The level of commercial support given to accredited continuing medical education providers has dropped for the second consecutive year, according to the "ACCME Annual Data Report 2009." It fell to $856 million in 2009, a 17 percent decrease from the $1 billion reported in 2008. This decline, which brings the total level of commercial support back to levels not seen since 2003, is the second time since ACCME began recording this data in 1998 that the report shows fewer dollars being spent by pharmaceutical, biotech, and medical device companies to support accredited CME. Over that two-year period from 2007 to 2009, commercial support has dipped more than 29 percent.

After rising exponentially from 1998 to 2004, the growth rate had been slowing year over year until 2008, when the level of support given to accredited CME providers dropped 14 percent. The reasons for the decline can be attributed to a number of factors, including new state pharma marketing laws, negative media attention on industry/healthcare collaborative activities, the federal healthcare reform bill passed this spring, and pharmaceutical company mergers and acquisitions that shrink the total number of dollars available for supporting CME. While it’s unclear which is cause and which is effect, the number of accredited CME providers is decreasing along with the levels of commercial support: The 2009 data report includes information from 707 ACCME-accredited providers, down from 728 accredited providers in 2008.

Not surprisingly, the percentage of total income for accredited CME providers also decreased: In 2008, 44 percent of the total income reported was from industry grants; in 2009, industry grants account for only 39 percent, with the remaining revenues coming from advertising and exhibits (13 percent, up from 11 percent in 2008) and “other” income, such as fees paid by learners (48 percent, up from 45 percent in 2008). This led to a drop in total income of almost $183 million, or almost 8 percent, which brings the total income levels to $2.2 billion, just below what they were in 2005.

Also down was the total number of CME activities, which went from 100,935 in 2008 to 95,062 in 2009, a drop of almost 6 percent. The number of hours offered fell 10.4 percent to 689,768, reversing the almost 4 percent increase found in the 2008 report. Directly sponsored activities made up the majority of activities offered, numbering around 72,000, which is still 12 percent fewer than in 2008; jointly sponsored activities reached almost 23,000. In terms of numbers of activities being offered, directly sponsored Internet (enduring materials) was offered the most, with directly sponsored courses a close second, followed by jointly sponsored courses. In terms of the number of hours offered, directly sponsored regularly scheduled series comes in first, closely followed by directly sponsored courses.

On the bright side, total expenses actually decreased 7 percent in 2009 to a total of $1.7 billion; and the number of physicians and nonphysicians taking part in accredited CME actually increased 1 percent (to 10.7 million docs) and 3 percent (6.8 million other nonphysicians).

The 1,518 local providers accredited by state and territory medical societies that also were included in the 2009 report also saw a decrease in the number of activities produced in 2009 over 2008, and a 7 percent decline in the hours of instruction for directly sponsored CME programs they offered in 2009, compared with 2008.

Distribution Among Provider Types

The decline in commercial support appears to go almost across the board when it comes to provider types. While medical education and communication companies still get the heftiest percentage of the commercial support reported by accredited providers, they did experience a 21 percent drop in 2009, from more than $463 million to $365 million, and total income was down more than 9 percent. However, MECCs did see a 17 percent increase in other income from items including registration fees and allocations from a provider’s parent organization or other internal departments.

The next biggest recipient of commercial support in 2009, medical schools, also saw a $13 million decline in pharma grants, down about 6 percent from its 2008 total. Nonprofit physician membership organizations went from more than $202 million in commercial support in 2008 to just over $161 million, and other nonprofits saw their commercial support totals also reduced by almost 35 percent. The government and military, on the other hand, got a 41 percent bump in commercial support for their CME activities in 2009—though that still represents only an additional $53,000 in actual grant dollars—but the amount these organizations received from advertising and exhibits plummeted from $908,704 in 2008 to $340,473 in 2009. Insurance and managed-care companies, also on the low end of the total commercial support recipient list, saw a similar uptick in grant monies in 2009, along with a decrease in advertising but more exhibit income.

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