General information and trends in continuing medical education (CME), as well as key takeways that those trends necessitate, based on Accreditation Council for Continuing Medical Education (ACCME) 2013 Annual Report data (released July 2014) and general market analysis for trends impacting participation in education across health care.

1. Glenn Laudenslager, Charge Ahead Marketing, July 2014

2. Physician participation down 4% 2013 vs. 2012, activities up ~3%*
Internet enduring materials account for 23% of all activities, 32% of
physician participations (↓6%), and 53% of non-physician participations*
◦ Average participation vs. registration rates are 30-45% (based on ancedotal conversations)
Online CME activities with commercial support in 2013**
◦ Live: 565 events, 58,955 total participants, avg = 104 participants (physician & non-physician)
◦ Enduring: 4,938 events (11%), 2,466,333 total participants, avg = 499 participants (physician & non-physician)
Online CME activities without commercial support in 2012**
◦ Live: 2,273 events (↑28%), 164,665 total participants, avg = 72 participants (physician & non-physician)
◦ Enduring: 22,421 events (↑15%), 7,013,616 total participants, avg = 313 participants (physician & non-physician)
2012 vs. 2013*
◦ Internet enduring ↑7.5%, courses flat, regular series ↑2%, PICME ↓ 13%
* ACCME and state-accredited providers
**ACCME-accredited providers only

3. Physician participation down 5% 2013 vs. 2012, activities flat
Internet activities account for small portion of education
◦ Total Internet activities ↓12%, only 10% of total participations
Courses and regular series dominate education at state level
◦ 90.5% of total activities, 85% of total participants
Courses
◦ 26,027 activities, 980,688 total participants, avg = 38 total participants
Regularly Scheduled Series
◦ 11,951 activities, 2,624,111 total participants, avg = 220 total participants
Other Notes
◦ 41,494 activities offered by state-accredited providers, 1,500+ online enduring materials
Challenges even for state
associations to get attendees
to their events

4. Mobile is a driving force
◦ Smartphone usage has plateaued in 80-85% range (Manhattan Research, 2013)
◦ iOS is dominant platform (http://mobihealthnews.com/32232/in-depth-mobile-adoption-among-us-physicians/)
◦ 2/3 of physicians own a tablet, smartphone, and a desktop/laptop; 76% own a tablet, will grow to 4 out of 5 in 2015
(http://mobihealthnews.com/32232/in-depth-mobile-adoption-among-us-physicians/2/)
◦ 74% use smartphones for professional purposes (http://mobihealthnews.com/32232/in-depth-mobile-adoption-among-us-physicians/3/)
◦ 47% are digital omnivores – use smartphone, tablet and PC in professional capacities (Epocrates, 2013)
◦ Medical apps growing among consumers & clinicians (http://www.modernhealthcare.com/article/20131214/MAGAZINE/312149983)
Increase in usage of social media and number of influencers
◦ High percentage of physicians use social media professionally or personally (60-90% depending on study; Hopkins,
QuantiaMD, Frost & Sullivan, etc.)
◦ New guidance released in 2013 from JAMA, ACP
◦ Key channel to reach influencers: physician-bloggers, medical associations, hospitals, advocacy groups
Adjusting to new and evolving requirements
◦ Maintenance of certification (http://www.abms.org/maintenance_of_certification/ABMS_MOC.aspx)
◦ Depending on the state, CME/CE credits are required in risk management, ethics, HIV, end of life, pain management
(http://www.medscape.org/public/staterequirements)

5. Hospitals and health systems are increasing their influence
Higher percentage of graduates choose hospital-owned practice settings (MGMA, 2011)
Higher reimbursements, administrative costs of private practice, Medicare populations, and other reasons
Hospital and health system employment rising
◦ Total number of doctors employed by hospitals ↑75% since 2000 (MGMA, 2011)
◦ Between 2001 and 2011, physicians & dentists employed by hospitals ↑40%+ (AHA, 2013)
Medical practices owned by hospitals ↑90%+ since 2005 to 49.5% of all
practices (MGMA, 2011)
Health insurance reform puts more emphasis on risk-based payment approaches, hospitals that own physician
groups can shift patients away from higher-cost hospital care into outpatient network and share savings
http://www.healthecareers.com/article/why-hospitals-are-stepping-up-their-physician-hiring/168115
http://money.cnn.com/2012/07/11/smallbusiness/doctors-employment-survey/index.htm
http://www.usatoday.com/story/money/business/2013/09/04/hospitals-buying-doctors-offices/2762757/
http://www.beckershospitalreview.com/compensation-issues/7-trends-in-hospital-employed-physician-
compensation.html
http://capsules.kaiserhealthnews.org/?p=28015
http://www.modernhealthcare.com/article/20140222/MAGAZINE/302229986

6. Hospitals and health systems
47K+ total activities, 27K+ courses, 14K+ regularly scheduled series, 3K+ online activities, 381K+ hours of instruction
5.2MM total participations
Schools of medicine
29.5K+ total activities, 11K+ courses, 7.5K+ regularly scheduled series, 9.9K+ online activities, 330K+ hours of
instruction
5.1MM total participations
Physician membership organizations
26K+ total activities, 15K+ courses, 200+ regularly scheduled series, 5.5K+ online enduring activities, 140K+ hours of
instruction
4.5MM total participations
These three types of providers account for:
• 75% of all CME activities
• 60% of all participations

7. Physician shortages in key therapeutic areas
◦ Graduating physicians selecting primary care has declined in each year of the past decade (MGMA, 2011)
◦ Oncology, mental health, primary care, dental, and more
Key shortages in primary care and mental health
◦ 6,100 Health Professional Shortage Areas (HSPA) for primary care (HRSA, 2014)
◦ 4,000 HSPAs for mental health (HRSA, 2014)
◦ http://www.hrsa.gov/shortage/
◦ http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/
Physician shortages will drive growth in mobile utilization
◦ Busier schedules and growing clinical applications for tablets facilitate use of these devices for education
◦ EHR adoption eating into smartphone and other technology time (http://mobihealthnews.com/32232/in-depth-mobile-
adoption-among-us-physicians/2/)
◦ http://healthland.time.com/2012/08/16/doctors-using-ipads/
◦ http://www.informationweek.com/healthcare/mobile-wireless/doctors-tablet-use-almost-doubles-in-201/240000469

8. Growth of PAs and NPs in care delivery system
◦ PAs: Will grow to 140,000+ by 2020 (AAPA); NPs: Will grow to 198,000 by 2025 (Medical Care, 2012)
◦ Primary care NPs projected to increase 30% and primary care PAs projected to increase 58% from 2010-2020
◦ Driven by physician shortages, health care needs in rural areas, new patients from health care reform, shift towards
patient-centered care models
“The United States today faces a crisis in access to primary health care. Millions of newly insured people will soon
seek additional health care. They will confront the current and projected shortfall of primary care providers to
deliver that care.” (New Nurse Practitioner to Primary Care Provider, 1/19/12, http://www.medscape.com/viewarticle/756444)
“A fully enabled nurse practitioner workforce will increase access to quality health care, improve outcomes and
make the health care system more affordable for patients all across America” (Nurse practitioners look to fill gap with
expected spike in demand for health services, 5/13/12, http://www.washingtonpost.com/national/health-science/nurse-practitioners-look-
to-raise-profile-fill-gap-from-doctor-shortage/2012/05/12/gIQAHmHYLU_story.html)
“The NP workforce is predicted to grow 130% between 2008 and 2025” – “…by 2025, physicians will not be
delivering primary care to the general patient population; instead, primary care will be provided by non-physician
providers including nurse practitioners (NPs).” (Nursing Economics, 2012, http://www.medscape.com/viewarticle/773243)
Growing interest and demand for interprofessional education activities
◦ NPs, PAs, nursing staff, case managers, social workers, administrative staff will make up a higher percentage of
education activity participants
◦ “Increasing numbers of healthcare system leaders and policymakers have recognized that achieving the Triple Aim will
require more widespread adoption of new models of interprofessional education and collaborative practice.” (Josiah
Macy Jr. Foundation, January 2013, http://macyfoundation.org/docs/macy_pubs/TransformingPatientCare_ConferenceRec.pdf)

9. Clinicians will complete a growing amount of education internally
◦ Higher employment and thousands of activity options from hospitals/health systems and schools of medicine
◦ Education on other topics (training, IT, compliance, credentialing) will drive higher utilization of internal processes
(online and offline) that also deliver CME, as well as employer-provided mobile devices and content
◦ Financial reward and quality measures increasingly linked to clinical performance
◦ http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
◦ http://macyfoundation.org/docs/macy_pubs/TransformingPatientCare_ConferenceRec.pdf
Clinicians have less time to participate in external education
◦ Clinicians have less time to search for education, yet have more available options to choose from
Changing state licensure requirements make membership organizations
a default go-to resource

10. Source: T. Gorrindo, Massachusetts General Hospital, 2013
Institutional Quality

11. Dynamic functionality is necessary for engagement
◦ Mobile-friendly, responsive design for email
◦ Dynamic content recommendations/suggestions (via website or email)
◦ Integration between mobile, CMS, LMS, social sharing, SEM/SEO, and other technology

12. Content strategy is now a new and important part of educational design
◦ Active social media outposts are key to engagement and an easy entry point into educational brands
◦ Leverage and repurpose internal knowledge into content/education all year long (checklists, whitepapers, posters, etc.)
◦ Rethink activity marketing budgets to support year-round brand presence (or allocate a separate brand-level budget)

13. Being discoverable is necessary to be relevant
◦ Mobile-responsive web design/functionality is a must
◦ Mobile + social media + content + SEO + paid search

14. Current and past health care clients
Glenn L. Laudenslager IV, MBA
chargeaheadmarketing@gmail.com
Twitter: @ChargeAheadMktg
CME Market Statistics & Trends, July 2014
http://www.slideshare.net/glaudenslager/market-info-august-2014
Marketing to Today’s Clinicians, MeetingsNet Medical, November 2013
http://meetingsnet.com/cme-design/marketing-cme-todays-clinicians
Marketing to Today’s Clinicians, CMEPalooza, March 2014
http://cmepalooza.com/marketing-to-todays-clinicians-laudenslager/
Google Glass and Medical Meetings: On the Inside Looking In, MeetingsNet Medical, May 2014
http://meetingsnet.com/cme-design/google-glass-and-medical-meetings-inside-looking