Governance Structure Of The American Board of Radiology: Focus On The Board of Governors

From its beginning in 1934 to October 2015, the ABR maintained a single Board of Trustees (BOT) to implement the necessary oversight to continue its goals and objectives and carry out its mission, now stated as, "To certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients." This is certainly a multi-faceted effort in a multi-specialty environment that incorporates the disciplines of radiology, interventional radiology, radiation oncology, and medical physics. My tenure in the ABR began in October 2013 as a Trustee representing Diagnostic Medical Physics on the BOT. I quickly learned of the multiple committees and cross-commitments of 25 trustees needed to provide the oversight, direction and decision-making processes of a wide spectrum of issues, and the presence of an Executive Committee comprising the officers who lead the operations, finance, compliance, strategic planning and other business and professional responsibilities, all of which were integrated within the structure to create exams and deliver certification and maintenance of certification services. Decision authority of the Executive Committee was limited, resulting in unwieldy and inefficient implementation of policies and directives, often revisited by the Board because of re-discussion and re-voting.

In 2014, President Jim Borgstede brought in a consultant specializing in board size, structure, and function to review the ABR Board structure and make recommendations on improving efficiency, quality, and decision-making processes. The ultimate outcome of ongoing discussions and task force meetings, resulted in substantial bylaw changes 1.5 years later in October 2015, to form the Board of Governors (BOG) as the Governing Board to direct the corporate powers, business and affairs of the ABR, and the Board of trustees (BOT) as the body to oversee the examination processes (certification and maintenance of certification including exam standards, alternate pathways and management of volunteer committees). This was a major heavy lift requiring careful considerations of appropriate balance and identification of interactions between the BOG and the BOT, expertly guided by the then current President, Dr. Mickey Guiberteau. The hierarchical structure of the ABR is shown in Figure 1.

The ABR BOG is comprised of the officers of the corporation, including the President, President-Elect, Secretary-Treasurer, and the chair of the BOT, in addition to board members chiefly recruited (but not always) from the BOT. There are currently 8 "governors", but 7 to 11 can serve as determined by the needs of the BOG and the directives of the President. Each governor serves a term of 2 years, once renewable. Unlike the representational structure of the BOT, the BOG members serve in the best interest of the ABR independent of their disciplines. As BOG members term out, the nominating committee strives to identify candidates from each discipline to ensure a minimum of one seat on the BOG and to provide for balanced interactions and deliberations during board meetings. This is usually achieved by replacing the retiring governor with an individual from the same discipline. Current BOG membership is listed on the ABR website.

Primary BOG responsibilities are to provide oversight of ABR operations and to direct ABR policies. These include budget and finance duties, regulatory compliance, certification policies, intersociety relations, short-term and long-term strategic planning, governance structure, nomination/election processes, bylaws maintenance, and election of officers and members. Committees are explicitly identified in the bylaws to implement BOG activities, directives, decisions, and policies, and are constituted as:

• Finance
• Bylaws
• Audit review
• Professionalism
• Hearing
• Strategic planning
• Certification policy
• Executive compensation
• Nominating

Each governor is assigned a portfolio of responsibilities at the discretion of the President and maintains membership on committees as described in the bylaws. The small size of the BOG requires participation in most committees, with exceptions for simultaneous participation in the Professionalism and Hearing committees. As needed, Trustees are appointed to assist in meeting the charge of the BOG committees. Details of BOG and BOT duties and responsibilities are specified in the ABR bylaws.

The BOG selects and employs an Executive Director (ED), who serves as the Chief Executive Officer. The ED is responsible to the BOG through the President to implement policies relative to the mission, goals and objectives of the ABR, with directives to plan, organize, coordinate and direct the staff, programs, and activities of the corporation. Associate Executive Director (AED) positions assist the ED as liaisons between the BOT and ABR staff. Of note for this article is the excellent work performed by Dr. Don Frey as the AED for Medical Physics, who provides the consistent institutional knowledge, great support, and exceptional service for the medical physics trustees and governor. The reporting structure is illustrated in Figure 2.

For Medical Physics, Dr. Geoffrey Ibbott was the first to serve on the BOG as Secretary-Treasurer, from October 2015 to October 2017. This led to the appointment of a Trustee in Therapy Medical Physics, now served by Dr. Matthew Podgorsak, which effectively expanded the presence of medical physicist volunteers to 4 individuals within the Board structure of the ABR. With Dr. Ibbott's term completed in 2017, I was nominated to the BOG appointment, leaving a vacancy in the Diagnostic Medical Physics Trustee position, subsequently filled by Dr. Kalpana Kanal. Even though my presence on the BOG is as an independent diplomate, I serve as the bi-directional communications conduit between the medical physics Trustees BOT and BOG regarding current issues, directives, and policies. This is achieved through participation in bi-weekly medical physics BOT conference calls, monthly (or as needed) BOG conference calls, and in exam activities where appropriate, including oral examinations. For the BOG, I am assigned and responsible for the communications portfolio, and am Editor of the BEAM, the quarterly ABR newsletter. I am proud of our many recent accomplishments including providing all Part 1 and Part 2 candidates with feedback about their exam performance. I also look forward to the next several years of improvements that will be coming to the ABR for all diplomates, particularly Online Longitudinal Assessment. Participating in efforts that are meaningful and beneficial to our profession continuously pushes me to do the best I can. Indeed, it has been a great honor to serve as a Trustee representing Diagnostic Medical Physics and now as a Governor of the ABR. Certainly, I am open and welcome to suggestions and comments regarding this article or any other issue you have on your mind regarding the ABR – there's always room for improvement. Please contact me via email.