July 2000
Volume 64 |
Number 7
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ADMINISTRATIVE UPDATE
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| Cloudy Forecast
But With a Chance for Sun |
Thomas H. Cromwell, M.D., Secretary
Membership! Yes, I know it is one of those topics that holds
your interest like reviewing medical staff bylaws or the budget
... your eyes glaze over and the fog creeps in. But stay awake
for a moment and read on. We may have a problem.
Like most of you, I never gave ASA membership much thought until
assuming the office of ASA Secretary last October. The minimal
interest I had prior to that was satisfied by periodic assurances
that membership was healthy and that ASA represented in excess
of 90 percent of practicing anesthesiologists. That is, or course,
in stark contrast to the often drastic hemorrhage of membership
rolls of many medical societies throughout the country, most notably
the American Medical Association (AMA), which now represents little
more than one-third of practicing physicians. Additionally, many
state medical societies are on the brink of extinction, infected
by the "terminal apathy" often mentioned by ASA President-Elect
Neil Swissman, M.D., in his presentation to component societies.
But is ASA membership as healthy as we would like to believe?
Is ASA immune to terminal apathy? While our membership is indeed
at an all-time high of nearly 36,000 members and has grown by
over one-third in the past 10 years, there are a few clouds on
the horizon:
1. Membership rolls have grown by less than 10 percent
in the latter half of the 1990s.
2. The increase in total membership over the past decade
is, to a certain extent, a reflection of the aging of our Society
in that the retired category has increased at the expense of the
two most vital components of membership: active and resident members.
3. ASA membership doubled from 1975-1995. However, the
rate of increase of active membership has dropped nearly
75 percent since 1995. From 1990-1995, ASA added between 600-800
new members each year to the rolls. That figure dropped to 164
in 1999.
4. Whereas the growth of anesthesiology residents outpaced
most other specialties from 1980-1994, the total number of ASA
resident members has fallen 37 percent, from a peak of 5,500 in
1994 to about 4,200 this year.
5. The darkest and most menacing cloud looming on the horizon
is yet to be assessed: the effect on resident recruitment of the
ill-advised proposed rule change by the Health Care Financing
Administration to eliminate the requirement for physician supervision
of nurse anesthetists. Should this rule change become reality,
the influence on recruitment is difficult to calculate but is
potentially devastating.
Membership data for 1999 will not be complete until June 30,
2000, and there is cautious optimism that these data will show
significant growth in active membership over the past year. In
any event, it would appear that we have a great deal of work to
do.
The ASA Committee on Membership, and indeed the entire ASA,
will be considering a number of initiatives to enhance ASA membership.
Many of these initiatives will be aimed at younger members of
our specialty. We need those young members to in turn encourage
residents to become resident members of ASA and facilitate their
transition to the active category upon completion of residency.
An entirely new membership category for medical students was originated
two years ago and has increased to more than 200 members. An ASA
task force is now finalizing another entirely new category of
membership for consideration: an educational affiliate for nurse
anesthetists and anesthesiologists' assistants.
Exit surveys conducted when ASA members fail to renew membership
indicate three primary reasons for their departure:
1. Disagreement with ASA policy.
2. Requirement for component society membership.
3. Perception of value in ASA membership.
As ASA must represent all of its members, an occasional conflict
may arise in regard to policy, but we would certainly hope that
the members do not resign as a result. We believe that there are
more appropriate methods of resolving conflicts. Component societies
are the fabric of ASA, and there is a fundamental necessity of
membership in components as well as the parent organization. These
things will not change.
On the other hand, perception of value in membership can and
must be enhanced at both component and ASA levels. We will work
to accomplish that goal within ASA, and we strongly encourage
components to do the same. But the entire membership must assist
in this effort. Take a look around you; many of us practice with
colleagues who do not belong to ASA. It is the obligation of each
one of us to bring them into the fold.
The benefits of membership in ASA are obvious to most of us.
But a few of our colleagues need to be reminded that ASA is the
only organization that can provide:
1. The largest and most respected anesthesia meeting in
the world.
2. The most widely acclaimed anesthesia journal in the
world.
3. Periodic updates on issues of concern to anesthesiologists
in the form of ASA NEWSLETTERs and President's Updates.
4. Educational opportunities in the form of ASA refresher
courses and workshops.
5. A member directory including e-mail addresses.
6. Legislative advocacy at state and federal levels.
7. Access to state and federal legislators and a voice
in governmental affairs available to few individuals.
8. A collective effort throughout the country to deal with
professional affairs of practicing anesthesiologists.
Events in the past five years have made it quite obvious that
government, payers, administrators and insurance companies have
a tremendous influence on our lives and practices. Whereas membership
in ASA was important in the past, it is now vital! Convince
your colleagues to participate in ASA. If you cannot convince
them, give me a call and I will give it a try.
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