Does Association Membership Still Make Sense?

Private practice doctor Susan Zeveloff credits her medical association for giving her the resources to ace her internal medicine board exams and feel confident in her leadership role.

But in the 20 or so years that have followed, her feelings of gratitude toward that association have lessened considerably. Her first complaint: The association's priorities are not in sync with her own - or those of other physicians.

"I feel like the educational focus is now wholly devoted to passing the board," says Zeveloff. "Since docs have to recertify every 10 years since 1990, the [association] is a 'board mill.'"

Not only that, says Zeveloff, but the association was "less than responsive" when she really needed them several years ago, when she was "beset" with more than one frivolous malpractice lawsuit, to address the issue of tort reform on a larger scale.

"The only honest way to attract primary-care doctors is to actually improve the conditions [in practicing medicine]" says Zeveloff. "I believe [the association] needs to focus solely on this and not be constantly distracted."

Zeveloff plans on retaining her membership as a condition of her disability insurance. But she is not alone in the feeling that her medical association doesn't represent her professional interests. And with so many free social networking and advocacy opportunities already available online, many younger physicians are questioning whether they actually need an association - or membership in multiple associations - period.

What your dues pay for

Like many solo practitioners, Peabody, Mass.-based Alain Chaoui is busy working with patients and often finds he needs help with keeping up to date with continuing education requirements and legislative issues.

"I work hard to listen to my patients here in the office, and I need some place to formulate these concerns," says Chaoui. "The Massachusetts Medical Society offers something important: a forum. The MMS helps me as a physician with practice management, my education requirements, and advocacy."

Chaoui was so happy with his benefits as an MMS member that he recently became the chairman of the MMS membership committee.

"It helped me so much as an individual that I felt that every physician in the state should use it," he said. "I thought, 'if I don't promote it to my colleagues, it's a waste.'"

Chaoui, who is also a member of the American Academy of Family Physicians and the Massachusetts Academy of Family Physicians, says the hundreds of dollars in annual membership dues are even more worth it these days.

"In terms of practice management, as a small office, it is difficult for me to hire a big firm to consult with me," says Chaoui.

Many medical associations' benefits are similar: access to resources (online libraries, and a network of consultants and attorneys), discounts on medical journals, discounts on insurance, CME-credit courses and webinars, hands-on help in choosing an EHR, and advocacy for issues affecting members. This last benefit is where big differences in associations may reveal themselves.

Medical associations are also known for taking on private insurance companies, often with legal action, says Laurie Morgan, a consultant with Capko & Company who works with physician practices, noting a recent case between the California Medical Association and Anthem Blue Cross, one of the state's largest for-profit insurers, regarding payment of claims disputes.

"It was a critical issue as a physician and it would have been difficult for a doctor to take on that fight," says Morgan.

Associations: to join or to pass?

Throughout their careers, physicians are continually faced with recurring questions related to medical associations: Which associations should I join, and which should I retain membership in? And how do you decide which associations to pass on altogether?

Often the decision is influenced by a medical association's position on hot-button political issues, such as healthcare reform.

In 2009, the AMA saw a 3 percent decline in membership, which AMA President Cecil Wilson attributes to physicians who decided not to renew membership because of the position the AMA took in supporting health reform (the association has since bounced back, says Wilson, with a higher percentage of new members in 2010 than the year prior).

Though no association can please every member all the time, associations still aim to give physicians a voice at the national level.

"We are spending a lot of time and resources finding out what physicians want in their practices," Wilson says.

Fred Ralston, Jr., president of the American College of Physicians, says his association's members always work hard to better use its finite resources to improve their practices in a changing world, but they should know that there are no guarantees.

"The ACP has worked hard to deal with significant challenges presented by our legal system and will continue to do so," says Ralston. "Failure to succeed should not be confused with failure to try."

Another reason physicians might be reticent to join or continue membership is if they perceive similar opportunities offered freely elsewhere. One of the most commonly cited benefits of medical associations is their advocacy on particular issues, such as lobbying Congress for a legislative change.

But sometimes the minority voices get swallowed. Many popular physician blogs offer practice-based physicians, regardless of whether their opinion reflects the majority, the chance to take a stance on big issues (such as malpractice legislation) that may differ from the stance of their medical association. Likewise, if a physician uses Twitter or Facebook to connect with her peers, she might also feel like she doesn't need to be a member of any (or many) medical associations to network with other physicians.

"I have talked with other physician social media 'early adopters' and yes, the role of the professional organization for the sole purpose of networking - this role is diminishing with the emergence of social media outlets," says Mike Sevilla, a family practitioner and social-media advocate previously known for his "Dr. Anonymous" blog. "It is certainly not the number one factor why physicians are shying away from professional organizations, but social media does play a role in this."

Finally, the decision to not join a medical association is also a financially motivated one.

"I think physicians are making choices related to costs," says Wilson. "There are a variety of associations, as well as national societies, so a fair number of physicians may have four or five or six associations they are eligible to join. Considering the economic climate now, they are making choices about how many they can belong to."

Marisa Torrieri is associate editor for Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the June 2011 issue of Physicians Practice.