February 2004

Grant Results

SUMMARY

From 1997 to 2001, researchers at the Medical Group Management Association Center for Research conducted a study on the role of continuing medical education in meeting the financial and strategic goals of group practices.

The study consisted of interviews, telephone surveys and internet surveys of representatives of medical practices.

The center is the not-for-profit research arm of Medical Group Management Association, the Englewood, Colo., membership association representing more than 11,000 medical group practices.

Key Findings
The principal investigator reported to the Robert Wood Johnson Foundation (RWJF) that the low number of survey participants prevented the researchers from "drawing any statistically significant conclusions." But in his report to RWJF, he noted "indicators and trends" that could be derived from the survey results:

  • Almost half of all responding practices (47 percent) do not have a written policy regarding continuing medical education, which suggests that it is generally not part of a group's organizational strategy.
  • Regardless of group characteristics, the role of continuing medical education is not well defined, applied in an organized way, or used to meet the organization's financial or strategic goals.
  • Most groups do not influence either the types or the subject or content of continuing medical education programs in which their providers participate.
  • Although continuing medical education is a general and substantial cost for group practices, it is not managed as an investment.
  • The working hypothesis of the study — that "[continuing medical education] would become a major component of managed care's strategic planning activities as markets became more competitive" — was rejected by both the data and the research experience.

Funding
RWJF supported this project through a grant of $400,260.

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THE PROBLEM

One third of all nonfederal physicians are employed in group practices, according to AMA estimates. Where once group practices functioned as loose associations of relatively independent colleagues, many of today's group practices are closely managed corporations of interdependent providers.

With the rise of managed care, these group practices have been forced to develop expertise in a range of new areas, including: implementing strategies for disease prevention; understanding cost effective disease management; employing clinical practice guidelines; staffing, teamwork and working with nurse practitioners and physician assistants; and relating effectively to diverse populations.

It remains unclear to what extent providers of continuing medical education, who have traditionally focused on individual medical providers as their clients, are adapting to the needs of these group practices.

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THE PROJECT

In the primary study, four university-based providers of continuing medical education conducted four interviews over 12 months with representatives of 21 group medical practices. Questions focused on each medical group practice's characteristics, including details on its providers; its policies and practices regarding continuing medical education; and how its individual providers use continuing medical education.

To supplement the data from the primary study, the investigators also conducted telephone surveys with 240 group practices (101 responded) and Internet surveys of 1,400 groups (250 responded). (See the Bibliography for details on survey instruments.)

The primary study represented a significantly scaled back version of the researchers' original project plan. They had hoped to recruit 10 or more university-based providers of continuing medical education, who, in turn, would interview a total of 60 group practices that were representative of group practices nationally. Instead, while 10 providers of continuing medical education joined the study, only four participated until the study's completion; only 24 group practices began the study and 21 completed it.

Many providers of continuing medical education cited the burden of participating in the study without remuneration as one reason for dropping out. In their original budget proposal, the investigators proposed compensating these providers, but RWJF rejected this line item, reasoning that providers of continuing medical education would have an intrinsic interest in the outcome of the study and should be willing to participate uncompensated.

The grantee organization, the American Medical Association (AMA), the Society for Medical College Directors of Continuing Medical Education, and the American Academy of Physician's Assistants provided in-kind support for the project. An advisory committee composed of representatives of academic providers of continuing medical education, group practices, and other professionals provided overall direction for the project. (See the Appendix for a list of committee members.)

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FINDINGS

The principal investigator reported to RWJF that the low number of survey participants prevented the researchers from "drawing any statistically significant conclusions." But in his report to RWJF, he noted "indicators and trends" that could be derived from the survey results:

  • Almost half of all responding practices (47 percent) do not have a written policy regarding continuing medical education, which suggests that it is generally not part of a group's organizational strategy.
  • Regardless of group characteristics (size, mix of providers, mix of specialties, extent of managed care business, location, use of outcomes and utilization data, teaching affiliations, financial resources for continuing medical education), the role of continuing medical education is not well defined, applied in an organized way, or used to meet the organization's financial or strategic goals.
  • Most groups do not influence either the types or the subject or content of continuing medical education programs in which their providers participate.
  • Although continuing medical education is a general and substantial cost for group practices, it is not managed as an investment. At the organizational level, groups are not interested in continuing medical education. It is not used by practices as an instrument to change provider behavior in order to meet organization goals or to improve outcomes in a measurable way.
  • The working hypothesis of the study, that "[continuing medical education] would become a major component of managed care's strategic planning activities as markets became more competitive," was rejected by both the data and the research experience.

Communications

Investigators gave two presentations at the Society for Medical Directors of Continuing Medical Education's "Congress 2000: A Continuing Medical Education Summit on the Practices, Opportunities and Priorities for the New Millennium," held April 12–16, 2000, in Universal City, Calif.

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LESSONS LEARNED

The project director drew the following project lessons from the study:

  1. Time and effort need to be expended to capture the universe of medical groups in the United States from which to draw an accurate sample, and significant resources will be necessary to maintain this database. Mergers and acquisitions in the health care industry make ongoing maintenance of the database necessary. (Project Director)
  2. A successful research project in the group practice setting requires incentives to aid in recruitment and retention of participants. In the current study, the university-based providers of continuing medical education (which are, for the most part, self-supporting institutions) and group practices (coping with time and payment issues of managed care) gave priority to research for which they received remuneration. (Project Director)

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GRANT DETAILS & CONTACT INFORMATION

Project

Continuing Medical Education in the Group Practice Setting

Grantee

Medical Group Management Association Center for Research (Englewood,  CO)

  • Amount: $ 400,260
    Dates: November 1997 to December 2001
    ID#:  031427

Contact

Terry Hammons, M.D.
(303) 267-0163
gth@mgma.com

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Continuing Medical Education in the Group Practice Setting Advisory Committee

David A. Davis, M.D. (Chair)
Associate Dean for Continuing Medical Education
Office of Continuing Medical Education
University of Toronto
Toronto, Ontario

Carolyn H. Asbury, Ph.D.
University of Pennsylvania
Division of General Internal Medicine
Philadelphia, Pa.

Stephen C. Crane, Ph.D., M.P.H.
Executive Vice President
American Academy of Physician Assistants
Alexandria, Va.

John P. Mamana, M.D.
President/CEO
Virginia Medical Associates
Springfield, Va.

Jean Johnson Pawlson, Ph.D., R.N.
Associate Dean Health Sciences Program
George Washington University
School of Medicine and Health Sciences
Washington, D.C.

Dennis K. Wentz, M.D.
Division Director/CME
American Medical Association
Chicago, Ill.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Purcell EG and Paolino AR. "Medical Groups as Sources for Data for Continuing Medical Education (CME) Research: The Need for a Comprehensive Database and Innovative Recruitment Strategies." Unpublished.

Survey Instruments

"Self-Administered Physician Questionnaire." The Center for Research in Ambulatory Health Care Administration, fielded August 1998.

"Physician Questionnaire — Contact 1." The Center for Research in Ambulatory Health Care Administration, fielded August 1998; five contacts.

"Self-Administered Physician Assistant Questionnaire." The Center for Research in Ambulatory Health Care Administration, fielded August 1998.

"Physician Assistant Questionnaire — Contact 1." The Center for Research in Ambulatory Health Care Administration, fielded August 1998; five contacts.

"Self-Administered Nurse Practitioner Questionnaire." The Center for Research in Ambulatory Health Care Administration, fielded August 1998.

"Nurse Practitioner Questionnaire — Contact 1." The Center for Research in Ambulatory Health Care Administration, fielded August 1998; five contacts.

"Group Questionnaire — Contact 1." The Center for Research in Ambulatory Health Care Administration, fielded August 1998; two contacts.

"Changing Provider Behavior in Group Practice Settings Through Continuing Medical Education (CME): Research Protocol Manual." The Center for Research in Ambulatory Health Care Administration, fielded August 1998.

"Faxed Survey Questionnaire Administered to Groups in High and Low Managed Care Penetrated Markets." The Center for Research in Ambulatory Health Care Administration, fielded September 1999.

"Telephone Survey Questionnaire." The Center for Research in Ambulatory Health Care Administration, fielded March 2000.

"Internet Survey Questionnaire." The Center for Research in Ambulatory Health Care Administration, fielded April –June 2000.

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Report prepared by: Jan Hempel
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Nancy Barrand