Moneyball: The Art of Winning the American Dental Association Membership Renewal Game

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1 This article was downloaded by: [ ] On: 19 June 2014, At: 03:22 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: Registered office: Mortimer House, Mortimer Street, London W1T 3JH, UK Journal of Relationship Marketing Publication details, including instructions for authors and subscription information: Moneyball: The Art of Winning the American Dental Association Membership Renewal Game Julie M. Coe a & Al M. Best b a Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA b Department of Periodontics, School of Dentistry and School of Medicine, Virginia Commonwealth University, Richmond, VA, USA Published online: 13 Jun To cite this article: Julie M. Coe & Al M. Best (2014) Moneyball: The Art of Winning the American Dental Association Membership Renewal Game, Journal of Relationship Marketing, 13:2, , DOI: / To link to this article: PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content ) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at

2 Journal of Relationship Marketing, 13: , 2014 Copyright Taylor & Francis Group, LLC ISSN: print / online DOI: / Moneyball: The Art of Winning the American Dental Association Membership Renewal Game JULIE M. COE Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA AL M. BEST Department of Periodontics, School of Dentistry and School of Medicine, Virginia Commonwealth University, Richmond, VA, USA We analyzed 2010 Virginia Dental Association (VDA) membership data to identify predominant factors to American Dental Association (ADA)/VDA membership renewals. Multivariable regression analysis revealed that age, specialty, geographic location/local component, ADA years, VDA years, and dues payment percentage were related to renewals. Nonrenewals occur predominantly among newer members those with ADA membership years <5 years, 6 10 years, and years renew 81%, 94%, and 98% of the time, respectively (p =.0004). Newer members should be the target segment in relationship building. Further studies need to evaluate core services performance related to membership renewals, especially for this group. KEYWORDS American Dental Association, association management, membership retention, professional association, relationship marketing Michael Lewis s book Moneyball made the case that the collective wisdom of baseball insiders can be subjective and often flawed (Lewis, 2003). Similar arguments can be made regarding winning the American Dental Association (ADA) membership game. As a representing body of dentists in the United States, in 2010 ADA had about 128,119 members, which was Address correspondence to Dr. Julie M. Coe, Department of General Practice, School of Dentistry, Virginia Commonwealth University, Lyons Dental Building, 520 North 12th Street, P.O. Box , Richmond, VA jmcoe@vcu.edu Color versions of one or more of the figures in the article can be found online at 155

3 156 Moneyball 68.2% of all licensed dentists in the United States (ADA, Department of Membership Information, 2010a). Although this percentage (also known as market share) is still higher than that of other professional organizations, there has been a notable trend of a decline in the percentage of dentists who join the ADA (ADA, Department of Membership Information, 2010b). Over 5 years, the market share decreased from 71.3% in 2005 to 68.2% in Many constituents have been experiencing similar trends. 1 In 2010, the Virginia Dental Association (VDA) had 2,891 members, representing 67.7% of active licensed dentists in Virginia, a decline from 72.8% in 2005 (ADA, Department of Membership Information, 2010b). This trend of declining membership has implications for ADA as well as VDA. Representing all dentists in the nation/state as one voice would become more difficult and decreased revenues from dues would affect the financial management of the association. In addition to the declining trend of membership market share, there seems to be a great deal of variance in market share by dentist characteristic (target group; ADA, Department of Membership Information, 2010b). ADA reported that, among the active licensed dentists across the United States in 2010, only 17,152 of 32,012 (53.6%) all minorities joined ADA and 29,247 of 43,399 (67.4%) new dentists (dentists who have graduated within 10 years) joined ADA. Comparing general practitioners and specialists, one finds that 98,111 of 150,043 (65.4%) general practitioners joined ADA, whereas 30,008 of 37,855 (79.3%) specialists joined ADA. Market share by 5-year age group for ages to active licensed dentists shows interesting results: The lowest market share (64.9%) is found in age group, whereas the highest market share (87.6%) is found in age group. There seems to be a market share variance by race, too. In 2010, 42.9% of all African American/Black active licensed dentists joined the ADA, whereas 75.6% of all White active licensed dentists joined the ADA (ADA, Department of Membership Information, 2010a). VDA has variances in membership market share similar to ADA for the aforementioned factors (ADA, Department of Membership Information, 2010b). Both declining trend of membership and variances in membership market share by target market initiated a number of membership efforts at the ADA level as well as the constituent level. In VDA, this declining market share seems to be inversely related to the increase in membership nonrenewals. Figure 1 shows these trends over the past 20 years, with a negative correlation (r =.76, p =.0001). To improve membership market share, VDA s leadership made membership renewal a priority followed by recruitment and has very actively pursued a number of membership initiatives (ADA, 2009; VDA, 2010). Specifically, the 2009 VDA membership growth workshop stated that the membership to ADA/VDA is a choice among the competing professional associations now a days and VDA need to track buyer behavior of those who renew and those who do not renew.

4 J. M. Coe and A. M. Best 157 FIGURE 1 Trends in Virginia Dental Association Market Share and Nonrenewal Rates. (Created from American Dental Association Recruitment and Retention Reports for Active Licensed Dentists: ) (One is always a member of both ADA/VDA: by tripartite bylaw, members cannot be the member of ADA without being a VDA member or vice versa). However, those efforts did not seem to lead to a visible increase in membership renewals, which necessitated further assessment of membership renewals and related factors. The report ADA Survey of 2011 Nonrenews summarized responses of 292 former ADA members regarding reasons for not renewing and concluded that this was a deliberate choice, with cost of membership and benefits as they relate to costs being major reasons. Of the respondents, 41% said that they did not plan to rejoin. One limitation of this report seems to be that it included only descriptive statistics but did not examine multiple factors related to renewals at the same time. The purpose of this present study was to use modern statistical techniques to identify the significant factors associated with 2010 VDA membership renewals. In contrast to VDA s traditional approach of assessing factors to renewals only one at a time, a multivariable approach can examine relationships between all factors and the outcome of interest.

5 158 Moneyball METHODS This study was approved by the Virginia Commonwealth University Institutional Review Board. The data were obtained from VDA on the membership as of December The member characteristics tested for a relationship to renewal were grouped into three sets of factors: demographic characteristics, practice characteristics, and relationship with ADA/VDA. The variables are defined here. Renewal Nonrenewal in 2010 was defined as a VDA member in 2009 who did not pay 2010 dues as of December Note that 2010 membership dues were due on January 1, 2010, and drop letters notifying past-due members were sent out starting July 1, New members in 2010 showed up as renewals. Demographic Characteristics Gender, race, and age were considered to be possibly related to membership renewal. For the purpose of analysis, race was collapsed into four categories: not reported, Black, Hispanic, and all others combined. Whites, Asians, and Pacific Islanders were combined because of their similar renewal percentages. Age in years was calculated as of 2010 on the basis of birth year. Practice Characteristics Type of practice was collapsed into four groups: none specified, associate, nonowner (including independent contractors), and owner. Dental specialties included the following: none specified, general practice, dental public health, oral and maxillofacial pathology, periodontics, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, prosthodontics, endodontics, and pediatric dentistry. The VDA has eight geographic/local components: Piedmont, Southside, Peninsula, Shenandoah, Southwest, Northern Virginia, Richmond, and Tidewater. Members join a local component based on their practice location. Relationship With ADA/VDA The database had information on the total number of years of ADA membership and the total number of years of VDA membership. In addition,

6 J. M. Coe and A. M. Best 159 ADA/VDA members dues varied: 0%, 25%, 50%, 75%, or 100% of the normal dues based on each individual member s characteristics. The relationship between renewal and each of the member characteristics was described first, and a test for differences was done using chi-square tests (preliminary analysis). Then, because many of the membership characteristics were correlated, a multivariable logistic regression was used to test for the significance of the membership factors. The logistic regression model included the following factors: gender, race, age, practice type, specialty, VDA component, ADA total years, VDA total years, and dues payment percentage. Analyses were performed using SAS software (SAS Version 9.3 and JMP Pro Version 10, SAS Institute, Cary NC). Statistical significance was identified using α<.05. RESULTS There were 3,417 individuals who were members in 2009, and 113 did not renew their membership by the end of 2010, resulting in a renewal rate of 96.7%. Results are reported in three sections, corresponding to three groups of predictors to the renewals: demographic characteristics, practice characteristics, and relationship with ADA/VDA. In each section, the preliminary (bivariate) analysis of each factor is described first followed by the significance of each factor based on the multivariable analysis. Demographic Characteristics In the preliminary analysis, gender appears to be significantly related to renewal (p <.0001 by chi-square test) female members renew less often. Age also appears to be significantly related to renewal younger individuals renew less often. But gender and age are correlated (female dentists are more likely to be younger). So the question becomes, which is the predominant factor leading to fewer renewals: gender or age? To take other factors into account, we conducted a multivariable logistic regression analysis, and gender turned out not to be significantly related to renewal (p =.273; see Table 1) after all other factors were considered together. Similarly, race initially appears to be associated with renewal. That is, Whites renew at about 98%, and Blacks seem to have the lowest renewal rate (89%). A simple chi-square test indicates possible differences depending upon race, but the multivariable analysis indicates that factors other than race contribute to this apparent difference (p >.57). There is no evidence for renewal rates being different depending upon race/ethnicity. Age appears to be related to membership renewal in the preliminary analysis and remains significant in the multivariable model (p <.0001).

7 160 Moneyball TABLE 1 Demographic Characteristics and Distribution of ADA/VDA Membership Nonrenewals and Renewals in 2010 (N = 3,417) No. a (%) Demographic Characteristic Nonrenewals Renewals p b Gender.273 Female 43 (6.6) 611 (93.4) Male 65 (2.4) 2,689 (97.6) Race c.576 Not reported 31 (6.0) 484 (94.0) Black 14 (11.1) 112 (88.9) Hispanic 3 (5.5) 52 (94.5) American Indian 0 (0.0) 4 (100.0) Asian, Pacific Islander 7 (3.5) 195 (96.5) White 58 (2.3) 2,457 (97.7) Age decade c < s 2 (5.0) 38 (95.0) 30s 39 (8.1) 445 (91.9) 40s 22 (4.0) 522 (96.0) 50s 18 (2.3) 757 (97.7) 60s 15 (1.8) 803 (98.2) 70s 6 (1.6) 359 (98.4) 80s 3 (1.5) 198 (98.5) 90s 0 (0.0) 39 (100.0) Notes: ADA = American Dental Association; VDA = Virginia Dental Association. a Number of members who either did not renew or did renew their membership in b Logistic regression results from a model including the following factors: gender, race, age, practice type, specialty, VDA component, ADA total years, VDA total years, and payment percentage. c For the purposes of multivariable analysis, race was collapsed into four categories: not reported, Black, Hispanic, and all others combined. Age was entered as a continuous covariate in the logistic regression model. Practice Characteristics Table 2 shows the relationship between three practice factors and membership renewal. It would appear that associates renew less often than owners (89.6% vs. 97.7%, respectively, chi-square p <.0001). However, after all of the other factors are adjusted for, this apparent difference due to practice type becomes nonsignificant (p >.8). Specialty-related differences remain significant after other factors are adjusted for (p =.022). The highest renewal rate occurs in those not specifying a specialty, dental public health, oral and maxillofacial pathology, and periodontics ( 99%). Those with a more typical renewal rate (approximately 97.8%) include prosthodontics, oral and maxillofacial surgery, and orthodontics. The lowest renewals occur in endodontics, pediatric dentistry, and general practice (95.7%). The VDA s eight local components vary in membership size, ranging from 118 members to 1,282 members. Both the preliminary chi-square (p <.02) and the multivariable model show that there is a difference in renewal depending upon component (p =.0095). The three largest

8 J. M. Coe and A. M. Best 161 TABLE 2 Practice Characteristics and Distribution of ADA/VDA Membership Nonrenewals and Renewals in 2010 (N = 3,417) No. a (%) Practice Characteristic Nonrenewals Renewals p b Practice Type.883 None 29 (5.9) 462 (94.1) Associate 15 (10.4) 129 (89.6) Nonowner 11 (4.2) 252 (95.8) Owner 58 (2.3) 2,461 (97.7) Specialty c.022 None 4 (0.7) 552 (99.3) Dental public health 0 (0.0) 11 (100.0) Oral and maxillofacial 0 (0.0) 7 (100.0) pathology Periodontics 1 (1.0) 103 (99.0) Prosthodontics 1 (1.8) 56 (98.2) Oral and maxillofacial 3 (2.0) 145 (98.0) surgery Orthodontics and 5 (2.4) 205 (97.6) dentofacial orthopedics Endodontics 3 (3.0) 97 (97.0) Pediatric dentistry 4 (3.7) 103 (96.3) General practice 92 (4.3) 2,025 (95.7) Geographic component.0095 Southside 2 (1.7) 116 (98.3) Southwest 5 (2.8) 175 (97.2) Peninsula 4 (1.8) 220 (98.2) Shenandoah 5 (1.9) 260 (98.1) Piedmont 3 (1.0) 303 (99.0) Tidewater 21 (4.9) 407 (95.1) Richmond 26 (4.2) 588 (95.8) Northern Virginia 47 (3.7) 1,235 (96.3) Notes: ADA = American Dental Association; VDA = Virginia Dental Association. a Number of members who either did not renew or did renew their membership in b Logistic regression results from a model including the following factors: gender, race, age, practice type, specialty, VDA component, ADA total years, VDA total years, and payment percentage. c For the purposes of multivariable analysis, the specialties were collapsed into three groups: high-renewing specialties = none, dental public health, pathology, and periodontics; low-renewing specialties = endodontics, pediatric dentistry, and general practice; and middle-renewing specialties = all others. components represent 68% of all members and account for 84% of all nonrenewals. Relationship With ADA/VDA The effect of membership history is shown in Table 3 Individuals with fewer than five ADA membership years renew at a substantially lower rate than those with 6 10 years (81% vs. 94%, respectively). And those with ADA years renew 98% of the time. This trend toward ADA total years being

9 162 Moneyball TABLE 3 Relationship With ADA/VDA and Distribution of ADA/VDA Membership Nonrenewals and Renewals in 2010 (N = 3,417) No. a (%) Membership History Nonrenewals Renewals p b ADA Years c (19.2) 147 (80.8) (6.4) 485 (93.6) (2.2) 448 (97.8) (1.8) 219 (98.2) (1.5) 703 (98.5) (1.8) 665 (98.2) (1.8) 375 (98.2) (0.4) 262 (99.6) VDA Years c (12.1) 510 (87.9) (1.9) 469 (98.1) (1.2) 245 (98.8) (1.5) 266 (98.5) (1.4) 646 (98.6) (1.8) 654 (98.2) (1.8) 273 (98.2) (0.4) 241 (99.6) Payment Percentage < (0.8) 630 (99.2) (13.2) 118 (86.8) (5.0) 362 (95.0) 75 7 (10.1) 62 (89.9) (2.9) 2,132 (97.1) Notes: ADA = American Dental Association; VDA = Virginia Dental Association. a Number of members who either did not renew or did renew their membership in b Logistic regression results from a model including the following factors: gender, race, age, practice type, specialty, VDA component, ADA total years, VDA total years, and payment percentage. c For the purposes of analysis, both ADA total years and VDA total years were entered as continuous covariates in the logistic regression model. Both ADA and VDA total years have a positive effect on renewal after other factors are adjusted for. positively related to renewal is significant (p =.0004). Similarly, those with five or fewer VDA years renew at a substantially lower rate than even those with 5 10 years of VDA membership (88% vs. 98%, respectively). This trend toward VDA total years being positively related to renewal is significant (p <.03) after other factors are adjusted for. The relationship between membership counts across ADA total years, VDA total years, and age is shown in Figure 2 In the stacked bar charts, the green bars correspond to the number of members who did renew, and the red bars correspond to those who did not. Two features are clear. The first is that the red bars show that a great deal of attrition in membership (69%) occurs prior to 15 years of ADA membership. Moreover, 71% of all attrition occurs prior to 13 years of VDA membership. The second feature is evident in the green bars. The trough in the green bars at 15 years is the result of the

10 J. M. Coe and A. M. Best 163 FIGURE 2 Death Valley: Distribution of Membership Counts Across American Dental Association (ADA) Total Membership Years, Virginia Dental Association (VDA) Total Membership Years, and Age. The green area indicates renewing membership and the red area indicates not renewing membership. aforementioned attrition in membership occurring prior to 15 years of ADA membership. After 14 years of an attrition rate of 1.5% on average (estimated from Kaplan Meier survival analysis), there are not many members with 15 ADA total years around. In the middle panel of Figure 2, higher red bars prior to 10 years of VDA membership are evident, and this results in a dearth of teenagers in the green bars.

11 164 Moneyball That attrition is more related to membership years than age is evident from the bottom panel of Figure 2. The nonrenewal red bars are more evenly distributed, and the population histogram represented by the green bars is more representative of the U.S. population and licensed dentists in general. The multivariable analysis takes into account that age is correlated with ADA total years (r =.92) and VDA total years (r =.84) and that the two membership years variables are correlated (r =.89). The relative effect of each is reliably estimated in the multivariable model. Finally, there are clearly differences in the renewal rate depending upon the payment code (see Table 3). Although it is indeed true that those who pay 0% essentially always renew (>99% renewal) and those who pay 100% renew at a lower rate (97%), those who pay between 25% and 75% do not renew at a rate of higher than 97%. In fact, the lowest renewal occurs in those who pay only 25%. Unlike in baseball, when Billy Beane says, He gets on base a lot. Do I care if it s a walk or a hit?, ADA members taking the reduced rate walks don t end up winning games renewals are less likely. Identifying At-Risk Groups Using all of the aforementioned significant predictors age, specialty, component, ADA total years, VDA total years, and payment percentage Figure 3 presents the probability of renewing for different combinations of the predictors. The vertical axis shows the renewal percentage with a reference line for the 96.5% prevalence of membership renewal overall. The horizontal axis shows ADA total years, the principal component that accounts for 92% of all of the correlation between age, ADA total years, and VDA total years. The renewal rates by payment percentage are shown by the five dotted lines in each panel of Figure 3. Each panel represents different combinations of component and specialty. Individuals below the reference line may be considered at higher risk for membership nonrenewal. The four panels show the combined effects of all of the factors separately for each component size and specialty. The upper right panel corresponds to the best case scenario, in which one is a member of a small component and is a specialist in one of the higher renewing groups (most likely no specialty or periodontics). In this case, except for those with partial payment in the early years, all are well above the 96.5% reference line. The actual renewal rate was 99.2% overall. However, this group constitutes less than 7% of the total membership. In contrast, the lower left panel corresponds to the worst case scenario, in which one is a member of a large component and is in one of the lowest renewing specialties (e.g., general practice). Of the 1,589 members in this group, 1,507 renewed, resulting in 94.8% renewal. This group corresponds to 46.5% of all VDA members and greatly contributes to lower overall renewal.

12 J. M. Coe and A. M. Best 165 FIGURE 3 Renewal Probabilities as a Function of American Dental Association (ADA) Total Membership Years, Payment Percentage, Component Size, and Specialty. Each panel corresponds to a small size component or a large size component, and low-renewing specialties (general practice, endodontics, and pediatric dentistry) or high-renewing specialties (periodontics, pathology, surgery, or none). Dotted lines correspond to payment percentage: 0% to 100%. Renewal probability values are only shown in the year ranges in which each payment percentage commonly occurs. The solid black horizontal line indicates 96.5% prevalence of membership renewal overall. DISCUSSION The point of view of the baseball statistician in Moneyball is that there is an epidemic failure within the game to understand what s really happening. And this leads people who run major league baseball to misjudge their players and mismanage their teams (Lewis, 2003). To our knowledge, this study is the first one that has examined the relationship between various factors and actual membership retention behavior in a professional association. The analysis result strongly suggests that predictors of renewals in a multivariable analysis are different from the factors that appear important in preliminary analyses looking at factors one at a time (commonly found

13 166 Moneyball in previous ADA or VDA reports). Because the multiple factors affecting renewal are correlated with one another, all factors should be considered together. This study s multivariable analysis revealed that member age, specialty, ADA total membership years, VDA total membership years, VDA local component, and dues payment percentage are the significant factors related to membership renewal after all other factors are adjusted for. Factors such as gender and race were found not to be significant after we adjusted for other factors, whereas the common anecdotal perception is that women and ethnic minorities are less likely to renew and should be the target group to improve retention. The Importance of Relationship Marketing and a Consumer Focus in Association Management A professional association s successful accomplishment of its mission and objectives depends on key marketing activities: maintaining current members, recruiting new members, and motivating members to be involved (Ferguson & Brown, 1991). Current members are the most important market, and marketing to current members is found to be more effective and efficient than marketing to potential members (Brown, Lusch, & Nicholson, 1995; Gruen, Summers, & Acito, 2000). One study estimated that a company spends 6 times as much to find a new customer as it does to retain a current one, which emphasizes the importance of retaining current members (Rosenberg & Czepiel, 1984). A management approach that views customer relationship as the key asset of an organization has been referred to as relationship marketing (Brown et al., 1995; Gruen et al., 2000) and has been growing in not-for-profit association management (Gruen et al., 2000). Our study found that the less time a member has been with ADA/VDA, the less likely he or she will be to renew his or her membership. Apparently relationship marketing needs to be implemented to build relationships between individual members and the association on an ongoing basis, identify what benefits or services members value the most, and actively help members to realize and experience the membership s value. This may lead to increased retention, especially for the most vulnerable group of newer members (less than 15 years of relationship with ADA). Also, this relationship marketing effort has to be consumer focused. Although member retention depends on individuals perceptions of the value of the membership and the association s services, associations often relinquish responsibility for helping members realize the value of membership (Ferguson & Brown, 1991). The value of membership is often intangible, and members pay cash for the membership before they experience the benefit of it. When their expectation is not met, these members are not likely to be retained (Levitt, 1986).

14 J. M. Coe and A. M. Best 167 The Importance of Identifying Market Segments and Designing Value According to the Segments This study implies that not all members are the same in terms of their likelihood of renewing their membership. Newer members are the most vulnerable group to nonrenewals and need the most attention to build relationships. For this market segment, association management may need to customize its approach in membership value and benefits. Membership benefits that can influence renewals may be different for newer members from for older members. Association management should identify benefits that influence renewals for the vulnerable market segments and allocate resources accordingly. Limitations of This Study First, as only Virginia members were studied here, there are limitations in extrapolating our findings to all U.S. members. Second, this study analyzed cross-sectional data, which did not allow us to follow each member s renewal behavior longitudinally. In addition, this study did not assess ADA/VDA core service performance related to retention for various market segments (newer members vs. older members), although a study by Gruen et al. (2000) found that core service performance was the most important construct that directly affected member retention. Future studies can examine ADA/VDA core service performance as perceived by various market segments and determine which services are the key to renewal. It will benefit ADA/VDA greatly to focus their resources to influence membership retention and market share. CONCLUSIONS Our analysis of 2010 VDA membership identified factors associated with membership renewals after adjusting for all other factors and found that member age, ADA total membership years, and VDA total membership years were the most significant factors related to membership retention. Newer members were much less likely to renew their membership and should be the association leadership s target market segment in building relationships. In addition, there is evidence that general practitioners and specialists in endodontics and pediatric dentistry are at higher risk for nonrenewal, as are members in larger components. The commonly held belief that women and ethnic minorities renew less often is a misperception that does not consider all other related factors together. Further studies are needed to evaluate core services performance related to membership renewals, especially for

15 168 Moneyball the vulnerable groups. This will likely help ADA enhance services with high impacts on retaining its members. ACKNOWLEDGMENT Sincere gratitude is expressed to the Virginia Dental Association, especially to Ms. Leslie Pinkston and Drs. Alfred Certosimo and Kyle Coble, for their valuable contribution to this study. NOTE 1. The tripartite membership system requires that every member of ADA also belong to one state dental association (i.e., the Virginia Dental Association in Virginia) and a local component. REFERENCES American Dental Association. (2009). Virginia Dental Association membership growth workshop: Vision, action, collaboration. Chicago, IL: Author. American Dental Association, Department of Membership Information. (2010a). National recruitment and retention report for active licensed dentists end of year Chicago, IL: Author. American Dental Association, Department of Membership Information. (2010b). National recruitment and retention report for active licensed dentists Virginia Dental Association end of year Chicago, IL: Author. American Dental Association. (2011). ADA survey of 2011 nonrenews (unpublished report). Chicago, IL: Author. Brown, J., Lusch, R., & Nicholson, C. (1995). Power and relationship commitment: Their impact on marketing channel member performance. Journal of Retailing, 71(4), doi: / (95) Ferguson, J., & Brown, S. (1991). Relationship marketing and association management. Journal of Professional Services Marketing, 2(2), Gruen, T., Summers, J., & Acito, F. (2000). Relationship marketing activities, commitment, and membership behaviors in professional associations. Journal of Marketing, 64(3), doi: /jmkg Levitt, T. (1986). The marketing imagination. New York, NY: The Free Press. Lewis, M. M. (2003). Moneyball: The art of winning an unfair game (1st ed.). New York, NY: Norton. Rosenberg, L., & Czepiel, J. (1984). A marketing approach for customer retention. Journal of Consumer Marketing, 1(2), Virginia Dental Association. (2010). Virginia Dental Association new dentist and membership workshop. Richmond, VA: Author.