Since 1981, the Society for Academic CME (SACME) Research Committee has surveyed continuing medical education (CME) units at medical schools in the U.S. and Canada. Beginning in 2008, the Association of American Medical Colleges (AAMC) partnered with SACME to prepare this report. The Biennial Survey of Society members includes questions about the organization of the CME unit, its relationship to the larger organization in which it resides, the ‘product’ of the CME unit (courses and other activities and interventions), its funding base, research and innovation, and other items related to the operation of the CME unit.
The survey is electronically distributed to all U.S. and Canadian medical schools, teaching hospitals in the U.S., and clinical academic societies who are members of the AAMC’s Council of Academic Societies (CAS). The most recent survey results from 2010 were recently released and are summarized below.
Conferences and Courses
On average, the survey showed a drop in CME units over the past three years. Specifically:
- In 2010, over 130 courses on a yearly basis vs. 147 in 2008
- In 2010, approximately 1,363 credits vs. over 3,000 credits in 2008
- In 2010, attendance of 7,500 physicians vs. 9,000 physicians in 2008
- In 2010, attendance of 4,000 non-physicians vs. 4,600 non-physician participants in 2008
Regularly Scheduled Conferences, Series, or Rounds (RSS)
There was also a drop in CME units who provide credit for regularly scheduled conferences, series. Specifically:
- In 2010, 58 regularly scheduled series vs. 83 in 2008
- In 2010, 1,600 credits vs. 2,274 in 2008
In addition, the numbers of asynchronous audio, video, and online courses also decreased. Specifically:
- In 2010, 52 courses used video, audio vs. 170 in 2008
- In 2010, over 230 credits were given vs. 266 in 2008
- In 2010, these attracted 4,000 documented physician users vs. 6,895 in 2008
Commercial Support of CME
For 2009, CME units were asked report the revenue they generated from a variety of previously-selected sources. In total, representing the responses of a large percentage of the academic enterprise devoted to CME in North America, over 100 CME units reported $342M in annual revenues, of which they spend slightly over $370M, for a net overall loss. Of their revenues:
- 37% derived from registration fees (markedly up in two years from 29%);
- 28% from commercial support (markedly down from 2008 at 54%); and
- Advertising and exhibits at 17% (nearly tripled from 2008 when it was 5%).
- Institutional and other funding streams were essentially unchanged.
By this report, there has been a sizable decrease in the proportion of commercial support in a two-year period. US schools reported 34% direct commercial support, appreciably decreased from previous surveys, which indicated more than half of revenues derived from this source.
Teaching hospital revenue streams (when compared to US medical schools) reflect a similar percentage of income:
- Commercial support (31%)
- Advertising and exhibits (12%); and
- Registration fees (33%).
Academic society’s revenue streams garnered:
- Much less support from commercial entities (11%)
- Registration fees (18%) and
- A significantly larger percentage from advertising and exhibits (48%).
With respect to the number of CME activities which received commercial support:
- In 2010, 68 activities received commercial support vs. 145 in 2008
- In 2010, 26 of these activities would have been solely supported vs. 48
- In 2010, 42 activities would not have been offered without commercial support vs. almost all 48 programs in 2008.
Discussion
Interestingly, the report showed that 98% of respondents had policies regarding commercial conflicts of interest (COI). This number is important for two reasons. First, such a high percentage of COI policies may account for the decrease in commercial funding, although the numbers are roughly the same since 2008. Nevertheless, there is a good chance that increased enforcement, oversight, or changes to those policies in light of recent media attention could have resulted in policies banning commercial support of CME or creating policies that make commercial support unappealing to sponsors and frowned upon my institutions.
Second, this high number of policies should be a positive reason why academic medical centers should be collaborating with commercial entities to create CME. With policies in place, potential COIs can be managed, bias can be eliminated, and the quality of programs can be significantly increased. In fact, over 85% of the 88 US schools who responded reported a moderate or extensive change in their operation of CME units by adopting the new ACCME criteria. This change is important to recognize because it shows that medical schools are implementing policies that align with ACCME criteria, which ensure adequate management of commercial support and objectivity in program content.
Conclusion
Ultimately, the apparent decrease in the average number of standard courses, accredited CME activities such as rounds, and regularly scheduled series is concerning. This decline is almost surely related to the decline in commercial support of CME activities at medical schools and centers.
Once commercial support is reduced, schools and centers can no longer support the resources or staff necessary to offer adequate or similar programs to faculty, staff, and surrounding community health care professionals.
Such a finding that commercial support is becoming harder and harder to get is problematic considering almost every school or medical center has a COI policy in place, suggesting that many of these institutions may need to revisit such policies to make sure they are not too burdensome that they are driving away commercial support.
In the end, medical schools and centers should be working with commercial entities to provide objective CME that will bring the latest advances, newest information, and clinical data to physicians. Much of the concerns that medical schools or centers have about the role of commercial support can be adequately addressed in institutional COI policies, but these regulations must carefully balance the role of commercial support so as not to deter academic-industry collaboration.
If commercial support continues to decline, and the number and kind of CME courses continues to decline, America’s leading medical schools and centers will face significant problems training and educating our health care professionals.