Should Medical Education Be For-Profit?
When I began my career as a physician decades ago, almost all medical education was not for profit. Fast forward a few decades and that has flipped, with most education now being hosted through money-making ventures. So is this a good thing or a bad thing?
The Traditional Non-Profit Medical Education System
Medical education was typically handled through professional societies. These were non-profits formed by physicians which often represented subspecialties. Like orthopedic surgeons forming the American Academy of Orthopedic Surgeons or Pain Management doctors forming the Spine Intervention Society. While the instructors for courses were often paid, the organization as a group decided what would be taught and how, and no one person financially benefitted from running the venture as the board of directors were unpaid positions. Hence, there wasn’t really a profit motive other than to grow the organization.
The New For-Profit Medical Education System
At some point in the past few decades, companies sprang up to provide for-profit medical education. These were either small businesses that made money off conferences, individual doctors who sold their services to other physicians, or large corporate ventures. How were these different? Let’s dig into one group that IMHO represents the typical for-profit venture.
A4M is a medical conference in the realm of anti-aging medicine. There’s certainly nothing wrong about the overall subject of preventing or slowing aging, but it’s the execution that’s unique. This is what I’ve observed through the years (these are my opinions):
- The standards for who gets on the podium to speak to thousands of physicians and influence their behaviors are sometimes relaxed. For example, while some speakers are experts, you see some that clearly aren’t experts. Why? In my experience, time on the podium can be purchased through the advertising systems in place.
- The A4M exhibit hall, the last time I was there, had dozens of booths selling medical products that weren’t legal.
- The breakout sessions had speakers talking about products that weren’t legal.
- Rather than courses being given, A4M has decided to call these “fellowships”. Why? If a physician can advertise that he or she has fellowship training in “X” without ever having to take a year or two off to actually go through an academic fellowship program, that’s an incredible sales feature.
What’s driving this commercial behavior in medical education? A4M is now owned by a large conference conglomerate.
One of the things that can happen when the first goal is to make money and the second is to educate medical providers is the concept of “butts in seats.” Meaning, conference venues or virtual settings are expensive, hence you need as many people at your conference as humanly possible. The problem for medical education is that there are often educational prerequisites required to protect patients.
Take for example this course given by a chiropractic group that takes any provider who will pay the fee (I confirmed this by a call). Here we have an untrained physician (whose license I was unable to confirm) teaching chiropractors (many of whom are legally unable to perform this injection):
A Modern Not for Profit Example
Many years ago it became clear to me that Regenexx had developed an immense amount of information that was proprietary. That could be bifurcated into two areas:
- Lab Intellectual Property – how we processed cells.
- Procedural Intellectual Property – how we performed complex image-guided injections.
While the first part should be kept in the company, the second part should be open-sourced to properly trained and qualified providers. Hence, I raised several million dollars in donations to begin a non-profit and created a coursework structure to hold that procedural information. This non-profit is now called the “Interventional Orthobiologics Foundation” or IOF. That coursework has since been evolved by many others.
IOF was always non-profit. That organization was handed over to the field as a whole through choosing a series of presidents who would take it in directions where it could best serve physicians. Meaning, our company had no influence over the destiny of the non-profit.
Outside of me serving as one of seven board members, IOF has taken on a life of its own. Each president brought unique skills and has moved the organization forward. The presidents or board members are not paid anything for their service (including me), so whatever decisions are made about what or who to teach or who to put on the podium at a conference are all based on the medicine and science and not based on someone going home with a big bonus.
There are other non-profits out there serving different fields, but it’s easy to see how they operate differently than the for-profit conferences and teaching services.
Should Medical Education be For Profit?
My opinion is that we shouldn’t allow for-profit medical education. The incentives to teach what is profitable over what’s best for the patient are just too enticing. Properly run commercial education services can make millions. Properly run non-profits get by financially and focus on the medicine.
The upshot? IMHO, we have a for-profit medical education problem. Adding a profit motive into how doctors or other medical providers get educated is a prescription for disaster.