"How's Membership?"

HARDLY A DAY GOES BY without someone asking, "How many members do you have?" Or, "How's membership holding up? You'd think I would have those numbers memorized, but I always have to run out my office door and grab a little display plaque with the latest numbers: 1,247 active, 27 associates, 26 affiliates, 389 medical students, 9 on leave and 395 retired, for a total of 2,076.

The numbers have changed little over the last two years. Of the total physicians in the three-county area, our glass is close to half full. About 100 new members come in each year, offset by retirement, resignations and relocations.

Like most people in business, I like to slice and dice the numbers to glean some new insights (and magic, if possible). Recently, I looked at the numbers by medical group affiliation. Of our active members, 828 come from 40 medical groups with five or more physicians. The 419 remaining members are in solo practice or groups with less than five physicians.

Fourteen groups are at, or very near, 100 percent participation. Nearly half of all our active members come from four groups, and nearly 70 percent comes from the region's 40 medical groups with five or more physicians. Within the same 40 groups, there are a whopping 1,274 non-members.

So what's the difference between decisions of individual physicians to become members and those of a medical group and its leaders? I majored in psychology and social science (who didn't in the late 60's?), so I took a psycho/social approach to the question.

In many ways, a medical group's decision to require membership of its physicians, or to actively encourage membership, or to do nothing, is not unlike a solo physician's decision. Both the individual and the group have a sphere of reference, experience, maturity and attitudes that affect their decision. As I reviewed the 40 medical groups, I could easily identify why this group or that group is so positive and supportive, while another is so negative and recalcitrant.

Obviously, the leadership of the group (its board and/or voting partners) is a key factor. It's an awareness that membership, representation and the efforts by organized medicine are good for the group and the profession.

The individual physician, in my mind, is not much different than the medical group in decision-making, except that an individual may be more willing to let someone else shoulder the responsibility. If a group is functioning like it should, its members should realize that group success is equal to the sum of its parts and the investments they make for the long term.

The real membership challenge is to "get their attention," "push the hot button" or "find the killer application," as they say in the high-tech world. We work hard on this, but a two by four, judiciously applied, would help.

There are a myriad of reasons given for not joining, and except for those based on religious or ethical grounds, we have the answers for all of them. If it is a question of benefit vs. investment, we like to show the MICRA chart below. If it's the terrible Medi-Cal reimbursement rates, we like to point to the 16.7 percent increase we won after marching 300 physicians on the Capitol steps, and that we are now fighting to preserve.

If someone says, "You're just a group of good ol' boys," we have an answer — just look at our committees and our students. Ask, "What have you done for me?" and we can show examples for specific individuals or for everyone. If questioned about community service, we proudly point to our SPIRIT Project and Adopt-A-School Program.

I did not find any magic, though I can now rattle off some new numbers. We can be very thankful for all those who support organized medicine, individuals and medical groups alike.

Newly attached to the back of my membership plaque is a quote, long lost to me and only recently rediscovered:

"Every man owes a part of his time and money to the business or industry in which he is engaged. No man has the moral right to withhold his support from an organization that is striving to improve conditions within his sphere."

— Theodore Roosevelt, 1908

bsandberg@ssvms.org