Questionnaire for the Position of AMA Delegate and AMA Alternate Delegate

Questionnaire for the Position of AMA Delegate and AMA Alternate Delegate
Please record your answers in the box below each question, in 400 words or less. In an effort to promote transparency in the Nominating Committee process, the Society posts completed questionnaires in the “member only” section of the Society’s website. Therefore, by completing and submitting this questionnaire you authorize the Society to post it on the website for review by Society members.

Position Description:

AMA Delegates and Alternate Delegates innovate and collaborate to advance changes in laws and policies at the national level to benefit physicians across the country, including in Wisconsin. AMA Delegates/Alternate Delegates:
- attend WisMed, AMA and regional meetings,
- support campaigns to elect Delegates to AMA committees,
- serve on special committees, and
- review resolutions and policy positions to advance the interests of Wisconsin physicians and improve the practice of medicine throughout the United States.
While the amount of time spent on WisMed activities will vary, candidates should plan to spend 17–20 days per year on various meetings and other tasks. Some of the activities might occur on weekends.
Name*

First NameLast Name
Email*
example@example.com
District*
YesNo
Question 2: What interested you in serving in this role? *

0/500
Question 3: Why do you believe this position is important to the Wisconsin Medical Society? *

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Question 4: What are the most important issues facing Wisconsin physicians that require action at the national level? *

0/500
Question 5: What are the biggest challenges facing the AMA and how should the organization evolve to meet new challenges in the health care environment? *

0/500
Question 6: If you disagreed with or opposed a resolution passed by the Society that included a provision to “also introduce a similar resolution to the AMA,” how would you proceed? *

0/500
Question 7: Describe a situation in which you used both innovation and collaboration to arrive at a solution. How would you apply your experience to this role?*

0/500
Question 8: Describe your experience communicating with other physicians, groups and staff. What would your approach to communication be in this role? *

0/500
In the past ten (10) years, have your hospital privileges and/or medical license been limited, revoked or suspended? If so, please describe in detail the basis for the action. Additionally, have you ever been convicted of a felony offense? If so, please describe the nature and date of the conviction as well as the state in which the conviction occurred.*

0/500
I am available January 24Other
I affirm that the information contained in this questionnaire is true and correct. Signature*

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All candidates must submit a curriculum vitae not to exceed three pages, a cover letter no longer than one page, a completed candidate questionnaire for the office the candidate is seeking and a completed Disclosure of Significant Affiliations (conflict of interest) form, found https://form.jotform.com/221634386278160.

Please upload your CV and Cover Letter below.
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