I have been trying to stress that DO's will be given a seat at the table and have been mostly met with the belief that their impact will be negligible. Looks like you guys may be off by a little.
http://www.do-online.org/TheDO/?p=120691
Although I'm sure that this is somehow a "bad" thing for DO's and somehow they're still giving up power.
Here is the thing - the AOA sources you are quoting are being overly simplistic. If you look at the actual ACGME bylaws, an 80% vote is not the norm.
https://www.acgme.org/acgmeweb/Portals/0/ab_ACGMEbylaws.pdf
Section 12. Matters Requiring Seven-eights Vote of the Directors: The following
matters shall require a seven-eights vote of the directors present and
voting at any regular meeting of the Board of Directors at which a quorum
is present:
a) A change in the term or terms of any director; and
7
b) Any amendment to this provision of the bylaws.
Section 13. Matters Requiring Votes of Directors and Members:
Notwithstanding any other provisions of these bylaws,
a) The following matters shall require first, a seven-eights vote of the
directors present and voting at any regular meeting of the Board of
Directors at which a quorum is present, and thereafter, if the
Board of Directors passes the matter, a four-fifths vote of the
members:
i) Dissolution;
ii) Sale or transfer of all assets;
iii) Merger;
iv) Addition of a member;
v) Removal of a member;
vi) Amendment of Article IV, Section 2, Article V, Sections 2,
3, or 13 of the bylaws; and
b) The following matters shall require first, a three-quarters vote of
the directors present and voting at any meeting of the Board of
Directors at which a quorum is present, and thereafter, if the
Board of Directors passes the matter, a four-fifths vote of the
members:
i) Amendment of Article II, Section 1 of the bylaws;
ii) Any single capital expense that exceeds 20% of the
reserve fund, as defined in the annual auditors' report;
iii) Aggregate capital expenses that would exceed 30% of the
reserve fund in a given fiscal year; and
iv) Any actions that would cause the debt to equity ratio to
exceed 1.0.
on number of votes
Section 2. Number and Residency Directors: The number of directors shall be a
minimum of twenty seven and a maximum of thirty. Without the
amendment of the bylaws, the Board of Directors may change the
number of directors, within the minimum and maximum, for terms
beginning upon adjournment of the annual meeting of the Board of
Directors. Directors need not be residents of the State of Illinois.
This number will be increased by 7 to accommodate the AOA. They have a 20% max vote if the minimum number of directors within this scheme is chosen. If, however, 30 prior ACGME seats are used there is no longer an AOA majority vote. There are also additional board members outside of this scheme which may throw a wrench in whoever published the veto vote thing in the first place:
Additional Directors: One to four at large directors, three public
directors, one ACGME Council of Review Committees director, and two
resident physician directors shall serve on the Board of Directors. The at
large directors and the public directors shall be appointed by the Board of
Directors. The Chair of the ACGME Council of Review Committees shall
be the Chair of the ACGME Council of Review Committees director. One
resident physician director shall be the Chair of the Council of Review
Committee Residents. One resident physician director shall be appointed
by the Resident and Fellow Section of the American Medical Association.
In selecting the resident physician for appointment to the Board of
Directors, the Resident and Fellow Section shall seek the advice of
national organizations representing resident physicians who are currently
participating in graduate medical education.
Again, because it is all speculation and nothing has been signed on either side (with the exception of an agreement to work towards an agreement), I will wait for the actual resolution before feeling comfortable agreeing with the very sunny interpretations that some people are giving.
In terms of non-monetary policy and things that do not affect the bylaws a simple majority suffices:
Manner of Acting: The act of a majority of the directors present and
voting at a meeting at which a quorum is present shall be the act of the
Board of Directors, unless the act of a greater number is required by the
statute, these bylaws, or the Articles of Incorporation. If a quorum is not
present at any meeting of the Board of Directors, a majority of the
directors present may adjourn the meeting to another time, with at least
thirty days' written or electronic notice of the time and location of the
adjourned meeting. At any adjourned meting at which a quorum is
present, any business may be transacted which might have been
transacted at the original meeting. Withdrawal of directors at any meeting
shall not cause failure of a duly constituted quorum at that meeting.
This part directly precedes the "matters which require 7/8s vote" section I quoted earlier. Things in that section all deal with changing terms of directors, editing bylaws, and capital expenses, nothing about governing or accrediting programs. Matters involved in setting up RCCs are by simple majority alone. There are also detailed matters of quorum stating that at least 2 directors from each of the 5 (soon to be 6) members (AOA, AMA, ect...) must be present. If they sent all 7 directors, and each of the other 5 each send their 2 for a minimum quorum, there is still not enough for a veto vote on matters that affect residencies.
Again, the details of the resolution have yet to be established. The AOA may demand a narrower variance in board members to ensure their veto power over things which include their involvement - however all of these things require editing of the bylaws which requires an 80% vote to do, and unless I am mistaken, the current "agreement to work towards agreement" was subject to a simple majority, the actual numbers not withstanding - 80-85% of the current members (i.e. not AOA) will need to vote in favor including AOA board membership before any of that can happen in the first place. Until then the AOA programs have provisional accreditation that, technically, could be stripped at any time (again, unless there is something concrete that points to me being mistaken, but from what I have read the AOA is not a member until 2015, and nobody said that this motion will absolutely definitely go through. This is a major ACGME bargaining chip if I am correct)
Here is the part that we have been talking about that is a simple majority vote in which the AOA has lost power:
Quote:
ARTICLE XI - MODUS OPERANDI
Section 1. Establishing Institutional Requirements and Program Requirements for
Institutional and Program Evaluations:
a) Institutional Requirements: The Board of Directors shall adopt Institutional
Requirements for all institutions that sponsor ACGME accredited graduate
medical education programs. The Institutional Requirements may be
approved by a majority vote of the directors present and voting at any regular
meeting of the Board of Directors at which a quorum is present, provided that
the proposed change has been previously submitted in writing to the
directors for review and comment.
b) Program Requirements: Each Review Committee shall prepare Program
Requirements for the specialty programs over which it has cognizance. The
Program Requirements shall be approved by the respective Review
Committees, after review and comment by their Review Committee
appointing organizations, and then submitted for approval by the Board of
Directors. Program Requirements may be approved by a majority vote of the
directors present and voting at any regular meeting of the Board of Directors
at which a quorum is present.
Section 2. Accreditation:
a) Except as provided under Article XI, Subsection 2(c) of these Bylaws, the
Residency Review Committees shall evaluate and make recommendations
regarding the accreditation of programs in graduate medical education in
accordance with the Institutional and applicable Program Requirements,
notify program directors of their recommendations, and submit their
recommendations to the Board of Directors.
b) The Board of Directors shall accredit programs in accordance with
the Institutional and applicable Program Requirements, following receipt of
the recommendation from the appropriate RRC, and shall promptly notify the
program directors of its determination. The Board of Directors may establish
procedures to delegate its accreditation authority to an appeals panel which
includes the Executive Committee for appeals from expedited accreditation
actions.
c) Upon application of a Review Committee, including RRCs, the IRC, and the
TYRC, and following a review of its performance, the Board of Directors may
Relevant Excerpt from ACGME Bylaws, Policies and Procedures (approved 2/08)
Council of Review Committee Chairs
Page 3
delegate accreditation authority to the Review Committee. Such delegation
shall be for a period to be determined by the Board of Directors. The Board
of Directors shall conduct periodic reviews of the accreditation process of the
Review Committee and of its authority to accredit.
d) The Board of Directors shall have published annually the Institutional and
Program Requirements for accreditation of institutions and programs in
graduate medical
So, basically, each body gets to send "directors" who get to vote. The only thing the AOA can THEORETICALLY veto is removal of the AOA, or spending money (which is a non issue because I doubt they have too differing of fiscal interests). The RRCs are nominated, and voted upon, a simple majority vote system in which even though the AOA can nominate, it does not mean that they will be seated (although there was talk of the AOA requiring inclusion on RRCs for prior AOA programs, so that may be in the final product) at which point the RRC gives a recommendation and it is voted upon via simple majority by the board. There are at least 3 areas in which AOA interests can be subverted if the rest of the ACGME found it in their best interest.
. You gotta have some fire at you at somewhere. Otherwise, you should have been happier than before.
Unless the # has more to do with representation of # of programs or # of docs..... some calculation other than a simple equal share of the pie per organization.
