The exotic choice of staying home: Why CME rules have to change

San Diego, Tucson, Orlando, and Dallas. Those are a few of the modest destinations to which I have traveled, as a hospitalist, to attend CME conferences, using the pre-tax CME benefit from my employer, including paid days off.

As a young professional, my yearly CME trips gave me a mildly magical sense of privilege: “Really? They’re going to pay for all of this?” Browsing through various CME conference options and dreaming of where I could go next was rather fun.

Admittedly, I sometimes coveted exotic destinations such as Maui, Costa Rica, Paris, or a Caribbean cruise. Ultimately, however, I eventually chose conferences that required only modest travel and ones that conserved a reasonable balance between practical professional development and (as a Northerner) an escape to a warm and sunny climate.

Then one year, I reached a boldness beyond my typical capacity, and I requested CME that was excessively exotic. I met a brick wall of resistance.

Briefly, our hospitalist group was short-staffed that year, and because of that, I had put off making any CME travel plans until the year was almost over. I didn’t want to give up my allocated CME days, but by then, there really wasn’t a relevant conference that would fit in between my remaining shift assignments.

So, to maximize flexibility for me and the group’s work schedule, I proposed to skip travel, purchase audio files of 50 hours of CME talks, and work on them at home, taking off any five days that would be best for the schedule. It seemed like a rational proposal to me, for the following reasons:

First, the audio files that I purchased were recordings of recent, accredited CME conference talks (like the ones I usually traveled to attend). Second, in order to receive a CME certificate for each of these lectures, I was required to take a pre-test and post-test and submit my responses electronically (never required at any conference I had attended). Third, I was able to choose 50 lectures (from hundreds of options) that were most relevant to my practice (rather than being stuck with limited choices at a conference, or missing one interesting lecture due to overlap with another interesting lecture). Fourth, it was very cost-effective and eco-friendly: no travel, lodging, or dining costs — pure education. Fifth, it saved time: no wasted days traveling to and from a conference location. Sixth, I could listen to the lectures more than once, or rewind to re-listen to parts that weren’t clear the first time through, or even share the lectures with interested colleagues or students. Seventh, I could listen to the lectures with flexibility: While driving, exercising, or washing dishes, and I could take breaks when it was best for me.

To my surprise, my exotic proposal was flatly declined: “That’s not what CME days are for,” I was told. “We could be audited.” Although I thought that particular employer was uniquely irrational, I later encountered the same rejection by another employer.

Really? My employer will pay for a 5-day trip to Maui, to attend (or miss) lectures for a few days, stay at a nice hotel, and dine out; but will not allow me to take those days off for home study, even though the latter option is clearly more cost-effective, time-efficient, flexible and can be monitored. Where has common sense gone?

So, what could be the argument so strongly in favor of actual attendance at a live conference? As a PhD student, I had attended international research conferences at which graduate students and principal investigators presented fresh data, shared ideas, and networked. I could definitely see the value in that rich, on-site interaction, but from what I’ve seen at CME conferences, information flow there is a one-way street. That is, doctors sit, listen, check the evaluation boxes, then leave. Sure, there is socializing and renewal of old friendships, perhaps, but for the large majority of physicians, attendance is not motivated by their cutting-edge research interests.

Of course, I would never wish to deprive anyone of their annual exotic CME trip, and I plan to go on some more trips myself; however, in contrast to the denial I received, I think there is actually a much stronger argument for eliminating CME travel benefits, and instead preserving only financial support for academic, research-oriented conferences for physicians with actual academic pursuits. It is very evident to all of us that conscientious physicians can easily keep up to date with relevant clinical guidelines in many ways now, and the restraints imposed by an on-site conference are primitive and outdated. One could argue that the most meaningful and effective time to learn and update our clinical knowledge is real-time, while caring for our patients; that is, by reviewing clinical topics online as they arise during the course of patient care. Case-based review as well as current “hot topics” can also be easily found on websites like UpToDate and Medscape, and those of professional organizations, like ACP and SHM. We don’t have to leave our home or office.

In summary, I enjoy a unique CME adventure as much as anyone else, but when CME benefits exclude the exotic choice of staying home, we have really wandered too far off the path.

David M. Mitchell is a hospitalist.

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