Who Owns Veterinary Continuing Education? Part 3 of 4: Corporate CE and spectrum of care (#491)

In Part 3 of this series, I want to explore:

• How corporate sponsorship can quietly narrow the spectrum of care, and

• How an outcome-focused CPD system can help us reopen it.

  
  

Picture this.

You’re at a major conference, in a standing-room-only session on chronic enteropathy in dogs.

The speaker is excellent, the slides are polished, and the diagnostic workup on each case includes: full lab panel, abdominal ultrasound, GI panel, endoscopy with biopsies, and long-term branded diet and drug regimen.

Everything is labelled gold standard.

No one mentions what to do when the client has $400, not $4,000.

You walk out with an armful of notes, and a quiet sense that if you can’t deliver this level of care to every patient, you’re somehow less than.

That’s how continuing education can narrow the spectrum of care. Not by explicit decree, but by repeated exposure to one version of good medicine, often underwritten by companies that profit when that version becomes the norm.

In human medicine, the Institute of Medicine (IOM) has warned for years that when commercial entities are major funders and shapers of CE, there is real risk that education becomes a vehicle for market expansion rather than a neutral exploration of options.

The same forces are alive and well in veterinary CE.

What Spectrum of Care Really Means

At its core, spectrum of care acknowledges three realities:

• Patients differ

  
  

  • Age, comorbidities, temperament, disease stage.

    
    

• Clients differ

  
  

  • Finances, values, risk tolerance, cultural background.

    
    

• Contexts differ

  
  

  • Rural vs urban, 24-hour vs solo practice, well-insured vs cash-only communities.

    
    

For any given problem - say, a dog with cruciate disease or a cat with CKD - there isn’t one morally superior pathway.

There’s a range of reasonable diagnostics and treatments, each with trade-offs: cost, invasiveness, likelihood of success, and impact on quality of life (for animal and humans).

Spectrum of care isn’t doing less.

It’s matching care to context in a way that’s transparent, ethical, and grounded in evidence where evidence exists.

How Corporate CE Narrows the Spectrum

Corporate involvement in CE is not inherently evil. As the IOM notes, commercially linked organizations can bring resources, logistical skill, and high-quality materials.

The problem is what gets repeated, normalized, and rewarded when sponsors have a strong say in: topic selection, speaker choice, and framing of “standard of care.”

Here are a few common patterns:

1. The “Gold Standard” as Default

• Sponsored CE often anchors on:

  
  

  • advanced imaging,

    
    

  • specialty procedures,

    
    

  • newest (often expensive) drugs,

    
    

  • branded diets, and

    
    

  • high-tech monitoring.

• Lower-cost or “good-enough” paths - careful history, good physical exam, trial therapies, watchful waiting, palliative care - may be mentioned only briefly, framed as compromises rather than legitimate options for many families.

• Over time, attendees internalize a hierarchy:

Gold standard (shiny, sponsored, tech-heavy).

Everything else (awkward, second-tier, “if you must”).

• That’s spectrum-narrowing.

2. Standard of Care = Standard Product Pathway

• When the same companies that sell the tests and treatments also fund the education, standard of care can quietly morph into standard product pathway.

  
  

• For example:

  
  

  • Workups are built around panels and platforms from a single provider.

    
    

  • Monitoring plans revolve around proprietary apps or wearable tech.

    
    

  • Case examples are selected where these tools clearly save the day.

    
    

• There may be little discussion of:

  
  

  • when a cheaper test is enough,

    
    

  • when a trial of therapy without advanced diagnostics is reasonable,

    
    

  • when not to treat aggressively.

    
    

The IOM’s conflict-of-interest report on human CE highlights this risk explicitly:

Commercial entities have long used CE to shape prescribing and product usage, raising concerns about bias and market-driven education.

3. The Invisible Client

• In many CE talks, the client is an abstraction:

  
  

  • unlimited funds,

    
    

  • no competing responsibilities,

    
    

  • deep desire for maximal intervention.

Real clients are not like that.

Yet when client finances, culture, and emotional bandwidth are left out of the CE conversation, we implicitly teach:

• This is what good care looks like; if your clients can’t afford it, the problem is them, not the model.

  
  

• That mindset fuels moral distress in vets and shame in clients, and squeezes the spectrum of care down to a narrow corridor.

  
  

How a CPD Lens Re-Opens the Spectrum

In Part 2, we talked about moving from counting hours to measuring impact.

Outcome-focused CPD asks:

• What problem are you trying to solve in your actual practice?

  
  

• What learning will help you solve it?

  
  

• What changed as a result?

If we put spectrum of care at the center of that process, the picture shifts dramatically:

1. Start With Local Reality, Not Sponsor Priorities

• Under a CPD model, your starting question might be:

  
  

  • How can we offer realistic options for pyometra when half our clients don’t have access to credit?

    
    

  • How do we manage CHF in a town where referral is 5 hours away?

    
    

  • What spectrum of care makes sense for diabetic cats in our community?

    
    

• From there, you seek out or design learning that speaks to those questions, not simply whichever sponsor is currently touring a roadshow.

• The IOM argues that CE/CPD funding should be:

• Aligned with the goals of quality and safety, free from conflicted financing wherever possible, and

  
  

• Part of a comprehensive system of professional development.

• If we adapt that principle to veterinary CE, then spectrum-of-care work becomes a high-value CPD target, not an afterthought.

2. Treat Cost and Context as Clinical Variables

• In an outcome-focused CPD project, your audit forms might explicitly include:

  
  

  • approximate cost of each diagnostic and treatment path,

    
    

  • how many options were presented to the client,

    
    

  • what the client ultimately chose, and why,

    
    

  • short- and medium-term outcomes.

    
    

• Then you ask:

• Are there low-cost pathways delivering surprisingly good outcomes?

  
  

• Are we over-using high-cost options without clear gain?

  
  

• Where are clients declining all care because the only option offered was the “gold standard”?

• This kind of practice-based investigation is exactly the sort of activity the IOM envisages when it talks about CPD as part of an “evidence-based learning system” that can improve quality and value of care.

• Now spectrum of care isn’t theoretical; it’s mapped onto your own caseload.

  
  

3. Design CE That Explicitly Explores the Spectrum

• Imagine CE sessions built like this:

  
  

  • Present a common problem (e.g., canine cruciate, feline hyperthyroidism).

    
    

  • Walk through three or four genuinely viable care pathways:

    
    

    • full referral-level workup and intervention,

      
      

    • mid-range shared care approach,

      
      

    • minimalist option focused on comfort and function,

      
      

    • palliative-only path in appropriate cases.

      
      

• For each path, discuss:

  
  

  • expected outcomes,

    
    

  • costs (to client and clinic),

    
    

  • ethical considerations,

    
    

  • communication challenges.

• Now ask the room:

  
  

  • Which of these paths is available in your practice?

    
    

  • Which one(s) do you talk about - and which do you silently omit?

    
    

  • What would it take to broaden your menu of options?

    
    

• Corporate sponsors can still support such sessions, but only if they accept that their product is one tool among many, not the star of the show.

  
  

4. Build Spectrum-of-Care Metrics Into CPD

• If regulators and colleges begin to reward outcome-focused CPD, we can make spectrum of care part of what counts.

  
  

• For example:

  
  

  • CPD credit for documented projects that:

    
    

    • increase the number of options routinely offered for certain conditions,

      
      

    • improve client understanding and satisfaction around trade-offs,

      
      

    • reduce the number of clients who decline all care because the only option offered was unaffordable.

      
      

• Recognition for practices that can show:

  
  

  • stable or improved clinical outcomes and

    
    

  • a wider spread of acceptable care pathways.

• This shifts the center of gravity:

• Away from Did you attend the new chemo-drug talk? and

  
  

• Toward Did you broaden and improve the real-world care you can offer?

What CE Providers and Societies Can Do (Right Now)

Professional organizations and CE providers sit at the junction between sponsors and learners. The IOM points out they, too, can have conflicts - juggling their role as protectors of the profession with their need for sponsorship income.

Some concrete moves they can make:

1. Require spectrum of care to be addressed in clinical sessions.

   
   

   • No single-path “gold standard only” talks.

     
     

   • Speakers must outline at least two or three reasonable options, including lower-cost or palliative paths where appropriate.

     
     

2. Label sponsored sessions clearly, and balance them.

   
   

   • Sponsored talks are clearly marked as such.

     
     

   • For every heavily sponsored gold standard session, offer independent sessions on spectrum-appropriate care.

     
     

3. Include client and nurse voices.

   
   

   • Panels that include technicians and client representatives can sharpen the discussion on what is realistic, humane, and sustainable.

     
     

4. Promote practice-based CPD.

   
   

   • Offer tracks or awards for vets who bring data from their own spectrum-of-care projects - real cases, real numbers, honest reflections.

     
     

These steps don’t ban sponsorship; they re-balance the conversation so the spectrum of care stays visible.

What You Can Do as an Individual Vet

Even without systemic change, you can start to reclaim the spectrum in your own learning:

• When attending CE, ask yourself:

  
  

  • What would this look like in a low-budget context?

    
    

  • What are the minimum diagnostics I truly need to move forward safely?

    
    

  • How would I handle this if referral wasn’t possible?

    
    

• When you’re the speaker:

  
  

  • Always present more than one care pathway.

    
    

  • Be explicit about costs and trade-offs.

    
    

  • Name spectrum of care out loud; normalize it.

    
    

• In your CPD portfolio:

  
  

  • Document cases where you deliberately chose a different point on the spectrum and what happened.

    
    

  • Reflect on how CE influenced those choices, for better or worse.

    
    

In other words, don’t just ask: What did I learn?

Ask: Did this CE expand or shrink the options I feel comfortable offering?

Bringing It Back to the Core Question

The IOM’s central message about CE financing and regulation is simple but powerful:

• Funding is patchy and often conflicted.

  
  

• Commercial entities are major players in CE, especially in medicine and pharmacy, raising persistent concerns about bias.

  
  

• To protect the integrity of professional development, CE should be free of undue influence from conflicts of interest, and funding should be aligned with quality and safety, not marketing.

If we apply that to veterinary medicine, then spectrum of care is not a soft, optional side topic. It’s a stress test of our CE system:

• If sponsorship narrows the spectrum until only high-cost pathways feel legitimate, our education has failed its patients.

  
  

• If outcome-focused CPD helps us reclaim a realistic, ethical, evidence-informed range of options, then we are doing what education is supposed to do:

  
  

  Freeing us to think more clearly, not binding us to a single script.

In Part 4, I’ll try to bring these strands together with a proposal for a Veterinary CPD Observatory.

A practical, transparent way to monitor who funds our CE, what it teaches, and how it shapes the care we actually deliver.

#bunyipsbooksbeyond