Monday, November 05, 2007

Online CME Growth is Bad News for Pharma Marketers

It's very instructive to peruse ACCME's annual report data if you want to understand the trends in pharma support of physician continuing medical education (CME). ACCME stands for Accreditation Council for Continuing Medical Education. It's an organization that allows other organizations to provide "accredited" CME credits through educational programs. Doctors need a certain amount of CME credits every year to maintain their licenses.

The ACCME data includes information about the number of physician participants in CME programs, the CME hours delivered (1 credit usually means one hour of educational activity as estimated by the CME provider), etc. And it breaks this information down according to the type of CME provider (medical school, for-profit company, medical society, etc.).

I recently perused the ACCME data in preparation for an opinion piece I am writing for a major industry publication. I'll share my analysis with you here so that you don't have to do the math and prepare the charts yourself!

Pharma industry financial support of CME
The charts below show what percent of CME income is provided by commercial sponsors -- mostly the pharmaceutical industry. Since 2003, when new guidelines went into effect, the growth in industry supported CME has decreased and leveled off in terms of percent of total (click image to enlarge).

Last year, the pharmaceutical industry provided $1.19 billion to sponsor CME programs ($1.44 billion if you include advertising and exhibits at CME events).

Online CME Taking Off!
Meanwhile, the number of physicians participating in online CME “events” has increased dramatically, especially in 2006 (see figure at left).

Approximately one quarter of physician participants in CME activities occur via the Internet. However, only about 5% of the total hours of instruction are delivered via the Internet.

This is bad news for the pharmaceutical industry.


Online CME is delivered mostly via physician Web sites like Medscape. These days, “stickiness” is a more important measure of Website success than number of “visitors.” As far as pharmaceutical marketers are concerned, the more physicians that get CME credits online, the less likely they are to attend live events where collateral marketing can easily occur.

The data seem to bear this out.

In 2003, about 264,000 hours of CME were delivered at regularly scheduled live conferences. In 2006, this dropped to 218,000 (in 2005 it was even lower: 183,000). Compare this to about 5,000 total online hours of CME in 2006!

The bad news -- for pharma marketers -- is that pharma’s return on online CME investment may be much less than for live events such as symposia at medical conferences.

The good news is that it costs much less to deliver online CME than live CME. It could cost so little that physicians may actually be enticed to pay for it themselves rather than accept pharma's charity and possible influence over the content! Ha ha ha ha ha ha ha ha ha ha! If you think that will happen, please see


  1. Anonymous10:26 AM

    I'm afraid you see the glass half empty here John- While eCME may mean less "collateral marketing" it grants 100% of the physician attention on the subject which is under discussion. How much could it cost to have this share of voice in a large event?

  2. Halftown,

    Thanks for your comment.

    Whereas at live events, the sponsor can have exhibit booths, what's the equivalent online? Banner ads? Even if allowed alongside CME, these ads are routinely ignored to a greater and greater extent. How else is brand marketing linked to eCME?

  3. Anonymous5:11 AM

    First and most important, eCME is usually sponsored by a pharma company. This means that the contents of the course are agreed with the sponsor.
    Second, you can use the usual online advertising techniques: widgets, branded links, interstitials, advertorials... The list is endless!

  4. John:

    Do you think the more physicians that get CME credits online, the less likely they are to use e-detailing?



  5. There is -- or should be -- a distinction between CME and detailing.

    CME should NOT be promotional and biased towards one product. It can also cover data from trials not used to prove efficacy for any product.

    eDetailing, on the other hand, is only about one product and may only cite data from "approved" drug trials, unless the physician specifically asks for other information.

    The latter bit is the main benefit of CME -- you can get into off-label information such as trial data without the physician specifically asking for it.

  6. Sorry. To answer the question:

    Physicians will continue to use eDetailing to get information about a specific product, but depend on eCME to learn about unapproved uses of drugs.

    So I don't think the 2 are mutually exclusive.

  7. Thanks a lot John,

    I have another question for you.
    Do you think the more physicians that use e-detailing, the more likely they are to use web 2.0?

    Thanks in advance


  8. A more interesting question would be will pharma companies support Web 2.0 based eCME programs? Or are they afraid of the wisdom of the crowd?

  9. One of the main benefits of online CME is the availability of content at your fingertips. Many physicians will use the online CME as a reference tool rather than for obtaining CME credits.

    This is one reason for the disparity between number of physicians participating vs. the number of CME hours deliverered, which is calculated based upon actual CME certificates provided to the participant.

    According to our research, three additional factors impact the number of CME hours recorded for online programs: 1) physicians don't complete the entire online course; 2) many (specialist) physicians are not driven by the number of CME credits to participate in a program, since they will accrue more than enough during the year to satisfy their requirements; and 3) the online courses require the completion of post-test to obtain CME credits, and as a validation of active participation. This is another hurdle compared to live programs where your mere attendance is sufficient to fill out the CME form and obtain credits.

    By the way, while the growth of pharma support has tailored off somewhat in recent years, this growth rate is now comparable to the annual growth rate of the pharma market place. The 2006 annual CME report also shows that the total market almost doubled between 2000 and 2006 and that the CME industry has a whole has become more efficient with gross profit increasing from 17.1% in 2000 to 23.6% in 2006.

  10. Jan,

    Thanks for pointing out how hours of CME are measured online.

    It appears that there is no direct way to measure actual hours spent in visiting online CME programs to compare to actual hours physicians spend at live CME events. As you point out, the official "CME hours" reported by ACCME does not correlate with actual hours online.

    What you say only further supports my contention that online CME offers much less "face time" with physicians for ancillary marketing purposes -- as you say, many physicians do not finish the program or use it only for reference.

    But, how are "physician participants" measured online? Are you a participant ONLY if you complete the program, take the quiz, and get the credits? Or are you a participant merely because you accessed the site/signed in/registered?

  11. John,

    Online CME is a different communication channel than live or printed CME, and as such demands a different strategic and management approach. Adult learning principles and content will need to be adapted and applied specifically for the channel for maximum educational impact. Its purpose, execution and educational impact must be viewed in independently from live CME.

    The annual CME reports are a compilation of the completed surveys of the 729 accredited providers (2006). The surveys leave some room for interpretation with regards to their completion and, as such, it is difficult to answer your question about how total physician participation in online CME is computed. I believe that this stat generally consists of the number of physicians (and others) who have accessed the online program.

  12. Jan,

    Thanks again.

    Of course, here I am only looking at CME as another opportunity pharma marketers have of getting their messages in front of physicians, if only around the whatever firewalls may exist. I am not saying that, in terms of educational impact, that you can compare apples to oranges.

    Speaking of comparing apples to oranges, in the Nov/Dec issue of Pharma Marketing News just published (see, TNS experts explain how they help marketers look across the full spectrum of media -- traditional media like radio, TV, print -- and and give them a common way of measuring them against new media like blogs and word of mouth.

    I guess the way to do this across the spectrum of CME channels is through measurement of patient treatment outcomes?


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