CME providers agonize over eliminating the possible perception of bias in their activities due to pharmaceutical industry support, but are docs similarly concerned — and if so, are they concerned enough to pay their own way? For the first time, Medical Meetings posed those questions in the 2005 Physicians' Preferences in CME Survey. We also explored several other new areas, asking doctors whether it is important that CME activities are based on high levels of evidence, and what types of meeting formats motivate them to change their practice behavior. In addition, we included our traditional questions about what methods docs use to obtain CME, and how they make decisions to attend out-of-town conferences — with some surprising results.

We Won't Pay

At last fall's Annual Conference of the National Task Force on CME Provider/Industry Collaboration, several presenters suggested that the only way to ensure that CME is free of bias is to shift the onus for paying from the pharmaceutical industry to healthcare workers. How do docs feel about that? About how you'd expect. Survey respondents say pharma funding does not cause problems with content, and even if it does, they can sort out the good from the bad. And, also not surprisingly, they said they wouldn't be willing to pay more for their CME to reduce the need for pharmaceutical grants.

When asked to rate how concerned they are that pharmaceutical industry funding inappropriately influences certified CME activities, on a scale of 1 (not at all concerned) to 6 (extremely concerned), 22 percent said it wasn't a problem at all for them. Just 11 percent rated it a 6. In the aggregate, those who gave it a lower priority by rating the issue 1, 2, or 3 accounted for 53 percent of the total. However, about 45 percent gave it a higher priority, rating the issue a 4, 5, or 6. (Totals do not add up to 100 percent because of rounding off.) But since the percentage of doctors who were not at all concerned was double that of those who were very concerned, it still follows that, when asked if they would be willing to pay substantially higher fees for CME activities to reduce the need for pharma funding, fully three-quarters said no.

And they were more than happy to share their reasons why, which fell into two basic camps. First, they said, CME already costs too much, and second, CME either isn't compromised by the financial relationship to pharma, or they felt that they can filter out any bias themselves. As one respondent said, “I'm a cheapskate.” Another summed it up this way: “Already it is pretty costly. I think we're smart enough to see bias.” One got a little haughty: “I make my own decisions about my practice. If you are so weak a person that you can't make independent decisions, then don't go.” A few even want to see more pharma involvement in CME, such as the physician who commented, “I think pharmaceutical companies should be allowed to be more involved, as they were in the past, i.e., the 1920s.” One respondent said, “I'd rather have the pharmaceutical industry pay for this type of thing rather than the gewgaw junk they offer,” or, as another said a bit more tactfully, “I don't see any undue influence from pharmaceutical companies, and since their spending is limited, CME is a good way to use the money.” In a similar vein, one responded, “They have money, let them spend it. They aren't lowering drug costs anyway.”

The few respondents (18 percent) who said they would be willing to pay more to reduce the need for commercial support of CME were equally vociferous in their views, though. “A resounding yes,” said one respondent. “So much information is tainted.” Another reasoned that having the additional money would help pharma keep drug costs reasonable for consumers. One of the more cautious yes-sayers added that he or she would be willing to pay more as long as it was “within reason.”

Perhaps related to the issue of bias is their response to a question asking how important it is that CME be based on a high level of evidence. On a scale of 1 to 6, with 1 being “not at all important” and 6 being “extremely important,” fully 84 percent of respondents rated the importance of evidence-based CME either 5 or 6, and just 4 percent answered on the lowest two points of the scale. As one person commented in response to the question about paying more to reduce pharma commercial support for CME, “As long as speakers are not biased toward the [commercial supporter] and stick with the facts, it is OK” for pharma to support activities.

Get Out of Town

As for how they obtain their CME, respondents increased the percentage of CME they received at out-of-town meetings — reversing a seven-year slide. Thirty-seven percent of the CME they received in the past year was through out-of-town meetings — up from 35 percent last year. Those under 45 years of age were the largest proponents of out-of-town meetings, saying they got almost half of their CME that way, compared to 33 percent for those who are 45 to 55, and 35 percent for docs who are older than 55.

The second-most-popular CME format was local meetings, where respondents said they received 25 percent of their credit hours. This means that survey respondents earned 62 percent of their CME in live meetings. Reading journals came in a distant third, with 15 percent of credit hours earned through that medium, followed by audio/videotapes, online CME, CD-ROMs, and audioconferences. But meetings planners, particularly those who produce local meetings, shouldn't rejoice yet. There was a five-point slip in the percentage of hours earned by attending local meetings to go along with the two-point rise in hours earned at meetings that require overnight travel, making for an overall year-over-year decrease of 2 percent in total hours earned at live meetings.