The Internet opens up new international promotional opportunities that were unimaginable 10 years ago.

International CME marketing has all the challenges of the domestic variety — and then some. Lists for international direct marketing are less abundant than those for domestic. Language can be a barrier, and currency fluctuations can create problems. Direct marketing rules and regulations, postal and otherwise, are different — and in some cases less favorable. Finally, health care professionals' incomes abroad are generally lower than in the United States.

Nonetheless, because millions of physicians are outside the borders of the United States, there is significant opportunity. And the Internet opens up entirely new promotional opportunities as well as distance learning utilities unimaginable 10 years ago.

Consider Canada First

Off-line or on, the best strategy for international CME empire-building is probably the same as Rome's: Start close to home and work your way out. Probably the easiest international foray is into Canada. Good lists are readily available, and language is no barrier, except in Québec, where promoting in French must be considered. The best Canadian mailing lists have a physician-specific language-selection criterion allowing you to either segment by language or promote only to physicians who speak English. Physician income is lower in Canada than in the United States, but U.S. CME is affordable and travel between the two countries is relatively easy.

Mexico is a different story. Lists of English-speaking physicians are available but are not as comprehensive. Health professional income south of the border is far lower than in the United States or Canada.

Expand to Europe

European health care incomes will support U.S. course fees, but distance and language differences are an impediment. Lists of English-speakers are available. In general, outside the United States and Canada, mail-order buyer lists are probably the best, because they identify physicians willing and able to successfully navigate the barriers to buying U.S. products and services.

Direct mail has been a mainstay for international marketing to physicians. To use direct mail effectively, you need a mailer with experience and expertise in the field. Each country has its own postal regulations: Ignore them at your own peril! International lists are formatted far differently from those in the United States, so if your vendor doesn't have international experience, ask for recommendations. As always, check with colleagues for referrals. And be aware that you can expect higher costs than with domestic mailing.

E-mail Buzz

E-mail lists of international physicians are available and worth testing. E-mail has the advantages of speed and economy. On the other hand, you may wish to check with legal counsel, as there are privacy regulations overseas that differ from the United States, where, as of this writing, I believe there is no federal legal standard.

Perhaps the most attractive aspect of email marketing is “buzz.” Here's a case in point: “We have a fantastically successful overseas recruiting strategy”, says George Lundberg, MD, editor-in-chief of Medscape. “It is called ‘buzz’. Happy users recruit new users at zero cost and effort for us.” (About 40 percent of Medscape's 650,000 members registered as MDs are from outside North America, he says.)

Scour customer lists of your past CME events for attendees from other countries. With membership organizations, target members outside the United States. Try to capture their e-mail addresses and include them in online and off-line promotions. Encourage them, as Lundberg suggests, to tell a friend to generate buzz.

Now that the world is your promotional oyster, bon appétit!

Terry Nugent has 25 years' experience marketing medical meetings. Since 1989, he has been director of marketing for Medical Marketing Service Inc., an American Medical Association database licensee. Send your questions or topic ideas at T-Nugent@mmslists.com.