The Future of Continuing Medical Education
Nine in ten physicians say they would use online CME after the pandemic, and 48 states mandate it. That combination of regulatory requirement and shifting delivery format gives CME one of the more predictable revenue models in education, and deal flow held at 37 transactions in 2023.
Continuing medical education has a characteristic that most education categories would envy: the customer is legally required to buy it. Forty-eight states enforce specific CME requirements, and continuing education is necessary not only for maintaining state medical licenses and specialty board certifications but for keeping current in a field where treatments and protocols change constantly. That mandate produces revenue predictability for industry participants, which in turn produces a steady bid from both strategic and financial acquirers.
What is changing is delivery. In-person CME remains popular, but online and blended learning are rapidly replacing traditional classroom methods, helped by the adaptable nature of medical content. Nine in ten physicians report they would use online CME after the pandemic, and 72% of those who normally preferred in-person would switch. The global CME market, valued at $9.2 billion in 2022, is expected to reach $15.8 billion by 2031 at a 6.2% CAGR. Underneath that, deal flow rose slightly in 2023 to 37 transactions, with strategic buyers taking 57% of activity, a reversal from the years when financial buyers dominated.
How Mandated Requirements, Digital Delivery, and Precision Education Are Reshaping Continuing Medical Education M&A
Demand is mandated and consistently high. Healthcare professionals must stay current with the latest advancements, treatments, and practices to ensure the highest standards of patient care. The expected 13% growth in healthcare professions and the requirement for CME in 48 states demonstrate a critical need for diverse CME solutions.
E-learning fits how clinicians actually work. E-learning is increasingly favored among healthcare professionals because it provides flexible, precise learning opportunities and bite-sized modules that fit into busy schedules. Precision education, where content depends on the skills of the individual, aligns well with e-learning delivery.
Digital and hybrid delivery is now the default. The transition toward digital and hybrid delivery responds to the COVID-19 pandemic while strategically enhancing accessibility and flexibility for healthcare professionals. Notably, 9 out of 10 doctors surveyed prefer online CME post-pandemic.
New technology is changing the product. The incorporation of artificial intelligence, virtual and augmented reality, and simulation is significantly transforming the CME landscape, offering more immersive and effective educational experiences than lecture-based formats can.
The buyer mix has flipped. Strategic buyers were more acquisitive in the space in 2023 compared to the past, where financial buyers dominated. Of the 37 transactions in 2023, 21 came from strategics and 16 from financial buyers.
Three specialties are drawing the interest. Key medical specialties experiencing growth and deal interest include oncology, pharmaceuticals, and mental health and wellness, each with its own content cadence and its own set of scaled acquirers.
Deal flow ticked up in 2023. The CME market experienced a slight increase in deal-flow in 2023 with 37 transactions against 33 in 2022, driven by consolidation trends, technological advancements, and global expansion efforts. Of transactions with disclosed valuations, the median deal size was $2.7 million for buyouts and $15.5 million for strategic and financial transactions.
CME Industry Outlook
The global CME market, valued at $9.2 billion in 2022, is expected to reach $15.8 billion by 2031, growing at a steady 6.2% CAGR. That growth is fueled by widespread adoption of online education post-COVID and increasing demand to fulfill CME requirements. The shift to digital platforms during the pandemic produced a surge in online medical education tools offering interactive and flexible learning experiences.
Online tools, ranging from virtual classrooms to digital resource libraries, provide engaging multimedia content and real-time updates, which matter in a field where scope of practice changes constantly. Online CME programs also offer convenience and accessibility, letting practitioners meet educational needs anytime and anywhere. The industry income figures show how durable that demand is: revenue dipped in 2020 as live events stopped, then recovered past its pre-pandemic level by 2022.
| Activity Type | 2021 | 2022 |
|---|---|---|
| Regularly scheduled series | 544,940 | 571,251 |
| Live course | 392,432 | 437,257 |
| Enduring material | 191,756 | 227,260 |
| Other/blended learning | 36,880 | 36,199 |
| Journal CME/CE | 9,022 | 10,877 |
| Performance/quality improvement | 9,063 | 5,385 |
| Manuscript review | 2,305 | 2,013 |
| Internet searching and learning | 2,143 | 1,790 |
| Committee learning | 1,975 | 1,726 |
| Test-item writing | 1,326 | 1,232 |
| Learning from teaching | 783 | 742 |
| Total | 1,192,625 | 1,295,732 |
Key Trends & Drivers
Transition Toward Digital and Hybrid Delivery
Digital formats make learning more accessible and flexible, accommodating busy schedules and reducing barriers like travel. In a recent survey, 9 out of 10 physicians report that they would use online CME post-pandemic, and 72% of physicians in the survey who normally preferred in-person CME would switch to online. For providers, the practical consequence is that content libraries and platform economics now matter more than event logistics.
Precision Medical Education Is an Expectation
Precision medical education, inspired by President Obama’s 2015 initiative with the National Institutes of Health, mirrors the personalized approach of precision medicine by tailoring training and professional development for physicians. It aims to optimize learning outcomes and enhance patient care by integrating data and technology to improve personalization. In a 2024 report, the American Medical Association redefined its medical education strategy by including precision education as a priority. One standout initiative is Reconnect, an AI algorithm integrated into EHR systems by multiple AMA departments, which anticipates learning needs before patient visits.
Demand for Short, Digestible CME
Time management is a significant challenge for healthcare professionals, which drives growing demand for concise, easily digestible courses. Microlearning has emerged as a highly effective solution post-pandemic, and the evidence is specific: Medscape Education studies demonstrated a 19% improvement among diabetologists and endocrinologists and a 26% improvement compared to their pre-assessment after a 15-minute online audio summary. Interactive case-based microlearning modules increased the confidence of 65% of infectious diseases specialists and 40% of pulmonologists in diagnosing a particular disease. Accreditation bodies including the American Medical Association are now recognizing and accrediting short-duration educational activities, which promotes their integration into clinicians’ learning journeys.
Healthcare Professions See High Job Growth
Healthcare professions are expected to grow at 13%, driven by an aging population, increased access to healthcare, and advances in medical technology. The sector has proven resilient to economic downturns. As the healthcare industry continues to expand, the importance of well-trained staff increases with it, and the growth is concentrated in exactly the mid-level roles that carry heavy continuing education requirements.
Segment Highlight: Medical Simulation
The medical simulation market, particularly its augmented and virtual reality segment, is a rapidly evolving domain covering technologies designed to replicate clinical scenarios for educational and training purposes. AR and VR platforms offer immersive environments where healthcare professionals can practice and refine skills in a risk-free setting. The market was valued at $2.5 billion and is expected to reach $8.7 billion in 2030, growing at an 18.8% CAGR.
Several factors drive that growth. Foremost is a rising emphasis on patient safety: an estimated 250,000 patients die every year in the U.S. as a result of errors during medical procedures. Advances in AR and VR are enhancing the realism and effectiveness of simulation, increasing adoption among educational institutions and healthcare providers. And there is a persistent shortage of skilled professionals who need effective training. A Health Workforce Simulation Model report estimates a national shortage of 26,980 geriatricians by 2025: supply is expected to increase 74%, from 3,590 to 6,230 workers, while demand increases 45%, from 22,940 to 33,200.
Two 2024 transactions define the segment. In February, CAE, a longstanding leader in software-based simulation training, completed the sale of its healthcare business to Madison Industries for C$311 million. The division has since rebranded as Elevate Healthcare, offering simulation across anesthesia, cardiology, emergency medicine, and pediatrics, including an integration with Microsoft HoloLens. Also in February, NBME, a leading medical assessment organization, acquired MedVR Education, an extended reality platform specializing in healthcare skill development, for an undisclosed amount. That deal pairs MedVR’s simulation-based learning technology with NBME’s expertise in psychometrics and test development, extending the assessment portion of its learning modules.
M&A Overview
The CME market experienced a slight increase in deal-flow in 2023, driven by consolidation trends, technological advancements, and global expansion efforts. Among the 37 transactions, 21 were strategic buyers, or 57%, and 16 were financial buyers, or 43%. Of all transactions with disclosed valuations, the median deal size was $2.7 million for buyouts and $15.5 million for strategic and financial transactions. The tilt toward strategics is the notable change: financial buyers dominated this space in prior years.
Growing Healthcare Segments Receiving Investor Attention
Oncology. The oncology segment holds the highest market share of the CME market and is projected to grow at a 6.8% CAGR from 2024 to 2032. Cancer, the second leading cause of death in the US according to the CDC, has spurred increased interest among physicians in oncology-based CME programs, and the growing number of cancer patients drives physicians to enhance their skills. A key player is Clinical Education Alliance, acquired by The Riverside Company in 2020 and a debt financing issuer again in 2024.
Pharmaceuticals. The pharmaceutical segment provides essential education on the latest drug developments, clinical trials, and treatment protocols, addressing the need for continuous learning as new therapies arrive. In 2023, 55 novel drugs were approved in addition to variants of existing drugs. Notable deals in pharmaceutical CME over the last twelve months include TRC Healthcare, which offers programs to pharmacists and clinicians, and MediConf, which keeps physicians updated on drug development.
Neuroscience and mental wellness. This segment focuses on educating healthcare professionals about advances in neuroscience, mental health treatments, and patient care strategies. Notable transactions in the last twelve months include NEI Global, which helps professionals diagnose psychiatric and neurological diseases, and Empower Education, which offers courses for mental wellness coaches and health practitioners.
Notable Transactions
May 2024: Med Learning Group, a full-service accredited CME company offering case-based, interactive, patient-centric programs through both live and online activities, completed an acquisition of Talem Health supported by DW Healthcare Partners, a healthcare-focused private equity firm. MLG acquired Talem Health to leverage its expertise in supporting clinicians in rural and underserved communities, enhancing MLG’s ability to address health disparities and improve patient outcomes.
April 2024: LCW Medical Communications, which specializes in high-quality medical writing, editing, and consulting services, completed its acquisition of MediConf for an undisclosed amount. MediConf provides medical education and continuing professional development courses tailored for nurses and pharmacists, specializing in interactive webinar courses and also offering clinical training for general practitioners. Through the acquisition, LCW aims to expand its reach, diversify its curriculum, and drive innovation in medical education delivery.
July 2023: HMP Global, an omnichannel leader in healthcare content, events, and education and a portfolio company of Susquehanna Growth Equity, completed an acquisition of NEI Global for an undisclosed amount. NEI sought a partner to help accelerate growth and execute a series of growth initiatives while maintaining its industry reputation. With the acquisition, HMP Global adds an essential partner to its healthcare education offerings, helping clinicians meet continuing medical education requirements and professional education goals. Navagant was the sole financial advisor to NEI on this transaction.
Select Transactions
The table below covers CME and medical communications transactions from January 2023 through August 2024. Two things stand out. Medical communications and medical writing agencies change hands as often as accredited CME providers do, which reflects how closely pharma-funded content sits to accredited education. And the buyer list is heavily sponsor-populated at the platform level, with 424 Capital, Oak Hill, New Mountain, Achieve Partners, and Eden Capital all active, even as strategics took the majority of 2023 deal count.
| Date | Target | Acquirer | Target Business Description | EV ($mm) | EV/Rev | EV/EBITDA |
|---|---|---|---|---|---|---|
| 28-May-24 | DaVinci Education | Achieve Partners | Developer of a healthcare education platform | – | – | – |
| 22-May-24 | NEJM Healer | Lecturio | Operator of a medical education company | – | – | – |
| 16-Apr-24 | Med Learning Group | Unitranche | Provider of medical education services | – | – | – |
| 16-Apr-24 | MediConf | LCW Medical Communications | Provider of medical education and continuing professional development courses | – | – | – |
| 03-Apr-24 | Six Degrees Medical | 424 Capital | Provider of medical communications services | – | – | – |
| 29-Mar-24 | Talem Health | Med Learning Group | Provider of medical education services | – | – | – |
| 21-Mar-24 | InformMe | Bregal Unternehmerkapital | Developer of digital patient education software | – | – | – |
| 16-Feb-24 | Elevate Health | Madison Industries | Developer of simulation-based education technologies | $230.8 | 1.5x | – |
| 15-Feb-24 | MedVR Education | National Board of Medical Examiners | Manufacturer of virtual reality products for the healthcare industry | – | – | – |
| 14-Feb-24 | FORCE Communications | Oak Hill Capital | Provider of medical communication and engagement services | – | – | – |
| 01-Feb-24 | Avant Healthcare | New Mountain Capital | Operator of medical communications | – | – | – |
| 12-Jan-24 | Classward | Eden Capital | Provider of EMS educational services | – | – | – |
| 13-Dec-23 | Orion Santé | BNP Paribas Développement | Provider of healthcare education services in France | $17.4 | 2.0x | – |
| 13-Dec-23 | T3 Labs | Accelmed | Provider of medical device training | – | – | – |
| 20-Nov-23 | TRC Healthcare | Colibri Group | Provider of medical advisory services | – | – | – |
| 10-Oct-23 | Empowered Education | International Sports Sciences Association | Operator of an online educational platform | – | – | – |
| 03-Oct-23 | HCPro | AHIMA | Provider of information, training and consulting services for the healthcare industry | – | – | – |
| 31-Aug-23 | Advanced IT Concepts | FVLCRUM | Provider of systems and compliance services, including medical simulation and training | – | – | – |
| 29-Aug-23 | Wellstar MCG Health | Wellstar Health System | Provider of hospitals and healthcare | $797.0 | – | – |
| 08-Aug-23 | Nutrition in Motion | HUSK | Provider of nutrition consulting services | – | – | – |
| 04-Aug-23 | Bamboo Medical Communications | Aptitude Health | Operator of medical communications | – | – | – |
| 02-Aug-23 | Lifecast Body Simulation | 1315 Capital | Developer of synthetic human and animal models | – | – | – |
| 02-Aug-23 | Maformationmedicale.fr | L’institut de Thérapie Manuelle et de Physiothérapie | Operator of a healthcare training platform | – | – | – |
| 01-Aug-23 | Finger Lakes Health | University of Rochester Medical Center | Provider of healthcare | – | – | – |
| 01-Aug-23 | MyMedi.ca | Avicanna | Operator of a medical cannabis care platform | $2.7 | 0.4x | – |
| 11-Jul-23 | Elentra | Achieve Partners | Developer of an e-learning platform for healthcare professionals | – | – | – |
| 10-Jul-23 | Neuroscience Education Institute | HMP Global | Operator of a medical education company | CF | CF | CF |
| 28-Jun-23 | LiV Agency | Clinical Education Alliance | Provider of medical education services | $13.5 | – | – |
| 15-Jun-23 | I.V. Nurse Consultants | Dynamic Access | Provider of medical consultation services | – | – | – |
| 01-Jun-23 | ECS Billing and Consulting South | Howard, Wershbale & Co. | Provider of billing, revenue cycle management and consulting services | – | – | – |
| 28-Apr-23 | Liberum (Educational Software) | Management | Developer and provider of online education solutions | – | – | – |
| 12-Apr-23 | Makara Health | Berkshire Partners | Provider of healthcare communication services | $394.0 | – | – |
| 03-Apr-23 | CiiTECH | Tenacious Labs | Operator of a cannabis therapeutics platform | $0.3 | – | 8.2x |
| 08-Mar-23 | Grupo Saned | Medscape | Provider of health and medical information services | – | – | – |
| 08-Feb-23 | Strategik & Numerik | Bpifrance | Provider of healthcare communication services | – | – | – |
| 18-Jan-23 | Synetic Life Sciences | Intermediate Capital Group | Provider of strategic consultancy services | – | – | – |
| 16-Jan-23 | Grupo MedCof | Wise Up | Provider of medical education training | – | – | – |
| 04-Jan-23 | Venel Institute | Lehigh Valley Health Network | Provider of educational and training services | – | – | – |
Disclosed transaction multiples only.
EV = enterprise value.
| EV/Rev | EV/EBITDA | |
|---|---|---|
| Mean | 1.3x | 8.2x |
| Median | 1.5x | 8.2x |
| Harmonic Mean | 0.8x | 8.2x |
Public Buyers
The listed comparables split cleanly on profitability rather than on category. Doximity carries a 48% EBITDA margin, the highest in the group, and Healthstream and Wilmington both run in the low 20s with multiples in the 13x range. At the other end, Udemy’s 3% margin produces a 45.4x EBITDA multiple that says more about the denominator than about the business, and Pearson and Learning Technologies Group both trade in the mid-single digits on EBITDA against negative revenue growth. For a CME seller, the useful read is that recurring, accreditation-linked revenue with real margin is what earns a premium here.
$USD in millions, except share price
| Market Capitalization ($) | LTM | EV / LTM (x) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Company | Price ($) | % of 52-Wk High | Market Cap | EV | Revenue | Gross Margin % | EBITDA | EBITDA Margin % | 1-Yr Rev. Growth | Rev. | EBITDA |
| Doximity | 25.99 | 75.2% | 4,778 | 4,787 | 475 | 89% | 230 | 48% | 13% | NM | 20.8x |
| Healthstream | 28.12 | 90.3% | 857 | 877 | 285 | 66% | 65 | 23% | 4% | 3.1x | 13.5x |
| Learning Technologies Group | 0.82 | 71.8% | 667 | 669 | 699 | NM | 105 | 15% | (4%) | 1.0x | 6.4x |
| Pearson | 13.37 | 97.3% | 8,879 | 8,872 | 4,468 | 51% | 1,369 | 31% | (10%) | 2.0x | 6.5x |
| Stride | 36.00 | 68.0% | 47,401 | 50,206 | 6,560 | 84% | 2,032 | 31% | 4% | 7.7x | 24.7x |
| Udemy | 7.11 | 44.4% | 1,092 | 1,093 | 765 | 60% | 24 | 3% | 13% | 1.4x | 45.4x |
| Wilmington | 5.11 | 96.7% | 456 | 456 | 155 | 24% | 35 | 23% | 20% | 2.9x | 13.0x |
Source: PitchBook, as of July 2, 2024.
Share prices as of 08/05/24.
EV = enterprise value.
LTM = last twelve months. NM = not meaningful.
| EV/Rev | EV/EBITDA | |
|---|---|---|
| Mean | 3.0x | 18.6x |
| Median | 2.5x | 13.5x |
| Harmonic Mean | 2.0x | 12.2x |
Navagant has followed buyers that have been highly acquisitive in the space as well as those that have completed notable CME transactions. Our industry expertise and network provide unique insight into this buyer universe, including the companies’ industry and growth perspectives.
Meet the Team Behind This Report
With over two decades of experience, Jacob is the Managing Director of Navagant, having been a key contributor since its inception. Leading as Managing Director and Co-Founder, he has played a vital role in establishing Navagant’s strong brand presence, building relationships with clients and servicing them with integrity. Demonstrating a remarkable talent for deal-making and unwavering dedication to his clients, Jacob has earned recognition as a leader in various industries, most prominently the Education and Training industry. He began his career at Rabobank International and later focused on software and direct marketing industries with Andersen Corporate Finance LLC. Then, in 2003 he founded Capstone Partners and led their Education and Training Practice, until 2023 when he co-founded Navagant. As a highly accomplished leader, Jacob serves as an inspiring mentor and role model to the firm’s up-and-coming professionals, further solidifying his significant contributions to the investment banking industry.
Shawn is a Founding Member and Managing Director of Navagant and brings over 19 years of experience to the firm. Shawn has led execution efforts on 70+ transactions resulting in over $3.5 billion of proceeds for clients. He assists owners of middle-market companies in achieving their strategic growth objectives, exit strategies, and liquidity goals. Formerly, he served as a Managing Director of Capstone Partners in the Education and Training practice. His investment banking career began with Raymond James, where he focused on deal execution and client development for both public and private companies. Shawn’s previous experience includes serving as an officer in the US Navy where he served as a destroyer navigator and communications officer, student naval aviator, and fleet Tomahawk cruise missile officer.
Caleb is a Vice President at Navagant. Previously, Caleb was an Associate at Capstone Partners’ Education and Training practice. Prior to Capstone, he was an Analyst at Carr, Riggs, and Ingram Capital Advisors, the investment banking subsidiary of a Top-20 regional accounting firm. He holds a BBA in Financial Management from Charleston Southern University.
Endnotes & Sources
- U.S. Bureau of Labor Statistics. Healthcare Occupations: Occupational Outlook Handbook. https://www.bls.gov/ooh/healthcare/home.htm
- BoardVitals. Continuing Medical Education: CME State Requirements. January 6, 2023. https://www.boardvitals.com/blog/cme-requirements-by-state/
- PlatformQ Health. Survey Shows HCPs Turning Online for CME. April 28, 2020. https://www.platformqhealth.com/2020/04/28/survey-shows-hcps-turn-online-for-cme-we-must-not-ignore-other-medical-topics/
- PitchBook Data. CME Transaction Activity. 2024.
- Growth Plus Reports. Continuing Medical Education Market Anticipates a Reach of US$15.8 Billion by 2031, Propelled by a 6.2% CAGR. GlobeNewswire, January 18, 2024. https://www.globenewswire.com/news-release/2024/01/18/2811374/0/en/Continuing-Medical-Education-Market-Anticipates-a-Reach-of-US-15-8-billion-by-2031-Propelled-by-an-6-2-CAGR-Growth-Plus-Reports.html
- Smith, T. Precision Education: What It Is and How It’s Advancing Med Ed. American Medical Association, March 6, 2024. https://www.ama-assn.org/education/changemeded-initiative/precision-education-what-it-and-how-its-advancing-med-ed
- Dahiya, S., & Bernard, A. Microlearning: The Future of CPD/CME. Journal of European CME, 10(1). https://doi.org/10.1080/21614083.2021.2014048
- Verified Market Research. Global Healthcare and Medical Simulation Market Size, Status and Forecast to 2026.
- CAE. CAE Announces Sale of Its Healthcare Business. October 24, 2023. https://www.cae.com/news-events/press-releases/cae-announces-sale-of-its-healthcare-business
- NBME. NBME Acquires MedVR Education to Enhance Assessment for Medical Professionals. February 15, 2024. https://www.nbme.org/news/nbme-acquires-medvr-education-enhance-assessment-medical-professionals
- Straits Research. Continuing Medical Education Market. https://straitsresearch.com/report/continuing-medical-education-market
- Mikulic, M. Number of Novel Drugs Approved Annually by CDER (2008-2023). Statista, May 16, 2024. https://www.statista.com/statistics/817534/annual-novel-drug-approvals-by-cder/
- PR Newswire. Med Learning Group Holdings Announces Acquisition of Talem Health. May 22, 2024. https://www.prnewswire.com/news-releases/med-learning-group-holdings-announces-acquisition-of-talem-health-302153102.html
- LCW Medical Communications. LCW Medical Communications Acquires MediConf UK Ltd. April 16, 2024. https://www.lcwmedcoms.com/news-release-lcw-medical-communications-acquires-mediconf-uk-ltd/
- Business Insider. HMP Global Announces Landmark Acquisition of Neuroscience Education Institute (NEI). July 11, 2023. https://markets.businessinsider.com/news/stocks/hmp-global-announces-landmark-acquisition-of-neuroscience-education-institute-nei-1032437826