The fourth annual survey of physician preferences in continuing medical education (CME) has several informational firsts. For the first time, we asked physicians to indicate all the ways in which they obtained CME credit. We also broke out data on CME participants who received most of their CME credit by attending meetings-and found significant variation in the factors that influence their decision to attend out-of-town meetings, compared to the total sample. We also asked how much advance notice physicians want when making plans to attend CME activities.

We have continued to ask questions that medical conference organizers tell us are important. For the fourth year, we have asked physicians to rank the factors that influence their decision to attend an out-of-town meeting; for the third year we have compared the meeting-attending activity of women to the total group; and for the second year we have asked how much of physicians' expenses are reimbursed. And, as we have since the beginning, we've asked about destination and meeting facility preferences.

Please be sure to read the Methodology section; we used a new mailing list this year, which makes year-to-year comparisons less analogous. We also changed some tabulation methods-these changes are noted where they occur. On the other hand, there are a few questions that we have asked in the same manner year after year. For these, we have made comparisons to previous surveys when there appears to have been a change large enough that the difference in lists-in the editor's judgment-may not completely account for it.

While we have focused exclusively on physician preferences, we believe this survey will be worthwhile for those who plan conferences for any and all healthcare providers, because attendees-whether or not they have an MD or DO after their names-are all adult learners, who seek practical, participatory education.

We hope these survey results are useful as adjuncts to needs assessment, and that they will spur creative thinking about meetings and the way they are marketed to physicians. At very least we hope they instigate discussion about what brings physicians and others to meetings. Throughout, readers will have the benefit of comments and analysis by our expert consultant, David A. Shore, PhD, assistant dean and director of the Center for Continuing Professional Education and a member of the faculty at Harvard University School of Public Health-and author of the Marketing Medical Meetings column that appears regularly in this magazine.

Factors We presented physicians with a dozen factors that might influence their decision to attend a meeting requiring travel and asked for a ranking based on a Likert Scale. A score of five indicated that the factor was very important; a score of three that the factor was neutral; a score of one that the factor was unimportant. So the ranking shown above indicates that 11 of the 12 factors were ranked as at least somewhat important factors.

When physicians say geographic location is the most important factor in their decision to attend an out-of-town meeting, we interpret that to mean that if they are going to the trouble to invest several hours in traveling, that they want to end up somewhere that adds value to their trip. But it can also mean that they want the travel time investment to be small. The high ranking of meeting length as a concern suggests this. On average, respondents don't want to be away from their practices or their homes for too long. Speaker reputation appears far more important than the reputation of the sponsoring organization-as does the need for CME credits. CME providers counting on a nationally recognized name for a competitive edge, take note.

To borrow a mnemonic from the newspaper trade, the Five Ws (Who, What, When, Where, and Why) are all important factors to physicians-along with Price (registration fee plus other costs).

CME The World Wide Web will be a competitive threat to meetings someday-but not yet. Eighty-two percent of the CME credits earned by physicians in our survey were obtained at meetings. In the "other" category, the leading source of CME credits was audiotapes. While the average age of respondents who obtained at least some of their CME credit via CD-ROM or the World Wide Web was 47, respondents ranged in age from 34 to 76, with the distribution of ages concentrated at each end of the scale.

Women obtain more of their CME credit through attendance at local meetings than the group as a whole. They obtain credit by reading journals in about the same proportion as all respondents, don't use electronic media at all, and get slightly more CME through "other" sources. Women respondents were proportionately larger consumers of audiotapes than men.

Out of Town Meeting Attendance In the past 12 months, 49 percent of respondents attended two or more out-of-town CME meetings. In the next 12 months, 54 percent of respondents plan to attend two or more out-of-town meetings. (In previous surveys, we asked only about plans to attend meetings, without distinguishing between local and out-of-town meetings.) Fourteen percent of respondents say they plan to attend three or more meetings in the next 12 months. Looking only at women respondents, 39 percent say they attended two or more out-of-town meetings in the last 12 months, and more than one out of four attended no out-of-town meetings. For the coming 12 months, 46 percent of women respondents say they plan to attend two or more meetings-an increase, but still far below the meeting activity level of the respondent group as a whole.

Active We separated out those physicians who obtained at least 60 percent of their CME by attending meetings and who had obtained at least 40 hours of CME credit in the previous 12 months. This group of respondents obtained an average of 67 hours of CME credit during the previous 12 months, compared to a survey average of 50.4 hours, and they obtained 84 percent of their credit by attending meetings, compared to a survey average of 71 percent.

This group might be called the "Need To Know" segment of the physician community. The most important factor in their decision to travel to attend CME meetings is because the CME they want is not available locally. This group ranks the reputation of the sponsoring organization more highly than the respondent group as a whole. They also rank high the ability to combine a family vacation with a meeting-perhaps because they travel so much more than the total respondent group. Note that they rank meeting length dead last among factors influencing the decision to attend, even below "employer requires." This suggests that time away from practice is less important to this group. "These are the attitudes of employees," says Shore. "As healthcare in America goes, so goes CME."

Men are far more prevalent among the "most active" group than women. Published research by Henry B. Slotnick, PhD, PhD, an adult learning expert at the University of North Dakota, indicates that women are less inclined to travel to attend CME meetings than men, and this data supports his finding. Look back at the previous chart on specialties and note that 81 percent of the anesthesiologists who responded to the survey are men; only 57 percent of pediatricians responding to the survey are men. (Note also that for the first time this year, more of the total survey respondents in both internal medicine and psychiatry were women than men.) Even among women respondents who travel, their comments on other factors influencing their decision to travel to attend a meeting are different from their male counterparts. For example, ". . . availability of children's programs if family is to join me . . ." and ". . . how busy work is, how busy home life is (school/kids) . . ." These compare with comments by men, which focus more on topic relevance.

At nine percent of total, anesthesiologists are the third largest specialty group in the total group of respondents, after pediatricians (ten percent) and internists (ten percent). Yet they make up 12 percent of the most active group. Pediatricians aren't even on the chart. A possible explanation for this imbalance (beyond gender, as discussed above) is that CME directors report a trend toward more specialists attending CME so that they may eventually qualify as primary care providers-a high-status occupation in the world of managed care. Pediatricians already have that status, and thus don't have the same economic spur to attend meetings as other specialists.

Places We may have to stop running this chart; the same ten states keep showing up! We've added an extra two this year which finished closer to the top group than the remaining 38 runners-up: The District of Columbia and Pennsylvania. It may be no accident that the home states of the cities of Boston, Houston, and Philadelphia are on this list. All three have made concerted efforts to draw medical meetings. Maybe these efforts are paying off among physicians who have made the trips and liked what they saw.

Canada, which has made our top-ten list every year, won the top spot this year by a convincing margin. Many respondents listed two or more Canadian cities as preferred destinations. All the others in the top ten are repeaters from last year. Mexico's recovery as a preferred destination (it scored lower last year) is notable. Spain dropped off the list-perhaps marking the end of the Olympics promotional afterglow.

We have changed the tabulation method for this question, so direct comparisons to previous years are not valid. We ask respondents to rank a choice of eight venues from highest to lowest. Rather than a conversion of "most preferred" and "next most preferred," we totaled all responses. We also added a new category: Worksite. Using this methodology, resort hotels are still the most preferred destinations for CME meetings, although not by as large a margin as in previous years. Conference Centers and Convention Centers/Exposition Centers tie for second-most-preferred as they did a year ago, but downtown hotels are now in a lower tier, grouped with universities and suburban hotels. Airport hotels and the worksite fared poorly. Note: While managed care organizations may want to offer more onsite CME, physicians do not prefer it.

Time&Money A constant question for medical conference organizers is when to promote meetings and what to charge for attending them. Respondents, on average, say they need nearly four weeks of advance notice to plan for a local CME meeting, and nearly 13 weeks of advance notice to plan for an out-of-town CME meeting. Note: The average for out-of-town meetings may be a bit misleading. The median amount of time (center of the distribution) was 11 weeks. The average is slightly distorted by the eight percent of respondents who say they want 26 weeks or more to plan attending an out-of-town meeting! Another aspect of time is the time of year that physicians prefer to travel. March, February, and October were the most preferred months; December was the least-preferred month. Note that this year, for the first time, "no preference" scored high-as high as March. The preferred starting day for a three-day meeting is Thursday (24 percent of respondents), followed closely by Friday (22 percent of respondents). The percentage of those preferring meetings to start on a Monday has increased to 12 percent this year from four percent a year ago, and the percentage of those with no preference has also grown-to 12 percent this year from nine percent last year. "This reflects the growing number of physicians who are employees-who are interested in attending on company time," says Shore.

We asked respondents how much of the total expense (registration fee, travel, lodging, meals-everything) of attending an out-of-town CME meeting was paid for or reimbursed by their employers. Note that we did not ask for a definition of employer-we cannot tell whether "employer" means HMO, group practice, or even self. Assuming that respondents do not have another source-grant money, for example-we were really asking how much of the cost of attending the physician paid out of his or her own pocket. The answer: Nearly half of respondents pay their own way, and more than a quarter have more than three-quarters of their expenses covered. Note that only 54 percent of those who had no expenses covered had at least one HMO affiliation; 100 percent of those who had 76 percent or more of their expenses covered did have at least one HMO affiliation.

Methodology What a difference a list makes. For the first time this year, 1,000 physicians selected by nth-number sample from the American Medical Association (AMA) Masterfile-supplied by MMS, Inc., Wood Dale, IL-received our survey. In previous years we had used a list of physicians who had indicated that they were active in CME. Faithful followers of surveys past will recall our concern that women physicians were underrepresented in the sample. Last year, for example, only 16 percent of respondents were women, at a time when the AMA estimated that the actual physician workforce was 19 or 20 percent female. This year, 33 percent of respondents were women.

Even though we used a sample of physicians who did not declare themselves to be active in CME, 97 percent of respondents indicated they had participated in CME during the previous 12 months. This is the same standard by which physicians active in CME were selected in the list we used in previous surveys. So even physicians who do not characterize themselves as active in CME do in fact participate.

That's the good news. The bad news is that despite inclusion of a dollar incentive (as in previous years) we got a poorer response rate: only 23.5 percent, compared to 44.7 percent a year ago. It may be that physicians who do not perceive themselves as active participants in CME are less likely to respond to a survey asking them about their CME meeting participation.