After scrapping plans for a radical reorganization last week, the American Medical Association is going back to the drawing board to try to solve one of its most enduring and perplexing problems: a plunge in membership.
The AMA's House of Delegates met for six days in Chicago last week for its annual policy-making conference, addressing a dizzying array of issues that included patient "shadowing," boutique medicine, bioterrorism training and therapeutic cloning.
But one vital, overarching issue-the AMA's flagging membership numbers-took center stage for the 541-member governing board, which shelved a controversial plan to transform the doctors' group into an "umbrella organization" devoid of individual members. Despite losing more than 18,000 members and $4.3 million in dues last year, the governing board overwhelmingly opted for the status quo, voting to continue as an organization based on individual members who pay annual dues of up to $420 per year.
Now the AMA, which has lost a total of about 30,000 members since late 2001, must find ways to renew interest in an organization that many doctors say has become an irrelevant anachronism.
"It's a difficult problem and we haven't found the solution, that's obvious," said William Plested, a member of the AMA board of trustees who helped direct a yearlong, $1.1 million initiative to study a variety of different membership models and organizational structures.
The AMA announced last week that it would hold a "membership retreat" in July, convening top leaders from across the country for a brainstorming session designed to develop a plan to entice reluctant physicians to pay their dues-literally and figuratively. Leaders like Plested, a cardiovascular surgeon who was elevated to the position of board chairman at the annual meeting, say they are confident that creative methods to boost membership will bubble up from that retreat.
"We just don't have the answers now," he conceded. "We aren't going into that summit with any preconceived ideas. We're going to come out with a plan. Stayed tuned-we'll have the answer."
Still the largest doctors' group in America, the AMA has approximately 260,000 members-or about 27% of all U.S. physicians. Nearly half of those members are students, residents, retirees or exempt members who pay far less than full dues (Students can purchase a four-year membership for $17 a year).
As the AMA prepares for its big membership summit, a similar effort is being planned by leaders of specialty societies and state medical groups, the very organizations that have robbed the AMA of many of its members by offering better-focused or more tangible services.
Michael Williams, a neurologist from Baltimore, expressed relief that the AMA finally has made a decision on the membership model after another long, costly internal debate about reorganization-the third such undertaking in the last decade.
"This organization has been going around and around and around for years," he said. "We've finally made a decision on the membership model at this meeting. Now we've got to go back and encourage other doctors to join the AMA."
Williams said he would start hammering home his membership message at the next board meeting of the American Academy of Neurology, whose 9,400 members include only about 2,800 who also pay dues to the Chicago-based AMA.
That disparity is not unique among either specialty societies or state medical associations. The largest state organization, the Texas Medical Association, has about 38,130 members, but only approximately 18,200, or about 48%, are also members of the AMA. In California, about 23,000 of the 34,000 members of the California Medical Association are dual members-the largest number of any of the 50 states but still far below expectations, said CEO Jack Lewin, a physician who vowed to adopt a get-tough approach to doctors who don't want to pay the freight.
"There are a lot of doctors out there enjoying the benefits of the AMA without paying for them," Lewin said, referring to the general advocacy efforts the organization mounts on issues like federal reimbursement levels and liability reform efforts. "There are freeloaders out there. They need to pay their fair share."
Lewin said he would lobby for a progressive but dramatic reduction in membership dues at the AMA. In several years, Lewin said, he hopes that annual dues will fall to around $100 per year-a figure he believes will attract enough new members to generate almost as much dues revenue as the association currently takes in.
"If the AMA can get the dues down, they'll see three or four times as many doctors joining," Lewin said.
By endorsing the individual membership model, the House of Delegates rejected a once-popular plan to transform the AMA into an "organization of organizations" that would have been partially funded through a portion of the annual dues from the 170 specialty groups and state medical associations that now comprise the governing body.
That plan was doomed by turf wars, financial issues and a concern that such an affiliation with an umbrella group like the AMA would force specialty societies to dismantle their political action committees.
The House of Delegates, which meets twice a year, also voted to streamline the AMA's business operations and reduce governance costs. Most members involved in the yearlong organizational study favored a reduction of at least $5 million a year in those costs.