A five-minute conversation with the right person can be more enlightening than five hours online. The most powerful search engines out there are other people. You can begin a fruitful exchange on the Net, but if you want a more powerful relationship, you'll need to climb up to the greater bandwidth of a face-to-face meeting." That's a quote from John Perry Barlow, an early proselytizer for the Internet, and co-founder and vice chairman of the Electronic Frontier Foundation. Readers, keep that quote in mind as you scan the results of this year's Physician Preferences in CME Survey--because there's a new delivery channel for CME, and it appears inevitable that it will change the way medical conference organizers go about their business.

Meetings requiring travel still hold the highest share of the CME market, at 32 percent, but electronic media (primarily the World Wide Web and CD-ROM) have grown tremendously. Nearly one-fifth (19 percent) of the average 56 hours of CME earned in the past 12 months by respondents to the Sixth Annual Physician Preferences Survey was obtained by logging on to the Internet or plugging a disk into a CD-ROM drive.

What impact is this having on meetings? While there is no direct correlation, 18 percent of respondents did not attend any out-of-town meetings in the previous 12 months, compared with only six percent of respondents who had not in 1994.

The percentage of respondents who attend two or three meetings, however, is virtually unchanged at 50 percent, compared to 49 percent a year ago.Will the world divide into those who attend meetings and those who do not? Time will tell.

How Physicians Obtain CME "In 1998, a physician could earn up to 255 hours of CME credit at our Web site," says Judy Blackwell, director of membership and member relations for Medscape, a New York City-based Web site for physicians. "When a physician sees a clinical condition that he or she is unfamiliar with, Medscape has information that is easily accessible 24 hours a day." For an initial fee of $50, physicians can earn unlimited credits at the site.

Rival online CME provider Medconnect, a unit of Medical Networks, Inc., based in Princeton, N.J., issued 8,600 CME certificates in 1998, according to Raj Lakhanpal, MD, the company's president and CEO. At Physicians Online in Tarrytown, N.Y., another Web-based CME provider, an average of 15,000 physicians visit the site each day. The number of physicians who have actually obtained CME credit through online courses at the site "is in the thousands," according to Laurie Murphy, a Physicians Online spokesperson. At the Cyberounds Web site, operated by New York City-based InterMDnet Corp., 62 hours of CME credit are available, sponsored by New York's Albert Einstein Medical College.

Medical associations and hospitals are also in the online CME business now, with such organizations as the University of Florida and the American Academy of Family Physicians offering a large selection of courses.

The average survey respondent earned 56 hours of CME in the past 12 months. Of this, 54 percent was obtained by attending meetings, down from 59 percent in the 1998 survey, and down from 72 percent in the 1997 survey. The percentage of credit earned by reading journals declined to 19 percent from 22 percent last year.

Lastly, eight percent of the total CME credit earned by respondents was obtained by "other" means, including listening to audiotapes or watching videotapes, up from four percent a year ago.

In short, the World Wide Web and CD-ROMs provide a new, successful means of obtaining CME credits.

Decision to Attend Location and speaker reputation have been the top-two factors influencing the decision by a physician to attend an out-of-town CME meeting since the 1997 survey. Next among the 12 factors respondents were asked to rank are two logistical concerns: How many days away from home and work the meeting will require, and the meeting's calendar date.

Breaking out the results by gender shows that women physicians are even more concerned with the logistics of attending out-of-town meetings. They rank location, date, and length of meeting ahead of speaker reputation as factors influencing their decision to attend. A similar breakout, this time by age, shows that physicians under the age of 40 rank location and dates ahead of speaker reputation, and regard the ability to combine attending a meeting with vacation as the sixth most important factor, much higher than the respondent group as a whole.

Regardless of age or gender, employer requirements remain at the bottom of the list of factors influencing the decision to attend a CME meeting involving travel.

Travel Preferences California, Florida, and New York retain a firm lock as the most preferred state destinations for out-of-town CME meetings. The District of Columbia and Pennsylvania, both newcomers to the list last year, have retained their rankings. This year marks the first appearance of Washington State as a preferred destination (field trips to Microsoft?). New Mexico is also appearing for the first time, below long-time favorite and next-door neighbor Arizona, which ranked fourth this year. Absent from the list for the first time is Hawaii, which has been recovering from a visitor slump and recently opened its first-ever convention center.

Canada and England tied for most-preferred international destination. The appeal of these English-speaking countries has been steady over the life of this survey, as have the appeal of France and Italy. The Caribbean, which was the top international destination during the first two years of the survey, has traded places with France in this year's ranking. New to the list this year are Greece and Austria. Both countries have been active in marketing themselves to the medical meeting community--Austria through advertising, Greece by publicizing the opening of a new convention center especially for the medical market. Switzerland appears for the second year in a row. Spain, which dropped off the list after appearing in the 1996 survey, is back.

When viewed by gender and age, there was little difference in preferred destinations--although a somewhat smaller proportion of women physicians selected international destinations than their male counterparts.

Venue Preferences While resorts have remained the top choice of physicians since the first survey in 1994, conference centers have made a steady ascent as preferred venues, and, after tying for second place with convention centers last year, now have the second spot all to themselves. Cruise ships, which appeared in the rankings for the first time last year, took a very respectable fifth place this year. The respondent's own workplace, which ranked last as a preferred venue two years ago and fifth as a preferred venue last year, still managed to rank ahead of suburban and airport hotels this year.

Time and Money Issues February, October, and March were the most preferred months for attending a CME meeting requiring travel. April was next most preferred, followed by "no preference," then June and January. July, November, May, September, and August clustered around the middle range, and December remains a distant last as a preferred month because of end-of-the-year holidays.

Despite predictions that physicians would gradually begin acting like employees rather than entrepreneurs in their attitude toward time at work, weekend meetings are, if anything, more strongly preferred than ever. Fully 36 percent of respondents prefer three-day meetings to begin on a Friday, followed by 26.9 percent who prefer Thursday as a starting date. Only 1.5 percent prefer Tuesday as a first meeting day, while 7.6 percent indicate no preference one way or the other. As in years past, these findings reinforce the importance of "time away from home/practice" as an important factor in the decision to attend an out-of-town CME meeting.

The average survey respondent needs about 13 weeks to plan to attend a CME meeting requiring travel; this figure varies little by age or gender. This means that organizers of a meeting scheduled to begin October 7 should have brochures in the hands of the target audience by July 15 to accommodate the planning needs of attendees. Time required to plan for attendance at local meetings averages 34 days; women respondents need about 38 days to plan attendance. The 34 day figure is up significantly from last year's results, when the average respondent needed just 18 days of advance notice. This suggests that physicians, like nearly every one else here at the end of the millennium, have increased demands made on their time, and thus require more notice to plan attendance at CME meetings.

When it comes to reimbursement of expenses for attending CME meetings, physicians divide into the haves and have-nots. For the second consecutive year, 31 percent of respondents have more than three-quarters of their total expenses for attending a meeting reimbursed by their employers, while 45 percent (up a point from last year) do not have any expenses reimbursed. The remaining 24 percent of respondents have anywhere from less than 25 percent to as much as 75 percent of their expenses reimbursed.

Practice Setting On average, 48 percent of respondents describe themselves as in group practice. There are 36 percent of respondents who describe themselves as in solo practice; this is lower than last year's 38 percent, but still high compared to the American Medical Association's membership figures, which indicate about 25 percent of physicians in solo practice. Interestingly, 40 percent of women respondents say they are in solo practice, while 70 percent of respondents under the age of 40 describe themselves as being in group practice. As indicated in previous years, either CME appeals more to physicians in solo practice, or else solo practitioners are better about responding to surveys like this one. Of the remaining 16 percent of respondents, one-quarter (four percent) work for staff-model HMOs, with the remainder in corporate or academic medicine. Worth noting: Eight percent of physicians under 40--which is to say twice the average--work for staff-model HMOs.

Affiliations In the last two surveys, there were no physicians without at least one network HMO affiliation (wherein physicians work out of their own offices and manage their own practices, but have a relationship with one or more large insurance providers). A startling 38 percent of respondents to this year's survey say they have no such affiliations. Of those who do have network HMO affiliations, 47 percent have more than four relationships, which suggests a competitive situation in which such inducements as fully reimbursed CME may play a part.

The Future It is no accident that this year's survey results opened with the quotation from John Perry Barlow about the power of meetings. It's clear that the Web has become an important new means for the delivery of CME to physicians. What future then do medical meetings have? Every time communication among people with shared interests becomes easier, so does their desire to actually have Barlow's "high-bandwidth" experience--a face-to-face encounter. Physicians may look more to the Web and other sources for Category 1 CME credit, but they will continue to look to meetings for a richness of experience that technology cannot--at least not yet!--hope to match.

One thousand surveys were mailed to an Nth-number sample from the AMA Physician's Masterfile, as supplied by the Buckley-Dement division of Acxiom, Corp., Conway, Ark. A one-dollar incentive was mailed with the survey. There were 195 responses, of which 185 were usable. Royco Mailing Services, Medford, Mass. tabulated the survey results. Thanks to Bob Ghika at Royco for the cross-tabulations.