Intro: Dr. Kyle Reynolds, is a vascular surgeon at the MedStar Heart & Vascular Institute specializing in the treatment of peripheral arterial disease. Having grown up in an underserved community, Dr. Reynolds understands how feeling heard and supported in healthcare settings makes a world of difference for patients. He makes treatment decisions collaboratively with patients to suit each individual's life and goals. Passionate about limb salvage and addressing disparities, he remains active in research, focusing on advancing care for those most affected by vascular diseases. In our latest interview, Dr. Reynolds shares his insights on the challenges and innovations in treating vascular diseases, the importance of early PAD awareness, and his approach to balancing professional and personal passions.
When you think back, either during fellowship or immediately after, was there a clinical subject matter or therapy area that you wish you were taught or had more experience in?
I was really fortunate to have my training at MedStar, a program where we just did a lot of everything. That vast exposure was a beautiful thing because it gave me the ability, as an attending, to feel comfortable operating in various spaces. As a first year attending, I performed some complex aortic procedures including a TAMBE as part of the trial, along with open aortas, carotids, deep venous cases, and of course, complex lower extremity cases, to doing what I am most passionate about, which is working on complex lower extremity cases and in deep venous systems. However, one therapy we didn't focus on until I was graduating was the treatment of pulmonary embolisms.
We were heavily involved in Deep vein thrombosis (DVT) management along with iliocaval reconstructions. but the pulmonary embolism (PE) space, at the time, was managed by our colleagues in other specialties. That changed as I became an attending, so getting ready to do PEs required that I learned a lot. I had to work with my mentor to learn that space, the different devices, and all the tips, tricks, and pitfalls. I thought to myself, “Hmm, okay, this is very different and something new to start learning.”
Do you see more programs focusing on PE work now versus 5-10 years ago?
Definitely. It is interesting to see at different meetings attended by more than one specialty, the variability on which team is involved at different hospital systems. Sometimes it is interventional radiology (IR), or interventional cardiology, or vascular surgery, or a combination. It changes. Even though it changed for us, many vascular surgeons aren’t necessarily as present in this space or managing this disease pathology like we are in our hospital system. Still, as proceduralists become more familiar with some of the newer larger bore devices that weren’t present 10 years ago, it has become more prevalent in vascular surgery training.
You've been involved in research across various areas like iliocaval reconstruction, limb salvage, and carotid work. How would you advise younger physicians in residency or fellowship to engage in more clinical research?
It might sound monotonous, but I think when you first start managing your patients, getting your rhythm and achieving good outcomes should be your priority before diving into clinical trials.
With that said, I was fortunate to get involved in research early on. Two key factors were focusing on what I was passionate about and always asking questions about new technologies and future directions. Picking something you are genuinely interested in makes a big difference because your enthusiasm shows. It’s also crucial to have enough case volume to support your research. If I’m not comfortable with something or it's not a part of my practice, I wouldn’t start my research there. But in areas where I’m heavily involved clinically, I naturally begin to ask how things can be improved and what changes can be made. This curiosity helped me form the right questions for research.
Building relationships with industry is also beneficial. For clinical trials, having strong industry ties and a site that can support the trials is essential. There are many components to this. Starting as a sub-investigator to your site for trials can teach you a lot. If you have a mentor or someone who is the primary site investigator at your site, collaborating with them can help you learn and grow in your research capabilities. Having mentors or collaborating with others for your own research is also helpful, especially if you’re new to research.
When it comes to treating calcific plaque in the arterial system, which is increasingly prevalent and hard to treat, do you have a default algorithm for how you approach it?
For calcified plaque areas, I tend to use intravascular lithotripsy (IVL).
My experience with IVL began with popliteal artery calcified lesions, especially behind the knee, where you don't necessarily want to place a stent. Although there are special stents for this segment I still believe it is beneficial to have other options. When it comes to surgery I always think about the long-term plan—what are my options for this patient in the future since I'll be continuing to care for them. With regards to SFA lesions, depending on the lesion and its morphology, I try to “leave nothing behind” and stent provisionally. I'm not one to place a stent right away for every lesion.
In order to take this approach and achieve good outcomes, I started using IVL in many calcified vessels, along with a drug-coated balloon (DCB) to help improve patency. We’re starting to see from industry sponsored and real world data, that with appropriate vessel prep using different devices followed by DCBs, we can achieve great patency rates even in calcified vessels. IVL helps decrease dissections in calcified vessels, one of the top determinants leading to bail out stenting.
I fully realize every patient is different. But taking the example of a calcific lesion in the popliteal artery, if you start with IVL, will you typically follow it up with atherectomy if you can't get the luminal gain that you're looking for with IVL? At one point will you use other therapies?
This is a very long topic, one that needs a dedicated PowerPoint presentation with a flowchart, "If this, then maybe this; if that, then maybe this.”
I primarily use intravascular ultrasound (IVUS) to examine the lesion morphology. If it's concentric, I'll start with IVL. My main goal with IVL is luminal gain while avoiding vessel dissection and with IVL this usually gives a residual stenosis of less than 30%.
As you mentioned, however, sometimes it doesn’t. If there is an eccentric, protruding plaque lesion, or if a concentric lesion still has significant residual stenosis which is a top predictor of reintervention in one year, then atherectomy, especially directional atherectomy, has a role to help with luminal gain. As every patient is different, anatomy and risks such as embolization have to be considered and it may be better for the patient to undergo an open intervention. That's the beauty of being able to perform open surgery.
Intro: Dr. Kyle Reynolds, is a vascular surgeon at the MedStar Heart & Vascular Institute specializing in the treatment of peripheral arterial disease. Having grown up in an underserved community, Dr. Reynolds understands how feeling heard and supported in healthcare settings makes a world of difference for patients. He makes treatment decisions collaboratively with patients to suit each individual's life and goals. Passionate about limb salvage and addressing disparities, he remains active in research, focusing on advancing care for those most affected by vascular diseases. In our latest interview, Dr. Reynolds shares his insights on the challenges and innovations in treating vascular diseases, the importance of early PAD awareness, and his approach to balancing professional and personal passions.
When you think back, either during fellowship or immediately after, was there a clinical subject matter or therapy area that you wish you were taught or had more experience in?
I was really fortunate to have my training at MedStar, a program where we just did a lot of everything. That vast exposure was a beautiful thing because it gave me the ability, as an attending, to feel comfortable operating in various spaces. As a first year attending, I performed some complex aortic procedures including a TAMBE as part of the trial, along with open aortas, carotids, deep venous cases, and of course, complex lower extremity cases, to doing what I am most passionate about, which is working on complex lower extremity cases and in deep venous systems. However, one therapy we didn't focus on until I was graduating was the treatment of pulmonary embolisms.
We were heavily involved in Deep vein thrombosis (DVT) management along with iliocaval reconstructions. but the pulmonary embolism (PE) space, at the time, was managed by our colleagues in other specialties. That changed as I became an attending, so getting ready to do PEs required that I learned a lot. I had to work with my mentor to learn that space, the different devices, and all the tips, tricks, and pitfalls. I thought to myself, “Hmm, okay, this is very different and something new to start learning.”
Do you see more programs focusing on PE work now versus 5-10 years ago?
Definitely. It is interesting to see at different meetings attended by more than one specialty, the variability on which team is involved at different hospital systems. Sometimes it is interventional radiology (IR), or interventional cardiology, or vascular surgery, or a combination. It changes. Even though it changed for us, many vascular surgeons aren’t necessarily as present in this space or managing this disease pathology like we are in our hospital system. Still, as proceduralists become more familiar with some of the newer larger bore devices that weren’t present 10 years ago, it has become more prevalent in vascular surgery training.
You've been involved in research across various areas like iliocaval reconstruction, limb salvage, and carotid work. How would you advise younger physicians in residency or fellowship to engage in more clinical research?
It might sound monotonous, but I think when you first start managing your patients, getting your rhythm and achieving good outcomes should be your priority before diving into clinical trials.
With that said, I was fortunate to get involved in research early on. Two key factors were focusing on what I was passionate about and always asking questions about new technologies and future directions. Picking something you are genuinely interested in makes a big difference because your enthusiasm shows. It’s also crucial to have enough case volume to support your research. If I’m not comfortable with something or it's not a part of my practice, I wouldn’t start my research there. But in areas where I’m heavily involved clinically, I naturally begin to ask how things can be improved and what changes can be made. This curiosity helped me form the right questions for research.
Building relationships with industry is also beneficial. For clinical trials, having strong industry ties and a site that can support the trials is essential. There are many components to this. Starting as a sub-investigator to your site for trials can teach you a lot. If you have a mentor or someone who is the primary site investigator at your site, collaborating with them can help you learn and grow in your research capabilities. Having mentors or collaborating with others for your own research is also helpful, especially if you’re new to research.
When it comes to treating calcific plaque in the arterial system, which is increasingly prevalent and hard to treat, do you have a default algorithm for how you approach it?
For calcified plaque areas, I tend to use intravascular lithotripsy (IVL).
My experience with IVL began with popliteal artery calcified lesions, especially behind the knee, where you don't necessarily want to place a stent. Although there are special stents for this segment I still believe it is beneficial to have other options. When it comes to surgery I always think about the long-term plan—what are my options for this patient in the future since I'll be continuing to care for them. With regards to SFA lesions, depending on the lesion and its morphology, I try to “leave nothing behind” and stent provisionally. I'm not one to place a stent right away for every lesion.
In order to take this approach and achieve good outcomes, I started using IVL in many calcified vessels, along with a drug-coated balloon (DCB) to help improve patency. We’re starting to see from industry sponsored and real world data, that with appropriate vessel prep using different devices followed by DCBs, we can achieve great patency rates even in calcified vessels. IVL helps decrease dissections in calcified vessels, one of the top determinants leading to bail out stenting.
I fully realize every patient is different. But taking the example of a calcific lesion in the popliteal artery, if you start with IVL, will you typically follow it up with atherectomy if you can't get the luminal gain that you're looking for with IVL? At one point will you use other therapies?
This is a very long topic, one that needs a dedicated PowerPoint presentation with a flowchart, "If this, then maybe this; if that, then maybe this.”
I primarily use intravascular ultrasound (IVUS) to examine the lesion morphology. If it's concentric, I'll start with IVL. My main goal with IVL is luminal gain while avoiding vessel dissection and with IVL this usually gives a residual stenosis of less than 30%.
As you mentioned, however, sometimes it doesn’t. If there is an eccentric, protruding plaque lesion, or if a concentric lesion still has significant residual stenosis which is a top predictor of reintervention in one year, then atherectomy, especially directional atherectomy, has a role to help with luminal gain. As every patient is different, anatomy and risks such as embolization have to be considered and it may be better for the patient to undergo an open intervention. That's the beauty of being able to perform open surgery.
Intro: Dr. Kyle Reynolds, is a vascular surgeon at the MedStar Heart & Vascular Institute specializing in the treatment of peripheral arterial disease. Having grown up in an underserved community, Dr. Reynolds understands how feeling heard and supported in healthcare settings makes a world of difference for patients. He makes treatment decisions collaboratively with patients to suit each individual's life and goals. Passionate about limb salvage and addressing disparities, he remains active in research, focusing on advancing care for those most affected by vascular diseases. In our latest interview, Dr. Reynolds shares his insights on the challenges and innovations in treating vascular diseases, the importance of early PAD awareness, and his approach to balancing professional and personal passions.
When you think back, either during fellowship or immediately after, was there a clinical subject matter or therapy area that you wish you were taught or had more experience in?
I was really fortunate to have my training at MedStar, a program where we just did a lot of everything. That vast exposure was a beautiful thing because it gave me the ability, as an attending, to feel comfortable operating in various spaces. As a first year attending, I performed some complex aortic procedures including a TAMBE as part of the trial, along with open aortas, carotids, deep venous cases, and of course, complex lower extremity cases, to doing what I am most passionate about, which is working on complex lower extremity cases and in deep venous systems. However, one therapy we didn't focus on until I was graduating was the treatment of pulmonary embolisms.
We were heavily involved in Deep vein thrombosis (DVT) management along with iliocaval reconstructions. but the pulmonary embolism (PE) space, at the time, was managed by our colleagues in other specialties. That changed as I became an attending, so getting ready to do PEs required that I learned a lot. I had to work with my mentor to learn that space, the different devices, and all the tips, tricks, and pitfalls. I thought to myself, “Hmm, okay, this is very different and something new to start learning.”
Do you see more programs focusing on PE work now versus 5-10 years ago?
Definitely. It is interesting to see at different meetings attended by more than one specialty, the variability on which team is involved at different hospital systems. Sometimes it is interventional radiology (IR), or interventional cardiology, or vascular surgery, or a combination. It changes. Even though it changed for us, many vascular surgeons aren’t necessarily as present in this space or managing this disease pathology like we are in our hospital system. Still, as proceduralists become more familiar with some of the newer larger bore devices that weren’t present 10 years ago, it has become more prevalent in vascular surgery training.
You've been involved in research across various areas like iliocaval reconstruction, limb salvage, and carotid work. How would you advise younger physicians in residency or fellowship to engage in more clinical research?
It might sound monotonous, but I think when you first start managing your patients, getting your rhythm and achieving good outcomes should be your priority before diving into clinical trials.
With that said, I was fortunate to get involved in research early on. Two key factors were focusing on what I was passionate about and always asking questions about new technologies and future directions. Picking something you are genuinely interested in makes a big difference because your enthusiasm shows. It’s also crucial to have enough case volume to support your research. If I’m not comfortable with something or it's not a part of my practice, I wouldn’t start my research there. But in areas where I’m heavily involved clinically, I naturally begin to ask how things can be improved and what changes can be made. This curiosity helped me form the right questions for research.
Building relationships with industry is also beneficial. For clinical trials, having strong industry ties and a site that can support the trials is essential. There are many components to this. Starting as a sub-investigator to your site for trials can teach you a lot. If you have a mentor or someone who is the primary site investigator at your site, collaborating with them can help you learn and grow in your research capabilities. Having mentors or collaborating with others for your own research is also helpful, especially if you’re new to research.
When it comes to treating calcific plaque in the arterial system, which is increasingly prevalent and hard to treat, do you have a default algorithm for how you approach it?
For calcified plaque areas, I tend to use intravascular lithotripsy (IVL).
My experience with IVL began with popliteal artery calcified lesions, especially behind the knee, where you don't necessarily want to place a stent. Although there are special stents for this segment I still believe it is beneficial to have other options. When it comes to surgery I always think about the long-term plan—what are my options for this patient in the future since I'll be continuing to care for them. With regards to SFA lesions, depending on the lesion and its morphology, I try to “leave nothing behind” and stent provisionally. I'm not one to place a stent right away for every lesion.
In order to take this approach and achieve good outcomes, I started using IVL in many calcified vessels, along with a drug-coated balloon (DCB) to help improve patency. We’re starting to see from industry sponsored and real world data, that with appropriate vessel prep using different devices followed by DCBs, we can achieve great patency rates even in calcified vessels. IVL helps decrease dissections in calcified vessels, one of the top determinants leading to bail out stenting.
I fully realize every patient is different. But taking the example of a calcific lesion in the popliteal artery, if you start with IVL, will you typically follow it up with atherectomy if you can't get the luminal gain that you're looking for with IVL? At one point will you use other therapies?
This is a very long topic, one that needs a dedicated PowerPoint presentation with a flowchart, "If this, then maybe this; if that, then maybe this.”
I primarily use intravascular ultrasound (IVUS) to examine the lesion morphology. If it's concentric, I'll start with IVL. My main goal with IVL is luminal gain while avoiding vessel dissection and with IVL this usually gives a residual stenosis of less than 30%.
As you mentioned, however, sometimes it doesn’t. If there is an eccentric, protruding plaque lesion, or if a concentric lesion still has significant residual stenosis which is a top predictor of reintervention in one year, then atherectomy, especially directional atherectomy, has a role to help with luminal gain. As every patient is different, anatomy and risks such as embolization have to be considered and it may be better for the patient to undergo an open intervention. That's the beauty of being able to perform open surgery.
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Delivered straight to your inbox. Completely free. No spam.
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World's Brightest Physicians
Delivered straight to your inbox. Completely free. No spam.
Let's move on to more business-related questions. Thinking back to your fellowship, are there a few concepts you wish you knew then about the business of healthcare?
Luckily my mentors started introducing me to some basics on the business side of healthcare which I tried to bolster on my own during my first few years as an attending. Vascular surgery conferences have started offering sessions geared towards fellows and new grads about the business of healthcare, beyond just billing. SVS offers a leadership course that includes tackling decisions in the c-suite. They do a great job of pairing you up with more experienced members as well, giving help on how to navigate personal challenges you may be facing or trying to understand.
However, one thing I had no real concept about was the Maryland total cost of care model. It's a unique and complex system with the goal of driving down the cost of healthcare, where reimbursement isn't per case or per service. Instead, with the hospital payment program, each hospital receives a population-based payment amount to cover all of the hospital services that will be provided for the year. The idea is to incentivize hospitals to provide value-based care and decrease readmissions, unnecessary procedures, and unnecessary costs. However, the budget is based on expenditure from two years ago, which is something I had to pay attention to when rapidly growing the vascular footprint at one of our hospitals. Nothing prepared me for that; it's something I'm still figuring out. It's important to truly understand how reimbursement works because what's standard nationally can be very different locally or within your hospital.
There's a fair amount of data suggesting that many physicians leave their first job outside of fellowship within five years. Why do you think that is, and do you have any advice for others on how to find a practice that might prevent this scenario from happening?
When coming across this data while preparing to find my own first job, I used to assume this meant the practice wasn’t a great fit for the new surgeon, or vice versa. But it might also be about a surgeon figuring out what they want from their career. Maybe they prefer academia over private practice or the other way around. They may want to change their volumes, their location, their scope of practice, or they’re given an opportunity (sometimes with a title) somewhere else. So, leaving is not always negative. For example, one of my co-residents loved his first job, but when his mentor moved to another hospital, he saw a great opportunity to continue working with him, expand his role, and build a program so he made the move.
Sometimes, it's not that the new attending didn't love their job or situation but that a great opportunity came up elsewhere. The best advice I can give is to ensure you're in a good scenario, but not everyone knows what they want right away. It's okay to change jobs within five years if a better opportunity arises. It's not necessarily a bad thing. Some people see it as a negative, but I've seen it work out positively. Personally, I'm very happy and haven't left my position.
About a year ago, there was a piece in SVS that profiled your celebration of Black History Month. You mentioned the disparities in health outcomes, especially regarding amputations among black patients. From your standpoint, what are a few things that vascular surgeons or cross-disciplinary teams can do to improve this issue?
This could be a longer essay than my algorithm for calcified vessels. There are many small and large things that can be done. Starting with the smaller actions, PAD awareness is crucial. Many societies are promoting this, and it's important for vascular surgeons to spread the word. When out in the community and visiting different collaborating physicians, I often find that both patients and doctors aren't as aware of earlier-stage interventions and programs that can help prevent amputations in many different ways, such as diabetic bootcamps and programs targeted towards managing modifiable risk factors. Recognition of CLTI is also a problem and patients presenting at a later stage lead to higher amputation rates when there are a lot more things that could have been done if patients were seen by appropriate specialists sooner.
One thing I'm striving to do is increase PAD awareness in community hospitals, emphasizing early evaluations, pulse exams, noninvasive imaging, optimal wound care, and diabetic care. Medicare data shows that amputation rates are three times higher in Black patients compared to others. The Amputation Reduction and Compassion Act, which has not been passed yet, aims to reduce these rates by requiring Medicare, Medicaid, and group health insurance plans to cover preventative screenings for high-risk individuals. This could help catch and treat PAD earlier, potentially preventing amputations.
The bill would also establish a PAD education program at hospitals to increase awareness among doctors who are not vascular specialists. It would implement quality payment measures to reduce avoidable amputations. I think it would be great if there's an act that can actually push PAD and require prophylactic treatment to help screen high-risk patients. One significant point in the bill is disallowing payments for non-trauma amputations if no anatomical testing was performed first. Many patients undergo amputations without a full evaluation, including angiograms and assessments for potential interventions.
Recently, Dr. Kirksey published an article highlighting this issue. Patients often get amputations without anatomical assessments or angiograms, instead of trying treatments like free flaps or FDA-approved versions of DVA. PAD awareness and this legislative act are steps in the right direction.
When you’re operating, do you listen to music? If so, what are your top songs?
That's tough because I can't listen to the same three songs on repeat. When I was an intern or junior resident, we used to play just the radio in our ORs and joked about how often we heard the same songs. We'd say, "Oh, this is a five Despacito song case," or "this case was three God’s Plans." For me, it can't be the same song over and over.
But earlier today, the first song on my playlist was Ain't Nobody by Chaka Khan. I love it. Sometimes, when we're doing bypasses, we call it the Hamilton Bypass and play the Hamilton musical soundtrack. So, those are a few favorites.
How about movies? Do you have a few all-time favorites?
Oh, yeah. I'd say Wedding Crashers and Coming to America are probably my top two. I can watch those over and over again on a plane.
If you had a chance to go back to your mid to late 20s, is there anything you would tell the younger version of Dr. Reynolds from a professional standpoint?
I'd say it's worth it. I'd do my residency all over again so I’d tell 20-year-old Kyle to just keep at it and enjoy the ride in the process, because it's worth it.
Let's move on to more business-related questions. Thinking back to your fellowship, are there a few concepts you wish you knew then about the business of healthcare?
Luckily my mentors started introducing me to some basics on the business side of healthcare which I tried to bolster on my own during my first few years as an attending. Vascular surgery conferences have started offering sessions geared towards fellows and new grads about the business of healthcare, beyond just billing. SVS offers a leadership course that includes tackling decisions in the c-suite. They do a great job of pairing you up with more experienced members as well, giving help on how to navigate personal challenges you may be facing or trying to understand.
However, one thing I had no real concept about was the Maryland total cost of care model. It's a unique and complex system with the goal of driving down the cost of healthcare, where reimbursement isn't per case or per service. Instead, with the hospital payment program, each hospital receives a population-based payment amount to cover all of the hospital services that will be provided for the year. The idea is to incentivize hospitals to provide value-based care and decrease readmissions, unnecessary procedures, and unnecessary costs. However, the budget is based on expenditure from two years ago, which is something I had to pay attention to when rapidly growing the vascular footprint at one of our hospitals. Nothing prepared me for that; it's something I'm still figuring out. It's important to truly understand how reimbursement works because what's standard nationally can be very different locally or within your hospital.
There's a fair amount of data suggesting that many physicians leave their first job outside of fellowship within five years. Why do you think that is, and do you have any advice for others on how to find a practice that might prevent this scenario from happening?
When coming across this data while preparing to find my own first job, I used to assume this meant the practice wasn’t a great fit for the new surgeon, or vice versa. But it might also be about a surgeon figuring out what they want from their career. Maybe they prefer academia over private practice or the other way around. They may want to change their volumes, their location, their scope of practice, or they’re given an opportunity (sometimes with a title) somewhere else. So, leaving is not always negative. For example, one of my co-residents loved his first job, but when his mentor moved to another hospital, he saw a great opportunity to continue working with him, expand his role, and build a program so he made the move.
Sometimes, it's not that the new attending didn't love their job or situation but that a great opportunity came up elsewhere. The best advice I can give is to ensure you're in a good scenario, but not everyone knows what they want right away. It's okay to change jobs within five years if a better opportunity arises. It's not necessarily a bad thing. Some people see it as a negative, but I've seen it work out positively. Personally, I'm very happy and haven't left my position.
About a year ago, there was a piece in SVS that profiled your celebration of Black History Month. You mentioned the disparities in health outcomes, especially regarding amputations among black patients. From your standpoint, what are a few things that vascular surgeons or cross-disciplinary teams can do to improve this issue?
This could be a longer essay than my algorithm for calcified vessels. There are many small and large things that can be done. Starting with the smaller actions, PAD awareness is crucial. Many societies are promoting this, and it's important for vascular surgeons to spread the word. When out in the community and visiting different collaborating physicians, I often find that both patients and doctors aren't as aware of earlier-stage interventions and programs that can help prevent amputations in many different ways, such as diabetic bootcamps and programs targeted towards managing modifiable risk factors. Recognition of CLTI is also a problem and patients presenting at a later stage lead to higher amputation rates when there are a lot more things that could have been done if patients were seen by appropriate specialists sooner.
One thing I'm striving to do is increase PAD awareness in community hospitals, emphasizing early evaluations, pulse exams, noninvasive imaging, optimal wound care, and diabetic care. Medicare data shows that amputation rates are three times higher in Black patients compared to others. The Amputation Reduction and Compassion Act, which has not been passed yet, aims to reduce these rates by requiring Medicare, Medicaid, and group health insurance plans to cover preventative screenings for high-risk individuals. This could help catch and treat PAD earlier, potentially preventing amputations.
The bill would also establish a PAD education program at hospitals to increase awareness among doctors who are not vascular specialists. It would implement quality payment measures to reduce avoidable amputations. I think it would be great if there's an act that can actually push PAD and require prophylactic treatment to help screen high-risk patients. One significant point in the bill is disallowing payments for non-trauma amputations if no anatomical testing was performed first. Many patients undergo amputations without a full evaluation, including angiograms and assessments for potential interventions.
Recently, Dr. Kirksey published an article highlighting this issue. Patients often get amputations without anatomical assessments or angiograms, instead of trying treatments like free flaps or FDA-approved versions of DVA. PAD awareness and this legislative act are steps in the right direction.
When you’re operating, do you listen to music? If so, what are your top songs?
That's tough because I can't listen to the same three songs on repeat. When I was an intern or junior resident, we used to play just the radio in our ORs and joked about how often we heard the same songs. We'd say, "Oh, this is a five Despacito song case," or "this case was three God’s Plans." For me, it can't be the same song over and over.
But earlier today, the first song on my playlist was Ain't Nobody by Chaka Khan. I love it. Sometimes, when we're doing bypasses, we call it the Hamilton Bypass and play the Hamilton musical soundtrack. So, those are a few favorites.
How about movies? Do you have a few all-time favorites?
Oh, yeah. I'd say Wedding Crashers and Coming to America are probably my top two. I can watch those over and over again on a plane.
If you had a chance to go back to your mid to late 20s, is there anything you would tell the younger version of Dr. Reynolds from a professional standpoint?
I'd say it's worth it. I'd do my residency all over again so I’d tell 20-year-old Kyle to just keep at it and enjoy the ride in the process, because it's worth it.
Let's move on to more business-related questions. Thinking back to your fellowship, are there a few concepts you wish you knew then about the business of healthcare?
Luckily my mentors started introducing me to some basics on the business side of healthcare which I tried to bolster on my own during my first few years as an attending. Vascular surgery conferences have started offering sessions geared towards fellows and new grads about the business of healthcare, beyond just billing. SVS offers a leadership course that includes tackling decisions in the c-suite. They do a great job of pairing you up with more experienced members as well, giving help on how to navigate personal challenges you may be facing or trying to understand.
However, one thing I had no real concept about was the Maryland total cost of care model. It's a unique and complex system with the goal of driving down the cost of healthcare, where reimbursement isn't per case or per service. Instead, with the hospital payment program, each hospital receives a population-based payment amount to cover all of the hospital services that will be provided for the year. The idea is to incentivize hospitals to provide value-based care and decrease readmissions, unnecessary procedures, and unnecessary costs. However, the budget is based on expenditure from two years ago, which is something I had to pay attention to when rapidly growing the vascular footprint at one of our hospitals. Nothing prepared me for that; it's something I'm still figuring out. It's important to truly understand how reimbursement works because what's standard nationally can be very different locally or within your hospital.
There's a fair amount of data suggesting that many physicians leave their first job outside of fellowship within five years. Why do you think that is, and do you have any advice for others on how to find a practice that might prevent this scenario from happening?
When coming across this data while preparing to find my own first job, I used to assume this meant the practice wasn’t a great fit for the new surgeon, or vice versa. But it might also be about a surgeon figuring out what they want from their career. Maybe they prefer academia over private practice or the other way around. They may want to change their volumes, their location, their scope of practice, or they’re given an opportunity (sometimes with a title) somewhere else. So, leaving is not always negative. For example, one of my co-residents loved his first job, but when his mentor moved to another hospital, he saw a great opportunity to continue working with him, expand his role, and build a program so he made the move.
Sometimes, it's not that the new attending didn't love their job or situation but that a great opportunity came up elsewhere. The best advice I can give is to ensure you're in a good scenario, but not everyone knows what they want right away. It's okay to change jobs within five years if a better opportunity arises. It's not necessarily a bad thing. Some people see it as a negative, but I've seen it work out positively. Personally, I'm very happy and haven't left my position.
About a year ago, there was a piece in SVS that profiled your celebration of Black History Month. You mentioned the disparities in health outcomes, especially regarding amputations among black patients. From your standpoint, what are a few things that vascular surgeons or cross-disciplinary teams can do to improve this issue?
This could be a longer essay than my algorithm for calcified vessels. There are many small and large things that can be done. Starting with the smaller actions, PAD awareness is crucial. Many societies are promoting this, and it's important for vascular surgeons to spread the word. When out in the community and visiting different collaborating physicians, I often find that both patients and doctors aren't as aware of earlier-stage interventions and programs that can help prevent amputations in many different ways, such as diabetic bootcamps and programs targeted towards managing modifiable risk factors. Recognition of CLTI is also a problem and patients presenting at a later stage lead to higher amputation rates when there are a lot more things that could have been done if patients were seen by appropriate specialists sooner.
One thing I'm striving to do is increase PAD awareness in community hospitals, emphasizing early evaluations, pulse exams, noninvasive imaging, optimal wound care, and diabetic care. Medicare data shows that amputation rates are three times higher in Black patients compared to others. The Amputation Reduction and Compassion Act, which has not been passed yet, aims to reduce these rates by requiring Medicare, Medicaid, and group health insurance plans to cover preventative screenings for high-risk individuals. This could help catch and treat PAD earlier, potentially preventing amputations.
The bill would also establish a PAD education program at hospitals to increase awareness among doctors who are not vascular specialists. It would implement quality payment measures to reduce avoidable amputations. I think it would be great if there's an act that can actually push PAD and require prophylactic treatment to help screen high-risk patients. One significant point in the bill is disallowing payments for non-trauma amputations if no anatomical testing was performed first. Many patients undergo amputations without a full evaluation, including angiograms and assessments for potential interventions.
Recently, Dr. Kirksey published an article highlighting this issue. Patients often get amputations without anatomical assessments or angiograms, instead of trying treatments like free flaps or FDA-approved versions of DVA. PAD awareness and this legislative act are steps in the right direction.
When you’re operating, do you listen to music? If so, what are your top songs?
That's tough because I can't listen to the same three songs on repeat. When I was an intern or junior resident, we used to play just the radio in our ORs and joked about how often we heard the same songs. We'd say, "Oh, this is a five Despacito song case," or "this case was three God’s Plans." For me, it can't be the same song over and over.
But earlier today, the first song on my playlist was Ain't Nobody by Chaka Khan. I love it. Sometimes, when we're doing bypasses, we call it the Hamilton Bypass and play the Hamilton musical soundtrack. So, those are a few favorites.
How about movies? Do you have a few all-time favorites?
Oh, yeah. I'd say Wedding Crashers and Coming to America are probably my top two. I can watch those over and over again on a plane.
If you had a chance to go back to your mid to late 20s, is there anything you would tell the younger version of Dr. Reynolds from a professional standpoint?
I'd say it's worth it. I'd do my residency all over again so I’d tell 20-year-old Kyle to just keep at it and enjoy the ride in the process, because it's worth it.
