"Are you kidding?" says Norman B. Kahn, MD, director, division of education, American Academy of Family Physicians (AAFP) in Kansas City, MO, when asked if specialty society meetings were experiencing an attendance drop-off in today's managed care-driven world. "We just had our 50th anniversary meeting, with record attendance--nearly 20,000 attendees."

CME experts once predicted that given the changing educational needs of physicians--and the shrinking of their discretionary income--societies would replace annual meetings with regional meetings that were less expensive to attend. Things haven't played out that way. As the healthcare system continues to evolve, physicians are turning to specialty societies for leadership.

The AAFP's experience is not unique. Attracting 26,000 people, including 10,764 members, the American Academy of Ophthalmology (AAO) annual meeting in October also was an attendance record-breaker, says Kathryn A. Hecht, EdD, vice president, clinical education for the San Francisco-based organization. The American College of Osteopathic Family Physicians (ACOFP), Arlington Heights, IL, also reports rising attendance; and attendance at the Elk Grove Village, IL-based American Academy of Pediatrics' (AAP) annual meeting remains stable.

Hecht expects the annual meeting to remain strong. "I think ophthalmologists see our annual meeting as a source of so many kinds of education and information, it serves so many purposes," she says. "It will be the last thing they will give up."

Sorush Batmangelich, EdD, president, BATM Medical Education Consultants in Buffalo Grove, IL, agrees. Annual meetings provide physicians with the critically important opportunity to share experiences with peers, he says. "One of the major ways physicians change practice behaviors," he stresses, "is through interaction with colleagues."

Managed Care Education Physicians are attending annual meetings in record numbers for more than networking opportunities. Over the last few years, specialty societies have adapted their course offerings to the reality of the new healthcare environment. "Managed care education is one of the hottest topics in all specialty societies," says Batmangelich. "Members look to specialty societies to provide that education to them, to help them change."

One of the reasons attendance is increasing at ACOFP meetings, says R. Russ Ruston, meeting and convention coordinator, is because of the managed care education the academy has offered for the past three years. "Physicians negotiate attendance as part of their managed care contracts," he says. The AAFP's managed care track has more than doubled in size since its inception several years ago, adds Kahn, and is always oversubscribed.

The American Academy of Orthopaedic Surgeons (AAOS) has had enormous success with a series of courses on managed care it offers around the country, says Mark W. Wieting, vice president, education programs, with the Rosemont, IL-based society. Offering both beginner and advanced levels is very important, given the spectrum of markets nationally, Wieting points out.

"There are some areas where managed care is a new phenomenon, and those people are interested in the basics," says Wieting, "while in highly developed markets they're looking for more sophisticated things like contracting and managing risk." Staying on top of trends is also key; the AAOS's 1998 course is on options in consolidating markets--mergers and buy-outs of orthopedic practices.

Societies are also helping members cope with the shift in primary care physi-cian/specialist relations. One new trend, says Hecht, is that ophthalmologists are asked more and more to provide education for primary care physicians about eye care skills. In response, the AAO produced a resource guide for its members last year, with teaching scenarios and bibliography. The Academy also offers a workshop, based on the guide, at its annual meeting.

Welcoming the Team If specialty societies are to remain CME leaders, they must expand their perspective even further, asserts Shelley L. Hicks, assistant vice president of education, American Academy of Physician Assistants, Alexandria, VA. Societies should turn managed care organizations' (MCO) focus on team delivery to their advantage, Hicks suggests, by creating educational packages for practitioner teams.

"Multidisciplinary education makes sense because that is exactly how health care is being delivered," agrees Batmangelich. "Physician assistants, nurse practitioners, anybody who is providing cost-effective care, needs to be figured into the education equation."

But will societies open up their education to non-physicians? More and specialty societies are doing just that, Batmangelich says. The AAOS, for example, is interested in the team environment, says Wieting, and is considering offering a package price for educating surgical teams.

But Hicks offers a different perspective. "I think you'll probably hear many of the specialty societies talk about team education, and that's it," she says.

"It's not a real popular thing," acknowledges Ruston. "I think we're dealing with physicians who say, 'Look, I put in all the time and effort and I don't want to couple with someone who has put in half the time and effort.' I don't mean to discount physician assistants, but I can't blame physicians for how they feel."

The Secret Weapon: Credibility While more and more MCOs are starting CME departments, specialty societies have something that can't be created over-night: a long-standing reputation for education with integrity.

When an MCO conducts patient care audits with their members and recommends ways for members to improve their performance, and then offers its own education to provide those skills, that education may lack credibility--and MCOs are concerned about that, says Kahn. "The physician who has just been audited may perceive the MCO's motivation to be more fiduciary than educational," Kahn says. "There is a potential for outside entities like AAFP to develop education interventions that are based on patient outcomes, well-documented in literature, and have outside credibility."

The First Steps The AAP is one organization that is actively planning collaboration with MCOs. "As part of our strategic planning process, we hope to collaborate with MCOs, so that we become the provider for pediatric education," says Suzanne Ziemnik, MEd, director, division of CME. The AAP is currently developing a tool kit based on the otitis media with effusion (middle ear inflammation) practice parameter, and plans to collaborate with a health care delivery system to launch the tool kit in 1998. The project, which is underwritten by Pfizer, will be the first collaboration with an MCO for the AAP. "We've been talking about it for years, and quite honestly, I wish we'd embarked on it three years ago," Ziemnik admits.

Why have the AAP and other specialty societies dragged their feet on establishing educational partnerships with MCOs, while medical schools and academic medical centers have formed collaborations? "Maybe it is a non-recognition of the impact of managed care," Ziemnik reflects. "The hospitals and medical schools deal with [managed care] daily. We are very removed from that environment."

Looking for Leadership As specialty societies continue to interact more closely with MCOs, they face not only the potential for cooperation, but a collision of values. Members are attending specialty society meetings in record numbers in part because the courses are tackling controversial ethical and philosophical issues. Members look to specialty societies for leadership because "specialty societies are there to preserve the ethical integrity, the value, and certainly the quality of care," says Batmangelich. A case in point: the AAP recently ran a successful conference called An Insider's Guide to Managed Care, says Ziemnik. The bottom line underscored at the conference was how to benefit the patient. "We gave consideration to children with special healthcare needs," Ziemnik says. "We feel those children are falling through the system."

Most physicians identify primarily with their specialty, regardless of where they work, asserts Kahn. "They consider their specialty society to be the organization that looks out for their needs, and helps them provide the best care to patients. They may or may not turn to MCOs with the same expectation."