The drug industry dialed back its continuing medical education (CME) grant-giving in 2011, continuing a negative trend of the last few years. But this time around, revenues from exhibit halls and registration fees, which offset the pharma funding cuts in 2010, couldn’t completely save CME, as total income went into the red.

Pharma has been decreasing its CME funding for the last four years. In 2008, it sliced it by 15%, then in 2009 trimmed grants by another 17%. In 2010, the bleeding appeared to slow, with a mere 3% cut. But last year, industry returned to double-digit percentage decreases, with an 11.4% cut-back to $736 million, according to the ACCME (or the Accreditation Council for Continuing Medical Education, a non-governmental, fee-funded group which accredits CME providers and serves to referee the medical education industry).

That’s $94 million less, in actual dollars. Industry grants now account for about 33% of these providers’ total CME income, according to the latest data, down from a high of 50% in 2006.

Last year’s total is a bit lower as it excludes in-kind support, such as when a company loans a provider a device to use for teaching purposes. The ACCME board, based on feedback from providers, decided last year not require them to quantify the dollar value of this kind of commercial support any more. (Another change that began with the 2011 report: Income from organizations sanctioned by state and territory medical society accreditors was added. These providers, which number 1,392, received another nearly $16 million in commercial support for CME in 2011, less in-kind support, although a comparison with the previous year is not available).

The industry funding cuts seemed to spare no one. All of the providers accredited by the ACCME—from publishing/education companies and hospitals to medical societies and schools—saw less drug industry support. Some still found ways to make more revenue. Publishing/education companies drew 2.2% more income, and hospitals saw a 3.3% revenue increase from other sources of CME revenue.

What were these other sources? Contributions from ads at medical meeting exhibit halls, where pharma and device firms show off their wares to attendees, rose 7.2% to $296 million, and other income like registration fees also increased 4.4% to almost $1.2 billion, suggesting more doctors are paying their own way to attend courses.

However, while these contributions kept overall CME income in the black in 2010, they weren’t enough to prevent total CME income from dipping 1.1% in 2011 to $2.2 billion. (Factoring in the state-accredited providers, total CME income rose 4.8% to $2.3 billion.)

It was an ugly year on other fronts: the number of ACCME-accredited providers fell by seven to 694; about 72,000 fewer physicians attended courses; and since the number of activities rose (by 8% to 88,178), average physician attendance per activity was down about 8%.

Bright spots included a jump in the number of non-physician attendees (up 1% to 7.9 million), and a 34% increase in the number of hours of instruction available.