The CME enterprise has had a few rough years. Some physicians requested or accepted too much honoraria for too little work. Some educational presenters turned a blind eye to science while winking at promotion. And some employees of organizations involved in CME funding, development, and certification broke the rules.

With the help of news media, regulators, and the U.S. Senate, we identified the problem: ourselves. A handful of CME stakeholders didn't abide by accreditation policies or keep ethical promises. And compliance enforcement was weak.

An Easy Target

But instead of fixing the problem, some of us are consumed with identifying blame. And the easy target is money itself. Several proposals have been devised to split up, dole out, or eliminate the $1 billion in annual CME grant funding.

Some CME leaders want to create a centralized pool for CME grants. Others want pharmaceutical manufacturers to set aside 5 percent or 10 percent of their total grants for a repository that supports education in “underfunded” therapeutic areas, such as preventive healthcare for children. And a few even propose eliminating commercial support of CME altogether.

There will always be a few people who take money to break the rules. But blaming CME troubles on commercial support is similar to making clinical “attribution errors” described by author Jerome Groopman, MD, in his bestselling book How Doctors Think. When a doctor smells alcohol on the breath of an emergency room patient, Groopman writes, he tends to attribute the health problem to alcohol abuse instead of what may be its real root cause. Money has the same effect in CME. We accuse money, when our own sloppy or unethical practices are to blame.

Schemes to pool money or get government involved in CME grants won't fix the problems we face. Pooling money will only chase commercial supporters away. Pharmaceutical manufacturers make huge investments to develop drugs in specific therapeutic areas. Requiring them to invest in medical education outside these areas is like forcing a urologist to start performing heart surgery. We won't like the results.

Entrusting a small review panel or the government with a billion dollars will only diminish the quality and quantity of CME. The government's budgetary management record has been shoddy, at best. Limiting or eliminating CME funding will only hinder the progress we're making.

Focus on Quality

Take a look at the ideas for improving CME quality: a national certification program for CME professionals; increased transparency from accreditation boards, commercial supporters, and accredited providers; valid educational outcomes measurement. If we want improvement, we need more funding, not less.

Improving CME by focusing on our own performance … increasing transparency to identify where the problems are … implementing more rigorous compliance measures. This kind of thinking is right on the money.

Stephen M. Lewis, MA, is president of the Institute for Continuing Healthcare Education in Philadelphia. Reach him at