March 24th, 2012

Whither Conferences? Searching for the South by Southwest Passage

Several Cardiology Fellows who are attending ACC.12 this week are blogging together on CardioExchange.  The Fellows include Tariq AhmadBill CornwellMegan CoylewrightJeremiah Depta, and John Ryan (moderator). Read the previous post here. Read the next post here.

Attendance to cardiology conferences is in decline. It is an obvious fact observed by the decreasing numbers of attendees in the halls walking between sessions, and perhaps more tellingly by the decreased number of companies willing to send exhibitors to the ACC and AHA to promote their products.

There are a variety of reasons given for this, the most popular one being that the poor economy is effecting both academic institutions and private practitioners. People also argue that there are simply too many meetings these days, especially as the field has become more subspecialized. Finally, the immediate digital availability of these conferences. A snapshot of my Twitter feed from an hour ago demonstrates that you can get a pretty good idea about the results being presented in real time:












However, I think these common conceptions are inaccurate and misleading I have another theory.

These common concerns could equally be applied to other conferences. However, Comic Con in San Diego continues to attract 130,000 attendees every year for four days of TV, science fiction and comic book discussions. Similarly, the South by South West Festival continues to grow every year, with attendance reaching 20,000 this past year a 100% increase from 4 years ago. Think that these pop culture comparisons aren’t fair? Fine, take the HIMSS conference focused on health care informatics held in Las Vegas just over a month ago: it surpassed expected attendance by 5,000, drawing 37,000 in all.

The audiences of these events aren’t immune to downturns in the economy, they have plenty of gatherings large and small to choose from, and they are at least as digitally savvy as cardiologists. These conferences clearly are providing an in-person experience that cardiology conferences are not, as manifest by their growth in numbers and our decline. I think the simplest reason that conference attendance at ACC and AHA is decreasing is because people are not getting enough out of it. The design and content has not evolved since the hay-day of 30,000-plus attendees. What worked before—such as the unveiling of clinical trials and vibrant exhibition halls—simply does not attract people anymore. In my opinion, the common thread contributing to the current growth in the events like South by Southwest is the focus on user-generated content and the fact that the attendees feel themselves to be a part of the conferences, not just seat fillers.

The organizers of the ACC, the AHA probably only have a few years to figure out how how to generate this sense of ownership.

How can this best be achieved?

Is it by increasing the number of abstracts accepted? Or does the manner in which the landmark trials are presented need to be changed? Our field needs your ideas, so please share them.

10 Responses to “Whither Conferences? Searching for the South by Southwest Passage”

  1. Steven Greer, MD says:

    Dr. Ryan

    I like this posting. I would add this fact that differentiates medical conferences from the other ones you list. All medical conferences are paid for by the drug and device companies. Without them, they would not exist. This is not the case for ComicCon, for example.

    The bad economy results in fewer people insured which means fewer drug prescriptions are filled and fewer elective procedures and non-elective procedures are performed. This has caused companies to merge, so there are fewer drug and biotech companies. Also, the budgets for those companies are slashed.

    Then, add to all of this the new laws making payments to doctors more transparent and the IOM ethics guidelines to distance meetings from bias of industry, and you get ghost towns at the ACC and AHA.

    And lastly, were most of these meetings really anything other than paid junkets for doctors to get away? Were the breaking trials essential to see presented in a short plenary session with little Q&A? Weren’t these meetings just industry trade shows?

  2. Steven Greer, MD says:

    “Medical meetings” still not adhering to industry bias guidelines

  3. One cannot help but agree, particularly the ghost-town impression.

    On the other hand, in those days of the 30K+ attendees at the conferences, the atmosphere was much more festive, with give-aways galore, including pillows (yes!) as I recall.

    Hubbub, schmooze, and non-academic, almost amusement park background did foster more personal and human contact. The rest of medicine is also much changed… we like to think for the better. The well attended trade shows do have more “entertainment value” and lattitude.

    I believe there is also a relationship between the decline in physician autonomy and the influence of electronic records and guidelines, vis-a-vis the perception of what will be gained by personal attendance at the conferences compared to reading abstracts, reviews, discussions, and video clips. Attendance and support by industry, in terms of what their stake may be, and priorities of allocation, roughly mirrors these changes.

    The success of the European congresses may hold some answers.

    Richard Kones MD

  4. Stewart Mann, DM (Oxon), FRCP(UK), FRACP says:

    Some of us are also beginning to have at least a twinge of conscience about the huge carbon cost of national/international conferences, especially from delegate travel.

  5. Thank you for the insightful comments. It certainly seems that the conferences of times past were more lively affairs, and I appreciated the “trade show” comparison. I think the issue regarding physician autonomy is important as this may contribute to decreasing the yield from these meetings. Finally of course there is the issue of increased of all gifts given to physicians-

  6. Karen Politis, MD says:

    Years ago, conferences used to be a lifeline for physicians working outside academic teaching centers. Books and journals were our only arternative to keep up-to-date. We would return from conferences inspired and ready to improve our daily routines, having learned a lot in just a few days, from excellent lectures, lively dialogue and informal discussions with old and new friends.
    Today, one comes home with a feeling of having wasted time. Much of the information is readily available online. Many lectures have flashy titles, but end up rehashing what we already know. There is a lot of pomp and circumstance, but rare moments of inspiration.
    Given the carbon footprint Dr. Mann mentioned, and the possibilities of the internet, plus less funding from Pharma, I believe that the age of conferences as we know them is at an end. Give me something that will amaze, inspire and make me feel happy I attended, and I will gladly pay my way, as people who go to South by Southwest.

  7. Adding to the contributory factors of attendance shortfalls: subspecialization and increasing complex technology within cardiology may also be reducing the global attendance.

    Duplicating the “trinket effect” of practically-useless novelties–other than pens and post-it notes–upon liveliness at meetings will require a very different and unique solution, if there is one. Truth be known, the vast majority of such items sat in office drawers unused, and eventually were disgarded. Quite wasteful, really.

    Disillusionment and lack of gratification with practice is common, and this too plays a role in enthusiasm and motivation to learn. Attendance may be a barometer of this mood.

    Of greater concern is the potential void in educational funding, as industry support recedes. The dilemma is outlined by Howard Brody in J Law Medicine & Ethics, Unless this problem is addressed, attempting to legislate something-out-of-nothing may result in a morass with potentialy unanticipated consequences. Funding for medical education and research is being ratcheted down, yet demands continue to rise. Greater productivity and relevance are expected, despite an increasing administrative and regulatory burden.

    The question posed by Dr Ryan is really a multi-headed hydra, and may not be easily solved through novel improvements in meeting content, although that may certainly be a great beginning.

    Richard Kones MD

  8. The external milieu of practice, particularly cardiology, is changed forever, and medical education will follow. The ambience and sense of satisfaction described by Dr Politis may soon be a nostalgic memory. Meetings will change as part of a sea change in the greater whole—an obligatory metamorphosis imposed upon practitioners by a combination of circumstances.

    The added value of meetings, compared to electronic methods of learning, depends upon one’s position and point of view. Industry, unsponsored solo practitioners, general cardiologists in groups whose expenses are prepaid, technological developers, and researchers will differ in their assessment.

    A commentary in today’s JAMA by John PA Ioannidis, whose work is revealing and thought-provoking, casts additional doubt about the future of meetings in the current traditional model: Are Medical Conferences Useful? And for Whom? JAMA. 3/28/2012;307(12):1257-1258.doi:10.1001/jama.2012.360 ( After considering the many issues, and the sheer number of meetings, Dr Ioannidis calls for objective study of the benefits vs the rewards. Almost immediately, however, it is apparent there will be competing interests in the outcome of such RCTs.

    Richard Kones MD

  9. Thanks for drawing our attention to this paper, Dr Kones. This is very helpful and a good read.

  10. Matthew Carr, MD says:

    The amazing on line “live” case presentatons, conferences, group discussions and didactic material have , in my estmation, made meetings unecessary. I get ore education at less cost and discomfort by watching the material on line or sold on flash drives tan I ever did by attending meetins. Wiht he exception of simulator work , Id rather not ever atttend a meeting ( except of course for the night life in San Fran, Vegas or NY)