Who commissions the work and who pays for it
Accredited continuing medical education is developed by a provider and paid for by a grantor or another funder, and the medical writer, engaged by the provider, writes first the funding proposal and then the content of the activity, working between the provider, the funder and the faculty. Commercial support for the field fell from 2008 while other income grew, the funders that remained began to ask for measured outcomes in exchange for a grant, and by 2021 commercial support was rising again.
Who commissions the work and on what terms
Continuing education in the health professions includes continuing medical education. Its providers range from health systems, medical schools and government agencies to private medical education companies and medical specialty societies, and freelance medical writers most often work with the last two.
Before an accredited programme can be developed, a proposal is written and submitted to obtain funding for its provider, in answer to a grantor's request for proposals, and the medical writer provides services to the provider. The proposal must justify why the commercial supporter should give money to the medical education company or specialty society, and it typically consists of a programme agenda, an outcomes measurement plan, a budget, a delivery schedule, credit information, an audience generation plan and a needs assessment. Medical education companies often outsource needs assessments to freelance medical writers. The educational needs assessment is the primary component of a funding proposal, and freelance and staff writers are also involved in preparing the materials for live or enduring activities. Once a proposal is funded, the writer typically works with the expert faculty on content that may include test questions, case studies, monographs and slide decks, and may also draft outcome reports for supporters, text for infographics or conference posters; well-established writers may write scripts for interactive patient case simulations or publish outcome reports in peer-reviewed journals.
In 2007 continuing medical education was a $2.4-billion industry coming under increasing scrutiny from legislative and regulatory bodies to ensure its independence and balance. Because of the increasing demands on the industry, many medical education and communication companies wanted to partner with freelance writers who could write well, meet tight deadlines and show that they understood the process of continuing medical education. One speaker in 2007 suggested that a writer who wants to work in the field establish a partnership with such a company, expand their knowledge of the industry's guidelines, identify a clinical competency or specialty area, consider fees carefully, knowing that the company cannot recoup the costs of preparing a proposal, and be receptive to new writing styles and formats. Another encouraged writers who bid on projects to ask questions before agreeing to undertake one, to clarify what the company will provide and what the writer must provide, and to be sure they can meet every deadline and deliver high-quality documents.
A writer who prepares needs assessments must be able to work quickly, because the time between receiving a grantor's request for proposals and the submission deadline is usually no more than two to three weeks. Such a writer also needs experience of continuing medical education, the ability to balance educational needs with the grantor's needs, and the ability to tell a coherent story. In 2007 openings in the field were often posted on the American Medical Writers Association's online jobs listing, in the trade press and at online job sites.
In one writer's view in 2009, a writer in continuing medical education must be familiar with the Standards for Commercial Support of the Accreditation Council for Continuing Medical Education, which give guidance on maintaining independence, resolving conflicts of interest and preventing commercial bias, and the main skill is following the council's guidelines while understanding the needs of the client. Adult learning principles are also an important part of the field. A writer can specialise in certain therapeutic areas or be a generalist, and since the needs of companies vary, neither is preferable in general, although companies commonly need writers with expertise in specific therapeutic areas.
As of 2026, a considerable proportion of activities are funded by institutions such as hospitals or universities or by the participants themselves, and commercial sponsorship makes up only part of the funding, but programmes funded by pharmaceutical companies are where many medical writers, freelances in particular, can find varied work. A project is approved, with suitable key opinion leaders in place, before the writer is invited to collaborate. Once the writer is on board, the industry client is completely hands-off apart from providing the topic, although a commercial sponsor has a vested interest and the activity may coincide with the launch of a new product or a change in clinical guidelines. The writer develops the content with the faculty who will deliver it, for example a discussion guide and slides for a recorded round-table discussion or podcast, or content for a panel question-and-answer session that accompanies a symposium at an international conference, and works with the medical experts, the sponsor and the media company.
The parties the content has to satisfy
Developing the content of a live or enduring activity was described in 2007 as a balancing act between the goals and expectations of the presenters, the grantor and the provider, all of whom must walk the tightrope of the guidelines and regulations on continuing medical education.
A writer needs to know the rules and guidelines, avoid any conflict of interest, use credible sources and verify data, and should partner with providers who share the writer's ethical principles and who use peer reviewers as subject-matter specialists to guide and validate the educational content. Practitioners agreed in 2007 that continuing change in the field would only increase the challenges that medical education and communication companies and their staff faced, but that freelance writers could develop mutually satisfying partnerships with those companies if they were willing to adapt to the industry's requirements.
The shifting funding model
The formal structuring of continuing medical education began in the 1950s, and it took approximately 30 years for the field to grow into a multimillion-dollar industry, mostly because pharmaceutical companies became its primary funders. Following that interest, for-profit medical education and communication companies sprang up by the hundreds and joined hospitals and not-for-profit trade associations as primary providers across the United States.
Accounts of the scope of Pfizer's withdrawal of support differ. On 2 July 2008 Pfizer announced that, with immediate effect, it had ceased to provide direct financial support for continuing medical education courses offered by for-profit medical education and communication companies, a decision that a spokeswoman said had to do with mitigating the perception of a conflict of interest. Pfizer was to continue to support programmes arranged by academic institutions, teaching hospitals and medical societies, acknowledged that it would be supporting commercial providers indirectly where those organisations contracted with such companies, and was to honour its existing commitments to those companies. In early July 2008 no other pharmaceutical or biotechnology company was known to have adopted a similar policy. A 2009 report of an industry conference on pharmaceutical marketing says instead that Pfizer had announced that it would no longer support any programmes of continuing medical education.
The overwhelming sentiment at that conference was that commercial support of continuing medical education would drop drastically in the near term, and that support would come from nonprofit groups, academic organisations and possibly fees paid by physicians, as in professions such as law or teaching, where learners pay their own way. Stanford School of Medicine had banned any direct commercial support of its continuing medical education. A pharmaceutical employee at the conference questioned why his company should support continuing medical education under the new restrictive guidelines, and academic providers were questioning why they accepted support from pharmaceutical companies. Continuing medical education was in a paradigm shift, not business as usual, and many continuing-medical-education companies were leaving the field. Continuing-education executives consulted at the time foresaw no change in their need for freelance medical writers, but writers might have fewer companies to work with, and the effect of the changes on fees was unknown. The mood at the conference was sombre, but those attending appeared engaged and willing to adapt.
By 2009 the Institute of Medicine had formed an ad hoc committee to consider whether to recommend establishing a national, interprofessional institute on continuing education that would be independent of industry. The project was sponsored by the Macy Foundation, which had funded a 2008 report that recommended phasing out industry support for continuing education. The accreditation council, having called for comments on whether industry should support continuing education, said that it would not take final action until the end of 2009. Later in 2009 the council announced that it would not be taking any action to end the commercial support of accredited continuing medical education, and that it had two innovations at the idea stage: a designation and review process for providers that wished to identify a programme as free of commercial support or free of promotional teachers and authors, and a central granting agency, independent of the council, that would accept unrestricted funds from industry and distribute them to accredited providers. Still in 2009, the council then decided not to act on three proposals that it had issued in April, under which providers would have had the option to offer accredited education labelled as free of commercial support or as free of promotional teachers and authors, and the council would have created an independent entity to distribute unrestricted grants for accredited educational projects.
Other bodies took positions in 2009. A special communication in JAMA argued that medical societies "must distance themselves completely from industry promotions" and gave ten guidelines for avoiding conflicts of interest, one of them not allowing satellite symposia to take place immediately before, during or immediately after a society's conference. In March 2009 the American Psychiatric Association ended its practice of allowing industry-sponsored educational seminars and meals at its meetings. An Institute of Medicine report on conflicts of interest in medicine recommended that a new system be developed for funding accredited continuing medical education, free of industry influence. That report was funded in part by the Macy Foundation, which had called for the elimination of industry support for continuing medical education.
In 2010 continuing medical education was hurting financially and would need to keep changing if it was to survive in a form recognisable to those then entrenched in the field. In the preceding twelve months, approximately 10% to 20% of all providers of continuing medical education had closed permanently or shifted their business in a different direction. Commercial funding for medical education had increased every year between 1998 and 2007, fell for the first time in 2008, and by all signs fell further in 2009. Reports in large metropolitan newspapers had spurred Congress to hold hearings in 2009 on potential conflicts of interest, which put industry leaders on the defensive. Medical education and communication companies remained the primary recipients of the pharmaceutical industry's funding, although their share was falling rather precipitously according to a 2008 report from the accreditation council.
In 2010 the changes in the field were seen as possibly bad news for some groups, such as the meeting planners and onsite project managers whom providers had traditionally employed to coordinate large series of meetings, and possibly good news for adult education experts, statisticians and medical writers. For writers, according to the president of the Alliance for CME, the move towards performance improvement brought more online work, self-assessment modules and large, complex projects that need a great deal of content. It may force writers to leave their comfort zone and adapt to writing for new technological platforms, but those who adapt quickly and prove their value can have a lot of success. In the alliance president's view in 2010, the value proposition for continuing medical education should be greater than it had ever been, and if no suitable alternative to the current model is found, patients downstream will be harmed.
According to the accreditation council's annual report for 2010, providers had a steady increase in commercial support from 1998 to 2007, when it topped $1.2 billion, a 40% increase on 1998; funding from pharmaceutical companies began to decline in 2008, and by 2010 commercial support contributed 54% less than in 2008. The decline is attributed to drivers that include new laws on pharmaceutical marketing, unfavourable media coverage of relations between physicians and pharmaceutical companies, and dwindling pharmaceutical budgets. Overall income nonetheless rose by 3% from 2009, the first rise in three years, because income from sources other than pharmaceutical companies increased, including registration fees, advertising and exhibit fees. One possible reason given in 2011 for the rise in participation and in revenue from registration fees was a radical change in how continuing medical education is designed and implemented: what physicians are willing to pay for is more interactive education, such as hands-on workshops, learning environments with small-group peer interaction, and curricula that give multiple opportunities to learn. According to the accreditation council, commercial support was by then by far the exception and not the rule: in 2010 only 20% of the 81,500 activities offered had commercial support, those activities attracted only about 20% of all physician participants, and almost half of providers reported $100,000 or less in commercial support.
In 2011 the landscape of continuing medical education was shifting, and with it opportunities for medical writers were growing. That year the chair of the Alliance for CME's member section for medical education and communication companies described an industry in a disruptive state and so well positioned to try different funding models, in which providers were forming collaborations with rarely tapped sources of support such as health care provider groups, insurance companies, government interests and health technology companies; the cost of producing education had not changed, but the partners had, and each brought the ability to provide some funding. One effect of the involvement of such new stakeholders was to broaden continuing medical education from clinical content centred strictly on the relationship between physician and patient to programming that takes account of the effect of the wider health care system on health outcomes. Programmes created with such partners include patient informed consent with a malpractice insurance company, interprofessional communication with a company that contracts physicians to hospitals, and decreasing clinician burnout with a health care provider group. In the section chair's view, the shift opens opportunities for writers to engage with new stakeholders in health care education, and learner audiences might expand with the mission of each new collaborator.
The initial reaction of pharmaceutical and device companies to the accreditation council's 2006 criteria, which put tighter restrictions on commercial funding, was to pull back funding for continuing medical education in favour of investment in other marketing channels. According to the council's annual report for 2011, commercial support dropped by 37% between 2006 and 2011, from $1.2 billion to $752 million. Over the same period support from registration fees, physician employer support and other non-commercial grants rose by 37%, and total revenues were down by 1%. Between 2001 and 2011, by contrast, commercial support rose by 32%, income from registration fees, employer support and other non-commercial grants nearly doubled, rising 94%, income from advertising and exhibits nearly doubled, rising 93%, and total funding rose by 69%.
Estimates of the share of funding that came from industry differ. Commercial support was put at 50% in 2009. In 2010 approximately 60% of the funding was said to come still from the pharmaceutical industry. In the council's data, commercial support was 41% of revenues in 2001, 50% in 2006, 37% in 2010 and 32% in 2011, while other income was 48% in 2001 and 55% in 2011 and advertising and exhibits were 11% and 13%.
What funders ask for in exchange for a grant
By 2012, in the global economic crisis, many pharmaceutical and device companies found their budgets for medical education cut dramatically, which increased the pressure to deliver medical education cost-effectively and to demonstrate a return on the investment. Budget restraints also meant that agencies had to become more creative in how they delivered medical education. In many cases it had become a requirement to demonstrate the success of an initiative by assessing outcomes against pre-specified key performance indicators, to determine whether its objectives had been met and whether the money had been well spent.
At a forum on educational grants in September 2012, numerous representatives of commercial supporters said that chief executives had become keenly interested in the payback and benefits of investment in continuing medical education, as they are in their marketing alternatives, so the education now had to perform. Commercial supporters had adopted requirements for measuring outcome levels in their new grant guidelines, recognising improvement in patient health and community health as proof that their products are worthwhile and effective; in place of the former shoulder-rubbing between company representatives and physician clients, they wanted to see physicians learning and applying what the education taught in practice, to the betterment of patients and communities and ultimately of the companies' bottom lines. By 2012 commercial supporters showed three new trends: funding the grant proposals whose educational objectives and measurements are aligned with outcomes, creating request-for-proposal processes in which the grantor accepts only proposals that respond to publicised company needs, and designating a select list of grantees who have been pre-approved to submit proposals.
The market after the contraction
From 2006 the industry went through significant changes, including adjustments to its methods, funding and objectives, and some professionals thought that continuing education would no longer exist; by 2012 it had settled into a sustainable trajectory. Income from commercial support reported by accredited providers in the United States rose in each year from 2015 to 2021 apart from a setback in 2020, which was probably caused by the COVID-19 pandemic. According to the accreditation council, the field reported $2.81 billion in total income in 2021, of which $895 million was commercial support from large pharmaceutical and medical device companies, a sharp increase from $723 million the year before. Commercial support accounted for 32% of the income that accredited providers in the United States reported for 2021. Because content creation is at the core of educational programmes, this growth means continued opportunities for medical writers, who may also write needs assessments and other parts of grant proposals. Market forecasts project growth of 5.9% for continuing medical education and continuing education between 2022 and 2027, from $2,715.22 million to $3,830.46 million.