Sure, the growing influx of international attendees causes housing headaches. But you can make the process (almost) painless with proactive strategies

At the American Society for Micro-biology's (ASM) fall meeting, 55 percent of the attendees--nearly 7,500 people--were from outside the United States. That's up from 35 percent just four years ago. International attendees at the American Urological Association's 1999 annual meeting may have numbered only 4,842, but that was 56 percent of the total, and the percentage has risen steadily since 1994. At the American Heart Association's most recent meeting, half of the 22,000 attendees were international.

The increase in international attendance in the last five years has been "phenomenal," says James Youngblood, vice president, meetings, publishing, and science resources, AHA.

Many health care organizations are seeing a dramatic increase in the percentage of international attendees at their meetings. What's causing the growth, and what are the implications for planners?

For many international attendees, the appeal is the education--both formal, in the educational sessions, and informal, through networking.

"Infectious disease is such a global issue, and people can learn a lot from each other," says Nancy Elder, CAE, director, department of meetings and expositions for ASM. "The resulting exchange of information among developed and developing countries is of benefit worldwide."

Adds Jacy Hanson, director of meeting services, American Diabetes Association (ADA), "The quality of education and advancements in science are so much further ahead in the United States that the educational process is better" for the international attendees.

Education is the draw even though international attendees usually do not get credit at home for the sessions attended here. If changes are effected that make it easier for European physicians to earn CME credits for courses attended in the United States (see Creating Euro-CME, MM September/October), international attendance is likely to be even greater, say some planners.

Hanson notes another attraction for international attendees: "It's more prestigious for health care professionals to have their papers presented at a meeting in the United States."

Physicians from other countries who want to attend U.S. meetings often get a boost from pharmaceutical and medical device companies. In many countries, such companies are permitted to provide unlimited support to physicians. A no-cost trip to a meeting that's professionally valuable--what physician wouldn't want to take advantage of that opportunity? No wonder they're coming in droves.

Given all those factors, the trend isn't likely to taper off anytime soon. While the growing influx of international attendees creates challenges--with housing and exhibitors, for example--it also creates opportunities. Here are examples of how planners have turned the trend to their advantage.

The Growth Factor Some organizations are not just going with the flow--they are using strategies specifically intended to boost international attendance and thus strengthen the organization.

"Ninety-five percent of the ophthalmologists in the United States are [our] members," says Debra Rosencrance, CMP, vice president of meetings and exhibits for the American Academy of Ophthalmology. "In order to grow, we must look for new markets." The organization saw its first real jump in international attendance in 1991, the year it held a joint meeting with the Pan American Association of Ophthalmology.

"A lot of people were exposed to the meeting that year," says Rosencrance, "and our largest international group is still from the Latin [American] region."

International attendees benefit the association: because they usually aren't members, they pay the full registration fee. But there's another advantage. Rosencrance agrees with ASM's Elder that the diversity of attendees benefits her members.

"We have presentations by doctors from every region of the world."Thus attendees learn about different incidence of diseases and also are exposed to a wider range of experiences. For example, "People have more experience with refractive surgery in Latin America."

Another organization targeting international attendees is the American Academy of Otolaryngology, which about six years ago began developing a multifaceted program to grow its annual meeting.

"Our president would select a country or group of countries to come as our guests and receive free registration," says Jack Harmon, director, department of meetings. "People would come as our guests, then go back home and tell their friends to come to our meeting and expo--our trade show is the largest display in the world for otolaryngology."

In 1997, the academy began to offer corresponding membership for international attendees, and even prepared a promotional video to show overseas when recruiting corresponding members. There are now corresponding membership societies in Spain, Hong Kong, Korea, and Brazil, among others. Thanks to these proactive efforts, international attendance at the annual meeting has grown from 10 percent to 30 percent.

Housing Headaches International attendees enrich both the coffers and the conference. Still, they do present challenges. Perhaps the biggest is that they further complicate the thorny issue of housing. Typically, international attendees make both flight and housing arrangements through tour operators, who tend to book outside the official conference room block. That practice plays havoc with pickup history, of course, as planners don't get credit for those rooms.

"ASM had been fighting the tour operators and not permitting them to book outside the block," says Elder "We wanted to find a way to work with them for the benefit of the attendee."

A positive approach yields more rewards than smoothing the housing situation, Elder points out. Tour operators help promote the meetings in which they are involved, she says; in her case by providing ASM's marketing materials to interested people. They also promote their services to pharmaceutical companies, who are encouraged to participate in the meeting.

Give 'Em Options ASM's solution was to devise three ways to obtain rooms for groups, and detail those methods in a registration and housing guide that is sent to all international operators.

*Method #1: Tour operators may book rooms within the official housing block. "We require a letter of appointment from the [drug or device] company that has hired the tour operator," says Elder. "Otherwise, we won't reserve a block of rooms." The letter of appointment gives the tour operator legitimacy and also indicates that the number of rooms being requested is reasonable. The tour operator must pay a nonrefundable deposit two months out and must complete the group housing form.

Naturally, Elder prefers that the tour operators book within the block. But she's a realist. The other two ASM-sanctioned methods allow operators to book rooms outside the block.

*Method #2: Tour operators may book small blocks of rooms in the official hotel but outside the official block. Elder explains that major hotels usually have three sales teams--for the group market, the corporate market, and the international market. A pharmaceutical company, for example, might call an official hotel's corporate sales office and ask for 10 or 20 rooms for physicians it is sponsoring. Those rooms would be outside the block, and the pharmaceutical company would probably pay a higher rate, usually the transient rate. That will happen--there's no way to prevent it--but "we need to be aware of it," says Elder. Making the procedure acceptable encourages tour operators to report it.

*Method #3: Operators may book in a nonofficial hotel. This can occur either if it's not possible to obtain rooms in an official hotel, or if certain groups want to stay in a specific hotel that is not part of the block.

"We permit groups to book outside the block, but we don't allow group tour operators to register people unless we know where they are," says Elder. "We require specific forms and verifications."

With this new approach, "We are getting results," says Elder. "Now, if they don't go to the official hotels, we know where they are and I have a history."

Preemptive Strike At the American Diabetes Association, Hanson's approach is to contact hotels well in advance and book two types of room blocks. "We tell them we want to negotiate our block at one rate and a separate block at a higher rate that we'll sell to the international tour operators. Tour operators don't care if the room is $15 or $20 more per night," she maintains. In return for the higher rate, however, "We set up a separate registration desk for them and give them a staff office." When tour operators see the extra benefits they get for the higher rate, they're willing to work with ADA, she says.

Meanwhile, at the American Heart Association, Youngblood has had to devise ways to circumvent tour operators who circumvent the rules. AHA will give the operators up to 50 rooms. "The operators who give us trouble," Youngblood says, "are the ones who go around the system and book on speculation. Then we're in a pinch--we need rooms and the hotels can't give them to us." Hotels give tour operators those blocks, of course, because they want the business. "We tell the hotels to require a full deposit," says Youngblood, which should discourage the operators who book speculatively.

"The situation is so critical," says Youngblood, that "we've stopped publishing the locations for our future dates" to try to prevent tour operators from getting there first. "But most association planners contract two years out for a citywide. So it's easy for a tour operator to find out where you're going and go ahead of you."

Lose the Headache For other organizations, outsourcing is the solution to the housing headaches. A few years ago, the Radiological Society of North America (RSNA) began working with Paris-based ESA Voyages, a specialist in international group travel management. When ESA opened an office in Chicago, Michael O'Connell, who was then director of meetings and convention services at RSNA, joined ESA as president of the new ESA North America. His former employer became his first client.

Janet Cooper is RSNA's managing director, convention operations, and she reported to O'Connell when he was with the society. She recalls that when RSNA handled international housing itself, one of the problems it faced was room requests from two or three tour operators in one country, all of whom, it turned out, were working with the same attendees. That meant that too many rooms were held and RSNA lost the opportunity to use them. And there were also tour operators booking outside the block.

"We met with the hotels and asked them to refer tour operators to RSNA," says Cooper. "The hotels are good about working with us. And any tour operator that comes to us is referred to ESA, which handles all our international groups." ESA coordinates those groups and eliminates the problem of duplicate room blocks. In addition, says Cooper, "We can get the internationals registered in advance and that reduces on-site registration."

Harmon at the Academy of Otolaryngology this year began outsourcing to ESA North America for several reasons: to bring more international groups into the block and reduce its own workload, of course, but also to assist international attendees. "We want to offer internationals an easier way, more of a package," he says. ESA provides meet-and-greet service and has multilingual staff on site at hotels and at the convention center to help with such things as ticket exchanges and lost passports.

O'Connell explains that ESA acts as a clearinghouse for all international group activities (organizations still use a third-party company like ITS to handle housing for U.S. attendees). That means that he can coordinate not only the tour operators but also, for example, a group of clients (physicians or other health care professionals) sponsored by an exhibiting company. And, he says, "We make sure that the rooms are actually used by physicians, that there isn't a kind of gray market of rooms for exhibitors."

Any agent or company booking rooms through ESA must pay a nonrefundable deposit, usually $200 per room, when the contract is signed. "If the tour operator doesn't deliver, his money is at risk," says O'Connell.

So, which of these is the perfect strategy? The one that will bring all the tour operators into the official block? Even O'Connell at ESA North America had to laugh at that question.

But the strategies must be tried, fine-tuned, and tried again. Concludes Elder at ASM, "This is a continuous-improvement process."

Meanwhile, On the Exhibit Floor... International attendees are a mixed blessing on the exhibit floor. Exhibitors that have an international presence see them as prospects, of course. But exhibitors that don't sell overseas--small companies, especially--see them as a nuisance or even a reason to drop out.

Managed care is the main reason that the American Academy of Ophthalmology's exhibitors are glad to see international attendees, says Debra Rosencrance, CMP, vice president of meetings and exhibits. "So many doctors are now under managed care that they are no longer the sole decision-makers," she explains. "But the international attendees show up with cash, and they purchase. They do the majority of the buying on the show floor."

In fact, Rosencrance overheard one U.S. physician say that the situation has become uncomfortable for him and his colleagues: there are instances in which an exhibitor who is talking with a U.S. physician will turn away and give his attention to an international attendee.

Companies with products that are approved for sale overseas, but not in the United States, are taking full advantage of the opportunity to talk with overseas prospects, Rosencrance adds. One pharmaceutical company with many products that are not approved for U.S. sale this year is building into its booth a separate "international room" where staff can meet with international attendees.

New U.S. Customers At the American Society of Microbiology meeting, there's been an increase in international exhibitors as well as international attendees. Nevertheless, there are many exhibiting companies--pharmaceutical companies, in particular, that want to sell only to U.S. attendees.

"We asked ourselves how we could increase the U.S. customer base," says Nancy Elder, CAE, director, department of meetings and expositions. The answer: by targeting other groups of health care professionals. To develop accredited courses for pharmacists, the society worked with the University of Kentucky. "We began the program last year, and this year the number of pharmacists who attended tripled," says Elder. And that means more U.S. prospects for the exhibitors who prefer them.

While the majority of exhibitors, from the big companies--the Mercks, the Pfizers--are looking for international attendees at the American Urological Association convention, "We also need to keep the smaller exhibitors that aren't globally focused," says Kevin Wohlfort, director of industry relations and exhibits. "The first impression they get is that the attendees are international, and we do see attrition each year."

Exhibitors get that impression because international attendees are in the exhibit hall every day, says Wohlfort. "We need to make a concerted effort to get domestic attendees to spend more time on the exhibit floor."

Free Lunch To accomplish that, AUA now provides a free lunch in the exhibit hall when there are no conflicting educational sessions. This year, the association launched the President's Circle Exhibit Floor Challenge. Attendees had score cards that could be validated when they visited each of 10 specific exhibits. Anyone whose card was validated by all 10 was entered in a drawing for prizes paid for by contributions from those exhibitors. Prizes included free airfare and hotel accommodations for next year's meeting.