As I See It

The Oral Tradition — Silenced

Tighter CME rules weaken lecture content and alienate top speakers.

By Paul S. Koch, MD, Editor Emeritus

It's getting hard to find a good speaker. Whereas once upon a time we could attend any number of meetings and find many an eloquent teacher, we now find many of our favorites staying home rather than traveling to our towns to share their knowledge.

I loved it when one of my favorite speakers came to a town near me. I would attend the meeting, the dinner, or whatever forum was held and drink in every word. The questions on everyone's mind: “What are you doing? What are you finding?”

The oral tradition in ophthalmology was strong, and I am fortunate to have listened to some of the best. Hearing luminaries in the field give first-hand accounts of their methods was invaluable. But I fear it may be nearing extinction.

Too Many Chefs at the CME Dinner

The first attack came several ago. I'm sure you, like I, enjoyed the informal collegiality of dinner meetings and picked many a brain.

One day, decisions were made that each talk had to be vetted by the lawyers for their corporate sponsors and delivered unaltered. Talks became a version of reading the product brochure. That led a number of excellent speakers to hop off the circuit.

Then, several states made it illegal to attend a corporate dinner unless CME was awarded, so the CME companies got their foot in the door.

Certain CME companies, straining to “eliminate bias” by controlling the content of meetings, have made it a condition of awarding CME credits that they must review the slides of every talk months before the meeting is held. That puts the onus on the speakers to prepare their talk months in advance, and believe me, no one is enthusiastic about that. The easy way out was to submit an established talk from their archives instead of preparing a fresh one current right up to the day of the meeting. Color me guilty on that count, too.

Next, the CME companies review the slides without knowing what the speaker plans to say about each. Then they reject entire segments of talks and instruct speakers to remake the talk or it cannot be presented.

In many cases, this is tantamount to ordering the speaker to spend many hours preparing what is essentially a new talk. “You don't want to hear my talk?” some are saying. “Fine. Forget about it, I'm staying home.”

RSVP With Regrets

If you have not noticed the quiet disappearance of some of our top speakers, you will soon. The CME vetting companies have become so irritating that many an invitation to speak has become an invitation not entirely flattering or welcome. Lately I've been hearing more of my friends say that if the meeting has a requirement that slides have to be censored, that's a meeting invitation that will be declined.

This has gone entirely too far. The CME requirement to eliminate bias assumes that physicians are too stupid to recognize it and we have to be protected like little babies. That is just plain silly, and if we don't put a stop to it soon there won't be any meetings of worth. That means either eliminating the vetting process by the CME companies, or eliminating their presence in the first place, by having more meetings that don't award CME credits. We do not need credits every time we get together.

Good speakers have plenty of things to do with their time, and altering a talk two or three times until the life is sucked out of it and it's down to mush isn't one of those things. They're happy to give their latest, “Here's what I'm doing, here's what I'm finding” talk, but not a watered down and censored version that someone else wants them to give.

How about we get rid of this nonsense that every dinner and every lecture has to have CME attached and have more get-togethers where we can leave Big Brother home? OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is: paulkoch@kocheye.com.