Governance by the few? The risks of piecemeal change at the OMA

How will members view a shift to piecemeal governance changes at the OMA?As the Ontario Medical Association (OMA) annual general meeting (AGM) in Ottawa on May 7 approaches, it will be important to see how those in attendance interpret and vote on motions that would alter board director eligibility and governance on behalf of Ontario’s physicians and approximately 45,000 OMA members.Having served in multiple leadership roles at the OMA over the past 20 years, including seven years on the board of directors, I have participated in several governance reviews. Most recently, the comprehensive GT2020 review led to the current governance structure.Historically, governance changes at the OMA have followed extensive consultation with physician leaders and stakeholders, with final decisions ratified through broad member engagement or representative bodies such as general council.In contrast, the proposals before this AGM raise questions about whether we are now moving toward piecemeal governance change, rather than deliberate, system-wide review.From the motions being proposed, concerns appear to focus on: the role and voting rights of non-physician board directorseligibility criteria for board service, including past presidentsthe removal or reduction of structured candidate vettingRegardless of one’s position on these issues, several fundamental questions arise:Why are significant governance decisions being made at an AGM where, at best, less than 3% of members will participate—and where proxy voting is not available? Why are these changes proceeding outside of the broader consultation processes involving sections, districts, MIGs and other physician leadership bodies?What are the implications of making structural changes to board There are, without question, legitimate issues worth addressing:Board–management dynamics: The transition of the board from an operational to a strategic body remains a work in progress, particularly with the evolution of senior management structures.Role of public (non-physician) directors: Introduced under the current model, their recruitment, role and contribution warrant thoughtful evaluation—but within a comprehensive review, not in isolation.Board renewal and continuity: Prior to 2016, there were strong concerns about overly long tenures limiting renewal. The current discussion appears to revisit this tension—balancing experience, continuity and the need for fresh perspectives.Skills-based governance vs. open elections: There is an inherent tension between building a strategic, skills-based board and a purely open electoral process without structured assessment of competencies.These are not trivial questions. They are core governance design issues that affect the effectiveness, legitimacy, and future direction of the organization.The OMA already has established structures—such as general council and the priority and leadership group (PLG)—that are well positioned to support broad, inclusive and deliberate consultation on these matters.It is also important to recognize that a significant proportion of the membership—likely the majority—is either unaware of these governance issues or not actively engaged in them, despite mandatory membership.Governance changes of this magnitude benefit from transparency, engagement and system-level thinking, rather than decisions made in a constrained forum with limited participation.It is often said that democracy dies in darkness.The question now is not only what decisions will be made in Ottawa—but how those decisions will be perceived by the broader membership and what that will mean for the OMA going forward.Dr. Hirotaka Yamashiro is a Toronto pediatrician.

Governance by the few? The risks of piecemeal change at the OMA

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