Electing ASCO’s Leaders: Can We Improve the Process?

Electing ASCO’s Leaders: Can We Improve the Process?

Clifford A. Hudis, MD, FACP, FASCO

@CliffordHudis
Jul 29, 2014

I am writing because I really want everyone’s input—comments, email, phone calls, written notes—on an issue that has been a slowly growing concern for all of us at ASCO: Our election and specifically our members’ participation in it. While we may pat ourselves on our collective backs for selecting great leaders (present company excepted . . .), if the measure of an election process is the active engagement of our voters, it would be hard to argue that we are succeeding.

Some background: Elections give voice to the people and represent the ultimate ideal of representative government for democratic nations around the world. Our faith and reverence for free and open elections makes them sacrosanct to some.

ASCO’s elections: From its very beginning, ASCO has held contested elections for its President (technically, “President-Elect”) and other leadership positions. This allowed every member of our growing organization to both aspire to leadership and to have a role, through their votes, in guiding the organization.

The current concern:  As above, it is low voter turnout but the key issue I want to focus on is the presidential election and ways we might improve the process and limit some of its potential risks. To be clear, the proposal below does not change the process of electing members of the Board of Directors or the Nominating Committee.

As a reminder, under our current structure ASCO members elect a Nominating Committee that assembles a slate of candidates for open Board seats, Nominating Committee seats, and for President-Elect (also for Treasurer when that position is open every third year). After interviews and careful deliberation, two candidates for each position are selected, and their qualifications are posted on our website (ASCO.org) along with the answers they provided to the key questions posed by the Committee. Then we attempt to draw voters to the voting website through mailings, email, social media, and direct discussions with our colleagues.

In the election of 2013, just concluded, fewer than 10% of us voted. We now have just about 25,000 members in voting categories, about one-third of them “international” (as opposed to U.S.–based), but despite our overall growth, the number of votes and percentage voting has been falling steadily. This has occurred despite concerted efforts to highlight, simplify, and extend the opportunities to participate. After years of gradual erosion in the level of voting by our members, several conclusions are possible. Either we are completely comfortable with the excellent options afforded by our Nominating Committees or we are mostly apathetic about whom we select to lead the organization. Neither response seems good for ASCO in the long-term as it reflects a lack of engagement in this vital shared responsibility. 

It seems to me that several characteristics of our current approach demand consideration:

1. We do not run a truly contested election. We bar formal campaigning so that even if there were real policy, philosophical, vision, or outlook differences between the two candidates for President-Elect, our members would be hard-pressed to find this out.

2. Our Nominating Committee carefully selects well-qualified  and well-matched candidates based on service, area of interest and practice, perceived skills, and, let’s face it, prominence (call it “networking”) to make sure that the best possible people are at the helm. As a consequence:

a. We only place outstanding and eminently qualified candidates on our ballots, making the choices difficult and largely without clear impact on the organization;

b. We have no “primary” process, and therefore no direct reflection of any popular mandate, and;

c. In the interest of fairness and balance, we typically run candidates for President-Elect from similar affinity groups (i.e., pediatric oncologists) against one another (more about this below).

In summary, we pick two excellent candidates, either one of whom we would trust to lead; we prevent them from truly developing or highlighting any potential differences in vision, goals, or skills; and we then declare a winner and loser based on the input of no more than 10% of our members. A winner likely garners 5-8% of the eligible members’ votes!

At this point, you may not believe any of this is a problem. We have strong leadership, the organization is very well run and well served, the members are not complaining about the elections (especially since they don’t seem to even be particularly aware of them!), and candidates are willing to stand for the election year after year. In response, I would agree that this may not be a big problem right now. Indeed, one option we can consider in response to the current situation is to do nothing.  But, I think we may pay a steep and hidden price in the future if we continue to take this laissez-faire approach.

Here are some risks of doing nothing:

1. We fail to obtain the benefits of optimal diversity in our leadership. The simple reason for this is that we have a range of affinity groups (medical oncologists being the largest) and then subgroups (breast cancer oncologists traditionally being the largest) that frequently provide support for candidates from among their midst. That means that it is generally true that a breast oncologist will outpoll a pediatric sarcoma surgeon, regardless of all other qualifications and factors. To overcome this, our Nominating Committee constructs “balanced” ballots that led, for example, to the recent choice between two pediatric oncologists (and Michael Link’s excellent year as our President!). But, what if one great head-and-neck radiation oncologist was identified as a possible candidate? Who might we run her against to create some equal chance of success? A thoracic medical oncologist would, in our organization, likely have greater immediate name recognition and would predictably emerge victorious. Similarly, outstanding leaders from community-based practice who may not be as well-known nationally are at a distinct disadvantage in our contested elections even though a majority of our domestic members practice outside of academic centers.

2. Because we contest the election, we subject some of our most deeply committed members and volunteers to a public loss. In some cases, they might willingly stand for election a second time, but others may be reluctant to run again, and we forfeit many talented leaders in such a process.

If none of this concerns you, then what follows may be offensive, as I am suggesting that we consider doing away with the contested presidential election. (Again, technically, I am referring to the election of our President-Elect.) Instead, I would propose that we maintain the current Nominating Committee structure and process and continue to run candidates for those roles and for the Board of Directors, but that we then include a simple up or down vote for the presidential candidate. The qualifications for President-Elect include prior service (completed) on the Board of Directors, so any candidate will have prevailed in an earlier contested election. Thus we would maintain some degree of the “representation” of the voters we seek. The candidate would be selected, as is true now, by an elected Nominating Committee, so this would not be a “closed” process. But with this approach, we would eliminate the possibility of having to declare that anyone “lost” the presidential election, and we would avail ourselves of possible leaders who are now not electable because they come from smaller or less well-known subgroups within the ASCO membership.

I acknowledge that this proposal does not address the overall low voter turnout. In fact, we might predict that without the presidential candidate to drive (gently, it seems!) interest in the election, we might see even lower participation. If this is a problem, we could turn our attention to other revisions or overall approaches in the future. But, in the meantime, we would reduce some of the costs (both fiscal and psychological) of the current system. Abandoning the contested presidential election seems to me like a way to potentially strengthen ASCO and would, of course, require a bylaws revision and approval by vote during the Annual Business Meeting.

I am truly interested in everyone’s thoughtful input on this. Election reform was not a key agenda item of my year as President, and I am very open to the point of view that a contested election, regardless of the low rate of participation, is important (although I am not currently convinced). Regardless of your bias, I ask everyone to consider very carefully whether we really think we are on the right and only path at present and what we could to improve the situation.  Please provide feedback (even if you don’t vote).

Disclaimer: 

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Comments

David L. Graham, MD, FASCO

Jul, 29 2014 9:52 PM

Cliff,
THis is a great topic to raise. Even if the choice is to keep things the same, the discussion is invaluable.

You mention candidates losing once being less willing to run. Are there any data regarding people losing one election and going on to be voted into something else?

One thought regarding the election: if the timing were to be moved, there could be voting kiosks available at the Annual Meeting with regular mentions made of the chance to vote. That way you at least get the members at the meeting regularly "pestered" to vote with a relatively easy way to do it. It could even potentially made as a function in the Annual Meeting companion app.

I look forward to the other discussion and ideas.

Michael A. Thompson, MD, PhD

Jul, 30 2014 12:51 PM

I think many of us are happy with ASCO and presidential leadership and had not thought about disrupting the leadership mechanisms at the highest levels. Likely those that are most aware of these issues are the relatively small percentage of those that have run for president.  I think this is a provocative and insightful discussion.

I agree with David that even if the status quo is kept, challenging it and re-examining the relationship of members, leaders, and ASCO as an organization is valuable.

Voting during the Annual Meeting when much of the membership base is together and energized is a great idea. Voting electronically (via app or online) has authentication issues, but these are certainly addressable by our IT-philic leadership and staff.

I have been involved with reviewing membership engagement via the Conquer Cancer Foundation and in other roles and I believe that improving member value, buy-in, and engagement can do nothing but help our organization.

Mike 

Clifford A. Hudis, MD, FACP, FASCO

Jul, 31 2014 11:15 AM

Extending the vote to include the annual meeting involves big changes in the Board's cycle of activities....but we might revisit. We have had electronic voting with no clear impact on the continuously declining rate of voter participation.

Peter Paul Yu, MD, FASCO, FACP

Aug, 02 2014 2:11 PM

Cliff,

Thank you for your call for dialogue on a subject that is critical to the future of our Society. If less than 10% of our members vote for the President-Elect, Board Member (including Treasurer) and the Nominating Committee positions, there is grave risk that the resulting Society’s leadership may not comprehend the breadth of our membership’s concerns. It has been suggested there are two possible interpretations for this low voting turnout: either our membership is fully satisfied with the direction and successes of ASCO, or that our members are apathetic about the election. Given the multiple challenges that ASCO members face in our daily lives such as the survival of community practice, decreasing career development opportunities for fellows and the ongoing threats to the clinical trials research enterprise, it is difficult to believe that ASCO members are content with the current state of affairs in the oncology world. In the face of so much ongoing disruption to our way of life, why is the turnout so low?

That these problems must be solved and that ASCO is precisely the right organization to do so is beyond dispute, but could it be that ASCO members think otherwise and why would that be? All of these issues and many more are being aggressively attacked by our over 20 ASCO committees, each operating under the leadership of a committee chair who has long and deep knowledge of the subject matter and supported by the over 300 dedicated and professional ASCO staff. At any given moment, there are some 1,000 ASCO member volunteers contributing their energy and intellectual firepower in service to the Society, our membership and on behalf of our patients. It is very likely that the majority of the 2,500 or so that vote are ASCO members who have seen first hand through their committee experience what ASCO can achieve and thereby understand the importance of having our best and brightest at the helm.

I believe that we could improve the member voting rate if we did a better job communicating to our general membership what the strategic plan of the ASCO Board is and how that plan is realized through the committees as they address the pressing issues that the committees have identified as most salient to the needs of our members. To that end, John Cox, Editor of the Journal of Oncology Practice and Chair of the Annual Meeting Education Committee is tightening the connection between the ASCO committees and the program tracks that determine the Educational Session content of the Annual Meeting so that the most important membership issues and what ASCO committees are doing about them can be explained to our members.

Another approach is to broaden the opportunities whereby our members can participate in committee work by re-engineering the committee structure to eliminate some of the barriers that our members may perceive exist. Presently, committee appointments are for three-year terms in which a committee member is expected to actively contribute to the full spectrum of the committee agenda, whether they have expertise or interest. For community oncologists who have time limitations, such a commitment can be daunting. In addition, because of the 3-year terms, the number of committee members is limited. Because of this, consideration is being given to allowing ad hoc appointments to time limited task forces that operate within a committee and address a specific narrowly defined issue.

How will we decide if re-engineering of ASCO is the right approach to the challenge of exciting our membership over the election choices? Two task forces are now being formed. One task force will study our committee structure to examine whether we can evolve committees that are more nimble in addressing the issues that matter most to our members, increase the opportunities for membership involvement in committee work and align committee work across committees and in accordance with the ASCO Board vision for the Society. The second task force will examine the nomination and election process itself with the goals of ensuring leadership that represent the full spectrum of ASCO membership and guarding against having our present severe limitations on campaigning inhibiting candidates developing and expressing their personal vision for ASCO. This task force will examine what defines a community oncologist, at least for the purpose of holding an elected office. With the emergence of very large oncology practices and hospital based staff models, the traditional view of the community oncologist as a one who works in a small independent practice no longer represents where an increasing number of our members care for their patients. Third, I have asked Joe DiBenedetto, the Chair of the ASCO Membership Committee, to have this committee inform ASCO on how we can better serve membership needs and in so doing increase membership loyalty and participation in the affairs of the Society.

Cliff has advanced strong arguments for having the ASCO President-Elect appointed from the list of past Board members rather than being directly elected. However, the premise largely rests on the belief that the elected ASCO Board members and the elected Nominating Committee members truly represent ASCO membership. That this is so remains unclear if less than 10% of ASCO members vote. Furthermore we are still dependent upon having a healthy pipeline of committee volunteers and committee chairs to draw upon that are inclusive of the diversity US and international oncologists. I view the low participation rate in the ASCO elections as an indicator that there are underlying issues in how our Society relates to its membership and that remedying the root causes is the key to having ASCO better prepared to face the challenges that confront us all.

Peter

Sharon B. Murphy, MD, FASCO

Aug, 06 2014 2:52 PM

Cliff,
As a long-standing ASCO member and as someone who was nominated and ran for President-elect twice, I was interested in your post on electing ASCO's leaders and appreciate your raising of the issues.  I am a pediatric oncologist and twice was nominated for President and ran against a medical oncologist and lost both times, and I think my experience may have contributed to the Board's past decision to change the bylaws and create "balanced ballots."  But the present policy is still not satisfactory in my opinion. Not only does it create "winners and losers", but it may be difficult to find candidates to contest in some of our oncologic subspecialties, and opportunities for community oncologists to serve are limited even though they are the majority of our members.
The shockingly low voter turnout of 10% is a surprise, but maybe is not unusual. We should check with AACR and ASH, for instance, to see what proportion of their membership votes in annual elections. 
I would favor some re-assessment of current practice and encourage efforts to engage more of our members in participating in the Society's governance, committees and Board.
From Peter's post, it seems as if this topic is to be addressed by some task forces and standing committees in the coming year.
Thanks for raising the issue and asking for input.
Sharon Murphy, FASCO
 

Lillian P. Burke, MD, MHM

Aug, 08 2014 8:45 AM

I often do not vote, and the two main reasons are: 1. the information is too long to read and absorb given time available, and 2. I don't know the people and successful leadership depends very much on the leadership skills of the person rather than their particular ideas.  I do try to look through the candidates and vote if I have time AND if there seems to be a clear difference between the candidates in terms of their plans for the society and I favor one over the other. For these reasons, I would prefer the leadership to be picked by a nominating committee of people who know the people involved, rather than through a general election.  The important thing here would be to open the process up for nominations to avoid an "in group" taking over, which, given the nature of power, would happen at some time. It is interesting that the group has chosen to match positions by specialties, and this is one thought, but what if the best leader is actually someone with a different specialty?  How can we find the best leaders?  There also needs to be a way to avoid the "name recognition" part of leadership.  First, name recognition is certainly one admirable attribute since the ASCO leadership needs people who know how to push the organization forward in the public's eyes and someone who has done this for him/herself has a good chance of doing this for the organization, but other attributes that are needed also. 

I also applied at least once for committees and did not get even a word back. This was an obvious waste of my time. It seems that everyone who wants to contribute should be allowed to contribute. Why close the process? 

Most people who are involved or would be interested probably go to the annual meeting or would be willing to (this is a testable proposition).   My thought is that there is a need to open the process up and invite more people to be involved and contribute to committees, even if the contributions are minimal. Perhaps everyone should be invited to be in an "interest group" which would have the opportunity to meet at the annual meetings. This could include an interest group relating to governance, disease specialty groups, basic science specialty groups (e.g. signal transduction groups, clinical trial innovation), population interest groups (elderly, rural, etc.). These groups could meet in the early evening, after big talks or series so that they could invite the people at the talk to attend.  It might be a bit of a free for all and perhaps should be limited to members or professionals given problems at the last meeting although there could be a group for patients/advocates also.  While we want to reach out to non-members, ASCO is for members and the patients we serve. As these groups became active, they could choose leaders who then could contribute to nominating committees and enter leadership. 

One option is to allow proxy voting. For instance, I have a friend who has been very active in leadership positions and I would prefer him to choose leaders for me since he knows them personally and I trust his judgement. If voting occurred at the annual meeting, the candidates could give talks and there could be discussions and those with proxies could vote their proxies at that time.  

Another option is to allow representative type of governance.  For instance, everyone could be allowed to vote his own vote, but members could also join a group for voting purposes but only one group.  The groups could be self forming. Some might join a regional group, while others might join a "lung cancer" group or "pharmacy group". Since each member could join only one group, members would not be limited by geography or lack of interest in their specialties or regions. Each group could pick a representative(s) to attend the governance meeting(s) and vote their proxies after having the opportunity to meet with the various candidates. The proxy voter could get a small amount towards ASCO attendance.  For instance, if a proxy holder got $25 towards attendance for each proxy (only for use at the meeting and requires participation in the governance meetings), those with 50 to 100 proxies would have a substantial assistance towards attendance and this number of members is small enough to allow the representative to know the wishes of those who have given their proxies. 

As ASCO moves forward on these issues, it will be important first to identify the "mission" of the discussions.  We should identify potential  "specific objectives" and test these with the membership.  Once the specific objectives are identified, one can identify a way to do this and then there will be a way to find out whether the goals have been met.  For instance, it will be difficult to make changes quickly as these require voting to change the constitution, but one could allow the membership to give proxies to colleagues to attend an interest group relating to governance at the next ASCO.  Of course, these proxies could not officially vote but they could contribute the thoughts of their proxy voters to the discussion and at that meeting, they could vote their proxies (including split their votes also). 

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