Varicose Veins Pittsburgh – Opposing Approaches to Vein Care

Varicose Veins Pittsburgh – Opposing Approaches to Vein Care

Tips to Help You Choose a Vein Center in Pittsburgh

The following scenarios are actual examples of how differently you are treated in two contrasting methodologies used in Pittsburgh varicose vein centers.

Many people feel that all vein places are the same.

So they just pick the closest.

Let’s pull back the curtain and see what really goes on behind the scenes.

I think you will find the truth quite revealing and actually quite shocking.

The first approach to vein care is the franchise approach.

The second is the traditional one physician/patient approach.

Let’s take a closer look.

Varicose Vein Scenarios Available in Pittsburgh

Situation #1 – You enter the consultation room. A female assistant (of some kind) greets you. You have no idea about their training or background. She wears the white coat. She doesn’t inform you of her qualifications. She looks at your legs briefly and tells you that you need a Doppler test on your veins. She orders a medical test without a doctor even evaluating you. You get the test done. Someone else informs you that you need multiple procedures done. You never see a doctor. Finally, on the day of the procedure, a doctor shows up. He or she does a procedure. You never see him or her again. They tell you that you need a few more procedures. You don’t understand why. Other assistants perform those procedures. You feel unsure that the lack of continuity of care may not be optimal to your care. You leave concerned and unsure. You feel like a number in their caseload.


Situation #2 – You enter the consultation room. Dr. Happel, your vascular surgeon, greets you. He seems nice. His qualifications as a fellowship trained vascular surgeon are made clear to you. He informs you that you are in the only inspected and accredited vein center in Pittsburgh. You breathe a sigh of relief. He examines your legs. He himself, being a certified vascular ultrasound technician performs a complete Doppler examination of your veins. He does not delegate any of your examination or your treatment to anyone else. In ten minutes, he shows you the problem and clearly discusses the treatment plan in words that you can easily understand. There is no rush. He follows you through with your treatment personally performing all of the necessary procedures himself. You feel confident being treated by a varicose vein specialist with over thirty years of experience. He has been in control of the diagnosis and treatment of your varicose veins from beginning to end. You leave feeling grateful and relieved.

The franchise gang approach is all about getting things done quickly.

In and out. Car wash style.

It’s more efficient and cost effective for a vein franchise if they don’t have to pay a doctor except for the procedure itself.

It’s much cheaper and cost effective for them to have a nurse or medical assistant to talk to you instead.

People never see the doctor during the consultation or after the procedure.

Patients who come to see me for a second opinion after this type of mistreatment, say they “felt uncomfortable” with the other office.

After the in and out rush treatment, they can’t tell me the other vein doctor’s name or even the name of the other place.

That’s because they never even got a chance to see the doctor.

It’s faster and more cost efficient for the vein franchise.

“Speed and efficiency do not always increase the quality of life.”

– Robert Fulghum from All I Really Need to Know I Learned in Kindergarten

 Varicose Vein Doctor Tells All – and It is Not Good

As an example of what else goes on behind the scenes in the vein world in Pittsburgh, I am including an excerpt from a letter that I recently wrote to a primary care physician after seeing a patient who came in for a second opinion.

I have written this kind of letter countless times to try to stop these kinds of abuses.

Here it is.

Dear Doctor:

Your patient requested that I send you a letter regarding her second opinion with me.

When your patient presented to my office, we had quite a lengthy consultation. I listened to all of her detailed concerns. I closely examined her legs in the standing and sitting positions.

Then I personally performed a venous reflux examination of her great saphenous veins – at no additional charge – to determine if her original Doppler done at the previous office was legitimate. I hold both the RVT and RPVI certificates and am credentialed to both perform and interpret vascular ultrasound.

Her left great saphenous vein was entirely normal on Doppler exam. There is absolutely no reflux in this very small and obviously normal vein.

The report from the other vein doctor’s office of very severe reflux, (greater than 4 seconds of reflux) on this left great saphenous vein was deliberately falsified, in my opinion, to justify the recommended ablation of that normal vein.

Her right great saphenous vein did have reflux but there are only spider veins in her right ankle and foot. These spider veins are of no clinical significance. Her only symptom in her right leg is substantial right knee pain for which she receives injections by her orthopedic surgeon.

I unequivocally concluded that your patient has no venous symptoms of any clinical significance.

Your patient does not require any venous procedure at all.

She has no varicose veins and has absolutely no symptoms of venous insufficiency.

Any laser treatment of a completely normal left great saphenous vein and of the asymptomatic right great saphenous vein – on this frail and elderly patient – would be a huge disservice and be completely unnecessary.

The other vein doctor who gave the original opinion recommended two unnecessary saphenous vein ablations.

The problem of dishonest physicians motivated by greed in the venous field has become pervasive.

Respected vascular surgery leaders have repeatedly condemned these kinds of misconduct across the country resulting in the creation of the new accreditation of vein offices by venous societies as an official response to attempt to stop these abuses. My vein center is the only accredited vein facility in Pittsburgh.  We have passed an on-site physical inspection and currently getting our reaccreditation.

Profit driven doctors indiscriminately eradicate saphenous veins without concern for the well-being of the patient. As you know, cardiac and peripheral vascular surgeons value the saphenous veins as bypass conduits.

In addition, many press, radio and TV ads and so-called “screenings” by these types of doctors entice patients to have unnecessary procedures.

Vascular surgeons throughout the country have repeatedly seen patients who were told that they need their saphenous veins ablated after a duplex scan performed by some fly by night lab, yet when we repeat the study, it’s normal.

Are those physicians simply uneducated or are they committing fraud, and even more seriously, physically abusing the patient?

If they cheat by performing unnecessary saphenous ablations, what else are they doing fraudulently? Invasive cardiologists are discovering that there are a whole lot of arteries other than the coronaries just waiting to be dilated and stented whether they need to be or not.”


John Happel MD

The biggest problem with abuses of unnecessary procedures and testing in the vein field is that there is no risk of punishment if caught.

There is no peer review.

The IAC, state medical societies, and calling the offenders have proven useless. Instead what is happening is that insurance companies are cutting benefits to retaliate for the massive influx of new claims from these types of operations.

These vein franchise places always offer vein screenings. They are great enabler of inappropriate care.

Is a free vein screening really free?

Read more about why vein screenings are a disgrace and should be outlawed.

Vein Franchise Have a Lot of Mouths to Feed

No wonder they need to advertise.

They need a wide net.

They devalue the field of medicine by heavily marketing above improving health.

In franchised vein centers there are:

  • field-marketing representatives
  • clinical regional office managers
  • revenue cycle technicians
  • directors of IT or an IT help desk managers
  • patient services managers
  • corporate administrators
  • directors of marketing
  • an office of business development
  • representatives at multiple offices in half a dozen states
  • dozens and dozens of billing people

That’s literally hundreds of employees that don’t have anything to do except perpetuate their business model.

Should varicose vein centers even have field marketing reps and managers who are in charge of setting up tents to entice prospective unwary patients wherever possible?

Should vein centers set up tents at senior events, wine tastings, gyms, and regattas?

These are more than just veiled forms of advertising. It is blatant crass marketing that drives up medical costs unnecessarily.

 Really Scary Varicose Vein Clown Doctors in Pittsburgh

Web sites whose vein doctors are described as being “board certified” are comical.

Creepy clowns, lurking around somewhere in plain sight.

Scary? Not really if you know the following truths.

Their marketing firms are trying to pull a fast one.

Many people assume they are board certified in vascular or vein disease when they are not. If you look closer they are really board certified in emergency room medicine, family practice or radiology.

These are unqualified docs with deceptive board certification in other specialties besides venous disease.

There is also deceptive marketing by rogue non accredited boards like The American Board of Venous & Lymphatic Medicine. It is not a member board of the American Board of Medical Specialties (ABMS) so is not a board at all.

These doctors state that they are diplomats of this pseudo board/college to give their credentials an aura of credibility and authority.

It is a sham and a hoax.

Google your Vein Doctor

There is a digital footprint of all doctors that you can learn from. Check out their qualifications and experience on LinkedIn. All vein doctors are not the same.

Find out if the entire vein center is accredited or if it has been inspected. The IAC Vein Clinic commission is the only regulatory body for safety and quality in the vein field.

They inspect cars, planes, hospitals and restaurants don’t they?

Why should the vein center that you choose be excluded and slip under the radar?

Do not let unqualified and untrained vein doctors take advantage of the unregulated office environment where there is no oversight at all from government or consumer safety groups.


The incentives for misconduct are huge and the risk of being caught and punished are minuscule.

Only by writing about this and educating the consumer can these types of practices and abuses be made public.

As a fellowship trained board certified vascular surgeon with over 30 years of experience specializing in veins, you can know that you’re in excellent hands because education, experience, and specialization matters.

So how important is it to see a true vein specialist with over three decades of experience?


Our approach is the traditional doctor/patient relationship from the minute you first walk into the office until completion.

We don’t have literally hundreds and hundreds of employees behind the scenes. At our office, Dr. Happel and his staff will recognize you and call you by name when you visit.

Experience the difference by calling us today at 724-969-0600 or click here for more information.

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.