This article originally appeared in the Winter 2023 issue of the Ontario Medical Review magazine.
In governance, there is more than one way to ensure representation in leadership.
The Section on General and Family Practice is doing so by reducing the size of its executive from 20 to seven. This less-is-more approach is part of an effort to more broadly represent the needs and interests of SGFP’s 15,000 members.
The move aligns with changes taking place for all sections of the Ontario Medical Association, resulting from its ongoing governance modernization process. The SGFP is shifting from a regional representative model to a skills- and experience-based executive. It is also looking at new ways for more members to contribute to section discussions and decisions.
For the SGFP, reducing the size of its executive will allow for nimble leadership and more effective decision-making, said Dr. David Barber, chair of the SGFP, which is the OMA’s largest section.
Prior to this reorganization, the SGFP executive included at least one regional representative position from each of the 11 districts, as well as members-at-large. The size of the executive ballooned as a result and meetings were tougher to manage. Dr. Barber, an assistant professor in the department of family medicine at Queen’s University in Kingston, said there were complaints that the SGFP couldn’t make decisions.
“Trying to make a decision with 20 people at the table is really difficult,” he said. “It bogs down the whole process.”
A new sections charter, established during the sections’ review last year, allows for flexibility in the size of the executive, with some positions being optional, and allowing for discretion over the number of members-at-large. According to the charter’s formula, for example, SGFP’s executive could include up to 18 positions, but the section decided to keep the group smaller. The executive members also include a tariff lead, who is responsible for all matters related to physician compensation. This skills-based, three-year term position won’t be elected, but will be filled through an expression-of-interest process open to all members.
To Dr. Barber, the SGFP’s seven-member executive will allow for more free-flowing and productive conversations. “It’s a much more effective and efficient meeting.”
“You’re engaging more doctors, who feel they have a voice in what’s happening, and you’re developing potential future leaders” — Dr. David Barber
This new executive composition was approved at an SGFP executive meeting in October. The SGFP interim executive currently includes a chair, vice-chair, past chair, three members-at-large, the tariff lead and two ex-officio members: the treasurer and a new executive director. This interim structure will be in place until May, when newly elected individuals begin their terms following the single election period that began in November.
Terms for the chair, vice-chair and past chair positions have increased from one to two years to ensure continuity and as per the section's charter. Going forward, the chair and vice-chair positions will be voted in directly by members, instead of being selected from the executive by executive members.
Tariff lead (appointed)
Past chair (acclaimed)
Executive director (ex-officio, non-voting)
|Dr. Barber (Y2)
|Dr. Maraj (Y2)
|Dr. Mastrogiacomo (Y2)
|Open application process
|Open application process
Any member who is a primary member of the SGFP can submit their name for election to the SGFP executive.
Just representing geographies was a narrow way to look at governance, said Dr. Cathy Mastrogiacomo, past chair of the SGFP. “I think it was a flawed model.”
It’s hard for any one person to fully represent the wide-ranging needs and viewpoints within a district. More than that, she said sections should be representing various service model types, constituencies and perspectives, not just a region.
“When you have a regional representation model, which is what we had until now, it is only normal that executive members may subconsciously come to the table with their regional issues in mind,” said Dr. Mastrogiacomo, a Toronto family doctor in solo practice.
Under the new approach, those serving on the executive may come from large or small communities, work in different settings or have specific issues they want to bring to the forefront. No matter, “you come together as one group with the idea that you’re representing all family doctors,” she said.
This streamlined executive composition is part of a broader trend in governance. The SGFP executive is reducing its members but adding “more informed decision-making,” said Dr. Barber.
“When you have a regional representation model, which is what we had until now, it is only normal that executive members may subconsciously come to the table with their regional issues in mind” — Dr. Cathy Mastrogiacomo
Could a general vote result in bigger urban centres dominating the executive?
“This is a risk of having an open election,” said Dr. Mastrogiacomo. “The big cities will bring the votes, and the vote may be skewed. Remember also that our board will have an evaluation process, as part of best practices.”
The SGFP has committed to continual improvement to ensure this new model meets member needs. Any changes put forward will require review, to validate the accuracy of the envisioned changes and determine if further revisions are needed.
The section plans to complement the new executive with a comprehensive committee structure to ensure they have the capacity to address all the work the section’s mandate requires.
Previously, the SGFP had many working groups, but they started and stopped based on emerging topics, and their makeup was drawn only from within the elected executive. With the new structure, committees will now include members based on their skills and interest in participating. “The larger representation — rural, focused practice, different practice model, different stages in practice, etc. — will occur at the committee level,” Dr. Mastrogiacomo said.
The SGFP is looking to start populating some of its committee structure in early 2024. There will be ample opportunity for OMA members (possibly 50 annually) to apply to serve on these committees. This will mirror the OMA’s appointment process, with some committee members also holding positions on the SGFP executive.
The first three defined committees will cover tariff, policy and advocacy, engagement and communications. Committee members will help lead by developing statements on prioritized matters that the section or the OMA can take up as advocacy issues.
The section also plans to increase representation in other ways, including working more closely with the existing OMA medical interest groups, fora and OMA networks (formerly assemblies). These consultations might bring in another 500-plus voices.
The SGFP and other sections are also introducing the concept of a broader physician leadership group. It could include other doctors, guests and subject matter experts who can participate in executive-level discussions in an advisory/non-voting capacity.
“This is like SGFP 2.0. There will be more opportunities to participate and have people’s voices heard,” said Dr. Barber.
Tapping into the abundance of views and energy of the SGFP membership has multiple benefits, he said.
“You’re engaging more doctors, who feel they have a voice in what’s happening, and you’re developing potential future leaders,” Dr. Barber said.
Dr. Mastrogiacomo hopes her peers will embrace more ways to get involved in SGFP deliberations and decisions, from the ground up.
“That’s where the representation happens,” she said. “I really feel that the members need to be heard. Every voice is important.”
The changes to how the Section for General and Family Practice runs is one result of a broader review of the OMA’s 49 sections, which occurred in summer 2023.
OMA staff carried out the review in partnership with physician leaders. Co-developing these recommendations helped staff better understand sections’ needs and concerns.
This member-driven initiative is part of the OMA’s continuing efforts toward governance transformation. Under a new section charter, which the OMA’s Board of Directors approved in September 2023:
The new charter and strengthened leadership model aim to give the sections more flexibility to serve members better. The sections’ review followed last year’s districts’ review, which also brought about a new charter and executive structure
Next up in the OMA’s governance modernization process is a review of the medical interest groups, fora and branch societies. Together, the steps taken in the OMA’s governance transformation aim to ensure a member-driven organization that represents all voices and protects the interests of members.
Stuart Foxman is a Toronto-based writer.