This year's physician preferences survey — the ninth annual — was still in the hands of some respondents on September 11. Rick Lowe, our market research maven at Primedia Business, our parent company, was able to separate surveys returned before and after that date. We waited with no small trepidation for the results — and were astonished when they showed no statistical variation.
We also conducted two separate follow-up surveys, and in each one found that although they were concerned about travel safety, a large percentage of respondents indicated that they did not intend to alter their travel plans.
So, we salute those intrepid travelers who have refused to panic while in pursuit of medical knowledge, wherever they might have to travel to find it.
We sent two post-attack surveys to physicians to ask about the effect on their travel plans. The first survey went to the same sample as the main survey. Because of the short amount of time available, and possibly because we were going back to the same audience with a second request for information, the effective response rate was only 6.4 percent. Bearing the low response rate in mind, we decided to publish these findings anyway, since we thought the trends indicated would be helpful to you.
We asked physicians, in light of the terrorist attacks, how concerned they were about travel safety and security. About a third of them were “extremely concerned.”
Asked how they would change their meeting attendance habits in light of September 11, nearly half said they would choose more regional or local CME activities in preference to out-of-town meetings. Medical associations whose memberships have significant overlap with other associations may want to consider co-locating meetings. Or, they may want to pick up on the recent trend toward “medical team” meetings and offer not only CME for physicians but CEUs for operating room and other support staff.
Even though physicians told us they were more likely to choose regional or local meetings, this does not mean that they plan to forsake travel. In fact, when we repeated our original survey question about plans for attending meetings requiring travel in the next 12 months, there was essentially no difference at all in their pre — and post — September 11 responses. Only 17 percent of respondents indicated no plans to attend CME activities requiring out-of-town travel in the coming 12 months. This compares favorably to the 2001 survey, when 21 percent of respondents indicated that they did not plan to travel, and to the 2000 survey, when 24 percent said they had no plans to travel. This finding makes sense in light of respondents' increased willingness to travel to obtain CME that is not available locally.
The second post-attack survey was directed to an audience of psychiatrists reached with the assistance of one of our sister enterprises, Interactive Medical Networks, a CME provider. This survey was conducted via e-mail, and went to a much larger sample (3,200 psychiatrists). At 8.3 percent, the effective response rate was slightly higher than the mail survey discussed above.
Among this group, only 17 percent were “extremely concerned” about travel safety and security. Asked whether they would change their CME preferences in light of the attacks, an impressive 44 percent said they would continue to travel as planned and did not anticipate any changes. The second largest response, however, came from the 35 percent of respondents who said they would choose more regional or local events. And, as was the case with the first study, plans for attending out-of-town CME activities in the next 12 months were consistent with the overall survey's pre — September 11 results.
Top trends this year include, believe it or not, an increase in the number of physicians who say they travel to attend CME activities because they can't find equivalent learning locally. The percentage of physicians who say they earn CME at out-of-town meetings is up, too. On the other hand, the total number of Category 1 hours earned has declined for the fifth year in a row.
Other trends:
Physicians remain pressed for time;
They say obtaining CME credit is a bigger factor in their decision to attend an out-of-town meeting;
They're getting a bit younger as a group. And women are still a growing demographic in the practice of medicine. In the 2000-2001 entering class at medical schools in the U.S., 46 percent were women.
In the 1998 survey report, there was some discussion of “chore or choice,” that is, the notion that physicians may choose to participate in a CME activity strictly for the knowledge and credits to be gained, or because there is some additional value to participation beyond these two generic requirements. Judging from this year's results, it is time to bring this subject up again. Why? In 1997, we began asking whether one of the factors affecting a physician's decision to travel to attend CME activities was because they couldn't find a local source of information. In that first year, physicians ranked “no local equivalent” eighth among the factors influencing their decision to travel to a CME activity. In each subsequent year, this factor was ranked ninth. This year, it was tied for second with meeting length (days spent away from practice) as a factor.
When cross-tabulated against the number of CME activities attended in the previous 12 months, those physicians who had attended three or more out-of-town meetings ranked “availability of education (no local equivalent)” higher than physicians who attended fewer out-of-town meetings. This suggests that physicians will in fact travel to attend a CME activity if they can't find a local equivalent.
The next obvious question is, why now? One possible answer is that the CME topics important to physicians are changing quickly, and local CME providers cannot keep up with this acceleration. Another is that medicine has become such a complex discipline that no local education source can possibly be all things to all physicians. A third possibility is that, after years of trying to pry open that black box called “marketing,” national associations and specialty societies have finally found effective ways to make the case that their meetings add value in a way no other CME experience does.
Whether one or all these possible explanations fit, the finding that physicians see CME as a choice rather than a chore — and one that they will travel to obtain — can only be construed as very positive for the medical meetings business, especially in light of the discouraging counter-effect of the September 11 attacks on overall willingness to travel.
When making plans to attend meetings requiring travel, the average respondent indicates a need for 13 weeks' advance notice. That means a brochure for a meeting at the end of January must be in the hands of prospective attendees by late October. Even that may not be soon enough because about one quarter of all respondents say they want more than 13 weeks — in fact as much as 25 weeks — to plan attendance at an out-of-town meeting.
When asked about making plans to attend local CME activities, respondents say they need five weeks to plan. Again, a significant proportion of respondents (29.8 percent) want more than five weeks — up to as much as 12 weeks — to plan attendance at local activities.
Asked which methods they use to obtain CME credit, the largest proportion of respondents (66.7 percent) say they do it by attending meetings. This is an increase over last year (64.2 percent); in fact, in this year's survey, a slightly larger proportion (39.9 percent) of respondents say they use out-of-town meetings to obtain CME credit than last year (37.6 percent).
Overall, year-to-year changes in methods of obtaining CME show very little change compared to 2001, except for the use of online services and CD-ROMs, which dropped to 4 percent from 6.1 percent a year ago. The peak year for online CME was 1999, when nearly 20 percent of respondents said they were using the Web or CD-ROMs to obtain CME. Another change was in the category of “other” methods (chiefly audio tapes), which increased slightly from last year's 9.9 percent.
Last year's survey raised a flag over an apparent decline in the average total number of hours of CME earned by physicians. The trend has continued. The number has declined from 78 hours in 1998 to 50.8 hours a year ago and just 49.4 hours this year.
The decline has slowed, but the trend is still pointing the wrong way as far as CME providers are concerned. Again, it seems ironic that as more methods for obtaining CME come into use, the total number of hours earned declines. For those interested in market segmentation, 10.8 percent of respondents say they earned 80 hours or more Category 1 hours in the past 12 months. As is the case with consumer goods, if you can identify the heavy users, they can be quite a lucrative market!
There is, however, a counter-trend at work here. For the first time, physicians ranked the need for CME credits third among the factors influencing their decision to attend an out-of-town CME meeting. Last year, it ranked eighth; in 2000, it ranked sixth. What this suggests is that even if physicians are earning fewer Category 1 credits than before, they still highly value earning such credits, and expect them to be available when attending meetings requiring travel.
As reported last year, time and cost considerations are making a seemingly inexorable march forward among the concerns of physicians. This year, meeting length (along with availability, as discussed above) tied as the number-two factor influencing the decision to attend an out-of-town CME meeting. Meeting date ranked fourth (up from sixth a year ago). Paradoxically, when asked about preferred months of the year for attending meetings, “no preference” ranked highest of all (33.3 percent of respondents, far above February, which was the top choice of only 11.4 percent of respondents).
A possible conclusion: Physicians now have so little time available for traveling to meetings that time of year finishes a distant second to simply finding several days in a row available for meeting attendance. If that is so, then it is more important than ever for CME providers to have a good handle on the habits of their attendees. For example, if most of them are free in December, then December is the time to meet, regardless of usual practice.
A companion argument might be that once a regular date (and maybe location) has been established for a conference, organizers would do well to hang onto that date for future meetings. When attendee time is at a premium, a regular schedule can be a marketing plus.
At the day-of-the-week level, however, physician preferences so far remain constant. As in surveys past, most respondents (36.8 percent) prefer Friday as the starting day for a three-day out-of-town meeting.
Slightly more than half (50.4 percent) of respondents to this year's survey say they prefer to attend an out-of-town CME meeting at a resort. Hotels, at 49.1 percent, are a very close second. Last year, for the first time in the life of this survey, hotels were the top preference of respondents. For the 2002 survey, conference centers ranked third; medical centers/facilities ranked fourth; and restaurants ranked fifth in order of preference.
The big movements compared to previous years were the restaurant category, which moved up from eighth a year ago (Dine-and-dash, anyone?) and the cruise ship category, which moved from dead last a year ago to sixth this year with 11.4 percent of respondents preferring CME at sea. This may reflect the aggressive marketing of ship-based CME that has gone on in the last year, as reported in “Cruise Control,” in the July/August issue of Medical Meetings.
California, Florida, and New York remain the undisputed most-preferred states among respondents. As discussed in previous years, destination preference works two ways: A state may have drawing power based on its attractions, or simply because of its population.
There is some evidence this year that in fact physicians' perceptions of states as desirable meeting locations carries significant weight: Texas is the second most populous state, but for the first time since 1994, for reasons unknown, it has fallen out of the top 10 (Could all that TV footage of President Bush at home on his ranch enjoying 100-degree-plus heat in August have somehow turned physicians off?).
Returning to the list this year after brief absences are Hawaii and Virginia. States falling off the list, besides Texas, were Nevada and Louisiana, despite the fact they boast two of the biggest U.S. convention cities — Las Vegas and New Orleans, respectively.
For only the second time in the nine years of this survey, a non-English-speaking nation finished second as a preferred international destination. (France was also the second-most-preferred international destination in 1996). As mentioned in the 2000 survey, there is a certain inevitability to the ascendance of France as a preferred destination, because demographics are on its side: Women prefer France above all other international meeting destinations, and as the proportion of women grows in the total physician population, so grows the popularity of France for CME.
This year 26.3 percent of respondents are female, which is actually slightly below the 2000 level of just under 30 percent, but far above the 17 percent recorded in 1994. (The 2001 gender split has been omitted, due to sample skewing that year.) Those two Anglophone destinations, England and Canada, finished first and third respectively in this year's results.
There was some concern that the terrorist attacks on the United States might discourage a preference for international travel. While the short-term impact has clearly been very bad — witness the sudden bankruptcies or near-bankruptcies of several international air carriers — conference organizers should remember that the internationalization of CME has, over the medium term, greatly increased the attractiveness of overseas destinations. Consider this: In our first survey in 1994, only 9 percent of respondents indicated that they would willingly travel overseas to attend medical meetings. While we have never asked specifically about actual international travel, judging by the quantity of responses — not to mention the greatly increased breadth of preferences — physicians are far more willing to go overseas to attend meetings than they were nine years ago, present circumstances notwithstanding.
As mentioned earlier, the gender split in this year's survey is 72.4 percent male, 26.3 percent female, which corresponds to American Medical Association (AMA) figures for 1999 showing 76.6 percent male and 23.4 percent female. This number has been gradually increasing over the life of the survey.
The age of the average respondent is 46.6, and, as mentioned in last year's survey, the trend is toward a younger physician population. Consider that nearly a third of respondents (32.4 percent) are under the age of 40. Correspondingly, the average number of years in medical practice is only 18, with a quarter (25.4 percent) of respondents having less than 10 years' experience in medicine.
Far more physicians — 46.5 percent — are in group practices than in any other type. The percentage of solo practitioners returned to trend this year at 15.8 percent. Last year it rose to 26.8 percent, and stood at 19.6 percent in 2000.
Physicians' relationships with network health maintenance organizations (HMOs) continues a trend seen in the last few years in which most physicians either reject such affiliations completely or embrace them enthusiastically. About a third (33.8 percent) of respondents report having no HMO affiliations, and about a quarter (24.1 percent) have five or more such affiliations. The remaining 42.1 percent have between one and four such affiliations. This suggests that network HMOs hoping to differentiate themselves by offering CME to members face a difficult task, if the audience they hope to reach has either no affiliation or so many affiliations that achieving differentiation is not worthwhile.
A year ago, we reported an uptick in the percentage of physicians who belong to four or more medical associations; that statistic remains unchanged this year, at 21.5 percent of respondents. Only 4.4 percent of respondents do not belong to any medical association; 70.7 percent belong to two or more.
Last year, 49 percent of respondents said they were not reimbursed by the organizations they worked for any of the expenses associated with attending an out-of-town CME activity. Thankfully, the number has dropped to 38.2 percent this year. That is still a large proportion of have-nots.
Meanwhile, the percentage of respondents who have three-quarters or more of their expenses reimbursed has climbed to 35.1 percent, up from 27.7 percent a year ago.
For the first time this year, we asked physicians directly about their use of the Internet. The results are illuminating. While 20.6 percent of respondents say they use the Internet to obtain CME, only 4 percent of respondents to the question about methods of obtaining CME say they got it online.
This suggests to us that while more physicians may be using the Internet to obtain CME, they are still obtaining only very few actual hours of CME that way. Remember, too, the other part of the response to this question: 76.8 percent of respondents are not using the Internet to obtain CME credit. Online CME providers still have a lot of market potential to tap.
Online CME providers may also be interested to learn that 53.2 percent of respondents access the Internet at their offices, while 78.7 percent go online at home. And, as the percentages imply, many access the Web in both places. The lower number for office access may be important for online CME providers making assumptions about the connection speeds of their audience: High-speed Internet access is still more likely in an office setting than in a home setting.
One more statistic that won't make online providers very happy: We asked those 76.8 percent of respondents who did not use the Internet to obtain CME why that was so, and 39.4 percent said they had no interest in online CME.
It may also be time for a shake-up in the Web site design department, because 33.7 percent of respondents said they didn't use the Internet because the sites were too frustrating to navigate.
Cover letters and questionnaires were mailed to 1,200 physicians on August 27, 2001. Names were selected on an nth-name basis from an American Medical Association Masterfile list supplied by Synavant in Atlanta.
To increase the response rate, the Medical Meetings logo was used on the mailings to associate the study with this publication. A dollar incentive was enclosed with the mailing. An alert postcard was mailed on August 22. A first-class commemorative stamp was used to differentiate the survey mailing from direct-mail solicitations. A toll-free fax-back option was offered. A follow-up mailing was sent on September 10. The response cutoff date was October 3, at which time 236 surveys had been received. Of those, eight were incomplete and discarded. The post office returned 32 pieces as undeliverable. As a result, the effective response rate was 19.5 percent.
Surveys were received both before and after the terrorist attacks. Questions were tested based on whether they were returned before or after that date; responses were found to be statistically equivalent. Consequently, on October 9, 2001, self-mailing surveys asking about changes in travel plans were sent to the same list of 1,200 physicians. The self-mailer included a postage-paid reply card. By November 19, 75 usable surveys were returned. Again, 32 pieces were returned by the post office as undeliverable. The effective response rate was 6.4 percent.
A second post — September 11 e-mail survey was conducted among 3,200 psychiatrists with the assistance of Interactive Medical Networks (IMN), a CME provider and fellow Primedia company. Strategies to increase response included a link directly to the survey site and an incentive — a chance to win a $50 Amazon.com gift certificate. The effective response rate was 8.3 percent.