Be Your Own Varicose Vein Patient Advocate

Be Your Own Varicose Vein Patient Advocate

Recent Letter Sent to Me from a Local Vein Center Looking for a Vein Doctor

I received a letter from a nearby vein center today in search of a vein doctor to replace the previous three vein physicians that they have employed over the past five years.

Their letter emphasized the opportunity (in bold letters) to “make up to $1,500 dollars + per day” and have a “flexible part time schedule”.  No house call, weekends or holidays were also emphasized in bold print.

It gets better.

Please pay attention to the following line from the blanket recruitment letter sent to all of the vascular surgeons in Pittsburgh.

The following requirement that the competing vein center in Pittsburgh wrote as a prerequisite for practicing venous surgery at their center is the most important point that patients can take home from this article.

The most egregious line in the recruitment letter sent to me that all patients must be aware of before setting foot in any vein center was – “Comprehensive training for patient evaluation, treatment and post-care will be provided.”

Are you kidding me?

They don’t give a Tinker’s damn if the doctor that they are hiring is familiar with varicose vein treatments or not. Patients have to know this is going on behind the scenes.

Do unsuspecting patients realize that doctors with any background, training and the motivation to make up to $1500 per day will be performing complex varicose vein procedures on them at this vein center in Pittsburgh?

You Have to Watch Your Back

Just as you must be your own advocate in financial matters, when you seek advice and treatment for your varicose veins, you have to look out for yourself.

For example, when you manage your savings and financial affairs you may seek advice from a financial advisor.

With many financial advisors, there is often a conflict of interest. Your retirement advisor may steer you towards investments that make more money for their firm.

In April 2016, the Labor department issued a new rule known as “fiduciary laws” that make it unlawful for financial advisors to steer customers toward products with higher fees and lower returns.

That means that now financial advisors must look after your interests first before their interests. That applies to retirement funds. Therefore, under the present laws, your financial advisor must not put their interests first.

That may seem evident at first but very often that was not the case. Investment firms are in business to make money. Almost half of their profits go to executives in the form of bonuses at the end of the year.

However, this is the first time that regulations were put in place to stop the obvious conflict of interest in the investment world.

Conflicts of Interest Treating Varicose Veins

If you have varicose veins, you must be your own patient advocate.

Dr. Mark Whitely stated it well and referred to watching out for yourself when choosing a varicose vein center as “carrying the can”. Varicose vein doctors have been known to offer treatments and care that was in their best interest and not yours.

These types of shenanigans have plagued the varicose vein field for the past twenty years. Laser and radiofrequency treatments were FDA approved to treat varicose veins in March 1999 and January 2002 respectively. Subsequently, the floodgates were opened. Surgeons were no longer the only doctors who could treat varicose veins.

Other fields of medicine are reimbursed based on qualifications, experience and board certification in the field in which the physicians practice. This is not true in the vein field.

A doctor who has just finished medical school and obtained their license can attend a three-day conference. The very next day they can perform venous procedures and be reimbursed at the same rate as qualified vascular specialists who have dedicated their training and lives to the treatment of venous disease.

Doctors of all kinds were suddenly “inspired” to the glorious field of ridding the world of unwanted veins.


Vein treatments can be safely and effectively be treated in the office setting. In fact, the office is the preferred place to treat veins. Not the hospital. Hospitals are more expensive, more congested and general anesthesia, which is usually performed in a hospital, is no longer required to treat varicose veins.

So why the sudden inspiration for doctors of all different backgrounds and training to suddenly flood the field of varicose veins treatments?

One reason is that any doctor with a license to practice medicine could.

Hospitals are closely regulated.

Doctor’s offices are totally unregulated. There is no oversight.

Hospitals have credentials committees to determine is a doctor has the proper training and credentials to perform procedures like heart surgery or brain surgery or vein surgery.

There is no one checking a doctor’s credentials or training to perform varicose vein surgery in their private doctor’s office where all vein procedures are currently performed in the United States. There is no mechanism in place to deal with the abuse of unnecessary venous Doppler testing and the unnecessary ablation of normal saphenous veins.

Vein Doctors Attempt to Police Ourselves

Doctors have a duty to review our colleagues and ourselves. When we we fail to monitor those in our midst who have strayed from helping patients, others will do it for us.

One form that this takes is the increasing control of medical insurance companies. Our insurance companies determine medical necessity. They tell us what tests and procedures are covered. They are the modern-day regulators of medical practice.

Attempts by the medical societies to help ensure quality office setting for varicose vein treatments resulted in the formation of the Intersocietal Accreditation Commission for vein Offices.

This IAC regulatory body is the only regulatory body that ensures safety and quality of varicose vein care in the office setting. They are the only agency that inspects varicose vein offices.

We may find ourselves being evaluated and judged by others who have less knowledge of the complexities of medical care and perhaps less compassion for the errors in judgment that all of us occasionally make.

What Else Caused the Boom in Varicose Vein Treatments?

You guessed it.


At first, insurance companies reimbursed these new minimally invasive procedures at inordinately high amounts. This resulted in a tremendous influx of doctors doing them. That resulted in a huge increase in the number of varicose vein treatments. There was a 4,529% increase in the number of varicose vein ablation procedures performed such as laser.

Dr. Peter Lawrence, former president of the Society for Vascular Surgery, attributes this to a significant amount of over treatment.

In my city, a varicose vein franchise sets up tents and passes out “goodies” to entice patients at community health fairs, yoga classes, regattas, senior citizen meetings, and at every event that their field analysts can find. They promise easy procedures that are covered by insurance.

That’s like throwing a net over a school of fish. Almost everyone has some unwanted veins. Enticing people to come in to have them fixed and promising everyone “insurance companies will cover it” is unethical and simply not true.

They advertise that 95% of veins are covered by insurance. That is fraud and deceptive marketing of the low hanging fruit variety. My patients bring up this ad when I tell them that no insurance company pays for the treatment of spider veins since they are cosmetic.

Advantages of Becoming a Varicose Vein Doctor

The following reasons are why inexperienced, untrained and unqualified doctors have flooded into the field of treating varicose veins:

  • There is a huge population of patients in this country with venous disease.  Lots of victims. Over fifty million people in this country have varicose veins. Over one million Americans have venous ulcers.
  • There is no night call.
  • No weekend work.
  • No holidays.
  • No mandatory hospital meetings.
  • Better lifestyle.
  • You can be your own boss.

Doctors value autonomy. You can work independently. Organizing doctors is like herding cats.

Dr. Jose Almeida, a board certified vascular surgeon, gave an introductory speech at his International Vein Conference that he hosts in May 2016. He asked the audience of vein specialists rhetorically, “Does anyone not have a colleague in their home town who is unnecessarily performing unnecessary vein testing and procedures for profit”?

No one raised a hand!

It has become an epidemic.

I see patients who come to see me for a second opinion every week who suspect that has happened to them. Often these patients are correct in their suspicions.

Turning Varicose Veins Treatments into a Commodity

Most patients believe that all vein clinics are the same. Nothing could be farther from the truth.

In this country, we place great value on the freedom of free enterprise. However, doing so comes at a cost in the field of health care. Some vein centers have put profit above the needs of their patients. This has led to an abandonment of values of ideals that we assume are present in all doctor’s offices.

This country’s health care is based on a system called “fee for service”. That arrangement rewards volume of varicose vein procedures. The more vein treatments performed the higher the reward.

Health care has become a business largely motivated by profit. This growth in medical spending and its incentives is unsustainable.  Government and insurance companies are a big part of the problem accounting to politicians and special interests.


Be your own patient advocate when seeking out the best varicose vein care.

All vein centers are not alike.

Spend at least the same amount of time and effort researching your vein doctor and vein center, as you would choosing your next car.

Choose the only varicose vein center in Pittsburgh that has been inspected!

They inspect hospitals, cars, banks, oil rigs, jets and restaurants.

However, vein center inspections (as crazy as it seems) are voluntary except in Massachusetts.

Call us at 724-969-0600 or click here to learn more about the only accredited and inspected vein center in Pittsburgh.

Our board certified vascular surgeon medical director, Dr. John Happel MD, has the longest experience treating and specializing in varicose veins in the city of Pittsburgh.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.