Jan Fitzpatrick
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Continuing medical education (CME) is arguably more important today than ever before. While clinical trials and scientific
studies and articles have proliferated, managed-care requirements have left many physicians with less discretionary time for
professional development. These time constraints, coupled with the sheer volume of information available, plus the complexity
of operating in a hyper-regulatory environment, have challenged both CME providers and those who fund the programs.
Commercial Support Wanes
A little number crunching reveals what may be a sign of the strain. CME is a $2 billion industry that is still growing. Annual
report statistics from the Web site for the Accreditation Council for Continuing Medical Education (ACCME) show that the number
of providers with ACCME accreditation increased from 686 in 2002 to 716 in 2004. Commercial funding, primarily from pharmaceutical
companies, also has increased from $746,015,426 in 2002 to more than $1 billion in 2004.
What that growth pattern masks, however, is a drop in the rate of increase for commercial support. Between 2002 and 2003,
commercial support for CME programs increased 30 percent; between 2003 and 2004, it increased only 10 percent. There has
also been a modest drop in the percentage of commercial support as part of the total funding (47 percent in 2002, 55 percent
in 2003, and 52 percent in 2004).
Major players in the CME world offer several reasons for the slowdown. "As recently as three years ago, you had an environment
where CME providers and grantors shared a common understanding of guidelines," says Martin Cearnal, chief strategy officer
of Thomson Medical Education. "That's no longer true. Today, every company interprets these rules and regulations a little
differently."
Sources of CME Slowdown
Tips on Designing CME
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Because each pharma company individually determines what FDA guidance on medical-education programs requires them to do, policies
and procedures dramatically vary from one company to the next. This means that CME providers must do substantially more research
to tailor a proposal specifically to that company's requirements. The length of time it takes to secure funding is therefore
longer, says Douglas Wicks, director of the Center for Continuing Outreach and Education at the University of Medicine and
Dentistry of New Jersey.
Though more experience with current guidelines could theoretically shorten the funding timeline, Wicks isn't holding his breath.
"The pharma industry is a moving target—it will continue to operate in a climate of vigorous, evolving oversight," he says.
Just last June, concerns over ballooning costs of Medicare and Medicaid led to a Senate Finance Committee letter that asked
24 large pharma and biotech companies to give information about educational grants they had made, especially activities that
promoted or discouraged off-label drug use.
There also are other reasons for the budget restraints, says Dr. Melinda Somasekhar, a former medical-education executive
at Wyeth, who is currently the assistant dean and director of Temple University's CME department. She says top executives
and marketing departments don't know how to measure their ROI in education now that marketing is no longer funding CME. "The
American Medical Association and ACCME say the goal of continuing medical education should be to change physician behavior
and improve patient outcomes," she says. "As someone with a background in research, I do believe that the quality of CME
will improve dramatically over the next several years, and that if we improve education, the long-term interests of pharma
companies will be well-served."
But, she says, it may take two or three years for educators to show top-level executives and marketing departments that
"there is a return on their investment in education even if you can't measure it as directly as you could in the days when
the budget for CME was in the marketing department."
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