Society for Academic Continuing Medical Education (SACME) and the Association of American Medical Colleges (AAMC), Recently released their bi-annual survey of academic CME, developed as a collaborative partnership between the was distributed online in the fall of 2008 to 137 medical schools in the United States and Canada. Some of the recently published findings from the “The Harrison Survey,” include:
– An increase compared to earlier SACME surveys in the percentage of physician-leaders in CME;
– Commercial support (especially in U.S. schools) is vital to funding educational courses especially given the commensurate lack of institutional support for CME; and
– Notable examples of increased linkages to internal programs and departments such as performance improvement, residency or allied health education, faculty development, and other entities.
The survey asked CME units to estimate the percentage of their activity that targeted an internal versus an external audience, and primary care, specialist or interprofessionals:
– 39 % target an internal audience versus 24 % external primary care physicians, and 19 % target external physician specialist audience;
– 24% attract an interprofessional audience (doctors, nurses, social workers and others); and less than 4 % reach out to the public or patients.
Budget Models
– 54 % of the respondents report a blended model in which the CME unit has some budget components separate from that of the institution, in addition to some institutional support (e.g., salaries, computer services) indistinguishable from that of the parent institution itself.
– 43 % report that the CME unit budget is entirely separate from other parts of the organization’s budget.; and
– Only three medical schools (<4 %) report that most (or all) of the CME budget is embedded in the full budget of another unit or program (e.g., educational affairs) of the organization or institution, and is not easily distinguished.
Academic CME Revenues and Expenses
– In total, the 83 CME units report almost $270 million in annual revenue, of which they spend slightly under $250 million ($246,362,675).
– Nearly $145 million ($144,384,926) derives from commercial support, with, registration fees of nearly $76 million ($76,916,261) as the second major funding source.
– In contrast, only ($549,933 – 00.2%) came from institutional educational research support
– Other revenues include 5 % from advertising; 6 % from the institution; 4 % from state/government support
Consequently, funding models differ significantly between U.S. and Canadian schools because there is much less commercial support in Canadian schools versus their U.S. counterparts (14 % vs. 56 %). Institutional support also varies in that Canadian schools CME units receive over 17 % of their support from institutions, three times more than their U.S. counterparts. Government funding is also almost three times more in Canada than the U.S. Similarly, registration fees generate roughly one-third (30 %) of the income in both the United States and Canada.
The “average” academic CME unit conducts 145 yearly activities that receive financial support from commercial sources. Of these 145 activities, over one-third (51) are solely supported by commercial support, and almost all (121) would not have been offered had commercial support not been available.
– 50 % of CME units indicate that all deficits and surpluses are the responsibility of the cosponsoring unit (e.g., clinical or academic department);
– 25 % report that all deficits and surpluses are shared between the CME unit and the cosponsoring unit by some negotiated arrangement; and
– 19 units (20 %) keep all deficits and surpluses; and 5 % indicate variations to this overall model
Accordingly, while most academic CME units have adapted or created policies related to fiscal and administrative issues, most units have no established policy (or are unaware of the existence of such policies in the larger institution) for rewarding or acknowledging faculty involvement in CME as a consideration in promotion and tenure.
Additionally, 80% of the 82 schools who responded reported a moderate or extensive change in their operation as the result of ACCME policy changes. Of the 110 units reporting; 34 units indicate participation in research or development activities.
The number of studies undertaken by these CME units varies from one to 20, with 18 earning $12 million ($8.3 million in grants or research activities). 33 % of reporting units indicated that all of the research was done by individuals located in CME unit only.
Lastly, nearly 50 best practices are reported, ranging from staffing issues, to educational issues, to new modalities in. The largest number of best practices was termed “integrative”—developing active, working linkages with health systems, hospitals, conflict of interest groups, and other educational programs in the institution.
SACME: Harrison Survey 2009