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The High Cost of Being a Good Physician Citizen

San Francisco Cable Car

[Today’s post is a guest post from Russell Roberson, MD, an anesthesiologist, critical care physician, and reader. We have no financial relationship.

Dr. Roberson is struggling to find balance between being a good steward of his own finances with being a good physician citizen. In this post, he explores the financial costs of various required or recommended licenses, certifications, and memberships. It’s amazing how quickly his CME fund is exhausted without even a thought of attending a conference or meeting.

Take it away, Dr. Roberson, and thank you for the enlightening post. -PoF]


PKA_250x250I started reading PoF and WCI within the last year and have thought about my expenses much more during this past year since they influence my ability to save for retirement and financial independence as much my income does.

I’m starting to get renewal requests for various professional society memberships and while I have noticed the last two years that the aggregate cost is expensive, it really hit home more this year given my personal finance reading over the past year.

I work as an anesthesiologist like PoF, but I also practice critical care. I have a CME fund of $3000/year that I can use for things such as conferences, professional society memberships, DEA registration, MOCA fees, ACLS, and state medical licensing fees.


Membership Has Its Costs


As a condition of my employment I’m required to maintain active ACLS certification, a state medical license (renewal requires proof that I have complete annual CME hours), DEA registration, and active MOCA participation through the American Board of Anesthesiology (ABA).

ACLS is $75 per year, my state medical license is $220 per year,  I currently have $250 per year budgeted for DEA registration based on the cost a few years back, and the ABA charges me $210 per year to be a participant in their MOCA program, which I have to do to maintain my status a Diplomate with their board certification process. That’s already $755 a year without joining a single professional society. [PoF: And that’s with a bargain ACLS cost. Renewing mine at my own hospital costs me $225 every other year. I also am required to maintain PALS and BLS, and in a former job, NRP]

I am not required to join any medical societies by my employer, but I do so to have the journals and CME hours that come with these memberships and to support the professional organizations that represent my specialties — basically trying to do my part financially to be a good physician citizen.

I specified financial support because I’m not particularly involved in any of these organizations on the local or national level and that’s probably even more important than financial support, but with a family and a lot of moonlighting I haven’t figured out how to do this.


The Added Costs of Medical Society Memberships


The main tangible benefit I get from these memberships is subscriptions to professional journals, which I can use to satisfy CME hours without spending any additional funds to attend meetings or to pay for online CME. I am currently a member of the American Society of Anesthesiologists (ASA – $950 per year including the fee for the state ASA component society), the International Anesthesia Research Society (IARS – $175 per year), American Medical Association (AMA – $420 per year), and the Society of Critical Care Medicine (SCCM – $395 per year).



These memberships get me a subscription the following journals: Anesthesiology, Anesthesia and Analgesia, JAMA, and Critical Care Medicine and again the associated CME hours (if I take a quiz on CME eligible journal articles) that I use meet the requirements from my state licensing board.

However, this is costing me $1,940 per year, or $2,695 per year when adding in the previous expenses. Throw in the cost of membership with my state medical society, which lobbies the state legislature on behalf of the state’s physicians and I’m up to $3,095 per year, officially having exceeded my CME fund.

I could use my employer CME money to attend a professional conference, but given the cost of the aforementioned required items and professional society memberships I would be paying for it out of my own pocket. I cannot use the CME fund to support any political action committees (PACs), so any PACs I choose to support costs me extra too.

Physicians are Opting Out


Many anesthesiologists dropped membership in the AMA because they were upset when the AMA supported Obamacare. However, my understanding is that the AMA determines a specialty’s voice in organized medicine based on the percentage of AMA members from that speciality so hopefully I’m helping anesthesiologists have a voice in AMA through my membership.

amaEven if that’s not the case, the included JAMA has some good articles on critical care medicine and occasionally anesthesiology. I also do think it’s important for organized medicine to have a voice in Washington. There seems to be a widespread perception that AMA doesn’t effectively represent medicine, which is hardly surprising since so few physicians are members, but surely having someone advocating for us is better than no one, even if you don’t agree with everything they support. Is it worth $420 a year? I have no idea.

Despite the potential benefits I have articulated for being a member of professional societies, I’m not with the crowd here with my membership in these societies. The vast majority of physicians are not members of AMA. I don’t know what the numbers are for ASA, but based on discussion with many of my attending physicians in residency, I think that many practicing anesthesiologists are not members of ASA.

[PoF: Guilty as charged, but that doesn’t stop the quarterly “dues statements” from arriving in both my home and office mailboxes.]

I suspect many physicians eschew these memberships because of the cost and the perception that these professional societies have been inadequate in addressing concerns important to physicians. These numerous memberships are basically costing me $95 per year over my $3,000 CME fund (I can’t just take the money and spend it on something unrelated), which isn’t too bad from a personal finance standpoint, but $0 would be better.

I suppose I could drop IARS and get to $0 out of pocket, but Anesthesia and Analgesia is a good journal. However, the more clear-cut downside to my various professional society memberships is that I would have to pay out of pocket to attend a professional meeting. Meetings are okay, but I would rather just take a regular vacation if I have to spend my own money.

[PoF – I’d like to add a few perspectives to Dr. Roberson’s analysis. We see the cost in terms of time, but what may be perhaps more costly is the time away from work required to complete the necessary requirements.

ACLS and PALS require a day off, and perhaps some travel. Same with meeting some of the MOCA requirements, such as the $1600+ simulation center experience. In order to meet these demands, we must take time away from our work or away from our vacation. The cost (or opportunity cost) can easily exceed a few thousand dollars.

Looking on the bright side, the costs that we bear are a relatively small fraction of our annual salary. $3,000 isn’t such a hardship when it’s 1% of our pay. Other specialties and professions will have some of the same costs without the earnings to offset them.

My recommendation to Dr.Roberson is to attempt to negotiate a higher CME allotment and / or have some of the required expenses reimbursed outside of that fund. My group benefits from both a larger fund and having some core expenses reimbursed separately, including MOCA, ASA membership, DEA, and the state licensure.


San Francisco Cable Car


Sure, you can get your CME from the back of the magazine, but the knowledge seems to stick so much better when you pick it up in San Francisco or Maui. I jest, but there actually is a lot to be gained from the networking and live interaction at these meetings that can’t be replicated on paper or screen.]


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What do you think? Are you a member of any professional societies? Do you travel for some or all of your CME? Are some or all of your expenses covered by an employer / group fund? Are those expenses worthwhile for you?

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36 thoughts on “The High Cost of Being a Good Physician Citizen”

  1. Pingback: Should I Take 40 Weeks Off Every Year? - Passive Income M.D.
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  3. Dear PoF,

    I’ve become an avid reader of your blog over the last few weeks. Your theme of achieving FI/RE as a means of managing burnout really struck a chord with me. Although I am many years away from FIRE as a resident, would you be able to share some insight into other strategies you’ve used to mitigate burnout?

    Even this early on, I feel incredibly irritated and frustrated by the computerization and corporatization of medicine. Like you and many other physicians here, I went into medicine to help people to the best of my abilities, but often feel hampered by the mindless clicking, endless paperwork and inane levels of charting. It seems that things don’t substantially improve following residency and it makes me question whether or not I even want to stay in this career field.

    Thank you in advance for your time!

    • Good question, EBO.

      Thanks for following along, and I’m glad you found the site! When I was in medical school, everything was done on paper. Everything.

      In residency, outpatient preops were done in Centricity, and we had an electronic anesthesia record in 1 or 2 (of ~30) rooms. Times have changed.

      There is a lot of literature devoted to fighting burnout – Dike Drummond, MD has made a career of it. Lots of articles on KevinMD.

      Since you’re in residency, you can choose a job that has the fewest headaches. Options will vary by specialty, but those in concierge / cash only private practices seem to have fewer administrative headaches. Take ample time off (after residency) to recharge. Exercise, eat well, etc… but ultimately, the solution for all needs to external. Fix the root cause, rather than treat the symptoms of individuals.

      Best of luck!

  4. I thought this post would discuss the hours of unpaid or poorly paid hospital committee work and time doing MOC. Those are more significant than a few hundred bucks in fees.

    • Well, we are talking about a few thousand bucks, but I agree. All of my committee work was entirely unpaid. Someone’s gotta do it, but it’s no longer me. The MOC stuff? A story for another day, but I’ve got a good one.


  5. We take a $20,000 allowance, which dates back to the days, long ago, when you could use such an account to pay for medical and dental expenses not covered by insurance. We never dropped the amount of allowance and allow people to take whatever is left as salary at the end of the fiscal year or roll it into the next year, up to $20,000 being rolled over (or one year’s worth). When you leave or retire, you take whatever is left in your fund as salary.

    My costs for keeping up with licenses and professional societies is similar, but over the 20 year span of my private practice career, as the prices for membership have increased, I have cut out some of these societies. I was never a member of the AMA and do not plan to join.

    In the past, five or more years ago, I would attend one (often two) meeting or course every year. As I wind down my career, I have less interest in attending these meetings. I formerly really especially enjoyed a subspecialty meeting to keep up with old friends from training, but they rarely go anymore, and now we keep up on Facebook and meet in person on a social basis when we can. There are online versions of many of the courses and meetings, and I cannot see ever having to attend again for the purpose of continuing education, but I would attend if there were a networking opportunity.

    In the past, there were courses and meetings that were connected to resorts (Beaver Creek skiing, Disney World, Hilton Head Island, etc.) which made for fun, partially deductible family vacations. I enjoyed going to the meeting or course in the morning and late afternoon and skiing in between, a very popular meeting format. Or meeting in the morning and beach in the afternoon. More recently, the registration cost of these has risen so much that it is often financially more prudent to just go skiing (or to the beach) where and when you want and skip the meeting (and the deduction).

  6. I find JAMA to be a fairly low impact journal, and given I disagree with many AMA policies, and find the value for the cost of membership low, I have never joined. I think you will find that the journal will still come to you despite not renewing (in fact, I get the journal and have never joined AMA).

    I think you will find a subscription to the NEJM much more valuable, and about 1/4 the cost.

  7. I was ecstatic when my group boosted my CME reimbursement to $2000 from $1000. It finally covered more than my annual society renewal.

    You could trace this all the way back to the exams and board certifications we must complete as well. I am sure for some specialties; this could easily reach $10,000. Unfortunately, it is all part of the cost of being a physician and not likely to get us much sympathy from the general public.

    The most helpful thing is for new physicians to be sure to but a line item in their budget for these licenses and memberships. In an era where people are cutting the cable to save the $100/month on their cable bill, you could be spending more $$$ per month just to keep that MD behind your name.

    • Geez, DiD. Double that number again and you’ll be in a ballpark range of something fair.

      I guess if you’re in a group, and money is fungible, more CME dollars might mean a smaller pie to share for salary, so it might not matter as much. You pay one way or another.


  8. This is exactly what I remind myself of when I have to pay to renew all my licenses and certifications in teaching. I could have it WAY worse. We are expected to be part of several different professional groups, too. But the cost pales in comparison to this. Goodness! I am still grumpy about having to give the state more money in the spring, though 😉

    • Your cost in actual dollars may be a lot less, but I’m guessing its a higher percentage of your discretionary income.

      Just like your donations may not be in the six-figure range, you’re donating a higher percentage of your income than most. I’ve heard from several CPAs that most people donate very little. You hear a lot more from the people who tithe or make substantial donations, but that doesn’t mean everyone is doing it.


  9. This is an issue in Canada as well. I would say the issues are even more severe in terms of people with their hands out. State license is $1700 a year (yes you read that right), Membership in the Royal College (Re: Fellow/Board certification essentially) ~$1000/year. State medical association fees ~$1000/year (required as this is the organization which handles negotiation for our salaries or billing rates, and membership in the CMA (Canadian Medical Association) ~$500/year – required for my job for uncertain political reasons. So basically $4200 a year excluding other profession specific organizations.
    Also in terms of MOC it is impossible to get it from just journals, we have to take additional courses and complete alternate forms of continuing education to maintain our status – there are 3 different types of credits we are required to collect each cycle.
    On top of that marginal tax rates over 50% are becoming the norm and effective tax rates for salaried physicians are usually in the 40s even after whatever deductions you can scramble to find (there aren’t many)

    • Yes. What Canadoc said. Medicine is expensive in Canada!

      Is there a way of getting journal access without paying for all the memberships? I have an appointment at our local university, which gives me access to all the online journals to which the university subscribes. There is occasionally an article I can’t access, but I can then order the article through the library for free.

    • Holy Schnikes!

      Even after converting from the Loony, that’s still extraordinarily expensive. The taxes, too. I guess someone’s got to pay for that wonderful free universal health care.


  10. Another cost added on to the back of physicians. This does not even touch the board recertification process which is a huge money making racket machine as demonstrated by what has been discovered at the ABIM. How much of any of this actually helps with what should be our bottom line, taking good care of patients?

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  12. Perhaps a small benefit of being in an academic medical center that offsets my lower pay a little — I have free 24/7 access to just about every major medical journal in the world (English ones at least). My CME money is ~$2000/year, and I usually get to spend that on a conference. I stopped paying dues for AAP awhile ago despite being a big fan of the organization primarily because my CME money doesn’t go far enough otherwise.

    • True, PEMDoc. It is kind of funny to be upset about getting a few thousand less to cover CME trips in a private practice situation where we’re making maybe $50,000 or more above what we would in salary as an academic.

      The perks are nice when you get them, though. I think physician morale would be boosted more by better food in the physician’s lounge than a commensurate few hundred dollars increase in salary.


      • We don’t get free food, let alone “better” food in our lounge. However to your main point, if I made an additional $50k (probably what I would get if I went private), I would probably also think the employer has the money to pay for my licensing and board exams too and I would ask for more. The academic centers constantly cry poor (and to be fair there’s sometimes an occasional element of truth to that) and frequently short you on salary and other tangible benefits. My employer has an amazing tuition benefit for children going to college, but of course I have to stay with them through my kids going to college to realize that benefit.

  13. I just went through this myself. $3K in CME funds. I paid for American Heart Association) AHA (approx 300) and then went to pay for American College of Cardiology (ACC) and remembered it was nearly $1,000. I had already spent some of the cash on prior CME funds and so if I want to renew my ACC dues I will be paying out of pocket approximately $300….

    I talked to my friend who is actively involved in the ACC and he said I have to think of the AHA and ACC as different organizations. The ACC’s role is to lobby for us and that can get expensive. Cardiologist were out lobbied by radiologists in the 90s and it hurt our bottom line. The AHA on the other hand has a large budget already and focuses on research and education of the public. It was an interesting conversation as I had never thought about it in these perspectives.

    • Always good to get a different perspective. The ASA cost is similar to ACC.

      If it weren’t for CME funds and employer / group reimbursements, I wonder how well these societies would be funded.


  14. I’m not sure I followed everything in this article. Does CME mean Continued Medical Education? I’m guessing that must be it, which is like our CLEs (Continued Legal Education). Law firms typically cover all expenses associated with getting enough CLE credits to keep yourself in good standing since it’s a requirement for your law license. There are big time providers of CLE credits (like the Practical Law Company) that are free to attend for lawyers working at large firms thanks to the contracts negotiated by the firms with these types of companies.

    I’ve never really heard of a fund being provided to lawyers so they can meet their CLE requirements (although I have seen provisions in contracts granting doctors a fund like the one described in this article). Instead, I receive a professional development allowance that I can use towards any type of professional development but it doesn’t have to directly tie to receiving CLE credits.

    • Yeah, sorry, it’s a lot of alphabet soup.

      Here’s a glossary:
      CME = Continuing Medical Education
      DEA = Drug Enforcement Administration
      MOCA = Maintenanc of Certification in Anesthesia
      ACLS = Advanced Cardiac Life Support
      PALS = Pediatric Advanced Life Support
      BLS = Basic Life Support
      NRP = Neonatal Resuscitation Protocol
      JAMA = Journal of the American Medical Association
      I believe the rest are covered above.

      We pretty much live in a world of acronyms. Here’s a typical entry in a progress note: PMH: ASCVD c̅  hx MI, DES x 3, ischemic CM EF 35%, COPD c̅  DOE, O2 qhs, DM2, PVD, CKD III

  15. I guess that i am a poor citizen; I gave up my ASA and CSA memberships back in 1992 and saved a bunch over the years . I just could not see the benefit of these organizations in representing the rank and file. Back in 92 , Clinton cut medicare reimbursements approximately 50 % and even today the nominal reimbursements are less than they were in 1992.

    • You have to wonder if it would be even worse if we had no representation, though.

      “If you’re not at the table, you’re on the menu.”


  16. I agree with PoF, $3000 isn’t bad if it is strictly for CME. For myself state license, DEA, One national membership and one specialty specific membership is covered. We can take BLS/ACLS for free at the hospital but if we take it elsewhere we would have to use CME. You should definitely negotiate either more CME of for them to pay for things essential for you to do your job, like have a state license, DEA license etc. Membership are cool but there is nothing like going to Maui…and being reimbursed for it.

    • That seems reasonable, Hot Dawg.

      I wish I could shift some of my CME money to my salary. It’s more than I really need. First world doctor problems.


  17. I don’t get any CME allowance. But, if I did, it would be taken from the group pot and result in lower reimbursement anyway, so it’s probably a wash.
    I’m a member of ACEP and a board member of the Arizona chapter, as well as a Fellow there (basically just a title). They keep you hooked, though, not only because they do good work lobbying on behalf of ED patients and docs, but also because if you skip paying dues for a year you lose the Fellow title.

    • Sounds like you’re being a good physician citizen, CBL.

      I was an independent contractor for about half of my ten year career. I didn’t travel as much, and when I did, I found discount lodging. On the plus side, in a self-employed scenario, CME travel is a deductible business expense.


  18. On my future job, I will get a CME allowance of 2500 per year. It hadn’t clicked in my brain until now that I would have to pay for access to all those subscriptions (some of which I really like) with my CME money. While in fellowship, I get free access to most of them through the University.
    I have spent the last few years looking forward to be an attending so I could finally go to conferences in San Francisco and Maui and get reimbursed for the costs – I totally agree that the benefits of going to live conferences cannot be achieved with reading articles.
    Well, time to wake up, DrMoneyTails, put your tail between your legs and carefully decide where to spend that CME money that’s not even yours yet.

    • $2500 is pretty low, Dr. Money Tails. Hopefully some of your standard expenses will be reimbursed outside of your CME fund.



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