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February 01, 2013

DOD and Army Restrict Attendance at National CME Conferences a Move Towards Local and Online Education

Army Medical Conference
In the wake of new federal conference oversight, the military medical services are navigating how to ensure that medical personnel can continue to receive vital continuing medical education (CME) and keep up with the latest advances in their field, while adhering to new conference regulations, according to a release from U.S. Medicine

In September, the Department of Defense (DoD) released a memo describing how it would implement conference oversight guidance provided by the Office of Management and Budget (OMB) earlier this year.  The OMB guidance requires agencies to decrease spending on travel by 30%.  In addition, deputy secretaries must review any conference that could cost more than $100,000, with expenses of more than $500,000 prohibited without a waiver from the agency’s secretary.  Conference spending data must be publicly posted each January by federal agencies.  As we noted last year, DOD closed its CME office.  

DoD’s September memo noted that, while Panetta and Deputy Secretary of Defense Ashton Carter remain accountable for all of DoD’s conference-related activities, “a small set of the department’s senior leaders will have the authority to approve and grant waivers in exceptional circumstances, as required by the OMB memo, for any conference with a total cost to the Department above $500,000.” 

“These officials will also act as the approval authorities for all conferences, regardless of total cost, that involve a co-sponsorship relationship or no-cost contract with a non-federal entity and/or a request for approval of spousal travel — as well as for all conferences hosted by a non-DoD entity where the total cost of attendance to their DoD Component exceeds $20,000.” 

Medical Conferences 

Army Medicine officials said they are conducting a review to determine the impact the guidelines will have on medical personnel. 

“We anticipate that the new DoD conference regulation will have an impact.  The Army interim guidance is more restrictive than the DoD conference regulation; it includes a moratorium against non-DoD conference attendance until 31 December 2012.  New Army guidance is expected at that time,” the officials noted. 

“Presently, the leadership of Army Medicine is conducting a thorough review to determine precisely what that impact might be and how we can best mitigate the potential risks while ensuring strict compliance with the existing regulation.  Because this review process is ongoing, it would be premature to speculate on the findings.”

Air Force Surgeon Lt. Gen. Thomas Travis told U.S. Medicine in a written statement that the Air Force Medical Service is following DoD policy regarding conference approval but is “taking special care to ensure graduate medical education and continuing medical education requirements are met.” 

“We have developed a process to project future conference attendance requirements far enough in advance to comply with the approval process and assure that all of our professionals can meet their education and certification requirements.  We are doing this from headquarters level to minimize the impact on our medical facilities,” Travis said. 

According to Navy Surgeon General Vice Adm. Matthew Nathan, Navy Medicine supports and is operating within the current DoD conference guidelines, but is working with DoD officials “to submit requests and get approval on a case-by-case basis for both the hosting of DoD conferences and/or the attending of non-DoD conferences.” 

“Navy Medicine supports this policy and is applying strict scrutiny to not just conference travel, but to all travel requirements.  However, Navy Medicine is fully attuned to the importance of continuing medical education.  There is also a unique mission set within the medical community that requires collaboration in order to foster cooperation and partnership.  This is particularly true in the research and development community.  Navy Medicine therefore has not issued a moratorium on conference travel,” he told U.S. Medicine in a written statement. 

Richard Breen, director of MHS Strategic Communications, also said MHS is addressing the issue and suggested online and local training would be important. 

“Obviously, we are working to obtain approval on the MHS Conference because of the great educational opportunities it provides, among those allowing for attendees to earn continuing education credits, which helps them to maintain their medical credentials. The Department of Defense certainly understands the need for credentialing and quality training, and that is why we are moving toward professional development opportunities that would feature online and local training.” 

The stricter federal guidance comes as Congress is questioning federal agencies about their conference spending.  The increased scrutiny was largely prompted by reports of a 2010 General Services Administration conference in Las Vegas, where exorbitant spending included clowns and mind-readers.  In the latest controversy, lawmakers have been highly critical about two multi-million dollar VA human resources conferences in Orlando last year, as detailed in a recent VA Inspector General report. 

Neither has DoD avoided congressional scrutiny of conference spending.  In August, the House Oversight and Government Reform Committee asked Secretary of Defense Leon Panetta for more information on 64 DoD conferences for which the cost per person “exceeded that of the infamous 2010 GSA Western Regions Conference in Las Vegas,” according to the committee letter. 

DoD’s September memo noted that, even with the DoD’s “steadfast efforts to be an excellent steward of taxpayer dollars” and its “continuing implementation of the Secretary’s Efficiencies Initiative and President Obama’s Campaign to Cut Waste,” it “must do more to ensure that conference policies and controls are in place to prevent waste, duplication, and abuse.” 

Still, medical personnel, such as the recently retired former Air Force Surgeon General Charles Bruce Green, MD, cautioned that the new conference policies “definitely pose a threat to not just CME but to maintenance of skills and licensure.” 

“I know the department will find a balanced way forward but the wind shear in this transition will likely hurt professional associations who will not see attendance at meetings already scheduled and to individual doctors who will get caught with too little CME and no ability to log educational conference time,” he told U.S. Medicine. 

Several medical conferences apparently were already feeling the heat from the new conference regulations.  On the conference website, officials wrote that the Army “cancelled participation” in the FY13 Uniformed Service Public Health Training Symposium (previously called the Armed Forces Public Health Conference).

“Given the current financial climate, the Army Surgeon General’s office does not feel that we would be supported in a SECARMY request for a waiver of the DoD conference policy, given the costs involved to support a meaningful conference,” the conference website stated. 

The Association of Military Surgeons of the United States (AMSUS) made the decision in October to cancel its 118th meeting, originally scheduled for November.  In the past, AMSUS meetings regularly were attended by a range of federal and international providers, including surgeons general of the military services. 

“Due to unexpected circumstances beyond our control, we have been unable to secure the attendance of a sufficient number of military and federal health professionals to go forward with the meeting at this time,” the organization wrote on its website.

John Class, deputy executive director for AMSUS, told U.S. Medicine that the problem was a timing issue.  Getting approval for VA and DoD participation in the annual conference was taking longer than expected, in light of the conference oversight changes. 

AMSUS, he said, had still not heard a “definite answer” from either VA or DoD when it decided to cancel in October and, with time running out before the conference, felt that they could not ensure the value of the meeting. 

“It didn’t give us enough time to process all of the continuing education, and we were not sure that all the speakers could attend.  So we got to the point where we felt we may not be able to put on a quality event, and we just didn’t want to do that to our reputation,” he said. 

Class explained that the annual AMSUS conference provides many benefits, including continuing-education courses and networking opportunities with providers from other countries.

“Theoretically, you could come for a week and fulfill a lot of your continuing education requirements, just by coming to AMSUS,” he explained.  As for the annual MHS conference that is scheduled to take place in February 2013, DoD spokesperson Cynthia Smith told U.S. Medicine that organizers are “working to obtain approval” but planning a smaller conference. 

“There is a DoD conference review process, and we are working to obtain approval on the MHS Conference because of the great educational opportunities it provides, though we do plan to reduce our attendance numbers and have many other cost-cutting measures in place,” she told U.S. Medicine in a written statement.

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