Bottom up: How grassroots input shapes ACP policies

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

This month, the American College of Physicians’ Board of Governors (BOG) will meet in Chicago. One of the items on the agenda is the discussion of resolutions that will help to shape ACP policy. The resolutions process, which looks at proposed policy changes and directives to the Board of Regents (BOR) submitted by ACP Chapters and Councils, is a major part of the BOG’s work. Resolutions are a way of providing grassroots input to the BOR.

One of my biggest frustrations when I served on the BOR was battling the perception that ACP policy was developed “top-down.” I sometimes wondered whether people really thought that old men in robes and powdered wigs sat around a table in an ivory tower making decisions, without the benefit of input from the membership. This is hardly the case — ACP’s policy-making procedure is inclusive and well informed as a result of the resolutions process.

ACP has 70 chapters representing every state (some of the larger states have multiple regions, each with their own Governor), the District of Columbia, Puerto Rico, the Uniformed Services, and international chapters in Canada, Mexico, Central America, South America, Japan, Southeast Asia, and Saudi Arabia. Governors are elected by the members in their geographic region. ACP Chapter Governors are a diverse group. Almost 60% of members of the BOG are general internists, the rest internal medicine subspecialists. Over half spend 50% or more of their time in direct patient care, while only 10% provide no direct patient care. They practice in academic and private settings, and a large portion does so in primarily outpatient practices.

Resolutions submitted to the BOG can be on any topic. Chapter Governors and their Councils often write them, but any member may submit resolutions to their Chapter for approval. Once approved by the sponsoring Chapter, the resolution is referred for consideration at the next BOG meeting. Four months before the BOG meeting, the resolutions are posted on the BOG web page for online comment by the Governors, Regents, and other leaders, as well as on ACP’s website for comment by members.

Resolution topics range from national issues such as health care policy, medical education, reimbursement, and recertification to internal ACP matters such as dues, membership development, and communication. They can call for changes in ACP policy or direct the BOR to take a specific action, such as support legislation or develop a position paper on a topic.

The list of resolutions that the BOG will deliberate at its next meeting is a good example of the variety of subjects covered. The BOG will consider resolutions on eliminating co-payments for medications used for common chronic conditions, climate change, maintenance of certification, communication with ACP leadership, and registration fees for student poster presenters.

At the BOG meeting, a “Reference Committee” of Governors hears testimony on the resolutions. The Reference Committee is a mechanism for streamlining the process of carefully considering and refining the resolutions. Based on the live testimony and the online comments, the Reference Committee produces a report to the BOG with recommendations on which resolutions it should adopt as originally written, adopt with amendments, adopt as a reaffirmation of existing policy, or not adopt. At its business meeting, the BOG discusses the Reference Committee’s report in a parliamentary process where BOG members can accept, reject, or amend the Reference Committee’s recommendations.

Resolutions adopted by the BOG are transmitted to the BOR. Most of them are implemented as submitted. The BOR occasionally refers resolutions to committees for further study with a report back to BOR recommending whether to adopt the resolution in its original or an amended form, or not adopt. It is extraordinarily rare for a resolution from the BOG to be rejected by the BOR.

In summary, ACP Chapters can submit resolutions to the BOG calling for changes to ACP policy or action to be taken by the BOR. This is not the only way that ACP develops policy, but it is the most important one.

Of course, in an organization as large and diverse as ACP, members will not agree with every policy, but ACP members (and other physicians) should be aware of how the policies are developed and how they can participate in the process. For more information, contact your local Governor. Also, be sure to check ACP’s website for the call for member comments on BOG resolutions and ACP Internist for updates on the BOG’s actions on the resolutions.

Yul Ejnes is an internal medicine physician and a past chair, board of regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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