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Fewer residents and medical students joined APA in 1996 than in 1995, according to survey data compiled by the Office of Membership through the end of 1996, continuing a negative trend in year-to-year membership growth.
At the end of last year, total APA membership was 40,978. A total of 2,125 new members enrolled in 1996, of which 819 (38.5 percent) were residents and 1,140 (53.6 percent) were medical students. An additional 276 members were reinstated.
The combination of membership resignations, members dropped by APA or a district branch, medical students whose membership expired, and deaths led to a total loss of 1,960 members in 1996, slightly fewer than the 2,015 lost in 1995. Although APA membership continues to grow, there were 284 fewer residents and 396 fewer medical students signing up in 1996 than in 1995. Overall, the 1996 total of 2,401 new and reinstated members is a 23 percent decrease from 1995.
The largest declines occurred in the new medical students and members-in-training categories.
In an effort to understand why members are leaving, a membership exit survey was developed and sent to all members removed from the membership rolls. The survey revealed that most quit APA for financial reasons. Many said they would rejoin if dues were reduced.
"The impact of recent economic factors is apparent in terms of what's available for people to contribute in membership dues," commented Albert John Allen, M.D., Ph.D., a member of the APA Membership Committee and an assistant professor of child psychiatry at the University of Illinois at Chicago. In light of these pressures, the membership trends "are not totally surprising," he added. But they are cause for concern "because they mean that membership growth will not be a source of new revenue for APA," said Allen. "What it means is if we're going to do new projects within the Association, we're going to have to look for other revenue sources than membership dues."
Other factors are also causing APA's declining membership growth, Allen believes, one of which is the increasing fragmentation of psychiatry.
"There are a number of competing organizations out there that psychiatrists can belong to," he observed. The subspecialties, such as child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, and consultation-liaison psychiatry, have their own guilds, which many psychiatrists see as better championing their specific financial and professional interests than APA, said Allen.
"Each of those groups has its own interests, and I think you're going to have folks belonging to two or three," often at the expense of APA, said Allen.
Allen, an early career psychiatrist, understands the financial pressures behind the drop-off in early career psychiatrist members. Many are "coming out with significant debts, because of fewer grants, more dependency on loans, and with loans having higher interest and being shorter term," he commented. All these things combine "to put more financial pressure" on both early career psychiatrists and residents, Allen said.
Another issue is the squeeze of high district branch dues and high national dues, which is prohibitive for some people, said Allen.
The APA Office of Membership recently launched a program to address some of the issues that may be contributing to membership declines, Allen observed. Over the long term, members must feel they are receiving a tangible return for their membership dollar, he said (see article below).
The decline in U.S. medical school graduates choosing psychiatry is another factor hurting APA membership, Allen said. "We're not having as many U.S. medical school graduates going into psychiatry as we did 10 years ago. That's been a gradual decline."
Although an increasing percentage of psychiatry residents are drawn from the pool of international medical graduates, it is not clear whether APA is "drawing as many of those people proportionately as we see in residency programs."
Another factor is the change in APA's malpractice insurance program, Allen said. For many members who otherwise saw little cause to join APA, the malpractice program made the difference. But recent changes may have made it unaffordable for some and thus contributed further to APA's unsettling membership trends, according to Allen.
APA fared especially poorly in terms of new dues-paying members. The report notes that "since all residents are enrolled with a one-year waiver of dues and medical students do not pay any dues, the additional number of new dues-paying members [was] minimal (108, or 5.1 percent)."
Reinstatements in 1996 decreased to 276 from 305 in 1995, which, in turn, decreased from 326 in 1994. The report notes, however, that a dues amnesty authorized for calendar year 1994 led to a higher number of reinstatements that year than would otherwise have occurred.
The Office of Membership is working with members-in-training (MIT's) to facilitate their transition to general membership. A membership marketing plan was launched last month to enhance recruitment and retention efforts, according to the report.
The plan focuses on enhancing membership growth and member involvement by demonstrating the benefits of membership through a broad range of activities and by optimizing APA resources to provide better member services.
The tables above show membership gains and losses from 1993 through 1996.
Some of the membership loss may be a short-term consequence of the efforts to reduce the number of members not paying dues and get MIT's to upgrade to full membership, said Allen. The Membership Committee "is pushing harder" in these areas, he noted. While these efforts may cause short-term declines, the goal is to bring more members on board over the long term, he observed.
In response to concerns over recent membership trends, APA last month launched a program to address some of the issues believed responsible for the drop in new memberships.
The Office of Membership is working with members-in-training (MIT's) to facilitate their transition to general membership. In the past, some MIT's have not advanced to full member status for a variety of reasons (see story at right).
The membership office has also developed a membership marketing plan to enhance recruitment and retention efforts. The plan focuses on enhancing membership growth and member involvement, by demonstrating the benefits of membership through a broad range of activities and by optimizing APA resources to provide better member services.
The plan aims to demonstrate to prospective and current members the concrete benefits of membership, commented Albert John Allen, M.D., Ph.D., a member of the APA Membership Committee and an assistant professor of child psychiatry at the University of Illinois at Chicago, who spoke with Psychiatric News about the membership trends.
"In the long term, the solution is that members have to feel they are getting a significant return for their membership dollar." This cannot be "a nebulous representation" but must involve concrete benefits, he asserted.
APA needs to highlight the various benefits that membership confers, including job placement, specialized publications, and a strong voice in Congress, he noted. "It's always more real if you can see it, hear it, feel it. Many members have a sense of APA as some nebulous entity in Washington."
(Psychiatric News, May 16, 1997)