Too many medical organizations — supply exceeding demand?

Professional organizations duplicating services; could be time to collaborate, merge.

Issue: May 2003

ByDouglas W. Jackson, MD

Douglas W. Jackson, MD [photo] --- Douglas W. Jackson, Chief Medical Editor

As clinician-surgeons treating patients, we are constantly aware of the demands on our time. Increasing expenses are also constantly impacting some of our decisions. An area that will come under more scrutiny is related to maintaining our professional requirements and standards. This is our ongoing education, learning and updating of surgical skills. Our time and expense choices have to balance the value of membership in medical organizations with our involvement and dues.

What does it bring in terms of improved patient care, meeting our individual educational needs and our desires to maintain support and proactive advocacy for our profession. I have found that membership dues, the expense of attending meetings, the time needed to read my journals and other professional publications, as well as the requests for donations to PACs, research foundations and special needs have exceeded my desire and willingness to “belong” to as many medical organizations as I have in the past.

There are medical organizations at the local, county, state, regional, national and international levels. There are those that serve generalists, specialists and sub-specialists. Most of these organizations have membership dues that increase periodically; many produce publications and have full-time professional staffs. In addition, most seem to be increasingly requesting donations and funds for special needs.

While medical organizations do not represent a bubble in the traditional financial sense with an imminent collapse, I can see how collaborations and selective mergers could eliminate 20% to 30% of the current organizations. In addition, those that remain should become more efficient and lower the costs per unit for their services and programs. In my experience and through talking to orthopedists, it does not seem we will belong to as many organizations in the future and will selectively belong to a few.

Time for selective mergers?

Professional Dues: There are many reasons for belonging to medical organizations, and these change as our career paths become more individualized and as we get older. In my case, I made the decision to cut back on the number of memberships to professional organizations when my dues exceeded $6000 per year. In addition to the cost of dues, many of these organizations require regular attendance at meetings to maintain membership status. This had required me to attend some meetings more frequently than I wished. I decided to limit my membership to those organizations in which I actively participated and/or to those that most directly met the needs of my patients, my professional and educational needs and met my desire to support effective professional advocacy and health policy.

The dues in most medical organizations tend to increase with time. It is not unusual to see an increase in dues every three to five years to adjust for inflation, expanding programs and increasing number of staff. Unfortunately, there is a built-in creep for increasing expenses in medical organizations. These are eventually passed on to the membership in dues increases, assessments or requests for donations. Boards of directors in voluntary organizations have difficulty pruning programs, avoiding rapid fiscal responses to posed crises and making unsuccessful fiscal outlays to explore opportunities on behalf of the membership that turn out to not make a difference.

Most volunteer organizations have difficulty trying to be like a business with sound fiscal planning. Often their business plans do not include prospective benchmarks to measure success of the new programs. There is not an active review process that results in sunsetting programs in a timely manner that do not meet predetermined objective goals. National volunteer organizations have an internal political structure that makes it difficult to cut out somebody’s special programs and departments once they are in place. Reductions in the number of staff seldom occur unless there is a financial crisis. Does every organization need executive leadership, a financial department, meeting and educational planning staff, fundraising, health policy section, marketing, journal(s), etc?

Businesses have undergone mergers to eliminate duplications in staff and programs. Medical organizations are past the time when we need to apply more business and fiscal standards. It has become more difficult for umbrella organizations to serve and meet all the needs of the individual members. Should many organizations specialize, collaborate or merge and become more selective in the programs they support? As members, our only choice now is to pay our dues to a medical organization or drop out of the organization. We vote to a degree in support of the current organization each time we pay our dues.

Finding time to read

Journals: With all the developments in our field — from molecular biology to health policy — the volume of reading material is staggering. There was a survey recently that compared readership in 20 orthopedic surgery type journals. I am not sure why I currently pay over $500 a year for journals that are not the most efficient way to meet my scientific needs. I spend more time reading journals and publications in other fields and in electronically retrieving reading material than I do in the journals I receive. This is a reflection of my interests at this point in my career and may not apply to many orthopedists but illustrates again that one approach does not meet all our needs.

Even after selectively limiting my memberships, I still receive approximately five journals per month, in addition to the publications from industry and other publishers. At the same time, the electronic material sent, sold and made available on the Web increases regularly. I do not take the time to read all the journals I receive, and some months I do not even open some of them. I used to bind all my journals with a real sense of satisfaction. For the past 10 years I have noticed that I do not search my old personal journals for articles. I usually electronically find the articles I desire. In addition, the expense of binding and finding space for storage caused me to stop saving old journals. Electronic articles can be stored and retrieved with greater ease, less cost and less space.

In addition to these personal considerations for journals, when I walk around our medical offices where I practice I notice there may be up to eight of the same journals delivered to our address each month. They not only accumulate on my desk but also on some of my partners’ desks. Some issues go unopened for months. Unread journals are eventually placed into the circular file by the desk. Physicians in our group want to store their journals at the office because of limited space at home. If we do this, we only need one copy of each journal (not eight). There is more information printed than we can process and store. It is a challenge to know how to effectively deal with unread publications.

I prefer more executive summaries and scientific abstracts and being able to retrieve pertinent information in a timely manner. Along these lines, it is our goal to make Orthopedics Today a timely scientific newspaper that gives you capsular summaries and current thinking on specific topics occurring in the field of orthopedics and to stimulate those interested in more to explore the sources and references. As a sidelight, we will be adding some more personal sections that focus on good and inspiring news of what individual orthopedic surgeons are doing.

It is a given that we all benefit from peer-reviewed, well-presented scientific material. The challenge is how to meet our scientific needs and yet allow for individual reading and learning habits. User-friendly, individualized approaches will significantly reduce the unnecessary number and sheer volume of journals distributed. This area represents a challenge because we may not need the number of printed journals currently being circulated.

Meetings take time

Medical organizations have annual meetings, interim meetings and courses. There will always be a need for a certain number of scientific and educational meetings and courses. They serve as valuable educational platforms for presentation of new and a review of old work. They provide the live peer review of ideas. They develop teaching and leadership skills for members involved in the organization and allow important social interaction. This face-to-face interaction with peers is invaluable both for educational and social exchanges. There are numerous reasons that individuals attend these meetings.

The market place has spoken on this issue to meeting and course planners. The costs of travel and time away from practices and home are much more limiting than they used to be. Orthopedic surgeons now are more concerned about how that time away cuts into their personal life, their practice and surgical volume than in years past. More local opportunities and meetings are now available, as well as home-study opportunities to meet their educational needs. These are often sponsored by industry and/or jointly sponsored with medical organizations and institutions. Physicians are more selective in a choosing educational opportunities. They prefer not to spend money and time away for unnecessary travel unless it is done in an efficient manner and meets their individual specific educational needs.

My last editorial dealt with the importance of our PAC. I feel we have a degree of responsibility to fund the only voice we have in Washington, D.C. that represents our profession and the special aspects of orthopedic care.

More now than ever before orthopedic surgeons scrutinize their expenditures. They will ask their organizations to cut overhead and look into reductions in expensive duplication of services and programs. We all have had to do this in our offices and practices and as individuals have taken the impact of reduced fees (revenues) for the same time worked. Have our medical organizations mirrored our improved individual efficiencies?

Hopefully, sharing some of my thoughts and your thoughts will stimulate all of us to look at our prioritization with medical organizations and help us to be more efficient and discriminating with our time and funds. In the end, it may help you support those organizations that are meeting your and your patients’ needs with more resources.