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).