Similarly, handwashing in hospitals unfortunately does not seem to increase after lectures and discussions; increasing handwashing seems to require the prospect of penalties. Studies on the effect of CME on the practice of medicine indicate that CME exerts only minimal effects on medical practice.2 More extensive programs and automated ordering systems have been put into place by hospitals to improve compliance with recommended guidelines for medical practice. Thus, the evidence suggests that not only are we impervious to brainwashing but that we don’t seem to listen, either. So, Medicare will now pay physicians to document adherence to guidelines and it is likely that pay-for-performance is the future for many common conditions.
What Does CME Teach?
If CME does not change the way physicians practice, what is it good for? CME plays many roles. In some states, evidence for minimal attendance at CME events is a necessary condition for maintaining a license to practice. Many physicians also take home new ideas about treating specific difficult patients from CME events and can become familiar with new approaches to therapy. Moreover, CME is good for morale: knowing there is progress in the treatment of difficult diseases makes it easier to face the patients who come to us for help with those diseases. Finally, medicine and—in particular—rheumatology, are cognitive pursuits, and education is at the very center of how we perceive ourselves as professionals. Continuing education is as much part of the fabric of our profession as the stethoscope; CME makes us more than just “healthcare providers.”
Continuing education is as much part of the fabric of our profession as the stethoscope; CME makes us more than just “healthcare providers.”
Traditionally, medical schools and hospitals were the main distributors of CME, but over the past few years CME has burgeoned into an industry with nearly $1 billion in revenues providing nearly 67,000 CME activities in 2003. That year there were 697 accredited providers of which 100 were for-profit organizations generally hired by pharmaceutical companies to arrange CME events.3 What can we make of all of this educational activity that is regarded so lightly by Medicare, among others? And what are we to make of all of this economic activity in pursuit of such ephemera?
It is obvious that much of the funding that drives and supports CME comes from the pharmaceutical industry and—to many observers—pharma funding taints most CME. There have clearly been instances when the covert influence of the pharmaceutical industry on the content of CME has been documented and the clear implication has been that medical practice was negatively influenced. But if CME has as little effect on actual practice as Medicare seems to suggest, does the commercial influence matter so much?