Hospitalist Lenny Feldman, MD, FACP, FAAP, SFHM, of John Hopkins School of Medicine in Baltimore, is the proverbial study in contrasts. He is the longtime editor of SHM’s Consultative & Perioperative Medicine Essentials for Hospitalists, a free continuing medical education (CME) repository more commonly known as SHMConsults (www.shmconsults.com). But in February, he helped lead “Updates in Hospital Medicine 2013: Evidence-Based Reviews on the Management of Hospitalized Patients.” That program, arranged by Canadian education provider CMEatSea (www.cmeatsea.org) and held aboard a cruise ship in the eastern Caribbean, attracted some 60 hospitalists, nurse practitioners, and physician assistants interested in earning up to 14 credits.
On the one hand, Dr. Feldman is a pioneer of free virtual CME. On the other, he is an example of the big-ticket CME events that were much more commonplace five or 10 years ago.
“It’s tough,” Dr. Feldman says. “There’s no doubt that once you’ve built that virtual infrastructure, it allows many more people access to CME than if they have to come together. But with that said, particularly at a meeting like HM13, there’s so much more to it than just the CME. The networking is a huge part of that.”
This is the current state of CME, in which ever-tightening physician budgets plus a massive pullback of pharmaceutical industry support equals a landscape of fewer and fewer big-ticket events and more and more online offerings. The expense of large-scale offerings means that many physicians look for more than just the credits available when deciding which events to attend.
For many hospitalists, of course, SHM’s annual meeting remains the best opportunity of the year for CME. Accordingly, those credits are often cited as one of the biggest lures for many of the nearly 3,000 hospitalists who are expected to convene May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md.
“You can always get CME credits locally by attending lectures at your own institution, but so often the content of these lectures is really not something that has been vetted and put forward by hospitalists,” says HM13 course director Daniel Brotman, MD, FACP, SFHM. “I think the people who attend this meeting know where the field is going, not only because of the content that’s offered, but because of who else is there. That’s different than going to an hourlong lecture by a cardiologist at your institution on atrial fibrillation.”
—Lenny Feldman, MD, FACP, FAAP, SFHM, John Hopkins School of Medicine, Baltimore
CME budgets typically run $3,000 to $3,500 per physician, but can range from as low as $2,000 to as high as $5,000 annually, according to rough estimates from industry leaders. Opinions are mixed on whether those budgets have been significantly reduced over the past few years, but “they’re certainly not going up,” Dr. Feldman says.
What is falling year after year is the amount of money that the pharmaceutical industry is providing to support CME, says Daniel Guinee, executive vice president of educational firm ASiM of Somerville, N.J. The drug industry funded $1.2 billion of CME in 2007, according to the Accreditation Council for Continuing Medical Education (ACCME). That number dropped to $736 million in 2011, the latest year for which ACCME has statistics. Guinee says many expect the total for 2012 to be approximately $600 million, then level off.
Some applaud the drop-off in industry funding as a needed correction to ensure any potential bias is eliminated. To that end, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs in 2011 adopted a policy urging the avoidance of industry funding of CME when possible. But just 42% of physicians in one study said they were willing to pay higher fees to eliminate that funding source (Arch Intern Med. 2011;171(9):840-846).
Guinee attributes much of the drug industry’s pullback in funding to companies’ uncertainty over transparency and reporting required by ACCME, the FDA, and the U.S. Department of Health & Human Services (HHS).
“The companies want to use their money as they want to,” Guinee says. “Instead of putting the money out there … as way to support medical education, they’re saying, ‘You know what? We’ll just hang on to it and spend it in other ways.’”
Dr. Feldman, whose SHMConsults project has been supported by the pharmaceutical industry for seven years, says it’s unclear where future funding will come from in order to support CME. But ACCME president and chief executive officer Murray Kopelow, MD, says that while commercial support—the industry term for pharmaceutical funding—has steadily fallen, “other income” rose 221% from 2006 to 2011 for ACCME-accredited providers and ACCME–recognized, state-accredited providers. ACCME says that income can include activity registration fees, government or nonprofit foundation grants, and allocations from accredited providers’ parent organizations.
“The balance of revenue has shifted,” Dr. Kopelow says.
Education When You Need It
Also shifting is the nature of CME delivery. Since 2007, the number of live Internet CME activities has risen 33%, while the number of journal CME activities has risen 13%, according to ACCME figures. The number of courses in which participants physically attend is virtually static.
SHM has embraced the virtual concept and is looking to add as many online learning opportunities as feasible, says Catharine Smith, SHM’s senior director for education. That includes updates to SHMConsults and the Hospital Quality and Patient Safety Online Academy (www.hospitalmedicine.org/hqps), as well as future offerings based on core competencies. Virtual CME allows hospitalists to meet CME requirements when it is convenient for them and allows providers to set up both live events and enduring materials, Smith says.
“More online CME opportunities from SHM’s Learning Portal is about bringing quality content to hospitalists,” Smith said in a statement. “This reflects SHM’s understanding of the professional needs of hospitalists.”
She added that measuring outcomes can be easier online, as data recording in that manner is easier than during a big meeting. Then again, it’s also difficult to gauge just how well a learned lesson is then incorporated into practice.
For all its advantages, online CME shouldn’t replace all face-to-face learning, Dr. Kopelow says.
“Physicians consult colleagues and reflect on what they have learned before integrating the new information into their practice for the benefit of patients,” he adds. “It is this process that accredited CME promotes and supports. Online CME supports this process, but it does not replace the total process of continuing professional development.”
Dr. Feldman says physicians will have to decide for themselves what works for them, particularly if reduced CME spending by the drug industry continues to crimp offerings.
“There’s going to be a huge sea change there in terms of folks needing to decide where they’re going to want to spend their CME money,” he adds. “Are they going to choose some of these easier-to-use, online CME offerings if they think that going to meetings is becoming prohibitively expensive? Only time is going to tell.”