Redesigning Continuing Education in the Health Professions (2010) / Chapter Skim
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3 Regulation and Financing
3 Regulation and Financing
Pages 55-78
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From page 55... ...
This chapter explores regulation and financing of continuing education in the largest sectors of the health care workforce -- medicine, nursing, pharmacy, and social work.1 REGULATION OF CONTINUING EDUCATION IN SELECT HEALTH PROFESSIONS The current regulation of CE attempts to ensure high quality learning for health professionals by targeting individual professionals through licensure, certification, and credentialing, and by targeting providers of learning activities through accreditation. As 1These are the largest professions as measured by numbers of professionals, with more than 200,000 clinicians.
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From page 56... ...
This requirement is arguably the strongest regulatory tool available to assess individual health professionals. However, licensure has been linked only tangentially to performance improvement (Davis et al., 2003)
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57 REGULATION AND FINANCING Average number of annual CE hours 0 1-10 11-20 21-30 31-40 41-50 Figure 3-1(a) R01551 CEUs for MDs Average number of annual CE hours 0 1-10 11-20 21-30 31-40 41-50 FIGURE 3-1 Average number of annual CE hours for physicians (M.D.s)
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From page 58... ...
Certification Certification is the process by which professional specialty societies or credentialing bodies -- not regulatory bodies -- certify individual health professionals as qualified experts to practice in a particular area of a profession. In professions that require certification, such as medicine (under specialty boards)
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From page 59... ...
Regulatory variations also result in some types of health professionals receiving more continuing education than others. For exam ple, nurses are required to take only 5 hours of CE annually in one state and 15 hours in others.
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Increasingly, hospitals, insurers, and even partners in clinical practice require varying amounts and types of CE activities (Peck, 2000)
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From page 61... ...
hours against one's pharmacy to acquire factual knowledge license • pplication-based CPE to • urther CPE A F apply knowledge learned requirements • Practice-based CPE • Fines • ormally organized learning • Withholding licensure F 3-25 CE eventsb hours • rofessional meetings or P organized learning experiences • ndividual professional I activities Regulation in social work is particularly variable; for example, states differ greatly in how they establish licensure categories and what titles they confer. Various licenses (e.g., licensed clinical social worker, licensed social worker, licensed graduate social worker)
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From page 62... ...
has developed a separate, voluntary set of standards for CE that requires social workers to complete 48 hours of CE every 2 years to be recognized at the national level. If health professionals fail to fulfill CE requirements, various degrees of repercussions and disciplinary action occur.
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Accreditation of CE Providers in Select Health Professions Accredited CE providers include organizations such as hospital systems, professional membership and specialty organizations, publishing/education companies, professional schools, and, in some cases, state boards. Accreditation bodies generally conduct formal accreditation processes at both regional and national levels.
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From page 64... ...
, included various participation.a The ACCME currently serves as the body that accredits institutions and organizations nationally to offering CME and to designating Category 1 credit, and recognizes institu tions and organizations, including state medical societies, to confer CME accreditation that enables the designation of Category 1 credit for qualified CME activities. a Participants included the AMA, American Board of Medical Specialties, American Hospital Association, Association for Hospital Medical Education, Association of American Medical Colleges, Council of Medical Specialty Societies, and Federation of State Medical Boards.
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From page 65... ...
For example, in medicine, the ACCME calls on a group of more than 150 volunteers to interview providers applying for reaccreditation and requires providers to submit an annual report describing the size and scope of activities planned and executed. The ANCC conducts site visits of continuing nursing education (CNE)
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A complete breakdown is not available for all health professions, but Figure 3-2 shows CE providers in medicine. Medical schools provide the most hours of continuing medical education (45 percent of the total)
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Particularly in medicine and pharmacy, com mercial CE institutions are important providers of CE. Commercial entities include medical education and communication companies (MECCs)
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Some health professionals pay out of pocket for their CE, while employers, commercial entities, and others may pay for all or part of the continued learning expenses of other professionals. Thus, CE funding comes from numerous sources, including health professionals themselves, employers, commercial entities, and the government.
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From page 69... ...
On average, a physician paid slightly more than $1,400 per year for his CME.3 Data on the costs of CE paid by individual health professionals in each profession were unavailable for this assessment. Some organizations see continuing education as an investment in staff development and bear at least a portion of CE costs.
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From page 70... ...
. Since the 1960s, the dependence of CE on commercial funds has raised concerns about bias and con flicts of interest with respect to companies using CE as a means of inappropriately influencing health professionals, especially physicians, to increase their market shares (Podolsky and Greene, 2008)
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From page 71... ...
Some efforts have been made to develop safeguards meant to ensure that CE providers are free from conflicts of interest. Yet widespread skepticism remains as to CE funders' intentions 4 The total commercial support listed in the ACCME Annual Report Data (2008)
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From page 72... ...
The regulations require CME providers to disclose conflicts of interest and resolve relevant financial relationships with any commercial interest among those in a position to control CME content. For example, the ACCME requires CME providers to give a balanced view of therapeutic options and encourages the use of generic names of therapies, rather than promoting specific proprietary names (ACCME, 2006)
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Checks and balances will be needed to ensure that professional societies are meeting all of these obligations appropriately. Future Financing for a More Comprehensive System Whether continuing education for health professionals should be financed by government, industry, employers, or individuals is still being debated.
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bitmap image The availability of industry funding has the potential to influ ence the types of CE programs offered. Currently, if alignment with industry interests determines the content of continuing education, areas of health care and patient safety that fall outside of industry interests generally receive less support.
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It is not clear, though, precisely how the content would change in the event conflicted funding sources disappeared because the content and types of CE that are biased and sponsored by conflicted sources is not well-defined. Also, it is important to understand that under such circumstances, CME providers may also change the amount and types of CE activities they sponsor.
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If better aligned with overall efforts to improve the quality of care, continuing professional development could maintain professional competence and help prepare professionals to improve patient outcomes in the absence of industry funding. Significant spending that currently supports less effective activities could and should be redirected toward more effective activities to counter the significant losses from conflicted funding sources.
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2000. Continuing medical education and continuing professional development: International comparisons.
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From page 78... ...
2005. Commercial support and continuing medical education.
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