Committee on Membership April 21-22, 2012 Executive Summary There is increasing attention and focus within the AAP

on ensuring that AAP remains relevant to members in a rapidly changing healthcare environment. The AAP Board of Directors dedicated a significant portion of its January meeting to discussing member value and will do so again in May. The current state of membership exemplifies the need for more focused attention throughout the volunteer and staff leadership of the AAP, and exploration of new models. Overall membership growth in numbers has been flat for the past three years. During this same period market share of board certified pediatricians who are AAP members has declined. Current market share of board certified pediatricians is 63%, down from 64% one year ago, and 66% two years ago. Current market share of sub-boarded subspecialists is 47%, down from 49% last year, and 51% two years ago. The market share decline appears driven primarily by weakness in young member recruitment and renewal. The number of medical students matching into pediatric residency and eventually going on to take and pass the ABP exam has been unabated. Consistent for many years, each year 3,300 pediatricians leave residency to pursue their career paths. Overall, AAP is successful in transitioning only 49% to membership. Over time this has led to a decline in market share, and a swell of newly or recently boarded pediatricians who are not members. In the last five years this number has swelled to over 8,000. This population of young members has been approached over a dozen times, with varied marketing messages and approaches, but has proven extremely resistant. Positive gains have been achieved in Chapter and Section membership compared to last year, with the number of chapter members increasing 9.5% and Section membership increasing 5.5% respectively. These increases are attributable to chapters and sections paying more attention to messaging about value and importance of membership. There has been much focus and attention in past years on AAP data systems struggling to maintain reasonable business performance against industry benchmarks. Several consecutive upgrades to the Net.Forum system were completed this year and appears to have been very successful through phase 1 of this process. With basic data functions addressed, attention is now turning to the Online Payment system, and the Chapter Membership System. AAP Membership 2015 and Beyond The Committee on Membership engaged in a strategic review of each part of the membership pipeline, and each category of membership, to discuss changes in the market and environment in which members are operating, changing needs, and how the AAP will need to adapt to remain relevant. Overall, there was a clear consensus on two themes through each discussion: First, healthcare delivery models, particularly the percentage of members becoming employed is a major game changer for membership strategy. Individual AAP product lines were noted to have benefited greatly by leveraging this shift and selling group site licenses and access to

various AAP products. There was very strong consensus that AAP needs to build membership into this successful business model, as the potential exists for business success to come at the expense of diminishing member value. The COM recommended that the AAP move quickly to develop an integrated member benefit and pricing model for groups that promotes and incentivizes membership as desirable, or they fear membership will become completely unnecessary and obsolete. The DOM has contracted with an association membership consultant to benchmark group models across medical societies and to help facilitate discussion of what a group or hybrid model may look like in the AAP. DOM staff was asked to reach out aggressively to colleagues throughout the AAP to catalyze this discussion. Second, traditional models of membership marketing simply are not yielding the same results as in past years. The Board and AAP will need to develop and invest significant resources to change the marketing model. The COM members believe that once the member value models are developed, an intensive ground campaign, mobilized through the Districts, will be needed to orchestrate visits to academic centers, health systems and community practices to emphasize the importance of membership and engagement in the AAP. DOM staff was asked to develop a draft proposal for consideration inclusive of revenue potential, expense and ROI, at the May ACBOM meeting. As the Committee reviewed each stage of the career pipeline, dozens of creative, excellent ideas were generated with a request for follow-up discussion. The following outlines a few of the key recommendations and actions from the discussion that will proceed to ACBOM in May: Proposed Potential Bylaw Changes Recommendation: That Fellowship Trainees who have taken and passed their general pediatrics board exam be allowed to vote and have all rights and privileges as Fellows while they continue to pay an in-training dues rate. Recommendation: That the AAP establish medical student membership as a national membership category rather than a section affiliate membership. Recommendation: That the AAP address the Emeritus transition issue with either, or a combination of, eligibility change to 70 years of age and tiered dues pricing. Recommendation: That the AAP expand membership criteria for Resident Member to include residents in i-ACGME accredited programs. Action: Discuss with the SOMSRFT to determine linkage to resident section of international residents. Proposed Actions on Strengthening and Moving on Member Value Action: That DOM staff meet with leaders in relevant AAP Sections and Departments to prioritize ideas, and develop a short and long range plan to address resident awareness of AAP member value. An update will be presented to the COM and AAP Board at their Fall meetings. Action: That DOM staff work expeditiously with Department leaders in the AAP and McKinley Advisors to develop a group model or hybrid approach for consideration and decision-making by the time of the Fall COM meeting and AAP Board meeting.

Action: That the DOM staff convene meetings with relevant Departments to examine existing pricing structures for site licenses, including the Digital Portal, and work to ensure membership in the AAP is strongly incentivized. Action: That DOM staff meet with staff in the DOE-DOMS to review and prioritize ideas to strengthen member value at the NCE, develop a plan and report back to the COM in the Fall. Action: That DOM staff meet with the DOC to develop an organization-wide member valuemessaging and social media strategy, and present to the COM in the Fall. Action: That the DOM staff develop and present a budget proposal to the Board in May to conduct extensive on the ground recruitment of lapsed members that balances revenue potential against required investment with a projected ROI. ALF Resolutions There was significant discussion regarding 2012 ALF resolutions 54 and 55SC, relating to improving chapter membership growth through discounting national dues and conducting a pilot to unify national and chapter dues, respectively. It was evident from the discussion that there is strong support and consensus that chapters are a valuable asset and key component to accomplishing the work of the AAP. There was not unanimity or strong consensus that either of the two resolutions were the strongest options to consider in strengthening national-chapter relations or working relationships. As it is considered an opportune time to assess the way the world is changing around members and the AAP as it relates to member value, several COM members and staff suggested it was also an opportune time to evaluate whether the existing model of chapter-national relations is a viable working model for the future. It was noted the resolutions are proposed treatments to address urgent symptoms the chapters are perceiving, but neither may be addressing larger underlying issues and questions being raised about the current national-chapter structure. It was noted that while implementing both resolutions may potentially resolve a short-term issue for certain chapters, even greater problems and challenges may be created for sections, or for national. The Committee on Membership noted its support for these resolutions in concept and principle, but before proceeding or advocating for implementation, felt it was important for the AAP Board to find a vehicle to surface and address the larger underlying issues. As such, the COM made the following recommendation (which was not unanimous): Recommendation: That the Academy establish and convene a work group comprised of Academy staff, chapter EDs, and national and chapter leaders to discuss the overall structure and culture of national-chapter relations, and map out the details of a potential pilot to evaluate the need for national/chapter restructuring of dues and working relationships. As well as the following corollary actions: Recommendation: That the district representatives of COM be supported and funded to attend the summer district meetings and the SAP representative of COM attend the ALF. Action: That the district meeting agendas include time to collect input from the chapters on critical components of such a pilot.