Your Dues at Work
Where do membership dollars go, and how are they spent?
As chair of the ACR BOC, I have enjoyed welcoming several new members to the board. Each time, I remember the exhilaration I felt when I joined the board and saw first-hand the scope and scale of ACR activities. Having volunteered for several radiology professional societies in the past, I felt privileged to be part of an organization that truly makes a difference in the lives of practicing radiologists.
All too often, professional organizations opine as to what should be done to remedy certain ills facing our specialty, but none have the power to effect meaningful change — other than through education of their respective memberships. Commonly, the leaderships of these other organizations conclude that the best course of action is to encourage ACR leaders to guide the College toward certain advocacy efforts on behalf of practicing radiologists across the country.
The breadth of activities under the purview of the College matches the breadth of our core purpose: “To serve patients and society by empowering members to advance the practice, science, and professions of radiological care.” The College has hundreds of different programs, ranging from promoting radiologists’ professional development to advocating at the state and federal levels. Those members who participate in financial management of their practices may wonder how these activities are supported and specifically how dues dollars are used. Answering this question requires an understanding of the corporate structure of the ACR.
Our organization has four corporate entities: the ACR, the American College of Radiology Association (ACRA®), the ACR Foundation (ACRF), and the American Institute of Radiologic Pathology (AIRP®). The ACRF is the philanthropic arm of the College and has largely focused on raising funds in support of health policy research. The AIRP succeeded the Armed Forces Institute of Pathology, providing continuation of this critical educational resource for radiologists in training. Both of these corporate entities are rather easily understood. Meanwhile, ACR members often ask why we have both the ACR and the ACRA. Although buried in the complexities of the Internal Revenue Code, the answer is really quite simple — advocacy and RADPAC®.
The ACR was founded in 1923. For several years, the organization operated largely as an honorary society, focused on awards and recognition such as the ACR Gold Medal and the ACR Fellowship programs. Many years later, as Congress debated creating a national health insurance program known as Medicare, the ACR recognized the need for radiology to have an advocate in Washington, D.C. As a result, the College formed a government-relations wing to be the specialty’s voice in policymaking. This function has grown rapidly, with ACR focusing on critical issues like nationally set physician reimbursement schedules for Medicare (the Medicare Physician Fee Schedule, which also acts as a basis for many private insurer fee schedules), procedure coverage determinations for exams (such as mammography and lung cancer screening), and reimbursement policies (like the sustainable growth rate and the multiple procedure payment reduction).
While it was clear that radiology benefitted from representation on Capitol Hill, ACR is a 501(c)(3) charitable organization, which is severely limited by federal law in the amount of money it can spend on lobbying. As advocacy became more important to radiology, the ACR regularly bumped up against that limit. At the same time, campaign finance reform placed a greater emphasis on political action committee (PAC) contributions, but the 501(c)(3) designation prohibited the ACR from sponsoring a PAC.
In 1997, the ACR established a new corporation as a 501(c)(6) business league. Today, that organization is the ACRA. The key difference between the ACR and the ACRA is that the law permits unlimited lobbying by the ACRA, which is also allowed to sponsor a political action committee, RADPAC, launched in 1999. Members’ contributions to RADPAC help sustain candidates who are supportive of issues important to radiologists, and the ACRA pays the administrative costs of operating RADPAC. Hence, as of July 1, 2003, all ACR members automatically became members of the ACRA, and all advocacy activities (including government relations and economics) were placed under the ACRA.
Member dues are paid to the ACRA directly, which uses most of these funds for advocacy and economics. Any dollars that remain after these programs are funded are transferred to the ACR. Approximately 95 percent of the money transferred is used to support member and chapter services. The remainder offsets the costs of other supporting services; no other ACR programs are funded directly by member dues.
This arrangement ensures adequate funding for advocacy, because while federal law permits funds to be transferred from the ACRA (a 501(c)(6) organization to the ACR (a 501(c)(3) organization), funds cannot flow in the reverse direction. Therefore, any change in membership dues, positive or negative, affects primarily the dollars that are available for our advocacy efforts. An increase in dues would result in more dollars available for these efforts, while a reduction in dues would provide fewer dollars for our advocacy and economics programs — areas that have been consistently identified in membership surveys as most critical.
This strategic structure of having dues dollars go to the ACRA allows the College to advocate for its members on Capitol Hill to ensure radiology has a voice in Congress in support of our patients and our profession. Members may rest assured that their dues dollars are being used first and foremost for the issues most near and dear to their hearts — advocating for optimal care of their patients through the vibrant practice of medical imaging, image-guided therapy, and radiation oncology.
By James A. Brink, MD, FACR, Chair