OFFICIAL CALL TO 2018 HOUSE OF DELEGATES MEETING

Transcription

1 OFFICIAL CALL TO 2018 HOUSE OF DELEGATES MEETING The 2018 annual meeting of the House of Delegates of the Pennsylvania Medical Society (PAMED) will be called to order at the Hershey Lodge in Hershey, Pennsylvania on Saturday, October 27 at 10:30 am. The second session of the House is scheduled for Sunday, October 28 beginning at 8:00 am. ELECTIONS In accordance with Chapter XII, Section 1 of the PAMED Bylaws, (t)he officers of this Society shall be a president, a president elect, a vice president, an immediate past president, a secretary, a treasurer, and a speaker and a vice speaker of the House of Delegates. There may be such assistant treasurers and assistant secretaries as may be designated by resolution by the Board of Trustees. Chapter XI, Sections 1-4 state that: Elections shall be held in accordance with these bylaws and the Standing Rules of the House of Delegates. All contested elections shall be by ballot and a majority vote shall be necessary to elect candidates except that delegates and alternates to the American Medical Association and to the Committee to Nominate Delegates and Alternates to the American Medical Association shall be elected by a plurality vote. Election by acclamation shall be valid when there is no contest and therefore such positions need not be included on a ballot. The speaker shall appoint tellers who shall be responsible to the speaker for a count on a vote in any session of the meeting of the House of Delegates. Tellers are also responsible for the counting of all ballots and reporting the results directly to the speaker. In accordance with Chapter X, Section 1 of the Bylaws: Nominations for all offices to be elected by the House of Delegates may be made by seated delegates from the floor of the House or published in the Official Call upon recommendation of the respective section or district. To be accepted by the House, nominees should possess the prescribed qualifications for the office for which they are nominated. Chapter X continues: Nominees for officers and trustees, if known, will be published in the Official Call. Where candidates for offices are unopposed, except for the office of Vice President, there will be no nominating speeches. Nominations for delegates and alternates to the American Medical Association shall be made by the Committee to Nominate Delegates and Alternates to the American Medical Association and published in the Official Call. Nominations for the Judicial Council shall be made by the Board of Trustees at least thirty (30) days prior to the annual meeting. At least one qualified person shall be nominated for each expiring term. These names should be disseminated to the members of this Society via appropriate means as determined by the secretary. Nominations for district trustees shall be made from the floor of the House and only by seated

2 2 delegates from their respective districts for which positions need to be filled. Nominations for a trustee from the specialties organized in Pennsylvania and recognized by the Pennsylvania Medical Society and the American Board of Medical Specialties shall be made by the seated delegates from those specialties in the House of Delegates. Nominations for special section trustees shall be made from the floor of the House and only by seated delegates from their respective special sections for which positions need to be filled. In accordance with Chapter XI of the Bylaws, the following elections shall be in order: Vice President: Michael A. DellaVecchia, MS, MD, PhD, FAAO, FACS, FICS, FCPP (Philadelphia County) is eligible for election. Steven A. Shapiro, DO, FAAP (Montgomery County) is eligible for election. Speaker, House of Delegates: John J. Pagan, MD, FACS (Bucks County) is eligible for reelection. Vice Speaker, House of Delegates: John W. Spurlock, MD (Northampton County) is eligible for re-election. Fifth District Trustee: Heath B. Mackley, MD (Dauphin County) is eligible for re-election. Eleventh District Trustee: David A. Csikos, MD (Cambria County), who was appointed by the Board in February 2018 to fill the vacant Eleventh District Trustee seat until the House of Delegates in October 2018, is eligible for election. Twelfth District Trustee: Joseph A. Anistranski, MD (Luzerne County), who was appointed by the Board in February 2018 to fill the vacant Twelfth District Trustee seat until the House of Delegates in October 2018, is eligible for election. Surgical Specialties Trustee: Christopher J. Buzas, DO, FACS, FASCRS (Montour County) is eligible for election. Early Career Physicians Section (ECPS) Trustee: John M. Vasudevan, MD (Philadelphia County) is eligible for re-election. Resident & Fellow Physicians Section (RFS) Trustee: Tani Malhotra, MD (York County) is not eligible for re-election due to her recent relocation. Medical Students Section (MSS) Trustee: Matthew R. Hope (Lackawanna County) is eligible for election. Mr. Hope was appointed by the Board in August 2018 to fill the vacant MSS Trustee seat until the House of Delegates meeting in October The vacancy was created due to the resignation of Michael A. Loesche, MD, PhD (Philadelphia County), who graduated medical school. eyasinski/orb/official call/2018 official call w_bylaws

3 3 In accordance with Chapter X, Section 1 of the Bylaws, elections for Delegates and Alternate Delegates to the American Medical Association are in order. In accordance with Standing Rule Number 10, elections for Delegates will be held on Saturday afternoon, October 27, 2018, and elections for Alternate Delegates will be held on Sunday morning, October 28, Delegates whose terms expire December 31, 2018 are: 1. James A. Goodyear, MD (Montgomery County) 2. Daniel B. Kimball, Jr., MD (Berks County) 3. Anthony M. Padula, MD (Philadelphia County) 4. John P. Williams, MD (Allegheny County) 5. Virginia E. Hall, MD (Dauphin County) The Committee to Nominate Delegates and Alternates to the American Medical Association makes the following nominations for Delegates to serve for two (2) years commencing January 1, 2019 and expiring December 31, 2020 (elect 6 includes 1 additional AMA allocation): 1. James A. Goodyear, MD (Montgomery County) 2. Scott E. Shapiro, MD (Montgomery County)(moving from Alternate to Delegate as Chair of the AMA Delegation; term will expire December 31, 2019) 3. Jill M. Owens, MD (McKean County)(moving from Alternate to Delegate as Vice Chair of the AMA Delegation; term will expire December 31, 2019) 4. Bruce A. MacLeod, MD (Allegheny County) 5. John P. Williams, MD (Allegheny County) 6. Virginia E. Hall, MD (Dauphin County) Alternate delegates whose terms expire December 31, 2018 are: 1. Bruce A. MacLeod, MD (Allegheny County) 2. Aaron E. George, DO (Franklin County) 3. John M. Vasudevan, MD (Philadelphia County) The Committee to Nominate Delegates and Alternates to the American Medical Association makes the following nominations for Alternate Delegates to serve for the following terms commencing January 1, 2019 and expiring December 31, 2020 (elect 5 includes 1 additional AMA allocation and a position vacated that was not previously filled): 1. Aaron E. George, DO (Franklin County) 2. John M. Vasudevan, MD (Philadelphia County) 3. Bindukumar C. Kansupada, MD (Bucks County) 4. Dale M. Mandel, MD (Philadelphia County) 5. Danae M. Powers, MD (Centre County) 6. James W. Thomas, MD (Montgomery County) 7. Hans T. Zuckerman DO (Lebanon County) eyasinski/orb/official call/2018 official call w_bylaws

4 4 The Committee to Nominate Delegates and Alternates to the American Medical Association has not yet received a nomination from the Residents and Fellows Section for one slotted position for Alternate Delegate for a one-year term commencing immediately following the conclusion of the 2018 House of Delegates annual meeting and expiring at the conclusion of the next annual meeting to replace Dane Scantling, DO (Philadelphia County). The Committee to Nominate Delegates and Alternates to the American Medical Association has not yet received a nomination from the Medical Students Section for one slotted position for Student Elect for a one-year term commencing January 1, 2019 and expiring December 31, 2019 to replace Rachel Thomas (Philadelphia County). Also to be elected will be two members for three-year terms to serve on the Committee to Nominate Delegates and Alternates to the American Medical Association. The term of Richard T. Bell, MD (Berks County) expires on December 31, 2018; he is eligible for re-election. The term of George R. Green, MD (Montgomery County) expires on December 31, 2018; he is not eligible for re-election. Edward P. Balaban, DO (Centre County) has been nominated to serve on the Committee; he is eligible for election. In accordance with Chapter XVI, Section 2 of the Bylaws, the Judicial Council shall consist of five members elected by the House of Delegates on nomination by the Board of Trustees or from the floor of the House. Each Judicial Council member shall serve a term of three years; no person shall be eligible to serve for more than three consecutive terms. Current members of the Judicial Council are: Edward H. Dench, Jr., MD (Centre County); Victor F. Greco, MD (Luzerne County); C. Eve Kimball, MD (Berks County); John A. Malcolm, Jr., MD (Union County); and Carol E. Rose, MD (Allegheny County). Erick J. Bergquist, MD, PhD serves as Secretary and Alternate Member of the Council. The term of John A. Malcolm, Jr., MD will expire at the conclusion of the 2018 House of Delegates; he is not eligible for re-election. eyasinski/orb/official call/2018 official call w_bylaws

5 Pennsylvania Medical Society 2018 House of Delegates COMPENDIUM OF PROPOSED BYLAWS AMENDMENTS Table of Contents 2017 Proposed Amendment Subject Bylaws Chapter re: Description of Proposed Amendment 1 MEMBERSHIP Expand of the Affiliate Member Category to include Physicians 70 Years of Age or Older Attachment(s) Appendix 1: Board Report 2018 Proposed Amendments Subject Bylaws Chapter re: Description of Proposed Amendment 2 MEMBERSHIP Eliminate the Provision Requiring Applicants to Hold or Be Eligible to Hold Unrestricted or Unlimited License for PAMED Membership Attachment(s) Appendix 2: Signatures 3 MEMBERSHIP Clarify that medical staff coordinators are not exempt from paying member dues 4 MEMBERSHIP Streamline Membership Categories by eliminating Affiliate and Associate member categories and including only the following membership categories: Active, Retired, Supporter, Honorary, and Administrative members 5 DUES Allow Optional Alignment of Component Medical Society Annual Dues with State Medical Society 6 SPECIAL SECTIONS 7 SPECIAL SECTIONS 8 SPECIAL SECTIONS Align Early Career Physicians Section Eligibility Requirements with the American Medical Association Requirement Add Women Physicians Section to PAMED Special Sections Update Medical Student Section and MSS Governing Council to Reflect Current Practice Appendix 3: Signatures

6 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Crystal Morret, PAMED Director, Member Service & Knowledge Center) Back to Table of Contents SUBJECT 1 Membership: The Expansion of the Affiliate Member Category to include Physicians 70 Years of Age or Older Currently, the bylaws have a separate category of membership for Associate members; physicians who are 70 years of age or over (in the year of application) and have been an active member of PAMED or an active member of a constituent association of the American Medical Association. These members are not required to pay annual dues and are not required to maintain a license. In 2016, a proposal was submitted to eliminate the Associate member category by moving the description of these (prospective) members into the Affiliate category. After deliberation by the House of Delegates, the proposal was referred to Board of Trustees for Study. In 2017, the Board of Trustees recommended that the House adopt the proposed amendment to expand the Affiliate Member Category to include Physicians 70 Years of Age or Older. The rationale for the Board s recommendation is provided in Appendix 2. The 2017 HOD subsequently adopted the Board s recommendation. The amendment, as drafted, was reviewed and rejected by the Bylaws Committee, in favor of a similar, more streamlined, set of amendments proposed by the Membership 2020 Taskforce (Subject 4); these amendments also include the elimination of the Associate member category. The Bylaws Committee recommends that the amendments proposed by the Membership 2020 Taskforce be adopted in lieu of HOD 2017 Board Report 2 regarding the Expansion of the Affiliate Member Category to include Physicians 70 Years of Age or Older. If the amendments proposed by the Membership 2020 Taskforce are not approved by the House, the Bylaws Committee recommends additional review of the amendments proposed by Board Report 2 with a report back to the House no later than 2019.

7 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Officers & Directors of the Chester and Delaware County Medical Societies) Back to Table of Contents SUBJECT 2 MEMBERSHIP: Eliminate the Provision Requiring Applicants to Hold or Be Eligible to Hold Unrestricted or Unlimited License for PAMED Membership Currently, to be eligible for active membership of the Society, an applicant must (1) hold the degree of Doctor of Medicine or Osteopathic Medicine or the equivalent from a recognized accredited medical school, and (2) hold or be eligible to hold an unlimited license to practice medicine and surgery in Pennsylvania. This proposal, submitted by the Chester & Delaware County Medical Societies, seeks to remove the requirement to have an unrestricted or unlimited license to be a PAMED member. PLEASE NOTE: This proposed amendment was submitted with the signatures of 15 active or associate members (Appendix 1). Per our Bylaws at Chapter XIX, Subsection (a), the proposed amendments may be submitted, without Bylaws Committee consideration, to the Secretary for publication in the Official Call.

8 Subject 2: Eliminate the Provision Requiring Applicants to Hold or Be Eligible to Hold Unrestricted or Unlimited License for PAMED Membership Back to Table of Contents Amend the bylaws as follows: CHAPTER I - MEMBERSHIP SECTION 1 Rights and Privileges of Membership Including Voting Rights All members of this Society shall have all of the rights and privileges of membership except as otherwise provided in these bylaws. No member of this Society of any class shall have any direct vote in the affairs of this Society except as to such matters, if any, where such vote is required by the laws of the Commonwealth of Pennsylvania. SECTION 2 Admission to Membership To be a member of this Society a physician must be a member of a component society; honorary members are not required to do so. The term, physician, means a person who has received formal and recognized training in the art and science of medicine and is qualified to acquire an unlimited a license to practice medicine and surgery in the Commonwealth of Pennsylvania. SECTION 3 Membership Categories a. Active Member 1. Persons who hold the degree of Doctor of Medicine or Osteopathy or the equivalent from a recognized accredited medical school, and who hold or are eligible to hold an unrestricted a license to practice medicine and surgery in Pennsylvania, are eligible for active membership in this Society. Upon admission to membership, such members shall have the right to vote and hold office in this Society. 2. Residents and fellows serving in residency or fellowship programs approved by this Society are eligible for active membership in this Society. Upon admission to membership, such members shall have the right to vote and hold office in this Society. 3. Medical students enrolled in a medical school approved by this Society are eligible for active membership in this Society. They shall make application directly to this Society. Such students are entitled to all rights and privileges of membership. Medical student active members shall pay such amount as is fixed each year by the Board of Trustees. b. Affiliate Member Any physician not engaged in active practice within the jurisdiction of the component society may be an affiliate member of this Society and remain as such providing the individual is one of the following: (1) a physician who is a member of a national medical society of a foreign country; (2) an American physician who is engaged in missionary or philanthropic labors who may or may not have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania;

9 (3) a full-time teacher of medicine or of the arts and sciences allied to medicine who does not have a license to practice medicine and surgery in the Commonwealth of Pennsylvania; (4) a physician who is engaged in research or administrative medicine in Pennsylvania who does not have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania; (5) a physician who is retired from active practice; or physician who resides in a state other than Pennsylvania and concurrently maintains active membership in another state medical society. An affiliate member may vote, hold office, and serve as a member of any workgroup or committee on the state and county levels. c. Associate Member An associate member shall be a physician who is 70 years of age or over (in the year of application) and has been an active member of this Society or an active member of a constituent association of the American Medical Association. An associate member shall not be required to pay any annual dues and shall not be required to maintain a license. d. Honorary Member Physicians who are not residents of Pennsylvania, but are members of their own state or territorial medical association, may be elected to this category by the House of Delegates by a three-fourths vote at any annual meeting. The individual is not required to have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania. The honorary member is not required to pay any annual dues. No more than two honorary members may be elected in any one year to this category by the House of Delegates. An honorary member is not entitled to any of the rights and privileges of membership. e. Administrative Member An administrative member shall be (1) a county society executive, who may or may not be a physician, (2) an administrator from a practice with at least one physician member, or (3) a hospital medical staff coordinator who meets the State Society s membership guidelines. An administrative member shall be exempt from paying dues except for medical practice administrators from a practice with less than a 50 percent physician membership level, as of the current membership year. An administrative member may not vote or hold office, but may serve as a non-voting member of any workgroup or committee provided that the percentage of administrative members does not exceed 25 percent.

10 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Crystal Morret, PAMED Director, Member Service & Knowledge Center) Back to Table of Contents SUBJECT 3 MEMBERSHIP CATEGORIES: Membership Categories, Administrative Members Currently, the bylaws define administrative members as follows: (1) a county society executive, who may or may not be a physician, (2) an administrator from a practice with at least one physician member, or (3) a hospital medical staff coordinator who meets the State Society s membership guidelines. Per the bylaws, an administrative member shall be exempt from paying dues except for medical practice administrators from a practice with less than a 50 percent physician membership level, as of the current membership year. The proposed language would clarify that medical staff coordinators are not exempt from paying member dues. Rationale: According to PAMED Membership Staff, Medical staff coordinators have always paid 10% of full active state and county dues (unless county society chooses to forego the dues). The amendment is being proposed to align the bylaws with current and historic practice.

11 Subject 3: Revise the definition of an Administrative Member so that is clear that medical staff coordinators are not exempt from paying member dues. Back to Table of Contents Amend the bylaws as follows: CHAPTER I MEMBERSHIP SECTION 3 - Membership Categories E. Administrative Member An administrative member shall be: (1) a county society executive, who may or may not be a physician, (2) an administrator from a practice with at least one physician member, or (3) a hospital medical staff coordinator who meets the State Society s membership guidelines. An administrative member shall be exempt from paying dues except for medical practice administrators from a practice with less than a 50 percent physician membership level, as of the current membership year. (1) A County Society Executive. A county society executive, who may or may not be a physician, shall be exempt from paying dues; (2) A Practice Administrator. Practice administrators from a practice with at least one physician member and a membership level of 50 percent or more, as of the current membership year, shall be exempt from paying dues. Practice administrators with less than 50 percent membership are not exempt from paying dues; or, (3) A Hospital Medical Staff Coordinator. Hospital medical staff coordinators must meet the State Society s membership guidelines and are not exempt from paying dues. An administrative member may not vote or hold office, but may serve as a non-voting member of any workgroup or committee provided that the percentage of administrative members does not exceed 25 percent.

12 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: PAMED Board of Trustees Membership 2020 Taskforce) Back to Table of Contents SUBJECT 4 MEMBERSHIP: Streamline Membership Categories by eliminating Affiliate and Associate member categories and including only the following membership categories: Active, Retired, Supporter, Honorary, and Administrative members Currently, the PAMED bylaws mandate the following categories for PAMED membership: Active Full Affiliate research/admin Active Resident /Fellow Affiliate retired Active Student Affiliate out of state Affiliate Foreign Medical Society Associate Affiliate missionary Honorary Affiliate teacher Administrative According to the Membership 2020 Taskforce, PAMED s membership categories have been confusing and inefficient for potential and current members over the years and, at times, prohibitive to the sales process when the individual wishes to quickly pay for their membership. As a result, the taskforce has proposed the following membership categories be reduced to the following seven categories: Active Full Active Resident /Fellow Active Student Retired Supporter Honorary Administrative To operationalize this recommendation: The Affiliate member category would be replaced by the Supporter category a broader membership category that would capture all new applicants who would have been eligible for affiliate membership. A new Retired Member category would be created. Individuals who, prior to November 2018, qualified as Affiliate Retired members will be moved to the Retired member category. The Associate member category would be deleted, consistent with 2017 House-approved directive to eliminate the Associate member category and expand the Affiliate Member Category to include Physicians 70 Years of Age or Older. However, individuals who prior to November 2018 qualified as Associate members would keep their Associate member status and all rights and privileges related to this member category.

13 Subject 4: Eliminate Affiliate and Associate member categories; Include only the following membership categories: Active, Retired, Supporter, Honorary, and Administrative members Back to Table of Contents Amend the bylaws as follows: CHAPTER I - MEMBERSHIP SECTION 1 Rights and Privileges of Membership Including Voting Rights All members of this Society shall have all of the rights and privileges of membership except as otherwise provided in these bylaws. No member of this Society of any class shall have any direct vote in the affairs of this Society except as to such matters, if any, where such vote is required by the laws of the Commonwealth of Pennsylvania. SECTION 2 Admission to Membership To be a member of this Society a physician must be a member of a component society; honorary members are not required to do so. The term, physician, means a person who has received formal and recognized training in the art and science of medicine and is qualified to acquire an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania. SECTION 3 Membership Categories a. Active Member 1. Full Active. Persons who hold the degree of Doctor of Medicine or Osteopathy or the equivalent from a recognized accredited medical school, and who hold or are eligible to hold an unrestricted license to practice medicine and surgery in Pennsylvania, are eligible for active membership in this Society. Upon admission to membership, such members shall have the right to vote and hold office in this Society. 2. Residents and Fellows. Residents and fellows serving in residency or fellowship programs approved by this Society are eligible for active membership in this Society. Upon admission to membership, such members shall have the right to vote and hold office in this Society. 3. Students. Medical students enrolled in a medical school approved by this Society are eligible for active membership in this Society. They shall make application directly to this Society. Such students are entitled to all rights and privileges of membership. Medical student active members shall pay such amount as is fixed each year by the Board of Trustees. b. Retired Member. A physician who is retired from the active practice of medicine, and currently resides in Pennsylvania or was previously active in the Society. A retired member may vote, hold office, and serve as a member of any workgroup or committee on the state and county levels. c. Supporter Member. Any physician who is engaged in professional activities related to the practice of medicine, but who is not engaged in active practice within the jurisdiction of the component

14 medical society. A supporter member may not vote or hold office. A supporter member may serve as a member of any workgroup or committee on the state and county level. d. Affiliate Member Any physician not engaged in active practice within the jurisdiction of the component society may be an affiliate member of this Society and remain as such providing the individual is one of the following: (1) a physician who is a member of a national medical society of a foreign country; (2) an American physician who is engaged in missionary or philanthropic labors who may or may not have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania; (3) a full-time teacher of medicine or of the arts and sciences allied to medicine who does not have a license to practice medicine and surgery in the Commonwealth of Pennsylvania; (4) a physician who is engaged in research or administrative medicine in Pennsylvania who does not have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania; (5) a physician who is retired from active practice; or (6) a physician who resides in a state other than Pennsylvania and concurrently maintains active membership in another state medical society. An affiliate member may vote, hold office, and serve as a member of any workgroup or committee on the state and county levels. d. Affiliate Member. The affiliate member category was discontinued effective November An individual who, prior to November 2018, qualified as an affiliate member who was retired from active practice will be classified as a retired member. All other individuals who were affiliate members prior to November 2018 will be classified as supporter members. e. Associate Member An associate member shall be a physician who is 70 years of age or over (in the year of application) and has been an active member of this Society or an active member of a constituent association of the American Medical Association. An associate member shall not be required to pay any annual dues and shall not be required to maintain a license. e. Associate Members. The associate member category was discontinued effective November An individual who was an associate member prior to November 2018 will retain their associate member status. f. Honorary Member Physicians who are not residents of Pennsylvania, but are members of their own state or territorial medical association, may be elected to this category by the House of Delegates by a three-fourths vote at any annual meeting. The individual is not required to have an unlimited license to practice medicine and surgery in the Commonwealth of Pennsylvania. The honorary member is not required to pay any annual dues. No more than two honorary members may be elected in any one year to this category by the House of Delegates. An honorary member is not entitled to any of the rights and privileges of membership. g. Administrative Member

15 An administrative member shall be (1) a county society executive, who may or may not be a physician, (2) an administrator from a practice with at least one physician member, or (3) a hospital medical staff coordinator who meets the State Society s membership guidelines. An administrative member shall be exempt from paying dues except for medical practice administrators from a practice with less than a 50 percent physician membership level, as of the current membership year. An administrative member may not vote or hold office, but may serve as a non-voting member of any workgroup or committee provided that the percentage of administrative members does not exceed 25 percent.

16 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Philadelphia County Medical Society) Back to Table of Contents SUBJECT 5 Dues: Allow Optional Alignment of Component Medical Society Annual Dues with State Medical Society This proposed amendment addresses the percentage of dues that a county medical society is currently required to assess on each of the dues categories. The current Bylaws language mandates that the CMS dues categories and the percentage of full annual dues paid by each category must align with PAMED s categories and percentages. The proposed revision would allow flexibility for any CMS to assess its own percentages as they deem appropriate.

17 Subject 5: Allow Optional Alignment of Component Medical Society Annual Dues with State Medical Society Back to Table of Contents Amend the bylaws as follows: CHAPTER III - DUES SECTION 1 Purpose Money for the purposes of this Society shall be raised by dues. SECTION 2 Annual Dues County medical society dues categories must be in accord with the state Society s categories. The state Society s full annual dues for a calendar year are to be fixed by the Board of Trustees. County medical societies may set their own annual dues in accordance with their bylaws;.the percentage of full annual dues to be paid by each category may be in accord with the state Society s percentages. County medical society dues categories and the percentages of the full annual dues to be paid by each category must be in accord with the State Society's categories and percentages. The full annual dues are to be paid by all members of this Society, except as provided in these bylaws. The Board of Trustees may establish exceptions to the full annual dues for categories of members. Pilot programs for dues category changes shall have no longer than a three-year cycle. These programs shall be submitted annually to the House of Delegates for its information. SECTION 3 Special Assessments A special assessment requires the approval of the House of Delegates after hearing the Board of Trustees state the nature thereof, recommend the amount, and suggest the manner and time of payment. SECTION 4 Payment of Dues The annual dues shall be paid to the executive vice president of this Society or to the member s component society. The Board of Trustees shall set the delinquent and termination dates for non-payment of dues. The executive vice president may provide for installment payment of dues. A special assessment shall be paid directly to the executive vice president prior to the due date of any special assessment. SECTION 5 Delinquent Dues/Delinquent Members An annual dues or special assessment not paid by the date prescribed shall be delinquent. A delinquent assessment or delinquent dues renders the member delinquent and such member shall not be entitled to exercise any of the rights and privileges of membership in this Society during the period of delinquency. The executive vice president shall send a notice to each delinquent member within 15 days of the date such member becomes delinquent, stating the amount due and requiring the member to pay the amount

18 within 30 days after the date of the notice or be terminated automatically from membership in this Society. SECTION 6 Dues Year The calendar year shall be the dues year for the purpose of the annual dues of members and the fiscal operation of this Society. SECTION 7 Other Income In addition to dues as prescribed in these bylaws, funds for this Society may also be raised by voluntary contributions and in any other legal manner approved by the House of Delegates.

19 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Andrew Lutzkanin, MD on behalf of the Early Career Physicians Section) Back to Table of Contents SUBJECT 6 Special Sections: Early Career Physicians Section Under PAMED Bylaws, to be eligible for the Early Career Physicians Section, an individual must be under 40 years of age or in the first five (5) years of professional endeavor after residence and fellowship training programs at the time of election. The proposed amendment would extend the number of years an individual is eligible to be a member of the section from the first five (5) years of practice to the first eight (8) years of practice. According to the ECPS, extending the term of eligibility to eight years would match the ECPS with the AMA Young Physician Section to allow for more active PA Med members to more easily participate at that level. Additionally, as the medical society makes efforts to attract new members, particularly those physicians early in their career, extending eligibility increases the pool of potential members for the section to reach out and engage with. Ultimately, this will align eligibility at the state and national level to provide clarity to a given member s stage in career.

20 Subject 6: Extend the number of years an individual is eligible to be a member of the section from the first five (5) years of practice to the first eight (8) years of practice. Back to Table of Contents Amend the bylaws as follows: CHAPTER XIV THE BOARD OF TRUSTEES SECTION 6 Terms The term of the early career physicians trustee shall be one year so long as the early career physicians trustee is under 40 years of age or in the first five (5) years eight (8) years of professional endeavor after residency and fellowship training programs at the time of election. CHAPTER XVIII SPECIAL SECTIONS SECTION 3 Early Career Physicians Section The purpose of the Early Career Physicians Section is to increase involvement of early career physicians in organized medicine and provide a direct means for early career physician members of the Pennsylvania Medical Society to participate in Society activities and policymaking. Membership in this section shall include all active physician members of the Pennsylvania Medical Society who are under 40 years of age or in the first five (5) eight (8) years of professional endeavor after residency and fellowship training programs.

21 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Sherry L. Blumenthal, MD, MS Ed, FACOG) Back to Table of Contents SUBJECT 7 SPECIAL SECTIONS: Add Women Physicians Section to PAMED Special Sections Currently, there are four Special Sections identified within the Bylaws: The Residents and Fellows Section, the Medical Students Section, the Early Career Physicians Section, and the International Medical Graduates Section. The proposed amendment, submitted by Dr. Sherry L. Blumenthal, seeks to establish a fifth section, the Women Physicians Section. According to Dr. Blumenthal, 37% of physicians in PA are women, 46% of medical students and residents are women, and 50.6% of the incoming medical school class is female, but only 18% of female physicians in PA are PAMED members, and only 19% of the Board of Trustees is female. In support of the amendment, Dr. Blumenthal states that the Society and the Board benefit from greater diversity and equality by encouraging increased participation by women. She notes that, currently, there are 3691 women members of PAMED, while there are 1193 Early Career members 1247 International Medical Graduate members, and 2885 Medical Student members.

22 Subject 7: Add Women Physicians Section to PAMED Special Sections Back to Table of Contents CHAPTER XVIII - SPECIAL SECTIONS SECTION 1 Residents and Fellows Section Membership in this section shall include residents and fellow physicians who are members in the active category of the Pennsylvania Medical Society as graduates in training. The section shall elect from among its members: a. a governing council consisting of a chair, vice chair, secretary, and seven members-at-large, b. ten delegates and ten alternate delegates to the Society's House of Delegates, and c. one or more qualified nominees for the position of residents and fellows trustee to the Society's Board of Trustees who shall be placed in nomination at the annual meeting of this Society's House of Delegates by a delegate of the section, and d. one or more qualified nominees for the slotted alternate delegate position to the American Medical Association for recommendation to the Committee to Nominate Delegates and Alternates to the American Medical Association. The offices of governing council member and delegate or governing council member and residents and fellows trustee may be held simultaneously; however, the office of trustee and delegate or alternate delegate may not be held simultaneously. The regular functions of this section shall include, but not be limited to, the conducting of a business meeting held in conjunction with the annual meeting of this Society s House of Delegates. SECTION 2 Medical Students Section Membership in this section shall include the medical students who are members in that category in this Society. The governing council of the section shall consist of one representative from each medical school in the Commonwealth, the immediate past chair of the governing council, the medical student trustee, and the section's alternate delegate to the American Medical Association's House of Delegates. The governing council shall select a chair, vice chair, and secretary/treasurer, who shall also serve as the executive committee. The governing council shall also select (a) one or more qualified nominees for medical student trustee who shall be placed in nomination at the annual meeting of this Society's House of Delegates by a member of the governing council, and (b) one or more qualified nominees for the slotted alternate delegate position for recommendation to the Committee to Nominate Delegates and Alternates to the American Medical Association. The representative of each medical school to the governing council shall be selected by each respective medical school chapter in such manner as they shall determine appropriate, shall be a student at the school, and shall serve as delegate to the Society s House of Delegates. In the event that no qualified delegate is available to represent a particular school, then a delegate to represent that school may be selected from among the members of the section by the section's executive committee.

23 A member of the section may hold the offices of governing council member and delegate or alternate simultaneously and may also hold the offices of governing council member and medical student trustee. The offices of trustee and delegate or alternate may not be held simultaneously. The regular functions of this section shall include, but not be limited to, the conducting of a business meeting held in conjunction with the annual meeting of this Society s House of Delegates. SECTION 3 Early Career Physicians Section The purpose of the Early Career Physicians Section is to increase involvement of early career physicians in organized medicine and provide a direct means for early career physician members of the Pennsylvania Medical Society to participate in Society activities and policymaking. Membership in this section shall include all active physician members of the Pennsylvania Medical Society who are under 40 years of age or in the first five (5) years of professional endeavor after residency and fellowship training programs. The section shall elect from among its members (a) a chair, vice chair, and two members-at-large, and (b) one or more qualified nominees for the position of early career physicians trustee to the Society s Board of Trustees who shall be placed in nomination at the annual meeting of this Society s House of Delegates by a delegate of the section. The governing council of the section will consist of the chair, vice chair, trustee, and two members-at-large. The immediate past chair of the governing council will serve as an ex officio member. Delegates to the AMA Young Physicians Section and this Society s House of Delegates will be chosen by the council from among the governing council and from among other early career physicians who volunteer. The section is entitled to four delegates. The trustee may not serve as a delegate to this Society s House of Delegates. Terms and duties of officers are as follows: a. Chair: one-year term with no term limits. Duties include presiding over governing council meetings, assigning tasks to governing council members, and overseeing reports to the Board of Trustees. b. Vice Chair: one-year term with no term limits. Duties include chairing meetings in the absence of the chair, and coordinating programs and projects as assigned. c. Member-at-Large: one-year term with no term limits. Two members-at-large shall be elected and will undertake programs and projects as assigned. The period of time between the conclusion of one annual meeting of the House of Delegates and the conclusion of the next annual meeting shall be considered the term of office. d. Trustee: serves as Early Career Physicians Section trustee of this Society Board and participates in and advises the governing council. The term of office is as set forth in Chapter XIV, Section 6 of these bylaws. The section shall hold an annual business meeting in conjunction with the annual meeting of this Society s House of Delegates. All early career physician members of this Society are eligible to attend and participate in the meeting. County and specialty societies will be encouraged to send interested early career physicians, particularly if they are attending this Society s annual meeting. SECTION 4 International Medical Graduates Section The purpose of the International Medical Graduates Section is to enhance international medical graduate participation in organized medicine and enhance Society outreach, communication, and interchange with the international medical graduate segment of the Pennsylvania physician population.

24 Membership in this section shall include representatives, who are graduates of medical schools outside the United States and Canada, from county medical societies and specialty societies, and at-large representatives consisting of Society members who choose to participate in the section, all of whom shall have voting rights and be eligible to hold office. The section shall elect from among its members (a) a governing council consisting of a chair, vice chair, and one delegate and one alternate delegate to the Society's House of Delegates, and (b) one or more qualified nominees for the position of international medical graduates trustee to the Society s Board of Trustees who shall be placed in nomination at the annual meeting of this Society s House of Delegates by the delegate of the section. The offices of governing council member and delegate or governing council member and international medical graduates trustee may be held simultaneously; however, the offices of trustee and delegate or alternate delegate may not be held simultaneously. The regular functions of the section shall include, but not be limited to, the conducting of a business meeting in conjunction with the annual meeting of this Society's House of Delegates. Any physician member of the Pennsylvania Medical Society attending the Section s annual business meeting who is an international medical graduate has the right to consider and vote upon all matters that may come before the Section at the annual meeting. In addition, each component society and specialty society shall be encouraged to send one voting representative who shall be an international medical graduate to represent their component or specialty society at the Section s annual business meeting. Each person shall have only one vote, either as an individual or as a representative of a component or specialty society. No proxy or absentee ballot is permitted. SECTION 5 Women Physicians Section The purpose of the Women Physicians Section is to promote involvement of women, underrepresented in organized medicine, and to encourage women physicians to participate in leadership, policymaking, advocacy and other activities of the Pennsylvania Medical Society. Membership in the section shall include active members of the Society. Terms and duties of those elected by members in the section, who will serve on the Governing Committee, are as follows: a. Chair: two-year term with no term limits. Duties include presiding over governing council meetings, assigning tasks to governing council members, and overseeing reports to the Board of Trustees. b. Vice Chair: two-year term with no term limits. Duties include chairing meetings in the absence of the chair, and coordinating programs and projects as assigned. c. District Representatives: one-year term with no term limits. Each shall undertake programs and projects as assigned. The period of time between the conclusion of one annual meeting of the House of Delegates and the conclusion of the next annual meeting shall be considered the term of office. d. Trustee: serves as Women Physicians Section Trustee of the Board of Trustees and participates in and advises the governing council. The term of office is as set forth in Chapter XIV, Section 6 of these bylaws. The Trustee may not serve as a Section Delegate to the House of Delegates.

25 The Governing Committee will meet quarterly, once at the annual meeting of the House of Delegates, and three times by video or phone conferencing. The Section shall hold an annual business meeting in conjunction with the annual meeting of the Society s House of Delegates. All women physician and women medical students who are members of the Society are eligible to attend and participate in the meeting. County and specialty societies will be encouraged to send women physicians section members, particularly if they are attending the Society s House of Delegates.

26 SUMMARY OF PROPOSED BYLAW AMENDMENTS (Submitted by: Nathan Hoff, Matthew Hope, and Douglas Wells on behalf of the Medical Students Section Governing Council) Back to Table of Contents SUBJECT 8 SPECIAL SECTIONS: Update Medical Student Section and MSS Governing Council to Reflect Current Practice This proposal, submitted by the Medical Student Section Governing Council, seeks to update the Bylaws to reflect the current makeup and practices of the Medical Students Section (MSS) and the MSS Governing Council. The MSS notes that the current bylaws do not include numerous MSS Governing Council positions that are elected annually at HOD. In addition, the section notes that several of the positions currently in the bylaws have not been elected nor utilized by the Section for many years. PLEASE NOTE: This proposed amendment was submitted with the signatures of 15 active or associate members. Per our Bylaws at Chapter XIX, Subsection (a), the proposed amendments may be submitted, without Bylaws Committee consideration, to the Secretary for publication in the Official Call. See Appendix 3.

27 Subject 8: Update Medical Student Section and MSS Governing Council to Reflect Current Practice Back to Table of Contents Amend the bylaws as follows: CHAPTER XVIII - SPECIAL SECTIONS SECTION 1 Residents and Fellows Section Membership in this section shall include residents and fellow physicians who are members in the active category of the Pennsylvania Medical Society as graduates in training. The section shall elect from among its members: a. a governing council consisting of a chair, vice chair, secretary, and seven members-at-large, b. ten delegates and ten alternate delegates to the Society's House of Delegates, and c. one or more qualified nominees for the position of residents and fellows trustee to the Society's Board of Trustees who shall be placed in nomination at the annual meeting of this Society's House of Delegates by a delegate of the section, and d. one or more qualified nominees for the slotted alternate delegate position to the American Medical Association for recommendation to the Committee to Nominate Delegates and Alternates to the American Medical Association. The offices of governing council member and delegate or governing council member and residents and fellows trustee may be held simultaneously; however, the office of trustee and delegate or alternate delegate may not be held simultaneously. The regular functions of this section shall include, but not be limited to, the conducting of a business meeting held in conjunction with the annual meeting of this Society s House of Delegates. SECTION 2 Medical Students Section Membership in this section shall include the medical students who are members in that category in this Society. The governing council of the section shall consist of one representative from each medical school in the Commonwealth,; the chair, vice chair, and the immediate past chair of the governing council,; the medical student trustee,; the medical student trustee-elect; and the section's alternate delegate to the American Medical Association's House of Delegates.; the section s alternate delegate-elect to the American Medical Association s House of Delegates; the section s representative to the Board of Directors of the Pennsylvania Medical Political Action Committee; the medical student trustee to the Foundation of the Pennsylvania Medical Society; and, the medical student trustee-elect to the Foundation of the Pennsylvania Medical Society. The governing council shall select a chair, vice chair, and secretary/treasurer, who shall also serve as the executive committee. The following individuals shall serve on the executive committee: the section chair, the section vice chair, the medical student trustee, the medical student trustee to the Foundation, the representative to the Pennsylvania Medical Political Action Committee s Board of Directors, and the alternate delegate to the American Medical Association.

28 The governing council medical school representatives shall also select (a) one or more qualified nominees for medical student trustee who shall be placed in nomination at the annual meeting of this Society's House of Delegates by a member of the governing council the section, and (b) one or more qualified nominees for the slotted alternate delegate position for recommendation to the Committee to Nominate Delegates and Alternates to the American Medical Association., (c) one qualified nominee for the medical student trustee to the Foundation of the Pennsylvania Medical Society, (d) one qualified nominee for the medical student representative to the Board of Directors of the Pennsylvania Medical Political Action Committee, (e) one qualified nominee for the section chair, (f) one qualified nominee for the section vice chair, (g) one qualified nominee for the medical student trustee-elect to the Foundation, (h) one qualified nominee for the medical student trustee-elect. The representative of each medical school to the governing council shall be selected by each respective medical school chapter in such manner as they shall determine appropriate, shall be a student at the school, and shall serve as delegate to the Society s House of Delegates. In the event that no qualified delegate is available to represent a particular school, then a delegate to represent that school may be selected from among the members of the section by the section's executive committee. A member of the section may hold the offices of governing council member and delegate or alternate simultaneously and may also hold the offices of governing council member and medical student trustee. The offices of trustee and delegate or alternate may not be held simultaneously. A student may serve as both a medical school representative and only one of the following: the medical student trustee, the medical student trustee-elect, the section's alternate delegate to the American Medical Association's House of Delegates, the section s alternate delegate-elect to the American Medical Association s House of Delegates, the section s representative to the Board of Directors of the Pennsylvania Medical Political Action Committee the medical student trustee to the Foundation of the Pennsylvania Medical Society, and the medical student trustee-elect to the Foundation of the Pennsylvania Medical Society. The regular functions of this section shall include, but not be limited to, the conducting of a business meeting held in conjunction with the annual meeting of this Society s House of Delegates. SECTION 3 Early Career Physicians Section The purpose of the Early Career Physicians Section is to increase involvement of early career physicians in organized medicine and provide a direct means for early career physician members of the Pennsylvania Medical Society to participate in Society activities and policymaking. Membership in this section shall include all active physician members of the Pennsylvania Medical Society who are under 40 years of age or in the first five (5) years of professional endeavor after residency and fellowship training programs. The section shall elect from among its members (a) a chair, vice chair, and two members-at-large, and (b) one or more qualified nominees for the position of early career physicians trustee to the Society s Board of Trustees who shall be placed in nomination at the annual meeting of this Society s House of Delegates by a delegate of the section. The governing council of the section will consist of the chair, vice chair, trustee, and two members-at-large. The immediate past chair of the governing council will serve as an ex officio member. Delegates to the AMA Young Physicians Section and this Society s House of Delegates will be chosen by the council from among the governing council and from among other early career physicians who volunteer. The section is entitled to four delegates. The trustee may not serve as a delegate to this

29 Society s House of Delegates. Terms and duties of officers are as follows: a. Chair: one-year term with no term limits. Duties include presiding over governing council meetings, assigning tasks to governing council members, and overseeing reports to the Board of Trustees. b. Vice Chair: one-year term with no term limits. Duties include chairing meetings in the absence of the chair, and coordinating programs and projects as assigned. c. Member-at-Large: one-year term with no term limits. Two members-at-large shall be elected and will undertake programs and projects as assigned. The period of time between the conclusion of one annual meeting of the House of Delegates and the conclusion of the next annual meeting shall be considered the term of office. d. Trustee: serves as Early Career Physicians Section trustee of this Society Board and participates in and advises the governing council. The term of office is as set forth in Chapter XIV, Section 6 of these bylaws. The section shall hold an annual business meeting in conjunction with the annual meeting of this Society s House of Delegates. All early career physician members of this Society are eligible to attend and participate in the meeting. County and specialty societies will be encouraged to send interested early career physicians, particularly if they are attending this Society s annual meeting. SECTION 4 International Medical Graduates Section The purpose of the International Medical Graduates Section is to enhance international medical graduate participation in organized medicine and enhance Society outreach, communication, and interchange with the international medical graduate segment of the Pennsylvania physician population. Membership in this section shall include representatives, who are graduates of medical schools outside the United States and Canada, from county medical societies and specialty societies, and at-large representatives consisting of Society members who choose to participate in the section, all of whom shall have voting rights and be eligible to hold office. The section shall elect from among its members (a) a governing council consisting of a chair, vice chair, and one delegate and one alternate delegate to the Society's House of Delegates, and (b) one or more qualified nominees for the position of international medical graduates trustee to the Society s Board of Trustees who shall be placed in nomination at the annual meeting of this Society s House of Delegates by the delegate of the section. The offices of governing council member and delegate or governing council member and international medical graduates trustee may be held simultaneously; however, the offices of trustee and delegate or alternate delegate may not be held simultaneously. The regular functions of the section shall include, but not be limited to, the conducting of a business meeting in conjunction with the annual meeting of this Society's House of Delegates. Any physician member of the Pennsylvania Medical Society attending the Section s annual business meeting who is an international medical graduate has the right to consider and vote upon all matters that may come before the Section at the annual meeting. In addition, each component society and specialty society shall be encouraged to send one voting representative who shall be an international medical graduate to represent their component or specialty society at the Section s annual business meeting. Each

30 person shall have only one vote, either as an individual or as a representative of a component or specialty society. No proxy or absentee ballot is permitted.

31 Appendix 1 Back to Table of Contents Board of Trustees Report 2: Re: The Expansion of the Affiliate Member Category to include Physicians 70 Years of Age or Older Reference Committee A Recommendation 8 was introduced at the 2016 House of Delegates and referred for study to the Board of Trustees: RECOMMENDATION: Mr. Speaker, your reference committee recommends that proposed bylaws amendment Subject Four in the 2016 Official Call be referred to the Board of Trustees for Study. Currently, the bylaws have a separate category of membership for Associate members for physicians who are 70 years of age or over (in the year of application) and have been an active member of PAMED or an active member of a constituent association of the American Medical Association. These members are not required to pay annual dues and are not required to maintain a license. Additionally, the Associate members are currently split into two categories: Associate members who receive mail and Associate members who receive no mail. Individuals in the Associate members with mail category pay 10 percent of the full annual assessment each year and continue to receive PAMED communications. Individuals in the Associate members with no mail category do not pay dues and do not receive PAMED communications. The proposed amendment would eliminate the Associate member category. Physicians who are 70 years of age or over (in the year of application) and choose to receive PAMED mail would be moved to the Affiliate category. These individuals would still pay 10 percent of the full annual assessment of state dues; dues payment for the component medical society would be at the component medical societies discretion. Physicians who are 70 years of age or over (in the year of application) and choose not to receive PAMED mail would be grandfathered into the proposed iteration of the bylaws; these individuals would retain the Associate member title and would neither pay dues nor receive PAMED communications. Since the Associate member category would be eliminated, this membership option and title would no longer be available for prospective members. Your reference committee has determined that additional information is needed to make a proper determination. Individuals who testified cautioned against making changes that would discourage membership among older physicians, and any change that would impact overall membership numbers.

32 Individuals who testified acknowledged that physicians are working later in life and, as a result, recommended the deletion of any reference to a specific age for membership categories within PAMED s bylaws. The committee recommends further study regarding the impact of the proposed amendment on overall membership numbers and delegate representation. The following report was filed with the Board of Trustees for its review during the August 2017 Board Meeting. The Board approved the report. The report has been referred to the House of Delegates for final approval during the October 2017 meeting.

33 REPORT 2 BOARD OF TRUSTEES Recommendation of Reference Committee A: Reference Committee A Recommendation 8, introduced at the 2016 House of Delegates and referred for study to the Board of Trustees, recommends further study regarding the impact of the proposed bylaws amendment the expansion of the Affiliate Member Category to include Physicians 70 Years of Age or Older on overall membership numbers and delegate representation. BACKGROUND In 2016, PAMED staff proposed the expansion of the Affiliate Category to include physicians 70 years of age or older. This proposed amendment would result in the elimination of the Associate Member category. Since the Associate Member category would be eliminated, the related membership options Associate Member with Mail and Associate Member with No Mail would no longer be available. The bylaws reference committee determined that additional information was needed to decide whether the amendment should be adopted. Individuals who testified cautioned against making changes that would discourage membership among older physicians, and any change that would impact overall membership numbers. BRIEF CONCLUSION The House of Delegates should adopt the proposed bylaws amendment to expand the Affiliate Member Category to include Physicians 70 Years of Age or Older. Although the amendment could decrease the overall membership numbers and delegate representation, additional members could be gained from the expansion of the Affiliate Member category to include all physicians 70 years of age or older. ANALYSIS Current Process During the annual membership renewal period, PAMED sends an average of 150 invitation letters for Associate Membership to eligible physicians. The invitation letter provides three options for continued membership: (1) Continued Active Membership members in this category pay full membership dues, are eligible to receive all member benefits, and have the right to vote and hold office in this Society. (2) Associate Membership with Mail members in this category pay 10% of the full annual assessment for state dues; dues payment for the county medical society are at the county medical societies discretion. Associate Members with Mail are eligible to receive all member benefits, and have the right to vote and hold office in this Society. These members are not required to maintain a license to practice medicine. (3) Associate Membership with No Mail members in this category do not pay dues. They do, however, receive the PAMED Dose and the Pennsylvania Physician magazine. Associate Members

34 with No Mail have the right to vote and hold office in this Society. These members are not required to maintain a license to practice medicine. Of the approximately 150 physician members who are sent invitations, about 50% (or about 75 members) respond. Approximately 70% (52 members) request Associate Membership with Mail; 20% (15 members) request Associate Membership with No Mail; and, 10% (8 members) request to continue their Active Member status. The Associate Member with No Mail category is also populated by Associate Members with Mail who chose not to pay their renewal. Over the last five years, Associate Members with Mail were rolled to Associate Member with No Mail category. Members in the Associate with No Mail category remain in this category until they are flagged as potential ghost members individuals for whom PAMED no longer has valid contact information. Once the ghost members are identified, PAMED sends notification to the members respective county medical society and requests valid contact information. If valid contact information is not obtained within 30 days, the ghost member is dropped from membership. Annually, approximately Associate Members with No Mail category are dropped during the ghost membership handling process. Impact on Current Members As previously stated, the proposed amendment would result in the elimination of the Associate Member category. Therefore, the related membership options Associate Member with Mail and Associate Member with no Mail would no longer be available. The amendment would have the following impact on members currently in these categories: Associates Members with Mail: There would be no discernable effect on the members in this category. These members would be moved to the Affiliate member category. They would still pay 10 percent of the full annual assessment of state dues, and dues payment for the component medical society would be at the component medical societies discretion. They would continue to receive all member benefits, and maintain their right to vote and hold office in this Society. These members would not be required to maintain a license to practice medicine. Associates Members with No Mail: There would be no discernable effect on the members currently in this category. These individuals would maintain the status quo: they would not pay State dues, they would retain the Associate member title, their ability to vote, and would continue to receive the Dose and the Pennsylvania Physician Magazine. PAMED would send invitation letters for Affiliate membership to current members who are 70 years of age. These individuals would still have the option of paying 10 percent of the full annual assessment of state dues; dues payment for their respective county medical society would be at the county medical societies discretion. Impact on Overall Membership Numbers The proposed bylaws amendment could affect the Society s overall membership numbers. A decrease in membership would result from the stagnation and eventual elimination of the Associate Member with No Mail category; however, there could also be an increase in membership with the expansion of the Affiliate Member category.

35 A description of the impact of the proposed change on each membership category is provided below: o o o Active, Honorary, and Administrative Membership The proposed amendment would have no effect to these categories. We anticipate that eligible physicians would remain in the Active membership category at current rates, resulting in no change in this category. The Honorary and Administrative membership categories are not affected by the proposed amendment. Affiliate Membership The proposed amendment could potentially increase the number of members in this category. As of December 31, 2016, there were 822 members in the Associate with Mail category; these members would automatically be moved to the Affiliate Member category and, moving forward, all eligible physician members will be invited to become Affiliate member. In addition, the proposed amendment would open membership to all physicians who are 70 years or older at the time of application. As noted by testimony during the reference committee, physicians are working later in life. As a result, this amendment will create a new membership opportunity for all physicians who continue to work and see the value in organized medicine. Associate Membership Associate membership with mail The proposed amendment would eliminate this category. Members currently in this category would be moved to the Affiliate Membership category resulting in no net effect on the overall member count. Associate membership with No Mail The proposed amendment could potentially decrease the number of members in this category. As previously noted, existing members in this category would retain the Associate member title. They are not required to pay dues; however, they would receive the PAMED Dose and the Pennsylvania Physician magazine. They would retain their right to vote and hold office in this Society. However, this membership option would no longer be available. As a result, over time, there would be a decrease in membership numbers, resulting in the eventual elimination of this category. As of December 31, 2016, there were 1,371 members in the Associate member with No Mail category. Since approximately members in the Associate No Mail category are dropped annually, we anticipate total elimination of the members in this category in about 27 years. Impact on Overall Delegate Representation Per the bylaws, delegates elected by the component medical societies in the proportion of one delegate for every one hundred or fraction thereof of its active associate or affiliate members whose dues are paid or excused as of December 31 of the preceding year. The proposed bylaws amendment could affect the Society s overall delegate count; the overall delegate representation could decrease by approximately 5 percent (14 members). The reduction would affect only the County Medical Society (CMS) delegate representation. See Table 1. Table 1: Possible effect of the elimination of the Associate No Mail Category on Overall Delegate Representation Physician Delegate Counts (as of December 31, 2016) With no Bylaws Amendment With proposed bylaws amendment (i.e., elimination of Associate No Mail Category) Difference (+/-) CMS Delegate

36 Specialty Delegate Medical Students Resident Physicians Young Physicians IMG Medical Schools Resident/Student Total Twelve counties could potentially lose 1 or 2 delegates as a result of the proposed bylaws change. The remaining 48 counties would be unaffected. See Table 2. Table 2. Possible effect of the elimination of the Associate No Mail Category on Affected CMS Representation Physician Delegate Counts (as of December 31, 2016) With no Bylaws Amendment With proposed bylaws amendment (i.e., elimination of Associate No Mail Category) Difference (+/-) Philadelphia Delaware Lehigh Montgomery Northampton Berks Cumberland Dauphin Franklin York Erie Allegheny However, it is important to note that the number of delegates lost due to the elimination of the Associate Member with No Mail category could be counterbalanced by the expansion of the Affiliate Member category to all physicians 70 years of age and older.

37 A complete table of the membership numbers and delegate representation, as of December 31, 2016, is attached for your reference. CONCLUSION The proposed bylaws amendment would result in the stagnation and eventual elimination of the Associate No Mail category. Accordingly, overtime, the Society could experience a 7 percent decrease in overall membership numbers and an approximate 5 percent decrease in CMS delegate representation, with the eradication of this category. It is important to recognize, however, that these changes would not occur immediately; these changes would occur over many years. Additionally, individuals in the Associate No Mail category are members that would eventually be eliminated from the membership regardless of the proposed change. Despite the impact on the Society s membership numbers and delegate count, several benefits would be derived from the proposed change: New membership opportunity for physicians 70 years and older. Currently, only active members who are 70 years or older are eligible for Associate membership. The proposed amendment would open membership to all physicians who are 70 years or older at the time of application. Potential decrease in cost for county medical societies. County medical societies report some costs associated with maintaining members in the Associate with No Mail category. These costs are due to continued correspondence to members in this category and their participation at county events. The proposed bylaws amendment could potentially eliminate these costs, or allow for additional opportunity to subsidize these costs due to the additional membership that could be generated by opening the affiliate members category to all physicians 70 years or older. Simplifies membership categories. The PAMED membership team has stated that potential and existing members find the PAMED membership categories and dues structure confusing. The proposed bylaws amendment would take an additional step towards simplifying this information. Allows more consistent and accurate tracking of membership data. The majority of ghost members (i.e., individuals for whom PAMED no longer has valid contact information) are found in the Associate with No Mail category. By in large, these individuals are identified when mail sent to them is subsequently returned to PAMED. Due to the infrequent nature of these mailings, it takes a significant amount of time and effort to identify and eliminate those members who no longer exist. Because members of the remaining categories frequently receive mail and other correspondence from PAMED, the Society could accelerate the identification of these ghost members and respond accordingly; this would result in a more consistent and accurate reflection of PAMED membership. As a result, PAMED should move forwarded with the proposed bylaws amendment to expand the Affiliate Member Category to include Physicians 70 Years of Age or Older. Although the amendment could decrease the overall membership numbers and delegate representation, additional members could be gained from the

38 expansion of the Affiliate Member category by creating member eligibility for all physicians 70 years of age or older. RECOMMENDATION 1. The Board of Trustees recommends that the House of Delegates adopt the proposed bylaws amendment to expand the Affiliate Member Category to include Physicians 70 Years of Age or Older. David A. Talenti, MD Chair

39 Appendix 2: Chester/Delaware County Proposed Amendment Signatures Back to Table of Contents

40

41

42 Appendix 3: MSS Governing Council Signatures Back to Table of Contents X Nathan Hoff Foundation Student Trustee X Matthew Hope Board Trustee-Elect X Douglas Wells

43 X Aleesha Shaik MSS Chair X Anamika Saha Foundation Student Trustee-Elect X Gillian Naro PAMPAC Representative X Rachel Thomas AMA Alternate Delegate-Elect X John Trickett AMA Alternate Delegate X Arshjot Khokhar X M. Usman Ahmad X Thaddeus Wright X Daniel Kim X Jasmine Santos XChrstine Chen X Emili Del