When Memorial Sloan-Kettering Cancer Center in New York City stopped accepting commercial support for its continuing medical education activities last January, many at the institution had their doubts that the program would survive. “Our staff was very worried that this would deep-six the CME program,” says Thomas Fahey Jr., MD, senior vice president, clinical program development at MSKCC, and chairman of the CME committee. He and others were surprised at the decision, particularly because participants had not reported perceiving commercial bias in Sloan-Kettering activities.

One year later, CME at Memorial Sloan-Kettering is alive and well without commercial support, but the program — and the staff — have gone through quite a transition. “It's been a sea change,” says Peter Brodhead, administrator, CME at MSKCC. Here's how they did it.

Squeaky Clean

The decision to ban commercial support for CE/CME throughout the institution was made late in July 2006 by hospital leadership, particularly Robert Wittes, MD, physician in chief.

“Dr. Wittes has a deep belief in education being purely educational,” explains Brodhead. Given the current climate, where pharmaceutical companies are under intense scrutiny for their influence over doctors, Wittes felt it was necessary to cut ties and further remove MSKCC from anything that could compromise physician education.

“We really needed to be squeaky clean and certain that there was no commercial support for our CME activities that could be construed as influencing the program,” says Fahey.

At the recommendation of Wittes and senior management, the board voted unanimously to prohibit commercial support. The ban went into effect in two steps. First, Wittes mandated a six-month trial period, starting in January 2007, banning all commercial support for activities that took place on MSKCC property. “Dr. Wittes was leaving a window open to see if the ban was really was going to cause extensive damage,” says Brodhead.

It didn't, and the ban was made permanent, but the meetings were indeed quite different.

No Free Lunch

Overall, MSKCC runs between 15 and 20 large courses a year for external participants, which attract between 200 and 300 attendees. Plus, it runs dozens of internal sessions for employees. About 25 percent of the center's CME budget came from commercial support before the ban, with the rest coming from registration fees and departmental support.

On the positive side, the CME staff, which remained intact, no longer had to spend their time trying to get commercial support. “Lets face it, soliciting commercial support for any course can be a time-consuming and resource-draining matter,” says Brodhead, citing the stress of wondering if and when you're going to get the support.

But CME staff were busier than ever, helping course directors make the transition. “One of my challenges has been coaxing some course directors who have done commercially supported courses in the past to go ahead with this new policy,” says Brodhead. “The initial reaction from some was, ‘How am I ever going to do it without the money?’”

Brodhead's job was to help them figure it out. “It really involved working closely with course directors to look at budgets in a more strategic light,” he says. Rather than focusing on replacing the money, the staff concentrated on eliminating the excess. They came up with four cost-saving strategies.

The first strategy they implemented was to move three courses that were originally scheduled off-site at hotels to MSKCC's on-site conference center, which seats up to 350, resulting in significant savings. Going forward, all courses will be held on site.

Second, for some courses, CME staff eliminated lunches. Attendees either have to “brown-bag it” or pay for their own meal.

Third, they cut back on journal advertising and direct-mail campaigns to promote CME courses. Instead, they use internal resources, including the public affairs department and the marketing department, which has access to physician networks. They also plan to promote CME activities at meetings where MSKCC exhibits as well as through the alumni affairs department. “Do I think it could put us at a competitive disadvantage, having to limit advertising in journals?” asks Brodhead. “Sure. But it's forced us to look internally for opportunities that were right in front of our eyes that we had never seen before.”

Looking Inward

The fourth strategy was to encourage course directors to use as many internal speakers as possible. “We're taking a hard look at whether we really need to invite as many people from the outside to speak,” says Brodhead. For some courses, they do need to bring outside experts in, but for the most part, they have been able to use internal staff as faculty, saving on travel costs, hotel lodging, and speaker honoraria. (Internal faculty does not receive honoraria for speaking at CME sessions.)

For example, Brodhead is currently planning a CME session on ovarian cancer later this year that had 22 external speakers the last time it ran in 2005. For the 2008 session, they are planning to use just two external speakers.

Does limiting the amount of external speakers compromise the education? Brodhead says no. “We have the advantage of our reputation and a staff here that's extremely accomplished,” he says.

To further close the funding gap, MSKCC raised its registration fees for most external courses from 10 percent to 20 percent. (There are no fees for internal courses.) Course directors are reluctant to increase fees too much for fear that higher rates will deter participation.

So far, courses have paid for themselves with fees and cost-saving measures, but Brodhead knows the day is going to come when additional funds will be necessary. “Dr. Fahey and I have spoken at length about when we will need additional dollars, because we know that time will come.” (See sidebar at left for their solutions).

Checking for Bias

Even though there is no commercial support coming in, some things remain the same. For example, MSKCC still adheres to the Standards for Commercial Support. Also, CME officials still survey participants about whether they detect bias in the courses, just as they did before. Since Brodhead came to MSKCC five years ago, there have never been any complaints in the participants' evaluations of bias in the activities. There wasn't any bias reported last year either — but they still ask. “Just because there's no commercial support in no way makes our activity immune from potential bias,” says Brodhead. “We feel it's still extremely important to ask participants if they felt there was any commercial bias in the delivery of the material.”