Perception and Reality
To the “outsider,” becoming an ASA officer may appear to be the decision of the “insiders” who covertly decide the issue in the dead of night over a winter weekend at a secret rendezvous in Chicago. Certainly it may seem that the individuals who are elected to office have been within the organization in some capacity or other for an eternity. In general this is true, but like everything else, it has to be taken in context. What is really happening is that those individuals who become the “attendings,” or officers, of ASA have undergone one of the most arduous “residencies” to become qualified to lead such a prestigious organization.

Statistics
First a few statistics. ASA has more than 40,000 members. It has an operating budget of $23 million. There are a total of 59 employees at two locations in Park Ridge, Illinois, and in Washington, D.C. It runs the largest anesthesiology-related educational meeting for, on average, 17,000 attendees. It supports four foundations (the Wood Library-Museum of Anesthesiology, the Foundation for Anesthesia Education and Research, the Anesthesia Patient Safety Foundation and the Anesthesia Memorial Foundation) and has strong relationships with many other groups such as the various anesthesiology subspecialty societies, the American Board of Anesthesiology, academic institutions, the World Federation of Societies of Anaesthesiologists, the American Medical Association (AMA) and federal agencies. More than 44 different organizations with official ASA liaisons are listed in the directors’ handbook. The organization encompasses a wide range of activities in the scientific, educational, organizational and legislative arenas. Clearly the skills and knowledge required to run such an organization are not acquired overnight.

Where Do You Start?
As a resident or medical student: It is never too soon to become involved with your professional organization. ASA has a Resident Component specifically directed toward residents (and now with a Medical Student Delegation) with its own officers, programs, ASA committee representatives and a director who sits on the ASA Board of Directors. This component is expanding its horizons by becoming more politically active with residents attending the ASA Legislative Conference. Though the challenges of residency may seem to leave little time for political, administrative or other extracurricular activities, this group actually has the most to gain from organizational activities as well as the most to lose since they have the longest career time span.

At the local level: The first step is to become active in your component society. Many components, especially the smaller ones, are desperate for anyone to serve in any capacity. You may find yourself elected president simply by being there! In the larger components, the path is a little longer, often with contested elections, but the larger components also have internal districts, more committees and usually more challenges so that there are still multiple opportunities to become actively involved. At this basic level, you will learn the essential attributes and skills necessary to progress up the ladder. These attributes and skills include, first and foremost, doing the work. There is no substitute for this attribute. It also includes such important skills as doing your homework on a particular issue, working within a group, finding consensus, knowing when to take a stand on an important issue and networking with your colleagues. Individuals who exhibit these skills usually advance rapidly.

The second task is to identify your own assets or strengths. Everyone usually has a specific area of interest or skill. It may be scientific, administrative or fiscal. It does not matter where these strengths are, but the natural path is to build on that base. It is better to choose a discipline that you really enjoy rather than one that looks like an “easy” road, especially since the “easy” road usually does not exist.

I suspect that most individuals unintentionally begin their political careers by being asked to work on a committee or serve as a component officer. These individuals enjoy the challenge, find that they have an aptitude for this type of activity and then decide to advance up the ladder. You will never know if you will enjoy swimming in the pond unless you take the first step and enter the water.

At the national level: The next level is national involvement. The path gets steeper and the journey longer, but the rewards are commensurately greater. For most, becoming a delegate or alternate delegate from their component to the ASA House of Delegates is the first step to national recognition. Equally important in expanding your base, knowledge and network connections is appointment to an ASA committee. Individuals from outside your component will be able to evaluate your skills as well as you being able to evaluate their skills. Productive committee members are quickly recognized for their true worth and vice-versa.

So How Do You Get Appointed to a Committee?
Passively waiting for an appointment is not the path to success. You have to make the effort, especially as there are many more well-qualified applicants than openings.

• Let your director know of your interest. Each December the President-Elect writes to the directors asking for nominations for the next year.

• Take an active role in your area of interest by contributing a paper or NEWSLETTER article on the subject.

• Write to the appropriate committee chair with ideas and input on current issues.

• Attend Reference Committees at the ASA Annual Meeting and offer your testimony.

• Learn about the broader issues facing medicine in general by membership in such groups as AMA.

Essentially, become involved. Take an active role in your organization. Not only do you have something to offer, you also have the opportunity to learn.

The final step for national recognition is to be elected director or alternate director for your component. Though not an essential step, many of the officers will have served in this capacity at some time. At the Board of Directors meeting, you will interact with others of similar standing as well as the officers, section chairs and other representatives of the Society. You may serve on one of the Board Review Committees that help to guide ASA between annual meetings. All this activity creates the opportunity to build the support necessary to be elected as an officer.

In the larger components, becoming a director is considerably more competitive than in the smaller components that are sometimes grateful for anyone who will serve. The director from a large component, however, will come with a larger power base or constituency. A recent reorganization increased the number of these critical director positions by 25.

Working your way up through ASA is not the only pathway. It is just the most common path. Others have risen to high office by making significant contributions in other fields of anesthesiology. Almost invariably, however, these individuals have been active on ASA committees or task forces. They also have developed their administrative experience by working in organizations with mega budgets, multiple competing interests and conflicting institutional cultures and personalities.

What Are the Rewards?
The most basic reward is an element of ego gratification. Most individuals enjoy the recognition and deference that extends to someone who is in a position of power or authority. This reward, however, will not sustain anyone for any significant period of time and will soon be recognized for what it is. The much more fundamental and sustaining reward is the knowledge that you are advancing the medical practice of anesthesiology for now and future generations. Your leadership and decisions will impact the practice of anesthesiology for a significant period of time.

There are some intangibles that should not be overlooked, though:

• You are working as team with equally motivated individuals who produce a very stimulating environment. This can be an invigorating change from the some of the passive “naysayers” who exist in any group.

• You get the opportunity to meet and work with some of the “greats” in anesthesiology, an opportunity that normally would not exist for most of us, especially in smaller communities.

• You travel to Chicago for a getaway weekend in the winter and summer.

• Finally, in the fullness of time, you will be able to look back at successful initiatives and projects and say, “I was a part of that.”

What Are the Negatives?
The biggest down side has to be the time commitment. To do a proper job, you have to be prepared to commit the time, often not of your own choosing, to do the work. It may be a conference call or e-mail traffic, both of which are being used more frequently by ASA as a more cost-effective use of resources, or a face-to-face meeting, probably in Chicago (again!).

As a director, you are committed to the three Board meetings (March, August and October just after the ASA Annual Meeting), the House of Delegates at the Annual Meeting and probably the Legislative Conference in early May. This is in addition to any other state or committee activities. Though ASA covers the director’s travel plus per diem for “away” meetings (except for the House of Delegates and the Legislative Conference, though these may be covered by the component society), it does not nearly cover the true cost of your time, especially if you have to take extra time for travel. Interestingly enough, ASA has no difficulty in finding excellent, willing volunteers to serve.

As with any other extracurricular professional activity, support and understanding from family and the practice is essential to be able to effectively carry out your responsibilities.

How Do You Run for Office?
You have built up your curriculum vitae, done the networking, chosen the office and feel that you have some important contributions to make. So now you are ready to run. What now?

You need the support of your caucus, which is a loose coalition of geographically proximate (Washington and Texas!) component societies. The directors and delegates are well aware of the caucuses and how they function, but individuals looking to run for office who have not served in those posts may not be as knowledgeable. Anyone can run for office, but support from up to 25 percent of the House that comes from your caucus clearly is a very strong starting position. Discuss your interest with your director and caucus chair, and as the process will stretch over several years, do it sooner rather than later.

You will need support from other individuals from the other caucuses who also may be sponsoring their own candidate. Rumor has it that none of the caucuses has a block-voting rule, but even if they did, the actual vote is still by secret ballot. The organization is best served by having the most qualified individual serve, but geographic and other characteristics are important to maintaining balance as well.

When an individual decides to formally announce his or her candidacy is obviously a strategic decision to be made by the candidate, but expressing an interest in office early in the process will help your candidacy. Not only does it give you and others the opportunity to interact, more importantly it gives you the opportunity to evaluate the level of your support.

Why?
Only you can honestly answer this question.

On a personal note, my final observation paraphrases a quotation by Samuel Butler: “It is better to have run and lost than to have never run at all.”

Richard M. Flowerdew, M.B., is an attending anesthesiologist with Spectrum Medical Group at Maine Medical Center, Portland, Maine. He also is Chair of the New England Caucus.