I think that the ASA is very responsive to the concerns of its members . . . . so write to them. Call if necessary to find out the correct person to write to. Join the relevant ASA committees (open applications every January). There are multiple committees that write these materials (practice improvement, ASA, SEE) and determine whether or not to charge for them. Become an ABA examiner (yearly open applications if you have been a diplomate for a few years). Call the ABA and find out how to join their committees and get involved. Join the committee and design a survey to prove your point that people do mind being charged for these. The work that multiple people are doing here is important, but if you are willing to put in the time, things do change from the inside as well.
Do you really think so?
Posted from another site:
ASA Membership: Some Say No
Are changes needed?
Robert E. Johnstone, MD
I practice anesthesiology, so I belong to the American Society of Anesthesiologists (ASA). The ASA organizes the specialty, develops standards, unites me with colleagues and represents us to the public. I joined in medical school, and have benefited in myriad ways since. But some anesthesiologists do not belong—formerly a few unusual individuals, but now a sizable minority. While most anesthesiologists value their membership and believe it important for their future, why do others say no?
Nonmembership first arose about 20 years ago. Everyone I knew before then belonged to the ASA. If someone forgot to pay their dues, a simple reminder led to their check being sent, and an apology. That changed in the 1990s, when managed care began. Managed care linked patient care and financing, introduced big government into health care, renamed professionals as providers, disrupted practices, divided clinicians, made cost reduction a goal, created ideologues and birthed political advocacy.
The ASA has 30,000 active members, and 52,000 members in all when residents, retirees and others are included—numbers that change daily with recruitments, renewals and retirements. At any given time, however, one-fourth of U.S. anesthesiologists are not ASA members, and some have not been for years. Nonmembership has grown over the years, a fact which has perhaps not attracted much attention since overall membership numbers (including retirees, residents, etc.) as well as the resultant dues have increased during that period.
So Why Not Become a Member?, I Asked
Nonmember anesthesiologists generally keep low profiles, knowing their free ride on ASA advocacy, standards development, quality promotion and public relations upsets dues-paying members. However, they can be found. Our state board of medicine, for instance, lists physicians who self-identify as anesthesiologists. Cross-checking with the ASA roster shows one-fourth of them as not being members. Some practices have even developed nonmembership cultures, noticeable when they want help from members with recruitment, regulatory compliance, media coverage or clinical consultations.
So why do anesthesiologists not belong? Just apathy, akin to why so few people vote today, or perhaps disillusionment with organized anesthesiology, or something else? I asked a few, and listened.
Their most common answers involved
high costs, disagreements on issues and leader characterizations. Their focus was personal and present, not group or future.
ASA active membership costs $665 per year, plus the cost of required state component membership, which adds a few hundred dollars (e.g., California is $545, Florida is $395, and New York is $595). After requested political action committee (PAC) and foundation contributions, members often spend more than $2,000. Those also joining the American Medical Association, a state association and subspecialty society, which ASA leaders encourage, spend more than $3,000. Combining these with meeting, journal, education and other advocacy costs, many active members spend more than $8,000 per year on professional expenses.
Nonmember anesthesiologists receiving contract income without benefits and those working part time usually mentioned costs. Several said they would join the ASA if they did not also have to join their state component. Others said they would belong if their employer or group paid their dues.
One couple, both anesthesiologists and competent clinicians, nearing 60, who are working half time as locums contractors and were formerly very active in the ASA, wrote: “Most of our reasons for not joining last year (or this) was money. We are trying to cut down on expenses in order to maintain our lifestyles before we really retire. Can’t really explain it, but the other reason is that because we are only part time and not wholly invested in being anesthesiologists as a definition of our lives anymore, the ASA and the annual meeting seem to have less importance to us, and again, not worth the money.”
Some cost complaints are more specific. One private-practice cardiac anesthesiologist wrote, “(ASA) continuing medical education costs are too expensive. I can get my required CMEs [continuing medical education] for a much cheaper price.” Several complained about where the funds went (e.g., a new building, “150 employees” and “training sedation nurses”) or where the funds didn’t go (e.g., subspecialty society meeting support). Another frequent complaint, linking both costs and education, was perceived ASA support for the American Board of Anesthesiology Maintenance of Certification program.
Education costs of ASA products seem at or below the market. A national guideline for CME pricing is $12 per credit hour. The popular ASA Anesthesiology Continuing Education series costs $360 for 30 hours of credit.
Anesthesiology journal CME costs $120 for 12 credit hours. The ASA Practice Management Conference costs $41 per available CME credit, whereas the main alternative conference costs $47.
Cost Is Not the Only Issue
The issues nonmembers complained about reflected their personal circumstances, political views and ASA perceptions, especially on nurse scope of practice. An anesthesiologist who does his own cases wrote, “The ASA is committed to the care team model. I am not. For the most part, other specialties don’t have the same problem with their extenders that we have. …The ASA does not represent my views.” And another: “For me to rejoin (after many years), you need to take a stronger stand against CRNAs.” However, a critical care anesthesiologist wrote, “The ASA wasted time, energy and money on a battle with the CRNAs. … The correct patient-centered approach is to work with folks to build the best integrated model.”
Some complaints seemed bizarre, even fantasized. One long-time nonmember complained his group has not made him a partner, an unethical practice the ASA condones, and “the reason why I am not a member.” Several mentioned how hard they work, whereas ASA officers do not, for example, “all the ASA presidents and officers haven’t seen the inside of an OR in forever.” (This irksome comment drives me to note that I worked full time clinically while I was an ASA officer.) One anesthesiologist perceived the ASA as too conservative and aligned with Republican politics—his reasons for not belonging.
Logically, more members would make the ASA more influential, especially if united. In 2010, Art Boudreaux, MD, ASA secretary, wrote, “A membership goal is to make ASA an invaluable part of every anesthesiologists professional practice.”* This is not happening. Is it even possible?
From my limited survey, attracting all anesthesiologists into the ASA is currently not possible, and perhaps not desirable. The anesthesiology community is large, numbering approximately 65,000 physicians, and heterogeneous. Some nonmembers distrust authority. Some seem angry, stressed or loners, undesirable traits for an effective professional society. Two nonmembers, among the highest earners in a group where everyone else belongs, seemed fixated on maximizing their current incomes. One nonmember who gambles most weekends has trouble paying his rent.
Many nonmembers seemed detached from the ASA, engaged in other aspects of life, such as research, volunteer work in underserved areas, golfing and raising families. They tuned out the ASA and politics.
A few rejoin when their life changes. One anesthesiologist responded, “I only join when looking for work or writing a department manual.”
What To Do?
The ASA can celebrate a majority membership, healthy budget, robust agenda, high-impact journal and successful programs. Many other societies cannot. American Medical Association membership is down to 17% of physicians, its PAC a fraction of the ASA PAC.
But is a society built around advocacy, with dues its primary funding, one that can continue to grow? What if advocacy falters? What if cost resistance grows?
Should more be done to attract nonmembers? Reducing costs would respond to their most common complaint. Is co-membership in a state component really necessary? Could individuals elect to drop their state memberships by paying $100 more for general state-level activities? Could the ASA take over willing state societies and eliminate redundant administrations? The ASA pays millions of dollars each year to its foundations. Could other ways be found to fund them, and reduce dues? Most not-my-belief comments mentioned advocacy. Should education be emphasized over advocacy? Could different messaging reach nonmembers, correct misperceptions and engage them in the future? Would discounts for groups with 100% ASA membership encourage intragroup discussions? Should non-members be identified publicly for members to interrogate?
The answers are unclear, but a start toward fuller membership would be to recognize the numerous nonmembers, understand why, and change.
