At the American Medical Association, boosting membership is now job one, said new Executive Vice President P. John Seward, M.D.
"Your membership is the reason for your being," Seward said in an interview with MODERN HEALTHCARE. That's why he and the board of trustees are trying to reassert the importance of the member at the heart of everything the AMA does.
Despite its high visibility and national clout, membership in the nation's largest physician association is trailing growth in the profession itself.
Consider that in 1962, the AMA counted 82.1% of the country's 232,317 physicians in its ranks. By the end of 1995, it had 260,814 members out of a physician population of 596,851, excluding medical students. That's a 43.6% market share.
The reasons for this structural decline are varied and complex. They include economic changes in practice organization, a failure to attract young doctors, competition from specialty societies, and a federated membership structure that puts the national organization at a disadvantage vs. state and local medical societies.
About 35% of the AMA's revenues come from dues. In 1993, dues brought in $68.1 million of a $186.7 million budget. By 1995, the budget had risen to $199.2 million, but dues revenues held at $71.2 million, virtually unchanged from 1994.
Dues have held constant at $420 a year for four years. The board does not foresee any increase in dues in the near future. "It would be neat to even decrease dues and keep the same services," Seward said.
Dues-as-revenues isn't motivating the current drive. Rather, the association fears it could lose some of its clout if its membership drops below a certain proportion of the entire physician population. It's hard to carry on as the profession's self-appointed guardian of standards, ethics and practices if the AMA represents only an increasingly smaller portion of them.
"We must focus on value," said Peter Lauer, AMA vice president for membership. "We'll be doing much more aggressive outreach to physicians, and (we'll) show the AMA is changing with the times."
To help make the point, the AMA's weekly newspaper, inaugurated a new feature called "AMA for YOU" that stresses what members get. Headlines such as "Tough advocacy delivers results: Congress responds after AMA physicians object to unfair fraud and abuse proposal" spotlight the indirect benefits to all physicians of the AMA's lobbying.
The page also quotes an editorial from the Cleveland Plain Dealer lauding the AMA for its leadership against physician-assisted suicide. In the upper corner the page lists the (800) number to sign up as a new member.
To be on the safe side, the association is creating a sales force of 10 to canvas for new members, and each delegate to the House of Delegates is supposed to sign up five new members in the next six months.
A few years ago, the AMA launched an aggressive membership drive, M.D. 2000, that didn't come to fruition. Just after it started, the Clinton administration unveiled its healthcare reform effort. The association shifted resources out of the membership drive and into informing its members about legislative developments and lobbying. This time, it plans to stick with the program.
As to why physicians don't join, Seward cited four main reasons.
First, more and more doctors practice in large groups. The practice administrator may be in charge of association memberships, and that person doesn't sign the doctors up with the AMA.
"To him, it's not a value," Seward said. "We need our physicians to get out there and say, `Wait a minute, it's of value to us!'*"
The AMA is also concerned with physician "freeloaders," particularly in regard to what it calls its "Washington advocacy." Those doctors don't get a bill for that, but they get the value, Seward said.
Second, the AMA is increasingly having trouble retaining young physicians. For reasons not entirely clear, the AMA enjoys very high membership among medical students and residents, but they drop their memberships when they move into private practice.
Of course, the practice environment today is completely different from 30 years ago. Young doctors enter practice burdened with debt. At the same time, physician incomes are declining and other expenses are growing. The AMA membership can slide lower in the pile of financial obligations.
Seward brushed aside any suggestion that the AMA's social and economic conservatism might be unappealing to younger doctors. "An old paradigm that has no significance," he replied. Even though AMPAC's contributions to congressional candidates flow to Republicans by a 3-to-1 margin over Democrats, Seward said donations are oriented toward "programs, not people. It's very bipartisan."
Third, membership in specialty societies is growing while the AMA's stagnates. That's because, in Seward's view, they have "hooks" to attract members. In many cases to keep board certification, a physician must join the specialty society. Continuing medical education is often organized through specialty societies, which publish their own periodicals and hold meetings. It gives the doctor a more direct tie to that group than to the AMA, which has to be a big-tent organization and represent all the disparate interests of the profession.
The global scope of the AMA is, ironically, one of its liabilities in retaining members, Seward said. "When I go out and talk to physicians, they say, `Gee, I didn't know the AMA did that.' It's very frustrating."
Fourth, state and local medical societies, the AMA feels, sometimes don't promote the advantages of AMA membership as hard as they should.
That relationship is complicated by the AMA's reliance on the state and local groups to collect dues and forward them to headquarters in Chicago. "If you were going to design a system from a business standpoint, this is not the way you'd do it," Seward said. "Your dues collection comes from entities you have absolutely no control over."
To streamline these functions, the AMA's House of Delegates has commissioned a federation coordination team to eliminate redundancies and competition among the counties, states, specialty societies and the national AMA.