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Wednesday, June 24, 2009

Equity and Balance in CE Funding

In another post, I suggested that those of us in the field of continuing professional development might do well to look at five other kinds of bias and not just the bias that can be introduced as a consequence of commercial support for a CE activity. In this post I want to suggest a broader perspective on the funding of CME.

I don't think it is necessary to limit the debate about CME funding to the two extreme options most frequently advanced of late: either accepting or not accepting commercial support. I think there are certainly other, more reasonable and more equitable formulas and systems for funding CME/CPD activities that we could, in good conscience, work to bring about?

Equity - For one thing, I think it is time that we consider supporting a more “equitable" fee structure for those participating in formal continuing professional development activities in the field of healthcare. At the moment, physicians are asked to pay lower fees (or no fees) for most of their continuing education activities when compared with the fees other healthcare professionals are asked to pay for activities of similar duration. This in spite of the fact that physicians are much better compensated than others in healthcare. It is universally understood that this is a direct consequence of the high level of resources made available by commercial firms for activities provided to those wielding the "prescribing pen."

Wouldn't it be fairer and create some much needed leverage of a sort useful in beginning to alter the funding mix for healthcare continuing professional development activities, generally, if physicians were asked to pay at least as much as their colleagues for comparable activities. Physicians should expect to pay a reasonable fee that relates realistically to the total costs incurred by the sponsoring organization to provide the activity. To the extent that commercial funds and/or other funds are made available to support continuing professional development activities, these should be pooled and expended in such a way as to subsidize and thus lower the fees charged for all such activities in a given geographical region or organizational setting.

Better Balance - I have a second suggestion to be combined with the first. It would further reduce the impact of commercial support on CPD activities. And it would keep the cost of continuing education modest (thereby preventing cost from becoming a barrier to participation by any group of healthcare providers).

I propose we seriously consider recommending that support for all such activities would come from three approximately equal sources: 1/3 from participating healthcare professionals, 1/3 from public and/or non-profit sources and 1/3 from pharmaceutical and/or device manufacturing sources. We should explicitly limiting commercial support to something like one-third of total activity costs. This type of limitation would ideally be applied on a program-by-program basis. Less desirable would be applying it to the programmatic portion of a CE provider’s entire annual budget.

Asking both physicians and the government to pay their fair share of the cost of healthcare CE, right along side commercial entities, seems like an especially appropriate suggestion at this particular moment, when we are doing our best to piece together a major package of healthcare reforms here in the USA.

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