| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Research Reports |
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) (mcgintys{at}csus.edu). Ms McGinty is also a doctoral student in education at the University of San Francisco.
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
Address all correspondence to Ms McGinty
Submitted August 11, 1999;
Accepted November 2, 2000
 | Abstract |
|---|
Key Words: American Physical Therapy Association • Membership • Physical therapy
| Introduction |
|---|
 TopAbstract Introduction MethodsResultsDiscussion and ConclusionReferences |
|---|
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 |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussion and ConclusionReferences |
|---|
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
.05 level, unless otherwise indicated. Data analyses were performed using the SPSS for Windows, version 9.0.*
| Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussion and ConclusionReferences |
|---|
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.
|
|
.01) and being female and being self-employed (r=–.20, P.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.
|
|
|
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.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 (
2=20.26, P.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 |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussion and ConclusionReferences |
|---|
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.
| Footnotes |
|---|
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.
* SPSS Inc, 444 N Michigan Ave, Chicago, IL 60611. 
| References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussion and ConclusionReferences |
|---|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
