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President's Message

The key to democracy at ACP: the rise of the Board of Governors

From the September 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By William A. Reynolds, FACP

In the past, the College has been characterized by some as an "old boys club," as a "top-down" organization that is tightly run and controlled by a self-perpetuating leadership made up of the Board of Regents (BOR). While such a characterization may have been true at one time, it is no longer the case. Over the years, ACP has empowered its members by increasing the importance and influence of its Board of Governors (BOG).

The BOG was originally established when the College was reorganized in 1922. At that time, ACP Governors were appointed by the Board of Regents, and had an advisory—and largely ineffective—role in the College. In 1926, the BOG became formally organized and was given the primary task of encouraging qualified internists to apply for membership and endorsing applications to the national Credentials Committee.

At that time, ACP Governors met only at ACP's annual meeting—not yet called Annual Session—and had the power to make recommendations to the Regents. By the 1930s, however, ACP Governors and Regents were holding joint annual meetings. Following the first regional meeting in North Carolina in 1930, many other regions and states began holding regional meetings.

Evolving process

While Governors were initially appointed by the Regents, that process gradually evolved to one in which the national Nominations Committee presented candidates at Annual Session. In 1961, the Nominations Committee was expanded to include two Regents, two Governors and one member at-large. In a later development, the national Nominations Committee began soliciting nominations for Governors from local nominations committees; in 1975 local nominations committees started forwarding at least two nominees to the national committee. Today, the two nominations are forwarded to the Governors Subcomittee on Nominations for technical review and approval before the ballot is mailed to members of the region. Candidates can also be nominated by petition; to be considered, however, nomination petitions must be signed by at least 10% of members in a region.

Another turning point in College governance occurred in 1975. Jeremiah A. Barondess, MACP, then chair of the BOG and a future ACP President, challenged the first combined conference of the BOR and BOG to change the College's governance and expand the Governors' role in creating College policy. Today, the Chair and Chair-elect of the BOG both have voting privileges on the BOR. In addition, after a three-year term on the Board of Regents, they are automatically considered for unopposed re-election for a second term. As a result, the BOR generally has six current or former Chairs of BOG.

ACP Governors play a major role in nominating officers of the College. Because there are approximately three Governors for every Regent, the BOG has a dominant voice in the election held at the annual joint meeting of the two boards. In recent years, more than half of the members of the BOR have been Governors or former Governors. The vice-chair of every policy committee is a member of the BOG, and Governors serve on nearly all of the national committees and subcommittees. Governors perform these duties in addition to their regular duties, which includes meeting twice a year for multi-day meetings.

The BOG considers many policy issues and makes recommendations to the Regents, and since 1984 has drafted resolutions for action by the Regents. In addition, all drafts of policy papers are circulated to the Governors for comment and review. (All Governors are online so communication and feedback is rapid.) When the Governors object to the draft of a policy paper, the BOR reconsiders. Policy in the College is determined only after deliberation and review by the BOG.

In 1994, the BOG voted to remain an advisory body with the obligation and right to review all policy papers in draft form. Gone are the days when the College governance could be realistically accused of elitism and an "old boys club" demeanor. The change has occurred without dilution of any of the lofty ideals, standards and goals of the College or of our dedication to education and scholarship.

Representing members

It should be apparent that the governance of the College is very much representative of the membership. With the increased role and responsibility of the BOG has come a much greater workload and time away from practice or work. The College is fortunate to have so many dedicated members willing to serve so well.

In 1989, the College took another major step to give a greater sense of ownership to its members, particularly those non-academic practicing internists, many of whom had been denied Fellowship because of the publication requirement. ACP established three new pathways to Fellowship that enabled dedicated and otherwise well qualified members to advance to Fellowship without having been published. As a result, the number of Fellows has greatly increased; more than half of new Fellows now qualify by one of the new pathways. (For more information see Pathways for advancement to Fellowship) These changes were important because advancement to Fellowship is essential for members to obtain leadership positions.

Practicing internists are welcomed into the governance at all levels; in the last four years, two practicing general internists, one from Tennessee and the other from Montana, have been elected President of the College.

Members have been enfranchised through direct communication with Governors, by appointment to regional and national committees, by participation in the annual regional meetings-particularly in town hall meetings and the annual business meeting at Annual Session-and by submission of resolutions to the Governor which are considered by the BOG and then forwarded to the BOR for action.

In conclusion, I would like to add a personal appraisal based on my 18 years of service as a Governor, member of numerous national committees, Regent and now President: The change in the involvement, commitment, power and influence of the BOG has been dramatic and has completed the evolution of the College to a truly democratic institution. The College has never been healthier nor more vibrant and influential.

Editor's note: In this issue, ACP Observer launches CollegeWatch, a comprehensive section of College news and a message from the President. We hope the new format and enhanced coverage will help keep members informed of ACP activities and views.

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