Indian Pediatrics 2000;37: 190-192
Questionnaire Survey on Sponsorship of Continuing Medical Education Program by Pharmaceutical Companies
Mukta M. Jain, Salim A Khatib and Arvind Shenoi
From the Indian Academy of Pediatrics, Bangalore-BPS.
Reprint requests: Dr. Arvind Shenoi, Secretary, Indian Academy of Pediatrics, Bangalore-BPS, Perinatal Clinic, 53, Ist Floor, Jai Santoshi Maa Complex, Seshadripuram, Bangalore 560 020, India.
Manuscript received: March 22, 1999;
Initial review completed: May 3, 1999;
Revision accepted: August 23, 1999
The Indian Academy of Pediatrics, Bangalore Chapter (IAP-BPS) has been organizing Continuing Medical Education (CME) program for more than a decade. Organizing a two-day CME costs about Rs 70,000-80,000 (approximately Rs 300-500 per head per day) or even more. A delegate often pays only 50% or less of the true cost incurred, a post graduate student even lesser. To offset the costs of the CME, the society has been seeking contributions or sponsorship from the phama-ceutical companies.
With the advent of fierce competition and tighter financial budgets, the contributions to the CME from the pharmaceutical companies are on the decline. The companies are also demand-ing their due(1). This questionnaire based study was undertaken to examine these issues during a recent CME organized at Bangalore on June 13th and 14th 1998 under the auspices of IAP-BPS.
A pre-designed written questionnaire (copy available from the authors on request) was handed over to a cohort of 170 pediatricians, and post graduates who had registered as delegates for the annual CME program. The questionnaire consisted of 5 parts. The first part elicited basic data. The other parts elicited: (a) The role of pharmaceuticals in sponsoring a CME program; (b) Opinion on how the IAP-BPS can cut the costs of organizing a CME; (c) Option of bargaining with the pharmaceuticals; and (d) Explore alternative sources of funding the CME.
The questionnaire was handed over at the time of registration and collected four hours later. In order to ensure maximum response, a complete questionnaire was taken as an equivalent of a valid lunch coupon. The partici-pants were also given the option of anonymity. The questionnaires were collected, data tabu-lated and analyzed using descriptive statistics and Chi-square test.
A total of 137 responses were received of which 64 (46.7%) were complete in all respects. Seventy-three (53.2%) of the questionnaires were incomplete and the major defaulters were post graduates (49%). The categories of respondents and their sex distribution are depicted in Table I. The age of respondents ranged from 20-65 years. Forty-three (31.5%) each belonged to the group of 20-30 and 30-40 years of age and the rest were distributed in different ranges. Seventy-four (54%) had mentioned that they were members of IAP-BPS. Fifty-six (40%) of the respondents attended more than three CME's a year, 25 (18.2%) three, 29 (21%) attended two and 6 (0.7%) attended only one CME a year. In response to the question for mentioning reasons for attending a CME, 81 (59%) replied that they attended it to meet experts, 28 (20.4%) to update themselves, 25 (18.2%) to clarify doubts, 23 (18.2%) to prepare for exams, 17 (12.4%) to participate as speakers and 1 (0.7%) attended for other reasons. There was no statistical difference (p >0.05) between the groups in this aspect, except that post graduates attended CME usually to prepare for their examinations.
Table I__Category of Respondents and Sex Distribution of Subjects
A total of 120 (87.5%) of the respondents including 48 postgraduates, 21 practicing pediatricians, 25 teachers in major institutes and 17 practicing teachers, were in favor of pharmaceutical companies sponsoring a CME. Only 13 (9.6%) were of the opinion that a delegate should pay for the CME without any sponsorship and 4 (2.0%) had not responded. To the question whether Rs. 1000/- could be charged as registration fee for a 2 day CME, 117 (85%) said no. Sixty-eight per cent were in favor of having a fee of Rs. 200-300. There was no statistically significant difference in response to this question between the various groups (p >0.05). Opinions on various options for cutting down the cost of CME were polled. Eighty-one per cent were against inviting only local speakers, 56% agreed to have no bags or folders, 78% agreed for a working lunch, 69% were ready to pay for educational hand outs. No significant difference (p >0.05) was found amongst the various groups.
The option of raising funds by bargaining with the pharmaceuticals was also discussed. Sixty-five per cent of the participants were not in favor of bargaining, 25.5% agreed that they would bargain, however only 10% of them agreed that more than 50% of their prescriptions would reflect the above bargaining. No signi-ficant difference (p >0.05) was found in the various groups. The option for contributing to a corpus fund or willingness to raise money towards such a fund evoked a mixed response. Seventy-one (51%) were not willing to contribute to a corpus fund, 31 (21.8%) were in favor of the fund and 32 (23.3%) had not responded to the question. Forty per cent were not willing to raise money for the corpus fund. All the postgraduates were against contributing to a corpus fund. Twenty-three per cent of the remaining respondents were of the opinion that the maximum contribution to a corpus fund had to be around Rs. 1000/-, even though the amount required for such a fund was approxi-mately Rs. 5000/- per IAP-BPS member.
The Indian Academy of Pediatrics has been encouraging CME programs. Little thought has been given towards funding of such CME programs which cost a lot of money. The main expenses incurred are on the travel reimburse-ment of the speakers, accommodation, rent for venue, food and on hand-outs. Money collected from the delegates covers less than 40% of the cost incurred. In addition most organizations subsidize the post graduate students. Thus, extra funds are required to run CME programs. The general trend followed over the years has been to seek contributions from the pharmaceutical companies as a method of collecting funds. With the fierce competition, tighter budgets, increasing costs and with the increase in the number of CMEs organized every year, the pharmaceutical companies have become more demanding. They increasingly sponsor only programs which cater to their interests(1_4).
In this study most of the responders were of the opinion that a pharmaceutical company should sponsor a CME, but they were averse to bargaining. They felt that the maximum fee to be charged for a 2 day CME had to be between Rs. 200-300. This amount is unfortunately insufficient to cover the costs of a CME in a big metropolis like Bangalore. The CME in which this questionnaire was administered cost Rs. 625/- per head inspite of austerity measures like no souvenirs, gifts or banquet. The inaugural function was truncated to five minutes with no garlands or VIPs further cutting costs. An alternative, is for the IAP-BPS to create a corpus fund from the contributions of the members. The interest from the money collected for this fund can help partly to fund a CME. This method of funding did not find a favorable response. The third option explored was cutting down the costs. Though most of them were also against utilizing the services of only the local speakers inspite of being aware of the costs incurred on air fares, travel expenses and accommodation of outstation faculty. Majority of the responders were willing for a low cost working lunch, low cost venues, no gifts and payment for educational hand outs. Perhaps organizers need to consider these while organizing CME's in future. This questionnaire survey showed that the majority of the delegates at the CME programme were reluctant to pay the full costs of a CME and favored pharma-ceutical sponsorship. In this they were reluctant to accept bargaining with the company. Many respondents felt that bargaining was unethical.
The partially analyzed questionnaire was mailed to all the members of the organization to get a feed back on their opinions. Only 3 responses were received. The opinions expressed by these three were also similar to those in the study.
The questionnaire, thus raised more issues than it answered. With the CME becoming a necessity in future, how do office bearers raise funds? How much pharmaceutical sponsorship is permitted? Is it ethical? A recent spate of articles(1_4) on this issue has pointed out the difficulties of accepting sponsorship from pharmaceuticals. Perhaps the Academy needs to formulate some guidelines after adequately debating the issue.
We gratefully acknowledge the active support and encouragement of the current executive and senior members of the IAP-BPS without whose support this study would not have been possible.
1. Agrawal S. Medical profession and the pharmaceuticals. Indian scenario. Indian Pediatr 1998; 35: 641-645.
2. Manglik AK. Medical Profession and the Pharmaceuticals: Indian scenario. Indian Pediatr 1998; 35: 1097.
3. Mehta PN. Medical profession and the pharmaceuticals. Indian Pediatr 1998; 35: 1097-1098.
4. Srivastava RN. Medical profession and the pharmaceuticals. Indian Pediatr 1998; 35: 1099-1100.