The American Medical Association lost more than 3,000 members last year, a financial and organizational setback that left some observers pondering the continued relevance of the 153-year-old institution.
Still the nation's largest and most influential doctors' group, the Chicago-based AMA's membership dropped to 290,357, representing just 32% of America's 901,147 physicians. And nearly 82,000 of those members are either medical students or residents lured by deeply discounted annual dues.
The sudden drop comes despite an aggressive and highly public pitch for new members by the group's top administrator, E. Ratcliffe "Andy" Anderson, M.D., who vowed after taking the job in June 1998 to bring the "zeal of a missionary" to increase membership. His attempt to transfer that sense of mission to other members, challenging each to recruit one new AMA disciple, apparently failed to move the ranks.
Despite the numbers, AMA officials express confidence in the organization's ability to continue as the leading advocacy group for American physicians. One influential member of the board also expressed unequivocal support for Anderson, who earned about $650,000 in total compensation last year.
"We just renewed his contract," said Donald Palmisano, a New Orleans surgeon and a member of the AMA board of trustees. "We're concerned that membership is not rising rapidly. But it takes a while. The board and (Anderson) have set about a plan to do that. We have to see if this bears fruit. Membership is an issue that's on the front burner for everybody."
An AMA advisory committee is mulling several proposed membership models, including one radical approach that would confer AMA membership on any member of a related state medical group or specialty society. A final report will be presented to the 494-member AMA House of Delegates by the end of the year, Palmisano said.
"One of the things we have to do is expand benefits and other services to appeal to younger physicians. I really believe it's an exciting time for the AMA," he said.
Anderson was unavailable for comment despite repeated requests for an interview on membership trends.
Some blame the flagging membership on a series of key management and public-relations missteps by the AMA during the past few years, including the Sunbeam Corp. product-endorsement fiasco and the controversial dismissal of the highly respected George Lundberg, M.D., as the top editor of the Journal of the American Medical Association.
"I think they've lost the battle in terms of public relations," said Jerald Schenken, a retired pathologist from Omaha, Neb., who served on the AMA board from 1985 to 1994 and often has been critical of the organization. "They've lost their place in front (on issues affecting doctors). If they are to be leaders, they've got to find a way to represent American doctors."
The new membership numbers, the lowest in five years, resulted in a loss of more than $4 million in revenue, the AMA said. In 1999, when membership rose about 3,000 to 293,695, largely the result of discounts provided to medical students and residents, the organization lost about $4.8 million in membership revenue.
Last year, Palmisano said, medical students were offered annual AMA dues of just $20 per year or $68 for four years-a fraction of the normal annual dues of $420. Residents paid $45 per year or $120 for three years, he said.
"Young doctors don't even know about the AMA," Schenken said. "(The AMA) is doing a pretty good job in medical schools, with those big discounts. But there's a big jump from students and residents paying $20 or $30 and young doctors, with $140,000 worth of school debts, paying $420 a year."
The AMA also is slowly losing its total market share-a key indicator of its relevance and political influence. Many doctors, including the younger ones, are reluctant to pay the steep annual dues, preferring instead to join specialty societies and state medical groups that they feel are often better equipped to address precise concerns and narrow issues.
Palmisano said the AMA also is toying with the notion of reducing membership fees. One innovative new twist: lifetime memberships, with the total cost based on the member's age. In fact, the 61-year-old Palmisano himself recently wrote a check for $1,590 for a lifetime membership, which he considers a good deal for a long continued tenure.
Only three state medical societies now automatically combine membership in the AMA-Delaware, Mississippi and Oklahoma. When Illinois ended that requirement last year, it cost the AMA about 1,000 members, according to a spokeswoman for the 16,000-member state society.