Many physicians think membership in professional associations is the best way to affect change. Others think associations are bloated bureaucracies that don’t earn the dues they collect. Maybe they’re both right?
As one of about 750,000 practicing physicians in the United States, it’s unlikely that you could influence change merely by advocating for it on your own. But what if you added your name to the roster of a more powerful force - a medical association with thousands of members? Would that lend your voice some political power? It just might.
Being a physician is a more-than-fulltime job. Every day brims with your primary purpose - caring for patients. Add to that chasing down reimbursements from payers, staying (or becoming) technologically current, retaining compliance with shape-shifter legislation, and honoring your personal life. It’s all so physically, psychologically, and spiritually exhausting. Self-advocacy feels like a luxury you can’t afford, and you don’t know where to start anyway. Feeling pushed around, overworked, underpaid, and isolated, it’s really no surprise if a victim mindset takes root.
But feeling alone doesn’t necessarily mean you are alone. You can find refuge in your peers, and you should. “There’s safety in numbers,” says Ted Epperly, a family physician and president of the American Academy of Family physicians.
We’re talking about medical associations at the local, state, and national levels. A medical association - or any association in any industry, for that matter - exists because like-minded people banded together to support and forward a common cause. Think of a medical association as an archetypal big brother. He’ll come to your aid against the school bully, and he’s a kindred spirit who empathizes with your reality. Of course, there’s another side to big brothers: They tend to headlock you without warning, desert you for their latest love interests, and consistently beat you in a race to the bathroom. A relationship with an association can feel similarly disenchanting; many physicians find them hardly worth their time and money.
Still, Epperly espouses the notion that an association’s strength is its membership, whose sum is greater than its individuals. “The concept is that all of us are smarter than any [one] of us,” he says. “Our single greatest objective is advocacy, with people speaking on your behalf to very powerful groups - the president of the United States, large employers, insurance groups. … Through an organization you can get access.”
Such coming together works both ways. Surely, you’ve got some good ideas on how to effect fundamental change. “You can put in requests that can be acted upon,” says Epperly. “Many associations are kind of like unions: They represent you. Your membership can affect the association. It’s a two-way street.”
What’s the big deal?
Who do you think was pivotal in getting CMS to hold off on the Medicare cut this past July? The AMA, for one, along with many other concurring associations, including the AAFP. Speaking of which, the AAFP takes pride in its instrumental involvement in promoting the concept of the medical home in support of the primary-care physician. To date, four states have taken steps to transform this concept to actual legislation: Kansas, Massachusetts, Iowa, and Minnesota have passed pilot projects and/or payment reforms based on the medical home concept.
Those are just a few examples; you’ll find similar ones in most every functioning association across the United States.
Indeed, national medical advocacy organizations can be tremendously powerful, but only as much as their members support them. A groundswell of such support truly does make a difference, and there’s nothing like desperation among the constituents to serve as a catalyst. Consider what’s happening in the pediatric world:
“Things have gotten so bad for pediatricians that the floor is in sight. You’re finally seeing some pediatricians saying, ‘Wait a minute! This can’t continue!’” says Chip Hart, pediatric solutions manager at PCC, a pediatric-focused software and practice management solutions vendor.
How did this happen? Largely through increased communication among pediatricians and the strengthening of the American Academy of Pediatrics. “Ten years ago, the AAP was broadly viewed as advocating for children but not for physicians,” says Herschel Lessin, a practicing pediatrician in Poughkeepsie, N.Y.
But now, Lessin says, “the AAP has made some pretty substantial strides as it relates to legislative or policy negotiation on behalf of everyone in the specialty.” Many of those strides were where you’d expect them to be: In the “limbs” of the state level. For example, the New Jersey AAP chapter “has been stellar in getting the spotlight on payers and getting things fixed,” says Hart. “They got UnitedHealthcare to come and meet. [UnitedHealthcare] never comes to anything.”
Let’s get accessible
General medical associations and societies abound at all levels - county, state, regional, and national. You’ll want to poke around a prospective organization before joining. Ask yourself these questions before sending in your membership application:
Does the organization properly align with my views and goals? Do you “see” yourself as a member? For many cases, the fit - or lack thereof - will be obvious, as many associations are based on specialty. But there can be subtler niches, too, as in the American Association for Women Radiologists. Others concentrate more heavily on clinical issues or patient - as opposed to physician - advocacy. The Alliance for Cannabis Therapeutics may be just right for you, or maybe you feel more comfortable joining the American Society of Addiction Medicine.
To be sure you’re joining a group that will support your career as a physician, look carefully at its primary mission. “Any member organization has to be first to its members,” Epperly says. In the case of the AAFP, of course, this would be to help family medicine specialists do a better job, he explains.
That said, patient education is another good example where your county medical society can help you. “There are issues that come up between a patient and an insurance company - deductibles being a good example,” says Carol Mullinax, senior director of practice solutions for OSMA. “Nobody seems to remember them each year. [Patients] come in and get their bill and it’s more than they expected because of the deductible. They blame the practice. So we’ve created a handout for physicians to give to patients to explain it. Physician offices are great places to push out education to the public.”
Can I afford the membership dues? Some associations’ price of admission is rather steep, especially at the national level. The AMA wants $420 annually. State-level fees can get your attention as well. For example, the Texas Medical Association’s annual dues currently stand at $465; the Ohio State Medical Association’s is $565. In both cases - and this is true for most state-level associations - you must also join your county’s medical society and pay those dues, too.
Many associations offer significant discounts to medical students, first-year physicians, retired physicians, and the like. Some societies offer an associate membership for nonphysicians, especially practice administrators. OSMA started doing this three years ago. “That’s been very helpful to us,” says Mullinax. “They serve as a conduit to the physician.”
But if you’re in none of these “special discount” categories, then you’re looking at the full ticket price. “If you’re financially so strapped that you can’t find the margin to join, then you’ve got to take care of yourself first,” says Epperly.
He also notes that, while it’s not ideal, your membership might fade in and out during your tenure as a physician.
Sizing it all up
Some medical associations, such as the Texas Medical Association, enjoy high membership numbers. With 43,000 members, the TMA’s executive team spearheads some major issues. “We understand that if practices are not reimbursed appropriately, they can’t keep their door open,” says William Hinchey, TMA president and pathologist in San Antonio. “So we’re trying to get the Medicare payments up where they should be. On the national level, we’re vigorously addressing the reimbursement issue.”
But because they can get so large, state-level medical associations may become disconnected from the day-to-day concerns of practicing physicians; hence, they tend to work closely with county-level medical societies. Hinchey cites an example: “If a vote on a bill in the House is on a matter we think is important, we’ll let the county societies know that their membership should get a call in, and here are the talking points.” In this way, a big fist can add many, many fingers and get that much bigger.
State-level societies know how to streamline complex issues. Mark Jarvis, senior director for practice economics for OSMA, says, “We have prewritten letters physicians can use, and talking points, and key dates. We’ll say, ‘Call up your legislator and express X with emotion.’”
Does it work? Yes. “Our lobbyists can tell,” says Jarvis, when they hear “‘OK, OK, we got the message. Please cut it off.’”
Associations often subdivide even further. For example, the AAP has a plethora of committees, sections, and pediatric councils under the main body. Most are clinically oriented, but if you’re a pediatrician looking for a way to advocate for legislative change, then check out the AAP’s Section on Administration and Practice Management.
SOAPM has been instrumental in getting the word out to the nation’s pediatricians that they need to get active, says Lessin, largely through an Internet listserv. Lessin is the SOAPM liaison to the AAP’s national Committee on Practice and Ambulatory Medicine. “Those that were business-oriented were thrilled to find others who were like-minded,” he says.
The listserv grew to 1,000 members, who continue to discuss issues and publicize complaints. “There were those like me who were fairly strident in saying that the academy was not serving our needs [as physicians],” he says.
Finally, three AAP executive board members came to talk to the section; the next year, the whole board came. “Now the academy pays very close attention to us. What we’ve been able to do with our constant carping, if you will, is to move the AAP forward light-years. Every time one of us complains about a payer, the AAP writes a letter,” says Lessin.
What have you done for me lately?
Nothing’s perfect, of course. Riverside, Calif.-based primary-care physician Ann Hamilton is not impressed with her association. “I told them when they start earning their money, I’ll pay my dues again,” she says. In her view, the organization has not properly assisted with problems associated with a county HMO, “which is ripping off all the family doctors.”
Hamilton also remembers watching her father - who was an academic physician and one-time associate dean at Harvard Medical School - object to the way things were run, although he took a different tack. “My father says he paid his dues to the AMA so he could write them nasty letters,” she says. “I think he was mad at them for fighting with Truman about national healthcare.”
Kevin Windisch, a solo pediatrician based in Sparks, Nev., is disenchanted as well. Thinking of levying a class-action suit against his biggest payer for a colossal rat’s nest of a problem (getting his biggest payer to cover vaccines and autism screenings), Windisch has had great difficulty in accessing any kind of advocacy assistance from either his medical society or the AAP, either being brushed off or waiting for days for someone to return his call. He says, “The AAP is my bigger frustration. I got a little bit more from the local medical society. But why would I donate more money to the AAP? I don’t know how much that’s going to help me.”
Windisch agrees that the AAP’s SOAPM section may be worth a try, saying, “I may join SOAPM for a year or so. Maybe they’ve made inroads, but the AAP is hardly an advocacy organization.”
Does your own local society boast a somewhat-less-than-tiptop team of policy avengers? If so, the reason is probably not because they don’t care. More likely, it’s due to a lack of resources. Consider that OSMA has roughly 14,000 members, 70 percent of whom are physicians. This gives OSMA a pretty loud mouth and a strong arm. “It’s pretty impressive to go to a legislative body to speak for 10,000 physicians,” says Mullinax.
Lessin concurs. “There are 60,000 pediatricians in the U.S. Every single one of them should be a member of my section,” he says. “Even if people don’t want to participate, if they would just join and spend the membership fee, we could go to the academy as the largest section, not the 10th-largest.”
There’s a see-saw effect that goes on with any advocacy organization, where the society’s message can be drowned out or distorted depending on its size. A society with a small-ish membership might not carry the policy-changing heft of a mega-society, but its official viewpoint on an issue will more accurately reflect the individual opinions of its members. Conversely, when a society’s numbers increase into the thousands and beyond, it’s certainly louder and more likely to garner notice, but the best it can do is a composite stance of its associates.
In addition to its membership numbers, “an association is only as good as its executive committee - who’s running the show,” says Susanne Madden, founder of The Verden Group, a physician consulting and advocacy firm. The Texas Medical Association’s large membership “brings in a lot of dues, so they can hire the right people.”
As for Windisch’s society disappointment, Madden suggests, “Perhaps the reason they’re not as effective is because they only have volunteers for five or so hours a week.”
That’s your cue: If your medical society is suffering from organizational malnutrition, get involved, and help to transform it into a strapping, streamlined force to be reckoned with. On the other hand, if you’re in a dynamic, active force that heads up advocacy efforts with well-seasoned panache, then still get involved. It will only stay that way if you and your fellow physicians want it to.
Epperly says that the decision to get involved with a medical society should be an intentional one. To help illustrate this, he likes to quote this maxim of unknown origin: “If you’re not at the table, you’re on the menu.” His own decision came early, while he was still in medical school; he’d already noticed that his chosen path, family medicine, was undervalued and underpaid in the healthcare industry. Still, that’s the specialty he wanted. “I recognized the need to advocate on behalf of creating outstanding patient care through the patient-centered medical home,” he says. “We need primary care as a work force, and healthcare for all in our country; we weren’t getting there with our have/have-not setup in our country. The social injustice bothered me.”
That’s why Epperly decided to connect with a larger, supportive force whose sole purpose is to make his life’s work more fulfilling and equitable than he could do on his own.
A self-proclaimed “blue-collar kid from Idaho,” Epperly certainly didn’t just step into his AAFP presidential shoes without trying on many interim pairs. The AAFP requires a six-year path to presidency - three years on the board to start, then president-elect, then president, and finally chairman of the board. Any good association will have a similar arrangement that ensures its principals are prepared for the challenges of leadership.
Maybe you don’t want to travel that far up the executive ladder, and that’s OK, too. Being part of an association in any capacity is worth your time. “By you being a part of that group, you have the privilege of being able to help what the group does. You can put in requests that can be acted upon. You can run for the board and try to effect change. It’s a ticket to have your voice heard,” says Epperly. “When a group acts as a whole and the message is clear and aligned, that’s powerful. Together we’re stronger. I really believe that.”
Shirley Grace is an associate editor on staff at Physicians Practice. She can be reached at email@example.com.
This article originally appeared in the February 2009 issue of Physicians Practice.