With government bailouts in the hundreds of billions, two hundred million doesn't sound like a lot of money these days. And in fact it is just a drop in the $1 billion bucket of commercial support reported by accredited continuing medical education providers in 2008, according to the Accreditation Council for CME's “Annual Report Data 2008.” But it is $200 million less than the $1.2 billion providers said they received in 2007, which is the first time the total commercial support dollars have dropped since ACCME began recording this data in 1998.

This is the sharpest downturn in a downward-trending spiral that began in 2003, when previously exponential growth rates began to slow. Now, instead of the tiny 1 percent growth rate reported in 2007, we have a 17 percent decrease; in fact, commercial support in 2008 had fallen to just below the amount reported back in 2004. This is not unexpected, given the harsh light being shone on commercial support of CME (see the cover story on page 28). With several new state pharma marketing laws either recently enacted or under consideration — as well as federal legislation such as the Physician's Sunshine Act, which would require manufacturers and group purchasing organizations to report all payments over $100 to physicians and physician-owned entities — experts continue to predict a slide in commercial support made available to CME providers. Less than half (44 percent) of the total income reported was from industry grants; the remaining came from advertising and exhibits (11 percent) and “other” income, such as fees paid by learners (45 percent).

While advertising and exhibits income was up a tad (just over 1 percent, to $277 million), as were participant registration fees and allocations from providers' parent organizations (almost 5 percent, to just north of a billion dollars), this bite out of the commercial-support side was a substantial one, causing total income also to drop for the first time since 1998. While the drop was relatively small — just 5 percent — it erased the gains made in 2007, bringing total income levels in 2008 back to a touch below what providers earned in 2006. To make matters worse, CME providers are no exception to the rule everyone else is dealing with in this down economy: Just because your income is reduced, it doesn't mean your expenses go down. In fact, total expenses reported in 2008 rose 4 percent.

Despite all this financial doom and gloom, the number of CME activities offered remained stable at 101,000 (while there was a decrease noted, according to ACCME, this is due to a change in reporting by Internet providers). The hours of instruction actually increased about 4 percent, and the numbers of both physician and nonphysician participants also increased in 2008, by 18 percent and 21 percent, respectively. Directly sponsored courses made up the majority of activities offered, numbering around 28,000. Internet enduring materials were the second most popular offering, at more than 22,000. These two types of activities also were the most numerous among jointly sponsored activities offered.

Where the Dough Goes

Traditionally, medical education and communication companies get the lion's share of the commercial support reported by accredited providers, which again held true in the 2008 data. However, the more than $463 million in commercial support received by this group, categorized by ACCME as publishing/education companies, represents a more than 25 percent drop in just two years from the $620 million it received in 2006. The largest drop in commercial support over the two-year period was to providers in the government or military, which saw its relatively paltry $4 million drop to $128,790, an almost 97 percent downshift. The next biggest hit was to the hospital/health care delivery system providers, who saw their commercial support decrease by almost 32 percent since 2006, to $39 million. Medical schools also lost about 13 percent of the commercial support they received just two years previously.

The big winners in terms of commercial support are also an indication of where the pharmaceutical and medical device companies might feel safest putting their dollars these days: Nonprofits that are not physician membership organizations were up 75 percent, to $86 million, in 2008; insurance and managed care companies were up 43 percent to $376,833; and nonprofit physician membership organizations were up 12 percent, to $202 million.

There also has been a small increase in organizations that no longer accept commercial support, which now number 140, according to ACCME data. This brings the total proportion of providers that do not accept commercial funds to 20 percent.

AMA Joins the Blogosphere

The American Medical Association is really getting into social media these days. First it launched a profile page on Twitter(@AmerMedicalAssn), and now President J. James Rohack, MD, has started up a blog called On the Road With Dr. Rohack.

He will be blogging from the road as he spends around 200 days over the next year speaking and working with physicians around the country.

You can find the blog at www.ama-assn.org/ama/pub/health-system-reform/blog.shtml.