1.Name

2.Email Address

3.Phone Number

4.Business Name/Practice

5.Title

6.Practice-Specific Experience & Perspective (Choose all that apply)

Employed/Multihospital/System Setting - involvement in system-level decisions, leadership roles or strategic relationships

Private Practice - business management, financial accountability, operations, or payer strategy

Academic Medicine - teaching, research, mentoring or engagement with trainees/early-career physicians

Public Health/Community - population health, community-based care, rural/urban health challenges

Not Applicable

7.Please describe your experience in any of the above areas and how it would inform your contribution to the Board.

8.How has this experience given you insight into the challenges facing physicians today?

9.Governance & Board Effectiveness
Describe any experience you have serving on boards or committees. What attributes contribute to being an active, constructive board member?

10.Organizational Change & Strategic Decision Making Under Pressure
How do you approach these situations? Describe a time when you helped make a significant strategic decision in an organization facing financial pressure, declining revenue or major disruption. What was your role, what options were considered and what was the outcome?

11.Financial Understanding & Business Experience
Describe your experience with financial oversight or business decision-making. Have you been involved in budgeting, evaluating sustainability, managing a practice/business, revenue growth, profitability or addressing financial challenges?

12.Membership Value, Growth & Engagement
Membership organizations must continuously demonstrate value. What experience have you had with membership organizations (aside from MSMS)? How did those organizations demonstrate value to their members?

13.Innovation & Future of Medicine
Have you ever been in a leadership position in which you introduced new technology or innovative practices? If so, expand on this experience. How do you see these shaping the future of physician organizations?

14.Advocacy & Policy Perspective
What experience do you have with healthcare advocacy, public policy or working with governmental or regulatory bodies? How should an organization evaluate the effectiveness of advocacy efforts?

15.Contribution & Unique Perspective
What do you see as your most valuable contribution to the MSMS Board should you be elected?

16.Mission & Vision
What do you see as the mission of MSMS? What is your vision for how that can best be achieved?

17.Fiduciary Responsibility
MSMS Board of Directors duties include a Duty of Loyalty. To make decisions based exclusively on what the person believes to be in the best interests of MSMS. No director should vote or take a position on an MSMS issue based on personal interests or on the interests of another organization. If elected, will you be able to fulfill this duty?

Yes

No