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Democracy Amidst a Pandemic

June 25, 2020

“What is best for democracy is more democracy!” Senator Cory Booker (D-NJ).

Despite the restrictions created by coronavirus and social distancing guidelines, it is the responsibility of the Illinois State Medical Society (ISMS) to effectively represent its members. Technology has been incredibly helpful in this regard, with telephone conferencing easily evolving into video conferencing, but the basic challenge remains. How does the Society evaluate complex medical issues in a timely manner while continuing to represent the members in a democratic fashion? This issue became even more pressing with the cancelation of the Annual Meeting of the ISMS, originally scheduled for April in Springfield.

The ISMS operates under an organizational structure defined by the bylaws and a three-year governance Pilot Plan which was approved by the House of Delegates in 2018. There are several major components to the Pilot Plan including changes in Trustee districts and new approaches to leadership recruitment. The most well-received and least controversial change to the Annual Meeting was to decrease the length of the formal meeting from three to two days. In 2019, the first year of the condensed schedule, the post-meeting survey showed 92% approval of the new schedule.

A more provocative part of the plan was the replacement of annual resolutions review with a “continuous resolution” process. The rationale for this concept was that allowing resolutions to be submitted throughout the year helps ISMS evaluate and act on proposals in a more timely fashion. Resolutions are reviewed by committees and councils, which consider testimony from authors and feedback gathered through surveys of the general membership. The resolutions are then acted on by the Board of Trustees. The ISMS membership at large maintains the authority to review, revise, and even reverse such actions at the subsequent Annual Meeting.

We are now in a position to evaluate the effects of the governance Pilot Plan to date. With the system of annual resolutions in place from 2017-18, the total number of electronic comments on the resolutions for both years combined was 73. With the continuous resolution process in 2019-20, the resolution commentary rose dramatically to 400-800 comments per year. Even those who didn’t comment could offer a simple yes or no statement on whether they supported a resolution’s concept. Hundreds more chose to do so. An average of 170 individuals provided such an answer for each submitted resolution, for a total of more than 13,400 responses across both years.

 If one considers the number of electronic responses as a measure of membership engagement, then the continuous resolution process led to a dramatic increase in membership engagement, which might even be considered as a proxy for involvement in the democratic process itself.

Of course, the reforms in the Annual Meeting did not envision the chaos brought by the coronavirus pandemic. When the continuous resolution process was implemented in 2019, coronavirus had not even begun its genetic odyssey from its reservoir host species to humans. Nevertheless, it is appropriate to evaluate how the Pilot Plan fared under the stress of the coronavirus pandemic. 

In 2019 the Board’s actions were presented for approval as a consent calendar. An individual member could extract any item, and the item was then sent to a Reference Committee for testimony and report back. The membership subsequently voted on the item. During the pandemic of 2020, the system continued in a similar manner, but virtually. The consent calendar was offered electronically to the members in two batches for extraction. Of the 38 items that were offered, just four were extracted for further review at the 2021 Annual Meeting.  

In terms of membership engagement, the Pilot Plan appears to have functioned well, even during the coronavirus pandemic. Thankfully, physician engagement continues to rise. Our Society still functions under the 2018 governance Pilot Plan. At the 2021 Annual Meeting, ISMS members will have a chance to vote on the anticipated bylaws changes that would make the reforms and lessons learned in the Pilot Plan permanent.  

ISMS invites your comments about the Pilot Plan be sent to DrPanton@isms.org. ISMS continues to work to assure that whatever system of governance is ultimately adopted, that system should be timely, adaptable, and meet Sen. Booker’s requirement to maximize democracy.

Robert W. Panton, MD

Send your questions and comments to Dr. Panton.

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