Continuing Vacation.

• Author: AUSTIN, ELIZABETH
• Position: Taxpayers subsidize continuing education

While doctors and lawyers hit the slopes, you foot the bill

There's a kayaking trip off the Baja peninsula, scuba diving in sunny Palau, an exhilarating climb up Tanzania's Mount Kilimanjaro, whitewater rafting in Chile, even a dog-sledding adventure in Canada's Northwest Territories.

All of these exotic vacations have one thing in common: Every year, you, the taxpayers, pay for doctors to enjoy these trips and others like them. Most doctors are required to complete credits of continuing education (CE) to help them keep abreast of the latest changes in fast-moving modern medicine--and to keep their licenses. To encourage CE, the federal government allows doctors, as well as lawyers, dentists, and numerous other professionals, to deduct expenses--including travel, food, lodging, and entertainment--from their taxes.

And so they do, with gusto. As a result, by far the most popular sites for CE are out-of-state, almost always in places associated more with fun and frolic than with the pursuit of knowledge. The classes often bear only a tenuous link to the practice of medicine. The scuba diving expedition teaches the latest in "dive medicine" to landlocked obstetricians. The kayaking and the dog-sledding trip offer "wilderness medicine" to urban practitioners.

The CE mess began with noble intentions back in the sixties, when the public began to realize that knowledge becomes outdated very quickly. A number of well-meaning state legislatures began requiring licensed professionals to take CE courses. Doctors topped the list, but other professions soon had requirements as well. The result was a bonanza for professional associations, which can draw up CE guidelines, accredit presenters (who pay a fee for the privilege), and then charge participants for each course they attend. With thousands--sometimes millions--of dollars in revenues at stake, the professional associations have little incentive to weed out worthless programs. And all too often, they don't.

Now, mandatory CE is often just an excuse for a glorified (and subsidized) vacation. A study in the Journal of the American Medical Association (JAMA) noted that only 27 percent of the physicians' CE hours were spent in their home communities, and 53 percent were spent out of state. In short, in the absence of careful scrutiny, continuing education for America's professionals has become not a tool for keeping vital skills sharp, but a profitable business opportunity. The American Society for Training and Development estimates the CE industry has grown to $10 billion annually, most of which is tax deductible.

There is no shortage of exotic education--nor of willing participants. The State Bar Association of Ohio, for example, demands that lawyers keep up to speed on the latest developments in the legal profession by enduring hours of CE classes. But these poor souls don't suffer through the legal implications of DNA testing in Youngstown or Dayton; far more often they're in Acapulco or Puerto...