February 2003 Bulletin

Getting out the vote

How do the orthopaedists sitting on the Academy’s Board of Directors (BOD) get there? Research conducted by the Academy’s marketing research staff suggests many of you have a fuzzy understanding of the process. And, that lack of awareness has led to a decline in voting for leadership nominations.

Fellows vote for six members of the Nominating Committee who develop a slate of candidates for the next year’s Board of Directors. At the Annual Meeting, Fellows attending the Business Meeting vote for these candidates who will then serve on the Board.

A four-phase research project regarding voting patterns ensued after the Board discovered a startling fact: the number of Fellows voting for the Nominating Committee dropped from 40 percent of all eligible Fellows in Nominating Committee Year 1993 to 28 percent in Year 2002.¹

Marketing research staff conducted two focus groups of Fellows at the 2002 Annual Meeting. This research was followed by 15 interviews with participants in two Orthopaedic Learning Center courses held in April and May. Fellows provided feedback in these qualitative research studies.

Fellows vote for Nominating Committee candidates because they feel it is their duty to be involved in Academy activities.

Fellows do not vote because:

• They are confused by the process.
• This activity is of relatively little importance to them.
• This activity takes time away from practice and family.
• They are not familiar with the candidates.
• They don’t know why they should vote.
• Their office staffs mistake the ballot for "junk mail."

Armed with this information, staff conducted a survey of active Fellows to measure the extent to which these perceptions exist within the membership. In addition, staff developed demographic profiles of voters and non-voters in the most recent election for the 2003 Nominating Committee as well as a statistical analysis to determine the primary factors contributing to likelihood to vote.

At the end of October 2002, approximately a month after the conclusion of the 2003 Nominating Committee election, a random sample of 3,000 active Fellows received the survey. By cut-off on November 15, 2002, 703 Fellows had mailed or faxed back completed surveys for a 23 percent response rate. Generalizing their responses to a total of 15,881 Fellows, the maximum error range is +3.6 percentage points at the 95 percent confidence interval.

An analysis of the demographics of voters and non-voters in the 2003 Nominating Committee election revealed statistically significant differences. The analysis indicates that voters are more likely to be:²

• older (33 percent were age 60 or older)
• female (4 percent of voters vs. 3 percent of both non-voters and all Fellows)
• specialists (33 percent vs. 30 percent of non-voters)
• academicians (12 percent vs. 6 percent of non-voters and 9 percent of all Fellows).

Among the reasons fellows gave for not voting, qualitative research suggested some Fellows did not know why their vote was important. Based on this preliminary information the Academy forwarded a letter from the Academy president to a random sample of 2,500 active Fellows in advance of the election for the 2003 Nominating Committee. The letter indicated a ballot would be forthcoming and provided information on the role of the Nominating Committee and the importance of participating in the election. A statistical model was developed using the demographics of these voters and non-voters as well as receipt/non-receipt of the President’s voting encouragement letter.

Age and practice setting emerged as the primary contributing factors to likelihood to vote. Specifically, the demographic categories within these contributing factors with the greatest propensity toward voting are Fellows age 60 and older and those who practice primarily in an academic setting (academicians).

Respondents participated in the 2003 Nominating Committee election because they felt a relationship with the Academy and/or a relationship with the candidates. Their primary reason for voting was duty as an Academy member (85 percent). The opportunity to have input into Academy activities (55 percent) and loyalty to the Academy (43 percent further evidenced the impact of voters’ relationships with the Academy.

Candidate recognition (43 percent) and personal knowledge of the candidates (35 percent) were also influential in the voting decision. Personal knowledge of candidates was significantly more likely among academicians (57 percent).

Why respondents vote

While only 4 percent of voters reported that receiving a letter from the Academy president requesting their participation was a motivating factor, there is evidence that the letter may have had an impact on Fellows predisposed not to vote. Nearly 6 in 10 (57 percent) respondents who did not receive the letter also did not vote. However, only 33 percent of respondents who did receive the letter did not vote. These statistically significant differences imply that the presidential letter may have influenced positive voting behavior among a portion of fellows otherwise not inclined to vote.

Non-voting respondents provided diverse reasons for not voting but they chiefly revolved around a perceived lack of connection or representation. Not knowing the candidates (62 percent) or their positions on issues of importance to the respondents (46 percent) were the primary reasons given for not voting.

Non-voters also felt a lack of relationship with, and representation in, the Academy. Approximately one in five reported they feel disconnected from the Academy (22 percent or that it makes no difference who gets elected (18 percent). Approximately 1 in 10 (11 percent) believed the candidates reflected only academic interests.

Beyond the relationship issues non-voters also reported that their ballots got lost on their desks (19 percent) or they forgot to vote (11 percent). The Nominating Committee was not important to 17 percent of non-voters and 17 percent also did not understand the process. Time away from family (8 percent) and the practice (8 percent) were issues for other non-voters.

In general, both voters and non-voters agreed on the importance of specific characteristics of a well-developed slate of candidates for the Nominating Committee. The most important factor of any tested proved to be a balance of academicians and private practice orthopaedists among the slate of candidates (top-2-box rating of 81 percent)³. Other notable slate characteristics were geographic representation (56 percent) and candidates with a history of Academy involvement (40 percent). The latter was decidedly of less importance to non-voters (32 percent).

Approximately one in ten respondents perceived candidate age (12 percent), minority status (11 percent, female representation (11 percent) and AAOS course faculty service (10 percent) as factors in the development of a slate of candidates.

Top-2-Box Importance Ratings*

Underlined statistics are significantly different from bolded statistics across categories.

*Top-2-box ratings of "5" and "4" on a 5-point scale where "5" means "extremely important" and "1" means "not at all important."

While respondents generally agreed on the characteristics of a candidate slate, they exhibited less uniformity in rating the importance of specific factors in candidate selection. The most important consideration in candidate selection for all respondents was knowledge of a candidate’s position on the future of the Academy (70%). However, the table below suggests that, overall, non-voters were more interested in having substantive information about a candidate. Knowing where a candidate stands on real-world issues that affect their practices—especially reimbursement and maintenance of certification—proved more important to the candidate selection process than a list of CV credits. While the Board of Directors provides the ultimate leadership for the Academy, the perception is like-nominates-like; non-voters are clearly looking for a Nominating Committee that will clone itself.

Respondents who practice primarily in an academic setting differed significantly from respondents as a whole in their perceptions of the relative importance of many candidate attributes. Of significantly more importance to academicians were:

• personal acquaintance with the candidate (65 percent)
• previous Academy activities (67 percnt)
• professional appointments (58 percent)
• academic appointments (54 percent)
• other medical society memberships (30 percent).

Beyond personal knowledge of the candidate, these findings suggest that academicians place somewhat more importance than respondents in general on "resume" items, i.e., what the candidate has done rather than on where he/she stands.

The Academy is interested in improving the Nominating Committee election process to insure fellow participation and respondents offered suggestions in response to an open-ended question. The most frequently occurring suggestions for improvement involved providing more information on the candidates (15 percent) and offering more diverse representation in the slate of candidates (10 percent).

Although 6 percent reported the current process is fine as it is, only 3 percent of non-voters and 2 percentof respondents under age 45 agreed with this sentiment.

Beyond personal knowledge of the candidate, these findings suggest that academicians place somewhat more importance than respondents in general on "resume" items, i.e., what the candidate has done rather than on where he/she stands.

The findings of all four phases of the Nominating Committee voting research were presented to the Board of Directors at their December, 2002 meeting.

1. The Nominating Committee Year refers to the calendar year in which the Nominating Committee serves. For example, fellows voted in 2001 for candidates to serve in Nominating Committee Year 2002.
2. Demographic profiling of voters and non-voters in the 2003 Nominating Committee election included all eligible Fellows: active, emeritus and inactive.
3. Top-2-box ratings refer to importance ratings of candidate characteristics; ratings of "5" and "4" on a 5-point scale where "5" means "extremely important" and "1" means "not at all important." Percentages presented in the discussion of slate development and candidate selection are all top-2-box ratings.