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ASA Needs a New Election System

Op-Med is a collection of original articles contributed by Doximity members.
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Watching and working in ASA officer election campaigns for the past several years has been a deeply unsettling experience.

The ASA's officers today are outstanding anesthesiologists, dedicated to their profession and to the organization. But the process of electing them, from my viewpoint, is a dysfunctional endurance test, fraught with barriers to entry and hobbled by tradition.

Imagine a hybrid of ritualized Kabuki theater and a high-school campaign for homecoming queen, and you'd be close. And yet the results have binding effects on a 50,000-member, multimillion-dollar specialty society whose work affects the professional lives of all ASA members.

We need to reevaluate and redesign this system sooner rather than later for the health and long-term future of the organization. Here is a glimpse of some of the fundamental problems.

While in theory offices come open for election every year, in reality it's taboo to challenge an incumbent officer.

There are no term limits. An incumbent officer can be reelected indefinitely. So anyone thinking about running for office has no certain knowledge of what year an office may become vacant.

People may announce their intention to run for a given office years in advance of when the office is likely to become vacant, with the intentional effect of discouraging anyone else from running in opposition.

The campaign process is prohibitively expensive at personal cost to the candidates, often involving travel to multiple state society meetings. The cost alone is a barrier to entry for younger physicians, as is the time away from work and family.

The Caucus System

ASA for decades has divided itself into state and regional caucuses organized by geography: Mid-Atlantic, New England, Southern, Midwest, and Western. Of these, the Western caucus is the largest, as it includes both California and Texas, and New England is the smallest.

If the caucuses were intended solely to encourage debate of policy issues in smaller groups, that would be fine. However, the caucuses play a powerful, disproportionate role in the chess game of electing officers.

By tradition, a caucus will endorse only one candidate for any given office. If more than one candidate in a caucus wants to run for that office, the caucus is expected to decide internally which candidate to support and which one should gracefully withdraw.

The caucus leadership holds lopsided power in this "kingmaking" process. It is rare and highly controversial for anyone to buck the caucus system and run without caucus endorsement. This poses a significant barrier to entry for any new candidate, no matter how qualified, especially if he or she hasn't spent years (or decades) cultivating alliances.

Once the caucus has anointed a candidate, the leaders invariably declare that caucus members are free to act according to conscience and vote for the candidate of another caucus in the final secret-ballot election. However, caucus members are strongly discouraged from campaigning in support of an opposing candidate.

If two candidates appear equally qualified, caucus members often feel pressure to be loyal to the home caucus candidate. On occasion, caucuses have struck private deals to throw support to a selected candidate in return for future support of another candidate.

On the day before the final House of Delegates elections, candidates in contested races visit each caucus to answer questions, accompanied by "posses" of friends and allies carefully curated to demonstrate strong nationwide support. I'm not kidding about this; it's all part of election strategy along with the calculated choice of the person who will deliver the nominating speech.

Every word the candidates say is scrutinized for any weakness or flaw. These caucus rounds have been known to make or break campaigns. Candidates are under tremendous pressure not to make any memorable errors. Remember when Al Gore claimed invention of the Internet, and Hillary Clinton dismissed opposing voters as a "basket of deplorables"? ASA politicos remember what candidates say during caucus rounds long after the elections are over.

What's the solution?

Working out a better system should be a thoughtful process aimed at reducing barriers to entry for younger physicians and eliminating the "kingmaker" role of the geographic caucuses. At a minimum, changes to be considered should include:

Implementation of term limits (e.g. five or six years) for the offices below First Vice President, to make it clear well in advance when the office-holder will either run for higher office or step down;

Elimination of caucus endorsement;

Creation of a defined, open time period in each election cycle for declaration of intent to run for office, in order to eliminate the advantage of declaring years in advance;

Creation of a primary system to allow for multiple candidates from any state or region to conduct "virtual" campaigns, leading up to a preliminary round of electronic voting by delegates to narrow the race down to two final candidates;

Limits on campaign spending, or financial campaign support from the ASA, to make the cost of campaigning less prohibitive.

If the ASA is truly interested in increasing member engagement and decreasing cynicism, then we need to open the doors and windows and let in some fresh air. The current election atmosphere is toxic. We can do better.

Originally on A Penned Point

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