What’s the shelf life of clinical mastery?
For Dr. Peter Schneider, it turned out to be four weeks.
Now Professor of Vascular and Endovascular Surgery at UCSF, Peter has spent his career building and advising companies at the forefront of endovascular innovation — including Cagent Vascular and Intact Vascular (acquired by Philips), both of which he co-founded. But that instinct to push technology forward began long before the titles.
Long before minimally invasive tools transformed the field, he spent five years at UCSF training in general surgery, which included learning open cholecystectomy — removing gallbladders through long subcostal incisions beneath the rib cage. By the time he finished, he had performed more than 200 of them and taught junior residents where to place retractors, how to find the bile duct, and how to stay out of trouble.
His training ended in June. In July, the first laparoscopic cholecystectomy was performed at UCSF.
Within a month, a technique he had spent years mastering became outdated.
That realization changed everything. From that point on, his loyalty would be to progress itself — not to the techniques he had already mastered.
That mindset has defined his career. His mastery in the operating room became the foundation for something more unusual — the ability to see disruption coming and adapt before it arrives.
Meet The Specialist
Dr. Peter Schneider
Fast Take
Pioneering the Evolution of Vascular Surgery: From mastering open procedures to advancing minimally invasive tools, Peter’s career reflects the discipline’s transformation and his ability to anticipate what comes next.
Bridging Surgery and Startups: Co-founded Intact Vascular and Cagent Vascular, helping bring next-generation endovascular technologies from concept to clinic while advising strategics like Abbott, Boston Scientific, and Medtronic.
Advancing Education and Dialogue: Regularly chairs and lectures at major vascular conferences around the world and is the author of “Endovascular Skills,” a widely used guide to contemporary endovascular practice.
Seeing Disruption Before It Arrives and Glimpsing the Third Era of Vascular Surgery
That early lesson — mastery’s short shelf life — made Peter alert to disruption long before others saw it coming.
Years later, his brother sent him “The Innovator’s Dilemma” by Harvard Business School professor Clayton Christensen — a book that resonated deeply. “The ideas that change everything often do not look like good ideas at first,” Peter says.
The book gave him language for what he’d already experienced: true innovation starts at the edges, serving patients everyone else overlooks.
When Peter trained, vascular surgery was at the tail end of the open-surgery only era — operations that worked but came with high morbidity and mortality. Many patients were turned away because they weren’t strong enough for major procedures.
Then came the endovascular revolution. Over the next two decades, the focus shifted to making less-invasive approaches safer and more effective. For someone who describes vascular surgery as “plumbing,” the timing was perfect. It was tangible, creative, and mechanical — an engineer’s playground in a sterile field.
Now, he sees a third era unfolding. Technologies such as intravascular lithotripsy (IVL) and drug-coated balloons remain central to vascular therapy — they’ve redefined what’s possible in complex disease. What’s coming next will complement them, using genomics, AI, and advanced pharma to answer questions like which patients should receive IVL and why.
After decades of focusing on heart disease and cancer, pharma is finally looking to vascular medicine. PCSK9 inhibitors, GLP-1s, and other biologics are changing patient trajectories in ways that perfecting devices never could. “You can spend your whole life working on a better tool,” Peter says, “but you’re still working at the edge of the iceberg.”
Peter’s fascinated by what’s next: wearables and implantables that keep patients connected the way planes stay linked to ground control. “That same era is coming to medicine,” he says — one where devices and data work together to catch trouble before it starts.
What Doctors Don’t Know About Innovation — And How To Collaborate Better
Peter knows the business of medtech as well as the operating room. He’s co-founded companies, guided early-stage teams, and advised strategics like Abbott and Medtronic. And yet, he says, doctors and device developers still don’t understand each other as well as they should.
Many doctors, he says, imagine new technologies just “fall out of trees.” They don’t understand the years of design decisions, regulatory compromises, and financing struggles behind every device. “There’s no place where you can get that education,” he notes. “It doesn’t exist except by hook or by crook.”
If physicians better understood how devices come to life — from IP strategy to FDA pathways to venture funding — they’d be stronger collaborators and innovators.
The misunderstanding cuts both ways. Startups are often funded with institutions’ riskiest capital, which evaporates when the economy dips. Large strategics face shareholder pressure to produce quarterly results. Both sides care deeply about patients — they just rarely connect beyond transactional exchanges.
That’s a loss, Peter says, because some of medicine’s biggest problems can’t be solved by one side alone. For younger physicians who want to make a difference, he points to three frontiers:
Calcification — it’s getting worse, and no one really knows why. Tools exist to treat it, but not to prevent it.
Microvascular disease — think beyond wounds that won’t heal. Think early dementia, renal decline, organ-wide small-vessel deterioration.
Aortic deterioration — no one understands why the aorta simply falls apart from root to bifurcation.
“These aren’t device problems,” he says. “They’re biology problems.”
The challenge is that few people can straddle both worlds — practicing vascular surgery while diving deep into genomics or AI. Those who can will define the next generation of medicine.
He points to colleagues who already blend practice with data science, like Dr. Marc L. Schermerhorn at Beth Israel Deaconess and Dr. Sharon Kiang at Loma Linda University. One European counterpart even serves as a chief of vascular surgery while specializing in artificial intelligence.
Their work hints at what’s possible. Today, most clinical evidence is built on population averages — the so-called “number needed to treat.” It tells us how many people must receive a therapy to help one, but it also means many others get treatment without real benefit. AI could flip that equation, identifying which patients truly need high-intensity statins or aneurysm screening, and which don’t. As Peter puts it, “We need to screen smarter, not harder.”
The translators who can connect clinical intuition with computational insight — not just invent better devices — will matter most.
How Medicine Actually Evolves
Peter’s early career was filled with procedures that barely exist today.
During training, he performed countless operations for upper-GI bleeding caused by ulcer disease — complex, elegant surgeries like vagotomy, pyloroplasty, and partial gastrectomy. Each required years to master.
Then an Australian gastroenterologist swallowed bacteria to prove his theory: Helicobacter pylori caused peptic ulcer disease.
“Think of all the people I operated on because we didn’t know what the right answer was,” Peter recalls.
Were those surgeries wrong? Not for their time. But they weren’t the final answer.
Medicine, he says, is never “settled science.” Clinical guidelines keep surgery safe and consistent — no one wants improvisation in the operating room. But those same standards are snapshots in time. Medicine moves forward incrementally, then leaps ahead when a new discovery rewrites the rules.
In vascular medicine, drug-coated balloons and intravascular lithotripsy were among those sudden shifts. “They changed everything overnight,” Peter says. “That’s why you have to keep learning. Otherwise, you wake up and realize you’ve been left behind.”
The Vascular Surgery Conference of the Future
As someone who’s spoken at many major vascular meetings — from TCT and VEITH to LINC and VIVA — Peter has watched the conference model evolve in real time.
He understands why it feels old-school: late-breaking data reveals, global travel for information that could be shared digitally. Yet he believes conferences aren’t going away.
“During COVID, everyone felt stir-crazy,” he says. “You miss the human touch — that chance to say, ‘I’ve got this sick patient, what would you do?’ You can’t get that from a screen.”
What’s changing is scale and focus. Meetings are becoming smaller, more specialized, and more conversational. Vascular, like general surgery before it, has splintered into subspecialties — aortic, venous, limb salvage — each with its own micro-community.
Large umbrella conferences will need deeper, niche sessions to stay relevant. And while webinars and on-demand content are useful, Peter doubts anyone wants to spend all day on Zoom. “People want to hear from someone who’s spent a lifetime thinking about one problem,” he says.
Change is Constant, But So Is Connection
For all the technology shaping medicine’s future, Peter keeps returning to the same idea: progress depends on people. The startup founders, the industry engineers, the residents asking hard questions — each one expands the collective knowledge base.
“That’s what keeps the field alive,” he says. “It’s not the devices. It’s the people who care enough to build them, test them, and use them better.”
In a discipline defined by rapid change, connection — between physicians, patients, and innovators — may be the most enduring form of stability.
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