Interview with Dr. Alexandra Howson – Episode 331

In today's episode, John's guest Dr. Alexandra Howson will explain why you should consider building a nonclinical CME and CE writing business.

During this interview, Dr. Alexandra Howson provides practical steps to leverage your medical background, apply adult education principles, and tap into the multi-billion dollar industry of continuing medical education.

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The Journey to CME Writing

In this engaging conversation, John explores Dr. Alexandra Howson's fascinating transition from a trauma operating room nurse to a seasoned academician in Scotland and her subsequent leap into the world of medical writing. Dr. Howson shares her experiences, challenges, and the pivotal moments that led her to focus on continuing medical education (CME) as a thriving career choice.

Building a Writing Career

Alex sheds light on the intricacies of the CME world, emphasizing the importance of foundational skills, adult learning principles, and the dynamic nature of the field. The discussion delves into the pros and cons of pursuing a career in CME writing. And she offers valuable insights for clinicians considering a transition. Additionally, Dr. Howson provides practical advice on freelancing, building a sustainable business, and the rewards of networking within the CME community.


Connect with Dr. Alexandra Howson by visiting her official website for insightful blog posts, podcasts, and free guides on CME writing. Engage with her on LinkedIn for ongoing discussions and professional updates. Explore her Write Medicine podcast on platforms like Apple Podcasts or Spotify, delving into best practices and trends in CME. Consider joining her Write CME Pro membership for comprehensive coaching and professional development, or explore the University of Chicago Medical Writing Certificate Program for further credentials in the field.

For those interested in in-depth coaching and professional development in CME writing, consider exploring Dr. Howson's Write CME Pro membership. Details about the membership, including benefits and upcoming sessions, can be found on her official website.

NOTE: Look below for a transcript of today's episode. 

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Transcription PNC Podcast Episode 331

Why Build Your Own Rewarding CME and CE Writing Business?

- Interview with Dr. Alexandra Howson

John: I've spent a lot of time promoting continuing education over the years. In fact, I did probably over a hundred surveys for the ACCME and I just think it's always been something that I wanted to promote for my colleagues and when I was working in the hospital setting and so forth.

That's one reason why I am really anxious to talk to today's guest. The other is I love medical writing. I've had some other guests that talked about medical writing in the past. And when I recently discovered today's guest as being a CME and CE writer who also trains people to be medical writers, specifically in these areas, I just knew I had to have her here today. I think you'll really appreciate today's interview. So, hello and welcome, Dr. Alexandra Howson. I'm glad to have you here.

Dr. Alexandra Howson: I'm really happy to be here, John. Thank you for inviting me.

John: And I didn't mention, but it'll come up later. The fact that you're another podcaster of course also means that we have this kind of connection. This is going to be a lot of fun. I really want to pick your brain a lot because what I do is try to really find opportunities for listeners to pursue certain nonclinical, nontraditional careers. And this is one excellent one.

Dr. Alexandra Howson: It really is.

John: So, it's going to be fun. All right. To start off, I need you to give us a little bit about your background, education, clinical career, and maybe even why you left clinical activities.

Dr. Alexandra Howson: Oh, yeah, sure. Absolutely. I trained as a nurse about a hundred years ago in Scotland and worked as a trauma nurse in a regional trauma center for several years. As your listeners will know trauma is fast paced, it's pretty challenging. The turnaround times can be excruciating. And at some point I started toying with the idea of moving out of healthcare because I wasn't burned out. That's a very particular term, but I definitely felt frazzled and wasn't really sure what my long-term future in healthcare was going to look like. I really wanted the opportunity to do a deeper dive into medicine, health, and healing.

I trained as a nurse at a time in Scotland in the 1980s just before university programs for nurses were launched. I was still in the hospital-college system, so I didn't have a degree, and I really wanted the opportunity to do some academic work. And so, I had an opportunity to go to the University of Edinburgh to do an undergraduate degree in the late 1980s. I loved learning or writing and doing research, and so I stayed in academia for another 10 to 15 years hunkered down. I did a master's and a PhD and ended up teaching and doing research at University of Edinburgh and University of Aberdeen.

But I've stayed very much in the world of healthcare. Teaching courses on sociology of health and illness, medical sociology, doing research on public health and women's health, and teaching medical students in the context of health communication and public health courses that they did at the University of Edinburgh, University of Aberdeen.

John: Okay. That was definitely a right turn into academics. That was a big undertaking. But then it sets you up really well for being a writer and for teaching writing and that kind of thing. When did you really get into that aspect? Once you had become an academician, you were working at University. Just tell us more about that transition.

Dr. Alexandra Howson: Yeah, more of a push than a pull in a sense. As an academic and as a nurse, actually, I had been writing a little bit. And as an academic, of course, you're writing, you're publishing. I'd written books and research papers and that kind of thing. But my family moved from Scotland to the US in 2004, just toward the end of 2004.

And I looked for an academic job and I couldn't get one. That was the push part. In retrospect, I think this might have a bearing on some of the things that your audience experience. I think there were two things. One is I didn't really have an academic network in the US. I was at Berkeley for a year as a research scholar, but I didn't really build my network when we moved to the states.

The second thing is my heart wasn't in it. Academia in the UK in the 1990s got very research funding focused, and I wasn't really sure that I wanted to be in that mix, and I didn't really know what academia in the US looked like. I think there were kind of two things there that meant my search was half-hearted, to say the least.

Things really shifted for me when I stopped looking for jobs and started looking for work. I took a big step back in 2005, 2006, and started to look at what my skillset was and really that centered around of trifecta of research writing and teaching. And so, I started to look for work that would allow me to do those things.

And in that process, I found the American Medical Writers Association, which is a fantastic resource for anybody who's thinking about moving out of clinical practice into the medical writing world, which is a very vast world. I discovered that pretty quickly. There's regulatory, there's marketing copy, there's consumer health, patient education, and I found continuing medical education. I did a workshop at an annual conference probably around 2007 and knew at that point I'd found my sweet spot because CME and continuing education for health professionals requires research, writing. And as a writer, if I'm not doing the teaching, at least I have to understand what adult learning looks like and how to write in a way that promotes adult learning.

John: Yeah. And we all need to be continuing our education, but on top of that, we all are required to continue our education. So, there's a big demand there ongoing.

Dr. Alexandra Howson: There is. There absolutely is. And that's actually one of the things that makes CME such an attractive proposition for clinicians who are looking to move into medical writing because it's a multi-billion dollar industry apart from anything else. It's not going away anytime soon because of that mandatory requirement. And there is some interesting and creative things going on in accredited CME that aren't really permitted on the promotional side of education. It's kind of an interesting field in that respect.

John: Now, as someone who helps others become writers of CME and CE, stepping back from your own reasons for getting into it, what are the pros and cons of if someone's considering this? Because there are certain requirements you have to meet, but I think it maybe needs a certain type of personality. I don't know. What are your thoughts on the pros and cons of pursuing this type of career?

Dr. Alexandra Howson: Yeah. Yeah. That's a great question. I think CME is a really good place for people who see themselves as lifelong learners as information synthesizers and as problem solvers. Because you're doing all of those things all of the time in CME as a writer. You do, of course, have to be able to write and have the basics of writing down. If you are somebody who enjoys writing, but haven't had a lot of opportunity to do that in clinical practice, the American Medical Writers Association has some great workshops where you can polish your skills and even get certification for basic skills like grammar and punctuation and those kinds of things. And those are things that we can forget when we're writing consistently. It's definitely something to consider.

Writing is kind of a foundational skill. Having an understanding of adult learning, which of course, as a clinician because of mandatory CME, you know the drill. Now, I think that if you're a clinician, you probably also have participated in some pretty bad education activities. But that all feeds into the mix in the sense of you know what's worked for you as a clinician and what has allowed you to put something into practice in your own clinical setting. I think that's something to carry with you into the continuing medical education world if you're thinking about that as a possibility.

Being able to do the research and synthesize that information pretty quickly is a key skill. CME is fast-paced, and it's only getting faster because there's been a lot of private equity acquisition of continuing medical education companies with a different set, a different value set there in terms of turnaround times and that kind of thing. If you're a writer, you have to work pretty quickly in terms of finding out what the key data and research publications are, pulling that information together quickly. And also offering some synthesis and insight into what the kind of key findings are, and presenting that in a way for learners that is accessible and interesting and has applicability.

John: A couple things I guess I would comment on. Physicians and PhDs, we're doctors of all sorts like yourself. We've learned to sort of budget our time and keep our promises, but I feel like the medical writer in many cases has to be extremely self-disciplined. There's a schedule. Things are due, there are deadlines. And if you're working freelance, which I need to ask you that question too. Are most people freelance? Are most working for someone directly? You can maybe address both of those observations and questions.

Dr. Alexandra Howson: Yeah, absolutely. CME is actually one of the areas in medical writing, sort of under the medical writing umbrella in general, where there's a high rate of freelance work in comparison to something like regulatory, for instance, where that's very employment based. That's certainly a pro. If you are interested in the flexibility and freedom that can come with freelance work, you have to work at that in order to establish that flexibility for yourself. And I would say that in order to ensure that flexibility and freedom, the flip side of that is discipline as you suggest. You do have to think about how you're going to build your business as a freelance medical writer, whether it's in CME or not.

And I think this is certainly one of the areas for me where I experienced a kind of light bulb moment. I stopped thinking of myself as a freelancer and started thinking of myself as a freelance business owner. And then you start to get really serious about how you are going to build and sustain that business. Because you have to think about not only income, but revenue. You have to think about the bigger picture in terms of what you're bringing into the business, what you need to sustain the business, what you're going to pay yourself, how much you're going to use of your revenue to market, and what kind of marketing you're going to do, and what kind of long-term vision you have for the business you're building.

There's a lot of things to think about for sure. You can also not enter into that sort of business mindset and stay a little bit looser in that sort of freelance mindset. But I do know that things changed for me when I shifted into a kind of more business ownership type of mindset. Discipline is a huge part of not only building your business, but also keeping your promises. I like that phrase, to your clients, because you're going to be juggling more than one client at a time. And so, that scheduling can fall apart like a deck of cards. You have to kind of keep your finger on the pulse of all your different projects, when those timelines are due, the different tasks associated with those projects and the order you're going to do them in and those sorts of things.

John: Now, one of the things that's come up when I've spoken with other medical writers doing other things, let's say, other than the technical as you mentioned, is that at the beginning it seemed overwhelming. It's like you're looking for these people to work for as a freelancer, maybe doing journalistic or things aimed at the public, which is different from CME, which again, has those demands that you mentioned.

But what I've heard is that they find out, no, once you have an in and you have relationships with 2, 3, 4, it's recurring usually if you're doing a good job. And is that similar in the CME world?

Dr. Alexandra Howson: Repeat business is definitely the way to go. I think the first point that you mentioned there around relationships is key. CME is a very small world. It's pretty subterranean. It can be hard to find. I think it's a little different for physicians because obviously they have experience of doing CME. But it can still be tricky to find out who are the key players in the CME world. Fortunately, ACCME, the Accreditation Council for Continuing Medical Education makes that easy for us because it produces a quarterly list of every accredited provider. Well, you've done a lot of survey work for ACCME, so you know this. Every accredited provider in North America actually, and some in Europe as well. The European scene is very different. It's changing. It's always in flux.

And so, you can actually use that list as a starting point to think about a few things. First of all, the category of medical education provider you might be interested in working with. That could be medical societies like the American College of Cardiology, or it could be medical education companies. Medscape is a medical education company. And there are several other categories of providers.

That list also has the contact details for key people who are responsible for CME in those organizations. The list itself isn't kind of categorized. I actually have a categorized list that I share with my membership, but it's a good place to start. And there are some other places where you can find that information as well.

And to go back to your point about relationship building, you can use that as a way to take baby steps toward building relationships using LinkedIn. I know that you've talked about LinkedIn before on your podcast many, many times. It's a great resource for physicians thinking about this type of career move because not only do medical writers hang out on LinkedIn as their main social media platform, but also education providers as well. And there's a CME group on LinkedIn, which has about 13,000 members.

There are a lot of resources there to tap. Building relationships is a long game and it can often take six months to two years from that first contact point to securing a contract. But it's definitely a valuable marketplace to participate in and be visible in. And I think most importantly, engage with other people in the field.

John: Well, the nice thing about medical writing is that you can start doing it while you're still working clinically, or whatever you might've been doing before deciding to pursue this. So that's good. And you can do some of the things you've already mentioned.

Any other things for the fledgling writer, especially in CME or CE of other steps they can take? You've talked about networking, you've talked about accessing the ACCME list. Any other thoughts?

Dr. Alexandra Howson: Well, I think one of the key things I mentioned earlier is that it's a bit of a subterranean world. I think one of the key things is really to try and familiarize yourself with the landscape. Obviously physicians have an advantage. They know what CME is and why it's important, but getting a sense of who the kind of key players are, and what some of the key challenges and ongoing debates in the field are can also be helpful.

The alliance for continuing education in the health professions is the key organization to consider joining and participating in, to get that sense of what the field looks like. In comparison to some other memberships, the price point can be a little high, but they've just introduced a new to the field type of membership. I would recommend taking advantage of that and getting involved with that organization. That's certainly one thing to do. So, familiarizing yourself with the field.

The other thing is, there are ways to apprise yourself of key adult learning principles so that at least you have a kind of working knowledge of the basic foundation for CME. Adults like to learn at their own pace. They need access to information and education that is meaningful to their immediate clinical context. They want to be able to put things into practice right away. These kinds of things.

I think the other thing to think about is that writing isn't the only potential role for physicians as a nonclinical career. In CME you could think about being a clinical director, scientific director, medical director, so that you might do some writing as part of that role, but also be managing other writers to help create needs assessments, content for education activities and outcomes reports, which is the end result of all this education that we participate in and contribute to. And there are other roles like education strategy, business development, if you're interested in sales. There are a number of different things that physicians can do in CME.

John: One of the things I wanted to mention too, before I forget, is that for those who are listening or watching that aren't physicians, there are many non-physicians that write CME. So don't even directed at physicians for their requirements. I do some editing and I think half of the writers of the material I'm editing for physicians are written by non-physicians. Just like someone like you, master's, PhD, nurse, APN, PA, they just have the expertise and they have that mindset.

Dr. Alexandra Howson: Absolutely. And I think one of the things we've seen over the last few years is a growth in the movement of academics, researchers, nurses, pharmacists, radiographers, radiologists. A whole bunch of vets as well. Veterans.

John: I saw that on your podcast.

Dr. Alexandra Howson: Yes.

John: Did you interview a vet?

Dr. Alexandra Howson: Yeah, this morning actually we just released a podcast with a vet. So there are a lot of different types of clinicians who are moving into CME or trying to move into CME because they see it as a nourishing type of field to be working in.

John: Yeah. It is. It is. Well, we did mention that podcast so I want to hear more about the podcast. Why don't we segue to that now? Tell me how you started there, why you started the podcast, and what is the content that you're covering for the most part? Obviously probably about writing CME.

Dr. Alexandra Howson: Yeah. Like a lot of podcasts, the podcast has evolved a little bit. We are just coming to the end of our third year. I started the podcast in 2020, mainly as a way to actually keep in contact with my peers and colleagues in CME. And that has evolved into a couple of things. One is celebrating and elevating the work of the people who create education that supports health professionals.

And the second thing is to really use the podcast to explore best practices in creating that content. We focus on adult learning, we focus on formats. We focus on healthcare trends that influence the type of content that we create and a number of other things as well.

And I guess the third thing, there's three things. Every good thing comes in threes. It's to use the podcast as a place to share resources and support for people who are working in this field, because it's fast-paced. It's actually quite challenging to have access to practical resources to help you kind of do your daily work.

John: Yeah. And it's called Write Medicine. Is that correct?

Dr. Alexandra Howson: It's called Write Medicine. And we do talk about writing as well. We talk about things like storytelling. What that means in a clinical education context, we had Jay Baruch, who's an ER physician in Rhode Island. I think he published a book called Tornado of Life earlier this year. So, that episode really focused on patient stories and the significance of patient stories for clinical care and your own practice as a clinician. But also using writing as a way to work through your own clinical practice challenges. We talk about storytelling on the podcast as well as other things that contribute to creating content.

John: Very good. And I was going to thank you before a minute ago when you mentioned the Alliance, because I've had many medical writers. I've never actually had anyone mention, we've never discussed the Alliance before. And so, I'm glad you brought that up because that is an awesome resource.

Dr. Alexandra Howson: It is, absolutely.

John: Now another great resource is you because I know that you have some courses on your website. is your overall website for what you do.

Dr. Alexandra Howson: Correct.

John: But there's some really pretty interesting resources there. And I think this is one of the reasons why I started the podcast too, is because we're looking for these resources they didn't exist. And over time I've been able to make these connections with people like you that are creating things that if only more people knew about them. Tell us a little bit more about those things that you do.

Dr. Alexandra Howson: Sure. Absolutely. And first of all, yeah, I think you're right. I know that we've been talking about the creator economy for a couple of years now, but we're moving into an educator creator economy where people are not getting access to the support and information that they need to do their work. I think that's an interesting shift. I have a free guide, Write CME Roadmap, which provides information for people who are thinking about moving into CME. It's an eBook with a private podcast attached to it so you can listen on the go.

John: Nice.

Dr. Alexandra Howson: Yeah. You can listen on the go. You don't have to be tied to your laptop or your computer to read an eBook. And that the guide really takes you through some of the things that we've talked about today. And it's the first stepping stone if you're really not that familiar with CME. The podcast itself, of course, I see it as a resource.

I write a blog. There are a lot of articles on my blog around how to start thinking about building a portfolio. What are some of the key things that you need to be thinking about in terms of identifying your own skills if you're thinking of moving into CME. There are a lot of resources in the blog as well. And I run coaching programs and professional development membership, Write CME Pro, for people who are looking to build and grow their business into a sustainable business in CME.

John: Okay. I was curious about that. The Write CME Pro. That has more looking at the business aspects of it, the marketing or even the formation like forming an LLC or not forming an LLC. Those kind of conversations.

Dr. Alexandra Howson: Yeah. Actually we'll be doing more of that going into 2024 with the current cohort, but Write CME Pro does a number of things. First of all, we pull in experts from the CME world every couple of months or so to talk about things like accreditation which as a writer, you don't necessarily need to know all the ins and outs, but you do need to understand the significance of accreditation in the CME world. One of the things that I find, maybe you find this too, is that people can get very confused between accredited continuing education and promotional education and conflate the few. And it's important to separate those.

We have experts who come into the membership and share their perspectives on a whole bunch of different things including marketing and things to think about when you're building your business. We've just completed a series on that with Lori De Milto and Genevieve Walker who are experts in these fields and also our colleagues who teach along with me on the University of Chicago Medical Writing Professional Certificate Program.

John: Tell me about that certificate because people ask me all the time. Is there something I can do? Should I get a master's degree in writing or something? Or should I get a certificate from some organization? That sounds a little bit like something like that.

Dr. Alexandra Howson: Yeah. Their certificate program, it's the medical writing and editing certificate program at the University of Chicago. It used to be part of the Graham school. It's part of their business and professional development portfolio. There are core and elective modules in that program. Things like regulatory writing, clinical trials, publications. I teach ethics, medical writing and editing ethics, marketing and building a freelance business. There's a couple of other modules on the program as well.

And we do find a lot of health professionals are taking this program precisely for that reason. They are looking for a way to solidify and credentialize that shift from clinical practice into medical writing.

John: Okay. Now I have to apologize for that digression because I still had questions about Write CME Pro. That sounds very interesting with other experts and yourself involved. Is this something that's live, ongoing? Is it like group coaching? Is it recorded?

Dr. Alexandra Howson: Yes, yes. Every quarter we'll have an expert perspective. Every month we have group coaching, so we'll focus on practical things and do sprints. For instance, this year we've done sprints on writing outcomes reports, developing patient cases and writing test questions, which is an area of premium skill that is very challenging to learn. We bring in experts for that. Yeah, we have group coaching. We have replays, obviously, for people who can't make live sessions. We do the coaching live online. I'm actually shifting that to a private podcast. I'm all about private podcasts in 2024 because we're all busy. And being able to listen and learn on the move can be really helpful.

There are a lot of resources that we build up in Write CME Pro that are exclusive to members. Yeah, it's ongoing. In 2024 we'll be focusing a little more on things like building your business. Once you get going and you have a few clients, what do you need to start thinking about in terms of systems and in terms of a tech stack? And those sorts of things.

John: Okay. That helps a lot because you don't have one cohort that goes together for six months or a year. It sounds like its set up as a membership. People can just keep coming and they can drop off, of course, but as long as they're getting value, they just keep coming back and participating and you keep adding and growing the content.

Dr. Alexandra Howson: It is an ongoing professional development membership. We will be starting a cohort-based coaching program in the spring called CMEpreneur. It'll be a shorter program to get people sort of up and running. That they have all the tools in place they need to break into CME and build their business.

John: All right. Again, where do we go to find all that? That's all under your website, right?

Dr. Alexandra Howson: All the information that we've been talking about today is on, the podcast, the blog. You can also find me on LinkedIn. I encourage you to connect with me on LinkedIn. I love to have conversations with people. I spend quite a bit of time on LinkedIn every day. So, I'd love it if you could connect with me there.

John: Excellent.

Dr. Alexandra Howsen: Yeah, that's the main place.

John: All right. Well, that has been very useful and exciting to me to hear everything because I didn't even know about you six months ago. So now here I am, I got a podcast to listen to and all this stuff to learn about and share with my listeners.

This has been really fun. We're a little over our time, but any last words of encouragement for people out there, physicians and non-physicians, other clinicians who are thinking, "Eh, maybe I need to do something besides clinical in terms of looking at writing educational educationally?"

Dr. Alexandra Howsen: Yes. You have what you need to move into CME. One of the things I see again and again is heavy duty smart people coming from clinical settings and healthcare and moving out of that professional context into medical writing. And almost instantly losing a sense of identity and competence. But you have those things. Make connections, network with your peers, join some kind of group. Know that you already have the skills that you need in order to be a successful writer in the continuing medical education world.

John: Well, thanks for those inspiring words and I really appreciate you for being here today, Alex. It's been a lot of fun. I've learned a lot. Thanks a lot for being a guest on the podcast.

Dr. Alexandra Howsen: I really enjoyed it, John. Thanks a lot for inviting me. I appreciate it.

John: You're welcome. All right. Bye-Bye

Dr. Alexandra Howsen: Bye-Bye.


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