Reasons Given by California Physical Therapists for Not Belonging to the American Physical Therapy Association.

The American Physical Therapy Association (APTA) is the only national organization representing physical therapists (PTs), physical therapist assistants (PTAs), student physical therapists, and student physical therapist assistants throughout the United States. APTA provides a variety of services to members including, but not limited to, advocacy at the state and national levels, accreditation of professional (entry-level) physical therapist education programs, insurance and financial services, information dissemination, student scholarships, professional development, support for research, and publication of this journal.[1] APTA membership at the national level and APTA membership at the chapter level are simultaneous.

The APTA Membership Department reported that the percentage of licensed physical therapists in California who were members of APTA as of December 31, 1997, was only 22% (total number of members of the California Chapter of the Association/total number of licensed PTs living in state). California has the highest number of licensed PTs in the nation but was the third lowest state nationally in membership percentage in 1997, ahead of only Massachusetts and West Virginia. The APTA membership percentages in 1997 ranged from 4% in Puerto Rico to 66% in North Dakota, with a mean of 34% for all states (personal communication, APTA Membership Department, March 1998).

The lack of involvement in APTA--especially at a time when the future direction of the profession is changing rapidly in response to internal and external pressures--is a cause for concern to many APTA leaders and members. Substantive issues face the profession today, such as direct access, diagnosis by PTs, changing Medicare regulations, managed care, reimbursement concerns, and professional degrees (personal communication, California Chapter of APTA, Fall 1997). Because 78% of PTs who live in state and hold California licenses are not members of the California Chapter, this limits the Association's ability to be broadly representative of California PTs. Even if large numbers of PTs who hold California licenses no longer practice, it is still clear that a relatively low proportion of PTs in California are members of the Association.

An extensive literature search and telephone contact with both the national office of APTA and the California Chapter of APTA revealed no published research addressing the therapists' reasons for not joining APTA. In addition, no studies surveying licensed nonmembers were found. Our study was designed to obtain data on nonmembership. Our purposes were to identify the reason(s) given by the majority of licensed PTs in California in 1998 for not joining APTA and to compile a demographic profile of nonmembers. Although the material may not be generalizable to other states because of the high cost of chapter dues in California, the issues raised by the survey respondents bridge state limitations and seem to be issues that could have been stated by therapists in any location. California is the most populous state in the country and has the most licensed PTs. The issues that may be preventing colleagues from joining APTA should be of interest to all APTA members across the country.

Methods

Subjects

The subjects were a sample of 400 PTs licensed to practice in California who were not members of APTA. The sample was derived by cross-referencing a list of all licensed PTs in California with a list of California APTA members. The lists were supplied by the Physical Therapy Board of California and the California Chapter of APTA, respectively. The sample size of 400 was chosen using a sample size calculation for proportions based on a one-sample test.[2] The random sample was stratified by geographic distribution (in percentages) of PTs by county to ensure a geographically representative sample. Randomization ensured fairness of selection, not representativeness.

Instrumentation

A survey method was selected for reasons of efficiency, to maintain subject anonymity, and to provide standardization of question delivery to decrease the potential for bias due to interviewer interactions.[3,4] The survey was conducted in a cross-sectional manner over a period of 3 months. First mailings were done on the same day in September 1998, postcard reminders were mailed in October 1998, and second complete survey mailings were done in November 1998.

As part of the development of the survey instrument, a pilot study was conducted. The survey instrument used in the pilot study consisted of 2 open-ended, researcher-designed questions and a section requesting demographic data. The pilot study survey instrument was mailed in the summer of 1998 to the first 20 PTs whose names were randomly selected from the stratified cross-referenced list. An informed consent form and a postage-paid return envelope were included with the survey instrument. A follow-up mailing was done 2 weeks after the initial mailing to those PTs who had not responded to the first mailing.

There were 13 responses in the pilot study (65% return rate). The faculty researcher (SMM) analyzed these responses for emergent themes. The most common themes were used to derive strong, close-ended, declarative statements for the final survey instrument to provoke responses using a Likert-type scale. Possible responses ranged on a 5-point scale from "strongly disagree" to "strongly agree." The 5-point Likert-type scale was chosen instead of a forced-response scale because we believed we could use it to examine the relative importance of the issues presented to the surveyed therapists.[5] Clinicians and researchers with scale development experience having conducted multiple survey research projects and having taught survey research courses reviewed the final statements for clarity with respect to identification of the phenomenon of interest, clarity of the statements, conciseness, and relevance to the construct that the statements would enable us to identify reasons for nonmembership. Some redundancy of themes was built into the instrument for internal consistency. Response wording order was not reversed to avoid possible respondent confusion. The final survey instrument requested some demographic data to compile a nonmember profile.

Procedure

In September 1998, survey instruments were mailed to 400 PTs selected from a stratified random list of PTs licensed to practice in California who were not members of APTA. The geographic stratification was done by first identifying counties using the US Postal Service Zip Code Directory, then manually counting and determining the percentage of licensed PTs for each of the 58 counties in California. Then the sample of 400 PTs was allocated by this percentage over the 58 counties. A random table of numbers was used to select names from the numbered list of licensed PTs.[2] If the individual whose name was selected was an APTA member, the next higher-numbered PT who was not an APTA member was selected. The selections were listed by county until a county had its predetermined number of recipients. A cover letter explaining the purpose of the study and an informed consent form accompanied the survey instrument. A stamped return envelope was included with the survey instrument. A postcard reminder was mailed to nonrespondents 1 month following the initial mailing. A second mailing was sent to nonrespondents in November, 2 months after the initial mailing. All respondents were invited to provide their name and address on a separate page if they wanted to receive a copy of the results of the study. On receipt, secretarial staff separated the identifying page from the survey instrument to preserve the anonymity of respondents.

Data Analysis

Frequency distributions were calculated for all Likert-like scale responses and for demographic data. Means, standard deviations, and ranges were determined when appropriate. Although treating ordinal data such as Likert-like scale responses as interval data is well-established in psychology and other behavioral sciences, more conservative nonparametric procedures were chosen for our data analyses.[4,5] A chi-square analysis was performed to compare the responses to statements by gender and full-time versus part-time work status. Spearman rank correlation coefficients were calculated to determine any relationships between demographic data (eg, gender and work status). The Mann-Whitney U test was used to determine any differences in responses to the representation questions by the respondents who worked in that environment versus those who did not. All statistical tests were 2-tailed tests conducted at the P [is less than or equal to] .05 level, unless otherwise indicated. Data analyses were performed using the SPSS for Windows, version 9.0.(*)

Results

Response Rate

Out of the 400 survey instruments, 18 were returned as undeliverable, with no forwarding address. Of the remaining 382 survey instruments, 256 responses were received (67% return rate). Seventeen individuals received the survey instrument in error (they indicated they were current APTA members), and 5 survey instruments were returned unmarked, citing illness or other personal reasons for not completing them. This resulted in 234 usable survey instruments (61% of the 382 survey instruments). Not all participants responded to all items; as a result, sample subtotals varied from 204 to 234. Chi-square comparisons were made of responses from first and second mailings, with no differences observed. We believe that this finding demonstrates the stability of answers to the survey questions and no apparent response bias based on whether or not an individual responded to the first or second mailing. Eighty-nine percent of the respondents reported being previous members of APTA.

Demographic Information

Demographic data from the respondents are presented in Tables 1 and 2. Respondents reported practicing in 41 out of the 58 California counties. The percentage distribution of respondents by geography compared with the percentage distribution of licensed PTs by geography in California was within a few percentage points. This distribution demonstrated the geographic representativeness of the sample.

Table 1.

Demographic Data of Survey Respondents (n=232)

                                            Percentage of
                                            Respondents

Gender
 Female                                     79
 Male                                       21

Respondents who were:
 Working full-time (>35 h/wk)               48.5
 Working part-time (<35 h/wk)               41.9
 Not working as a physical therapis          9.6
 Employed by others                         78.9
 Self-employed                              18.1

Where respondents worked:
 Acute care/hospital                        34.5
 Ambulatory care/outpatient                 28.0
 Extended care/skilled nusing facility      26.3
 Federal/state/county                        6.5
 Home health care                           25.9
 Industrial rehabilitation                   8.6
 Private practice                           18.1
 Rehabilitation/subacute care               21.6
 School/preschool                            6.5
 Wellness/prevention                         1.3
Table 2.

Age and Years in Practice of Survey Respondents (n=232)

Age Range (y)                   Percentage of Respondents

20-24                            0.4
25-29                            9.7
30-34                           23.2
35-39                           16.7
40-44                           20.6
45-49                           11.4
50-54                           7.5
55-59                           3.9
60-64                           1.3
[is greater than or equal to]   5.3

Average age (y)                 41.2 (SD=10.9, range=24-80)

Years in Practice               Percentage of Respondents

1-5                             21.7
6-10                            23.1
11-15                           17.4
16-20                           15.2
21-25                           11.7
[is greater than or equal to]   10.9

Average years in practice       14 (SD=9.8, range=0-53)

In our sample, female PTs were less likely to work full-time and be self-employed than male PTs. Thirty-three percent of the male respondents reported being self-employed, whereas only 15% of the female respondents reported being self-employed. Eighty-three percent of the male respondents reported working full-time, whereas only 41% of the female respondents reported working full-time. Spearman correlation coefficients (2-tailed test) calculated for the gender and demographic questions revealed weak negative correlations between being female and working full-time (r=-.24, P [is less than or equal to] .01) and being female and being self-employed (r =-.20, P [is less than or equal to] .01).

Cost and General Benefit Items

Frequency distributions of the responses to all statements are shown in Tables 3 through 5. The survey statements with the stem "I do not belong to APTA because: ..." that generated the highest percentage of responses other than "no opinion" are shown in Table 3. Some responses appeared to be almost balanced, with equal numbers of those who agreed and disagreed with the statement. The location of district meetings appeared to be a concern to some respondents, with 29% agreeing that meeting locations are inconvenient and 33% disagreeing. Thirty-six percent of the respondents agreed with the statement that APTA member services are inadequate, whereas 32% disagreed. Thirty percent of the respondents agreed with the statement that APTA does not adequately address the continuing education needs of PTs, whereas 41% of the respondents disagreed with the statement.

Table 3.

Percentage Distribution of Responses to Survey: Cost and General
 Benefit Items

                                                  Strongly
I do not belong to APTA(a) because:       n       Disagree    Disagree

Geographic location of APTA district
 meetings is incovenient                  209     2.9         29.7

APTA-offered member services are          207     4.8         26.6
 inadequate

APTA does not adequately address the
 continuing education needs of
 physical  therapists                     204    6.9          34.3

Cost of national APTA dues is too high    215    0.9          4.2

Cost of APTA California Chapter dues      213    0.9          0.5
 is too high
                                          No                  Strongly
I do not belong to APTA(a) because:       Opinion   Agree     Agree

Geographic location of APTA district
 meetings is incovenient                  38.3      22.0      6.7

APTA-offered member services are
 inadequate                               32.4      28.5      7.2

APTA does not adequately address the
 continuing education needs of
 physical therapists                      28.4      24.5      5.4

Cost of national APTA dues is too high    6.5       27.9     60.0

Cost of APTA California Chapter dues
 is too high                              8.0       22.5     67.1

(a) APTA = American Physical Therapy Association.
Table 4.

Percentage Distribution of Responses to Survey: Representation Items

I do not belong to the APTA(a)                  Strongly
because:                                 n      Disagree   Disagree

APTA does not represent my concerns
 with national and state government
 agencies                                207    10.1       37

APTA underrepresents the interests of
 academic PTs(b)                         209     9.5       29.5

APTA underrepresents the interests of
 acute care PTs                          209     7.1       23.8

APTA underrepresents the interests of
 private practice PTs                    209     9.1       33

APTA underrepresents the interests of
 rehabilitaiton/subacute care PTs        206     7.3       27.7

APTA underrepresents the interests of
 long-term care PTs                      206     7.3       27.2

APTA underrepresents the interests of
 home health PTs                         207     6.8       25.1

APTA underrepresents the interests of
 my clinical specialty                   206     7.3       22.8

APTA underrepresents the interests of
 outpatient/ambulatory care and
 industrial rehabilitation PTs           206     7.8       27.2

APTA underrepresents the interests of
 wellness and prevention PTs             208     7.2       25.0

I do not belong to the APTA(a)           No                 Strongly
because:                                 Opinion  Agree     Agree

APTA does not represent my concerns
 with national and state government
 agencies                                33.7     13        5.8

APTA underrepresents the interests of
 academic PTs(b)                         47.1     10.5      2.9

APTA underrepresents the interests of
 acute care PTs                          53.3     13.3      1.4

APTA underrepresents the interests of
 private practice PTs                    46.9      7.2      3.3

APTA underrepresents the interests of
 rehabilitaiton/subacute care PTs        48.5      13.6     2.4

APTA underrepresents the interests of
 long-term care PTs                      47.6      15.0     2.4

APTA underrepresents the interests of
1 home health PTs                         50.7      15.9     1.0

APTA underrepresents the interests of
 my clinical specialty                   59.7       6.8     2.4

APTA underrepresents the interests of
 outpatient/ambulatory care and
 industrial rehabilitation PTs           51.9      10.7     1.9

APTA underrepresents the interests of
 wellness and prevention PTs             50.5      14.9     1.9

(a) APTA = American Physical Therapy Association.

(b) PT = physical therapist.
Table 5.

Percentage Distribution of Responses to Surveys: Action Items

                                                 Strongly
                                        n        Disagree    Disagree

APTA(a) should reconsider an inactive
 membership category                    214      0.5         4.2

APTA should offer a membership
 payment plan                           211      1.9         7.1

                                        No                   Strongly
                                        Opinion  Agree       Agree
APTA(a) should reconsider an inactive
 membership category                    23.4     40.7       30.8

APTA should offer a membership          21.8     38.4       30.3
 payment plan

(a) APTA = American Physical Therapy Association.

The next 2 statements on the survey instrument generated the strongest responses and agreement, and both statements related to cost. The responses to these statements (with the low numbers of "no opinion" responses) demonstrated a higher relative importance for these issues among respondents. With respect to national APTA dues ($245 at the time of the survey [personal communication, California Chapter office, Fall 1997]), 88% of respondents agreed (60% strongly agreed, 28% agreed) that the cost is too high, whereas only 5% disagreed. An even higher percentage of respondents agreed (67% strongly agreed, 23% agreed) that the cost of APTA California Chapter dues ($225 at the time of the survey) was too high, with only 1% disagreeing. A comparison of the responses of survey participants who worked full-time with those of survey participants who worked part-time demonstrated no differences for these 2 cost statements. When asked to select the primary reason for nonmembership, 88% of respondents indicated the high cost of national APTA or APTA California Chapter dues as the reason.

Representation Items

The frequency distributions of the primary representation statements are shown in Table 4, and they revealed that many respondents held "no opinion." Of those respondents who stated an opinion, disagreement outnumbered agreement by a ratio of about 3 to 1. Disagreement with the statements indicated satisfaction with APTA representation.

An analysis of responses to specific representation questions by respondents' corresponding practice setting utilizing the Mann Whitney U test revealed no differences in responses, except for those of individuals identified as practicing in home health care (z=-3.72, P [is less than or equal to] .00). Respondents who were practicing in home health care were more likely to agree (38%) with the representation statement "APTA underrepresents the interests of home health physical therapy" than were respondents who did not practice in home health care (9%).

Seventy-two percent of the respondents agreed with the statement that APTA should reconsider an "inactive membership" category for PTs who work part-time (Tab. 5). A comparison of the responses of survey participants who worked full-time versus those who worked part-time demonstrated that 84.1% of part-time workers agreed and 57.7% of full-time workers agreed with this statement ([chi square]=20.26, P [is less than or equal to] .009). Sixty-nine percent of the respondents agreed that APTA should offer a membership payment plan (at the time of the survey, the Association did not offer a payment plan for dues; APTA currently offers an installment plan).

Thirty-nine percent of all survey participants also wrote in response to the invitation to indicate other reasons for not belonging to APTA. Rather than adding other reasons, the written responses are consistent with the survey results and reinforce these findings. An analysis of the written responses for major themes showed that 66% were elaborations on cost issues, many relating personal stories. Reflecting on the national APTA dues costing $245 and California Chapter dues costing an additional $225 (personal communication, California Chapter of APTA, Fall 1997), one participant expressed "shock" at the cost of California dues compared with dues of other states. Another participant argued that, with more PTs, California should have lower dues because more people pay. For example, one respondent stated that she was a PT with a baccalaureate degree who at least yearly takes continuing education classes. She works for a PT with an entry-level master's degree who reportedly has not been to a course since 1985. After the move by the Association to support a postbaccalaureate entry-level degree, she stated, "I no longer felt they were representing my best interests." Another respondent stated, "I had to drop my membership when I was out of work due to pregnancy and haven't had the money to rejoin." Another respondent stated, "The APTA is far too expensive for a part-time PT or even a full-time PT to be affordable." Another working mother commented, "I work approximately 50 hours a year while I am raising small children. I cannot afford to pay dues while working only minimally."

Five respondents reported that while raising their families, they were working only part-time, and the cost of membership, in their opinion, was prohibitive when added to child care costs. Three respondents related that their dues had previously been paid by employers, but that was no longer the case, and they could not afford the dues. One respondent stated that with diminishing compensation for PTs, APTA should consider lowering dues. Five respondents indicated they might be willing to rejoin APTA if the costs were less. One of these respondents recommended that APTA do a cost analysis of what the gain in membership would be with lower costs and where the break-even point would be.

Twenty-five percent of the written comments defined representation issues (ie, identified areas of concern where they believed APTA did not represent their interests), including concerns regarding the professional degree in the profession, supervision of PTAs and PTA membership, and the perceived lack of effectiveness of APTA lobbying efforts. Three baccalaureate PTs expressed the belief that the APTA no longer represents their interests. The remaining comments revealed concerns about lack of perceived benefits of membership and criticisms of the physical therapy literature. Four respondents' statements questioned what APTA is doing currently. These respondents stated that if they knew what the Association was doing for them, they might be willing to join.

Discussion and Conclusion

We believe that our sample is representative of licensed PTs in California who are not APTA members. Although the results of our study may not be fully generalizable to other states, the information should be valuable to readers who may want to consider the variables that are affecting California PTs and whether they may be factors elsewhere. The primary reason identified in the survey for nonmembership in California was the high cost of dues. California has the highest state chapter membership dues in the country.[6] There was, however, overwhelming agreement among the survey participants that the cost of national APTA dues is also too high. There are other questions of representation, but the overwhelming issue cited is cost.

Survey respondents contended that some means needs to be found to maintain involvement in the Association of those PTs who do not practice full-time and for whom the cost of membership is, reportedly, prohibitive. This contention is apparent in the written comments of respondents who worked part-time and cited child care costs, family costs, and priorities as overriding their ability to pay dues. Four respondents suggested an option of receiving section journals instead of Physical Therapy to receive information with perceived clearer clinical relevance to their particular areas of practice.

We believe that the demographics of nonmembers warrant future study. Employment (full-time versus part-time) and practice patterns between nonmembers and active APTA members across the country may be different. Further study might provide the Association with information for how to target nonmember groups and present the professional association in a way more meaningful and relevant to their interests. In this study, the respondents seemed to practice in acute care, home health care, ambulatory care, extended care and skilled nursing facility, and school and preschool settings more than active members of APTA (personal communication, APTA Membership Department, August 20, 1997).

It seems especially important that 89% of the survey respondents, after once belonging to the Association, seemed to conclude that the value of APTA membership is not worth the cost. Although this prior membership may have been only while a student for some of the respondents, the experience of membership did not convince them of the value of membership in the professional organization. Only when APTA convinces them of the value of membership will they return to the Association. The professional association has recently initiated a new payment plan for dues,[6] an idea that found wide support in this study.

(*) SPSS Inc, 444 N. Michigan Ave, Chicago, IL 60611.

References

[1] Program Directors' APTA Resource Book. Alexandria, Va: American Physical Therapy Association; July 1997.

[2] Zar J. Biostatistical Analysis. Englewood Cliffs, NJ: Prentice Hall; 1984:380, 653-656.

[3] Creswell J. Research Design Qualitative and Quantitative Approaches. Thousand Oaks, Calif: Sage Publications; 1994:116-140.

[4] Portney L, Watkins M. Foundations of Clinical Research Applications to Practice. East Norwalk, Conn: Appleton & Lange; 1993:117, 153, 253, 273, 351.

[5] DeVellis R. Scale Development: Theory and Applications. Thousand Oaks, Calif: Sage Publications; 1991. Applied Social Research Methods Series, vol. 26.

[6] 2000 Membership Application. PT Magazine. 2000;8(7):24-25.

SM McGinty, PT, MS, is Director and Professor, Degree Program in Physical Therapy, California State University, Sacramento, 6000 J St, Sacramento, CA 95819-6020 (USA) ([e-mail]). Ms McGinty is also a doctoral student in education at the University of San Francisco. Address all correspondence to Ms McGinty.

MC Cicero, PT, is Staff Physical Therapist, Laguna Physical Therapy, Elk Grove, Calif.

JME Cicero, PT, is Staff Physical Therapist, Sutter Davis Hospital, Davis, Calif.

L Schultz-Janney, PT, is Staff Physical Therapist, Matrix Rehabilitation Inc, Santa Cruz, Calif.

KL Williams-Shipman, PT, is Staff Physical Therapist, California Children's Services, Bowling Green Medical Therapy Unit, Sacramento, Calif.

Mr Cicero, Ms Cicero, Ms Schultz-Janney, and Ms Williams-Shipman were students at California State University, Sacramento, at the time of the pilot study, and they completed this project in partial fulfillment of graduation requirements for the Degree Program in Physical Therapy, California State University, Sacramento.

All authors provided concept/research design, writing, and clerical support. Mr Cicero, Ms Cicero, Ms Schultz-Janney, and Ms Williams-Shipman provided data collection and fund procurement. Ms McGinty provided data analysis, project management, subjects, facilities/equipment, institutional liaisons, and consultation (including review of manuscript before submission). The authors thank the Physical Therapy Board of California for providing the list of California licensed physical therapists and the California Chapter of the American Physical Therapy Association for providing its membership list.

This study was approved by the Research Review Committee of the Degree Program in Physical Therapy and the California State University, Sacramento, Committee for the Protection of Human Subjects.

This study was supported, in part, by funds from the California State University, Sacramento, Student Academic Development Program.

This article was submitted August 11, 1999, and was accepted November 2, 2000.

Invited Commentary

The explanations that people give for what they have not done are often as revealing as their explanations for what they have done. McGinty and colleagues are to be congratulated for their exploration of the reasons that some physical therapists give for not belonging to the American Physical Therapy Association (APTA).

Their findings, at first, may seem quite simple--when dues are too high, people do not become members. Yet, the interrelationships among the data reveal a complex structure of attribution and belief. There is a contestable assumption that the reason offered by someone as an "explanation" of his or her behavior is also the cause of that behavior. Sometimes, a person will very carefully lay out a course of action based on beliefs, and certain beliefs may motivate a person toward acting in a certain way. However, a more accurate description of the day-to-day relationship between a belief and an action may be that the belief provides a logical context for the action and makes it rational (ie, "explains" it), but the belief does not cause the action to occur. Therefore a change in a belief may make an action more or less rational or logical in a particular context; however, it will not necessarily produce a change in behavior.

Although this may seem to be an esoteric exploration of motivation and behavior and may seem to be unrelated to membership in APTA, I note that an assumption of cause and effect is used both by respondents to this survey and by McGinty and colleagues. Nonmembers overwhelmingly cite the cost of dues as a reason for not belonging, an explanation of their behavior that is not at all surprising. We need only to look at the recent drop in APTA membership during the rise in unemployment of the past 2 years to know that there is a connection between economic well-being and membership. As the impact of the Balanced Budget Act has diminished in the last 6 months, membership has begun to grow again. The current membership dues for APTA and the California Chapter total a little more than a dollar a day. In the context of economic deprivation (eg, voluntary unemployment to raise a family or involuntary unemployment following a layoff), diverting even this small amount of discretionary income away from APTA dues toward other expenses is easy to explain. However, we should be careful to avoid a presumption that lowering dues will "cause" people to join. Lowering dues may only make it harder for some people to offer cost as an explanation of their decision not to join. (As an aside, it should also be noted that the majority of APTA members still do not pay their own dues, but rather receive membership as a work-related benefit,[l] Thus, fluctuations in membership may not reflect personal decisions as much as employer decisions.)

McGinty and colleagues are quick to note that many of their respondents are former members of APTA whose "experience of membership did not convince them of the value of the organization." This conclusion does not seem warranted by the facts of their study. Less than 20% of the respondents agreed or strongly agreed with the notion that APTA underrepresented any particular constituency. Furthermore, the proportion of respondents who either disagreed or held no opinion regarding statements of the "inadequacy" of APTA member services or continuing education was substantially greater than the number of therapists who agreed with these statements. One has to wonder what, if anything, would convince these nonmembers of the value of APTA? This is particularly perplexing, given that this survey explored only the direct benefits of membership. It is a common misperception that what one receives from membership in a professional organization comes chiefly through one's mailbox. Thus, it is not surprising that there are perennial suggestions to have "inactive" or "reduced" memberships for individuals who will forgo publications. This grossly underestimates what an organization such as APTA does. Can we really imagine the profession as we know it without APTA? Would there be licensure for physical therapists in 53 jurisdictions and in almost as many jurisdictions for physical therapist assistants? Would there be accredited education programs? Would there be any Code of Ethics or Standards of Practice for Physical Therapy? Would there be reimbursement for physical therapy services under Medicare and almost all private insurers? Would anyone be the voice of the profession on Capitol Hill or in the statehouses? All of these have been accomplished because of APTA membership dues, staff time, and member volunteers. There is no way to ensure that these APTA achievements accrue only to APTA members. Nonmembers owe a great deal to APTA as well--far more than $245 per year.

This study largely ignored one of its most intriguing questions; that is, the interrelationship between perceptions of a national organization and perceptions of its state affiliate. Except for the finding that respondents think that California Chapter dues also are too high, none of the items in this survey explored beliefs about the California Chapter. All of the items were directed at national activities. Nonetheless, this study demonstrates the value of directly asking the question, "How do you explain the fact that you are not an APTA member?"

References

[1] Member Opinion Survey. Alexandria, Va: American Physical Therapy Association; 2000.

Andrew A Guccione, PT, PhD, FAPTA Senior Vice President, Division of Practice and Research American Physical Therapy Association

Author Response

We appreciate Dr Guccione's thoughtful comments regarding our study. We did not mean to imply causality by the conclusions. We did intend to imply that there seems to be a strong relationship between the decision to not belong to the Association and the perceived high cost of membership.

The demographic makeup of our sample differed in several ways from the demographics of American Physical Therapy Association (APTA) members nationally.1 Forty-nine percent of the respondents in our sample worked full-time as physical therapists, whereas 78% of APTA members nationally worked full-time. Thirty-five percent of our sample worked in acute care, and only 13% of APTA members reported working in acute care. Twenty-six percent of our sample worked in home health compared with 11% of APTA members. These numbers suggest a different distribution of areas of interest and practice that may have influenced decisions regarding membership. We believe it is reasonable to assume that if cost were a major reason for nonmembership, as the respondents in our sample indicated, then physical therapists who worked part-time would be less likely to join the Association. We believe that our reasoning is consistent with APTA's statistics, which indicate that only 16% of members reported that they worked part-time; 42% of our sample worked part-time.

We did not find it surprising that most respondents had no opinion regarding areas of practice in which they were not engaged and of which they probably had no knowledge. We specifically chose to use a 5-point scale with a "no opinion" option to allow respondents to choose "no opinion" in an effort to establish the relative importance of the different issues addressed in the survey. Based on this rationale, cost was clearly the most important issue (only 7% and 8% of the sample indicated "no opinion" to the 2 cost statements compared with a range of 22% to 53% who indicated "no opinion" to the other survey statements).

We certainly did not mean to imply that the value of membership is only what we find in our mailboxes. We do think that APTA should consider offering reduced-cost memberships without publications. This change could have a positive effect on those physical therapists who indicated that they were married to other physical therapists and duplicate reading materials were not wanted. What several respondents requested was a choice of publications for members, specifically, section publications that they indicated might be more relevant to their practice. Whether these changes would lead to a change in membership status as our data indicate, however, can only be determined through future research or from changes in APTA policies.

We disagree that the survey was directed at national activities. The state chapters provide many of the services addressed in the survey at the state level such as services related to state licensure issues, practice protection from the encroachment of other professions, and services dealing with reimbursement issues related to state-mandated programs such as those in California (eg, California Children's Services, Medi-Cal, workers' compensation). The location of district meetings is certainly not a national issue, and continuing education is addressed at both the state and national levels. We agree that the interrelationship between perceptions of the national organization and state organizations deserves further study.

In addition, we think that critical inquiry into the comparative demographics of members and nonmembers is needed. This information might help the organization at the national and state levels to adopt strategies that address the needs of people who may be underrepresented in membership.

Reference

[1] Member Opinion Survey. Alexandria, Va: American Physical Therapy Association; 2000.

Susan M McGinty, PT, MS
Michael C Cicero, PT
Jessica ME Cicero, PT
Lori Schultz-Janney, PT
Kari L Williams-Shipman, PT