Democracy or aristocracy?
Philosophers have filled books with endless discussions on the best way men can govern themselves. Nowadays these discussions seem old fashioned since there is no one who dares deny that democracy is the best possible form of government. Democracy is such a powerful and generally accepted concept that even the worst dictators spend considerable resources to make credible the plebiscitary support received in faked elections, while autocratic military juntas still pretend to serve mock parliaments. Scientific societies are not countries, and you may argue that scientific progress rarely comes from general consensus, often having to fight against the current and widely accepted views to impose new concepts. This year the European Society will have its annual gala dinner in the City Hall of Stockholm, where the Nobel prizes have been awarded for more than a century. There is certainly a thorough consultation process before decisions are made, but everybody expects that the Nobel Prize Committee does not choose the most popular scientist in his/her discipline but the one who furthered scientific progress, proposing and gathering evidence to demonstrate new concepts. In general, real innovators are not immediately recognised and they often remain unknown for too long to stand a chance to be nominated in their lifetime if the process had to be based on conventional elections by their peers.
The specificity of medical societies
Should such a nomination process with no real elections be followed by the scientific societies as well? Certainly we should be careful not to use in public the word “aristocracy”, definitely not politically correct nowadays, but this is, indeed, what it is: a selection limited to the “best” members who already achieved success in the various aspects of their medical career; from respected clinicians who surged to apical positions in their hospitals to acclaimed scientists who furthered research in the experimental field or via well conducted clinical trials. I see nothing wrong in this, you want to nominate active organisers and recognised leaders with a track record of success at the helm of large medical societies. This is especially true at a time when the independence of the medical profession is being challenged by governmental bodies deciding on treatment based on cost and regulating medical training based on expected needs, irrespective of the recommendations made by the professional bodies. Some scientific societies, like the European Society of Cardiology, have the budget of a medium sized company, with hundreds of employees and large properties to run and maintain: you need somebody with managerial skills and the political will to steer this machinery to achieve the statutory goals of the Society and the interest of its members and their patients. Until a few years ago, the European Society selected a President via the decision of an elected group of wise men, committed not to sit for elections themselves in the future, through the examination of the curriculum and the interview of candidates to select the best possible new President, who was then presented to the members purely for a formal ratification.
Lessons from the recent changes in the electoral process of the European Society of Cardiology
The process changed four years ago, when Roberto Ferrari, an Italian Professor with an impressive track record in basic science, at least numerically not the strongest component within the ESC, became the first truly elected ESC President, with the largest number of preferences expressed by its members via the Society’s constituent bodies (National Societies, Associations and Working Groups) among a list of four candidates. In my view this result, not expected by many who considered belonging to large powerful clinical subspecialties an essential prerequisite, was greatly influenced by his clear program, committing himself to strengthen the role of the Associations and WGs and promising to take a sabbatical to consecrate his full attention to the growth of the Society during his Presidency. The new ESC President Elect will be officially announced in Stockholm, but we were pleased that for the first time this year the candidates spent time explaining their programme to the EAPCI Board, and to learn of the needs and listen to the suggestions of its members. I think this is one of the many advantages of a democratic electoral process, even if it is somewhat filtered by a nominating committee, in that it ensures accountability of the future President to the goals indicated in his or her program.
The electoral process according to the EAPCI constitution
I think it was very appropriate that EAPCI has chosen a similar mechanism in its constitution, with the President Elect, Secretary and Treasurer directly elected by its members from a list of candidates identified by the nominating committee. The advantage of this process, when it works well, is that it allows a preselection of candidates, gauging their understanding of how serious and well prepared they are in their commitment to work for the Association over the following years. The final decision rests entirely on the members, but instead of agonising over a choice encompassing an endless list of possible candidates, they are presented with a short list (a minimum of two) already selected by the nominating committee based on sound evidence in their CVs suggesting that the candidate has the personal qualities, background knowledge and motivation to fit the role.
The role of the nominating committee
This selection process is critical. You want the members of the nominating committee to be independent and fair judges of the qualities of the candidates, not forced, a priori, to support candidates from their own countries or based on their common participation in pressure groups to advance specific techniques or devices or, worse, because they both belong to the same advisory boards or management groups of companies, private CROs, core laboratories, congress organising committees. They are expected to go through potential or actual conflicts of interest, not in the formal way we often do for a congress presentation, but highlighting all the links and relationships perceived as a reason that might lead the potential candidate to make decisions not in the best interest of the growth of our Association. The ideal profile for a candidate to this nominating committee is that of a senior interventionalist with national and international standing, with a good knowledge of the rules and history of the Association, but enough of an “outsider” to ensure that candidates critical or not linked to the current leadership of the Association have a fair chance to be selected. The previous nominating committee prepares a list of possible candidates for the new one but, to ensure a truly democratic process, it is critical that also new faces come forward and propose themselves for a role which is not taxing (a few teleconferences and one or two physical meetings – but lots of e-mail reading) and is vital for the progress of the Association. The president of the nominating committee is, according to the Constitution, the Past President of the Association, this year William Wijns, myself in 2012. His primary task is to ensure that the rules and the timelines for selection of candidates are respected. He is certainly instrumental in certifying past involvement and track record of candidates who already participated in the activities of the Association in various capacities, in particular as chair or members of its committees. Six additional elected members of the nominating committee changing every two years was the mechanism the EAPCI Constitution adopted to ensure transparency of this critical selection process.
Who should consider applying for the positions of EAPCI President Elect, Secretary and Treasurer?
The most critical part, however, is to have a pool of valid candidates for the three elected posts: President Elect, Secretary and Treasurer. Their role and duties are indicated in detail at the website of the Association http://www.escardio.org/communities/EAPCI/about/Pages/board.aspx, and they may also serve as Chairmen of one of the Association’s Committees. Why should a doctor put his name forward for a role that requires spending a great deal of his/her time or, more likely, adding this extra burden to his/her already full list of clinical and administrative tasks, all this for an activity that gives you no money, attracts criticism and where you are expected to step down and offer up on a silver plate all the results of your work to the next elected officer, leaving empty handed the active service of the Association? If you need to be convinced, probably it is better that you do not even try to be elected. Fortunately, most medical societies still find enough motivated volunteers to ensure that doctors have their say in the regulation and organisation of medical services, issuing guidelines on treatment and modalities of training, as well as promoting data collection and dissemination of knowledge in independent congresses. I will not encourage very young professionals at the start of their career to put their names down for one of these demanding posts. It is probably better they spend more time in advancing their positions within their hospitals, in their national societies, and start to approach the Association showing their goodwill and capacities serving on the committees that, for all practicalities, lead its key activities. For opposite reasons, I would not encourage people who have so demanding administrative tasks at the helm of large institutes, or are so committed in a very busy clinical or research career as to be unable to reserve one day a week and many more evenings to engage in the activities of the Association. It is nice to add a prestigious post in a well recognised society to your curriculum, but this comes at a price. If you are not ready to pay it, better to leave it to other people willing to commit themselves. In theory Presidents and Board members are expected to set goals, in agreement with the General Assembly, secure financial and human resources and monitor progress. In practice, in a young Association like ours where Officers and Committee Chairs have not yet developed an ethics of duties and a routine schedule to ensure continuity of work and with limited resources for supporting personnel, most projects will require a continuous direct input to go forward.
National Interventional Societies: a big asset in training and helping in the selection of future EAPCI officers
In the selection of candidates for the electoral process, we have a big advantage compared to our US colleagues. In Europe, National Societies still have a major role because most of the health related matters are regulated at a national level so that the European Association coordinates and ensures homogeneity to processes necessarily decided at a national level. Successful active officers of national societies should be encouraged to switch to a pan-European position at the end of their terms: it is a logical choice since they have already learnt the job and maintain enough connections in their mother country to ensure solid links between the Association and its constituents. Europe is also characterised by clubs actively working in the promotion of research and technical progress in specific fields such as treatment of bifurcations, CTO and, although they still do not form structures, we may envision, and possibly should encourage, similar supranational efforts in the field of diagnostic techniques such as coronary invasive and non-invasive imaging (MSCT, IVUS-OCT) or for therapeutic methods necessarily reserved to a selected number of tertiary centres (TAVI and transcatheter mitral valve repair). Leaders in these fields should also be encouraged to put forward their names for election. An advantage of the electoral process is that candidates are expected to work on a program and gain support for it among the constituents of the Association. You do not have just to vote for a face and a name, but you can make your choice based on an individual’s program and commitments. Next winter I will be pleased to offer space in this Presidential Page to the candidates, allowing them to illustrate their programs, and I suggest they already prepare themselves to answer some specific questions:
– How to ensure the many activities promoted by EAPCI, from certification of training to promotion of registries and research, translate into active projects of value to practising interventionalists and trainees?
– How to give interventional cardiology a better standing in the greater family of European Cardiology?
Election year for EAPCI: a critical time for growth and decisions
The election year is coming for our young Association. All the members, all the interventionalists interested in the development of these techniques in Europe should get involved. Some should feel that it is their duty to propose their names to be part of the nominating committees; a few others should seek support from their National Interventional Societies in their application for the position of President Elect, Secretary or Treasurer. Everybody should follow this process closely, come to the General Assembly in Stockholm during the ESC Congress to understand the challenges ahead, and stay tuned to the EAPCI website to gather enough information to choose the best candidates when casting their vote.
Election process
Information on the election process will be available on the EAPCI web-site “red line elections”. The names of candidates for the nominating committee as well as for the various other positions will be posted on the website. Space will be given to those candidates selected by the nominating committee to present their programme and answer questions from the members.
Time intervals for the presentation of candidatures:
– Candidates to nominating committee: from 1/8/2010 to 15/10/2010
– Electronic ballot for the nominating committee: from 2/11/2010 to 15/11/2010
– Candidates to President Elect, Secretary, Treasurer: from 29/11/2010 to 15/1/2011; a letter of support from one or more National Society or other supranational organisations in interventional cardiology is highly desirable
– Selection of the official candidates by the nominating committee: from mid January to mid February 2011
– Electoral program of the candidates available on the EAPCI website: from mid February to end March 2011
– Electronic ballot for EAPCI President Elect, Secretary, Treasurer: from 30/3/2011 to 30/4/2011
– Announcement of results: EAPCI General Assembly EuroPCR 2011, 17-20 May 2011
– All EAPCI members who are practising interventionalists in countries member of the European Society of Cardiology and are member of their National Society and/or Working Group can vote. Becoming a new member is easy, simply visit:
http://www.escardio.org/communities/EAPCI/Pages/membership.aspx
