veins
There are other board certified specialists by the ABMS who manage vein treatment. Cardiologists, dermatologists, and international radiologists who are board certified under ABMS all undergo extensive training and certification. They must complete residency programs in their respective fields as well as take rigorous tests to become certified. These specialties are highly trained. However, they are not surgeons and typically gain their surgical expertise in vein treatment through supplementary training.