THE GOOD NEWS for CME providers who rely on revenue from live meetings: Docs still depend on your activities for the majority of their CME credits, according to this year's physicians' survey, which was conducted in September and October 2003. In fact, respondents said they got 63 percent of their total credit hours through local (27.1 percent) and out-of-town (35.9 percent) meetings from September/October 2002 to September/October 2003.

The bad news for all CME providers: The past five years' surveys have found that respondents earned fewer credits than the year before, and this year's survey shows that trend continuing. The difference is that for 2003, we decided to ask them why.

Another ongoing trend: Women, who took the lead last year, are still the biggest growth audience for CME providers — more than 20 percent of this year's MM survey respondents were female, and the number of female physicians continues to mushroom, according to data from the American Medical Association.

Then there's the PhRMA Code, the AdvaMed Code, the Office of Inspector General guidance — all the recent efforts to rein in pharmaceutical excesses in the CME field that have caused an upheaval in U.S. medical meetings. While most providers think this is a good thing, this year we decided to ask the docs what they think about the new regulations regarding gifts and entertainment. Here's what they had to say.

Docs Miss the Perks

First, we wanted to know if they even noticed any difference in the perks and gifts since the codes and guidances have gone into effect. They sure do: Almost 60 percent of survey respondents said they received fewer invitations to entertainment events organized by pharma, and close to 35 percent said the gifts they've received are less expensive and more patient-care-oriented. More men than women noticed a change in entertainment-related invitations (62 percent and 50 percent, respectively), and the older the doc, the more of a decline was noted, with 57 percent of younger-than-45s, 58 percent of 45-to-55-year-olds, and 65 percent of older-than-55s noticing a decrease in invitations.

How do they feel about it? Seventy percent either disapproved (36 percent) or had no opinion on the matter (34 percent), while only 27 percent thought the cutbacks were a good idea. For almost 30 percent of respondents, it wasn't an issue because they haven't seen any changes in the number of invitations and/or gifts they've received since the rules went into effect. This suggests one of two things: Either they weren't invited to lavish affairs to start with, or there still are some outfits out there who aren't complying fully with the regs.

The Downhill Slide

While the survey didn't ask if the paucity of perks was influencing their CME decisions, it may be a contributing factor to a continuing slide in credits earned this year. More than 23 percent said they earned fewer credits than in the past.

When it comes to out-of-town CME activities, the slide only deepens: 35.9 percent of the CME credits were earned by this year's participants in out-of-town meetings, compared to 37.4 percent last year, and 45 percent just six years ago.

A further disheartening trend: The youngest age range (under 45) earned the smallest percentage of their hours through out-of-town meetings: Just 34.2 percent, as opposed to the almost 39 percent for those older than 55.

Local meetings also slipped to 27.1 percent, down from 30 percent last year. Part of the reason for this might be that they're taking the idea of local to the extreme — in the write-in portion of the survey, self-education, self-evaluation, and home study accounted for well over half the credit hours earned by some respondents. Some said they earned up to 85 percent of their credit hours through biweekly home study, for example.

Other possible reasons for these declining numbers can be found in the responses of those who earned fewer credits between September/October 2002 and September/October 2003 than in the past: namely, that they're too busy (64 percent) and it is too costly to take time away from their practice (48 percent) to attend CME activities. This trend could serve as an alert to CME providers that the time is right to develop more point-of-care activities and CME detailing (one-on-one office-based activities).

The Female Factor

Female physicians continue to be a growth industry, something that's not likely to slow down in the near future. This year marks the first time more women than men applied to U.S. medical schools, according to the Association of American Medical Colleges. More than 20 percent of this year's MM survey respondents were female, and they tended to be younger than the men, with more than 15 percent in the 30-to-34 age range, compared to just 3.9 percent of the guys. Women also were slightly more likely than men to have participated in CME from September/October 2002 to September/October 2003 (95.7 percent to 94.9 percent, respectively), and also were slightly more likely to have participated in 80 or more hours of accredited CME than men (13.6 percent to 12.4 percent, respectively).

The Reimbursement Gap

Interestingly, more female than male respondents also said they earned fewer credits this year than in the past. Even more significantly, when citing the reason for the decline, there was a large discrepancy between the 5.4 percent of men who said it was due to employer restrictions on attendance/reimbursement and the 38.5 percent of women who said this was a major factor. This makes sense in light of the percentage of total meeting expenses that are paid/reimbursed by employers/medical organizations: While almost 22 percent of men got 100 percent coverage, only 15.2 percent of women did. This is ironic, given that almost 11 percent of women said that their employer requires attendance, compared to just under 4 percent of men.

Homeward Bound

Women also were more likely to stick close to home. Female respondents said they received 33 percent of their CME through local meetings in 2003, as opposed to 29 percent in out-of-town activities. The men's results were the flip side of the women's: 38 percent of male respondents got their CME in out-of-town meetings and 25 percent on the local level. Almost 59 percent of women said they'd prefer CME meetings to be held locally, compared to 42 percent of the men.

Still, when it comes to attending a larger quantity of out-of-town meetings, more than 9 percent of the women said they attended four or more out-of-town meetings in the past year, compared to 8.3 percent of men. They're also more willing to go abroad to do it, with 63 percent of female respondents saying they'd be willing to visit a foreign country to attend a CME meeting, compared to 46 percent of the male respondents. And women are planning to hit the road even more next year: 4.3 percent said they planned to attend more than five out-of-town meetings in the next 12 months, compared to 1.7 percent of the men.

Deciding to Travel

The meeting's geographic location is by far the top factor behind the decision to attend an out-of-town meeting for both genders, with women rating it slightly higher than men. This may relate to the fact that almost 21 percent of the women surveyed said the ability to tie meeting attendance to a family vacation is extremely important, compared to 18.5 percent of men.

Going out of town because they can't find locally equivalent education also was more of a factor for almost 35 percent of the women surveyed, compared to 22.5 percent of the men, and almost twice as many women as men said the number of days they'd have to spend away from their home/practice to attend the activity was an extremely important factor. Female participants also were almost three times as likely as their male counterparts to consider the opportunity to consult with colleagues about patient care issues an overriding factor when deciding to attend an out-of-town meeting. Several respondents wrote in “skiing” as an important factor in their decision on whether to attend an out-of-town meeting. Since all the write-ins on the “other” line on the deciding-factors questions were from men, one has to assume those making their decisions based on ski conditions were male.

Setting Their Sites

Whatever their decision is based on, docs do come to learn, and they like the education-focused conference center environment. For the second year running, more than half of respondents said they preferred their CME in a conference center setting, though resorts did come in a close second, followed by hotels. Medical centers and facilities, preferred by 16.9 percent last year, got 17.6 percent of this year's votes. In a distinctly odd pairing, these facilities tied with restaurants, which also were preferred by 17.6 percent of respondents. Hospitals, which received a preferred rating of 15.4 percent, were venues of choice for more than 20 percent of the over-55 crowd and close to that for women, but were the choice of only 6.8 percent of the younger-than-45 docs. Medical facilities also were much more popular with the older end of the scale, 24.3 percent of which preferred these venues, compared to just 8.5 percent of the youngest category.

And where do they want these facilities to be? Where else but the ever-popular California (35.2 percent) and Florida (31.7 percent). New York, which last year moved up to third place with 16.5 percent of the vote, this year gained ground by garnering 19.4 percent. And they mean it about the skiing thing — Colorado, which placed fifth last year, moved up to fourth at 11 percent, perhaps to the detriment of Arizona and Hawaii, which this year were both preferred by 9.3 percent of respondents, down from 12.6 percent and 10 percent, respectively, in 2002.

And for those who are willing to go abroad for their CME, London and the United Kingdom got 44 mentions, putting it well ahead of Paris, and France in general, which were mentioned by 30 respondents. Mexico also remains a top hot spot for CME, as does Canada. But the write-in answers tell a tale about today's fearless physicians: When asked what countries they'd be willing to visit for a CME meeting, some daring souls just said “all” or “any,” though one respondent did qualify that, saying “any without terrorists.”

February's the Favorite

While 40 percent didn't much care when the meeting is held, 11 percent liked February best (could it be that ski thing again?). Spring is the next best thing, with almost 20 percent chiming in for April or May meeting dates. Friday remains the best day for a CME meeting start, followed by Thursday, although a surprising 17.4 percent of women said they liked a Wednesday start date (compared to 8.9 percent of men).

As for your marketing timeline, 16.7 percent said they made plans to attend local CME meetings only a week in advance; 42 percent said they planned two- to four-weeks out for local meetings. For out-of-town CME, the planning times understandably grow longer, with the majority (37 percent) saying they plan their overnight CME nine to 12 weeks in advance, though more than 23 percent don't set their plans that far out.

The Online Bust Continues

While almost a quarter of participants said they obtained their credit hours through journals and audio/videotapes, CD-ROMs and online CME still aren't catching on. Though close to 40 percent say they use the Internet to obtain CME credit — and almost half can access the Internet at work — respondents said they got only 5.9 percent of their credit hours online. On the positive side for e-CME providers, this figure is up slightly from last year's 5.5 percent.

Why aren't they using it? More than 40 percent said they just weren't interested, and almost 32 percent said it was too frustrating to navigate. The write-in answers indicate that the time may still be coming for online CME: “Didn't need to but will start,” “Haven't tried yet,” “Just not had time to try it out,” and “I need training to make good use of it.”

Or maybe online providers need to heal their own programs. While they found it easier to navigate than the two older age groups, surprisingly, the under-45 group was most concerned over Internet security, and they were twice as likely to distrust the credibility of online education as their oldest counterparts. Or, as some of the respondents bluntly put it in their write-in answers, online CME is a “Pain in the ass,” “Ties up phone lines,” and is “Too boring, no human contact. Maybe I have ADHD.”


This is the 11th Annual Physician Preferences in CME Survey. It is the longest-running horizontal study of physician preferences and behavior regarding their participation in CME. On September 10, 2003, Primedia Business Marketing Research (a unit of MM's parent company, Primedia Business Media) mailed cover letters and questionnaires to 1,200 domestic physicians selected on an nth-number basis from an American Medical Association file provided by KM Lists, Marlton, N.J. A postcard alert was sent on September 4, and a follow-up mailing was sent on September 19. Letters in the first mailing were affixed with first-class commemorative stamps, and contained a one-dollar incentive and a postage-paid response envelope. A toll-free, fax-back option was offered as well. We received 227 usable surveys, a response rate of 20.9 percent.

More Data Available

This year's survey consisted of 25 questions. Responses to all of these were cross-tabbed by gender, age, and by number of out-of-town meetings respondents attended in the previous 12 months. To purchase the full report, visit The Research Store at, or contact Lynn Adelmund, Director of Corporate Research at (913) 967-1891.