The Accreditation Council for Continuing Medical Education (ACCME) recently published its 2013 Annual Report Data which includes data on the size and scope of the continuing medical education (CME) enterprise nationwide.
The report shows that in 2013:
- CME Economy grew by 2.8%, by $68,850,502, to $2,543,178,601. Thus, in six years since the market crash CME is still 5.3% below the peak revenue from 2007.
- Commercial support for CME decreased by 2.3%, by -$15,153,603 to $659,953,563 marking the seventh straight year of decline. This is a 47% total drop in commercial support since 2007.
- Commercial support now represents 25.9% of the total CME funding, down from 46.5% of total funding in 2007.
- Physician attendance decreased -3.9%, by -554,792 attendees, to 13,764,896.
- Non-Physician attendance increased 7.7%%, by 721,980 attendees, to 10,929,217
- The majority of CME activities (83%) did not receive commercial support.
- Physician attendance in internet live activities increased by 23% and internet searches increased by 13%. Attendance at live courses dropped 22% and journal CME dropped 13%.
- 33% of physicians attended regularly scheduled events such as grand rounds, followed by 30% who received credit for internet enduring materials, 15% for courses, and 8% for Journal CME.
- The cost per learner in CME programs varied widely, from $42 for hospital physicians to $220 for physician membership organizations.
- Physician’s attendance in CME provided by publishing and education companies represented 30% of all participants, followed by associations at 23%, with Universities and Hospitals each with 22% of the attendees.
- The data shows that there are more than 2,000 accredited CME providers across the country that offered more than 138,196 activities in 2013, a 3.5% increase from 2012. Accredited CME providers report that their 2012 activities educated more than 25 million participants including nearly 14 million physicians and nearly 11 million non-physician health care professionals.
In addition, the 2013 Annual Report Data features separate data sets about the CME delivered by ACCME-accredited providers and by state-accredited providers, offering an overview of the CME system at both the national and state levels.
The ACCME directly accredits providers that offer CME primarily to national or international audiences of physicians and other healthcare professionals. The ACCME also recognizes state and territory medical societies as accreditors for providers that offer CME primarily to learners from their state or contiguous states. All accredited providers within the ACCME accreditation system are held to the same high standards and are required to report information about their programs that the ACCME collects and analyzes in order to produce annual report data.
Physician v. Non-Physician attendees:
This chart shows the trend that while less physicians are attending CME activities, the last few years have seen a noticeable increase in non-physician attendees. Physician attendance decreased by 554,792 attendees to 13,764,896 in 2013. Physician participants still occupy a greater percentage of attendees, but the gap is narrowing.
Total CME Income by Source and Year 2008-2013:
The 2013 Annual Report Data includes an overview of commercial support received by ACCME-accredited providers. The data shows commercial support distribution by numbers and types of activities, hours of instruction, and participants. The ACCME is able to publish this commercial support overview because of the Program and Activity Reporting System (PARS). Launched in 2010, PARS is a Web-based portal designed to centralize and streamline the collection, management, and analysis of program and activity data from accredited CME providers. The structure of PARS and the CME community's adoption of PARS enable the ACCME to produce new information.
The 2013 Annual Report Data marks the 15th year the ACCME has been collecting, analyzing, and publishing information about accredited providers, and offers more than a decade-long perspective on the evolution of the ACCME accreditation system.
The total income of the CME industry increased by $68,850,502, or 2.8%, to $2,543,178,601 between 2012 and 2013, which is about half the growth seen in the year before and shows the growth rate in considerably slowing down. The total income has decreased by $141,943,696, or -5.3% since 2007.
Commercial support of CME continued to decline. Commercial support saw a 2.3% reduction from $674,747,166 in 2013 to $659,593,563 in 2012 and a total reduction of a full $589,331,309 or -47.2% since 2007.
Making up for some of this lost income, however, were increases in Advertising/Exhibits (2.4% in 2013 and 19.6% since 2007) and "Other Income," (4.9% in 2012 and 34.0% since 2007). Other income accounts for 61% or $1,543,387,272 of the total. According to the ACCME, "Other income" represents income other than commercial support and advertising and exhibits income; for instance, participant registration fees, and allocations from a provider's parent organization or other internal departments.
CME Income Sources Since 2007:
Commercial support now represents only 26% of the total CME enterprise, a 2.3% decline since 2012 and a 47 % decline since 2007. The rate of decline has fallen, but that may be due to the economy finally getting better. "Other Income" now represents 61% of the total revenue for accredited CME providers. Advertising and exhibits share has increased over time but not by very much.
CME Income By Type of Organization:
There are wide variations in the changes to CME income by provider type. Publishing and education companies saw their revenue increase by 9.1% while “Non Profit Other” had a -10.2% drop in their income. Other organization types saw less drastic changes, but, notably, hospitals increased their CME dollars by over $7.5 million.
Publishing and Medical Education Companies:
Total income increased 9.1% for publishing and medical education companies. However, total income since 2007 has decreased 20.7%. For publishers, commercial support increased 5.3% in 2013, which is down from 2012’s increase of 9.5%. This confirms that monies are not going back into commercial support over the Sunshine regulation.
The overall decline of commercial support going to publishers is 51.9% since 2007. Moreover, whereas commercial support was 71.5% of the enterprise in 2007, it was 43% in 2013. The income has increased minimally in advertising and exhibits (4% in 2013) and seen a dramatic increase in "other income" (12.3% in 2013).
30% of CME activities taken by physicians were provided by Publisher/MEC’s. Notably, in the “internet enduring” category (Page 5 of the ACCME report) the School of Medicine and Publishing/Education Companies (who are funded by commercial support) comprise 9,692 out of 19,068 activities or a total of 50% of all online activities (not the 17% as noted for ALL activities).
For schools of medicine (universities), total income increased 3.3% which is significantly better than 2012 which saw a decrease of -6.5% in 2012. Commercial support increased by 2.4%, a sharp difference from the year before which saw a decline of 20.3% in 2012 and 33.0% since 2007.
In the category of "other income" medical schools saw an increase of 5% in 2013. Exhibits remained the same .2% increase.
Schools of Medicine delivered most of their programming via courses, regularly scheduled series, and internet enduring materials. The vast majority of the physicians participating in CME associated with schools of medicine did so in regularly scheduled series.
Associations and Nonprofits:
For Nonprofits (physician membership organizations and other nonprofits), total income remained flat with less than a .3% decrease vs 2012, which saw an increase of 11.3%, and has increased 8.0% since 2007. Commercial support decreased 15.7% in 2013, and declined 46.2% since 2007.
The main physician participants in CME activities offered by associations includes internet enduring, journal CME and live courses.
Physician Participation by Activity Type:
The grand total types of activities supported directly by accredited CME providers are broken down below:
- Courses: 69,565 activities, with 397,642 hours of instruction and 2,039,397 physician participants
- Regularly scheduled series: 22,982 activities, with 492,674 hours and 4,601,531 physician participants
- Internet (enduring materials): 28,892 activities, with 51,510 hours of instruction, and 4,287,429 physician participants
- Enduring materials (other): 7,420 activities, with 42,176 hours of instruction and 1,158,776 total physician participants
- Journal CME: 4,574 activities and 1,158,776 physician participants
Activities by Organization
The total numbers of directly sponsored activities based on type of CME provider and the top three formats of CME offered are as follows:
- Hospital/health care delivery system: 47,843 activities. Courses (27,962); Regularly scheduled series (14,144); internet (enduring materials) (2,937)
- School of medicine: 29,517 activities. Courses (7,560); Regularly scheduled series (7,560); internet (enduring materials) (9,627)
- Publishing/education company: 20,393 activities. Courses (6,140); internet (enduring materials) (8,733); enduring materials other (4,175). journal CME (679)
- Nonprofit (physician membership organization): 26,176 activities. Courses (15,584); internet (enduring materials) (4,839); enduring materials (other) (4,839); journal CME (3,331)
- Government or Military: 4,446 activities. Courses (2,655). Most hours as well for courses (26,421).
Total Hours of Instruction 2007-2013:
Overall there were over 1,010,301 hours of CME content delivered. Regularly scheduled series offered the most total hours of instruction for directly supported CME (492,676); followed by courses (397,641); and internet, enduring materials (51,010); and enduring other (42,176).
CME Provider Breakdown by Hours:
- Hospital/health care delivery system: 381,579 hours; most hours are Regularly scheduled series (251,059)
- School of medicine: 330,849 hours; most hours Regularly scheduled series (217,778)
- Nonprofit (physician membership organization): 140,764 hours; and the most hours were for courses (95,381)
- Publishing/education company: 71,694 hours; most hours courses (36,189); internet (enduring materials) (12,859); enduring materials (other) (18,367)
- Government or Military: 36,021 hours; most hours courses (26,421)
- Non-profit (other) 28,408 – most hours courses (19,132)
Total CME Physician Participants by Provider Types:
Below is the number of total physician participants attending CME programs based on the provider of the CME.
Overall, publishing/education companies have the most physician participants (3,792,516) followed by:
- School of medicine: 3,350,517
- Hospital/health care delivery system: 3,120,685
- Nonprofit (physician membership organization): 2,906,337
- Non-profit (other): 265,568
- Insurance company/managed care company: 125,149
- Government or Military: 107,631
- Other: 96,403
- Publishing/education company: 3,792,516 participants; most participants: internet (enduring materials) (2,233,841); enduring materials (other) 977,653; courses (185,665)
- Hospital/health care delivery system: 3,120,685 participants; most participants: Regularly scheduled series (2,242,400); courses (555,097); internet (enduring materials) 181,859
- School of medicine: 3,350,517 participants; most participants Regularly scheduled series (2,167,909); courses (364,409); internet (enduring materials) 42,494.
- Nonprofit (physician membership organization): 2,906,337 participants; most participants internet (enduring materials) 886,711 followed by journal CME (847,438); live courses (779,409).
Cost Per Learner:
In 2012, the cost per learner in CME programs varied widely, from $42 for hospital physicians to $199 for government or military participants.
The CME Economy is still well behind where it was seven years ago. Accounting for inflation, the data should actually be considered a larger drop than the numbers reflect.
It is hopeful that rate of decline for commercial support has dropped; however, the rate of growth in other areas is sluggish as well. The overall picture of CME is slow but steady. Hopefully we will see good years ahead.