A SOMEWHAT DISTURBING trend appeared in this year's physician survey, which was conducted in September and October of 2004: The younger docs — those under 45 — were less likely to have participated in CME in 2004 than those in the higher age brackets. The younger docs who did participate in CME, however, really racked up the credit hours. Interestingly, the 22 percent of respondents who were female tended to earn fewer credit hours over the year than did the men. That women are earning fewer credit hours correlates with the age range also earning less credit as well, with almost 64 percent of the women being under 45, compared to just 35 percent of the male respondents.
With the ongoing discussion ofconflict of interest, asked the physicians participating in this year's survey what they thought about the subject. Again, younger docs differed in their responses from their elders.
While younger docs were less likely to have participated in CME, the overall slide in credit hours earned found in last year's survey seems to be turning around, albeit in a very small way. In 2003, more than 23 percent of the respondents said they earned fewer credits than in past years; in 2004, the result came in at 21.4 percent.
One thing that hasn't changed is that despite the attention CME providers have given in recent years to incorporating adult learning theory and interactivity into their online activities, live meetings continue to be physicians' preferred form of CME, according to this year's survey. The surveyed docs said that they got 64 percent of their CME in live meetings in 2004 (up 1 percent from the previous 12 months), far outpacing journals, audio/videotapes, CD-ROMs, and online activities as their preferred CME delivery vehicle — though online activities took an unprecedented jump since 2003.
The Young and the Restless
Those under the age of 45 were less likely to have participated in CME in the past 12 months than those over 45, with 75 percent and 98 percent, respectively, saying they have attended a CME activity in the past year. But the younger docs who did participate tended to rack up the highest amount of CME credit, with 19 percent of the under-45s getting more than 80 hours in the past year, compared to 12 percent for those 45 to 55, and 14 percent for those older than 55. Almost a quarter of the under-45s earned 40 to 49 hours, which was the most popular range for this age group. Those in the 45-to-55 demographic were most represented in the 50-to-59-hour and 20-29-hour ranges; while the over-55s were fairly evenly represented across the ranges.
When asked why they earned fewer credits, 40 percent of the under-45s said that they were too busy to take time away from their practices, compared to 25 percent and 21 percent for those 45 to 55, and 55-plus, respectively. Interestingly, none of the under-45s pointed toward the cost of being away from their practices as a reason for earning fewer credits, whereas that was a factor for half of those in the 45-to-55 age bracket, and more than a quarter of those 55 and up. None in the youngest group said that the reason they didn't participate was that accredited CME activities don't meet their needs, which was chosen by 12.5 percent of the 45-to-55s, and more than 21 percent of those 55 and older.
Employee restrictions on attendance or reimbursement was a bigger issue for the under-45s, with 20 percent noting this as a reason for obtaining fewer CME credits, compared with 12.5 percent of the 45-to-55s, and none of the 55-plus group. This seems a bit odd, given that the under-45 group tended to have higher percentages of their total expenses for out-of- town CME reimbursed than did the other age groups: Only 31 percent said they were not reimbursed at all, compared to almost 50 percent of the 45-to-55s and more than 60 percent of the 55-plus group. And they were more than three times as likely to say that their employer required attendance than were the other age groups. One possible reason for this discrepancy is that those who employ the under-45s are more likely to encourage the younger docs to attend out-of-town meetings, which they're reluctant to take the time out of the office to do, than to support them in other forms of CME.
This supposition is further bolstered by the age-stereotype-bucking finding that the under-45s said they earned just shy of 3 percent of their CME credits online or through CD-ROMs, compared to 11.6 percent for those in the 45-to-55 age range, and more than 5 percent for the 55-plus group. The under-45s were roughly equivalent to the other age ranges in the percent of hours obtained through local and out-of-town meetings, journals, and audio/videotapes.
Doc's-Eye View of COI
When we asked whether the credibility of a presentation was at risk when the attending docs perceive that the faculty member has a conflict of interest, more than 50 percent responded that they judge the credibility of the presentation on its own merits, regardless of the faculty's financial relationships. However, a surprisingly high 37 percent said they would question the credibility of the presentation. And fewer than 1 percent said they would trust the credibility of the session if they thought the faculty had a conflict of interest (See charts on page 31).
As to what constitutes a potential conflict in their eyes, the winner, at 63 percent, was a faculty member who receives research grants from the pharmaceutical industry. Three other options were a statistical dead heat at slightly more than 56 percent (respondents were asked to mark all answers that applied): The faculty member serves on a pharmaceutical company's speakers bureau; the faculty member is a consultant or serves on an advisory panel for one or more pharma companies; and the faculty member or a family member owns stock in one or more pharmaceutical companies. Among the write-in answers were “the faculty member owns a healthcare corporation” and “thediscloses a conflict.”
When the responses are broken out by age, there again are some differences. For example, only 46 percent of the under-45 group thought that a faculty member who serves on a pharma speakers bureau has a conflict, compared to 61 percent of the 45-to-55s, and 60 percent of those older than 55. But faculty owning stock in one or more pharma companies was marked as a potential conflict by significantly more of the under-45s than the other age groups: 78 percent thought it was a conflict of interest, compared to 43 percent of the 45-to-55 group, and 52 percent of the over-55s. In addition, fewer of the under-45s said they would judge the presentation on its own merits, 41 percent, compared to 59 percent and 50 percent of the 45-to-55s and over-55s, respectively. And while the numbers are small, 2.4 percent of the youngest group said they would trust the credibility of the presentation regardless of their perception that a faculty member had a conflict of interest — no one in the higher age brackets agreed.
Hold That Plane
While physicians obtained more of their CME at out-of-town meetings than from any other source in 2004, and 79 percent plan to attend at least one such meeting this year, there was some disheartening news for CME providers whose attendees have to travel to their activities. While the decrease was less than it has been for the past several years, the percentage of credit hours obtained through out-of-town meetings continues to slip. In 2004, respondents said they obtained 34.8 percent of their credit hours through out-of-town meetings, down from 35.9 percent in 2003. This is the seventh year of slippage in this area.
Local meetings that do not require overnight stays, however, are bucking up slightly, with an increase of 2.1 percentage points over 2003, to 29.2 percent. Women led men in the local-meetings trend, saying they obtained 32.7 percent of their credit locally, as opposed to slightly more than 28 percent for the men. Men also said they obtained almost 38 percent of their credit through out-of-town CME, compared to the women's 29 percent. Almost half the women said they obtained no credit by attending out-of-town meetings.
And it looks like the trend will continue in 2005. Almost 40 percent of the females surveyed do not plan to attend an out-of-town meeting in the next 12 months, compared to just 16 percent of the men. The most frequent out-of-town meeting-goers also will be men, who were twice as likely as women to be planning to attend five or more out-of-town meetings this year. Interestingly, more than half of the total respondents who don't plan to attend any out-of-town meetings in the next 12 months also didn't attend any in the past 12 months, so these folks aren't changing their patterns. Those who attended two or more out-of-town meetings last year uniformly said they plan to attend at least one such meeting in the next 12 months.
What drives them to take time away from their practices to attend an out-of-town activity? On a scale of 1 to 6 where 6 is “extremely important” and 1 is “not at all important,” geographic location, as in previous surveys, earned the highest response: 5. The next most important factor, they said, was that they couldn't find a local equivalent (4.5). Other top factors included the meeting dates, length, and speaker reputation. Least important, they said, was that an employer required them to go.
Docs Like Luxury
When it comes to live CME meetings, logistics can make or break a program. While more than 40 percent of respondents didn't much care when the meeting was scheduled in terms of season, they did have an overwhelming preference — almost 50 percent — for meetings that begin on a Friday, with Thursday running a distant second at 16 percent. While it was close, the majority (53 percent) preferred that three-day CME meetings be held out of town rather than locally.
And when it comes to types of meeting venues, docs are looking for luxury — more than 51 percent preferred resorts, knocking conference centers, the two-year front-runner, down to third place at 46.6 percent. Hotels, which were preferred by 44.4 percent in 2003, bumped up to second with 47.3 percent. Restaurants also moved up a notch to fourth, though the overall number of respondents choosing this type of venue dropped to 15 percent from 17.4 percent in 2003. Medical centers dropped to fifth with 14.4 percent, followed by hospitals (12.3 percent), cruises (11 percent), and universities (7.5 percent).
And they still like to meet in warm spots, like California (37 percent) and Florida (31.5 percent). New York remains in the third slot with close to 20 percent. Massachusetts got a big bump from ninth in 2003 to fourth place in 2004, perhaps gaining popularity from the coverage of the Democratic National Convention. Rounding out the top-10 list are Hawaii, Colorado, Arizona/Illinois (tie), Washington/Louisiana (tie), North Carolina, and Washington, D.C.
More than half of respondents were receptive to the idea of traveling internationally to attend a CME meeting. This year, the most preferred international locales were Canada and England, followed by France and Italy. Mexico and Spain also were hot spots, as were Australia and Germany.
Journals, CDs, Computers
When it comes to CME other than live meetings, women gained slightly more of their credit hours through journals than the men did (20.4 percent and 18.2 percent, respectively). Overall, journal CME accounted for 18 percent of credits earned in 2004, up from 15 percent in 2003. Women's numbers also were very close to the men's for both audio/videotapes and CD-ROM/online activities, with women gaining 7.3 percent of the credit in this manner, and men 7.4 percent. Audio/ videotape credit percentages dropped by almost two-thirds since 2003, from almost 9 percent to 3 percent. Overall, respondents said they earned 8 percent of their credit through CD-ROMs or online activities. While this percentage may seem small, it's a relatively big leap for this traditionally slow-growing segment — a growth spurt of more than 35 percent over the 2003 numbers.
In a separate question, respondents were asked if they use the Internet for CME credit. A significant 48 percent said that they currently use the Internet to obtain CME credit, a gain of 8 percent over the 2003 findings. While the use of the Internet for accredited CME is growing, it still remains a small percentage of the total mix. This may bump up as the American Medical Association and other organizations continue their quest to find ways to provide credit for point-of-care activities, including credit for online searches for information in real time.
Still, there's a way to go before online CME gains wide acceptance. More than 42 percent of respondents said they had “no interest in online CME,” which is slightly more than the 40 percent who said the same in 2003. A little more than a fifth of respondents said it was too frustrating to navigate — which is a fairly large drop from the 32 percent who had the same complaint in the 2003 survey. This indicates that, while providers aren't having as much success in getting docs to try it, once they do, they are having a better experience. Only slightly more than 13 percent said online CME isn't interactive enough, down from 23 percent in 2003.
Concerns over security also have dropped, with only 5 percent citing this as a factor in their decision not to use online CME, down from almost 8 percent in 2003. Strangely, despite the perceived improvements, 17 percent said they tried it but didn't like it, up from 15 percent in 2003.
This is the 12th Annual Physician Preferences in CME Survey. It is the longest-running horizontal study of physician preferences and behavior regarding their participation in CME. On September 15, 2004, Primedia BusinessResearch (a unit of MM's parent company, Primedia Business Media) mailed 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 postcard alert was sent on September 13, and a follow-up mailing was sent to nonrespondents on September 29. Letters in the first mailing were affixed with first-class commemorative stamps, and contained a one-dollar incentive and a postage-paid response envelope. We received 146 usable surveys, a response rate of 12.5 percent.
More Data Available
This year's survey consisted of 25 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.