Medical Organizations and Their Costs

October 1, 2009

When thinking of your medical organization affiliations, the pertinent question should be the value proposition. Is the act of paying dues spending money to make money, or throwing good money after bad?

In my never-ending quest to show docs how to either make a few bucks or save a few bucks, I have recently cast my squinty glare onto all of the medical organizations that I belong to. I've accumulated a bunch over time and I imagine, like many of you, that these yearly invoices get paid without much scrutiny.

The situation came to a head for me while doing my second consulting job for the Stanford Graduate School of Business on a medical organization that applied for help in gaining and retaining members. In business school lingo, the pertinent question is called "the value proposition." Plain English asks, "Am I getting my money's worth?"

There must be a zillion of these affinity groups ranging from the overarching AMA to tiny niches like The Society of Left Earlobes. So we should ask of each: 1) “Why do you exist?” and 2) “Why should I join/pay/participate?”

Having done the surveys, I can tell you that docs say membership helps find jobs, residencies, collect CME, facilitates networking and catching up with old friends, gets you to tax-deductible meetings, lobbies and, more subtly, reaffirms one's identity. All valuable services to many.

And there is no question that docs love fancy certificates, shiny pins, and additional letters after their names to tack onto our CV/resumes. I know I do, or did. Then at some point mid-career, you look at the full drawer and wall, the stack of unread affinity magazines, and the mound of unpaid invoices and say "Whoa, let's review this situation, Sparky.” Simplify and save money if you are not getting bang for your buck. The recession hasn't helped, either.

Also, it seems that joining and participating are not just about features and costs, but are both importantly influenced by who asks you to involve yourself. Mailers and advertising appeals have their uses, but are known to have low response rates by themselves. It's mainly people that matter.

The other psychological aspect worth noting is that organizations, like people, have a sort of independent inner life and feel they must perpetuate themselves. If they execute well, they will grow until they can't, and they sometimes hire consultants to help them grow further still. It's all good as long as they meet their constituents' needs.

At the core of the membership question, a doc has to feel that he or she is enhanced in some way to justify the trouble and expense of belonging. And these organizations that flourish are those best able to harness those among us who have the wherewithal to take a leadership role. I know that I am beating a dead horse when I say that leadership training is just one more area in which medical schools and residencies abrogate responsibility. So we have a limited pool from which to draw; those who see a problem that needs solving and who have the time, energy and inherited wit to lead. Every organization needs a sparkplug.

One universal problem that these organizations share is that docs are a hugely varied group of people, who even among the affiliated interest group specified, may not share a particular interest to be involved or even included. And with the medical and social landscapes always in flux, it's difficult to be light enough on your organizational feet to become and remain relevant.

Think about it. Alone, there are major generational, gender, financial, and geographical differences among the members of each specialty or affinity type. It's a wonder that any of them arise and persist.

But one major, and historical, gravitational pull on docs was and is the utility of the Guild. A self-protective banding together for primarily economic, but also for other (usually defensive) reasons of like-identified professionals. If you put all of these above reasons together, they usually provide enough glue to bind and build our many-faceted medical organizations.

But back to my question of the "value proposition." In my case, I find upon reflection that I no longer have many of the needs that originally led me to membership or to value their benefits. And one by one, I have been letting these things lapse, each for its own appropriate reason. They know full well that they have a retention problem and are not ignoring me, or those of you also of like mind. But, tax deductible or not, the hefty annual sums I have spent for these many years have gradually stayed home for other purposes.

So instead of belonging at this stage of my career, I'd like to think I use my experience and analysis helpfully to inform these medical organizations that ask how to become more relevant and "value-added." Maybe this article will provoke some in and out of our medical organizations, including medical schools and residencies, to review their individual situations. Ask for just the financial part of the equation — is the act of paying dues spending money to make money, or throwing good money after bad?