The conundrum of BCMA governance: Representation vs governance

Effective Board governance and meaningful representation are fundamental in order for the BCMA to remain an effective and vital organization that meets your needs as a physician and allows the BCMA to effectively advocate on behalf of patients.

The BCMA Board has a Committee on Governance and Restructuring (chaired by well-respected BCMA past-president Dr Arun Garg) that is tackling the issue of governance of, and representation within, our organization. This issue was of vital importance to last year’s president Dr Jack Burak, and the related work has continued during my year as president with my full support and commitment to the process.

But why should you care about this? Haven’t you heard all of this before? The simple answer is that we want to move the BCMA from being a very good organization to being a great organization.

The current model of our Board is a hybrid of representation and governance. With the exception of the officers, the Board members are elected by their geographic districts and are expected to bring to the Board issues of importance to their constituency. That is the representative function. However, once at the Board and when it gets to decision-making time, Board members are supposed to “leave their hats at the door” and make and support decisions that are in the best interests of the organization and its members—all of its members. This is not just what we are supposed to do; it is what we are required by statute and fiduciary duty to do. That is the governance part: making sure that the association does indeed carry out the tasks it has been set by the Board.
And there lies the conundrum. At times, it can become very difficult to fulfill both functions. And when these two ideals clash, Board members (as in all boards of directors) are required to put aside their representation role and assume the governance role.

To my mind, this has the potential to limit BCMA members’ ability to be truly represented, and also limits the ability for them to have their ideas presented at a forum where they can legitimately be discussed, argued, and eventually progress to the point where they will become association policy.

Two previous attempts to change our present structure by introducing a larger representative forum of some sort (the “representative” part of the equation) and a smaller Board (the “governance” arm) both failed when presented at previous annual conventions for numerous reasons and concerns that were expressed by members at the time. However, it has become clear to me that we do need to make sure that the two functions are separate to allow for full and proper representation of our members. This may or may not require new structures, but I believe that Dr Garg’s committee will produce a model that works well for our members and the association in this fast-moving and rapidly changing environment in which we work and live.

Externally, delivery of medical care has changed significantly due to the new regional health authorities. We as physicians need to have a structure in which we can interact effectively with the health authorities, and influence the decisions they make, as they become more and more closely involved with the direct provision of health care within their regions. Dr Garg’s committee has looked at that aspect of representation, and the Board has accepted an interim proposal that will allow significantly more interaction between the BCMA, physicians working in the health authorities, and the health authority administration.

Form should always follow function. Once we have fully defined the functions that we want to see, the ultimate structures we achieve should naturally follow. If there is found to be a need to change our governance and representation models, you will ultimately be asked for your opinion in a referendum. I urge you to carefully review the work that has been done and take time to familiarize yourself with the issues.

—Michael Golbey, MD
BCMA President