The US CME system and who must earn credits

You track credits to keep a license and a certification active, and the rules behind those credits decide what counts. In the United States that system rests on three physician credit frameworks, accreditation by the ACCME, the AAFP and the AOA, and separate requirements set by state boards and specialty boards.

What counts as CME in the United States

Continuing medical education helps you maintain competence and learn about new and developing areas of your field. You can earn it through live events, written publications, online programs, audio, video, or other electronic media. Content is developed, reviewed and delivered by faculty who are experts in their respective fields. As with academic journals, any potentially conflicting financial relationships for faculty members must be both disclosed and resolved in a meaningful way. If you want a grounding in terms and hour types, the CME basics guide walks through the vocabulary you will see on activity pages.

Where does CME sit in your training timeline

CME is part of what is known as the continuum of medical education. It follows undergraduate medical education, the training that leads to the M.D. or D.O. degree, and graduate medical education. That placement matters for you because undergraduate and graduate phases end with a degree or training completion, while CME has no single graduation point. You return to it across your working life to document that knowledge, skills, competence and performance remain current. The examples and perspectives in continuing education overview deal primarily with the United States and Canada and do not represent a worldwide view of the subject.

How did grand rounds become credit

Continuing learning is not a new concept. Since the beginning of institutionalized medical instruction affiliated with medical colleges and teaching hospitals, health practitioners continued their learning by meeting with peers. Grand rounds, case discussions, and meetings to discuss published medical papers constituted the continuing learning experience. CME credit was first established for physicians in the United States in 1958 by the American Academy of Family Physicians. From the 1950s through the 1980s, CME was increasingly funded by the pharmaceutical industry, and concerns about informational bias, both intentional and unintentional, led to increasing scrutiny of funding sources.

Who accredits what you take

The Accreditation Council for Continuing Medical Education developed standards to prevent what it defines as ineligible companies from influencing the content of CME activities. The ACCME Standards for Integrity and Independence in Continuing Education were most recently updated in 2022 and have been adopted by the accrediting bodies of multiple health professions within the United States. The pharmaceutical industry has also developed guidelines regarding drug detailing and industry sponsorship of CME, such as the Pharmaceutical Advertising Advisory Board and Canada's Research-Based Pharmaceutical Companies. The Wikipedia page does not publish a single national hour total for the United States.

What do the three physician credit systems ask of you

In the United States there are three major physician credit systems, each with its own history, credit labels, and audience. The AAFP system was established in 1958, includes Prescribed and Elective credit, uses activity-level accreditation by the AAFP, and serves family physicians. The AMA system was established in 1968, includes AMA PRA Category 1 Credit and AMA PRA Category 2 Credit, relies on ACCME-accredited providers to award Category 1, with the AMA as owner of the system awarding credit directly to physicians for some types of activities, and serves all MDs, DOs, and individuals who have completed an equivalent medical degree from another country. The AOA system was established in 1973, includes Categories 1A, 1B, 2A, and 2B, with the AOA as the accrediting body for organizations that offer AOA credit, and serves osteopathic physicians. There are other physician credit systems in other countries.

Formal or informal: which hours will your board accept

Formal activities are certified by the credit system or accrediting body or by the accredited CME provider. All systems have harmonized requirements including principles of educational design, evidence-based content, and the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Examples include AAFP Prescribed and Elective, AMA PRA Category 1 Credit, and AOA Categories 1A and 2A. Informal activities are self-directed learning activities that are not certified for credit by a credit system, accrediting body, or accredited provider. The parameters are defined by the credit system and may not include activities produced by or with influence from ineligible companies. Examples include AAFP Prescribed and Elective, AMA PRA Category 2 Credit, and AOA 1B and 2B. Some entities that require physicians to get CME credit, such as a state licensing board, do not accept the informal types to meet requirements, so you need to check acceptance before you count those hours. Your state board requirement page explains why each board writes its own rule on this point.

Who builds the course you attend

Continuing medical education activities are developed and delivered by a variety of organizations, including professional associations, medical education agencies, hospitals, and educational institutions such as universities and medical schools. In 2008, professional certification for CME planners was established by the National Commission for Certification of CME Professionals, earned by standardized exam and conferring the Certified CME Professional certificate. The National Commission maintains a registry of these certified professionals, and as of June 2011, the registry included 320 professionals. That certificate has since transitioned to the Certified Healthcare CPD Professional certification and is owned by the Alliance for Continuing Education in the Health Professions. The way those planners shape objectives, evidence, and evaluation is described in the program design guide.

Why does industry money still shape the debate

In the 2000s, critics such as Morris and Taitsman argued that the medical profession should eliminate commercial support for CME. The 2022 update to the ACCME standards continues to severely restrict potential influence by ineligible companies for all accredited CME activities, whether or not there is commercial support. Critics complain that drug and device manufacturers often use financial sponsorship to bias activities toward marketing their own products, and the record notes that providers can pitch topics designed to attract commercial sponsorship while sponsors can award grants to programs that support marketing strategies. In 2009, the Institute of Medicine said that CME had become too reliant on industry funding that tends to promote a narrow focus on the products and to neglect broader education on alternative strategies such as communication and prevention.

What do enforcement cases tell you about off-label promotion

Two cases are named to show how sponsorship and promotion drew government action. Gabapentin, sold as Neurontin, was approved by the Food and Drug Administration for adjunctive therapy in epilepsy, but Warner-Lambert sponsored CME activities that encouraged its use for off-label indications. In 2004, the Department of Justice brought civil and criminal charges against Warner-Lambert, which the company settled for 430 million dollars, with allegations that it paid kickbacks to doctors in the form of lavish trips to attend presentations about off-label uses. In 2010, AstraZeneca PLC was fined 520 million dollars in the United States for off-label promotion to doctors for the antipsychotic drug Seroquel. Industry-sponsored activities can violate federal statutes, according to the Department of Health and Human Services, including when a pharmaceutical manufacturer rewards high-prescribing physicians by directing a CME provider to pay or overpay them as faculty, consultants, or members of a speakers bureau.

What does Canada require for comparison

In the United States, many state licensing boards and specialty certification boards require CME to maintain licenses and certifications, with activity requirements regulated by the AAFP and the AMA in conjunction with the ACCME and the AOA for the respective credit systems, while state legislatures and specialty certification boards regulate what and how much CME physicians must obtain. In Canada, certification is provided by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. The Royal College is responsible for the development and implementation of all certifying examinations in each specialty other than family medicine. Specialist physicians who join the Royal College as fellows participate in the maintenance of certification program. For each five-year cycle, fellows are required to document 400 credits, with a minimum of 40 credits obtained in each year of the cycle, earned at one to two credits per hour based on the type of learning activity. The College of Family Physicians of Canada requires 250 credit hours over a five-year cycle, with 50 credits in each year, plus an additional 24 credit hours of higher-level learning over each cycle to earn and maintain fellowship. Each province and territory also requires documentation of ongoing CME for licensure. Pull your license cycle dates and your specialty cycle dates side by side, then match each planned activity to the credit label your board will accept.