Med Ed Review: From Regs, Few Riches

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Perhaps one of the most telling aspects of this year's Medical Education Review lies not just in the survey answers we received, but in how many providers submitted information for the listings: just 71, compared with more than 100 last year.

That's not to say that the marketplace has deteriorated to the extent that those companies have disappeared. A far likelier explanation lies with the regulatory microscope hovering over the industry and the subsequent focus on guidelines and regulations. Inconsistent communication and interpretation of those rules on all sides has fostered a culture of skittishness in which providers are justified in wondering whether they might be better off not being seen at all than risk being seen anywhere near the words “marketing” or “promotion.” That's the speculative part. Now for the facts. When asked if they thought business in 2008 would surpass 2007 levels, 42 respondents said “Yes” and just six said “No,” while 23 chose to say nothing. 

Here are some other questions we fielded:

What has been the biggest industry challenge for you over the past year?
By far the biggest challenges reported by providers were having to operate with tighter budgets/commercial support (15 out of 33 responses) and dealing with regulatory issues (14). Other responses included adapting to scale, the effect of M&As in the industry, adapting to online grant application processes, the impact from a lack of product approvals and achieving QI. “We are trying to move the industry to support larger educational activities that exists over multiple years,” said a respondent. “In that way we will be able to measure outcomes across a longer period of time. It will also allow us to adhere to adult learning principles.”

What types of programs are growing the fastest and why?
There seems little doubt about the biggest growth area: web-based programs accounted for 20 of 33 responses to this question, with most citing high user convenience and low program costs as the main drivers. Other answers included speaker training and lecture bureau management and on-demand video. “Clearly the digital space coupled with programs that have clear measurement have risen dramatically,” said one firm. “This is due to the shear size and reach of the audiences now available.”

Have you seen levels of commercial support rise or fall in the past year?
Almost two-thirds of 30 respondents to this question said they had seen levels of commercial support fall in the past year. Just three reported an increase, while nine said they were about the same. “The levels are the same,” claimed one provider, “but they are being granted to groups with proposals with solid data-driven outcomes plans.” Most firms that had seen a loss blamed it on regulatory issues, while some bemoaned problems with clinical data and approvals. “There hasn't been much good news on the efficacy side.” Others attributed the squeeze to the general decline of the industry.

Are grant approvals moving faster or taking longer? By how much, typically?
Most of the respondents (15 out of 22) reported that grant approvals were taking longer, with eight of these claiming that they were taking “months” longer. Just three firms experienced faster approvals, with another three reporting that they were unchanged. “They're taking longer than grantors even state on their RFPs and websites,” complained one respondent. Another added, “Denials come faster. But approvals come, on average, more slowly than 12 months ago.”

How has regulatory scrutiny impacted commercial support?
Again, respondents felt that regulatory scrutiny had directly impacted commercial support (9 out of 24). Others were frustrated by a slowdown in the legal review process and the restructuring of departments and procedures. “Lawyers are scared,” noted one firm, “and are pulling back funds as a result.”
The inconsistency of interpretation was also a frustration. “There are more hoops to jump through and more cumbersome request criteria,” said one respondent. “Companies interpret the rules differently and make their own—then don't say what they are.” 

Note: This is not a scientific survey.
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