Long-range planning: How to get involved in organized medicine

As I have traveled around the U.S. as AOA president, I am often asked by DOs and osteopathic medical students, young and old, “How do I get involved in the AOA? How are members of the Board of Trustees elected? What path did you follow to become President?”

Osteopathic physicians have many ways to get involved in organized medicine. For example, upon graduation and finishing my residency, I became active in my district osteopathic medical association and the American College of Osteopathic Family Physicians as a family physician from rural Oklahoma. Joining forces with MDs in state or national medical societies or volunteering in faith-, ethnicity- or cause-based physician associations are also starting points. But to become a leader in the AOA—that is, to be nominated and elected to the AOA Board of Trustees and perhaps eventually serve as AOA president—DOs must follow a long, well-defined path that begins with rising to a leadership position in a state osteopathic medical association.

Misconceptions abound about this process because many DOs do not understand the configuration of the AOA House of Delegates, which elects the AOA Board and votes on AOA policy. Although since 1993 each osteopathic specialty society has been allowed one delegate and one alternate delegate in the House, the AOA’s legislative body consists predominantly of state delegations.

Each state is entitled to one delegate and one alternate per every 100 AOA members in that state, rounding up from 75. As a result, states with several thousand AOA members, such as Michigan and Pennsylvania, have dozens of seated delegates. States with fewer than 75 AOA members have just one delegate and alternate each.

With the exception of the student, intern-resident and new physician in practice representatives, who have one-year terms, it is rare for someone to serve on the AOA Board who has not been at least a board member of his or her state osteopathic medical association. Moreover, most trustees have served as the president of a state association. Some have served as presidents of their specialty colleges as well.

While state societies have much more direct influence than specialty societies in the AOA House, the composition of the AOA Board does reflect certain trends in specialization among DOs. Fifteen family physicians and five internists serve on the Board, but the Board also includes an ophthalmologist, a radiologist, two surgeons and two OMM specialists. These trustees ascended to AOA leadership mostly through the support of their sponsoring state associations.

The AOA House is set up primarily as a state-based representative democracy, similar to the U.S. House of Representatives. As with the U.S. House, the largest states in the AOA House have the most representation. More than 20 years ago, the House decided to give specialty societies one vote each, but only after much debate over whether this would give AOA members who belong to both their state and specialty societies double representation.

Some DOs believe the AOA should give our specialty societies a stronger voice. To give specialty societies more proportional representation would require a complete overhaul of the AOA House. The state society-dominated House would need to vote for the transformation, which is unlikely. And such a revamping would take years to design and implement.

As it is, specialty societies can increase their influence in the AOA by pulling together all of their members who are state delegates to the AOA House. Before the House meets in July, a specialty society can petition such members to talk to their state delegations about specific issues important to the specialty.

[story-sidebar id=”181441″]

However, many specialty society board members are not active in their state associations. I encourage those who are not active in their state association to get involved. Belonging to your state association is one of your most effective tools in communicating the wishes of your specialty.

Making a mark

Making a mark in a state osteopathic medical association and rising in the ranks is not difficult for DOs who are hardworking, reliable and friendly. Go to your state meetings and volunteer for the committees. DOs who serve with distinction on state association committees generally will be asked to chair them. By continuing to make a good impression, these individuals often get elected to their state society’s governing board.

The main trait you need is a desire to serve. The time it takes to climb the leadership ladder depends on the size of the association. In a small state with few DOs, one can quickly rise to the presidency. In a larger state society, an aspiring leader may need to make an impact at the district level before ascending to the statewide board—a process that can take several years.

It’s a matter of proving yourself from the ground level up and being actively willing to give your time and effort. Based on my experience as president of the Oklahoma Osteopathic Association, by the time someone makes it to state president, he or she has put in thousands of hours of time.

State associations designate specific officers and other leaders to serve as delegates and alternates to the AOA House. In a small versus a large association, the path to becoming a delegate to the House is typically shorter. But once in the House, delegates from small states are less well-known and have less clout.

Large and mid-sized state associations offer many mentors and mechanisms for developing new leaders. For example, after achieving recognition as speaker of your state House of Delegates, you improve your chances of being elected speaker of the AOA House.

When a DO begins attending the AOA House as an alternate delegate and eventually a full-fledged delegate, he or she must make a favorable impression over a number of years before being considered for the Board. Before each meeting of the AOA House, held in July in Chicago, the House speaker selects delegates from the official roster to serve on reference committees. Shining on one of these committees, which exist for the duration of the meeting, is a way for newcomers to attract notice. How you speak and conduct yourself on the floor of the House will also be observed.

Call for nominations

When the House is not in session, those who hope for eventual election to the Board should serve on the AOA’s standing bureaus, councils and committees. Every February, the AOA president-elect calls for nominations of DOs who would like to volunteer their expertise and time toward such matters as osteopathic graduate medical education, state government affairs and OMED planning. Osteopathic entities that have designated slots on these committees, like osteopathic specialty societies, propose nominees. In addition, AOA members can nominate themselves by submitting a cover letter, CV and letters of recommendation.

With almost 70 bureaus, councils and committees, DOs have a breadth of opportunities to demonstrate their commitment to serving and making a contribution. Acquitting oneself admirably on an AOA committee requires top-notch communication skills. You also need to become educated on the issues and be prepared for meetings by having reviewed in advance all of the materials sent to you.

DOs who over several years have shown strong leadership skills in the House and on AOA committees have the best chance of being put forth by their state as potential nominees to the AOA Board. This requires an extreme dedication to medicine and to the osteopathic family and the ongoing support of their state association. Becoming a full AOA Board member, with a three-year term and a 12-year term limit, requires many years of service to the profession.

To make sure the Board is aware of the concerns of new generations of osteopathic physicians, one-year positions are allotted to a new practicing physician, an intern or resident, and a student, who alternates each year between a representative of the Student Osteopathic Medical Association (SOMA) and a representative of the Council of Osteopathic Student Government Presidents. After serving their terms, these individuals leave the Board and must work their way up the hierarchy of their state association and serve in the AOA House in order to be elected a full AOA trustee in the future.

New members of the profession can quickly gain credibility and responsibility by becoming active in SOMA and their college’s student government association and, later, by volunteering to serve on the AOA’s Council of Interns and Residents and Council of New Physicians in Practice.

Whole-profession approach

Although propelled to the Board by their state delegations, AOA trustees represent the whole profession, not just their states or specialties. You have to think more globally. Thus, to become a trustee and possibly president means putting aside narrow professional interests for the greater good of the profession.

I was blessed to be accepted into osteopathic medical school. We have been given an opportunity to serve mankind and to provide for our families in a style that most people can only dream of. I feel that we owe the profession. We have to give back. Get involved!