60% of med-ed providers expect revenue dip: survey

A mid-year survey confirms what many had suspected: The COVID-19 pandemic has wreaked havoc on the medical-education sector. 

The survey was fielded among accredited providers of med ed in June by the Accreditation Council for CME (ACCME) and shared with the media in late August. It drew 64 responses from across the spectrum, ranging from hospitals and physician societies to medical schools and med-ed companies. 

Results offer a glimpse into how these entities are coping amid a learning landscape that has been transformed, suddenly and significantly, over the last few months. Near-unanimous levels of respondents said they have canceled in-person events (97%) or repurposed them digitally (84%), while others revealed they have had to either furlough staffers (22%) or redeploy them (20%).

Going forward, most (60%) expect their revenue to decline in 2021, due in large part to the uncertain prospects for commercial support.

“There’s some unknowns there, for sure,” said Ed Dellert, chief publications and learning officer at the American Society for Gastrointestinal Endoscopy (ASGE). Biopharma and medical device companies, he said, have “faced budget reductions and cutbacks in regards to what they can and cannot support,” mainly because the pandemic continues to defy any and all predictions as to its expiration date.

Commercial monies are largely on hold for the remainder of 2020, Dellert said. That means grantors will be trying to figure out which virtual events to support well into the first half of 2021. 

Broadly, commercial support for medical education entities stems from two main sources, independent medical education grants flowing through a drug or device maker’s CME department, and advertising/marketing dollars arising out of the manufacturer’s brand budget. Registration fees collected when learners attend an activity account for just over half of all CME income, while a smaller fraction derives from sources like private donations and government grants.

Thirty-eight percent of respondents – mostly the nonprofit physician specialty societies – said they have had to refund fees or return commercial support in the last few months, notably after a bevy of professional societies put their spring medical meetings on hold. Some events were retooled for virtual consumption, while other gatherings were canceled outright.

In the latter camp was Digestive Disease Week, probably the world’s largest gathering of physicians and scientists in the gastroenterology community. “With that cancellation, we lost corporate support by way of exhibits, satellite symposia and commercial support overall,” Dellert recalled.

The vast majority of CME activities last year (92%) did not receive commercial support, accounting for 87% of learner interactions and 88% of all physician CME interactions, according to ACCME report data released over the summer. Commercial support for specialty societies fell 4.5% between 2018 and 2019, to nearly $102 million. For publishers and education companies, such funding increased by 3.3%, to just under $458 million.

But it’s the marketing dollars that often prop up the educational budget at big in-person medical congresses. And up until early this year, much of the CME enterprise had been heavily invested in live activities. What ACCME calls “courses” – live activities where the learner participates in person, such as an annual meeting, conference or seminar – accounted for just under half of all CME last year.

In 2019, according to ACCME, 33% of CME consumed by physicians came in the form of internet (or online) enduring (or on-demand) activities. More than two-thirds of non-physician learner interactions consisted of internet enduring activities. 

Survey respondents said that’s about to change, however. “Accredited providers anticipate that online programming will be the dominant format for the foreseeable future, a shift that may become permanent,” ACCME said in a statement on the findings. “Online education is generally more time-consuming for staff, due to time spent prepping speakers, conducting run-throughs and providing tech support.”

This shift will likely impact some accredited organizations more than others. Potentially hard-hit groups include hospitals/healthcare delivery systems and physician membership organizations, where live events have historically trended as a key format for number of activities, hours of instruction and associated revenue. 

As the CME community transitions to a mostly digital world, it’s also grappling with ascertaining the ROI of virtual events – yet another factor that’s clouding their 2021 revenue picture. The newer breed of online education is not only harder to produce; it may also be tougher to elicit support. 

“Thinking like a marketer, the value of a virtual exhibit hall is very limited in my mind,” said Allison Kickel, VP, education strategy at med-ed company Integrity CE. “Are pharma or device companies still going to spend the $50,000, plus that sponsorship money, which could have been a quarter-of-a-million dollars pre-pandemic, to try to capture people online?”

That’s the question on a lot of people’s minds these days, Dellert agreed. Asked what makes the most sense to support and what’s most effective in the virtual environment, he responded, “It really is a roll of the dice right now in regards to where this lands” 

Some 38% of survey respondents said they expect an increase in the number of CME activities next year, while 46% said the same for the number of learners. Dellert said he foresees a spike in the volume of so-called micro-learning segments: very focused content of shorter duration, delivered in bursts. An increase in the volume of content would make competition for HCP eyeballs that much more fierce.

Kickel said that Integrity CE, which held about 40% of its educational events virtually before the pandemic, has seen a boost in the number of learners. It’s a benefit of the lockdown which she said continues, although not quite at the rate of, “‘My kid doesn’t have soccer, so I can watch this tonight,’” she explained. 

“The biggest question is, Is this sustainable?,” Kickel continued. “Are we going to be able to manage the long-term Zoom fatigue?”

Added Dellert, “That’s where the CME providers are going to have to be really creative in how they approach their educational design in order to maintain those audiences.” Then again, he said, the ASGE, which leverages an in-house team for its virtual events, can run webinars “a lot more economically and efficiently because we don’t have the expenses of an in-person meeting: Faculty travel, food and beverage, on-site A/V costs, et cetera.”

Meanwhile, his society anticipates that virtual is here to stay and will continue to grow well beyond the COVID-19 pandemic. Face-to-face meetings will likely return once a vaccine is fully implemented, although to what extent is unclear. 

“Our anticipation is that the first half of 2021 is going to be predominantly a virtual focus,” he said. It will be followed by a hybrid approach in the second half, with smaller in-person activities likely to pave the way for the return of larger conferences. 

However, even these will look different than before. “We’re going to be more targeted in how we design even our face-to-face activities,” Dellert said. “Sitting and listening to a bunch of lectures in an auditorium or a ballroom – I don’t think people are going to really want that anymore.”