Challenge: Half of all U.S. physicians were now employed by health systems — and the AMA’s individual membership model was structurally unable to reach them
Outcome: Group membership grew 158% in five years; AMA reached 302,000 dues-paying members — the highest total in its history
The Situation
For most of its 175-year history, the American Medical Association built its membership around a single, stable assumption: physicians are independent professionals who make their own membership decisions. The model worked. For generations, the AMA enrolled physicians one at a time, built loyalty through individual engagement, and grew into the largest physician organization in the United States.
Then the physician market changed — and the model didn’t.
By the time Sequence Consulting began working with the AMA on its group membership strategy, more than half of all practicing physicians in the United States were employed by hospitals and health systems rather than practicing independently. Eighty percent of residents completing training were entering employed positions. The population of independent physicians — the traditional target of individual AMA membership — was declining every year, from 38.5% of practicing physicians in 2021 to 33.6% by 2025, with projections showing continued decline toward 28% by 2030.
The consequence was structural, not incidental. AMA penetration among employed physicians was just over 1%. The organization had built a sophisticated, well-resourced individual membership program — and it was aimed at a shrinking market while the majority of physicians sat largely out of reach.
The AMA wasn’t in crisis. Total membership was holding. But the trajectory was unmistakable, and the underlying market reality was getting harder to ignore: the individual membership model, however well executed, could not reach employed physicians at scale. The buyer had changed. The product hadn’t.
What Sequence Found
Sequence’s work began with a rigorous diagnosis of the physician market and the economics of the existing membership model — asking not just what was happening to membership, but why, and what it would take to change it.
The findings were precise and, in some cases, uncomfortable.
The individual membership model was structurally misaligned with how employed physicians made decisions. An employed physician doesn’t make the same kind of membership decision as a private practitioner. Their time is allocated by their employer. Their professional development resources are often managed or influenced institutionally. Asking an employed physician to opt in to AMA membership individually — paying out of pocket, justifying the time — was asking them to behave like an independent professional when they weren’t one. The barrier wasn’t the AMA’s value. It was the model.
The AMA had already tried to solve this with discounts — and it hadn’t worked. Before 2018, the AMA offered a group program structured primarily as a bulk discount on individual membership. Larger health systems received larger discounts — up to nearly 50% off — and participation generally required 75% physician uptake. Despite the apparent generosity of the offer, there were essentially no takers.
The reason was instructive: framed as discounted individual memberships, the decision fell to physicians, who didn’t see enough individual value to opt in at scale. Meanwhile, even the discounted price represented a meaningful system-level expense with no clear system-level return. The problem wasn’t the price. It was that health systems were being asked to buy something designed for a different buyer.
The real opportunity was to reframe the buyer entirely. Sequence’s analysis identified a different question: not “how do we get more employed physicians to join individually?” but “what would make health systems want to provide AMA membership to their physicians?” Health systems had strong organizational reasons to invest in physician engagement — burnout, retention, workforce stability, and credibility were all significant institutional priorities. An AMA relationship that addressed those priorities was potentially very valuable to a health system CEO or CMO. The AMA had never approached health systems as customers.
The shift in physician practice was not temporary. Sequence’s research made clear that the trend toward employment was structural, not cyclical. Independent physicians had declined every year for more than a decade. The pool of physicians making individual membership decisions was shrinking, older, and less responsive than it had ever been. Any strategy that depended primarily on individual physician acquisition was working against the grain of the market. Future growth required reaching physicians through the institutions where they worked.
The Approach
Sequence designed the health system membership model, built the case for it internally at the AMA, and drove it through board approval — a process that required convincing a 175-year-old physician membership organization to fundamentally change who its primary customer was.
That internal challenge is worth acknowledging. Proposing that the AMA launch a B2B institutional membership category — shifting from individual physician as buyer to health system as buyer — required making the case to leadership, staff, and a volunteer board that the existing model had a structural blind spot. Sequence researched, designed, and presented the analytical case that moved the organization from skepticism to commitment.
The model that emerged was built around three core shifts:
1. Health system as buyer, physician as member. Rather than asking employed physicians to make individual membership decisions, the new model positioned health systems as the purchasing entity. A single institutional decision could enroll hundreds or thousands of employed physicians. This removed the individual friction that had kept employed physician membership at 1% and aligned with how health systems already thought about physician benefits and professional development investment.
2. A value proposition built around system-level priorities, not individual benefits. The redesigned offer moved decisively away from discounted individual membership. Instead, it bundled AMA membership with assets tied directly to what health system leaders cared about: physician well-being programs and burnout assessment tools, access to AMA’s advocacy team, organizational recognition through AMA channels and the Joy in Medicine program, workforce support resources, and the institutional credibility of AMA partnership.
Health systems were no longer being asked to subsidize individual dues. They were being offered a partnership built around the outcomes their organizations were already trying to achieve. The conversation shifted from “how much of a discount?” to “what does this do for our physicians and our organization?” — and it resonated.
3. A tiered flat-rate pricing model that supported institutional decision-making. The pricing structure was designed for an organizational buyer, not an individual one. Tiered flat-rate pricing based on system size made the cost predictable, budget-friendly, and easy to approve internally. It removed the per-physician math that had made the earlier discount model feel expensive at scale and positioned the AMA as a strategic partner rather than a vendor negotiating headcount.
The Permanente Federation joined as the program’s charter member in 2018. Its participation — a large, historically independent health system choosing to engage with the AMA in a fundamentally new way — was the proof point that made the model real for the market.
The Result
Group membership grew 158% in five years — from approximately 26,000 physician members in 2021 to nearly 67,000 by 2025.
The AMA reached 302,000 dues-paying members in 2025 — the highest total membership in the organization’s history.
That record didn’t happen because individual membership rebounded. It happened because the health system model opened access to a population of physicians the individual model couldn’t reach. While individual physician membership declined modestly over the same period — a reflection of the structural market shifts Sequence had identified — group membership more than compensated, driving the overall total to historic highs.
The model also changed the economics of membership in important ways. Group membership renews at the health system level rather than the individual physician level, which means revenue is retained even as individual physicians come and go within a system — a fundamentally more stable retention dynamic than individual opt-in renewal. Health system members view AMA membership as a valuable professional benefit of their employment. Health systems leverage that as a physician recruitment and retention tool.
In the words of health system leaders who joined the program: “We came in through Joy in Medicine, but it quickly became more than that — it helped us organize everything we were trying to do around physician well-being.” And: “It gives us credibility internally. It helps us align leadership and show that what we’re doing is grounded in something bigger.”
What This Means for Your Association
The AMA’s health system story is not a healthcare story. It’s a structural story — and the structure it describes is playing out across every profession that has seen significant consolidation, employment, or institutionalization over the last two decades.
The pattern Sequence identified at the AMA shows up in law, accounting, engineering, architecture, pharmacy, and dozens of other fields: a profession that was once largely independent is increasingly practiced within large organizations. The individuals associations want to reach are employed. They make fewer independent professional decisions. And the membership models built for a world of independent practitioners are gradually losing their reach.
The AMA was reaching 1% of employed physicians not because those physicians didn’t value what the AMA offered. It was because the model required them to behave like independent practitioners. When Sequence reframed the question — from “how do we recruit employed physicians?” to “how do we become valuable to the organizations that employ them?” — the entire growth equation changed.
Three questions worth asking about your own association:
Has the professional or organizational structure of your potential membership base shifted significantly in the last decade? Consolidation, employment, and institutional scale mean that in many professions, the people associations want to reach are making fewer independent decisions. If your membership model is built for independent decision-makers and your market has moved toward employed or institutionally affiliated professionals, you may be facing a version of the AMA’s challenge.
Are there institutional buyers — employers, firms, systems, agencies — who have organizational reasons to want their people engaged with your association? Physician well-being, workforce retention, professional development, and institutional credibility are the reasons health systems engaged with the AMA. Most large employers in most professional fields have analogous priorities. The question is whether your association has built a value proposition that speaks to those priorities at the organizational level.
Is your membership product designed for how your potential members actually make decisions today — or for how they made decisions when your model was built? This is the hardest question, because it requires acknowledging that a model that worked well for a long time may no longer fit the market it was designed for. The AMA’s individual membership model wasn’t broken. The market around it had changed.
The lesson of the AMA’s health system model is not that individual membership doesn’t matter — it does, and the AMA continues to invest in it. The lesson is that when the market shifts structurally, the associations that grow are the ones willing to ask whether their model still fits the world their members actually live in.
About Sequence Consulting Sequence Consulting works exclusively with professional and trade associations to grow membership, strengthen revenue, and clarify strategy. Founded in 2001 by Chris Vaughan, PhD and Lisa Vaughan, Sequence brings the rigor of Big Strategy consulting to mission-driven organizations. Trusted by 12 of the top 20 U.S. associations.
