Challenge: A membership model structured around individual physicians that had evolved over time rather than been designed as a system — creating barriers for early-career professionals, leaving interprofessional audiences underintegrated, and making membership an individual decision in a team-based profession
Outcome: 50% membership growth in three years; interprofessional membership nearly tripled; international membership expanded significantly; more than 40 practices adopted team membership; fellows-in-training retention improved to the point where lapses became negligible
The Situation
The American College of Rheumatology was not struggling to grow.
The profession was expanding. New audiences were emerging. Demand was there. The constraint was the membership model.
ACR had built one of the most respected professional societies in medicine — the publisher of the field’s leading journals, the convener of the largest annual rheumatology meeting, and the organization responsible for clinical guidelines that govern practice across the specialty. Alongside ACR sat ARP — the Association of Rheumatology Professionals — a parallel organization serving the interprofessional care team: nurses, physician assistants, physical therapists, pharmacists, and the full range of allied health professionals who work alongside rheumatologists in treating patients with rheumatic diseases.
The two organizations served the same professional community. But the membership model had been structured primarily around individual physicians, with dues and benefits that had accumulated over time rather than been designed as a coherent system. As the field changed, the friction became visible.
Early-career professionals faced cost barriers that made membership difficult to justify when student loan debt was real and employer support wasn’t guaranteed. Interprofessional audiences weren’t fully integrated — present, but not purposefully served. Membership remained an individual decision in a profession where care was delivered by teams. Value was fragmented across programs and pricing that had grown complex over time.
Growth was available. The model was making it harder to capture.
What We Found
Sequence conducted a comprehensive research and analysis process — internal stakeholder interviews across more than twenty ACR and ARP departments and committees, member and non-member insights, competitive benchmarking, persona development, and segmentation review. The consultation process included the ACR Board, Executive Committee, Committee on Finance, Committee on Marketing and Publications, Governance Task Force, and ARP Executive Committee — a breadth of engagement that was itself a strategic choice. A model transformation affecting every constituency in a two-organization system needed to be developed with every constituency at the table.
Several structural problems emerged clearly from the research.
The career lifecycle wasn’t being served. There was no systematic approach to bringing members in early and keeping them through career transitions. Students and fellows faced abrupt pricing jumps that caused lapses at exactly the moment when building professional identity mattered most. Early-career professionals had cost barriers that made membership feel like an expense rather than an investment.
The interprofessional opportunity was underbuilt. Rheumatology had, to its credit, been more inclusive of its interprofessional care team than most medical specialties. But the membership model hadn’t kept pace with the team-based reality of how practices actually operated. A physician’s nurse practitioner, physical therapist, and practice manager participated in patient care together every day — but membership was still an individual decision made separately by each person, at prices that weren’t designed for team enrollment.
Content was insufficiently tied to membership. Significant resources were freely accessible to non-members, diluting the case for paid membership. The most valuable content — clinical guidelines — remained appropriately open access given their public health implications. But a range of educational programs, resources, and tools that could have strengthened the membership value proposition were available to anyone.
The a la carte structure was adding friction without adding value. A base membership with numerous separately-priced options created decision fatigue and focused attention on what members weren’t getting rather than on the substantial value of what they had. Simplifying toward a bundled model would increase perceived value at equivalent or higher price points.
International and team audiences had no real home. There was no formal pathway designed for the growing number of international rheumatology professionals who wanted ACR affiliation. There was no group option that made institutional sense for practices that wanted to invest in their whole team.
The Approach
Sequence designed a comprehensive membership model transformation — presented in phases to ACR’s governance bodies and the Committee on Finance — that addressed every dimension of the structural challenge.
Redesigning the individual membership structure across the career lifecycle. The individual membership architecture was rebuilt to eliminate barriers at entry and create a clearer path into full membership:
Free student membership for medical students, residents, and graduate students — bringing people into the ACR community at the moment when professional identity is forming, before cost becomes an objection.
Discounted early-career tiers at 50% off for three years post-fellowship — bridging the transition from training to practice without the pricing cliff that had been causing lapses.
Transitional pricing at 75% off for fellows-in-training, members over 70, those who are fully retired, and those who are permanently disabled — honoring different life stages without forcing people out of the organization.
Expanded access for allied health professionals and international members — creating formal pathways for audiences that had been present but underserved.
Moving to a bundled membership model. The shift from a base membership with many a la carte options to an all-inclusive model with limited a la carte pricing only for big-ticket items simplified the value proposition and made membership easier to justify. Sequence developed specific criteria for what should be bundled versus kept separate — and a range of educational programs, virtual resources, and practice tools moved into the included membership bundle.
Introducing team-based membership. The Team Membership Package allowed practices to enroll physicians and their interprofessional staff together — with discounts scaling by team size. Groups of three received 20% off. Groups of five received 30% off. Groups of seven received 40% off. The package included consolidated invoicing, practice recognition (a badge for websites and a plaque for the lobby letting patients know the entire care team were ACR members), and all individual membership benefits plus practice-specific resources.
The model explicitly targeted the physician as the sale point — positioning team membership as a professional development investment for the practice rather than an individual enrollment decision by each allied health professional. This reframe was critical. It moved membership from a personal choice to an institutional one.
Designing the pathway-based member experience. Five pathways organized the member experience around what members actually do: Practice Management, Science of Rheumatology, Treatment of Rheumatology Patients, Voice of Rheumatology (advocacy), and Rheumatology Pipeline (workforce development). Members selected the pathways most relevant to their work and received curated content, communications, and program recommendations accordingly.
Unifying two organizations under one strategy. The central architectural decision was positioning ACR and ARP not as parallel organizations with separate strategies, but as two expressions of a single mission — serving all professionals engaged in the fight against rheumatic diseases. ACR had always been ahead of most medical societies in its commitment to interprofessional inclusion. The model transformation codified that commitment structurally.
As Tami Brehm, ACR’s membership leader, described it: “We feel we’re a team-based specialty and that’s how we approach it.”
The Result
Membership reached 10,600 — a 50% increase in three years.
That growth came from exactly the segments the model had been designed to serve:
Interprofessional membership nearly tripled — the clearest validation of the team-based approach. Physicians who had once been skeptical of interprofessional inclusion became advocates for it as they saw the model working in their own practices.
International membership expanded significantly — the result of formal pathways that hadn’t existed before.
More than 40 practices adopted team membership — a new model that had been designed from scratch and didn’t exist before the engagement.
Fellows-in-training retention improved to the point where lapses became negligible — the direct result of eliminating the pricing cliff that had been driving early exits.
Critically, the core physician membership remained stable. ACR expanded its market without shifting away from its base — the outcome that every membership model transformation aims for and many fail to achieve.
The membership model transformation was independently recognized by the American Association of Medical Society Executives (AAMSE), which awarded ACR its 2025 Profiles of Excellence Award in the membership category — recognizing the model as a standout example of innovation in medical society management.
“The audiences that we intended to grow — we did just that.” — Tami Brehm, American College of Rheumatology
What made the growth sustainable wasn’t just the new tiers. It was that the model aligned membership with how rheumatology is actually practiced — as a team-based specialty where physicians, nurses, PAs, physical therapists, and practice managers work together. When membership reflects that reality, the case for joining becomes self-evident.
“I have physicians advocate for the interprofessionals. I couldn’t have scripted that any better.” — Tami Brehm, American College of Rheumatology
The shift in physician culture — from tolerance of interprofessional inclusion to active advocacy for it — was something the model helped enable. When physicians saw their own teams engaged, learning, and contributing to the professional community, the abstract argument for inclusion became concrete. The model made that visible.
“In this world, we focus so much on our differences. If you can just look at things from common ground — that’s where the magic really is. What do we have in common and where can we build from that?” — Tami Brehm, Vice President, Membership and Governance American College of Rheumatology
What This Means for Your Association
The ACR story is about what happens when an association is willing to step back from the accumulated decisions of its history and ask a harder question: if we were designing this membership model today, for the members we have now and the market we’re in now, would we build what we have?
Almost always, the honest answer is no. Membership models that made sense when they were designed drift out of alignment over time — as the profession changes, as the content landscape shifts, as new segments emerge that the original model didn’t anticipate.
The gap between the model an association has and the model it would design today is the strategic opportunity. For ACR, that gap was specific: early-career barriers, interprofessional underrepresentation, an individual purchase model in a team profession, and fragmented value. Closing that gap — systematically, with a model designed as a coherent system rather than a collection of accumulated decisions — produced 50% growth in three years.
Four questions worth asking about your own membership model:
Does your dues structure match the career lifecycle of your members? The moments when people are most likely to join — or most likely to lapse — are predictable: entry to the profession, transition from training to practice, early career, employer subsidy changes, retirement. A membership model that prices consistently across those moments treats all members the same. A model designed around those transitions reduces barriers where they matter most.
Is your profession team-based in practice but individual in membership? If the care, work, or decision-making in your field happens in teams — practices, firms, departments, systems — but your membership model requires individual enrollment decisions by each person, you’re asking people to make a personal choice about something they experience collectively. Team membership reframes that decision at the institutional level, where purchasing authority often sits.
Are you serving the full professional community or the core physician/practitioner segment? ACR’s inclusion of interprofessional members was genuinely unusual in medical societies — and it drove nearly a tripling of interprofessional membership when the model was properly designed around them. Most associations have adjacent professional audiences they’ve welcomed informally but haven’t fully served structurally. Designing for those audiences isn’t a distraction from the core — it’s an expansion of it.
What content is so valuable that members should have to pay for access? The content gating question is uncomfortable because it requires acknowledging that giving things away for free has real costs — to the membership value proposition, to dues revenue, and to the case for joining. ACR made deliberate decisions about what to bundle, what to gate, and what to keep open. Those decisions were made with criteria, not institutional habit.
The ACR membership model transformation didn’t happen because something was broken. It happened because leadership was willing to look honestly at what the model was and wasn’t serving — and to undertake the organizational work required to replace it with something better designed for the profession they actually serve.
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.
