The fifth annual survey of physician preferences in continuing medical education (CME) includes one new question about medical association membership (with a somewhat surprising result) along with questions about factors influencing the decision to attend out-of-town CME meetings, frequency of attendance, methods of receiving credit other than attending meetings, destination preferences, venue preferences, time preferences, reimbursement policies, and practice settings.

Now in its fifth year, this survey is the only longitudinal study we know of that looks at physician preferences in CME. We are well aware of the responsibility we have to produce comparable year-to-year results; at the same time, we must respond to our audience's requests for specific information. This means adding, refining, and sometimes dropping questions. We have, for example, dropped all the analysis of subcategories--e.g., gender, specialty, and age--at least until such time as we can get our response rates closer to the range of academic acceptability (see the methodology section for our current response rate). This is an ambitious target for a commercial magazine, as opposed to an academic journal, but our goal is to move beyond trends and toward projectable results.

As always, while we have concentrated exclusively on the preferences of practicing physicians, we hope the survey's results will prove useful to conference organizers and meeting planners in every healthcare field.

How Physicians Obtain CME The average survey respondent earned 78 hours of CME credit in the last 12 months. Fifty-nine percent of those hours were earned by attending meetings. This is down from last year's survey, in which 72 percent of CME was earned at meetings. Where did those physicians get their credits? Well, it had to happen: This was the year the World Wide Web became more than a blip on the screen as a vehicle for providing continuing medical education. A year ago, when we asked physicians how they earned their credits toward the American Medical Association's (AMA) Physician Recognition Award (PRA), a mere three percent said they used electronic media (CD-ROM or the Internet). This year, 15 percent say they are obtaining CME using these means. Such credit-granting Websites as Medconnect are clearly having an impact.

What are Medconnect and others like it replacing? Meetings, say our 309 survey respondents. A year ago physicians said they obtained 27 percent of their CME at local meetings; this year the percentage dropped to 21 percent. Last year, 45 percent of CME credit was earned at meetings requiring travel. This year, only 38 percent of credit was earned that way. Meetings requiring out-of-town travel are still the largest single means by which physicians obtain CME credit, but this is the first time we've seen this category decline. A brief discussion of why this may be happening can be found in the next section.

Travel Plans Decline For the first time, respondent plans to attend out-of-town meetings has declined: Only 42 percent say they plan to attend two or more out-of-town meetings in the next 12 months, down from 54 percent a year ago. Similarly, a year ago 14 percent of respondents planned to attend more than three meetings requiring travel; this year only nine percent indicate such plans.

According to David A. Shore, PhD, whose column on meeting marketing is a regular feature of this publication, physicians are beginning to look at CME in terms of "chore and choice." That is, they are distinguishing between those activities that provide necessary CME credit and those that hold some special interest. If a physician has been attending a meeting simply to earn CME credit, why not earn those credits in the privacy of home or office on a computer? The percentage of CME earned by reading journals has also increased, to 22 percent this year from 15 percent a year ago.

Factors Influencing the Decision to Attend The survey lists 13 factors that might influence a physician's decision to attend a CME meeting requiring out-of-town travel. Respondents were asked to rank these using a Likert scale, with 5 equaling "very important" and 1 equaling "unimportant." (See chart at right.) Among factors influencing a physician's decision to attend a meeting requiring travel, the biggest year-to-year gainer as a factor (3.5 percent more important) is "sponsor reputation." As the undeclared hostilities between for-profit and nonprofit CME providers heat up, this could become significant. Or it may be that some providers, regardless of their profit status, are finally learning how to better differentiate themselves from their competitors.

The factors that declined most in importance were attending because an "employer requires" it--down 15 percent; "meeting registration fee"--down seven percent; and wanting to combine meeting attendance with a vacation, which declined five percent.

Other factors, including the leading ones of "geographic location," "speaker reputation," and the need to consider the amount of time spent away from practice, have remained stable in their importance to physicians.

A possible concern regarding combining meetings with vacations: As physician incomes continue to plateau or decline, some meeting/vacation packages may be pricing themselves out of the market--even with the tax break that accrues to physicians attending professional meetings. "If you're careful, you can vacation for a lot less on your own, even allowing for the tax deduction," one physician says.

Travel Preferences We'll end the suspense right now: California and Florida retain their top positions as most favored states for attending a three-day, out-of-town meeting (see chart above). New York State retains its respectable third-place finish (respondents were asked to choose three, so scores exceed 100 percent).

Among preferred international destinations, the major countries of Western Europe, Canada, Mexico, and the Caribbean have always been top contenders. There were few surprises this time: England (a strong 60 percent), Canada (41 percent), and France (40 percent) topped the list. Italy followed, with 33 percent; then Mexico and the Caribbean, tied with 16 percent. The Caribbean, while still popular, has tailed off as a top destination over the last five years (In our first survey in 1994, it was the top choice). Other top choices included Germany (15 percent); Australia (15 percent); Spain (13 percent); "South America" and Sweden (both seven percent), and Bermuda, at six percent. (Note: In previous years, respondents were asked to choose from a list of countries; this year they were asked to write in their preferences--hence, South America as a preference.)

Venue Preferences This year, for the first time, respondents were not presented with a checklist of venues to choose from, but were asked instead to write in as many as five types of facilities they would prefer to visit for a CME meeting. (Because of multiple answers, results exceed 100 percent.) This unprompted method yielded different results. In our previous four surveys, resorts were clearly the top preference of respondents as meeting venues. This year, hotels were most often mentioned as preferred by 47 percent of respondents. Resorts were next, mentioned by 45 percent of respondents. These were followed by conference centers (34 percent); hospitals (11 percent); "own facility" (10 percent); "other" (6 percent); university (4 percent); and cruise ship (2 percent). The "other" category included the names of hotel chains, restaurants, camps, and ranches.

Time and Money Issues Respondents were asked to choose the three months during which they'd most prefer to attend an out-of-town CME meeting. Response totals exceed 100 percent because of multiple answers. October, which has always scored highly in the survey, finished first with 35 percent of respondents naming it one of the three months they'd most prefer. March, April, and February clustered around the 25 percent mark. "No preference" was the choice of 19 percent of respondents. At the bottom of the list: No one wanted to attend a meeting in December. November and July also fared poorly.

Weekend meetings are still most preferred by respondents, with 34 percent indicating a preference for a three-day meeting beginning on Friday, and 21 percent preferring Thursday as a start day. Tuesday is still the least preferred starting day for a three-day meeting, favored by only three percent of respondents. This finding is congruent with respondents noting "time away from practice" as a major factor influencing their decision to attend a meeting requiring travel.

Asked how much time they needed to plan attending a meeting requiring out-of-town travel, 27 percent of respondents wanted more than 12 weeks; 26 percent wanted 12 weeks; and 22 percent wanted eight weeks. This suggests that a brochure advertising a meeting on October 1 that is mailed in the last week of June is still not arriving early enough to suit the planning preferences of more than a quarter of the potential audience.

Local meetings are a different story. The average amount of time needed to plan attending a local CME meeting is two and a half weeks.

Even as respondents indicated a decline in their plans to attend meetings, the percentage of respondents who say that 76 percent or more of the total cost of attending is reimbursed by the organization they work for has increased slightly, to 31 percent, up from 27 percent a year ago.

Forty-four percent of respondents pay the entire cost out of their own pockets, down slightly from 46 percent a year ago.

Affiliations One new question on the survey yielded somewhat surprising results. Five years ago, it was widely predicted (in these pages and elsewhere) that physicians would cut back multiple memberships in medical associations. Yet 36 percent of respondents say they belong to more than four societies. (See chart on page 36.) One reason put forth by the New York State Medical Society at its Website: Societies are proving their worth these days not only by offering education but by acting as lobbyists who are out supporting issues physicians care about.This year we asked physicians specifically about affiliations with network health maintenance organizations (HMO). Sixty-one percent had at least one; 39 percent had none; and 30 percent had three or more. In past surveys, 100 percent of those physicians with at least one HMO affiliation had 76 percent or more of their total CME expenses reimbursed by the organization they worked for.

Practice Setting According to the AMA, about 25 percent of active physicians are in solo practice. Yet 38 percent of respondents to our survey, who were selected on the basis of having active practices and being active in CME, say they are in solo practice. Either CME appeals more to solo practitioners, or solo practitioners are simply better at responding to surveys like this one. In any event, the majority of respondents, 41 percent, say they are in group practices; eight percent are in hospital-based practices, five percent are in academic medicine, three percent work for corporations, and three percent work for staff-model HMOs (a stable percentage over the last five years).

One thousand surveys were mailed to an nth-number sample from the AMA Physicians master file, supplied by Medical Marketing Services, Wood Dale, IL. Names were selected from a list of physicians who were in active medical practice and who had earned the AMA's Physician Recognition Award. Surveys were mailed with a one-dollar incentive. There were 309 usable responses, for a 30.9 percent response rate. This return is better than the 1997 and 1995 surveys, but not as high as the 1994 and 1996 surveys. We continue to work on methods for improving response.

Our thanks to David A. Shore, PhD, Coopers & Lybrand Director of Continuing Professional Education at Harvard University School of Public Health for his ongoing advice and counsel.