“A move to an uncontested election format may streamline the election process, reduce member loss, and facilitate our commitment to diversity and broad member engagement, ensuring a vibrant and sustainable future for SGIM.”

Voluntary service and leadership within the Society of General Internal Medicine (SGIM) is our greatest strength and a critical function of our organization. Maintaining this volunteer pipeline necessitates an intentional strategy to ensure the future of the association. SGIM Council has been considering changes to the election format as one way to ensure a sustainable future. The question is, “Why change?”

This conversation began with the participation of our SGIM executive team (President, President-Elect, CEO, COO) in the inaugural Council of Medical Specialty Societies (CMSS) Governance & Leadership Excellence Across Medicine (GLEAM) Program. This program, designed to support the governance and leadership of medical specialty societies, brought together society leaders, and provided tools and connections to enhance organizational leadership. Sixty-two participants from 20 societies convened over a six-month period.

Surprisingly, GLEAM facilitators informed participants that the majority (> 60%) of high performing boards slate uncontested elections, moving away from competitive popular elections.1 My initial thoughts were skeptical—imagining uncontested elections would result in less transparency, fewer choices, and increased difficulty for some members to assume leadership roles. Even worse, in the current context where concerns about democracy are routinely discussed, how would this change be perceived by our SGIM members? In this column, I discuss the evolution of my thinking and new proposed recommendations from SGIM Council regarding our elections process.

At the GLEAM conference, we were asked to consider several questions:

  • What are the pros and cons of popular elections?
  • What happens to those who lose a popular election?
  • What is the impact on that candidate?
  • If you were not familiar with any candidates, how would you know who to vote for?
  • How can you ensure the board is comprised of the necessary competencies, diversity, experience, and backgrounds to advance strategy?

The ensuing discussions with other medical society leaders across the country played a crucial role in reshaping my thinking. My first-time service on the SGIM nominations committee (a required role of the president-elect) provided additional insights that further informed my current belief that we should consider a change. Here’s why.

No one would lose.

Uncontested elections are recommended as a leading practice for election methodology due to the potential for unselected members to become disengaged from overall involvement with the organization.1 I remember the first time I ran for SGIM Council. I lost… and it didn’t feel great. While I never considered leaving the organization, I did think carefully about whether to try again. Being nominated to a ballot for a national organization is no small task. It follows years of volunteer commitment, dedication, and service to the organization. It could feel like a slap in the face to lose—especially if it happens more than once. SGIM staff confirmed that some members lost elections and subsequently became disengaged or even left the organization. Of course, we want to keep our membership, but it is difficult to lose members who have been engaged enough to be considered for leadership positions. Ultimately, as we try to achieve our goal to grow and ensure organizational health, the impact of losing active members who do not win in popular elections is too great.

It would be easier to slate a ballot in the setting of fewer volunteers.

SGIM has always had an open call for nominations allowing unlimited submissions, including self-nominations. However, the number of people raising their hand to serve in leadership roles has declined. Beyond SGIM, decreasing volunteerism is a trend that has been observed nationwide,2 with almost one-third of executives (32%) and more than half of board chairs (53%) reporting difficulty finding people to serve on the board.3 These trends may have been exacerbated by the pandemic, when many examined and modified their priorities, often shifting their focus towards personal wellness and self-care. For SGIM, this dearth of volunteerism is most evident at the regional level, where we have already, if unintentionally, piloted uncontested elections due to limited volunteers.

We would be better positioned to strategically establish a Council with the needed diversity, competencies, and experiences to reflect SGIM.

That access to leadership service could be expanded via uncontested elections initially seemed counterintuitive. In fact, organizations that intentionally define and then recruit the desired diversity, skills, connections, and experiences that the board needs may find this easier.3 The SGIM nominations committee considers several factors during the nomination process including member’s region, academic focus, diversity, and prior work within the organization among other things. The committee also considers the current board composition to understand gaps and assure appropriate representation across our organization. However, because getting on the ballot does not guarantee election, an uncontested ballot would provide additional assurance that the SGIM Council has desired skills and representation.

Compare the scenario of a candidate from an organization or academic institution with fewer SGIM members to the candidate from an organization or academic institution with more SGIM members who might have a significant advantage in obtaining votes. This is further complicated by the fact that, on average, only about 20% of SGIM members vote in our annual elections. Even among SGIM voters it is possible that you may be unfamiliar with the people on the ballot, limiting an informed decision. An uncontested ballot could give us an opportunity to identify and grow the organization with active and engaged members from smaller institutions or even those that are newer to SGIM.

Since that initial GLEAM meeting, we have had several opportunities to engage stakeholders in this discussion across the organization—at the Council retreat, regional meetings, and commission and committee meetings. We found members have initial questions but are open to the discussion.

So, what is the plan? First, no final decision has been made. Our leadership team will continue to engage stakeholders in multiple forums—through meetings, SGIM Forum, and GIMConnect—before we finalize any changes. The goal is to be transparent about the factors that are driving our thoughts around this potential change. Next, at our annual retreat, we will discuss a proactive plan for engagement and action. This includes discussing strategies to increase voter outreach, engagement, and participation. Importantly, we also plan to develop a proactive and transparent SGIM Leadership Pathway Program to establish clear trajectories toward and support for organizational leadership.

Finally, it does not have to be all or nothing. We could start with a pilot that has a partial uncontested slate. For example, we continue with a popular election for our president while having an uncontested slate for secretary. Should we continue with popular elections in any form, we will need to intentionally consider ongoing opportunities for engagement for those members who are not selected.

Regardless, there are several things that will not change. SGIM members and potential candidates will continue to have an opportunity to be nominated. Nominated candidates will continue to present their platforms so that members can evaluate their qualifications and vision for the organization.

Reflecting on my personal thought evolution, I believe that a move to an uncontested election format may streamline the election process, reduce member loss, and facilitate our commitment to diversity and broad member engagement, ensuring a vibrant and sustainable future for SGIM. SGIM Council is committed to building on these early conversations to further strengthen the governance and leadership within SGIM, ultimately benefiting our members and advancing our mission.

We should not be afraid of change.


  1. Engle M, Brown W. (2019). Recruit the Right Board: Proven Processes for Selecting Critical Competencies. ASAE. https://www.asaecenter.org/publications/113311-recruit-the-right-board-proven-processes-for-selecting-critical-competencies-pdf. ISBN-13: 978-0-88034-402-9.
  2. Heim J. Nonprofits need more help than ever. Why aren’t Americans volunteering? Washington Post. https://www.washingtonpost.com/dc-md-va/2023/12/09/volunteer-decline-homeless-pandemic/. Published December 9, 2023. Updated December 11, 2023. Accessed May 15, 2024.
  3. Leading with Intent: BoardSource Index of Nonprofit Board Practices. https://boardsource.org/wp-content/uploads/2021/06/2021-Leading-with-Intent-Report.pdf. Accessed May 15, 2024.