The Case

As director of CME, Sara Spender has been in charge of program development at the Medical Movement Association for the last five years. During this time, aggregated evaluation data from the association's annual conferences have indicated increased learner competence and a positive impact on physicians' practice.

Yesterday, she received a call from Dr. Don Dinero, keynote presenter at the upcoming conference, who demanded more money to present his research. Sara tactfully tried to explain that the conference budget was finalized months ago and that additional funds for honoraria were not available. Dr. Dinero, openly irate, insisted he receive an additional $5,000 or he would pull out of the conference. Since the conference is in two weeks, what should Sara do?

Code Blue

Overstreet: This is a complex case because it's about more than simply the honorarium. The relationships between the association and its faculty, as well as with dues-paying members and conference attendees, need to be managed, too.

Parochka: Although caught between a rock and a hard place, the organization should meet the speaker's demands — this one time — and pay the increased fee. Thus, the other conference presenters will be satisfied by hearing the noted speaker and the conference agenda will have matched the published program. However, the organization should follow up by sending Dr. Dinero a letter explaining that future requests for additional honoraria will not be honored and such requests will serve as cause to eliminate him as a presenter.

Overstreet: Your approach would work, Jackie. Sara could also ask the CME committee chairwoman to speak with the presenter. As his peer, she might be able to explain the guidelines and constraints in a more collegial way than the CME director could.

Do faculty members often challenge confirmed honoraria payments?

Parochka: Although it's rare, some presenters decide their presentation is worth more than originally agreed and in the end demand higher payments. Such behavior places a strain on both the conference organizers and the budget. Since many persons attend annual meetings to hear noted national and international experts, eliminating their presentations might be considered false advertising!

What can organizations do to protect themselves from such behavior?

Parochka: The association should have a published honoraria policy that outlines guidelines for payments for both members and nonmembers. Such a policy should be disseminated to all of the provider's stakeholders. The policy will serve as backup for the faculty confirmation letter, which needs to spell out responsibilities and payment terms.

Overstreet: Excellent suggestions. I'd also include in the faculty letter the expected time commitment and planned deliverables, as well as a project timeline, and have the faculty sign and return the agreement signifying his or her intention to provide the specified materials in order to receive the honorarium.

Karen Overstreet, EdD, RPh, FACME, is president, Indicia Medical Education LLC, North Wales, Pa. Reach her at

Jacqueline Parochka, EdD, FACME, is president and CEO, Excellence in Continuing Education Ltd., Gurnee, Ill; and partner, PTR Educational Consultants. Reach her at

Your Views Welcome

To share your comments on this case, or if you have an “ethical hypothetical” you'd like reviewed, send an e-mail to Editor Tamar Hosansky at