Hospitals are merging with other hospitals. Independent practices are increasingly becoming part of health systems. Insurance markets continue to become even more dominated by fewer, larger companies. Healthcare is becoming increasingly centralized. The consequences remain the subject of vigorous debate. While proponents argue that consolidation has improved coordination of care, many physicians have experienced something quite different. Professional autonomy has diminished. Administrative burdens have multiplied. Decisions affecting patient care are increasingly made by large organizations rather than individual physicians. Ironically, despite promises that consolidation would improve efficiency, healthcare costs continue to rise. Patient access to care is progressively more of a challenge.
One unintended consequence has received far less attention. The changing nature of physician practice has also changed physician engagement with organized medicine. When physicians owned their practices, participation in county medical societies, state medical societies, and specialty organizations was often viewed as an essential part of professional life. Those organizations provided advocacy, education, networking, leadership development, and a collective voice for the profession.
Today’s employed physician often views membership differently. Increasing financial pressures, educational debt, competing professional demands, and limited discretionary time have caused many physicians to carefully evaluate every professional membership. Rather than belonging to several organizations, many now join only one, or none at all. The result is a challenge confronting nearly every physician organization. Membership has declined. Revenues have become increasingly dependent upon non-dues sources. Financial pressures have forced difficult decisions regarding staffing, educational programming, advocacy efforts, and member services. At precisely the moment physicians face unprecedented challenges from insurers, government regulation, workforce shortages, and corporate medicine, many of the organizations representing physicians are struggling to maintain the resources necessary to fulfill their missions.
Perhaps it is time for organized medicine to ask this difficult question. If consolidation has become the defining characteristic of modern healthcare, should organized medicine also examine whether its own organizational structure has become unnecessarily fragmented? This is not a call to eliminate medical societies or diminish specialty representation. Specialty societies are indispensable. They advance scientific knowledge, develop clinical guidelines, promote research, and provide continuing medical education that simply cannot be duplicated elsewhere. They make significant contributions to medicine.
This is also not an argument that state medical societies should replace specialty organizations. Organizations such as the Medical Society of the State of New York occupy a unique role. They unite physicians across every specialty to advocate before state government, defend the physician-patient relationship, protect the integrity of the profession, and promote policies that benefit all physicians and all patients.
Maybe we should focus on the proliferation of increasingly narrow subspecialty organizations. Over the years, medicine has witnessed the creation of an extraordinary number of increasingly narrow subspecialty organizations. Many serve relatively small memberships while maintaining separate administrative offices, executive staff, financial systems, membership databases, communications platforms, annual meetings, and governance structures. At a time when physicians are becoming less likely to maintain multiple memberships, we should ask whether this proliferation of organizations remains financially sustainable.
Subspecialty organizations could maintain their unique scientific identities while becoming more closely integrated with their broader parent specialty societies. Shared administrative services, unified membership structures, coordinated advocacy, and collaborative educational programming could reduce duplication without sacrificing the individuality or expertise that makes each subspecialty unique. Such an approach could strengthen both organizations. Broader specialty societies could benefit from increased membership and financial stability. Subspecialty organizations could devote more of their resources to education, research, and scientific advancement rather than maintaining increasingly expensive administrative infrastructures. Most importantly, physicians would receive greater value from their memberships. In an era of unprecedented consolidation throughout healthcare, perhaps the future lies in closer integration rather than continued proliferation, to become stronger together, working together.
All the best,
Mark J. Adams, MD, MBA, FACR
MSSNY President
