American Gastroenterological Association: Results of a membership poll

GASTROENTEROLOGY

SPECIAL

1986;90:482-5

ARTICLE

American Gastroenterological Association: Results of a Membership Poll DONALD Medical

M. SWITZ

College of Virginia,

Richmond,

Virginia

The Patient Care Committee of the American Gastroenterological Association determined that no data existed on the views or demographics of our rapidly growing membership. A 48-item questionnaire was developed and administered during 1982-1983. A random sample (232 of 2751 active members) was queried; 85% (196) replied and all returns were correctly completed. Respondents rate the American Gastroenteroiogical Association as “somewhat responsive” to practitioners’ needs but closer to “extremely responsive” to the needs of academic physicians. Full-time medical school faculty average 33% of their time in direct (digestive

disease related) patient care, with 15% spent on endoscopy; non-faculty members spend 56% of their time on such care and 22% on endoscopy. Only 2% of the 22% of members who do some “bench research” are < 35 yr old compared with 7% of the general membership. Most (97.9%) members have attended a Digestive Disease Week in the last 5 yr; they averaged 3.9 meetings and 2.5 courses. Members rank both Digestive Disease Week and GASTROENTEROLOGY a little toward the “research side” of a perfect balance. The American Gastroenterological Association (AGA) has enjoyed an enormous membership increase during the last decade. The number of members has risen 3.5-fold from 1302 in 1972 to 4509 active full-time members in 1984 (1). During the same time, the number of board-certified specialists in digestive diseases has risen 4.3-fold, from 929 (1972) to 4016 (1983) (2)! Received January 25, 1985. Accepted September 17, 1985. Address requests for reprints to: Donald M. Switz, M.D., Department of Medicine, Box 711, Medical College of Virginia, Richmond, Virginia 23298. The author thanks his colleagues on the AGA Patient Care Committee for their skillful efforts in the design and refinement of the questionnaire. He also thanks Presidents Tyor and Farrar and their Governing Boards for sage advice and support, and Dr. S. James Kilpatrick, Jr. for statistical consultation. 0 1986 by the American Gastroenterological Association 0016-5085/86/$3.50

Despite these dramatic increases in numbers of gastroenterologists, training programs continue to produce an unchanging average of 547 new trainees per year since 1979 (Greenberger, personal communication); 1000 new gastroenterologists finish training every 1.8 yr. In addition, the number of board certifications has risen from 450 in 1975 to 681 in 1983, a 50% rise in 8 yr. We are gaining 1000 new board-certified gastroenterologists every 3 yr (681 certificates in 1983). We have come a long way from the White Papers of the late 1960s that cited the lack of sufficient gastroenterologists for America.

In 1981, the Patient Care Committee of the AGA decided that demographic data on our rapidly enlarging membership would facilitate its work. Planning for the organization as a whole, during this time of rapid growth and change, might also be enhanced. Further, various members of the AGA had suggested that the views of the membership were not well documented for the leadership. Data were needed that might illuminate the decision-making necessary for the Association’s future. The AGA’s Executive Secretary, Charles B. Slack Inc., confirmed that no data, other than the number of members, existed. Demographic data have been requested at the time of dues payment, but fewer than 42% of members have replied. This information was thus of limited reliability and extent. Our only other data were obtained by a poll of the membership in the mid-1970s. Data from the 54-question query are no longer available. Until 1981 the AGA had no reliable data about the demographics, needs, or views of its members.

Methods The author and other members of the Patient Care Committee, in conjunction with the Governing Board and a consultant on mail questionnaires, constructed an eightpage, 48-item data form during a 12-mo period. The questionnaire was designed to obtain information about members’ views of the AGA’s “responsiveness” to their needs, data on the usefulness of the Undergraduate Teach-

February 1986

AGA POLL REPORT

ing Project and Viewpoints on Digestive Disease, as well as extensive information about Digestive Disease Week (DDW) (including the annual course). Other queries explored views about merger of the AGA and the American Society for Gastrointestinal Endoscopy (ASGE), the need for regional meetings and local chapters, membership criteria, Congressional liaison, and our journal, GASTROENTEROLOGY. Extensive demographic data were obtained. The form included multiple-choice questions, items for which a range of numbers (l-10) could be chosen (to express judgment), and opportunities for written comment. In order to speed data analysis, have the most reliable data, and not burden the entire membership, a sample (8.4%) of the 2751 active members was drawn using a table of random numbers. This sample size was chosen because responses in a data collection this size have a confidence interval of t8% (3). The selected members were queried by mail in December 1982. Eighty-five percent (196 of 232) of the questionnaires were completed and returned in ~3 mo. The responses were stored in a standard database package on an Apple II. This facilitated rapid, repeated, and exhaustive analysis of various subsets of the data and allowed reports to easily be made to the Governing Board.

Results An extensive analysis was carried out and reported to the Governing Board and the Chairmen of all AGA Committees in May 1983. Copies of that report are available from Charles B. Slack, Inc., 6900 Grove Road, Thorofare, New Jersey 08086, the AGA’s Executive Secretary. Members were asked their views of the “responsiveness” of the AGA to either the “practicing” or “academic” gastroenterologist. Responses were scored on a scale of 1-5, from “extremely responsive” to “not at all responsive”; a score of 3 represented “just the right balance.” Members reported that the AGA was “somewhat” [mean 2.1 +- 0.61 It was judged to be [SD)] responsive to practitioners. between “extremely” and “somewhat” (a score of 2) responsive to the academic gastroenterologist (mean 1.3 -+ 0.53). The clinical with full-time

Table

activities of the 36% of AGA members faculty positions and the 64% without

I. Clinical

Activities

of AGA Members

Clinical activities (mean % of total effort f 1 SD) Digestive disease only

Full-time faculty Yes No

General internal medicine

Endoscopy

n

x

SD

n

62 118

33 56

17 20

30 89

x

SD

n

15 9.9 31 22 14 92

Table 2. Members’ Ranking

of Digestive

483

Disease Week

Activities n

x

SD

Clinical symposia AGA course Plenary sessions Poster sessions Meet-the-professor Splinter groups Meet-the-investigator

181 163 190 184 166 158 141

7.7 7.6 6.5 6.2 5.9 5.8 5.0

1.5 1.7 2.5 2.2 2.7 2.4 2.6

Ranking: 1 = least informative;

10 = most informative.

Activity

(of whom 77% hold part-time teaching posts) were compared (Table 1). Full-time faculty spend, on average, 33% of their time in the care of patients with digestive disease (DD), with an additional 15% spent doing endoscopy and 13% on general internal medicine. Members without a full-time faculty position spend an average of 56% of their time in a solely-DD practice, with an additional 22% of their time spent on endoscopy and 26% on general internal medicine. Endoscopy consumes 25% of the total practice time of full-time faculty members and 22% of those without a full-time faculty position. Thus, endoscopic activities constitute a minor, but similar, fraction of work time for the two groups.

Twenty-two percent of the membership report they do some “bench” research. Only 2% of this group, however, are under 35 yr of age. In comparison, 7% of the whole membership, full-time faculty or ASGE members, are under 35 yr of age. The burgeoning role of endoscopy is exemplified by the finding that 56% of AGA members who also belong to the ASGE are 35-44 yr old. Fewer full-time faculty (39%) and “bench” researchers (44%) are in this age group. An overwhelming majority (97.9%) of AGA members have attended an annual meeting in the last 5 yr. On average, they have attended 3.9 (k1.32) meetings in that time. Sixty-six percent of the membership have attended a course during this time; they average 2.5 (t 1.2) courses every 5 yr. Members rank DDW activities in the following order of informativeness (rank, 10 = “most” to 1 = “least”): symposia (7.7), annual course (7.61, plenary session (6.5), poster sessions (6.2), and meet-the-professor luncheons (5.9) (Table 2). Members who do “bench” research rank symposia as 6.9 ? 1.6 and poster sessions as 7.0 + 2.2. Both DDW [score 3.5 ? 0.9 (rank, 1 = “too clini-

2

SD

cally oriented” to 5 = “too research oriented”)] and GASTROENTEROLOGY (3.4 * 0.8) are viewed by

13 26

11 20

the whole membership as a little on the “research side” of a perfect balance (Table 3). “Bench” investigators feel that DDW is perfectly balanced (score

484

GASTROENTEROLOGY Vol. 90, No. 2

SWITZ

3.1), whereas a group containing only full-time practitioners feels the AGA’s educational offerings are a little on the research side (score 3.8). These differences, however, are not statistically significant. Because the British had merged their national gastroenterological and endoscopic societies, we sought our membership’s views on this subject using a “yes/no” response. Merger between the AGA and ASGE is desired by 50% of AGA members who also hold ASGE membership and by 55% of the total sample. The majority (86%) of respondents read Viewpoints on Digestive Disease. The publication is ranked between “helpful” and “very helpful” on synthesis and summary of pertinent new information. It is judged to be helpful in the teaching of house officers, fellows, and students. The Undergraduate Teaching Project has been used by 51% of members [52 of 70 (74%) who are full-time faculty and 48 of 126 (38%) who are nonfull-time faculty]. They rate it between “helpful” and “very helpful.” Fifty-one respondents offered new subjects they would like to see covered. This information was transmitted to the Undergraduate Teaching Project Committee. Sixty-two p~ercent of members felt the AGA should sponsor regional clinical up-date sessions between annual meetings. Only 38% felt the AGA should be involved in the formation of local chapters. Members were asked whether the criteria for membership were too lax, too tough, or “about right.” Twenty-two percent of all members believe criteria are too lax; 78% believe they are “about right.” Thirty percent of all faculty members (21 of 70)and 17% of faculty members over age 55 yr (9 of 52) felt criteria were too lax. The AGA active membership is 97.9% male. The median age is 45 yr. Thirty-six percent of members have a full-time academic position; 49% have a part-time teaching post. Thus, 85% of the AGA membership are recognized (or paid) for their teaching efforts. Table

3.

Members’ Ranking of the Balance of Digestive Disease Week and of the Iournal Digestive disease week Group

x

SD

Gastroenterology x SD

All AGA members “Bench” researchers only Not full-time medical school facultv

3.5 3.1 3.8

0.9 1.0 0.7

3.4 3.4 4.0

Ranking: 1 = too clinically 5 = too research oriented.

oriented;

0.8 0.8 0.8

3 = just the right balance;

Table 4. Percent of Members Belonging to Other Organizations Organization ACG ACP AMA ASIM AGA

ASGE

AGA

ASGE

21

31

65

59

41

55

22

26

100 57

50 100

ACG, American College of Gastroenterology; ACP, American College of Physicians; AGA, American Gastroenterological Association; AMA, American Medical Association; ASGE, American Society for Gastrointestinal Endoscopy; ASIM, American Society of Internal Medicine.

Thirty-six percent (n = 70) of respondents have practices with more than 74% of the time devoted to digestive diseases and endoscopy. Thirty percent of this group belong to the AGA alone. Sixty-seven percent also belong to the ASGE. Members belong to many other societies. These include, in descending order: American College of Physicians (65%), ASGE (50%), American Medical Association (AMA) (41%),American Federation for Clinical Research (31%), American Society of Internal Medicine (ASIM) (22%), American College of Gastroenterology (ACG) (21%),American Association for the Study of Liver Diseases (20%), American Society for Clinical Investigation (7%), Society for the Surgery of the Alimentary Tract (4.6%), and the Pediatric Society (3.1%) (Table 4). Thirty-seven percent of AGA members do not belong to the ACG, fiSGE, or ASIM; 10% belong to the AGA, ACG, and ASGE; and 8% belong to the AGA, ASGE, and ASIM. Members of the ASGE, in their recently published poll (4), differ from AGA members in their memberships in other organizations (Table 4). Forty-eight percent more ASGE than AGA’members belong to the ACG (31% vs. 21%) and 34% more ASGE members belong to the AMA (55% vs. 41%).

Discussion What conclusions might be drawn from the results of this data collection? First, the practices of the academic and practicing physician members of the AGA are rather similar. Second, despite all the furor about endoscopy, its use consumes <23% of even the full-time clinician’s time. Third, members are religious in their attendance at the annual meeting and they rate the offerings there (and the Journal) highly. Data-gathering such as this is crucial for large organizations. When the AGA had only enough members to fill a room in an Atlantic City hotel, it was easy to recognize members’ needs personally. In

AGA POLL REPORT

February 1986

the age of a group with a membership of 4000, this is no longer possible without more formal methods. The results of this poll make it possible for both the leadership and membership to see the commonality of views of the various groups that constitute the AGA. At DDW, various “separatist” views are often expressed; e.g., that DDW provides insufficient attention either to science or clinical medicine. Each group believes it has a legitimate view it fears is unheard. Data collections such as this make clear the small differences among the subsectiohs of the AGA membership. There is much more that we have in common than one would expect listening to DDW hallway discussions. For the AGA to fulfill its national role, demographic and other data are crucial. In speaking to Congress, just who is our membership, how do we serve society? Are there parts of our Association that need to be improved? Now we have additional data to support the small number of young individuals engaged in “bench” research in gastroenterology. “White papers” are important, but societal data can be very helpful to our discussions on Capitol Hill. This is the first public recording of the numbers of fellows-in-training as well as of the growth of our Society and of the number of board-certified gastroenterologists. It allows us to see that if we continue our output of 547 trainees per year, we will probably double the total number of board-certified gastroen-

485

terologists by 1992. Health Maintenance Organizations utilize only one full-time gastroenterologist per 100,000members. Therefore, we now have enough board-certified specialists to care for a country of 400 million, using such a delivery system. We are gaining 1000 new board-certified specialists every 3 yr. What will we do with all these physicians? As expected, we are quite like our sister society, the ASGE (4) (Table 4). However, there are differences, and they are worth recognizing. It is also valuable to know the views of the membership on issues such as merger. These are not the only questions that need to be asked or answered. The members who responded with alacrity to requests for information deserve our thanks. Hopefully, the leadership will ask again, soon, and the membership will again respond in its characteristic thoughtful manner.

References Charles B. Slack, Inc. Executive Secretary, American Gastroenterological Association, 6900 Grove Road, Thorofare, New Jersey 08086. American Board of Internal Medicine, Agenda Book for the Meeting of June 18,1984. Snedecor GW, Cochran WG. Statistical methods. 6th ed. Ames, Iowa: Iowa State University Press, 1967. Frank BB. The 1983 A/S/G/E Membership Survey. 1. Member characteristics. Gastrointest Endosc 1984;30:206-12.