McCunney, Robert J. MD, MPH
Medical societies have a long history dating back to their founding by Henry VIII of the Royal College of Physicians in the early sixteenth century, the Massachusetts Medical Society in 1781, and the American Medical Association in 1847. For centuries, medical societies have served a major role in promoting the interests of their respective disciplines, furthering the education of their members, and advocating in the public sector. Over the years, they have expanded beyond these primary roles of protecting professional interests and spheres of influence to develop standards of competency and codes of ethics and to address public concerns more assertively. 1 Despite the widespread nature of professional associations such as medical societies, articles on this topic in the peer-reviewed literature are surprisingly limited. 2–6
This commentary reflects one year’s service as president of the American College of Occupational and Environmental Medicine (ACOEM), an over 80-year-old medical society with nearly 7000 members. Its mission is set forth in Table 1.
As chief elected officer of the College, the president usually serves in a voluntary capacity and assumes the primary executive role in overseeing the organization’s activities, with the support of a paid staff that includes an executive director. Both of these leaders are subject to direction by the board of directors. ACOEM is a volunteer organization, and all officers and board and committee members serve without compensation for their time, energy, and intelligent commitment. Therefore, consensus is critical for success.
Although the specific activities of a president vary depending on the specialty and its history and contemporary challenges, the visionary, operational, and representative functions of that office require leadership ability, interpersonal skills, integrity, and a strong moral compass. The latter may be the most important in setting the example of avoiding conflicts of interest and ensuring a fair, deliberative process.
Roles of the President
One of the major challenges a president faces is setting the agenda for the term of office, and then encouraging participation and providing direction. Monitoring developments within the organization and informing the membership through various outlets such as newsletters and the Web improve one’s effectiveness in gaining support.
Within ACOEM, an officers’ retreat is held a few months before the president takes office. During this focusedthree-day effort, the four senior officers (Table 2) and the executive director formulate a plan for the year, including appointments of personnel, especially chairs of councils and committees. The president has the authority to make a variety of appointments, including those to the editorial board of the College’s Journal of Occupational and Environmental Medicine. Also during the retreat, the incoming president can test and nurture new initiatives. Five areas worthy of special emphasis include (1) research; (2) publications; (3) professional development, especially leadership training; (4) the Internet; and (5) scope of practice.
As the cliché goes, any field is only as good as its literature. Occupational medicine is no exception. In fact, in comparison with such other specialties as surgery, pediatrics, and internal medicine, the field is relatively early in its history. Historians, however, date its origins to a publication by Ramazzini, an Italian physician prominent in the early 18th century.
The College and the specialty (both of which are intimately related and mutually dependent) seem to derive great benefit from a focused effort directed to research. Such a focus, however, does not mean that members should become bench investigators or that the College should compete with academic institutions for research funds. Attention to research can take other forms, such as proposing research agenda for funding agencies, facilitating multisite investigations, or assisting members in critically reviewing and understanding the implications of research. A fundamental understanding of principles involved in occupational medicine research can enable members to recognize areas of practice worthy of evaluation. For example, evidenced-based standards of practice (built on firm investigations) can enhance the quality and standardization of occupational medical practice.
As a result of a special committee initiated by the president, a new Committee on Research was formed; as part of the Council on Scientific Affairs, its members represent corporate, academic, and clinical perspectives. As with any new initiative, its future success depends on the enthusiasm and effort of those involved.
Although the Internet has significantly altered how information is exchanged, publications, especially books, are unlikely to face extinction in the near future. In fact, were books to have been recently invented, they would likely be heralded as a great advancement; after all, they are portable, transferable, and storable, and their “hard drive” never crashes! Levity aside, the need to assemble information in a coherent form to educate, influence, and inform will persist regardless of the means by which it is stored, used, or transmitted.
Among professional societies, publications, regardless of the form (newsletter, position paper, or textbook) have diverse functions. Education, transfer of information, and enhancement of the discipline’s value are notable examples of how publications contribute to the success of any organization. Clearly, the publication of work designed to evaluate and document the effectiveness of one’s activities (ie, applied research) can promote the value of any specialty.
Although support of publications by professional societies takes many forms, some have separate publications divisions that encourage members to develop ideas and submit proposals for review. Eventually, authors receive assistance in the entire publication process, ranging from the creation of the initial outline to the marketing effort that (ideally) follows. Successful publications not only generate revenue, but they also help define the scope of services for the specialty, elevate and maintain its stature, and provide members with valuable educational material. Ideally, research and publication efforts should be interrelated and support designated educational ventures, the topics of which vary according to new developments and the current needs of the membership.
Professional development in the context of medical societies has numerous connotations. On the one hand, the term can be interpreted as improvement of a member’s medical practice, such as developing a consulting program, recruiting able assistants, or increasing effectiveness in the business aspects of running a small organization. On the other hand, professional development may refer to focused educational programs on specific topics pertinent to the specialty.
At the request of a special presidential committee, the board approved the development of independent courses covering musculoskeletal disorders, medical center occupational health, and practice management. Proposals for such topics were introduced toward the end of the presidential term to encourage these initiatives. Future topics can be based not only on new developments in the specialty, but also on the recommendations of attendees at national meetings.
An essential aspect of professional development is the acquisition of leadership skills pertinent to the work of both the College and its members. 7 Such skills cannot be assumed to be naturally acquired. Successful leadership depends in part on one’s ability to chair a meeting and engage the confidence of colleagues in a way that facilitates appropriate debate and attainment of consensus. 8 Divergent views, especially those counter to senior leadership, deserve sufficient airing. In fact, one of the major criticisms any committee chair can endure is the perception of stifling debate or of leaving an impression that policies are being railroaded to approval. 9,10
As a result of a special committee formed in early 2000, the College will develop a plan for formal training in leadership. Members can expect guidance in the principles of leadership to become more effective not only in their roles within the College, but also within their area of employment. Such skills are clearly transferable. 11 Moreover, the ability to develop such skills among one’s peers adds value to membership in the College. Ongoing attention to recognizing future ACOEM leaders and encouraging them to develop these skills and participate in College governance will lead to a vibrant organization. The experience a president gains in three years on the executive committee helps to provide training and build agenda for the presidential term.
It is difficult to overstate the potential opportunities the Internet offers to both the ACOEM and the specialty. 12 A special committee on the Internet, established at the onset of the presidential term, will report directly to the president to ensure that the College remains current in the technological upheaval under way in telecommunications. At the 2000 American Occupational Health Conference, on-line registration and a government affairs site were introduced on the existing Web page. Future plans include a private site for members (to be described as a members’ kiosk) to monitor continuing medical education credits and tabulate other personal professional information.
The Internet promises extraordinary potential for international engagement that can lead to the improvement of worldwide health and safety practices. International affiliations can take many forms, including joint conferences with other professional organizations. One such conference was introduced during the presidential term with Medichem, the largest scientific body of the International Commission on Occupational Health. Like the fall conference of 2000 with the American Industrial Hygiene Association, joint efforts provide an ideal venue for collaboration in a multidisciplinary field such as occupational health. Medichem offers additional potential in raising the academic caliber of scientific exchange; selected proceedings from their annual meetings have been published since 1995 in the International Archives of Occupational and Environmental Health, a peer-reviewed journal. 11
Scope of practice.
With the promulgation of Occupational Safety and Health Administration (OSHA) standards in the 1990s came the introduction of the term licensed health care provider (LHCP). This designation was used in the methylene chloride standard to refer to professionals authorized to conduct the medical evaluations required by the regulation. Although concerns were raised about both the definition and the scope of practice associated with the LHCP designation, OSHA deferred to state registration boards for interpretation. ACOEM eventually filed suit against OSHA concerning the use of LHCPs for medical surveillance. The case was rejected by an appellate court.
Occupational medicine (and other specialties, such as psychiatry, ophthalmology, and anesthesiology) has faced a gradual encroachment on its array of clinical services by other health care professionals. To properly address the role of physicians with respect to LHCPs, an appeal was made to OSHA to invite commentary on this topic in the preamble to the proposed OSHA standard on ergonomics (November 22, 1999). Somewhat surprisingly, the term LHCP has been used by the federal agency without inviting public comment on its implications. A special committee, the president’s most reliable tool for promptly addressing a specific issue, was formed. Consisting of physicians representing labor, management, government, and clinical perspectives, the committee will develop the College’s response to the OSHA overture.
ACOEM’s national organizational structure consists of three major units: the board of directors, executive committee, and house of delegates (Table 2). The board, consisting of 15 elected members, the senior officers, and the house of delegates, has primary authority for College activities. Both the president and the executive director are accountable to the board, which meets quarterly to oversee the organization’s fiduciary policy, public positions, and major initiatives. The executive committee meets monthly by means of teleconferences.
The president’s role in governance relates primarily to chairing meetings of the executive committee and board of directors. A critical role of both the president and the board is the legally defined financial responsibility in overseeing College activities. To be effective, the president must be knowledgeable about the major issues, display a sense of fairness, and promote open debate in board policy discussions. 13,14 Familiarity with proper parliamentary procedures, such as Sturgis, 15 and a temperament sympathetic to diverse opinions are invaluable in forging consensus. The art of effectively chairing a meeting, however, also includes an ability diplomatically to terminate debate when appropriate (Table 3).
In-between leadership meetings (eg, executive committee, board), the president and executive director need frequent contact. Attending to the College’s business often necessitates a president’s approval, an authority delegated to the office by the bylaws.
As the College moves into the future, periodic evaluation of the structure and role of the board will be valuable. The proper representation of such a diverse group as having one common point of view necessitates a wide net. A lively board that represents academic, clinical, corporate, and consulting perspectives can enhance the College’s effectiveness.
How the board functions is another topic worthy of periodic review. Currently, the board is subdivided into three subcommittees representing government relations, public policy, and strategic planning. These smaller groups evaluate policy in detail and present recommendations to the full board for approval. To ensure that appropriate information and background are reviewed, all councils, which represent diverse committees, report to a board member.
Board effectiveness depends on the background of its members, whose performance is based in large part on how well they are informed. The persuasiveness of the president, however, helps to influence key decisions. As with other organizations, some of the most important discussions related to policy tend to occur outside of the formal meetings, when board members can speak freely and off the record.
From the president’s perspective, the board can offer support for major initiatives and evaluate public policy, especially as related to government affairs. Ideally, the president seeks executive committee review and endorsement before presenting an option to the board. Successfully navigating the political waters requires a talent for engaging people in the merits of the venture. Attempting to force policy by using the presidential position rather than the power of the idea is a recipe unlikely to achieve success.
The president’s representative role encompasses government affairs, the media, and organized medicine. The president often serves as a spokesperson in public forums in which the College participates. Examples include meetings of the American Medical Association designed to promote interaction among medical societies and forge consensus on major health issues. Presentations at component society events enable members unable to attend national functions to become more engaged in College activities. Presenting oral and written testimony to government officials and assisting the College’s government relations staff in understanding the implications of pending regulations and legislation are tasks of great importance. The president may also be asked to prepare articles or op-ed pieces in support of the College’s position on pending regulations and federal agency rulemaking efforts.
In a field such as occupational medicine, labor and management perspectives on regulations can be strikingly different. The specialty, however, would be best served by focusing on health, particularly the prevention of occupational injuries and illnesses. Such a goal is clearly in the best interests of labor and management. A balanced perspective should be conveyed in meetings with regulatory agencies and in other public settings. The president’s challenge is to motivate members to take positions that promote the interests of the specialty, even if they may run counter to one’s employer. To be effective and maintain credibility, access to information and key government officials is critical to developing strategies that garner wide support. Fortunately, the College is ably represented by a full-time government relations staff person who lives and works in Washington, DC.
The president is usually the first contact for media inquiries, a role that demands timeliness, knowledge, and the ability to differentiate one’s personal perspective from that of the College. The president must also understand a topic sufficiently to recognize when referral is appropriate. Led by a full-time media-relations staff person, ACOEM issues press releases on College positions, articles published in the monthly Journal, and regular columns, such as the Labor Day Checklist. Media inquiries tend to originate from trade journals covering occupational health topics, national medical newsletters, radio, and, more recently, interviews over the Internet.
Dealing effectively with the media requires special skills that can be developed through training programs. The American Medical Association, for example, offers leadership programs on responding to reporters and handling interviews. Participation by ACOEM leadership in such media training efforts is advisable.
Serving as president of ACOEM is a considerable challenge to one’s organizational, technical, and interpersonal skills. Like most intense experiences, however, reflection after the fact provides a tempered perspective. The major organizational demand is to effectively manage one’s time, which is crucial to one’s success. Balancing the responsibilities of president with those of one’s family and employment requires careful planning, flexibility, and a sense of humor for the inevitable faux pas that develop. Availability for meetings, travel, the media, teleconferences, and review of College documents adds to one’s effectiveness. Reviewing minutes and position papers, answering phone calls and e-mails, and preparing presentations all require time—time that cannot be devoted to one’s primary source of income, family, or leisure. Nevertheless, overseeing special committees, councils, and noteworthy work of the College is essential for demonstrating the leadership warranted by the position. Recognition that the College is essentially a volunteer organization and that leaders serve without compensation is important.
As ACOEM moves into the twenty-first century and my tenure as president becomes a distant memory, some key principles for the College’s success are likely to remain in place. With respect to vision, the fundamental value of enhancing the scientific basis of the specialty cannot be overstated. Attention to research, publications, and education of members will strengthen the scientific core of the field.
In governance, the College would be wise to recognize the diversity of its members and to ensure wide representation in leadership activities. Active encouragement of the volunteer membership to assume leadership positions and develop the corresponding skills ought to be vigorously pursued.
Staff involvement, especially by the executive director, supports the business of the College. An executive director familiar with the operations of professional associations can bring professionalism to the position.
With numerous ongoing activities in a specialty society of upwards of 7000 physicians, the need for a president to set priorities is obvious. It is impossible to micromanage such a large society. Delegation is critical to one’s effectiveness.
Government relations will continue to be an important area for occupational and environmental medicine. An awareness of pending agency rulemaking and legislation and participation in meetings with agency officials and in the public process will support the College’s mission.
In conclusion, serving as president of a medical society offers a tremendous challenge and stimulus to one’s personal and professional growth. To be effective, a president must understand the College’s position on various topics and the expertise of colleagues to delegate accordingly. Key factors in a president’s success are employer support because of the enormous demands of the position in terms of time, leadership skills, and technical expertise. Ably addressing the role can enhance the impact of the specialty and lead to an experience of lifelong value.
© 2001 Lippincott Williams & Wilkins, Inc.