Southern Medical Association Qualitative Research

1. Southern Medical Association Qualitative Research November 2012

2. Why be a member? • Most members heard about SMA through colleagues or during their time as a resident, fellow, or medical student. • They decided to join for many reasons, including: • Free membership opportunities • Enticing insurance programs • Attractive multispecialty aspect • Relaxed and welcoming atmosphere • Attractive meeting and conference destinations • Specialty articles and educational materials (including CME’s) “I originally joined SMA because of the insurance programs, major medical and life insurance. The insurance programs were with major companies and major medical offered a number of deductible plans. Compared to my medical insurance at the time, SMA had better rates.” –Member “I liked the multispecialty aspect of it, as well as the locations of the annual meetings. The atmosphere was more relaxed and welcoming than some of the specialty societies I had seen before.” –Member “So as physicians we need to get about 25 hours a year and predominantly in our specialty as a neurologist and they had all of that for us and as the meetings would go on each year, there was a lot of camaraderie” – Internal Leader

3. SMA tradition is built on collegiality and bettering medicine “I like the idea that SMA members are a diverse group of medical specialists with differing opinions and perspectives.” –Member

4. But is it waning at SMA in our modern world? • They perceive the sense of collegiality may be waning and the organization may not be evolving to keep up with the changing needs of its members. • Website that is outdated in look, frustrating to navigate, and does not link members with one another • One annual meeting that often doesn’t fit in their schedule • No membership directory or way to reach out to other members • CME and meeting topics too focused on science and not on more clinical topics involving multiple specialties • Communications that are pushed to everyone rather than ones which pull those with similar interests together • “We used to pay an expert to come and talk and we sat in chairs and listened and that’s just too expensive and too time-consuming for today’s world. …Nobody has come up with a creative, interesting way to use the Internet to communicate. So, kind of need a genius there to come up with some ideas.” –Internal Leader

5. There is a visible gap between the thoughts of the Internal Leaders and General Members Members Internal Leaders SMA staff may need to help bridge this gap – • “Our role in the changing landscape of how to deliver medical care, especially with the Internet, needs to be carefully carved out so the doctor and patient benefit without the hazard of liability. SMA and SMJ can show us the way!” – Member • Have Ideas but not sure how to communicate them • Prefer smaller meetings • Quick and concise information • Online interactions • Public health awareness initiatives • Know things need to change but not sure how to proceed • Pondering a political advocacy stance to attract new members

6. Those benefiting from insurance offerings and the SMJ are most pleased with SMA membership • Some feel they have benefited greatly from certain aspects of the association, specifically insurance offerings and electronic versions of articles and journals. • “I have been happier with the Journal, the electronic version.” –Member • “I joined the SMA for the sole purpose of getting their group medical insurance. That is the only service I use and the only one I think that is beneficial to me.” –Member • A few members said they initially found value in a specific area of SMA and did not take advantage of other benefits until later in their membership. • “Membership was offered free to residents – it is that simple. I do not remember what I initially did with my membership, but over the years, I used side benefits like coding book discounts, Medjet [AirMed], and insurance.” –Member

7. Younger Members and those outside of private practice feel their expectations of membership are not being met • For others, SMA has not met expectations and feel resources are directed more towards older physicians (perhaps due to aging membership population) and specific specialties. • “I had initially hoped that the SMA would offer more information for a younger practitioner starting out, but at the time that I joined, it had evolved into a more established practice management.” – Member • “I don’t feel there is any emphasis on emergency medicine. The SMA seems to be targeted at office practitioners.” –Member • “I am sure there might be other benefits that I could use but many of them are not tailored to someone who does not need to worry about billing or practice management.” –Member

8. For Younger Members, SMA is missing the collegiality other organizations offer • They wish for: • Yearly influx of younger members coming out of residency • Opportunities for hands-on learning from older practitioners • Ability to present ideas and be heard at meetings • Ongoing interaction and the ability to bounce ideas off other members • Opportunities to be a part of guiding organizational efforts • Meeting topics and journal articles about navigating the first few years of practice • Short, quick CMEs on a variety of topics

9. Lapsed members leave SMA for a variety of reasons • Insurance benefits are now irrelevant – either hospital-owned or cost is too high • Time consuming – difficulty finding pertinence to offerings, longer meetings in far off locations, long scientific lectures • High cost of membership without clear advantage over other associations – many are unclear of where SMA fits with competitive state, national, or specialty associations • Unaware of all benefits of SMA – many used only one benefit and did not know of other aspects that would be beneficial • “The CME offering, there’s very little pathology. Every now and then there would be an online module that had some pathology related to it, but not very much. And just the journal itself, you know, the articles in it just, even though it was provided with the membership, the content of the articles or the range of topics for the articles weren’t very pertinent.” –Lapsed Member • “I belong to the American Academy of Family Physicians. I’m board certified and I feel like that’s my major resource as far as CME and keeping up to date and abreast on things. And it just seemed like I wasn’t referencing or using SMA as much and I just decided, really over the last year to just kind of let my membership lapse.” –Lapsed Member

10. Financial services are becoming less of a draw • As anticipated, financial services offerings are becoming less relevant to members. The offerings that attracted many to SMA are no longer a key reason to stay a member. • “Now as an employed physician, the SMA practice assistance offerings are not a resource I have utilized [recently].” –Member • “I think it’s an attitude of being an employee and not really being in charge versus having your own practice and wanting some net worth and develop your own plan for survival and success. Then you’re more likely to join groups like SMA, but if you’re employed and someone is telling you how you’re going to run your practice, what your goals are going to be, then you’re less likely to take initiative on your own.” – Key Member • Though the number of members in private practice is dwindling, there appears to be an increase in those operating as independent contractors who could benefit from the offerings. • Emergency room physicians we talked to are hungry for financial support services. • Even some urgent care physicians who are neither in private practice or in a hospital setting

11. Political advocacy – strong sentiments on both sides

12. SMA advocacy could be educational not political • A role more appropriately aligned with its mission: • Educational role – campaigns and information focused on raising awareness for public health and health education efforts • Non-partisan distiller of facts – a majority of physicians are searching for ways to become better informed about healthcare reform issues and have difficulty finding clear, concise facts free of hyperbole. Several suggest they would appreciate an organization that can summarize and clearly explain the facts behind healthcare reform efforts.

13. What content do Members and Non-members want to see? • When asked about the type of information they would like discuss, majority said universal and clinical. • Some examples given include: • Patient wellness • Team coordination • Pain management • Addiction issues • Female patient • Prevalence of specific diseases in the South • History of medicine • Physical exam techniques • Updates in certain fields Clinical “I think topics should be clinically relevant to maximize applicability to most members, who I suspect are clinicians and not basic scientists.” –Member Universal “Broad topics can bring in the most diversified groups, which are much more interesting when you have the opportunity to share your differing perspectives.” –Member

14. SMA communication is plentiful but rarely targeted • Most members feel inundated with communication from SMA. They have difficulty filtering through information and many admit SMA correspondence has become a bit like “white noise.” • “They have so much information that they have at their fingertips that they could organize it to be sent to only some groups and not others.” –Member • “I personally limit my email because of overwhelming unwanted information. When I want to know about something, I will look for it.” –Member • “I kept getting an abundance of correspondence from SMA, a majority of it was about insurance plans and other financial services which I already have covered by my hospital employer.” –Lapsed Member • Many comment that they would like target emails and correspondence so they know the information they are getting is of interest to them and easy to digest. • “I think that it is key to tailor the communication to the person you are trying to reach.” –Member

15. To be noticed, communication needs to be consistent, clear, and concise • Most participants agree they are more likely to read information that is: • Bullets or summaries that allow them to glance through the information quickly and retain the important highlights • Directs them to more information via a link or article about the topic • One member recommends a membership booklet that summarizes each benefit, has a renewal form, and gives information about costs and events.

16. Personal preferences vary for postal service or email • Those that prefer postal service mail want: • A monthly newsletter mailed with key information in a bullet-point format – they like a hard copy so they can share with their staff • “Pamphlets every few months sent by postal service so that I can browse at my leisure would be ideal for me. I get too much email already. With the pamphlet, I can share it with my staff and other physicians.” –Member • Meeting notices and brochures they can also share (this is even true for those that have an overall preference for email communication) • Updated reminder of member benefits and discounts with annual renewal • Others prefer an email or chat option and say they are best reached electronically. They hope for: • A bi-monthly update emailed digest of what is new with links to the specific articles on the website or in the Journal • An opportunity to search for and communicate with other members

17. Pushing Members to the website could be effective • A majority of members want to turn to SMA’s website for information. Though for some it is challenging to navigate, it is cited to be an overall more effective means of communication because they can search for the information they want, when they want it. • “I have never really felt that SMA does not do a good job of promoting its benefits, if anything , I sometimes feel a bit inundated with such information. I think the SMA website is an easy way to find out all you need to know.” –Member • They are looking for improvements in: • Overall look – graphics and colors – “Communication is a problem. I get more email than I care to get. Your website needs to be more attractive and friendly.” –Member • Ease of navigation • Linked to CMEs and Journal articles, ability to forward information on to others • Drop box approach to storing and sharing information with other members • Personalizing their membership needs – personal profiles, communication preferences, educational interests, expertise and speaking qualifications

18. The Southern Medical Journal What is working well Opportunity Areas • Many like the more recent content. • Topics relevant to the South • Available electronically and via print “I think there are some topics in the journal that are not covered elsewhere, like spirituality in medicine and things that are not considered hard science but still worth reading.” – Internal Leader • Format – cleaner look, look less research focused • Quick online access to article, ability to share easily • Offer free CME in conjunction with articles • Clinical information – more universal • Topics not covered in medical school but important now – health and wellness, etc. • Less research focused • Interesting case presentations • “The Journal needs to be more eye-catching • and look less research focused. It does not invite me to open the pages.” –Member

19. Conferences and Meetings What is working well Opportunity Areas • Meetings well worth the effort once there • Content for some has been on-point – especially primary care physicians • Non-members feel welcomed. • Shorter conferences – half-day sessions and limited number of days so they can take time off work without missing practice or family time • Varying topics each year – won’t come back if it is repetitive – “Same CME lectures each year, so they really didn’t change that much.” – Lapsed Member • Different locations – use this time as a vacation and do not want to go to the same place every year • Inspiring Facilities – that take on the flavor of the locale, trend away from mega convention hotels such as the Gaylord Hotels – “The Gaylord Hotels are too large and too spread out.” • Local or regionally based – speakers can travel to multiple locations to reach a wider audience • Interactive meetings – breakout sessions to get members moving – “The only problem is that when I went twice, 2 years apart, there was too much of the same material the second time so I didn’t find it as useful as I could have and have therefore decided to do something else this year.” –Non-member

20. Educational Opportunities What is working well Opportunity Areas • When a topic pertains to their sub-specialties. • Topics such as estate planning, practice management have provided good ideas for some. • Partner with other specialty organizations to bolster offerings • More opportunities to learn about a variety of topics • Updates to clinically relevant topics – pain management, HIV/AIDS, drug diversion • CMEs should be free, short, and easy to obtain • CMEs available on the website • Interactive CME opportunity • Ability to organize and store CME credits online • Offer sending CMEs to accrediting body when needed

21. Website What is working well Opportunity Areas • One-stop shop – can find information needed in one place • Can pay annual renewal on the site • Sweepstakes or incentive for joining and regularly logging on the website • Digested email with what is new with links to the website • Update look • Ability to personalize experience based on preferences • Job listings • More intuitive navigation • Catchy subject lines for articles and offerings “It is difficult to get a specific task accomplished on the SMA website.” –Member

22. Moving Forward

23. Keep in mind the “Highs” and “Lows” of an SMA membership

24. Learn from other organizations • Good balance of communication that is targeted and relevant • Members are not bombarded with marketing materials, but also are not left in the dark. • They only get information that is of interest to them. • Visually appealing and easy-functioning newsletter • Good graphics, vibrant colors, and a clear format • Centered around bullet points with links to more information so members can explore further topics that interest them. • Free, quick and specific CME’s • Many physicians will not participate in CME’s unless they are free, quick, and relevant to their practice. • Unbiased, evidence-based information • Information that is clinically focused and easy to understand

25. Facilitate frequent opportunities for conversation Members have great ideas!

26. The ideal organization in today’s world

27. Ideas for SMJ • Focus on Southern physicians • “The SMA journal cannot compete against journals like JAMA or NEJM. Articles have to be of local interest to the South.” –Member • Include information about what SMA is doing for its members • Advocacy, upcoming meetings, discounts, etc. • “The journal should also include information about what the organization is doing for its members i.e. any advocacy, upcoming meetings, etc.” –Non-member • Provide a summary of unbiased, non-political news highlights • Obamacare, cases affecting the South, malpractice reform, etc. • Many physicians comment that they don’t have time to read the news and would like a quick summary of updates periodically • Split the journal into sections • National, information vs. local or regional information; management vs. managed care; general vs. specialty, etc. • So readers can easily flip to section that is of most interest to them • One participant said he would like a joke or cartoon to lighten the mood • He gives an example of The Courtland Forum’s cartoons

28. Ideas for website • Simplify the homepage • Create clear, simple content with visually appealing colors and tabs • Model design and content after some of their favorite websites - USAA, AAA,ACEP, etc. • “Initial page should be fairly simple with clear links to various topics but made attractive with colors.” –Non-member • Make it more interactive • Animations, moving pictures, podcasts, videos, and links make the website easy to navigate and enticing to search through • “Topics of the Day” on the website. • Easy for physicians to quickly skim • Examples of topics include changes in Medicare, what is involved in ICD-10, reports about drugs/supplements/testing that patients may be hearing about on the news, etc. • Job listings on website • Enticing to young physicians especially • Have a directory of members

29. Ideas for website • Develop a syndrome Wiki • Although this may be difficult, one Internal Leader suggested this as a place physicians can turn to to find information • Provide a patient forum • Give patients a place where they can talk to another physician • Social media involvement • Especially attractive to younger members • “I think we’ve talked in council about being more involved in social media, maybe that would help us with our younger generation.“ –Internal Leader • Networking forum or online chat room • Physicians can seek advice with difficult cases (although may not be legally possible) • Gives them a place to discuss politics • Use promotions to encourage online involvement • “Perhaps advertised by occasional promotions, door prizes or sweepstakes like prizes, available regularly or perhaps advertised by sporadic, brief email.” –Member

30. Ideas for conferences or meetings • Have some conferences on a local level • “I think maybe the future would be, maybe even more conferences on a state or local level.” –Internal Leader • Half-day conferences in family-friendly locations • “We’ll have to think outside the box and maybe think about places that are easy to get to and things, places you come in for a day maybe rather than have to stay overnight. Try to tailor it to people’s needs.” – Internal Leader • Many comment that they would go more often if they could spend a lot of time with their family • Many said the New Orleans and Florida conferences were their favorite. • “I guess somewhat as far as the schedule, I like to usually have the conference in the morning until early afternoon and then give you the rest of the day off. That’s important.” –Lapsed Member • Provide lunch • “Having meetings at desirable locations, 3-4 day conferences during the week that are half-day or just over half-days. Or you could have some full days and provide lunch.” –Non-member • Offer discounts • “You could increase membership if you offered discounts to join if you attended a conference.” –Non-member

31. Ideas for attracting younger members • Student SMA on medical school campuses • “Well there’s a student AMA. I don’t know if there is a student SMA. That might be something we should look into.” –Internal Leader • Be a source of information about local help when setting up a practice • Provide statistics on practice types in specific areas • Continue free or discounted memberships to residents, fellows, and students • Have someone available to answer young physicians’ questions • “Having online focus groups, a topic of discussion, or being able to ask questions and possibly having a more experienced physician answer would be nice. Even for all levels of expertise.” –Member

32. General recommendations • Local meetings for different specialties • A few physicians commented that they would attend state or local meetings more often if SMA had certain nights devoted to specific specialties. • Communication preference box on application • Sections to check how they prefer to receive information, how often, and what topics they are most interested in • Information booths available at meetings • Gives physicians the option to talk to an SMA representative in person • Consider insurance options not readily available • Many participants mentioned they would purchase malpractice insurance through SMA if it became available. • Update on topics that explain current events in medicine without taking a political stance • Many physicians would love a place to get accurate information that is not politically skewed. • Partnering with other medical associations

33. Prioritizing Efforts Smarter Communication • Smart communication amongst all levels of leadership, administration, and staff is a top priority. With more ideas come more answers. • Do not shy away from more frequent conversations with members and lapsed members – what do they want in the organization? How can SMA deliver on those needs? • Look for ways for state councilors to meet and speak with members and potential members • Target communications to become relevant • Update electronic means of communication for efficiency and for connecting members virtually

34. Prioritizing Efforts Re-think meetings and conferences • Re-think meetings and conferences to capture a larger population • Topics should focus on clinical topics delivered in a manner that allows for plenty of interaction • Look for ways to offer shorter meetings that are more regionally based • Partner with other organizations to extend SMA’s visibility and the perception that more opportunities for learning exist • Consider new venues and meeting locations

35. Prioritizing Efforts Do not lose sight of reasons to belong • Do not lose sight of what makes SMA different. SMA’s tradition is built on collegiality and bettering medicine. These traditions are not only the reasons why members initially joined, but also what retains them. • “Could the SMA present itself as an organization that’s very important in terms of networking and services and education to the physicians who would identify themselves within their practice, within their community as saying ‘I know I need to be educated about this. I may not be the bean counter, but I need to know enough about how beans are counted to be able to say whether this is legitimate or not. I may not be the expert in putting together a clinical guideline, but I’ve got some ideas in my back pocket about how it’s done and how you improve quality in a quality way.’ I just think it’s a real opportunity, there’s no other organization that’s really in there doing that.” – Internal Leader