These days, a vein doctor can just about be anyone with an MD or DO degree.  And with the way things are going with deregulation,  it may not be surprising to see an NP or PA led vein clinic in the near future.  Let that sink in for a moment. Because there is no formalized training program for vein disease, practitioners with little or no vascular experience are performing vein procedures based on little more than industry-sponsored weekend courses.  As such, a vein doctor is not what you necessarily would always consider as someone with years of dedicated practice or training. Obviously, there should be concern about this and the training of some vein doctors to perform these endovascular procedures.  Understanding proper endovascular techniques and managing safe delivery requires years of supervised training. Patients need to objectively evaluate each vein clinic for how their doctors are credentialed and what training experience they have. For the most part, this requires doing your own research on who is the best vein doctor for your care.

The type of physician managing varicose vein and spider vein disease can be divided into 3 categories:

• Vascular Surgeon
• Vein Specialist
• Phlebologist

Vascular surgeons possess formalized training backgrounds in the management of vascular disease, both arterial and venous.  Vascular surgeons must complete 5 years of general surgery training followed by 2 years in sub-specialty training for vascular medicine.   In doing so, vascular surgeons undergo rigorous training in the diagnosis and management of surgical disease including endovascular, minimally invasive techniques.  Cardiology and interventional radiology fellowships often work in collaboration with vascular surgery programs to provide in-depth training for trainees. With the completion of the training program, vascular surgery fellows will be tested for ABMS (American Board of Medical Specialties) board-certification to demonstrate their competency in the management of venous and arterial disease.  This includes recognition as a board-certified expert to diagnose and treat varicose vein disease.

Advantages of Vascular Surgeon:

• Board-certified vascular specialists with completion of intensive residency and fellowship training for vascular medicine
• Best-suited to manage both simple and complex vein disease due to breadth of training
• Can provide complete care for both pre and post-procedure management
• Maintain hospital privileges for vascular medicine (Hospital accreditation for vascular medicine is based on board-certifications in ABMS-only recognized specialties)

Need to Consider:

• Every training program has different exposures to endovascular treatments.  Varicose vein disease is now managed with minimally-invasive techniques rather than vascular surgery.  Be certain that your vascular surgeon treats vein disease with modern, non-surgical techniques when appropriate

Phlebologists have varied backgrounds including general surgery, internal medicine, pain management, cardiologists and even vascular surgery.   The American Board of Phlebology was only established in 2007 with the goal of setting standards of vein practice but is not recognized by the American Board of Specialities due to the lack of a formal training program associated with its board certification. Phlebologists with this certification do not need to complete any formalized training programs in vascular medicine but can obtain “board-certification”  simply by passing a written test. Unfortunately, this is not enough to demonstrate competency with procedures that is gained only from formal vascular training in vascular surgery, cardiology or interventional radiology. Other residency programs including internal medicine, pain management, and family medicine simply do not provide this level of training as it is outside the scope of their practice. As such, board certification in phlebology or ABVLM (American Board of Vascular and Lymphatic Medicine) does not imply the completion of formal training in vascular medicine.  Phlebologists without training in either vascular surgery, cardiology or interventional radiology should not be automatically assumed as vascular specialists.

Advantages of Phlebologists

• A limited number of physicians who have additionally completed formalized training programs in either vascular surgery, interventional radiology or invasive cardiology.
• A written test is rigorous and does test the physician on knowledge (not skill).

Need to Consider 

• Phlebologists should be examined for backgrounds in ABMS recognized specialties such as interventional cardiology or vascular surgery
• A written examination is the only requirement for obtaining ABVLM certification
• Phlebologists with incomplete training are not required to be experts in vascular management

A vein specialist is a term used by many practicing vein doctors with varied backgrounds similar to phlebologists.  Again, it should be emphasized that vein specialists should have ABMS recognized board-certification in one of three specialties: Invasive cardiology, vascular surgery or interventional radiology to demonstrate the highest level of competency in vascular disease management.  ABVLM board-certification or alternatively board certification in non-vascular specialties such as internal medicine, family medicine or dermatology do not include supervised training for endovascular procedures or its potential complications. And while modern varicose vein treatments are no longer surgical, this does not imply that a trained vascular specialist is not recommended.

Advantages of Vein Specialists

• Vein Specialists are ideally ABMS board-certified in either vascular surgery, invasive cardiology or interventional radiology
• Interventional specialties possess unique skills for minimally-invasive techniques learned during rigorous training programs
• Maintain hospital privileges for vascular procedures (Hospital accreditation for vascular medicine is based on board-certifications in ABMS-only recognized specialties)

Who Is The Best Vein Doctor By Specialty?

If you have varicose veins or chronic venous insufficiency, the best vein doctor to see is an ABMS board-certified specialist with a focus on varicose vein disease. The physician you select should have specialty-specific training in vascular disease.

It’s true that not all vein doctors are vascular surgeons, however considering that vascular disease management requires a significant amount of experience and skill, we recommend you consult only with formally trained vein doctors with board certification in either vascular surgery, interventional radiology or interventional cardiology.