More dollars flow into continuing medical education

Spending on continuing medical education over a one-year period was up nearly 10% in 2005, to $2.25 billion, but a smaller percentage of that money came from pharmaceutical companies and other commercial interests than in years past, according to the recently released 2005 annual report of the Accreditation Council for Continuing Medical Education.

Commercial interests -- drug companies and medical device manufacturers -- increased their giving to CME providers to $1.35 billion in 2005 for such items as education grants and exhibit space.

But because of increased money from registration fees and noncommercial groups, the share of spending by pharmaceutical and device manufacturers covering CME costs as well as CME-related advertising and exhibit fees fell from 62% in 2004 to 60% in 2005.

Part of this decrease is also attributed to ACCME changing the definition of commercial support to exclude money or services from nonprofit or government organizations and non-health care-related companies.

Increased total spending in 2005 also translated into an increased number of total CME activities, with the national specialty societies and large CME providers still capturing a significant portion of pharmaceutical dollars.

Despite the net increase on paper, locally produced CME is facing a reduction in commercial educational grants as state medical societies and small- and mid-sized hospitals capture a smaller share of commercial CME support, some experts say.

With pharmaceutical and device manufacturers the largest contributors to educational activities for practicing physicians, say the experts, this could signal a reduction in the amount of CME available for physicians at the local level.

Murray Kopelow, MD, ACCME chief executive, said he's heard from CMEproviders that commercial CME funding is falling, particularly on the local level, but said the ACCME does not capture data at the local level.

"I'm not prepared to say that [commercial CME spending] is flattening out. It's too early to tell," he said.

But some state medical societies have been tracking those data and have documented the downturn. For example, Billie Dalrymple, director of CME for the Texas Medical Assn., said the amount of commercial funding for the smaller providers the medical society accredits dropped 9% in 2005.

"I'm hearing from hospitals that it's not as easy to get grants, that you have to do it online and you get denied and don't know why," Dalrymple said. "Then they find some other way to pay for it or use a [less-expensive] speaker."

Some say the reason for this shift is because of tighter guidelines from the Office of the Inspector General of the Dept. of Health and Human Services, more self-regulation by the Pharmaceutical Research and Manufacturers of America and updated ACCME standards.

To comply with these stricter conflict-of-interest guidelines, companies have set up separate units to administer CME support. The cost of these units has taken away some of the dollars for educational grants, CME experts said. Also, the additional paperwork and bureaucracy created makes the application process more time-intensive and has increased the number of rejections, which are big barriers for small CME providers with limited staff.

"It is harder to go through the hoops and get the odd $1,000 to $2,000 educational grant to support a speaker for grand rounds," said Harry A. Gallis, MD, president of the Alliance for CME and director of the Charlotte Area Health Education Center in North Carolina. "That's a common reality for most small hospitals and state-accredited providers."

Barbara Huffman, MEd, manager of CME for Carle Foundation Hospital in Urbana, Ill., is among those experiencing difficulty in getting funding for a local program. She is planning a CME conference on diabetes, and only one of the 15 companies her staff approached have committed to a grant. Six companies agreed to buy display space. In the past, at least six would have given a grant and bought display space, she said.

"I'm surprised," Huffman said. "Diabetes is a hot area, and I never imagined that there would not be grant money for a diabetes activity."

The hospital has a nonprofit foundation it can tap to help pay for education, so the lack of commercial support won't stop the show. But Huffman is seeing other area hospitals pull back on expenses, forgoing national speakers for less-expensive local ones.

Dr. Gallis does see an upside to the shift in funding. He said the industry is looking for CME that can show changes in physician performance and patient outcomes.

"The standards may be pruning out a few of the marginal conferences," he said. "It's a blessing in some ways. The industry wants to see that their money makes a difference."