Hail to the Chief: Dr. Ron Dalman

This article is part of a series of interviews with Stanford Surgery faculty who were, are, or will be presidents of surgical societies. Dr. Ron Dalman is Chief of the Division of Vascular Surgery at Stanford University and the newly sworn-in President of the Society of Vascular Surgery.

Rachel Baker: Why did you become involved in the Society for Vascular Surgeons?

Ron Dalman: The Society for Vascular Surgery is the oldest surgical society dedicated to the advancement of vascular surgical techniques and comprehensive vascular care. 2021 represents its 75th Anniversary; the founding meeting occurred at the Fairmont Hotel in San Francisco in 1946. Today, the SVS’s 6,000 members bring high-quality vascular care to their patients in 50 countries around the world.

As an academic surgeon, you not only want to help your patients, but also improve surgical care and train the next generation of surgeons. Being part of this organization allows me to do all these things but on a much larger scale.

The organization maintains a full-time lobbying firm in Washington D.C. in partnership with the American College of Surgeons, produces a suite of professional publications under the Journal of Vascular Surgery banner, and maintains the world’s largest registry of vascular surgical procedures. We conduct the Vascular Annual Meeting, support the Association of Program Directors in Vascular Surgery, provide on-line and in person courses in surgical techniques, procedural coding, practice management, and maintain on on-line library of education materials in our Learning Management System.  We produce guidelines (e.g. “Care of the Patient with Abdominal Aortic Aneurysm Disease), acceptable use criteria (AUCs), reporting standards for treatment outcomes for specific conditions, and consensus statements, among other reference works.

RB: Wow! That’s a lot. And you’re President of all that? How did that happen?

RD: Stanford has a long history of leadership in the SVS. I’m the 5th President of the SVS from Stanford, starting with Emile Holman (founding SVS member and 3rd president, 1949), followed by Frank Gerbode (1958), Tom Fogarty (1995), and Chris Zarins (1999).

In regard to process, currently about 50% of professional medical societies elect their officers, with the remainder being appointed by some alternative process. I was appointed Vice President by a vote of the SVS Nominating Committee in the Spring of 2018, and subsequently advanced through the roles of President-elect and now President beginning in July 2020.

In an ongoing effort to improve diversity, equity and inclusivity in the SVS, the membership this year voted to amend the bylaws to allow for a popular election of at least two candidates for every office, selected by the Nominating Committee. So, the process is undergoing significant change. 

RB: Is that in response to the recent BLM events?

RD: The SVS came out with a strong statement affirming the sanctity of black lives and denouncing police brutality shortly after George Floyd’s murder. We, through our Leadership and Diversity Committee and Diversity, Equity and Inclusion Taskforces (both running since well-before the current crisis) are working to ensure that the SVS supports all members in their career aspirations and educational needs. Through our Resident and Student Committee we are working continually to recruit underrepresented minority students and general surgery residents into residency and fellowship positions in vascular surgery to help improve care for all patients with vascular disease. Through our Appointments Committee process we strive to improve diversity and inclusion on all our committees, writing groups, task forces, and leadership positions.

Later this fall, we are publishing a diversity supplement in the Journal of Vascular Surgery. This is intended to examine all aspects of access to care, disparities in disease burden and outcomes of treatment between the races, educational disparities related to vascular surgeons in training and practice, hurdles in career advancement, and surgeon wellness issues related to racist policies and their consequences. We also will integrate some or all of the developing Stanford Cultural Competency Curriculum in this year’s SVS leadership retreat. 

Legislatively, we are working with our supporters in Congress to improve access for under-represented minorities to quality vascular care throughout the nation. We also recently created a video that highlights the diversity of our membership and the communities that we serve.

We acknowledge that many of these processes and policy changes, no matter how well-intentioned, are only a down payment on continued efforts to remove racist policies and structural impediments to equity and inclusion in health care. I intend to make diversity, equity and inclusion within the SVS a significant focus of my presidency. 

RB: What else do you hope to accomplish during your term?  And how has COVID-19 affected those goals? 

RD: The novel coronavirus completely changed my focus; it reduced travel and meeting participation to zero. In the complete absence of in-person professional meetings this year, we are continuing to iterate and perfect our on-line learning platforms to maximize the ability of our membership to stay abreast of scientific and clinical advancements in vascular disease management. 

The pandemic also greatly increased focus on SVS operations, member services and sustaining member’s practices given the unprecedented financial and logistical challenges we all face. As President I’m focusing on supporting our membership during extraordinarily difficult times, both in maintaining their practices and ability to provide care to their patients, as well as ensuring equity and diversity throughout our organization and, to the greatest extent possible, the environments where our members work.

Independently of COVID:

1)    We are working with 11 other medical specialties to forestall or eliminate significant reductions in procedural reimbursement for Medicare beneficiaries.

2)    We are working with peer organizations like the American College of Cardiology and the Society for Vascular Medicine to harmonize our efforts in quality, outcomes reporting, AUCs and guidelines creation.

3)    We are working with ranking organizations like Vizient and US News and World Report to highlight the status of Vascular Surgery as an independent specialty.

4)    We are preparing our membership to thrive in an era of population health rather than fee-for-service reimbursement by creating holistic outcome metrics that capture global health status and patient reported outcomes rather than strictly surgical outcomes.

RB: You mentioned collaborating with other specialties on Medicare reimbursements. Do you work with other surgical groups often?

RD: The SVS actually shares our building in Rosemont, IL with the American Academy of Orthopedic Surgeons (AAOS).

Many pioneering cardiovascular and transplant surgeons were founding members of the SVS, including Michael DeBakey and John Gibbons, the latter generally recognized as the originator of cardiopulmonary bypass. Interestingly, Stanford’s Roy Cohn and his surgical resident Samuel Kountz were regular contributors to the program of the SVS Annual Meeting in the late 1950s, early 1960s, reporting on their innovative experience with kidney transplantation between non-related donors and recipients, work which later enabled Kountz to become a world-wide leader in kidney transplantation at UCSF. The commitment of these pioneers to perfecting vascular surgical technique is immortalized in the name: the Society for Vascular Surgery (as opposed to “of,” as is commonly used in the Society of Thoracic Surgeons or the Society of University Surgeons, etc.). 

RB: Vascular surgery is a rapidly growing and evolving field, how do you stay on top of the latest technology?

RD: Actually, nearly the entire first floor of our Headquarters with AAOS is dedicated to surgical simulation, with state-of-the-art facilities currently used for surgeon training for new procedures by medical device manufacturers. For example, Silk Road Medical in Sunnyvale, has trained more than 500 vascular surgeons in their TCAR (transcervical carotid artery revascularization) procedure at the facility in Rosemont since it was approved by the FDA a few years ago. The SVS will also begin specialty post-grad training courses there later this year. 

RB: What qualities do you think make a good leader? 

RD:
• Ability to prioritize the interests of the group above those of yourself.
• Achieve change through building consensus.
• Encourage others to broaden their view of controversial situations and constituencies.
• Look beyond the cycle of personal responsibility (e.g. presidential term) to understand and promote the long-term best interests of the membership.
• Advocate for optimal patient care and societal value in harmony with member’s interests.
• Seek advice from experts on every topic, admit mistakes, encourage discussion, set goals, stay the course on existential issues regardless of difficulty or doubt.
• Maintain balance and grace in all interactions as the public face of your organization.
• Encourage, promote, and resource those you are leading to succeed in their own endeavors.
• Know when to step forward, and when to step back.