Should medical staffs charge dues?

The chief of staff overseeing a medical staff that never charged dues recently asked me whether they needed to rethink this practice. He was frustrated by the medical staff’s lack of resources to support CME, social events, legal reviews, and other medical staff activities. This frustration prompted him to consider taking the brave step of bringing this issue up at the next medical staff meeting.

His concern was not only political, but also strategic. The two other major hospitals in his area never charged medical staff dues, and he was concerned that doing so would make his medical staff less desirable to independent practitioners. As a result, he did the politically astute thing and contacted the other two chiefs of staff in his area to see if they were considering the same thing (they were). He asked The Greeley Company and HCPro to survey the field to see what percentage of medical staffs charge dues so that he could present some comparative data to his colleagues and staff.

As a result of his inquiry, www.MedicalStaffLeader.com performed a survey and received 223 responses from around the country. Of the respondents:

• 91% stated that their medical staff charged dues
• Of those that did not (8%), over half (59% or 4.5% of the total) are planning to charge dues in the near future
• 80% of those responding enforce some form of disciplinary action (e.g. fine, administrative suspension etc.) if someone chooses not to pay their dues
• Dues are utilized for the following purposes:  education (69%), social events (52%), fundraising (18%)
• Dues tend to range from $25-$500 with an average of approximately $150

Note: This data is accurate as of press time and should not be considered a final analysis Rather, it provides a snapshot of field activity.

From my own experience working with more than 300 medical staff throughout the country, I have seen the following constructive uses of medical staff dues:

• Legal advice: Medical staff bylaws and rules and regulations are a binding contract or compact in most states and often reflect complimentary and differing points of view between members of the organized medical staff and the governing board. Having a medical staff perspective to compliment the hospital’s legal perspective often leads to documents that provide a broader and more representative point of view. Dues can  be used to pay for such services.
• Continuing education: Medical staffs today represent the first generation of physicians required to participate in some form of maintenance of certification (MOC). This may be perceived as a financial burden for both hospitals and physicians. Using dues to purchase study materials and courses to support this certification process is a constructive way to advocate for patients and quality while supporting physicians and their practices.
• Social events: The traditional social fabric of the medical staff has unraveled with the mass exodus of physicians into the ambulatory setting and the growth of contracted hospital-based physician groups. Bringing the medical staff together and including members of senior management and the board is more important than ever to ensure that these essential leadership groups are able to work together by forming meaningful relationships with one another. Dues can help fund these activities.
• Advocacy support. Many medical staffs have transformed their physician health committees into physician advocacy committees to address the larger goal of providing support to colleagues in need. Many physicians suffering from alcoholism, depression, drug dependency, family loss, divorce, or estrangement find themselves in precarious financial straits and welcome any kind of material and emotional support. Medical staffs can help by putting a portion of their dues towards assisting these physicians. Helping a colleague in need is perhaps the most collegial thing that a medical staff can do and speaks volumes about its character and commitment.

Thus, my advice to this chief of staff who recently asked whether his medical staff should charge dues is to encourage his medical staff to think of dues as a resource to support the activities of the staff in a meaningful and thoughtful way. By expanding its capabilities and services, his medical staff can become the preferred organization for physicians in his region.

Wishing you continued success.Jon Burroughs, MD, MBA, FACPE, CMSL is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.