The Physician Payment Sunshine Act (PPSA) requires pharmaceutical companies to disclose payments over $10 to physicians and hospitals. The PPSA covers honoraria, travel to and from events, research grants, royalties, meals, speaking on a speakers’ bureau, and other payments. Although the PPSA does not cover indirect payments, it is important to consider how this will affect physicians, their participation in continuing medical education (CME) activities, and patient outcomes.


The Standards for Commercial Support of the Accreditation Council for Continuing Medical Education (ACCME), last updated in 2004, is a standard of conduct that CME providers must follow. Faculty of CME activities undergo a rigorous evaluation prior to appointment and are vetted to ensure that they have no relationships with industry manufacturers. As such, payments to CME faculty are irrelevant when it comes to disclosure under the PPSA. Other attendees of CME activities are encouraged to “decline any subsidy offered by a commercial entity other than the physician’s employer to compensate the physician for time spent or expenses of participating in a CME activity.”


With the implementation of the PPSA, if physicians decrease or decline participation in CME, how might patients be affected?


Lack pf physician/participant understanding of the act’s implications could hurt the success of CME programs to deliver timely information about medical practices.


In a recent survey, about 55% of the physicians who responded stated that they had attended CME activities at least four times in the last year. Over 85% said that CME activities are important or very important to their ability to improve patient outcomes. In the same survey, many stated that they would be less likely to participate in CME activities as a result of PPSA regulations, either as an attendee or presenter. Physicians fear that if information about their participation is reported publicly, it could be perceived as somehow inappropriate.

CME is a major source of information about possible therapies or innovations in medical practice, and has been proven to have long-term benefits to patients. CME also allows physicians to study a topic in-depth. Will physicians be able to get the information they need about a particular intervention from another source as effectively? CME is clearly effective about communicating important information about the practice of medicine, but it could be negatively impacted by the PPSA.

CME seeks to distance itself from industry bias in order to be as objective as possible in educating physicians. As such, physicians who serve as faculty are never paid through the manufacturer–only the CME providers, and asking manufacturers to disclose information about these kinds of payments seems to be unnecessary.


CME is considered a valuable way of disseminating information about innovative practices in medicine. The implementation of the PPSA could lead to a reduction in physician participation in these activities, which could in turn lead to reduced efficacy of patient outcomes. A better understanding of the effect the PPSA will have on CME programs will help eliminate bias against them.

For more information about this issue, contact the Kulkarni Law Firm.