PHYS THER
Vol. 81, No. 6, June 2001, p. 1231
Invited Commentary
Andrew A Guccione
Senior Vice President, Division of Practice and Research
American Physical Therapy Association
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Introduction
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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.1 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 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?"
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References
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- Member Opinion Survey. Alexandria, Va: American Physical Therapy Association;2000
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Copyright © 2001 by the American Physical Therapy Association.
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