More choices, more pressures. With the introduction over the past few years of Internet point-of-care and performance improvement activities, physicians' menu of methods for obtaining CME credits has grown larger than ever. On the downside, however, physicians are also burdened with more requirements to demonstrate their professional competence, due to the advent of maintenance-of-certification and pay-for-performance systems.

In our 2006 Physicians' Preferences in CME Study, we introduced new questions, asking doctors about how these changes are affecting their CME decisions. Since CME providers are grappling with how to evaluate the effectiveness of their education, we also asked physicians, for the first time, about their experience with outcomes measurements. And we dug deeper into doctors' use of online CME, breaking down which methods they preferred, in addition to asking our traditional questions about their CME participation.

Here are the key findings:

• About one-quarter of respondents said they plan to use Internet point-of-care during the next 12 months to obtain CME credits; 19 percent will use performance-improvement activities. Of those who use the Internet to obtain CME, Internet point-of-care is by far the most popular method.

• New Methods Take Off

  One-half of respondents said that maintenance-of-certification requirements will affect their CME decisions in the coming year; while 21 percent said that pay-for-performance requirements will influence their choices.

• While respondents still earn the largest percentage of their credits by attending out-of-town meetings, that percentage — 32 percent — was the lowest it's been in the history of our survey, except for the survey conducted in 1998, when it was also 32 percent.

About a quarter of respondents — 26 percent — said they plan to use Internet point-of-care (online self-directed learning) to obtain CME credit in the next 12 months, while 19 percent plan to use performance improvement (activities where docs track and evaluate a specific practice area). However, 53 percent of respondents didn't answer this question, perhaps indicating that CME providers need to be more aggressive in marketing these activities.

Women respondents are more likely to use these new methods, with 39 percent planning to use point-of-care compared to 20 percent of the men, while 22 percent of the women intend to participate in performance improvement, compared to 16 percent of the men.

MOC Makes a Mark

Interestingly, these activities are most popular with the older-than-55 docs. Thirty percent plan to use Internet point-of-care and 20 percent said they would use performance improvement — higher percentages than for their younger counterparts.

As for how they achieved their credits this past year, respondents earned 3 percent of their credits through PI activities. The age and gender breakdown shows a similar direction as it does for point-of-care. The older-than-55 physicians obtained more of their credits (4 percent) through performance improvement than younger-than-45s, who earned only 2 percent of their credits via that method. Women were also more likely to use PI — earning 6 percent of their credits that way, while the men earned only 2 percent of their credits through PI.

Outcomes Opinions

For 51 percent of respondents, maintenance-of-certification requirements will affect how they make decisions about participating in CME in the coming year — a clear message to CME providers to continue developing activities to help physicians meet these new standards. Forty-two percent said MOC would not affect their CME decisions, while 5 percent weren't sure, and 1 percent didn't answer. The highest percentage of those answering “yes” were the older-than-55 physicians, at 56 percent. Asked why, one respondent sounded a discouraging note: “Probably will do less CME because of the time required to do MOC requirements.” But others' answers were more positive, with one physician commenting, “It's always great to tie both together.” Another wrote, “CME is critical regardless of requirements.” Refusing to succumb to outside pressures, one doctor asserted: “I just go to the CME activities I like and can go to.”

As for pay-for-performance requirements, 21 percent said those would affect their decisions about participating in CME; again the older docs came in with the highest affirmative response at 23 percent. Fifty-three percent of total respondents said those requirements would not affect their decisions, while 23 percent were not sure, and 3 percent did not answer the question. Clearly not a fan of pay-for-performance, one physician wrote: “I'll do less learning and more ‘following the guideline’ cookbook medicine in order to get paid.”

Credits Climb

Asked which outcomes-measurement techniques they have participated in, the largest number — 38 percent — had filled out pre- and post-activity surveys, 12 percent had done self-reported chart reviews, 12 percent filled out surveys using case vignettes, and 11 percent had participated in three-month follow-up surveys. Five percent had participated in six to 12 month follow-up surveys, while the lowest percentage, 3 percent, had written commitment-to-change contracts. However, 49 percent of respondents did not answer the question — perhaps indicating that outcomes measurements are still not widely used in CME activities.

We also asked respondents to rate how valuable the various outcomes-measurement tools were in assessing whether a CME activity was effective in changing their practice behavior. A disclaimer here: Many more respondents answered this question than said they had actually participated in outcomes measurements — however, we are including their rankings as an indication of physicians' perceptions about the effectiveness of outcomes measurements. Pre- and post-activity surveys received the highest rating at 3.8, on a scale of 1 to 6, where 1 is not at all valuable and 6 is extremely valuable. Three-month follow-up surveys and surveys using case vignettes tied for second at 3.3; six- to 12-month follow-up surveys came in third with a rating of 3.1, while self-reported chart reviews were ranked 3.0, and commitment to change contracts came in last at 2.4.

Exploring e-CME

In good news for providers, respondents earned an average of 57 credits during the 12 months previous to the survey, compared to 51 last year. The highest percentage, 18 percent of respondents, earned 50 to 59 hours of credit.

The credit slide we've seen in previous years has slowed down, with 17 percent of docs saying they earned fewer credits than in past years, compared to 19 percent in last year's survey.

Respondents said they earned 7 percent of their credits through online services, an increase of 1 percent over last year. More popular with women, who obtained 9 percent of their credits online, e-CME accounts for only 7 percent of men's CME credits.

Travel Turmoil

For the first time we asked respondents what e-CME methods they used. Again, Internet point-of-care shows that it's gaining popularity: of the 30 percent of respondents who do log on to online services, the majority, 62 percent, use Internet point-of-care (online self-directed learning) to obtain their e-CME credits. The next most popular method was enduring Internet activities (i.e., pre-recorded presentation), comprising 21 percent of respondents' online credits. Doctors were much less likely to tune into MP3casts/podcasts or live Internet activities such as webcasts, earning about 5 percent of their credits through those methods.

Of those who don't use e-CME, 34 percent said they had no interest in it, and 29 percent said it was too frustrating to navigate. Docs also said it's not interactive enough, they were concerned about security and the credibility of education, or they just didn't like it. Write-in answers included: “I like books instead,” and “I work with the computer all the time and need a break.”

Location Leads

Out-of-town meetings are still the most popular means of obtaining credit, but the percentage of credits earned at meetings — 32 percent — was the lowest it's been since we started this survey in 1993, except for the survey conducted in 1998, when the figure was also 32 percent.

Men were far more likely to travel to out-of-town meetings, earning 34 percent of their credits at conferences, compared to women at 21 percent. Out-of-town meetings were most popular with the older-than-55 crowd; they earned 41 percent of their credits at conferences, compared to the younger-than-45s, who earned 33 percent, and 45 to 55s, who earned 23 percent of their credits at out-of-town meetings. About one-third — 32 percent — of respondents earned none of their credits last year at out-of-town meetings.

As for factors that influence physicians' decisions to attend out-of-town meetings, as usual, geographic location topped the list with a 5.0 rating, where 1 equaled not at all important and 6 equaled extremely important. Other important factors were meeting length (days away from home/work) with a 4.8 ranking, followed by meeting dates at 4.7, and availability of education (cannot find local equivalent) at 4.5. Need or desire for CE credits came in with a 4.4 rating, as did speaker reputation. The meeting's registration fee and the sponsoring organization's reputation were tied at 4.3; travel costs, as well as the ability to tie meeting attendance to a family vacation, both received a 4.0 ranking. The opportunity to consult with colleagues about patient-care problems received a 3.5 ranking, while “employer requires attendance” was the lowest on the totem pole, at 2.3.

CME professionals may be leery of resorts because of the regulatory environment, but docs like their luxury. Resorts are the favorite venue for CME meetings, chosen by 59 percent of respondents. Conference centers come in second with 57 percent of the vote, and hotels come in third with 52 percent. (Respondents picked multiple answers.)

Lectures Rule!

There were no surprises in respondents' destination choices. More than one-third of respondents (34 percent) preferred CME meetings held in California, followed by Florida (23 percent), Arizona (11 percent), and New York (11 percent). Other popular sites included Hawaii; Colorado; Texas; Massachusetts; Illinois; Washington, D.C.; and North Carolina.

Methodology

Nearly half the respondents, 47 percent, said they would be willing to visit a foreign country to attend a CME meeting. Favored destinations, as usual, included Canada, Mexico, the Caribbean, France, England, and Italy. Respondents also mentioned Asian countries such as South Korea, Japan, Singapore, and China.

While CME providers wrestle with incorporating adult-education principles into activities, docs stubbornly prefer lectures, according to our survey respondents. Asked which formats are effective in motivating them to change practice behavior when attending a meeting covering new clinical information, lectures with Q&A topped the list with a 5.0 ranking, where 6 equals extremely effective and 1 equals not at all effective. Case-based learning and hands-on, skill-building sessions tied at 4.4, followed by small-group interactive sessions at 4.0, and consulting with colleagues at 3.9. Lectures without Q&A were rated 3.6, followed by lectures with pre- and post-event tests at 3.4. Unstructured discussion about topic came in last, with a 3.2 ranking. Write-in answers included “hospital-based team discussion” and — gasp — “talking with pharmaceutical reps.”

More Data Available

This is the 14th Annual Physicians' Preferences in CME Study. It is the longest-running horizontal study of physician preferences and participation in CME. Data was collected between September 28, 2006, and November 2, 2006. Prism Business Media mailed pre-survey postcards, followed by cover letters and questionnaires, to 1,200 U.S.-based physicians selected on an nth number basis from an American Medical Association file provided by KM Lists, Marlton, N.J. A followup mailing was sent to nonrespondents. Letters in the first mailing were affixed with first-class commemorative stamps, and contained a $1 incentive and a postage-paid response envelope. We received 148 usable surveys, a response rate of 12.5 percent.

Survey Snapshot

Thank-you to Derek T. Dietze, MA, president, Improve CME, Queen Creek, Ariz., for his assistance in developing our new questions regarding outcomes measurement.

This year's survey consisted of 24 questions. Responses to all of these were cross-tabulated by gender, age, and by number of out-of-town meetings respondents attended in the previous 12 months. To purchase the full report, visit The Research Store at meetingsnet.com.

• Nearly three-fourths of respondents, 73 percent, are male, while 24 percent are female. Three percent did not answer this question.

• The average age of respondents is 50.

• Respondents have been in the medical field an average of 21 years.

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