Medical professionals are concerned about bias from commercial funding of continuing medical education but aren't willing to pay more money for CME if commercial funding is curtailed or eliminated.
That's the gist of a study released earlier this month in the Archives of Internal Medicine. According to the survey, 88 percent indicated that commercial funding introduces bias and that the higher the level of support, the greater the risk of bias. However, only 15 percent support elimination of commercial funding. Forty-two percent say they're willing to pay higher fees if it means decreasing or eliminating commercial funding for CME.
The study’s authors surveyed doctors, registered nurses, nurse practitioners and physician assistants attending live CME courses offered in January through June 2009 by the International AIDS Society-USA. Of the 1,347 surveys distributed, 770 were completed, a 57 percent response rate.
“Hopefully (the study) will help guide the debate of funding of CME,” said Jeffrey Tabas, MD, associate professor of clinical emergency medicine in the University of California, San Francisco’s Department of Emergency Medicine and one of the authors of the study.
“This could help push the thought of avoiding funding to individuals and push the funding to centralized sources. It’s a reasonable goal, I think, and that’s sort of somewhere in between the people who want to completely eliminate it and the people who want it untouched,” Tabas said.
Proponents of continued commercial funding say eliminating or reducing it will reduce the number of CME programs. Some contend that fewer CME programs could lead to more medical errors due to a lack of appropriate, updated education, thus increasing healthcre costs.
[See also: Report: Hospital errors harm 14 percent of Medicare patients.]
Opponents argue that even the potential of influence through commercial funding is inappropriate.
Those in the middle say commercial funding has its place in CME but it must be regulated, monitored and transparent.
“The access to continuing education is important and the profession accepts commercial support for CME as ethically appropriate and recognizes that there needs to be systems in place to prevent the bias,” said Murray Kopelow, MD, chief executive of the Accreditation Council for Continuing Medical Education, an organization that has worked to put standards in place regulating commercial funding of CME.
“It’s not wrong to find yourself at a boundary," he said. "It’s wrong to not know how to manage yourself at the boundary. We have clear guidance on how to manage yourself on this boundary. The upside is that we get education available to us that isn’t by industry, it is by the profession for the profession and it is simply paid for by industry.”
The study also indicates that while clinicians are aware that guidelines managing commercial funding are in place, their understanding of those guidelines and of what it costs to conduct CME programs is fuzzy.
Tabas said some survey respondents are willing to make changes, such as receiving online syllabi rather than printed ones or holding programs at cheaper venues, in order to reduce costs.
Kopelow said the most important finding of the study is the revelation that clinicians don’t seem to understand what controls are in place to regulate commercial funding of CME.
“On one hand (the survey results) validates our need for having rules because the profession believes that there is a potential for bias,” he said. “But on the other hand, why don’t these physicians know about the AACME standards for commercial support? All the work that the medical profession, nursing profession, pharmacists have been doing to ensure that the education that the professionals get is free of all this bias? Well, there’s education to be done. It’s part of the professionalism of medicine.”