Drawing up plans for the future
The PSF past President Nicholas Vedder, MD, can still recall the excitement he felt while attending his first ASPS/PSF Board of Directors (BOD) meeting 12 years ago.
"I remember sitting there and thinking that I would be involved in the future direction of the Society," he says. "And I sat there and listened the whole time. I don't think we voted on anything other than to approve the minutes. It was eye-opening to me – and discouraging. It really wasn't until I got elected to a position on the Executive Committee (EC) when I was Board Vice President of Academic Affairs that I realized that everything really happens at the EC level."
That fact, Dr. Vedder says, highlights a structural problem with ASPS. Although there are representatives from some membership groups, a few subspecialty societies and the public on the 29-member BOD, it typically meets just twice a year. Those meetings, Dr. Vedder says, mostly consist of rubber-stamping decisions already made by the EC – a smaller body composed of the ASPS/PSF presidential line and board vice presidents – which often meets monthly to tackle issues facing the specialty and Society.
In his own time on the board and the EC, ASPS immediate-past President Joseph Losee, MD, had a lot of time to think about that fact as well. That's why he spent much of his presidential term working on a plan to change the topdown structure to a bottom-up one that would not only be more representative of membership, but make the BOD a more nimble entity that could meet with more frequency and play a more defined role in navigating the Society's future. It also addresses the ever-increasing requests to add members from subspecialty societies, member sections, managed societies and others for greater representation at the board level.
Dr. Losee acknowledges the tough history that has been tied to this kind of proposal.
"It's not as if governance restructure is a new idea," Dr. Losee says. "We've tried this. Many presidents have tried this many different ways. In the past, maybe the task force charged with governance restructuring was for it and the EC wasn't, or the EC was for it and the BOD wasn't, or the BOD was but the Trustees weren't. At the moment, it appears as if – in general – the task force, the EC, the BOD and the Trustees have all been engaged, contributed and are approving of the concept."
All parties, however, want ASPS members to understand the potential change – and get involved with planning. The first "town hall" on the governance change is expected to be held in December, and Dr. Losee says there will be continued membership engagement efforts throughout the year to generate more buy-in and involvement with the proposal. Ultimately, Dr. Losee says, the goal is to facilitate the generation of new ideas from within the membership and stakeholder groups and provide a direct line to a more-nimble governing body that can take action on those ideas.
On paper, achieving that goal is slightly more involved.
At Dr. Losee's direction, the ASPS Board/EC Composition Task Force first convened in the fall of 2020 to identify opportunities for greater engagement on the part of the membership and significant stakeholders (e.g., state and regional plastic surgery societies, plastic surgery subspecialty societies and member special interest groups). The resulting task force recommendations led to the current plan for structural revisions to the ASPS/ PSF BOD – and development of a new body of constituencies called the Council of Representatives (COR) to provide representation to the aforementioned significant stakeholders. The COR would have three subcouncils: the Subcouncil of Member Sections, the Subcouncil of State/Regional Societies and the Subcouncil of Specialty Societies.
The specific details of how this reorganization will ultimately look are yet to be determined – the member feedback that the Society seeks in the coming months could also modify the plan. Under the structure presented to the current EC and BOD in October, the EC would be dissolved and the restructured ASPS/PSF Board of Directors would be streamlined to include the six members of the presidential line (ASPS president, The PSF president, ASPS president-elect, The PSF president-elect, ASPS immediate-past president, The PSF immediate-past president); the seven board vice presidents (academic affairs, development, education, finance, health policy and advocacy, membership and research); and the chairs of the three COR subcouncils. This structure would revamp the ASPS BOD, cutting it from 29 members to 16 members. Two board vice presidents would also be assigned to each COR subcouncil as a liaison, in essence giving these groups a stronger voice on the BOD.
The PSF BOD would consist of the same members as the ASPS BOD – and there may be up to three public members (right now, there is one).
The proposed structure would have the COR essentially represent ASPS membership from the perspective of the Society's major stakeholders. The subcouncils would have the authority to adopt resolutions and recommendations for consideration, response, action or disposition by the ASPS BOD.
Dr. Losee says one of the main reasons for moving forward with governance restructuring is because of the requests for greater representation on the Board of Directors. However, he adds that it's not practical to expand a board that already has 29 members and, perhaps more significantly, that doesn't function as a true board should.
"We should get real about creating a new BOD that's different from the current EC," he says. "Right now, the BOD isn't as effective as it could be. Yes, we need more representation, but we can't just keep piling people onto a BOD that isn't really making key decisions. I'd argue that would only dilute attention to any topic and not enhance participation. This proposal gives membership different kinds of voices – members can do work on committees, and now with the new proposed structure, subcouncil chairs, made up of the broad membership, would gain a voting seat. In essence, the subcouncils would help populate the agenda of the board." Once a resolution or recommendation of the subcouncils has been put before the BOD, the board would have the responsibility and obligation to take action – be it a motion to accept or reject, remand the matter back for further clarification or request an advisory opinion from the Trustees.
The scope of this change is not lost on Dr. Vedder, who not only said he'd waited 12 years for this kind of reorganization to occur, but also called the proposal the "most significant structural change" he's seen in nearly 30 years as an ASPS member.
In October, the ASPS/PSF BOD voted to move the idea forward to increase member understanding of the proposed new structure. Early estimates of the restructure do confirm that there would be a cost associated with overhauling Society governance, although it was noted that with certain older ASPS programs sunsetting and other possibly expendable items (e.g., cocktail receptions) on the estimate, that figure is fluid and likely will drop.
Dr. Losee says that with effort, the cost does not have to be significant. Dr. Vedder agrees, and says the return on investment for the Society would be profound.
"This is about increasing membership engagement, which is probably the most important thing that any organization can do," he says.
ASPS/PSF Board Vice President of Membership Steven Williams, MD, says if ASPS is going to continue on the track its established over the past few years of increasing its services to members, getting more organizational buy-in from state and regional societies – not to mention increasing international partnerships – governance changes have to follow that.
"The structure needs to grow," he says. "Dr. Losee recognizes that we need to make sure we're building a more representative body where ideas can come from grassroots sources in a more efficient manner. Ultimately, that should tie the governing structure more closely to the needs and desires of membership. When it comes to arguments that members make where they feel like they're not heard or that ASPS doesn't represent them, this is an answer to that. This is the first step in making a lot of that better."
As membership input is gained and plans are brought into clearer detail, Dr. Losee says he will prioritize keeping the plan on track. Acknowledging that previous attempts at governance restructuring also lost steam as various issues arose and drew attention away from those efforts, Dr. Losee says he wants a detailed proposal to make its way to the Bylaws Committee for a vote by general membership in 2022.
That means a year of work, however, and plans at this point remain flexible. During the Annual Business Meeting in Atlanta, Dr. Losee said he'd already heard from members who offered thoughts and ideas on structural changes that he liked in concept – and that he remains open to more such input from members. In the coming months, the task force will continue to pin down the financial analysis and build engagement from members, stakeholders and staff.
"We're starting now with general membership, state and regional societies and subspecialty societies to present the model, seek feedback, gain approval," Dr. Losee says. "Ideally, we present it to the ASPS/PSF Board of Directors during the Spring Meeting, and from there it could go to the Bylaws Committee to pin down the details ahead of a membership vote later in the year."
That means that in the months ahead, Society leadership will be eager to hear from members so that the final structure reflects as much input as possible. Dr. Williams encourages everyone to participate in the upcoming town halls.
"Membership expects a real return on investment from their associations with this organization," he says. "It's good to be able to demonstrate that return on investment. Without a more streamlined mechanism of getting those membership concerns and ideas to leadership, that can't happen. I think this is a critical opportunity – it's just a question of: Do they have the time to help us out with it?
"We're all very busy," Dr. Williams adds. "We all have incredibly hectic lives. But you know, 15-30 minutes of paying attention to this could be really great, because it means that an organization that has grown in resources and representation can serve you better."