Writer Jill Max quoted Lawrence S. Cohen, M.D., as saying: “One of the challenges in the environment is that physicians, because of managed care, find it increasingly difficult to leave the practice and go to a meeting.” [“Yale CME Gets a New Lease on Lifelong Learning,” Fall/Winter 2004.] I find this statement contrary to my experience with the Southern California Permanente Medical Group (SCPMG), a part of Kaiser-Permanente.

I joined SCPMG in July 1967 and became chief of ob/gyn. From the beginning, my department had weekly, mandatory, half-day CME meetings plus a weekly Friday morning hour for quality review. Speakers from the Department of Reproductive Medicine at the University of California, San Diego, were often present. Later, when the UCSD residency began, our hospital was the first in San Diego to have a resident.

Our partnership agreement specifies a half-day weekly of paid education time plus one week paid yearly to attend an educational meeting. I never had these benefits when I was in solo practice in Brockton, Mass. Because of these educational opportunities, as regional clinical coordinator for SCPMG, I was involved in improving the quality of practice. Two of our hospitals, in San Diego and Los Angeles, became No. 1 and No. 2 in the state for quality.

Myron K. Nobile, M.D. ’47, HS ’54
La Jolla, Calif.

Dr. Cohen responds: “My comments did not apply to groups such as yours, but they do apply to the average practitioner who is in a solo or group practice. In that instance, time away at conferences that award CME credits are not easily come by. It is true that grand rounds and specialty conferences are often given at the hospitals, but many physicians are not encouraged to attend; I applaud the success of your program at Kaiser-Permanente.”