Eighth Annual Physician Preferences Survey In 1994, every respondent to the Physician Preferences Survey planned to attend at least one out-of-town CME meeting. In 2001, 34 percent say they didn't attend any meetings requiring travel last year.

Let's start right off with the take-home message: If your organization's lifeblood is its annual conference, you had better make it an event that can't be missed. Because about a third of physicians responding to the Eighth Annual Physician Preferences Survey didn't leave home to attend a medical meeting in the past 12 months. A year ago, 24 percent of respondents said they had no plans to travel. The year before, it was 18 percent. For the first time, "local facilities" finished fourth as a preferred venue. A year ago, it was the sixth choice. Draw your own conclusions.

A second trend, not as strongly supported by the numbers: Physicians are earning fewer Category 1 CME credits per year than they used to.

A third trend: Online CME is not the all-pervasive source of credits we all thought it would be, but it is carving out a niche.

A fourth trend: Physicians are not having as much of their meeting participation expenses covered as in previous years.

Finally, a fifth trend, which may have an impact on the preceding three: Physicians are becoming more conscious of the total cost of attending meetings. Details on these and other findings follow, but first, a discussion of methodology.

E-Survey: More Docs, More Men We shifted our methodology for this year's Physician Preferences Survey, and it probably impacted the survey results. For seven years, we printed surveys with cover letters and mailed them with an incentive (usually a dollar bill) to a list of 1,000 physicians culled in an nth-number sample from a list vendor's version of the American Medical Association's AMA Masterfile. Most years, we sent follow-up postcards. And over time, returns trended lower and lower.

For this year's survey, we changed tactics: We did the survey electronically. Using the services of Synavant (formerly IMS/Clark-O'Neill), we e-mailed 10,000 physicians and asked them to go to our Web site and take the survey. We also sent reminder postcards to half the list. And, instead of getting fewer than 200 responses, we received 443 usable responses. It's a smaller percentage of the sample population, but a larger real return.

What we didn't realize was that using a list of physician e-mail addresses would result in a skewed sample. Specifically, a list of physicians with e-mail addresses is somewhat younger and a whole lot male-er than the general physician population. Our average respondent age was 46.5 years, compared to an actual population average of 48 years. And while 76.6 percent of the total physician population was male in 1999, according to the AMA, our sample was 84 percent male. So instead of having 23.4 percent female respondents, as we would have in a sample that reflected the normal population, we have only 16 percent women respondents.

The discrepancy actually confirms what we've seen in previous surveys: Women physicians as a group have not been as quick as their male counterparts to embrace the Internet. Interestingly, however, those women who have embraced it are enthusiastic users: 57.8 percent of women who have Internet access use it to obtain CME credit, compared to 52.3 percent of men.

Please note that in all instances when a comparison is made to the 2000 survey - where findings were reported by gender - that all numbers have been recalculated to include both male and female respondents, so they are reported in the same way as the 2001 survey.

CME Chill Has CME credit lost its appeal? In 1998, the average respondent earned 78 hours of CME credit. In 1999, this fell to 56 hours. In 2000 it rose again, but only to 63.7 hours - well below the 1998 number. And this year, the average respondent earned 50.8 hours of CME. Granted, four data points do not make a trend. But if you're a CME director, it is chilling to think that with all the new ways to earn CME credit, physicians might decide credit is not as important as it once was.

Physicians still earn more of their CME credits - 63 percent - by attending meetings than any other form. Yet, if your organization's well-being depends on high turnout at meetings, this is not the moment for self-congratulation. That's because the percentage of respondents who say they plan to attend no meetings requiring travel in the next 12 months is now 21 percent, down from 24 percent in the 2000 survey, but up from 18 percent in 1999. It's a far cry from the original 1994 survey when every respondent planned to attend at least one meeting.

What's keeping them home? In past surveys, we pointed to the increased proportion of women respondents, who did not travel as much as their male counterparts. But only 16 percent of this year's survey respondents were female, half the previous survey's percentage. Nor can we blame it on the Web. Physician usage of the Web to earn CME credit peaked at 19 percent in the 1999 survey, fell to 5 percent last year, and climbed to 7 percent this year.

Blame It on Our Youth It's not just our survey that reflects a younger doctor population. The physician population as a whole is getting younger. This may sound counterintuitive, after a decade of having a steadily aging physician population (mirroring the general U.S. population trend), but the introduction of women and minorities into the practicing physician population has, according to a study by Jeannette South-Paul, MD, and Kevin Grumbach, MD, resulted in a younger physician population group.

If the physician population is growing younger, then their decline in participation in CME and in meetings in general is in line with many other studies of physician behavior. Younger physicians do not feel as compelled to stay up-to-date on their specialties - they're not that long out of medical school. By the same token, they have other priorities, including working longer hours to establish their careers or raising families (most often men in the former case, most often women in the latter).

Attendance Meltdown As mentioned, 34 percent of survey respondents say they did not attend any meetings requiring travel in the past 12 months. Of the remainder, 44 percent attended one meeting; 22 percent attended two or more meetings. Asked about their plans for the coming 12 months, 21 percent of respondents say they won't attend any meetings requiring travel, 51 percent plan to attend one meeting, and 28 percent plan to attend two or more meetings. From today's perspective, it seems astonishing that in 1993, 81 percent of respondents planned to attend two or more meetings, 19 percent planned to attend one, and the percentage of respondents with no plans to attend meetings was zero.

The survey asks only about meetings where CME credit is available; it could be that noncredit meetings are successfully competing with for-credit meetings. Does the fact that respondents are earning fewer Category 1 hours, as discussed above, support this supposition? It's a knotty problem: Based on its consistent middle-of-the-pack ranking as a factor affecting the decision to attend, we've long assumed that offering Category 1 credit was table-stakes in the medical conference business. Last year's study showed that out-of-town meetings were a disproportionately large source of credits, compared to other forms of CME. But if physicians are deciding they don't need to earn as many CME hours as in the past, it may be that offering credit isn't the gold-plated lure it used to be.

California's Charm The number-one factor affecting the decision to attend a CME meeting involving travel is the event's geographic location, as it has been for six years. As we discovered in last year's survey, location is a two-edged sword. It can mean interest in a vacation destination, but it can also mean interest in a location close to home. No wonder California's lead as a preferred state is so unassailable! It has prime vacation destinations and the largest physician population of any state. Florida is still number two; New York is still number three. Appearing for the first time this year are Washington State (number eight) and Nevada (tied at ninth with Colorado).

On the international side, English-speaking destinations still lead, with England most popular and Canada close behind. European destinations loom large in the results: France, Italy, Germany, Spain, Switzerland, and Ireland are in the top group. The Caribbean, Bahamas, and Bermuda are still a top choice, as is Mexico. With a nod to exposure created by the Olympics, Australia has reappeared after a year's absence.

No Place Like Away from Home When it comes to facilities, there's still no place like away from home - although home is gaining ground. For the first time, hotels nosed out resorts as preferred meeting venues, 25.9 percent to 24.8 percent. Conference centers were third, preferred by 15.6 percent of respondents. This year, respondents could write in responses instead of choosing from a menu, resulting in new categories: 10.6 percent of respondents prefer to attend meetings at local facilities. Restaurants, also appearing for the first time, are preferred by 1.2 percent of respondents. (Are so-called "dine-and-dash" meetings put on by pharmaceutical firms becoming a larger part of the physician's medical meetings menu?) Cruises also popped up as a preference, cited by 1.1 percent of physicians.

So Many Meetings... So Little Time As in past surveys, Friday, at 33 percent, is the preferred start day for a three-day meeting. Thursday is next with 24 percent. Hardly anyone (well, 5 percent) wants a meeting to start on a Tuesday. For the first time, the percentage of respondents with no preference for a starting day declined, to 4 percent, from 7 percent a year ago and 7.6 percent two years ago. This suggests that respondents are now more selective about how their time is spent.

The same message comes through in the results for the question about preferred months. March is tops, preferred by 12.6 percent of respondents, followed by October (12.2 percent) and February (11.6 percent). Last year, 14.7 percent of respondents said they had no preference as to which month; this year only 5.6 percent have no preference. Looking at the factors that influence attendance, we find that meeting length, which includes a consideration of time away from practice, ranked third, up from fourth a year ago.

Flying Solo Survey respondents were more likely to belong to a group practice (31.2 percent) than any other type, but 26.8 percent of respondents say they are in solo practice. CME providers may want to adjust content accordingly, to acknowledge the needs of the solo practitioner.

This year, we're seeing a sharp increase in the percentage of respondents who report belonging to four or more associations (21.5 percent, up from 15.9 percent). This may reflect the splintering of the medical profession into more and more subspecialties. It further suggests greater competition among societies. If fewer physicians are traveling to national conferences, they are nonetheless choosing from a larger number of meetings to attend.

Disappearing Dollars We've seen that fewer physicians are planning to travel to attend meetings to obtain CME, that they are earning fewer hours of credit, and that they are more conscious of how they spend their time. Here is one last finding: Fewer physicians are being reimbursed for the cost of attending CME meetings. A year ago, 44.5 percent of respondents said they received no reimbursement from their organization for attending CME meetings; this year the percentage has increased to 49 percent. Similarly, a year ago 27.7 percent of respondents had three-quarters or more of their expenses covered; that has dropped to 21 percent this year.

All of this comes against the backdrop of greater expenditure on meetings by the pharmaceutical industry. Some of that spending is directed to accredited organizations as unrestricted educational grants for CME, and some is not. Based on the results of this year's survey, the much-vaunted gravy train isn't stopping for CME - at least not as often as it once did.