The Senate manages the business and affairs of The Colleges of Medicine of South Africa and is constituted as follows:

1. The immediate past president of the CMSA (retiring president), the president, elected members and co-opted officers and/or members, who will serve the needs of the Senate, appointed by the elected members of the Senate.
2. The large constituent Colleges, namely Anaesthetists, Family Practitioners, Obstetricians and Gynaecologists, Paediatricians, Physicians and Surgeons (General) are represented by so many persons as are determined by Senate, elected by the Councils of their Colleges. Each of these representatives have two votes at Senate meetings.
3. The small constituent Colleges, namely Cardiothoracic Surgeons, Dentistry, Dermatologists, Emergency Medicine, Forensic Pathologists, Maxillo-Facial and Oral Surgeons, Neurologists, Neurosurgeons, Nuclear Physicians, Ophthalmologists, Orthopaedic Surgeons, Otorhinolaryngologists, Pathologists, Plastic Surgeons, Psychiatrists, Public Health Medicine, Radiation Oncologists, Radiologists and Urologists are also represented by so many persons as are determined by Senate, elected by the Councils of their Colleges but each of these representatives have one vote at Senate meetings.
4. The Diplomates, who do not hold a specialist qualification, are represented by so many persons as are determined by Senate, but with the proviso that no more than one Diplomate so elected belong to a particular constituent College. Each of the Diplomate representatives have one vote at Senate meetings.

The Senate may appoint such observers as it may from time to time deem appropriate, but observers have no voting rights at Senate meetings.