Refining the structure and function of the ACR’s Board of Chancellors will optimize a governance framework for the future of the College.
FROM THE CHAIR OF THE BOARD OF CHANCELLORS
Leading associations routinely reassess and refine their governance structure to keep pace with changes in the environment in which they operate. Strong governance is essential for medical associations navigating rapid change, increasing complexity and rising expectations from members and external stakeholders. Please know when using the term Radiology/Radiologist, I am referring to diagnostic and interventional radiologists, nuclear medicine/molecular imaging physicians, radiation oncologists and medical physicists. The ACR has approximately 41,000 members that count all these specialists.
The College’s bylaws currently state that the ACR Board of Chancellors (BOC) is “not to exceed 34 members,” including three Board-elected officers (Board Chair, Board Vice Chair and Board Secretary/Treasurer), four Council-elected officers (ACR President, ACR Vice President, Speaker and Vice Speaker), a maximum of 15 Chancellors elected by the Council, a maximum of nine Chancellors who are appointed by the BOC Chair and an elected BOC seat for the Young Physician Section. Additionally, a representative from five radiology societies — the Radiological Society of North America (RSNA), the American Roentgen Ray Society, the American Radium Society, the American Society of Therapeutic Radiation Oncology and the Canadian Association of Radiology — may be selected to serve as a Chancellor. The Speaker of the Council may also appoint up to nine of the 22 Council Steering Committee (CSC) members.
Board members have three primary duties within their organization:
Additionally, the primary roles of Board members are to be good fiduciaries, strategists and stewards — and business-minded for the organization. During an assessment process and discussions among BOC members, it became apparent that the current structure and size of the ACR Board may be inadvertently compromising the ability for all Board members to have their voices heard. With some of the board’s work delegated to its Budget Finance and Executive Committees, not all Board members may be equally involved with strategic discussions and decisions of the College.
Given that the ACR’s BOC size and structure had not been re-evaluated in many years, in 2021, a group of ACR leaders (William Small Jr., MD, FACR, chair of the group, Jacqueline A. Bello, MD, FACR, Pamela K. Woodard, MD, FACR, Andrew K. Moriarity, MD, MBA, and James V. Rawson, MD, FACR) was convened to evaluate the size, structure and governance of the BOC. A report on their assessment and findings was provided to the BOC in January 2022, which came to the following conclusions and made these recommendations:
Based on the findings and recommendations of the group from 2021–22 and knowledge and insights gained by Christoph Wald, MD, PhD, MBA, FACR, (BOC Vice Chair), Dana H. Smetherman, MD, MPH, MBA, FACR, (ACR CEO) and myself (BOC Chair) during our participation in the Council of Medical Specialty Societies’ (CMSS) Governance and Leadership Excellence Across Medicine (GLEAM) six-month program on association governance in 2024, a BOC Task Force was assembled in early 2025. The BOC Task Force worked with a consultant, the McKinley Advisors Group, that specializes in medical associations and their Boards and governance structures to facilitate BOC discussions on the strengths, weaknesses and opportunities for improvement related to current BOC structure and size to optimize its governance and function to best serve the College.
During the discovery process, the McKinley Advisors Group interviewed over 20 current and former CSC and BOC members and surveyed more than 130 current and former CSC and BOC leaders and Councilors. Based upon the impressions from the interviews, surveys, and Board discussions and conversations between several past Board chairs and myself, the majority impression was that the current BOC size is too large and an outlier compared to best practices, national surveys and literature. For instance, the RSNA (>52,500 members), American Medical Association (>270,000 members) and American College of Cardiology (>56,00 members) have Boards that are 11, 21 and 15 members-in-size, respectively. During the CMSS GLEAM program, Drs. Wald, Smetherman and I learned that the ACR was the only medical association present at the GLEAM program with more than 30 Board members and a super majority had less than 20 Board members.
We need a governance structure that allows the organization to be able to adapt to change, course-correct and make timely and informed decisions to best serve its mission and members.
The College, like many specialty societies, faces the challenge of having the representation of the desired and needed knowledge, skills, expertise and competencies on its Board. We need a governance structure that allows the organization to be able to adapt to change, course-correct and make timely and informed decisions to best serve its mission and members. Over the years, the ACR has been fortunate to have very engaged, competent, committed and industrious BOC members. However, the current Board structure and size inadvertently create situations in which some BOC members feel as if they are left out of strategic and fiduciary discussions and do not have the opportunity to be involved or have their voices heard as much as they would like.
This above dynamic may create a sense among some BOC members that they do not need to read all BOC materials (often more than 600 pages) or come as well-prepared, because they assume another BOC member with more domain knowledge about a topic will provide the needed input. This phenomenon has been discussed in the literature as a specific drawback of having large Boards and is known as a “bystander effect.” The literature also highlights that in large groups, the fear of being judged also leads to inaction by some Board members.
The current Commission structure also inadvertently creates competing priorities for some Commission chairs who oversee a specific focus, specialty, subspecialty, modality or operation. This resulting confusion may occur because the primary expectation of a Board member is to be a representative of and fiduciary for the ACR and not a representative for a constituency or special interest group. Indeed, some decisions being made in the best interest of the ACR may not be seen as being helpful for certain constituencies. Therefore, BOC members should be unencumbered by operational and/or representational competing priorities as much as reasonably possible.
Having a Board that is representative in nature will always raise questions about equity and who is or is not represented on the Board. Therefore, current best practice is to have competency-based Boards that are expected to ensure that all voices are heard and considered — and that their fiduciary, strategic and business decisions are being made in the best interest of and for the overall needs of the College and its mission and members.
These impressions align with broader association governance research. Studies from BoardSource, the American Society of Association Executives, McKinley Advisors and teachings from the CMSS GLEAM program emphasize that large boards struggle with accountability, strategic focus and meaningful participation by Board members. These organizations cite that high-performing Boards typically range from 11–17 members and rely on a competency-based Board selection process rather than a representational structure alone.
Your ACR Board of Chancellors is about 18 months into an assessment process on how to best optimize the size, structure and governance of the ACR Board. The overarching goal of this process is to ultimately have a more strategic, agile and fiduciary-minded BOC to guide the ACR through these rapidly changing, volatile, complex, uncertain and ambiguous times in Radiology and healthcare. By aligning Board composition and governance structure with best practices; clarifying and reducing ambiguity in roles; and strengthening pathways for input from commissions, chapters, societies, large practice groups and external constituents, the ACR can modernize its functionality — while honoring its tradition of inclusivity and member engagement so that more voices and a broader perspective will be heard by the BOC.
As Former First Lady Rosalynn Carter once said, “A leader takes people where they want to go. A great leader takes people where they don’t necessarily want to go, but ought to be.” I want to applaud and personally thank the members of the Board of Chancellors for having the courage and fortitude to take on this critically important challenge and for being great leaders.
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