the right to revisit the topic. Another seminal event with potential economic impact occurred last year when Pfizer, the largest grantor, announced its deci- sion to stop funding CME through MECCs. For now, no other big grantors have followed suit.
AstraZeneca’s Mason, who is also 2009 chair of the pharmaceutical section of the Alliance for CME, says the number of grants her company awarded to MECCs represented only about 15% of funding last year and has decreased over the past few years. However, this trend is attributable to “the number of MECCs who are submitting grant applications and overall budget limitations.”
By contrast, in 2008 55% of AstraZeneca grants were awarded to hospitals, medical schools and healthcare systems representing about 25% of avail- able funding.
“AstraZeneca,” she says, “has not changed [its] approach to supporting quality, independent educa- tional activities.”
Opponents of commercially supported CME argue that physicians need to pay their way more often, and other funding sources being explored in- cluding third-party payers, large employers, govern- ment payers like Medicare and Medicaid and aca- demic institutions.
“It’s very clear the funding models, especially in medical schools and hospitals are probably go- ing to have to step up and provide internal support for their CME program. That’s one point even our
CME Revenues, 2004-2007
*Includes registration fees and internal allocations Source: ACCME 2006 Annual Report
Commercial Support — FDA-regulated
Commercial Support — Other
Advertising and Exhibits
Revenues ($ millions)
“Funding models are going to have to step up and pro- vide internal support for their CME programs”
Melinda Steel , MEd, CCME , managing director of CME, ex- as ech Univ. Health Sciences Center
deans need to hear,” says Melinda Steele, MEd, CC- MEP, managing director of CME at Texas Tech Uni- versity Health Sciences Center and immediate past president of SACME.
If the IOMs and Macy’s get their way, and pooled funding becomes a reality, that may hinder the movement toward impact performance-improve- ment oriented CME, which typically costs more to implement (see article on outcomes, p. 10).
With less money available for grants, a number of groups also will make the switch to the promotional side because they perceive it as easier to support. Those aligned with the medical community—insur- ers, foundations and societies—will be able to make that switch most gracefully, says Schaffer.
Credit check Brace for another form of downsizing in the CME enterprise: CME, with its traditional emphasis on credit, may one day become extinct. That’s what some say may happen with the implementation of Maintenance of Certification (MOC) for physi- cians by various boards of medicine. That’s because boards, which link MOC to a multistage process that includes performance improvement, will ask wheth- er physicians are competent, not whether a physi- cian earned x number of credit hours.
MOC will not dismantle the current credit sys- tem, argues Schaffer. Thirty-nine states still require a certain number of credits for individuals to be re-licensed, and state legislatures are not known to move quickly.
To be sure, the emphasis will shift from simple at- tendance to a portfolio-based approach. Yet, “It will be a long time before you see the credit system, if it ever does, go away,” he says. “The current credit system and MOC will start to work hand in hand. When you look at parts 2 and 4 of MOC [lifelong learning & assessment and practice performance as- sessment], it’s clear that there is a need for formal- ized med ed. That’s where I get excited. I see lots of potential for helping physicians do something they don’t know how to do, and that’s to learn to look at their entire practice and see what’s happening and get better, as opposed to looking at each individual patient, which is currently what they do.”
Evolution, not adaptation One of the main drivers of change is CME’s main regulatory body, the ACCME. Murray Kopelow, MD, ACCME CEO, says he envisions a future in