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  • 1. 1/9/03 Page 1 of 1 A Snapshot of Pulmonary Medicine at the Turn of the Century: the American Thoracic Society Membership Lynn M. Schnapp MD1 , Melissa Matosian2 , Idelle Weisman MD3 , Carolyn H. Welsh MD4 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA 2 Former Director, Membership Services & Marketing, American Thoracic Society, NY, NY 3 Dept. of Clinical Investigation and Pulmonary Critical Care Service, William Beaumont Army Medical Center, El Paso TX 4 Pulmonary Division, Denver VA Medical Center, Denver, CO, University of Colorado Health Sciences Center, Denver, CO. Address correspondence to: Lynn M. Schnapp MD Box 359640 325 Ninth Ave Harborview Medical Center University of Washington Seattle, WA 98104 lschnapp@u.washington.edu ATS membership survey Subject category: 155: professional education and training Word count: 2,988 This article has an online data supplement, which is accessible from this issue’s table of content online at www.atsjournals.org Copyright (C) 2003 by the American Thoracic Society. AJRCCM Articles in Press. Published on January 9, 2003 as doi:10.1164/rccm.200203-186OC
  • 2. 1/8/03 Page 2 of 28 ABSTRACT To describe the characteristics of the American Thoracic Society, the Membership Committee developed a survey to assess demographics, training, professional activities and needs of a diverse membership with a growing international segment. It also provided an opportunity to determine how the Society reflects the current state of pulmonary medicine in the United States. A self- administered survey was mailed to active members. Of responding members, 80% reside in the US or Canada; the remainder come from 90 different countries. The majority of North American respondents (1%) were white, non-Hispanic. Seventeen percent of respondents were female. Female respondents were younger with mean age of 42 years, compared to 47 years for males. Sixty-five percent of respondents identified clinical practice, 20% research, and 5% teaching as their major activity. More women (33%) than men (22%) identified themselves as researchers. The majority of respondents (69%) have a medical school faculty affiliation. The American Thoracic Society represents a global organization with diverse clinical expertise and scientific interests. The majority of respondents are clinicians; however, the membership has a strong academic bent with most reporting academic affiliation, and describing teaching as a secondary activity. Keywords (MESH): questionnaires, career choice, pulmonary disease (specialty), medical faculty
  • 3. 1/8/03 Page 3 of 28 INTRODUCTION A century ago, practice in pulmonary medicine was primarily that of diagnosing and monitoring infection. Tuberculosis was rampant, and infectious diseases were common killers. The American Thoracic Society, originally named the American Sanatorium Society, was formed at the turn of the nineteenth century, in 1905, as a division of the American Lung Association and focused on the medical aspects of tuberculosis (1). In 1960, the name of the society was changed to its current one to better reflect clinical practice (2). In recent years, the Society has expanded its scope of activities to meet the needs of its growing international membership and to encompass areas including critical care, sleep, nursing, and behavioral science. In 2000, the American Thoracic Society became an independently incorporated society. At that time, the American Thoracic Society conducted a survey of its membership to understand better the changing demographics and activities of the membership. The survey was designed to obtain information about the demographics, work practices, and areas of specialization of members, as well as to elicit responses regarding the satisfaction with the Society activities. This represents the first comprehensive survey of pulmonary physician practices, and includes both United States and international members.
  • 4. 1/8/03 Page 4 of 28 METHODS Survey Development: The ATS Membership Committee was charged with developing a survey to address issues related to demographics, training and professional activities, type of practice, and faculty affiliation of its membership. In November 1998, Phase I of the ATS Membership Survey was initiated. A 6-page, self-administered survey was sent to 13,598 members (3,113 international, and 10,485 United States and Canada). A reminder postcard was sent three weeks after the initial mailing, and a second mailing was sent to all non-responders one month later . Survey replies were accepted through April 1999. At the completion of Phase I, a preliminary data analysis was conducted. From this initial analysis, thirteen items were deleted from the questionnaire in an effort to increase the response rate and the revised questionnaire was mailed out to non-responders (Phase II). Results from the Phase II data collection was similar to the Phase I data and thus the data were pooled. The questionnaire was divided into the following issue areas: Training and Professional Activities, (8 questions), Member Benefits (5 questions), Postgraduate and Continuing Medical Education (2 questions), Annual International Conference (4 questions), Journals (2 questions), Technology (5 questions), Overall Satisfaction (3 questions), Demographic information (4 questions), and a section with questions specific only to the international members (7 questions). For complete set of survey questions see Figure E1 in the online data supplement. Statistical Analysis: The responses were analyzed using SPSS for Windows, version 10 (SPSS, Inc. Chicago IL). Data were scanned and entered in an Access database by Survey and Ballot Systems, Inc. (Eden Prairie, Minnesota) and then converted to SPSS data sets. Demographics, work setting, practice information and board certification data were analyzed with a descriptive program. The chi-square test was used to test gender-specific comparisons and compare North American (USA
  • 5. 1/8/03 Page 5 of 28 and Canada) to International responses with a two-tailed test for significance (3). A Fisher exact test was used when appropriate.
  • 6. 1/8/03 Page 6 of 28 RESULTS From combined Phase 1 and Phase 2 mailings sent to the 13,598 active members in the organization at the time of the survey, 126 were returned undelivered, and 6,973 responses were received for the final analyses . An initial 5,660 surveys were returned (42.0% response rate) with Phase 2 yielding an additional 1,313 responses out of 7,938 surveys sent (16.5%) for a total response rate of 51.8% (6,973/13,472) .A complete set of responses is available on the online data supplement Demographics: Nineteen percent (n=1320) of survey respondents were from the international community, and 81% were from North America. The international members of the Society come from more than 90 different countries in all continents except Antarctica. Ethnicity was analyzed for the North American members only. Self-classification of ethnicity of North American respondents showed that the majority of members (79%) were white, non-Hispanic (Table 1). Eighty-three percent (5,566) of respondents were male and 17% (1,116) female. Female members were younger than male members with a mean age of 42 for women and 47 for men. The majority of the membership (51.6%) was between the ages of 40-54 years old (Figure 1). The survey asked members to categorize their principal professional activity, defined as more than 50% of time in that activity. Sixty five percent of respondents listed clinical practice as their major activity (Figure 2). Twenty percent identify themselves as primarily researchers, either in basic science or clinical research. When analyzed in terms of gender, women were more likely to identify themselves as researchers than men (p<0.001) (Table 2). The principal activities of International members were not statistically different from US/Canadian members (see Table E25 in the online data supplement.). Teaching was considered a primary or secondary activity for 69% of
  • 7. 1/8/03 Page 7 of 28 respondents. Thus, although the majority regard themselves as clinicians, society members retain an educational and academic orientation to their careers. We next assessed whether age was associated with career choice differently for men and women. The percent of men identifying themselves as clinician is the same for those younger than 45 years (78.1%) compared to men at least 45 years old (78.5%) (p =0.743). In contrast, for woman younger than 45 years, 69.6% identify themselves as clinicians, whereas for woman older than 45 years old, a smaller proportion, 62.5%, identify themselves as clinicians (p=0.039) (Table 2). Thus, younger women are more likely to identify themselves as clinicians than their older counterparts. Training and certification: As expected, the majority of members hold an MD degree or its equivalent. Only 11.7% of responding members were not physicians. Nurses represent 1.4% of respondents (n=97). Fifteen percent of respondents have the PhD degree. Of these, 8.0% have MD/PhD degrees, 6.3% have non-nurse/non-MD doctorates, and 0.4% are nurse PhDs. To understand the prior training of our physician members, we asked about primary and secondary board certification. The primary specialties listed for the majority of physician members are internal medicine (74%) and pediatrics (14%). Other primary specialties include surgery (1.6%), anesthesiology (1.5%), pathology (1.1%), preventive medicine (1.0%), family practice (0.5%), physical medicine and rehabilitation (0.3%), and radiology (0.3%). The secondary (subspecialty) certifications for members are listed in Table 3. Members have subspecialty certification in numerous areas with many members having subspecialty certification in more than one field. As expected, physician members are most likely to identify their area of practice as pulmonary medicine, including critical care (78%). Critical care medicine and sleep medicine are relatively
  • 8. 1/8/03 Page 8 of 28 new areas of subspecialization. To assess the impact of these areas on physicians’ clinical activities, we asked what percentage of time physicians spent in those areas. The majority of physician members (77%) spend some time in critical care medicine although only 14% spend more than half of their time in critical care (Table 4). The time currently spent in sleep medicine is more limited, with 90% of clinicians spending less than 25% of their time in sleep medicine and only 2.3% spending more than half of their time in sleep medicine (Table 4). Work Setting: Work setting was assessed for members, and analyzed according to geographical and gender differences (Table 5). Significant differences in practice setting were noted for both criteria. International members were more likely to practice in a university setting than North American members 39.6% vs. 31.5%, p<0.0001). Female members were also more likely to practice in a university setting than male members (41.5% vs. 31.6%, p<0.0001). Consistent with the majority of respondents reporting teaching as a primary or secondary activity, 69% of respondents report faculty affiliation with a medical school. This number includes full and part-time salaried faculty as well as volunteer faculty. Overall faculty affiliation rates are higher for international members than for North American respondents and there are differences with respect to faculty rank. Specifically, for North American respondents, there are proportionately fewer full professors compared to international respondents (25% vs. 30%, p < 0.0001). For North American and International respondents, fewer women than men have reached the full professors level (12% vs 28.6%, p< 0.0001) (see Table E24 in the online data supplement). For both groups, there is a gender discrepancy at the assistant professor level with 41.1% of women and only 29.9%
  • 9. 1/8/03 Page 9 of 28 of men holding this rank (p < 0.0001). Similarly, proportionately more women are at an academic level junior to assistant professor (20.5% vs 14.6%, p < 0.0001). Technology We determined member access to different technologies. The overwhelming majority of respondents use a computer, either at home or at work (Table 6). International members were more likely than North American members to use a computer only at work, (29.8% vs. 20.1%) (Table 6). Internet access and email capability are common, with > 90% of total respondents reporting access to both, although international members were less likely to have either (Table 7). Overall, the preferred method of receiving communication from the American Thoracic society was mail (67%). However, when responses were analyzed by location, there were significant differences with respect to how respondents preferred to receive communication. For US members, 65% preferred mail and 30.9% preferred email; for international members, 46.4% preferred mail while 44.8% preferred email.
  • 10. 1/8/03 Page 10 of 28 Discussion: The response generated from this survey, the first survey of practitioners of pulmonary and critical care medicine, provided the American Thoracic Society with valuable insight into the needs of Society members. Not only were opinions on Society services, publications, and meetings compiled but the survey has also provided detailed demographics, training, and practice information as presented here. A strength of this survey compared to similar surveys of other physician groups is the inclusion of a sampling of both North American and international members. Other surveys of professional organizations have examined US members, Canadian members, or European members, but such surveys have not compared data across nations (4-10); this survey is unique in this regard. Our findings illustrate that ethnicities other than Caucasian are under-represented in the North American membership. In particular, African-American membership is sparse, as African- Americans comprise approximately 11% of the US population, but only 1.5% of the ATS respondents. This low percentage of minorities is not unique to pulmonary medicine. Overall, African-Americans represent 2.6% of all physicians in the US. Only 3.6% of physicians in internal medicine, 2.2% in pulmonary diseases, and 1.5% in neurology are African-American (11). The lack of minority physicians has important ramifications since minority physicians are more likely to provide medical care for minority patients and underserved populations (12-15). Current data indicate that minority students are selecting careers other than medicine (16,17). If so, the paucity of minority members in the ATS will persist for a long time. To improve this, recruitment strategies such as targeting prospective students with an interest in medicine at a high school, college, and medical school level, focusing on mentorship support during pulmonary training, and promotion of monetary support/scholarship programs are needed.
  • 11. 1/8/03 Page 11 of 28 The mean age of the membership is young, which may reflect this as an organization with a younger age than the majority of physicians in practice. In particular there is a preponderance of females in the younger age groups, consistent with the younger age of women physicians in the United States. According to the American Medical Association (AMA), females currently comprise 22.8% of all US physicians (177,030 of 777,859) (12). Per the AMA database, 45% of US physicians are older than 45 years (mean age 47.5 years), but 65% of female physicians are younger than 45 years and only 39% of male physicians are younger than 45 years (11) Women comprise a small proportion of pulmonary physicians. As of 1999, 11% of board-certified pulmonary physicians in the US were women (direct communication, American Board of Internal Medicine). American Thoracic Society respondents, however, show a higher percentage of women (17%). There are several possible explanations for this: first, our membership may reflect younger physicians, where the percentage of women is higher. Secondly, women may have been more likely than men to respond to the survey. However, the percentage of women respondents is identical to the percentage of women in the ATS membership database. Thirdly, non-physicians within the society may skew these proportions. However, non-physicians account for a small proportion of respondents (11%). Although women comprise 17% of American Thoracic Society membership, they appear to be entering pulmonary specialization from internal medicine at a lower rate than women completing internal medicine residency programs. In 1998-1999, 23% of the first- year fellows in pulmonary/critical care were women while in 1997-1998, 35% of internal medicine graduates were women (18). Investigation into subspecialty choice of women residents may be informative. In terms of academic position, results of the survey show that a lower percentage of women are full professors than men, despite the fact that older women were more likely than comparably aged men
  • 12. 1/8/03 Page 12 of 28 to identify themselves as researchers, particularly for the North American members. The lower success rates of women in scaling the academic ladder are similar to other reports of women physicians and women scientists (6, 19-23). A recent cohort study of medical school graduates showed that women pursue an academic career more often than men, however the number of women who advanced to associate and full professors was significantly lower than expected (19). In 1987, the first added qualification was offered in critical care medicine. In 1994, as an indication of the increasing involvement of pulmonary physicians in critical care medicine, the official journal of the American Thoracic Society changed its name from the American Review of Respiratory Diseases (1959-1993) to the American Journal of Respiratory and Critical Care Medicine . Although the majority of our members spend some time in the critical care field, few spend the majority of their time doing critical care. This may represent self-selection of our membership: pulmonary physicians who spend the majority of time in critical care medicine may choose membership in other professional organizations such as the Society of Critical Care Medicine. The same may hold true with physicians involved in sleep medicine; physicians with a strong interest and concentration in sleep may select other professional organizations. Sleep medicine is also a relatively new field of study with a board certification first offered in 1978. Of interest, in 1990, only 54 of 320 (17%) professional recruitment advertisements in the then American Review of
  • 13. 1/8/03 Page 13 of 28 Respiratory Disease requested sleep expertise; in 2000, 187 of 397 (47%) advertisements in the American Journal of Respiratory and Critical Care Medicine requested sleep expertise. It will be of interest to track practice activities over time to determine whether the areas of sleep and critical care medicine become the domains of a select group of pulmonary physicians or whether these areas will be integrated into a general pulmonary medicine practice. The rapid growth of computer-based communication and electronic transfer of information is evident in access to these technologies by the respondents. The use of technology by respondents parallels increasing use throughout the US. As of 2001, 56.4% of all US households owned a computer and 50.4% had Internet access. For households with incomes >$75,000, 89% owned computers, and 85.4% had Internet access (24). Despite the prevalence of Internet and email access, the majority of respondents preferred mail as the method of communication. As Internet use continues to grow at a record pace (25, it will be important to determine if electronic communication is embraced by more members over time. There are a number of potential biases to these data. First, surveys employ self-reporting which may be less accurate than observational studies. The response rate for the survey at 52% was comparable to other large sample surveys looking at a minimum of 1,000 physicians [26,27,28]. However, non-responders may have different characteristics from responders. We attempted to validate our results by comparing responses from Phase I to responses obtained from Phase II. Identical results were obtained from both phases, which suggests that non-responders may be similar to responders. Furthermore, other studies of physicians have shown that survey responders and non-responders share similar demographic profiles perhaps because physicians are a more homogenous group than the general populations (26,27,28). We also compared the survey demographic data to the ATS membership database and found similar breakdown of gender, age,
  • 14. 1/8/03 Page 14 of 28 ethnicity, work settings, principal activities and board certification, suggesting that the survey responders are representative of the current ATS membership. For North American members, American Thoracic Society membership might be considered representative of board-certified pulmonary physicians. Within the United States, this is a reasonable assumption as the American Thoracic Society membership represents 85% of the 9102 board certified adult pulmonary physicians (direct communication with American Board of Internal Medicine, 1999 data). There have been many changes in medicine during the last century, including development of the specialty of pulmonary medicine and the formation of the American Thoracic Society. The number of pulmonary physicians has dramatically increased in the past century, and the focus of clinical activities has continued to expand and evolve. The survey has provided a snapshot of the current activities and practices and demographics of pulmonary physicians. Some of the findings, such as the lack of ethnic diversity, small numbers of women choosing pulmonary or critical care medicine compared to internal medicine and slow academic progression of women illustrate findings that are similar to those reported in other professional societies (9,10,29,21). Other findings such as the strong educational ties of the membership were gratifying, suggesting that clinical and academic endeavors are important to ATS membership. With the large number of international members and members in numerous subspecialties, we are an increasingly diverse group. Knowledge of the membership facilitates strategic planning for the Society. The organization can be strengthened by focusing on the clinical interests of its membership, and by improving representation of minorities, women, and international members. In addition to identifying the current demographics and activities of our members and by extension, pulmonary physicians, the survey results provide a benchmark to measure changes in the profession as we continue into the twenty-first century.
  • 15. 1/8/03 Page 15 of 28 Acknowledgements: We thank Drs. Beth Kolko and J. Randall Curtis for advice and review of the manuscript, and Chris Keron for statistical expertise. Current address for Melissa Matosian: Manager Ovation Research Group 600 Central Avenue, Highland Park, IL 60035 mmatosian@ovation.org
  • 16. 1/8/03 Page 16 of 28 References 1. Wilson JL. History of the American Thoracic Society, Part I. The American sanatorium association. Am Rev Resp Dis 1979; 119: 177-184. 2. Wilson JL. History of the American Thoracic Society, Part III. The American Thoracic Society. Am Rev Resp Dis 1979; 119: 521-530. 3. Bland, Martin. An introduction to medical statistics, third edition. Oxford: Oxford University Press; 2000. 4. Dresler, CM, Padgett DL, Mackinnon SE, Patterson A. Experiences of women in cardiothoracic surgery, a gender comparison. Arch Surg 1996; 131: 1128-1134. 5. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K for the SGIM career satisfaction study group. The work lives of women physicians. Results from the physician work life study. J Gen Intern Med 2000; 15: 372-380. 6. Notzer N, Brown S. The feminization of the medical profession in Israel. Med Educ 1995; 29: 377-381. 7. Benya RV. Why are internal medicine residents at University medical centers not pursuing fellowship training in gastroenterology? A survey analysis. Am J Gastroent 2000; 95: 777-783. 8. Lambert TW, Goldacre MJ, Parkhouse J, Edwards C. Career destinations in 1999 of United Kingdom medical graduates of 1983: results of a questionnaire survey. BMJ 1996: 312; 893-897. 9. Deitch, CH, Sunshine JH, Chan WC, Shaffer KA. Women in the radiology profession: data from a 1995 national survey. Am J Roent 1998; 170: 263-270. 10. Limacher MC, Zaher CA, Walsh MN, Wolf WJ, Douglas PS, Schwartz JB, Wright JS, Bodycombe DP. The American College of Cardiology professional life survey: Career decisions of
  • 17. 1/8/03 Page 17 of 28 women and men in cardiology, a report of the committee on women in cardiology. J Am Coll Cardiol 1998; 32: 827-835. 11. Pasko T, Seidman B, Birkhead S. for the Department of Physician Practice and Communications Information. Physician Characteristics and Distribution in the US 2000-2001 Edition. American Medical Association; United States of America; 2000. 12. Komaromy M, Grumbach K, Drake M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med 1996; 334:1305-1310. 13. Davidson RC, Montoya R. The distribution of services to the underserved: a comparison of minority and majority medical graduates in California. West J Med 1987; 146:114-117. 14. Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA 1995; 273:1515-1520. 15. Xu G, Fields SK, Laine C, Veloski JJ, Barzansky B, Martini CJM. The relationship between the race/ethnicity of generalist physicians and their care for underserved populations. Am J Public Health 1997; 87:817-822. 16. Wagoner NE, Bridwell SD. High school students’ motivations for a career as a physician. Acad Med 1989; 64: 325-327. 17. Slater M, Iler E. A program to prepare minority students for careers in medicine, science, and other high-level professions. Acad Med 1991; 66: 220-225. 18. Kimball HR. Decline in sub specialization stabilizes. American Board of Internal Medicine News Update 2000; Spring/Summer: 1. 19. Nonnemaker L. Women physicians in academic medicine. New insights from cohort studies. N Engl J Med 2000; 342: 399-405.
  • 18. 1/8/03 Page 18 of 28 20. Committee on women faculty in the school of science. A Study of the status of women faculty in Science at MIT. MIT faculty newsletter, XI. Massachusetts Institute of Technology, 1999. web.mit.edu/fnl/women/women.html. 21. Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement, results of a national study of pediatricians. N Engl J Med 1996; 335: 1282-1289. 22. Benz EJ, Clayton CP, Costa ST. Increasing academic internal medicine’s investment in female faculty. Am J Med 1998; 105: 459-463. 23. Tesch BJ, Wood HM, Helwig AL, Nattinger AB. Promotion of women physicians in academic medicine, glass ceiling or sticky floor? JAMA 1995; 273: 1022-1025. 24. US Department of Commerce, Economics and Statistics Administration, National Telecommunications and Information Administration. A nation online: how Americans are expanding their use of the Internet. Available at: http://www.ntia.doc.gov/ntiahome/div/index.html 25. http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=55 26. Asch DA, Jedrziewski MK, Christakis NA. Response rate to mail surveys published in medical journals. J Clin. Epidemiol. 1997; 50: 1129-1136. 27. Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med 2001; 20: 61-67. 28. Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001; 35: 1347-1355. 29. Lalman D, Porter S, Sunshine JH, Bushee GR, Schepps B. Initial employment experience of 1996 graduates of diagnostic radiology and radiation oncology training programs. Am J Roentgen 1998: 171: 301-310.
  • 19. 1/8/03 Page 19 of 28 Figure Legends Figure 1: Percent of members in each age group by gender. A total of 6639 respondents, 5534 male and 1105 female are included. Age is divided into 5-year increments except for the 20-29, and 65 and older groups. Mean age of men is 47 years and of women is 42 years. Solid bars represent male and open bars female members. Figure 2: For the survey respondents, self-described principal activity is pictured. Clinical and research together comprise the principal activity for 84.8% of members.
  • 20. 1/8/03 Page 20 of 28 Table 1: Primary ethnic identification for North American (US and Canada) respondents Ethnicity Percent of North American Members White, non-Hispanic 79.4% Asian, Asian American 7.8% Indian or Pakistani 4.5% Hispanic 3.9% Arabic 1.5% African American, Black 1.5% Other 0.9% Pacific Islander, Native American or Alaskan Native 0.2%
  • 21. 1/8/03 Page 21 of 28 Table 2: Principal Activities stratified by Age and Gender Male Female Total < 45 years n=2123 > 45 years n=2298 Total < 45 years n=566 > 45 years n=269 Clinician 78.3% 78.1% 78.5% 67.5% 69.6% 62.5% Researcher 21.7% 21.9% 21.5% 32.5% 30.4% 37.5%
  • 22. 1/8/03 Page 22 of 28 TABLE 3: Subspecialty certification for US and Canadian physicians Certification Percent of physician members Number of members Pulmonary Disease 71% 3694 Critical Care 37% 2098 Allergy and Immunology 8% 443 Pediatric pulmonary 8% 419 Sleep medicine 6% 335 Neonatology 2% 134 Infectious disease 2% 120 Thoracic surgery 2% 89 Occupational medicine 1% 79 Pediatric critical care 1% 69 Cardiovascular disease 1% 49 Geriatrics 1% 45 Others (combined) 2% 122 Note: Totals exceed 100% as persons may have more than one field of certification
  • 23. 1/8/03 Page 23 of 28 Table 4: Physician Time in Sleep and Critical Care Medicine % tim in area Sleep Medicine (n=5,672) Critical Care Medicine (n=5,991) 0 42.6% 22.6% <25 44.6% 31.4% 25-50 7.7% 32.1% 51-75 1.5% 9.1% >75 .8% 4.8%
  • 24. 1/8/03 Page 24 of 28 Table 5: Primary Work Setting Total US/Canada International Male Female Full time staff in HMO 1.7% 1.8% 1.2% 1.7% 1.5% Practice, clinical or hospital 47.5% 49.3% 39.9% 49.4% 37.6% University 33.0% 31.5% 39.6% 31.6% 41.5% Government Federal, non-VA 2.3% 1.3% 6.8% 2.2% 2.2% Veterans affairs 3.3% 4.0% 0.2% 3.3% 3.3% Military 1.3% 1.4% 0.7% 1.3% 1.6% State/local 2.7% 1.8% 6.4% 2.6% 3.3% Industry 2.9% 3.0% 2.6% 2.7% 3.5% Other 5.3% 5.9% 2.6% 5.2% 5.3%
  • 25. 1/8/03 Page 25 of 28 Table 6. Do you use a computer? Total US International Yes, at work 21.9% 20.1% 29.8% Yes at home 13.4% 15% 6.7% Both at work and home 61% 61% 61.% No, I don’t have a computer 3.6% 3.9% 2.3%
  • 26. 1/8/03 Page 26 of 28 Table 7. Technology Access Do you have: Total US International CD-ROM 89.5% 90.8% 84.2% Soundcard 64.7% 68% 51.5% Modem 79.2% 83% 63% E-mail 92.5% 93.9% 86.6% Internet Access 91.7% 93.4% 84.6%
  • 27. 1/8/03 Page 27 of 28 0% 5% 10% 15% 20% 25% years
  • 28. 1/8/03 Page 28 of 28 Figure 2: 64.8% 19.8% 5.4% 4.2% 3.6% 2.0% 0.2% 0 20 40 60 80 Percentage ClinicalPractice Research Teaching Administration Other Retired HealthcarePolicy Principal Work Activity
  • 29. A Snapshot of Pulmonary Medicine at the Turn of the Century: the American Thoracic Society Membership Lynn M. Schnapp MD, Melissa Matosian, Idelle Weisman MD, Carolyn H. Welsh MD ONLINE DATA SUPPLEMENT
  • 30. SECTION I. MEMBER BENEFITS Table E1A. Rating of Current ATS Services (Mean Rank, 5= Extremely Valuable; 1= not at all valuable) US/Canada International Male Female Clinician Researcher AJRCCM 4.3 4.55 4.35 4.35 4.35 4.38 AJRCMB 2.29 3.07 2.38 2.62 2.05 3.64 ATS Journals On-Line 3.24 3.65 3.26 3.59 3.24 3.65 ATS Website 2.92 3.28 2.93 3.27 2.97 3.07 ATS News 2.74 2.64 2.69 2.88 2.71 2.66 On-Line Roster 2.41 2.71 2.43 2.71 2.37 2.83 Printed Roster 2.98 3.04 2.97 3.14 2.87 3.34 International Conference 3.89 4.41 3.93 4.27 3.84 4.47 Advoc/Pub. Policy office 3.21 2.04 3 3.34 3.01 3.09 CME from ALA or ATS 3.56 3.08 3.44 3.72 3.65 3 ATS Policy Statements 3.81 3.29 3.7 3.92 3.83 3.39
  • 31. TABLE E1B. RANK ORDER OF CURRENT ATS SERVICES Mean AJRCCM 4.36 International Conference 3.99 ATS Policy Statements 3.73 CME from ALA or ATS 3.50 ATS Journals On-Line 3.34 Advoc/Pub Policy office 3.03 ATS Website 2.99 Printed Roster 2.98 ATS News 2.70 On-Line Roster 2.48 AJRCMB 2.43
  • 32. Table E2. Rating of potential benefits (Mean rank, 5= extremely valuable; 1= not at all valuable) US/Canada International Male Female Clinical Researcher Research Funding 3.57 3.74 3.51 4.02 3.57 3.74 Enhanced Networking 3.33 3.53 3.28 3.74 3.33 3.53 Mentoring Programs 3.1 3.1 3 3.58 3.1 3.1 Clinical Practice Guidelines 3.91 4.2 3.95 4.07 3.91 4.2 Speakers Bureau 3.05 2.71 2.96 3.24 3.05 2.71 Increased CME Opportunities 3.54 2.8 3.41 3.62 3.54 2.8 Other 3.47 2.95 3.19 4.19 3.47 2.95
  • 33. Table E3. ATS Satisfaction (Mean rank, 5=exteremely satisfied, 1=not at all satisfied) US/Canada International Male Female Clinical Researcher Ease of access to ATS leadership 3.16 3.15 3.14 3.29 3.04 3.41 Responsiveness of ATS leadership to member concerns 3.15 3.09 3.12 3.31 3.03 3.38 Advocacy efforts of ATS 3.33 3.19 3.28 3.53 3.24 3.42 Dissemination of ATS Board activities 3.28 3.25 3.24 3.45 3.22 3.35
  • 34. TABLE E4. PARTICIPATION IN LEADERSHIP POSITION WITHIN ATS US/Canada International Male Female Yes 9.3% 5.4% 8.3% 11% No 90.7% 94.6% 91.7% 89%
  • 35. SECTION II. ANNUAL INTERNATIONAL CONFERENCE TABLE E5. NUMBER OF ATS INTERNATIONAL CONFERENCES ATTENDED IN THE PAST 5 YEARS US/Canada International Male Female Clinician Researcher None 12 7 12 7 13 2 1-2 34 33 34 32 40 20 3-4 31 39 32 35 33 34 5 23 21 22 25 14 44
  • 36. TABLE E6. VALUE OF ATS INTERNATIONAL CONFERENCE US/Canada International Males Females Clinician Researcher Not at all valuable 7% 1% 7% 3% 8% 1% Somewhat valuable 10% 3% 9% 7% 10% 4% Moderately valuable 14% 9% 14% 10% 14% 8% Very valuable 23% 28% 24% 21% 25% 21% Extremely valuable 46% 59% 46% 59% 43% 66%
  • 37. TABLE E7 ATS INTERNATIONAL CONFERENCE (Mean rank, 5= Extremely important, 1= Not at all important) Reasons to attend US/Canada International Male Female Clinician Researcher Meeting location 3.25 2.96 3.21 3.11 3.40 2.71 Travel costs 3.17 3.26 3.15 3.29 3.29 2.87 Educational opportunities 3.96 3.66 3.86 4.09 4.08 3.50 Content of scientific programs 4.05 4.22 4.07 4.10 3.95 4.39 Content of clinical program 3.94 3.87 3.93 3.98 4.23 3.22 Networking opportunities 3.07 3.10 3.02 3.32 2.88 3.51 Opportunity to present an abstract or poster 3.13 3.84 3.18 3.57 2.91 4.02 Reasons NOT to attend Location 2.97 2.73 2.94 2.85 3.09 2.38 Travel costs 3.07 3.26 3.06 3.28 3.17 2.77 Content of scientific 2.78 3.26 2.81 2.95 2.77 3.10
  • 38. programs Content of clinical program 2.83 2.99 2.83 2.96 3.02 2.33 Work schedule conflicts 3.85 3.42 3.78 3.85 3.96 3.31
  • 39. SECTION III. JOURNALS TABLE E8A. VALUE OF AJRCCM Overall US/Canada International Not at all valuable 1% 1% 0.1% Somewhat valuable 4% 5% 1% Moderately valuable 11% 12% 5% Very valuable 29% 29% 29% Extremely valuable 55% 53% 64% TABLE E8B. VALUE OF AJRCCM SECTIONS (Mean rank, 5= Extremely valuable, 1= Not at all valuable) US/Canada International Male Female Clinician Researcher Original Articles 4.09 4.41 4.15 4.19 4.09 4.32 Brief Communications 3.60 3.75 3.61 3.69 3.57 3.76 Case Reports 3.28 3.30 3.26 3.44 3.40 2.84
  • 40. Editorials 3.96 4.10 4.00 3.91 4.06 3.77 State of the Art 4.62 4.68 4.63 4.67 4.69 4.48 Clinical Commentaries 3.94 3.76 3.92 3.87 4.07 3.42 Pulmonary Perspectives 3.95 3.85 3.93 3.96 4.05 3.59 ATS Statements and Position Papers 4.30 4.04 4.23 4.36 4.36 3.87 Workshop Summaries 3.60 3.61 3.56 3.79 3.57 3.65 Correspondence 2.73 2.86 2.73 2.84 2.77 2.68 Announcements 2.83 2.67 2.77 2.97 2.77 2.87 Professional Recruitment 2.53 2.03 2.40 2.71 2.40 2.58 TABLE E8C. RANK ORDER OF AJRCCM SECTIONS
  • 41. Mean State of the Art 4.63 ATS Statements and Position Papers 4.25 Original Articles 4.15 Editorials 3.99 Pulmonary Perspectives 3.93 Clinical Commentaries 3.91 Brief Communications 3.62 Workshop Summaries 3.60 Case Reports 3.29 Announcements 2.80 Correspondence 2.75 Professional Recruitment 2.44
  • 42. TABLE E9A. VALUE OF AJRCMB Overall US/Canada International Not at all valuable 35% 38% 19% Somewhat valuable 28% 29% 28% Moderately valuable 14% 12% 21% Very valuable 10% 10% 14% Extremely valuable 13% 11% 17% TABLE E9B. VALUE OF AJRCMB SECTIONS (Mean rank, 5= Extremely valuable, 1= Not at all valuable) US/Canada International Male Female Clinician Researcher Editorials 2.93 3.57 3.04 3.25 2.84 3.59 Rapid Communications 2.90 3.49 2.98 3.28 2.68 3.77 Original Articles 3.12 3.77 3.21 3.56 2.88 4.11 Workshops 2.70 3.19 2.76 3.10 2.57 3.35 Perspectives 2.82 3.32 2.87 3.19 2.66 3.52
  • 43. Minireviews 3.21 3.74 3.27 3.62 2.99 4.06 TABLE E9C RANK ORDER OF AJRCMB SECTIONS Mean Minireviews 3.33 Original Articles 3.27 Editorials 3.07 Rapid Communications 3.03 Perspectives 2.93 Workshops 2.81
  • 44. TABLE E10A AJRCCM should include more: (Mean rank; 5=strongly agree, 1=strongly disagree) US/Can International Male Female Clinician Researcher Original clinical studies 3.93 4.03 3.94 4.00 4.03 3.66 Original basic science studies 2.91 3.24 2.96 3.04 2.77 3.62 Reviews of clinical issues 4.36 4.26 4.34 4.34 4.47 3.93 Reviews of basic science 3.44 3.62 3.45 3.56 3.34 3.88 TABLE E10B. Rank order for AJRCCM Mean Reviews of clinical issues 4.34 Original clinical studies 3.95 Reviews of basic science 3.47 Original basic science studies 2.97
  • 45. TABLE E11A. AJRCMB should include more: (Mean rank, 5= strongly agree, 1=strongly disagree) US/Can Internationa l Male Female Clinician Researcher Original basic science studies 3.53 3.82 3.59 3.66 3.39 4.04 Reviews of basic science 3.98 4.12 4.01 4.01 3.89 4.31 Bench to bedside review 3.96 3.96 3.95 4.03 4.03 3.89 State of the art 4.15 4.28 4.17 4.23 4.18 4.24 TABLE E11B Rank order for AJRCMB Mean State of the art 4.18 Reviews of basic science 4.01 Bench to bedside reviews 3.96 Original basic science studies 3.60
  • 46. SECTION IV TECHNOLOGY TABLE E12. USEFULNESS OF ATS WEBSITE (Mean rank; 5=extremely useful, 1=not at all useful) US/Canada International Male Female Clinician Researcher Ease of navigation 3.08 3.13 3.07 3.20 3.11 3.06 Information about the organization 2.83 2.78 2.79 2.96 2.82 2.84 ATS Journals online 3.47 3.70 3.50 3.63 3.49 3.69 International conference information 3.25 3.50 3.26 3.55 3.24 3.60 Registration for international conference 3.20 3.39 3.19 3.54 3.15 3.62 Accessing roster information 2.77 2.73 2.74 2.87 2.71 2.97 Calendar of events 2.98 3.02 2.95 3.19 2.99 3.06 Updates of ATS news 2.76 2.84 2.75 2.91 2.83 2.68 Downloading statements and position papers 3.31 3.43 3.31 3.46 3.42 3.14
  • 47. Viewing assembly websites 2.75 2.78 2.74 2.87 2.77 2.74 Critical care journal club 2.77 2.73 2.76 2.78 2.89 2.47 Links to other websites 2.89 2.91 2.87 3.02 2.93 2.78
  • 48. SECTION V. OVERALL SATISFACTION TABLE E13. SATISFACTION WITH ATS MEMBERSHIP (mean rank; 5=extremely satisfied, 1=not at all satisfied) Mean Rank US/Canada 3.32 International 3.42 Male 3.33 Female 3.36 Clinician 3.27 Researcher 3.5
  • 49. TABLE E14A. DO YOU PLAN TO RENEW YOUR MEMBERSHIP NEXT YEAR? Yes 92% No 2.2% Maybe 5.8% TABLE E14B If No, why? (More than one answer may be checked) Membership dues too high 58% Benefits of membership no longer suit me 21% No longer in pulmonary medicine 18% Another organization better represented their interests 18%
  • 50. SECTION VI. ADVOCACY AND LOCAL SOCIETY INVOLVEMENT (US CITIZENS ONLY) TABLE E15. PRIORITY OF ALA/ATS WASHINGTON OFFICE Rank Order of Advocacy issues (Mean rank, Lowest priority=1; highest priority = 5) Tobacco Control Policy 3.85 Health Care Policy 3.85 Medical Reimbursement Policy 3.55 Research Funding 3.45 Environmental Policy 3.41
  • 51. TABLE E16. PARTICIPATION IN ADVOCACY EFFORTS Yes 27.67 No 72.33
  • 52. TABLE E17. Washington office information obtained from (more than one answer may be checked): ATS News 58.2% ATS Washington Letter 14.5% ATS Website 5.4% Unaware of communications 23.5%
  • 53. TABLE E18. MEMBERSHIP IN LOCAL THORACIC SOCIETY Overall Clinician Researcher Yes 52.7% 55.8% 39.3% No 47.3% 44.2% 60.7%
  • 54. TABLE 19. LEADERSHIP POSITION IN LOCAL THORACIC SOCIETY Yes 23.5% No 76.5%
  • 55. TABLE E20. VOLUNTEER FOR LOCAL LUNG ASSOCIATION Yes 16.6% No 83.5%
  • 56. SECTION VII. INTERNATIONAL MEMBERS SECTION TABLE E21 General Information Yes No Is the International Conference well designed to meet your needs 87.4% 12.6% Do you receive ATS information in a timely manner? 77.2 % 22.8 % Are you aware that ATS co-sponsors educational opportunities with other societies? 84.7% 15.3%
  • 57. TABLE E22. SATISFACTION WITH INTERNATIONAL REPRESENTATION WITHIN THE SOCIETY (Mean rank, 5=extremely satisfied, 1=not at all satisfied) Not at all Satisfied 17.7 Somewhat Satisfied 28.2 Satisfied 39.4 Very Satisfied 12.2 Extremely Satisfied 2.3
  • 58. TABLE E23. VALUE OF JOINT MEMBERSHIP ARRANGEMENTS (Mean rank, 5=extremely valuable, 1=not at all valuable) Not at all valuable 10.1% Somewhat valuable 17.5% Valuable 27% Very Valuable 27.4% Extremely Valuable 18.1%
  • 59. SECTION VIII. PROFESSIONAL ACTIVITIES TABLE E24. CURRENT ACADEMIC APPOINTMENT Male Female US/Canada International Junior* N 535 138 497 197 % 14.6 20.5 13.7 23.7 Assistant Professor N 1095 277 1217 179 % 29.9 41.1 33.5 21.5 Associate Professor N 987 178 1000 204 % 26.9 26.4 27.5 24.5 Full Professor N 1047 81 920 252 % 28.6 12 25.3 30.3 Total N 3664 674 3634 832 % 100 100 100 100 *Junior includes trainee, postdoctoral fellow, and instructor
  • 60. TABLE E25. PRINICPAL PROFESSIONAL ACTIVITY Male Female US/Canada International Clinician N 3480 569 3274 885 % 78.3 67.5 76.1 78.3 Researcher N 962 274 1028 245 % 21.7 32.5 23.9 21.7
  • 61. TABLE E26 Usage of Continuing Medical Education Programs* Clinician Researcher US/Canada International Offerings at International Conference 58.3% 80.5% 61.4% 65.2% ATS State of the Art Review Course 23.3% 20.2% 20.9% 28.6% Local chapter CME conferences 20.3% 13.9% 22.8v 3.3% ATS-sponsored audio conferences 2.8% 1% 2.6% 1.5% CD-ROMS 34.3% 23.1% 28.8% 42.6% CME courses through other societies 44.6% 19.7% 43.9% 14.8% Audio or Video conferences through other societies 14% 6.9% 12.9% 9.3% Other 6% 4.9% 7.2% 4.3% *Respondents may choose more than one response