Bias? What Bias?

Bias? What Bias?

CME providers agonize over eliminating the possible perception of bias in their activities due to pharmaceutical industry support, but are docs similarly concerned — and if so, are they concerned enough to pay their own way? For the first time, Medical Meetings posed those questions in the 2005 Physicians' Preferences in CME Survey. We also explored several other new areas, asking doctors whether it is important that CME activities are based on high levels of evidence, and what types of meeting formats motivate them to change their practice behavior. In addition, we included our traditional questions about what methods docs use to obtain CME, and how they make decisions to attend out-of-town conferences — with some surprising results.

We Won't Pay

At last fall's Annual Conference of the National Task Force on CME Provider/Industry Collaboration, several presenters suggested that the only way to ensure that CME is free of bias is to shift the onus for paying from the pharmaceutical industry to healthcare workers. How do docs feel about that? About how you'd expect. Survey respondents say pharma funding does not cause problems with content, and even if it does, they can sort out the good from the bad. And, also not surprisingly, they said they wouldn't be willing to pay more for their CME to reduce the need for pharmaceutical grants.

When asked to rate how concerned they are that pharmaceutical industry funding inappropriately influences certified CME activities, on a scale of 1 (not at all concerned) to 6 (extremely concerned), 22 percent said it wasn't a problem at all for them. Just 11 percent rated it a 6. In the aggregate, those who gave it a lower priority by rating the issue 1, 2, or 3 accounted for 53 percent of the total. However, about 45 percent gave it a higher priority, rating the issue a 4, 5, or 6. (Totals do not add up to 100 percent because of rounding off.) But since the percentage of doctors who were not at all concerned was double that of those who were very concerned, it still follows that, when asked if they would be willing to pay substantially higher fees for CME activities to reduce the need for pharma funding, fully three-quarters said no.

And they were more than happy to share their reasons why, which fell into two basic camps. First, they said, CME already costs too much, and second, CME either isn't compromised by the financial relationship to pharma, or they felt that they can filter out any bias themselves. As one respondent said, “I'm a cheapskate.” Another summed it up this way: “Already it is pretty costly. I think we're smart enough to see bias.” One got a little haughty: “I make my own decisions about my practice. If you are so weak a person that you can't make independent decisions, then don't go.” A few even want to see more pharma involvement in CME, such as the physician who commented, “I think pharmaceutical companies should be allowed to be more involved, as they were in the past, i.e., the 1920s.” One respondent said, “I'd rather have the pharmaceutical industry pay for this type of thing rather than the gewgaw junk they offer,” or, as another said a bit more tactfully, “I don't see any undue influence from pharmaceutical companies, and since their spending is limited, CME is a good way to use the money.” In a similar vein, one responded, “They have money, let them spend it. They aren't lowering drug costs anyway.”

The few respondents (18 percent) who said they would be willing to pay more to reduce the need for commercial support of CME were equally vociferous in their views, though. “A resounding yes,” said one respondent. “So much information is tainted.” Another reasoned that having the additional money would help pharma keep drug costs reasonable for consumers. One of the more cautious yes-sayers added that he or she would be willing to pay more as long as it was “within reason.”

Perhaps related to the issue of bias is their response to a question asking how important it is that CME be based on a high level of evidence. On a scale of 1 to 6, with 1 being “not at all important” and 6 being “extremely important,” fully 84 percent of respondents rated the importance of evidence-based CME either 5 or 6, and just 4 percent answered on the lowest two points of the scale. As one person commented in response to the question about paying more to reduce pharma commercial support for CME, “As long as speakers are not biased toward the [commercial supporter] and stick with the facts, it is OK” for pharma to support activities.

Get Out of Town

As for how they obtain their CME, respondents increased the percentage of CME they received at out-of-town meetings — reversing a seven-year slide. Thirty-seven percent of the CME they received in the past year was through out-of-town meetings — up from 35 percent last year. Those under 45 years of age were the largest proponents of out-of-town meetings, saying they got almost half of their CME that way, compared to 33 percent for those who are 45 to 55, and 35 percent for docs who are older than 55.

The second-most-popular CME format was local meetings, where respondents said they received 25 percent of their credit hours. This means that survey respondents earned 62 percent of their CME in live meetings. Reading journals came in a distant third, with 15 percent of credit hours earned through that medium, followed by audio/videotapes, online CME, CD-ROMs, and audioconferences. But meetings planners, particularly those who produce local meetings, shouldn't rejoice yet. There was a five-point slip in the percentage of hours earned by attending local meetings to go along with the two-point rise in hours earned at meetings that require overnight travel, making for an overall year-over-year decrease of 2 percent in total hours earned at live meetings.

Women Defy Stereotypes

When it comes to barriers to attending an out-of-town meeting, the stereotype that women are more likely to obtain CME locally because of family concerns that make travel difficult doesn't hold true. Male respondents reported getting more than half of their hours locally, while women reported receiving only a quarter of their hours in local meetings. The percentage of hours earned through out-of-town meetings were roughly equivalent for both genders. More women than men also were planning to attend one to two conferences in the next 12 months, though twice as many men than women planned to attend five or more out-of-town meetings in the coming year. Then again, most of the respondents, both male and female, said they only planned for out-of-town meetings nine to 12 weeks in advance, so plans for the entire year likely weren't firmed up at the time most of the respondents took the survey. Men and women respondents had roughly equal numbers of hours earned through out-of-town meetings.

Both men and women are willing to go pretty far out of town to get their CME. More than half of the total respondents said they'd be willing to visit a foreign country to attend a CME meeting: 53 percent of men would go to an international locale, compared with 50 percent of the women who said they'd travel abroad.

Travel Decisions

With time away from practice being a bigger concern than ever, what is it that motivates busy physicians to head out of town to get their CME? The program's geographic location is the most important factor influencing their decision to travel, respondents said. They ranked meeting destination 4.9 on a scale where 6 is an “extremely important” factor, and 1 is “not at all important.” The second-highest ranked factor was the meeting's length, which got a 4.7 rating, followed by the conference dates, rated at 4.6.

As may be expected, women did rank the amount of time away from home/work as more important than men did. Women also were less likely than men to find the ability to tie meeting attendance to a family vacation as an important factor when deciding whether to attend an out-of-town meeting — women gave this a 3.6 rating on a 6-point scale, where 1 is “not at all important” and 6 is “extremely important” to their decision to attend.

Both men and women rated the lack of ability to find the local equivalent of an out-of-town meeting as an imortant factor (4.2 and 4.3, respectively), which may have contributed to the drop in local meeting attendance. Registration fees also were more of an issue for women than men, who rated this factor 4 to the women's 4.5. The meeting's geographic location, miscellaneous costs, and the need for continuing education credits also were more of a factor when deciding to attend an out-of-town meeting for women than men.

Credit Hours Rising

Whether they earn their credits through attending live meetings or online courses, or by reading journals, docs also are upping the number of CME hours they're taking, according to the survey. In the 2004 survey, just 19 percent clocked in at 80 hours or more; a quarter of respondents in 2005 said they got at least 80 hours of CME over the past 12 months. Women also took the lead in earning the most hours, with almost 17 percent in the 80-plus hour range, compared with 12 percent of the men. The largest percentage of younger docs, 23 percent, received 50 to 59 hours, as did 29 percent of the women. The 45 to 55-year-olds were most likely to be in the 80-plus-hour range, while those older than 55 preferred 20 to 29 hours.

As we've seen in previous years, there is still a significant percentage of doctors who are earning fewer credits than they may have in the past — although the news is better than last year. While 19 percent of those surveyed in 2005 said they earned fewer credits in the past 12 months than they had previously, this is an improvement over the 2004 survey results, where 22 percent said they earned fewer credits.

Their reasons for the slowdown were mainly that they were too busy and it cost too much to take time away from their practice. Employee restrictions on attendance/reimbursement, which hindered just 7 percent of the 2004 respondents from increasing their CME load, however, took a surprising jump for 2005: 27 percent cited this as a reason for earning fewer credits than in prior years. In 2004, this was almost exclusively a problem for the female respondents, but in the 2005 study, 27 percent of both men and women reported this as a reason for earning fewer credits.

Docs Love Lectures

Translating those increased hours into behavior change is another topic the 2005 survey tackled. Not surprisingly, the most common CME format — a lecture with a Q&A component — was deemed most effective in motivating respondents to change their practice behavior, with men and women both rating it a 5 on a scale of 1 to 6, with 1 being not at all effective, and 6 being extremely effective.

The second-most-highly-rated formats in terms of effectiveness in changing behavior were case-based learning and hands-on, skill-building sessions, which each earned a 4.4 rating. Consulting with colleagues came in at a surprisingly high 4.2 rating; in a survey Medical Meetings conducted last year on learning styles, this type of learning came in dead last. Lectures without Q&A came in at a middling 3.5, behind small group interactive sessions (4) but ahead of lecture with pre- and post-test (3.3) and unstructured discussion about topic (3). The only areas in which women ranked their preferences much differently than the men did were small group sessions and consulting with colleagues, both of which the women ranked as less effective change-motivators than the men did. (For more on physician learning preferences, see "Do Lectures Deliver?" [3] July/August 2004 Medical Meetings,

While they said that only 6 percent of their CME was obtained online in the past 12 months, more than half of respondents are currently using the Internet to obtain CME credit, the survey found. Eighty-four percent are getting their online CME from home, while 60 percent access the Internet at work. Interestingly, while fewer than 3 percent use their PDA for online CME access, the younger respondents were no more likely than the oldest group to use a PDA for CME.

Most say their main reasons for avoiding online CME activities are that they're just not interested (41 percent) and that it's too frustrating to navigate (35 percent). Almost 19 percent say it's still not interactive enough, and others have lingering concerns over Internet security (15 percent). Another complaint left in the comments was about “annoying pop-up ads.”

Twice as many men as women questioned the credibility of online education, and substantially more women than men said they had no interest in it, period. Interestingly, the under-45-year-olds had the fewest complaints about difficulties in navigating e-CME, but they also had the greatest concerns over Internet security and credibility of the education.


On September 29, 2005, Primedia Business Marketing Research (a unit of MM's then-parent company, Primedia Business Media) mailed cover letters and questionnaires for the 13th Annual Physician Preferences in CME Survey to 1,200 U.S.-based physicians selected on an nth number basis from an American Medical Association file provided by KM Lists, Marlton, N.J. (An alert postcard also was sent.) A follow-up mailing was sent to nonrespondents on October 13, 2005, to the same group. Letters in the first mailing were affixed with first-class stamps, and contained a one-dollar incentive and a postage-paid response envelope. We received 197 usable surveys, a response rate of 16.6 percent.

More Data Available

This year's survey consisted of 24 questions. Responses to all of these were cross-tabulated by gender, age, and by number of out-of-town meetings respondents attended in the previous 12 months. To purchase the full report, visit The Research Store [4].