Clinical Component

Navigating the Clinical Component

Full-Scope Vascular Surgery in a Community Setting with Academic-Caliber Resources

Your clinical practice will span the full breadth of modern vascular surgery. This is a true generalist role where you will perform open surgical reconstructions, complex endovascular interventions, and the essential bread-and-butter cases that keep a vascular surgery practice running. The group was built with the explicit understanding that every surgeon must be comfortable across the entire spectrum of vascular care. Dialysis access, chemotherapy port placement, carotid endarterectomy, aneurysm repair, venous interventions, and lower extremity revascularization are all part of the weekly workflow. There is no room here for a narrow subspecialty focus, and that is by design. As the program grows toward four or five surgeons, there will be opportunity to develop areas of focused interest, but today the practice needs surgeons who can handle whatever comes through the door with confidence and independence.

  • Broad-based vascular surgery scope: open and endovascular procedures, including aortic aneurysm repair, carotid disease, dialysis access creation and management, chemotherapy port placement, and venous interventions
  • Lower extremity revascularization across the full complexity spectrum, from straightforward angioplasty and stenting to complex multilevel reconstructions
  • Approximately one to one-and-a-half days of clinic per week; remainder dedicated to operative and procedural time
  • Surgical backup for interventional cardiology during TAVR, structural heart cases, and catheter-based complications, providing immediate availability that the competing group cannot match
  • Mentorship and collaboration available from colleagues, but you must be capable of managing complex cases and complications independently

Critical Limb Ischemia and Limb Salvage: The Program's Clinical Identity

The defining clinical mission of this vascular program is advanced limb salvage. SMG's interventional cardiologists pioneered a CLI program at TMH before the vascular surgeons arrived, and the addition of vascular surgery created the collaborative infrastructure needed to perform the most advanced revascularization procedures available. This is where the embedded cardiology relationship pays its greatest clinical dividend. You will work alongside interventional cardiologists who are deeply committed to CLI and who bring complementary endovascular skills, shared decision-making, and a referral pipeline that feeds both disciplines.

The procedures being performed here are not routine peripheral interventions. The program has brought deep venous arterialization (DVA) via LimFlow to Tallahassee, a procedure performed at relatively few centers nationally. The Detour procedure is performed jointly between interventional cardiology and vascular surgery. Antegrade and retrograde tibial interventions for chronic total occlusions are part of the regular case mix. The ideal candidate for this role is a surgeon who not only performs fem-distal bypasses (fem-tibial, fem-pedal) with confidence but who is genuinely energized by the challenge of saving limbs that other programs would amputate.

  • Active CLI and limb salvage program co-developed with interventional cardiology, positioned as one of the most advanced in the region for a community hospital setting
  • Deep venous arterialization (LimFlow) performed on-site; one of a limited number of programs nationally offering this technology
  • Detour procedures performed collaboratively between vascular surgery and interventional cardiology
  • Antegrade and retrograde tibial interventions for complex chronic total occlusions
  • Fem-distal bypass capability (fem-tibial, fem-pedal) strongly valued; the ideal candidate is comfortable with open reconstructions that complement endovascular approaches
  • Shared case planning and intraoperative collaboration with interventional cardiologists who specialize in peripheral work
  • High regional disease burden ensures consistent CLI case volume driven by diabetes, PAD, and limited access to preventive vascular care across the service area

The Cardiology Collaboration: Why This Model Works

In most markets, vascular surgery and interventional cardiology coexist in tension. Turf disputes over peripheral cases, competing referral patterns, and institutional politics create friction that drains energy and limits program growth. This practice was built specifically to eliminate those dynamics. Because both vascular surgery and interventional cardiology are employed under the same group (SMG), you share the same goals, the same patients, and the same financial incentives. There is no competition between disciplines. Cases are discussed openly, opinions are shared freely, and complex procedures are co-managed or co-performed based on what is best for the patient.

The practical benefits are significant. Interventional cardiologists refer carotid disease, aneurysms, and surgical candidates directly to you because you are part of their group and they trust the outcome. You provide surgical backup for catheter-based complications in real time because you are on the same campus and on the same team, not across town with a 30-minute response time. Equipment requests are handled through a single procurement process, and when the interventional team gains access to new technology or trials, vascular surgery benefits from the same institutional relationships.

  • Vascular surgery and interventional cardiology are employed by the same practice group (SMG), eliminating turf conflicts and aligning clinical and financial incentives
  • Direct referral pathway: cardiologists refer carotid disease, aneurysms, and surgical candidates to you within the group
  • Real-time surgical backup for catheter-based complications during TAVR, structural heart, and peripheral interventions
  • Shared access to equipment, new technology, and clinical trials through SMG and the Tallahassee Research Institute
  • Case consultations happen informally and immediately, with no barriers between disciplines
  • Genuinely collaborative relationship with mutual respect and zero institutional friction

Technology, Facilities, and the ASC Opportunity

You will practice in a well-equipped environment with access to the tools required for advanced vascular work. TMH's main campus includes four heart catheterization labs (two designated for peripheral procedures), hybrid-capable operating rooms, and a full complement of advanced imaging. The practice operates with a standing commitment from leadership to provide whatever equipment is needed to support complex revascularization, and current surgeons confirm that commitment has been honored consistently.

A cardiovascular-only Ambulatory Surgery Center (ASC) is opening in spring 2026 in a newly acquired building adjacent to the main campus. The ASC will include two procedural labs, vascular surgery office space, and dedicated infrastructure for outpatient vascular cases. The shell space is built and ready for build-out. This ASC represents a significant expansion of procedural capacity and, for partners, an equity investment opportunity with real estate participation and operational profit sharing. The facility is a joint venture between SMG and TMH, with TMH holding 51% majority ownership. SMG physicians will select the medical director and have direct input on operational design, with an explicit focus on efficiency that avoids the scheduling delays common in the main hospital environment.

  • Four heart catheterization labs on the main campus, two designated for peripheral procedures; hybrid OR capability
  • Full access to advanced endovascular tools and equipment; leadership commitment to providing whatever is needed for complex cases
  • Cardiovascular-only ASC opening spring 2026: two procedural labs, vascular surgery offices, dedicated outpatient procedural infrastructure
  • ASC is a joint venture (51/49 TMH/SMG); partner equity participation includes real estate and operational profit sharing
  • ASC operational design prioritizes efficiency with physician-directed scheduling
  • EMR: Epic system-wide

Research and Academic Affiliation

The Tallahassee Research Institute (TRI) provides access to industry-sponsored clinical trials, an established IRB, and dedicated research coordinators. Vascular surgery participates in the same research infrastructure that supports SMG's interventional cardiology and EP programs, which have active enrollment in trials including CHAMPION and OPTION. For a surgeon with research interests, this is a meaningful differentiator from typical community practice positions.

TMH's developing affiliation with Florida State University (FSU Health) is expected to create additional academic opportunities over time, including teaching roles within the existing internal medicine residency program and eventual participation in a planned cardiology fellowship. FSU's involvement brings state capital resources, academic infrastructure, and long-term institutional growth that strengthens the program's position as a destination center.

  • Research participation through the Tallahassee Research Institute with established IRB and coordinator support
  • Industry-sponsored trial access across cardiovascular and vascular disciplines
  • Teaching opportunities through the FSU-affiliated internal medicine residency program (~$5,000-$10,000 annually)
  • Cardiology fellowship in development, with vascular surgery involvement anticipated as the program matures
  • FSU Health affiliation brings capital investment, academic infrastructure, and long-term growth trajectory

Competitive Market Context: Full Transparency

There is one other vascular surgery group in Tallahassee. They are a six-surgeon practice that has operated in the market for decades and recently sold to a private equity firm. Both groups hold privileges and perform procedures at TMH. The competitive dynamic is real, and at times contentious. The other group has pushed back as SMG's vascular program has grown and captured market share.

This is disclosed because the right candidate needs to understand what they are walking into. The SMG vascular team views this competition as a strategic advantage for the right surgeon. You are joining the newer, more innovative, and more forward-aligned program. You are on the inside of the FSU Health transition. You are embedded within the region's dominant cardiology group with a direct referral pipeline. And as the senior partners in the competing group approach retirement, the market dynamics will continue to shift in your favor.

  • Competing group: six vascular surgeons (PE-owned), five in Tallahassee, one in Panama City; entrenched but facing operational and retention challenges
  • Both groups practice at TMH; competitive dynamics are acknowledged and managed
  • SMG's vascular program is positioned as the more advanced, technology-forward, and institutionally aligned option
  • Senior leadership in the competing group is approaching retirement age, which is expected to further shift market dynamics
  • The right candidate is someone who is energized by building a program in a competitive environment, not deterred by it

This is a clinical environment where your scope is broad, your volume is real, your colleagues are collaborative, and your ability to practice advanced vascular surgery is limited only by your own ambition and skill. For a surgeon who wants to build something meaningful rather than maintain someone else's status quo, this is the opportunity.

© Copyright 2023 Pacific Companies. All Rights Reserved.