The Disenfranchised Physician—The CME Merry-Go-Round

By Bob Sweeney

Did you know that, in 1950, doctors in practice could expect the total amount of medical knowledge to double every 50 years?  By 2020, according to the National Institutes of Health, it will take just 73 days!  How’s a physician supposed to keep up while managing the hectic pace of practice? And what should the focus be—staying current, learning and retaining new information, passing a test of some kind?  The means to a time-effective and satisfying outcome are very different depending upon what your goal is.

Aside from time constraints, practicing physicians also have to contend with inborn human psychology. For example, in How Doctors Think, Jerome Groopman, MD, evaluates cognitive errors in medicine, from diagnostic “anchoring” to “confirmation bias.”  With intense time pressures and demands from patients for definitive answers, once physicians leave their residencies, Dr. Groopman asserts, doctors tend to stick with diagnoses and treatments they are familiar with, and to ignore research that conflicts with what they already “know”.

An external observer might wonder why this set of circumstances is any different than that facing professionals in other professions—law, accounting, banking.  In some ways, of course, the issues are the same.  But the practicing physician faces a more critical tradeoff, in my view, because what he or she knows and retains has a real impact on the health and lives of other people.

Medical knowledge is also complicated by two other factors that represent the dark side of organized medicine:

  • There is plenty of evidence that the methods employed by the formal organizations responsible for ongoing medical education have no correlation with learning and remembering information. They may or may not help physicians pass a short-term test, depending mostly on the motivation and commitment of individual physicians.   That is because the methods used are designed for the convenience of the tester, not the testee.
  • The content of what is offered for learning, retention and testing is heavily biased by commercial interests with enormous financial stakes in the “learning” industry. You know who they are.

How can docs stand up for themselves in this environment, given that they are mandated to meet changing educational standards, face malpractice challenges if they fail to stay current, and must be ready to address patient queries spawned by increased information flow in the world of the internet?  How can physicians stay off the CME merry go-round?

The answers are not simple, but they begin with examining these key questions:

  • What is my specific objective with this learning event or curriculum—curiosity, keeping current, test preparation, fulfilling CME requirements?
  • What will it cost in time and money?
  • Will I be a better physician once I have used this learning material?  How?


Robert E. “Bob” Sweeney, DA, MS

Principal & Managing Director