After months of surveys, studies and focus groups, the American Medical Association's latest attempt to reverse a decades-long decline in membership boils down to a simple strategy: Adopt a more "member-centered" approach.
The structure of the initiative, unveiled during the organization's midyear meeting in Honolulu last month, involves proposals such as streamlining member benefits, teaming with state and specialty societies and ensuring that dues-paying doctors feel involved in shaping the AMA's agenda and policy.
The eight-page strategic plan is designed to stanch the decline of dues revenue at the AMA, which has lost almost 43,700 members-a drop of nearly 15%-in the last four years.
With a current membership of 250,000, the AMA represents 26% of doctors and medical students, and only one of every five active doctors in America. The good news: A decrease of 3.8% in 2003 was about half the decline in the previous year.
"We don't take a lot of solace in that," said Cecil Wilson, an internist from Winter Park, Fla., and a member of the AMA's board of trustees who is helping to spearhead the membership campaign. "But it is encouraging to say that there is at least the start of a turnaround. We are not absolutely sure what caused it. We would like to hope that some of the positive things that have happened in Congress have made a difference, particularly Medicare legislation."
Membership dues, which represent about 17% of the AMA's total revenue, are expected to drop by about $3.9 million in 2003 and to fall by another $2.7 million in 2004, according to the organization's annual report. Despite the continued plunge in membership revenue, the AMA's fiscal outlook remains bright, with projections of an $8.5 million operating profit in 2003 and a $4.1 million operating profit for 2004.
The AMA, struggling with membership declines for much of the past 20 years, spent at least $1.7 million in the last two years to study membership models and organizational structures. Last summer, the AMA's House of Delegates rejected a plan to transform the AMA into an umbrella organization composed of specialty societies and state medical associations after those independent groups resisted turning over part of their members' dues as a tithe to help support the AMA.
The AMA expects to spend about $5 million this year to fund many of the membership initiatives contained in the report, including a broad effort to develop closer working collaborations in marketing campaigns with specialty societies and state medical organizations. These groups have cannibalized the AMA, attracting younger doctors who feel closer links to local groups or specialty societies.
With about 60% of its members entering through state associations, the AMA's future cooperation and collaboration with state associations is vital to any membership turnaround, AMA officials said.
"This initiative is very important to see how the AMA can collaborate with specialty societies and state medical associations," said Calvin Sia, a pediatrician in Honolulu who has worked on AMA membership issues as a delegate representing the American Academy of Pediatrics. "The key is how do we get a feeling of togetherness, of trust? It's going to be very important. Whether they do this realistically, or just on paper, is something we'll have to see."
The AAP has approximately 55,000 members, but only about 6,000 also belong to the AMA, Sia said. An AMA survey in June 2001 found that only about 18,100 of the 93,100 members of the American Academy of Family Physicians also paid dues to the AMA at that time. That percentage is fairly typical of specialty societies, whose narrow, focused interests appeal to prospective members at the expense of the AMA's more broad-based national agenda.
"So far, the specialty societies and AMA working together hasn't been very successful," Sia said, adding that the plan's emphasis on closer cooperation with specialty societies is a "good sign."
Though the report includes few specific or detailed programs to combat the membership slide, it suggests a general emphasis on "co-marketing opportunities" between the AMA, state organizations and national specialty societies. "The AMA has excellent relationships with a number of national specialty societies, but has minimal co-marketing activity," the report said. It adds that the strategy must highlight residents as they enter specialty training, a point at which many of these young doctors, accustomed to paying just a fraction of regular annual dues, drop their discounted AMA memberships and join specialty societies. Holding on to those doctors is a key to the AMA's modest goal of a 1% to 2% annual increase in membership for the next three to five years.
The most dramatic part of the new plan is what is not included in the study. Despite pressure from some influential state medical-society officials to reduce the standard $420 annual membership fee to as little as $100 to attract a larger market share, the AMA has closed the door on that option for the foreseeable future, deciding that any substantial decrease could result in a finan-cial disaster.
For now, the AMA will continue to provide some discounts to large group practices that join en masse, like the Henry Ford Medical Group in Detroit, whose 800-plus doctors each received almost a 30% discount on the regular membership fee earlier this year. Wilson said discounts will be offered to group practices, not individual members, because doctors who join groups have an expectation that management will provide at least some funding for their association memberships.
"As we looked at things we've tried in the past, cutting dues (across the board) did not make a difference," Wilson said. "The observation has been that it's a very attractive thing to do to help increase membership, but it's also very risky. If you cut dues significantly and it doesn't work, there's no way to go back."
He said years of research has led to the conclusion that "there is clearly no silver bullet to suggest that there is one single thing we can do to solve this problem in membership difficulties."
"People are not joining membership organizations of any kind like they were in the past," he said. "We must bring a great deal of energy in making the AMA a member-centered organization, and focusing on the member."