These costs, of course, include time spent by staff developing CME activities. When Roy asked the audience via audience-response system if the time it takes to develop and implement activities has increased or decreased, the majority of the audience reported it was taking 25 percent to 50 percent longer than it used to. While 32 percent said that investing that extra time did result in their being able to provide higher-quality education, more than half said the extra time didn’t result in any change in the quality of education they provided.

Another big time-consumer is the need to get multiple commercial supporters for activities, which complicates the application and reconciliation processes. And, as Lois Colburn, executive director, University of Nebraska Medical Center–Center for Continuing Education, pointed out, “We get caught in the strange predicament of getting some of the funding, but then not knowing if we’ll be able to get the rest.” Deborah Samuel, MBA, director, Division of CME, American Academy of Pediatrics, said that, from the medical society perspective, grants are just one piece of what they have to worry about—the “administrivia,” including increasing institutional documentation demands, is what really bogs down the process. For example, she said, firewalls that separate education and development departments also result in a lot of duplication of funding outreach, and increasing reconciliation and evaluation requirements end up meaning more piles of paperwork.

Colburn also said that uncertainty about what they’ll end up needing for ACCME review also can add to the administrivia woes: “We’re trying to do quality education while ensuring that we have every bit of paper we might need if an activity gets pulled for ACCME review. It’s a never-ending battle.”