The Case

Linda Lumbar, who serves as grants manager for the Women's Alliance for Menopause (an Accreditation Council for CME — accredited nonprofit medical association related to wellness for perimenopausal women), is excited when an e-mail from Better Bones Inc. pops up on her BlackBerry. Linda recently submitted a grant proposal for a performance-improvement activity related to osteoporosis. She anticipated that the grant request would be approved because the proposal was very strong: It included documentation of identified practice gaps and commentary from the leaders in the fields of women's health, orthopedics, family practice, and endocrinology.

Linda is disappointed to read that although the grant request was approved, BBI can provide only 50 percent of the funding. The supporter also requested that she provide confirmation that WAM has obtained additional support, or that it has revised the activity scope based on the available funding. What should Linda do now? She wants to tell her boss and colleagues about the approval, but not until she has some ideas for decreasing the budget or finding additional support.

The New Normal

Overstreet: This is quickly becoming the norm in commercially supported education. Both providers and supporters are struggling with how to handle decreasing budgets, and all stakeholders are feeling the economic pinch. In this era of cost containment, everyone involved in developing continuing medical education needs to carefully review their processes and associated costs to ensure efficiency and value.

Don't Break the Bank

Parochka: Ms. Lumbar has three courses of action she can take: first, withdraw the grant request and not offer the activity; second, offer the activity with a modified scope; or third, seek more funding. All options will cause a certain amount of stress, and none is ideal.

Overstreet: Ms. Lumbar should evaluate several possible courses of action to ensure that WAM can create this activity instead of having to withdraw the grant request. For example, she could take both options 2 and 3: Look for additional supporters and evaluate ways to decrease the scope and cost of the activity.

Lumbar and her colleagues should identify other supporters who might have available funding related to women's health. In addition to traditional pharmaceutical companies, they could consider others with an interest in women's health, such as manufacturers of vitamins, calcium supplements, and bone-density testing equipment.

Parochka: Faculty members might be asked to accept lower honoraria and trim travel expenses. Also, professional organizations might be able to contribute educational materials or other resources relevant to the activity's content to help manage the costs. Vendors may also be asked for discounts on their services (e.g., Web hosting, printing).

Don't Let This Happen to You

Parochka: To protect themselves from these types of situations, providers will need to develop bare-bones budgets for incremental numbers of participants and varying materials. Then if funding is reduced, the project can proceed based on available funds. If the educational grant cannot support the total expenses, then physician participants may need to be asked to help support the costs. The days of a “free lunch” may be coming to an end.

Karen Overstreet, EdD, RPh, FACME, is president, Indicia Medical Education LLC, North Wales, Pa. Reach her at

Jacqueline Parochka, EdD, FACME, is president and CEO, Excellence in Continuing Education Ltd., Gurnee,
Ill; and partner, PTR Educational Consultants. Reach her at

Your Views Welcome / To share your comments on this case, or if you have an “ethical hypothetical” you'd like reviewed, send an e-mail to Editor Sue Pelletier at