Continuing Medical Education (CME) Cost and Over-Reliance on Psychiatric Drugs for Children: A Possible Link

On the day I began to formulate the idea for this piece, I received an email announcing a continuing medical education (CME) course in psychiatry. Number one on the list of course objectives was: "Implement recent developments in psychopharmacology in clinical practice." I was mulling over the issue of CME after having been recently informed that offering CME credits for the intensive program in Infant-Parent Mental Health at University of Massachusetts Boston in which I am a fellow might be prohibitively expensive. In contrast, my colleagues in psychology, social work, and counseling will be able to get CEU’s (continuing education units).

There are four MDs in my group of 25(three pediatricians and one psychiatrist.) For us CME is necessary for maintaining professional licensing as well as obtaining hospital admitting privileges and being credentialed with insurance companies. Staying up-to-date with important new research and knowledge is certainly an essential part of practicing medicine. Yet given the already massive time pressures on physicians, MD's are unlikely to take a course that does not offer CME credit. We are a distinct minority.

Not having any knowledge about this subject, I did some research. Apparently the cost of offering CME is regulated by an organization called the Accreditation Council for Continuing Medical Education (ACCME.) If a person or organization wants to offer CME for a course, they must apply to the ACCME. According to their website the cost for "pre-application"(I'm not sure what that is) is $1000. The initial accreditation fee is $7,500 and the annual fee is $3,000. The reaccreditation fee is also $7,500. The International Association for Continuing Education and Training(IACET) in contrast, charges an application fee of $450 and an overall fee of $2,300 for CEU accreditation.

In the Infant-Parent Mental Health Post-Graduate Certificate Program(IPMHPCP), in ten intensive three-day weekends over the course of a year, we learn from leading researchers and clinicians from a range of disciplines about how early relationships shape the brain and influence healthy emotional development. The same program is run in Napa, California. The program’s website states:

“The IPMHPCP goals are to prepare individual professionals who:
Are highly skilled and invested in infant-parent work;
Have an integrated understanding of infant-parent relationships, regulatory, and social-emotional/mental health concepts and theories;
Have an understanding of the major theorists, researchers, and clinicians in the area of social-emotional development, infant-parent mental health, and infant-caregiver relationships;
Are invested in an interdisciplinary approach to promotion, prevention, screening, assessment, treatment, monitoring, and policy development; and,
Are able, within their scope of practice, to provide promotion, prevention, screening, assessment, treatment, and monitoring of children age 0-5, their parents and other caregivers.”

How very relevant is this work both to pediatricians who see families early and often, and to child psychiatrists who treat young children. Yet if this program is unable to provide CME it is less likely that these disciplines will have access to this important information.

Instead pediatricians and psychiatrists learn primarily about how drugs shape the brain. I recently attended a full day CME course on “Child Psychiatry in Primary Care.” While we learned a great deal about medication, including the use of atypical antipsychotics for explosive behavior in young children, there was not one mention of the word "relationship."

In contrast, a pediatrician colleague of mine took a course last week given by leading childhood trauma researcher Bessel van der Kolk, (who I refer to in my two previous posts.) He offers a different model for understanding explosive behavior that is very much tied relationships, and he is critical of over-relaince on psychiatric medication. My colleague found the course extremely helpful and relevant, but CME was not offered.

I do not know why CME credits are so much more expensive than CEUs. But I do wonder if this system, which seems to have a good deal of control over who knows what, contributes to how we understand and treat emotional problems in young children.

I have no doubt that the IPMHPCP has left me well qualified to do the work I do, namely treat a range of behavior issues in young children within the setting of a pediatric practice. I have sought out the kind of educational opportunities I believe have most relevance for this kind of work. When it comes time to renew my license, I can only hope that the Board of Registration in Medicine will recognize this fact.