What is CME? A Carlat Primer

CME stands for “continuing medical education,” and it is continuing education for doctors who have completed medical school and residency.

Here’s a little historical background that might help in understanding what has become a very complicated, bureaucratic, and controversial system. (For the party line on CME and its history, see the AMA’s booklet, The Physician’s Recognition Award and Credit System.)

IN THE BEGINNING, there was no CME. There was medical school (known officially as “undergraduate medical education”) and residency (“graduate medical education”). Up until the 1960s, there was actually no official requirement that doctors had to keep on medical knowledge after residency. Most did, of course, by methods such as reading journal articles, going to grand rounds lectures at hospitals, and simply chatting with colleagues about what they were doing. But a certain percentage of doctors graduated from med school and residency, and then did no formal learning at all. What percentage? In 1955, the AMA surveyed practicing doctors and found that about a third reported that they had not taken any formal continuing medical education courses over the past five years.

As a result of this finding, the AMA set up a network of committees and work groups that eventually came up with a clear definition of what CME should be, and in 1967 created a nationwide accreditation system. This was the earliest version of what would eventually become the ACCME, but this nascent agency was controlled and run entirely by the AMA. The education credit dispensed was given an elaborate name that is officially trademarked by the AMA: “AMA PRA Category 1 Credit (TM).” The PRA means “Physician’s Recognition Award.” If you are an accredited provider, like me, you are explicitly required to use that entire phrase, in italics (no kidding), whenever you mention CME credits on any printed CME material. The AMA is so serious about this point, that they reiterate in different ways in their manual, eg: “The phrase ‘Category 1 Credit’ must never be used when referring to AMA PRA Category 1 Credit.” Okay, okay, we get it!

Eventually, the AMA got tired of the tedious task of being the certifying agency for America’s CME, and in 1981 it decided to share the pain by joining forces with six other medical organizations to form the ACCME (Accreditation Council for Continuing Medical Education).

What is “accredited” CME?

Accredited CME is medical education provided by organizations that have won an official stamp of approval from the ACCME. Becoming accredited involves a lengthy and expensive application process. You have to produce reams of paperwork, go through a site visit (yes, you have to fly two ACCME regulators to your city, put them up in a hotel, and spend a day getting grilled by them), spend more than $10,000 ($1,000 “pre-application fee,” $7,500 application fee, about $2,000 for the site visit), and then start biting your nails as you wait several months for the decision. Actually, most applicants get accredited, I think, though I haven’t been able to find specific figures. If you’ve got the money, the stamina for paperwork, and some reasonable medical education to offer, you’re pretty much guaranteed to get your initial accreditation. As usual, 90% of success in life is showing up.

So you’re accredited—now what? Does this mean that suddenly everything you have to teach turns into golden nuggets of information? Not really. It just means that you have promised to comply with a bunch of regulations, that you have created a paper trail to back it all up, and that you have parted with a chunk of your hard-earned money to achieve accreditation. By the way, you have to keep ponying up over the years—a $3,000 “annual accreditation fee”, a $7,500 reaccreditation fee payable every four years (every six years if you received “accreditation with commendation”), and a $1,500 progress report fee if you were found deficient on some criteria and have to prove that you are fixing the problem. (Here is a link to the ACCME’s fee schedule.)