CME industry ponders its uncertain future

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“Collaboration” was the buzzword at this year's Med Ed Congress, held May 7-9 in Philadelphia, but the uncertainty surrounding continuing education was certainly top of mind.

Attendance was down about 50% from last year's event, a vendor pointed out, to around 100, but the proportion of supporters to providers was unusually even, and, to this interloper at least, the conference had the feel of a tight-knit community under siege.

Tea leaves were read and re-read for portends. There was surprisingly sharp self-criticism and anguished rage against the misinformed goo-goos that would dismember an industry—one that advances the causes of medical science and human health. There was plenty of wonky shop talk littered with inside jokes. 

But above all, there were questions unanswered, the big one being: Where will we stand when the dust clears?  

Already, supporters have been reduced to little more than signing checks—and critics including the Macy Foundation object even to that. 

Meanwhile Sen. Chuck Grassley (R-IA), and his cohort Sen. Max Baucus (D-MT), continue to pry and prod for greater disclosure on grants. 

It remains to be seen whether the Institute of Medicine report due later this year will take a reasonable approach to neutralizing conflicts of interest, as the Association of American Medical Colleges did, or follow the Macy Foundation's lead.  

In the meantime, providers are scrambling to ensure continued accreditation under an ACCME rule change requiring strict separation of med ed and communications companies from those that handle drug marketing—and wondering if there will still be any commercial support when their August 2009 deadline to do so arrives. 

“All the scrutiny is severing communication between pro-viders and supporters,” said Tiffany Patrick, director, medical education at Millennium Pharmaceuticals. “And we need to talk—about educational gaps, appropriateness of intervention, timing, design and distribution” and much more. 

“Our critics are constantly on the lookout for information which confirms their bias,” said Brian McGowan, executive director of the FCG Institute for Continuing Education, taking up the cudgel of critical introspection. And while their search is certainly made easier by ignorance—for example, of the distinctions between non-accredited promotional CME and certified, accredited CME—commercial supporters and providers have given them plenty of ammunition. 

“We pretended no one was looking,” said McGowan. “We had 30 years to admit the system was broken. What was the cost of this abuse?”

McGowan was playing devil's advocate there, but give the devil his due, he said, citing the crass appeals of CME shysters peddling cruises, golf or travel packages, the focus on therapies over disease education, the absence of global standards for CME and the barriers to collaboration between providers. 

“Fortunately, the best time to make a change is during a crisis,” said McGowan, prodding his colleagues to engage their critics. “We need to listen and understand the motivations of our audience. Don't deny our flaws. Let's admit them and move forward.”

The crisis in continuing medical education is prompting supporters and providers to ask hard questions about what they do and how they do it. 

It remains to be seen whether they'll be granted time enough to incorporate the best practices gleaned into educating healthcare professionals.  
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