The High Cost of Being a Good Physician Citizen
[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]
I 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.
Even 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.
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.]
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?
My cell phone is on Republic Wireless. I pay closer to $25 a month for 2 lines. How much are you paying?