If you missed previous segments of the CMEslinger saga, you can read them here:

• Part 1
• Part 2
• Part 3
• Part 4

And now, our latest segment:

Part 5 (Scott)

As Sierra ambled down the spiral staircase that led into the front lobby, the CMEslinger was struck by how much his daughter had changed since the last time he saw her. It had been, what, 9 months since he drove the three hours to Sierra’s trendy loft apartment and took her out for her birthday?

“Geez,” the CMEslinger mumbled to himself. “Guess I should return that ‘World’s No. 1 Dad’ coffee mug.”

Sierra looked, well, different. Her hairstyle, her clothes, her general demeanor – she just didn’t look like the confident, sometimes cocky, young woman the CMEslinger was used to seeing. She looked tired and scared. It was enough to make the CMEslinger want to throw his arms around her like he used to do whenever Sierra came to visit him in the TAXIE offices as a little girl.

“Hi dad,” Sierra said as she hugged the CMEslinger, seemingly more out of obligation that familial affection. “Marge told me you’d probably show up sooner or later. You and your friend. Come on, let’s get on with it.”

A no-nonsense kind of gal. At least something about Sierra was the same.

Sierra signed in her visitors, escorted them to the corporate elevators located down the hall, and hit the button for the 24^th floor. When the elevator doors swung open, the CMEslinger and the man in black stepped out and stared in awe. They could see the entire city before them through the bank of glass windows. It was the kind of view most people would pay millions for. But then again, Tower Pharmaceuticals had many, many millions to spend on that sort of thing.

Sierra glared at the duo.

“If you want to play tourist, I can come back in an hour.”

“No, no, of course not,” the CMEslinger stuttered. “Lead the way, darling.”

“Don’t darling me, dad,” Sierra said. “I’m not your little girl, anymore.”

“So much for the teary family reunion,” the man in black muttered out of the side of his mouth.

“I’m no ingenue,” Sierra said, overhearing the man in black’s utterances. “But you already knew that. Come on already.”

Sierra led the trio down the hall to her office, adorned with a brass nameplate and a caricature of Velma, the sassy detective from the Scooby Doo cartoons. As her door swung open, Marge glared at the CMEslinger and the man in black.

“It took you long enough to get here,” Marge said. “I’m almost done my part. Now it’s up to you…and her…to save the day.”

“Almost done what? And what are we saving?” the CMEslinger said.

“You mean, you…they…” Marge said, looking inquisitively up at Sierra.

“No, I never called them,” Sierra said. “I didn’t want to… well, I was embarrassed.”

“Well then, I guess you better start from the beginning,” Marge said. “You boys better sit down. Storytelling time will let me finish up my part of this job before I hightail it out of here. I assume the folks back at TAXIE are pretty nervous right about now.”

It was all a bit much for the CMEslinger and the man in black to take in. But before they could start asking questions, Sierra had taken their arms in hers and walked them over to the cushioned sofa in the corner of her office. She pulled up her desk chair beside them and started to speak.

“Four years ago, the annual ACCME Data Report came out and, as usual, I immediately put my work aside to check out the financial state of our industry. And as usual, it was depressing. Registration fees were down 5%. Advertising and exhibits down 7%. Commercial support down 10%. It was the same story year after year. Depressing depressing depressing.

“So I went home, heated up a mug of tea and sat down in front of the television to watch the 76ers game with my journal in front of me. And that’s when it happened. Another ad for Linvolus, Tower Pharma’s ‘diabetes wonder drug.’ A midcourt Tower Pharma logo right in front of the 76ers bench. Tower Pharma patches on the uniforms of the 76ers players.

“I did some digging online and found that Tower Pharma had spent $510 million on direct-to-consumer advertisements for Linvolus alone in the United States that year. I’m sure those corporate sponsorships were in the hundreds of millions as well. Guess what they spent, at least according to their corporate transparency report, on CME programming for diabetes? $4 million. Total.

“I was tired of being underappreciated, but I was on the provider side of our world, so what could I do? So I made it my goal to come here and make things right. Six months later, I was hired.”

“But why didn’t you tell me, or anyone, all of this when you left TAXIE?” asked the CMEslinger.

“Remember what you told me when I came home with a black eye and a bloody lip after getting into a fight with Jessica Bronwell, that mean girl down the street, when I was 9 years old?” Sierra asked.

“Yeah, she was 3 years older than you and was twice your size,” the CMEslinger replied. “What did you expect?”

“But did you remember exactly what you said to me?” Sierra said.

“Sure, I told you the same thing my old man told me when I was a kid,” the CMEslinger said. “’Never get into a fight you have no chance of winning.’”

“Exactly,” Sierra replied. “I knew that one person fighting for dollars within Big Pharma seemed like the same situation, and I knew everyone was going to tell me that I was wasting my time, but it just felt like something I had to do. Not just for me, but for everyone who worked in CME for so long. For Marge. For the man in black. For you.”

“I see,” the CMEslinger said.

Tears started forming in the corner of Sierra’s eyes.

“And the worst part of it all is that you were right. I’ve been here for three years now and keep banging my head into the same wall over and over. I’ve worked hour after hour crunching data from providers, showing hard facts on the beneficial effect our limited budget is having on the healthcare team and the care of diabetes patients, arguing to my bosses that they don’t need another 30-second Linvolus commercial during the NBA playoffs. But I’m getting nowhere.

“Two weeks ago, I finally had enough. There was an advertising team outside my office filming a new commercial that is going to air during the Super Bowl – I read that we’re paying $10 million for 30 seconds of airtime. That is nearly three times my annual budget gone – poof – in about the time it takes you to drink one of your pickletinis.

“So I did something really, really stupid one morning. I called up one of my buddies in IT and had him override the budgetary limits of my grant approvals. I had been saving 15 of the best proposals that were submitted to me last year in the hopes I would miraculously convince my bosses to push more funding my way. In one fell swoop, I approved them all. $10 million worth of grants. Exactly what we’re paying for the Super Bowl commercial.”

“And that’s when you called in your emergency team,” the CMEslinger said. “Marge.”

“I didn’t know what else to do,” Sierra said. “I knew that as soon as anyone with their hands on the department budget found out about what I did, the best thing that could happen was that I would be fired. I ducked every email and phone call from the providers whose proposals I had funded and avoided countersigning any LOAs. But that wasn’t going to last long.”

Now it was the man in black’s turn to chime in.

“And so the two of you have been doing what, exactly?” he asked. “You realize that you pulled Marge away from TAXIE during their most crucial time of the year? They may lose their accreditation.”

“I know,” Sierra said. “And I feel awful about that. But we’re not stupid. Marge told me exactly how long she would be able to spend helping me here. We’ve been squeezing every ounce of energy into our value proposition to try to convince our executives once and for all that we’re worth investing in.”

“I’ll be leaving in a few minutes,” Marge interjected. “TAXIE will be fine. I have all of my files in pristine condition. I knew you would eventually figure out I was here and that you would come to save the day. Which you’ll be doing very soon.”

“Save the day? How exactly am I going to save the day?” asked the CMEslinger incredulously. “Besides you, I don’t know anyone else who works here. I don’t have any influence on any decisions this company makes.”

“You’re right, dad,” Sierra said. “You won’t be saving the day, at least not this time.”

Sierra locked eyes with Marge before swiveling to point her finger at the man sitting beside the CMEslinger, at the man in black.

“He will.”

Punxsutawney Phil saw his shadow – six more weeks of winter. Sigh.

Usually, we don’t care so much about what the seer of seers, sage of sages, prognosticator of prognosticators and weather prophet extraordinaire has to say about the seasons, but since these last few weeks have been particularly harsh for most of the country, we’re a little depressed now that spring seems further away.

You know what else has got us depressed? Our Ask Us Anything mailbag. It’s about to be empty, which should never happen. Surely you have professional and/or personal problems that you need us to weigh in on. Can you save your parking spot that you spent an hour digging out after the recent snowstorm with a traffic cone? What’s the best thing to do on a first date? How many licks does it take to get the center of a Tootsie Roll pop?

Our advice might not always be good, but it will be thoughtful and it is free. So please, submit your Ask Us Anything questions here so that we can at least have a ray of sunshine brightening our psychological skies.

And now, here is what we have to offer this month…

Dear Derek and Scott,

After reaching out to several supporters, I’ve noticed that some are happy to meet at the Alliance meeting while others are very clear that they don’t take meetings there. What drives supporters’ decisions to meet at the Alliance meeting, and why do those approaches differ?

Annoyingly,

Denied but Not Defeated

DEREK: This is a timely question considering the Alliance meeting is coming up in less than 2 weeks and I was just discussing this very issue with a couple colleagues last week. As a supporter, I’m happy to provide my thoughts on this situation and will take a crack at explaining the opposing view, too. As usual, I am compelled to provide a disclaimer that these are my own opinions, do not reflect those of my employer, blah, blah, blah.

My personal view of meeting with providers at the Alliance meeting and other conferences is that I am willing to meet and will try to agree to as many meetings as I can without driving myself nuts–accepting them on a first come, first served basis. I consider these kinds of meetings to be part of my job responsibilities and my role as a supporter. In general, I don’t have a lot of in-person external meetings throughout the year, so I’m willing to agree to more when attending conferences. Admittedly, part of my motivation stems from the years I spent working for CME providers in the first half of my career, so I guess I feel like I have a decent understanding of the value of these meetings from that side.

But let’s be honest, the true reason for this question is to ascertain why supporters don’t agree to meetings. I’ll offer three brief explanations based on conversations I have had with other supporters and my own experience.

The first reason is one of fairness and equal opportunity. If provider/supporter meetings are of value to the provider, and it is impossible to meet with every provider, then those who do meet with supporters are at an unfair advantage. If supporters can’t meet with every provider, then it is better for them to meet with no providers than some providers.

The second reason is to negate any appearances of bias and impropriety. We all know the work of CME is heavily regulated on both the provider and supporter sides of the equation. Some individuals and organizations feel the best way (or easiest way) to reduce the odds of getting caught up in any potential conflicts of interest is to avoid provider/supporter meetings entirely.

[Quick shoutout to Pam Wagner, who discussed both of the issues above in a recent LinkedIn post.]

The third reason, and the reason I concur with more than the first two, is simply one of time. These meetings take a lot of time and can make it difficult to enjoy the full conference experience. I’ll use myself as an example. For this year’s Alliance meeting, I received 20+ requests for meetings and have 14 scheduled, not counting evening meals. Along with those meetings I also have a session to moderate, try to catch up with friends I only see at conferences, and hopefully attend a few sessions as well. I have no idea how this compares with other supporters, but I assume they receive a similar number of requests and some likely even more. I share this not to brag or anything like that–it’s just how it is. This is probably oversharing, but for me, face-to-face meetings sap my energy. I’ll be exhausted by the end of the conference and start to lose my voice partway through from all the talking. When I decline a meeting request, it’s because I’ve reached the saturation point in my schedule. It’s not you, it’s me.

SCOTT: I don’t have a lot more to add here as I have never been on the supporter side, though I can certainly understand the concept of “meeting fatigue” that Derek cites. While I have never been a big fan of provider capabilities presentations, I do understand the value of personal relationships in our field and have always appreciated the willingness of some supporters to provide me with a glimpse of how their specific organization is structured and the way it which their team determines which education they do/don’t support. In many ways, I prefer this to happen during casual interactions rather than forced discussions during scheduled meetings, but I understand this occurs by happenstance and simply luck in running into someone you were hoping to meet.

Dear Derek and Scott,

I am thinking about submitting an abstract for presentation at CMEpalooza Spring along with one of my colleagues, but I’m not sure if our idea is any good or if we even have a chance at being accepted. Plus, neither of us has really presented to an audience like this before, so we’re kind of nervous that we’re going to make fools of ourselves.

Do you have any advice so that can make me feel better?

Sheepishly,

Nervous Nelly

SCOTT: You’ve come to the right place, Nelly, because Derek and I have years upon years of experience in making fools of ourselves. In fact, that would be a great name for our band if either of us was musically inclined (sadly, my instrumental career ended back in 5th grade when I put down the viola for good).

We often hear from people who kinda sorta think they have a good idea for a CMEpalooza Spring abstract but either they are too shy, lack confidence, or just get too preoccupied with other things to remember to submit it for consideration.

(Quick aside: This is a good opportunity, of course, for us to remind everyone that there are less than 3 weeks until abstracts for our Spring event are due. You can get all of the details on the submission process by clicking here).

We always consider CMEpalooza to be a low pressure kind of presentation atmosphere for a number of reasons:

1. You are not physically “seeing” your audience so there is no intimidation into looking at a sea of faces staring at yours. With a virtual event like ours, there could be 1 people watching or 1,000 (in reality, it’s somewhere in the middle). It really doesn’t make any visible difference to the presenter.
2. We encourage fun and creative approaches to education. You won’t have the pressure to come up with a long slide deck, unless you really want to. You won’t have the pressure to develop pages and pages of notes to keep you on track, unless you really want to. While we don’t encourage “winging it” without some sort of plan, we also don’t require any specific plan of attack. You can figure out your own preparation preferences.
3. We love seeing new faces present. While I admittedly will attend some sessions presented by longtime friends and colleagues who I admire at live events, one of the benefits of CMEpalooza is that you get a time slot with no competing session AND your session can be viewed as soon as it’s completed in our online Archives. Which are there forever and forever. All for free.
4. I’ll let you in on a little secret – we don’t get hundreds of great submissions to consider every year. We never know exactly how many submissions will come in, but your odds of being accepting for a presentation slot are significantly better than last week’s Powerball, for which your bought 10 tickets.

Derek, you want to add anything? I know your top 10 lists, so I left you a few to fill in. You are welcome.

DEREK: How very generous of you. No, I think you have covered the main points pretty well. I do want to reiterate that CMEpalooza is about as low stress an environment for presenting as you can find while still reaching a decent sized audience. And if it helps, we’re happy to lie to you about how many people you are actually presenting to, since you won’t be able to tell (“What’s that Nervous Nelly? How many people are watching your session? Oh, it’s only a handful, and one of them is my mom. Nothing to worry about. No truth at all to the rumor that we had 250 people watching the previous session. OK, maybe there’s a little truth to that rumor, but only a little.”)

Perhaps it has something to do with the calendar turning over, or maybe it’s because we’re all going a little bit stir crazy looking out our window and imagining how cold it is outside our front door, but this is always the time of year where I hear a lot about the need for “more innovation” in the world of CME.

We need to “re-imagine” how we design and deliver education. We need to “meet learners where they are” with our programming. We need to “think outside the box” to come up with groundbreaking solutions. We need to “get closer to the real provider/patient data” with our outcomes assessments.

I am sure you can come up with some of your own buzzwords or catch phrases that I missed. It’s an annual song and dance – rah rah rah, we can do this better! Let’s tap into our creative possibilities, form strategic alliances that maximize the strengths of the many instead of the few, and really get at the core of how our target audiences want to learn!

(For those of you going to the Alliance conference next month, you are going to hear this a lot)

It’s not that any of this is bad or misguided, but it’s simply unrealistic for a variety of reasons. We’ll start with the reason that no one ever seems to talk about as one of the primary barriers to innovation in CME: Money.

Let’s not lose sight of one simple fact: For most of us, the CME provider who employs us is operating as a business. It’s a business for supporters who devote a specific budget to therapeutic areas of interest. It’s a business for providers who need funding to pay the bills and support their teams financially, whether you are in an academic center, a member association, or a MECC. This is not a charity industry. Yes, most of us are in this at least in some capacity because we care about patients and want to make healthcare providers better at what they do, but there is nonetheless a financial component that underlines our work. If we don’t convince the internal teams within our pharma company to invest in CME programming, we’re out of a job. If we don’t get enough financial support from supporters to fund our programs, we’re out of a job. Plain and simple.

At last fall’s Alliance Industry Summit, there was one presentation in particular that drove home the limits that finances place on innovation in CME. It was a panel comprised of several representatives—both providers and supporters—from a far-reaching educational initiative that involved multiple interventions, an interesting longitudinal learner assessment, and various other tidbits that I can’t remember (this happens a lot when you get to be on the wrong side of age 50). Basically, it was one of those programs that nearly everyone would agree was “innovative” (don’t get me started about how everyone has a different opinion of what is or isn’t innovative – that’s another blog post for another day).

People were really interested in the activity design and its outcomes. “Yes, we should do more of this! This is the type of project my company would love!”

And then came the inevitable question, “Can you tell us—roughly—how much this project cost?”

The response? “Somewhere upwards of $2 million.”

More banging of the drum from the small contingent in the front row — “That’s great! This proves that pharma has money to support innovation! This is what we need to be investing in! Let’s convince our peers to shovel more money into CME so we can support projects like this! We can do this, people!”

But for most of us in the room, we knew right away that this project was the kind of interesting unicorn that pops up every now and then but simply isn’t realistic across even a relatively narrow broad spectrum. When you hear, “Our CME budget is down 10% this year, and it was pretty tight last year,” that’s not a formula for support of innovative programming. While innovation doesn’t have to be expensive—I like to think we do a pretty good job at CMEpalooza being innovative on a shoestring budget—to support the kind of manpower and high-tech doodads that “groundbreaking CME” often requires, a large price tag is usually attached to it.

Every week or so, I like to do an environmental scan to see what sort of online CME programming is available in a given therapeutic area. Without fail, the majority of activities I find are flat webinars – your basic 30 minutes of talking heads and slides, maybe with an animation thrown in or something like that, that we have been doing for years and years. Certainly, it’s nothing that anyone would argue is “innovative” or “re-defines CME.” It’s the same today as it was 10 years ago. The pendulum isn’t moving. Why, you ask? Yes, repeat after me…money.

Webinars are inexpensive to develop and produce, which makes them attractive for pharma to support. They are easy to create and hugely profitable for providers, which makes them attractive to propose. So, on one hand, you get a supporter with limited budget. On the other, you get a business unit (don’t hate only on MECCs here as all providers love their webinars) that is looking to strengthen their bottom line. So then, yes, you get a lot of accredited slide-video webinars out there (at least we’ve moved past the days of slide-audio). I don’t know that many people would argue that these sorts of programs are ideal for our learners, but they are functional and they are fiscally sound for all parties.

This isn’t something that most of us discuss in any sort of public forum because, well, it is frankly a bit embarrassing to admit that a lot of what we do is driven by dollars and not by what is best for our learner community. We would all love to be involved in those $2 million programs that really are exciting and impactful, but it simply isn’t the way the CME world is structured (note from Derek: maybe it should be.)

Now, money isn’t the only barrier to innovation in CME, and there is quite a bit of literature that argues that money is often just an excuse instead of a root cause that prevents innovation. There is likely some truth in this, but I feel strongly that the bottom line drives a lot of what chances we are/are not willing to take with our CME programming. Who is going to spend weeks developing a proposal for a $2+ million innovative initiative that has little chance of being funded as opposed to 10, $200K more realistic “tried and true” initiatives? (note from Derek: I think the argument of one large expensive program vs 10 small inexpensive programs is worth exploring more. Stay tuned….)

The world loves disruptors. Amazon. Uber. Netflix. Companies that truly redefine a space and make us rethink how we’ve done something for many years. But that doesn’t mean that every industry will get this kind of massive disruption, for whatever the reason. It’s just not the way the business world works.

So then, no, in my opinion, there will be no drastic shifts in the way that we design, deliver, and measure accredited education in 2026. Or 2027. Or 2028. I do not believe that we are an industry where any single innovation is going to massively overhaul the way that we design and develop education, at least not that I’ve seen. Shifts will be small—but still important—as we find cost-effective ways to innovate. AI platforms are getting better and more realistic. There are lots of interesting innovators and innovations out there in our community. But disrupting our world and “re-imagining CME”? Sorry, I just don’t see it.