When Bruce J. Bellande, PhD, took over as executive director of the Alliance for CME in 1996, all the organization owned were two file cabinets, a desk, a Mac computer, and some odds and ends. The Alliance had just moved from Chicago to Birmingham, Ala., and Bellande was the only full-time employee; in fact, he was the first full-time executive except for his predecessor, Frances Maitland. Now, 10 years later, the staff comprises eight full-time employees and four part-time employees, membership has reached a record high of more than 2,200, operating reserves exceed $700,000, and the 2006 annual conference attracted more than 1,600 participants.
Bellande began his tenure at the Alliance with the same goal he still cites as his mantra: elevating CME as a profession. And he still has those two file cabinets in his office. As for his future after he steps down as executive director at the conclusion of the 2007 annual conference, Bellande says he is considering several exciting options but hasn't yet made a decision.
His passion and commitment to CME began in the early 1970s, when the University of Mississippi School of Medicine received a block grant from the federal Department of Health, Education, and Welfare to teach local physicians about the latest advances in management of cancer, stroke, and cardiovascular disease. The physician directing the project had no experience in education and asked Bellande to help him. Bellande, who had received his degree in biology at the University of Mississippi, had been serving as liaison to the medical school's postgraduate education committee. (He went on to complete his graduate and doctoral degrees at the same university.) He and the project director conducted a statewide needs assessment and created a network delivering clinical education to small communities across Mississippi. Bellande was hooked on CME. “It was just wonderful to have that opportunity. At that time — the early seventies — they had the resources to get all that done. It charged up my batteries,” he recalls. “I said, this is really interesting and very much needed.”
Bellande continued his work in CME with a 10 year stint as director of education at the Southern Medical Association, also in Birmingham, before joining the Alliance for CME. We talked with him about his strategy for elevating the Alliance's visibility, the challenges faced by the CME community today, and his hopes for the future.
MM: What was the biggest challenge you faced as executive director?
The No. 1 challenge was transferring the Alliance from an [organization run by an] association management firm into an independent, self-sufficient association. When I took over, Frances Maitland was the only paid employee of the Alliance through thewith the management firm. The other services were provided by the firm's staff. The Alliance had no system for accounting, no system for membership database management, none of its own insurance. Everything was done by the firm. I mean everything — the whole shebang.
First, I had to make a decision about how we were going to manage the membership, and I did a lot of research, looking at membership data management software. There are a lot of companies out there; you can pay from $20,000 to $200,000 — and of course back then the Alliance's [total operating] budget was maybe $500,000. So, I had to try to select something that would meet our needs and was affordable. Which I did. We're still using it. I had to set up all the financials: how we would collect money, how we would disperse money, how we would account for money, do our audits; and I had to establish relationships with law firms and audit firms and accounting firms. It really was like starting from scratch. Within the first two weeks, I had pretty much done the research and gotten the database for membership and begun setting up the financial and legal relationships and office space that we needed and started recruiting staff.
MM: Who made the decision to switch from the association management firm and why?
Actually, it was mutual. The board members at that time felt that they wanted the leadership [to separate from the association management firm] and I would not have taken the position if the Alliance was not going to be an autonomous association.
If you're going to grow and mature as an association [it's difficult if] you're so reliant on someone else. Those people don't really work for you, they have no real sense of loyalty. It's you versus the management firm. I felt the Alliance had the potential to be its own association, to run itself, and to grow in so many ways, and I just didn't see that necessarily happening with the former structure.
MM: What is the accomplishment you're most proud of?
I would say the Alliance's position today as the premier [CME industry] association. An early goal of mine and one that I've maintained all along was to enhance the Alliance's visibility and quality, [its position of] trust and value, to capitalize on the opportunities for the Alliance to be engaged in making the decisions that influenced or controlled the CME enterprise and its environment.
But one of the challenges I had in taking over an organization that was managed by an association management firm was to increase the Alliance's involvement with other groups that we had never worked with before, such as the American Medical Association, the Council of Medical Specialty Societies, the American Board of Medical Specialties, and the Federation of State Medical Boards. And that was a real challenge, because we weren't at those tables. In several instances, [the organizations] had never heard of the Alliance. Then, we communicated to our members our visibility and the value of [positioning] the Alliance at tables and at meetings where important decisions were being made, keeping members abreast of what was happening and the implications for them. We also translated [those developments] into programming at the annual conference.
[Increasing the Alliance's visibility] really put us in a more proactive position of trying to determine our fate as opposed to being in a retroactive, ‘It happened; like it or lump it’ position — and that enhanced our value to members. [We could] say this is an organization that is shaping the future of the CME enterprise.
MM: What is the biggest positive change you've seen in CME during your career?
The most positive change is the professionalization of CME. The quality of what people do and how they do it has changed. It's going to have to change a lot more but [those transitions are] under way. I think the strategic imperatives of the Alliance are really going to set the foundation in place.
(See sidebar, page 38, for the Alliance's new strategic plan.)
The Certification Question
MM: Negative change?
Obviously, I think it is the public scrutiny of CME. I say it's negative because it's not correct. When journalists write articles about CME and its effectiveness and funding issues, they don't separate promotion from independent certified education. They don't understand it. They don't even understand CME. And they're trying to write about it in a very critical way. That element of media [criticism] is creating public scrutiny.
And that leads to the second negative change: increased outside regulation of CME. In particular, the Office of Inspector General has done some good things, but it also done some very negative things. And Stark II has been totally misunderstood by the regulators and has caused havoc in the hospitals. That is an atrocity right there. [The preamble to the Stark II Interim Final Rule, published in the Federal Register in March 2004, names CME as one of the perks hospitals might offer to physicians to entice them to refer more Medicare patients. In other words, according to some interpretations of the rule, CME activities could be seen by the government as contributing to the abuse of Medicare and Medicaid. For more information, see “Stark Raving Mad,, September/October 2004, available online at meetingsnet.com.] Those are two [examples] and there are others. These are situations where regulators don't know anything about CME, they don't seek [information about CME], and then they render opinions or decisions that have adversely affected CME in many ways.
For example, now we have had to build this highly bureaucratic, expensive, time-consuming process to provide grants — and I mean everybody's feeling it. Industry is so strapped with this, it's costing them a lot of time and money. And for providers, the timeline is extremely long. Some of the companies have streamlined [their systems] somewhat but it's still a lengthy process and it's becoming a highly competitive process. Those who are feeling it the most are people who probably need [commercial support] the most — your small providers, your community hospitals that just don't have the resources or the wherewithal to understand and participate in this new grants process.
Of Balance and Books
MM: What are the three biggest challenges facing the CME community today?
I would say the first would be to acquire the competencies necessary to [help physicians] address the [new] requirements of maintenance of certification and maintenance of licensure. [Under new maintenance of certification requirements being rolled out by the specialty boards, physicians will have to demonstrate competency in a number of areas on an ongoing basis.] Each state working with the FSMB is evaluating current requirements and exploring better ways to ensure the competence of physicians in licensing and relicensing. The public is demanding that level of regulation. In particular, there are two areas that have been carved out for CME and those are self-assessment and lifelong learning. Self-assessment is not the self-assessment of the past. We're not talking about a needs assessment of a survey population or target audience — we're talking about a [physician's] customized, individual self-assessment that will be linked to lifelong learning. The other is continued practice performance and improvement and there we're talking about [measuring] physician performance and then translating the need [for improvement] into educational opportunities. We're talking about just-in-time learning, point-of-care learning — different formats than just live meetings or monographs.
Another challenge is in the arena of funding, because [providers are so dependent] on pharmaceutical and device manufacturers' funds. Again, another challenge is continuing to increase the value and effectiveness of CME. And I think the last one is certainly the advocacy of CME as a profession.
MM: What new competencies will CME professionals need in the near future?
They need competencies in [designing] self-assessments and [developing activities using the new] formats I touched on — just-in-time and point-of-care learning, creating other innovative ways to facilitate physicians' meeting their self-assessment, lifelong learning, and practice performance and improvement requirements. We need to transition ourselves from meeting planners and educators to learning facilitators, counselors in learning. We need to make the transition from teacher-centered CME to learner-centered CME. We need to be seen as valuable, trustworthy, competent learning coaches or learning facilitators as opposed to people who put on the meetings. I'm not saying that meetings are going to go away — not by any means — however, I think we need to put greater emphasis on just-in-time, hands-on, and point-of-care learning opportunities as well.
MM: What does the future hold for CME provider/industry collaboration? What needs to be changed about the funding process?
If we continue to see greater and greater outside regulation, I think it will adversely affect industry's interest in supporting CME. There's a strong commitment there, but if you continue to have this high level of scrutiny and all these rules and all these regulations that's a real disincentive. We need to have greater balance in funding sources. Certainly industry should [play a role], but I think we need to begin to talk to and expect [funding support] from payers, particularly the Centers for Medicaid and Medicare Services and other public and private payers including HMOs and other managed care organizations.
I think pay for performance is going to have an impact. Physicians will receive reimbursement based on their performance [meeting] disease-specific practice and improvement standards. Those performance measures and how they are implemented are going to be critical for CME people and the payers. I think CMS and the public/private sector payers are really going to have to begin to support education. With the new maintenance of licensure, maintenance of certification, and pay for performance [requirements], physicians are going to be willing to pay more for education because it will be linked to an income incentive.
As for how the Alliance's initiative might dovetail with the National Commission's program, it's too early to predict, Bellande says. “They'll have their own standards and requirements. I can't speak for them regarding whether they'll recognize the Alliance's certificates of mastery in some way.”
The Alliance's Next Steps
MM: Where would you like CME to be in five years?
Continuing with my mantra, I would like CME to be a highly respected profession with professional standards, with maintenance of competency for CME professionals, including self-assessment and a core curriculum. I'd like to see CME stop being marginalized; I'd like CME to be at the center, viewed as the main vehicle for education and practice improvement for healthcare professionals. And finally, I'd like to see CME in control of its environment, and that means more advocacy [in the] political, regulatory, and accreditation [arenas].
Back when Alliance for CME Executive Director Bruce J. Bellande, PhD, was just a, he served on a committee that discussed establishing a certification program for CME professionals. That was about 15 years ago. Since then, he says, two separate task forces have debated the issue. Then, in early 2006, a group of CME professionals founded the nonprofit National Commission for Certification of CME Professionals, whose mission is to establish a certification program.
The Alliance is taking a different route, focusing its efforts on the maintenance of competency initiative it began several years ago. The Alliance has defined eight broad competencies — including adult learning, partnering, systems thinking, and administrative management — and 48 specific competencies within those areas. Currently, nine panels of experts are developing performance indicators of those competencies — what you need to know to demonstrate mastery of a particular area. Next, says Bellande, the Alliance will develop self assessment modules, a curriculum, and a system of recognition — but it will probably not be certification.
The problem with a general certificate, he points out, is that many CME professionals' jobs are highly specialized. There would be aspects of a general certification that aren't relevant and people may not feel it's worth the time to participate, he says. Instead, “I like the idea of certificates of mastery in given competencies as recognition,” he says. That way people can tailor their education to their specific professional needs and aspirations. “[A CME professional] might say, I have achieved my mastery in meeting planning, or in regulation and accreditation, or in the management of the CME operation, and so forth,” he says. The program will involve continuous self-assessment and reflection in practice. “It's maintenance of competence for CME — it's not an end point of just a certificate, he says.
Asked how he has balanced work and family responsibilities, Alliance for CME Executive Director Bruce J. Bellande, PhD, answers candidly. “My balance hasn't been particularly good. I've been so career-oriented — but I'm blessed to have my wife of 36 years, who has been an outstanding partner and supporter of me, and mother and teacher and nurturer of our children. Without [her support], I definitely would not have been able to devote the time and effort I have to a career, so I really attribute that blessing to her.” Bellande and his wife Mary Betsy have two children, Betsy, age 24, and Christopher, age 21.
When he does have free time, Bellande enjoys crossword puzzles, exercising (jogging, swimming, and hiking), and indulging his passion for raising orchids.
He also loves reading. While for years, he would read only nonfiction — books that would help him advance his career — he now balances that reading with fiction. Born in Alexandria, La., Bellande feels a strong tie to his roots. “I'm a Southerner and I'm biased to Southern writers,” he says. “I like William Faulkner. I love anyone who can write as well as he can about the visuals and culture of the South.” He also likes Eudora Welty and reads Harper Lee's To Kill a Mockingbird about every five years. “It's just a fabulous book.” For lighter fare, he turns to Pat Conroy, John Grisham, and the New Englander John Irving. And he still reads career-oriented books. “Jim Collins' Good to Great was one of the books I really enjoyed recently. There are so many wonderful things to read — it's just a matter of finding the time.”
The Alliance for CME is currently in the midst of developing a new strategic plan. The first major goal, says Executive Director Bruce J. Bellande, PhD, is to advance CME as a profession. That will involve setting standards for the profession of CME and for CME professionals and establishing best practices. In addition, the Alliance aims to develop an advocacy program and continue to strengthen its leadership position in the CME and broader education communities. To achieve that goal, the Alliance will need to groom leaders who can advocate for the CME profession, Bellande says.
The second goal, he says, is to transform knowledge into practice. That will involve establishing a competency-based curriculum for CME professionals and creating professional development and educational opportunities in addition to the annual conference. Toward that end, the Alliance has just launched a series of Webinars on topics including outcomes measurement, commercial support, and conflict of interest.
Another goal of the strategic plan is to develop new revenue streams in addition to membership dues and the annual conference income. To bring that goal to fruition, staff — rather than volunteers — will need to be involved in the development and management of products, Bellande says.
And, finally, the plan involves coordinating the effective transition of leadership to Bellande's successor. A search firm has been appointed, and the position is being advertised.
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