Organized Medicine's Biggest Fight-For Survival

By Guglielmo, Wayne J. | Medical Economics, March 9, 1998 | Go to article overview

Organized Medicine's Biggest Fight-For Survival


Guglielmo, Wayne J., Medical Economics


Facing a brave new world of health care, physicians are shunning traditional medical associations. The struggle to regain these doctors' loyalty-and dollars-has just begun.

If there's a growth industry in organized medicine today, it's catering to doctors' special-and specialty-concerns.

"For doctors starting out, specialty groups are much more important than the general associations," says Robert Blendon, professor of Health Policy and Political Analysis at the Harvard School of Public Health and the Kennedy School of Government. "The changes going on in medicine don't affect all doctors the same, so they want to belong to a group that really addresses their particular concerns."

Blendon's point is borne out by data from the specialty societies. Since 1980, membership in the American College of Physicians, excluding students, has nearly doubled, to 91,798 in 1997. The ACP's recently approved merger with the American Society of Internal Medicine, scheduled to begin in July, will add another 20,000 doctors. The American Academy of Family Physicians has also seen its rolls increase during this period. Active AAFP membership was 47,925 last year, a 65 percent rise over 1980.

"Medical specialty societies fill a perceived need," says FP J. Edward Hill, chairman of the AMA's membership committee. "Right now, they're in the catbird's seat."

By contrast, the AMA is losing members. Among fourth-year medical students, for example, 54 percent belong to the AMA. But that proportion slips to 40 percent after students enter their first year of residency, many going on to join their specialty societies.

The larger picture is even bleaker. The percentage of U.S. physicians who belong to the AMA now hovers around 43 percent, down from a historical high of slightly over 82 percent in 1962. Only 34 percent of young physicians-those 30 to 39-are AMA members, and that percentage has been slipping steadily over the past five years.

"This is a critical time for organized medicine and especially the AMA," says membership chairman Hill. "We've seen a steady erosion of our market share over the last 10 to 15 years. In the past several years, we've spent a good deal of time and money on recruitment, with mixed results."

The broad-based state medical societies are facing a similar crisis. Many struggle to attract a majority of the physicians in their states. At the Medical Society of the State of New York, for instance, membership has stalled below 50 percent, despite efforts to inject new blood into the organization.

"We've got to do a better job of reaching the under-40 group before it's too late," cautions internist Steven Hanks, chair-elect of the New York society's young physician section. "Surveys show that doctors who don't join organized medical societies by the time they're 45 aren't likely to join at all."

Wooing younger doctors is also crucial for successful societies like the Minnesota Medical Association, where an impressive 76 percent of the state's physicians are members. Unfortunately, only 25 percent of MMA's regular members-excluding residents and students-are in the hard-to-sell under-40 group. The real growth is at the other end of the age spectrum-among retired, non-dues-paying physicians.

What's behind the erosion membership

Why are the broad-based medical associations struggling? One big reason, critics and supporters alike say, is that they were slow to adapt to physicians' changing concerns.

"We're dealing with a different breed of physician from the generation that preceded us," says New York's Steven Hanks. "They're increasingly in debt, have different practice patterns, and more and more of them are employed. The medical societies were slow to recognize these demographic shifts."

Consider the trend toward employed physicians. According to 1996 AMA data, 42 percent of all patient-care doctors are now on the staffs of HMOs, hospitals, medical groups, or government agencies. …

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