Lifetime Learning Requirements Necessitate Online & Continuing Medical Education Test Preparation Services
In the end, medical test preparation and continuing medical education is about providing positive outcomes for patients from when a medical student is first starting their journey until they are ready to retire. The focus must be on efficacy and quality as people’s lives may very well be depending on it.
Demand for online and continuing medical education (CME) services has soared in the wake of the pandemic. According to the Association of American Medical Colleges, the number of students applying for medical school increased ~20% year-over-year (YOY), driven by heightened applicant altruism and aspiring physicians capitalizing on the healthcare labor market gap.1 Furthermore, employment in the Healthcare industry has continued to capture the most favorable outlook among occupational groups, with a projected growth rate of 16% from 2020 to 2030, which would contribute 2.6 million new jobs to the American Labor market, according to the U.S. Bureau of Labor Statistics.2 This predicted expansion is namely due to an aging U.S. population requiring additional medical care, exacerbated by the rising demand for healthcare services amid COVID-19. In addition, more than 40% of practicing physicians will reach the traditional retirement age of 65 in the next ten years, with many accelerating retirement plans due to burnout. The sudden shift in retirement patterns, coupled with the long-term demand for healthcare professionals greatly outpacing the supply, has produced a significant shortage of trained physicians.
Merger and acquisition (M&A) activity in the Online & Continuing Medical Education industry increased 47% YOY, with 22 transactions announced or completed in 2021 to-date. Strategic and private equity buyers have both expressed a strong interest in the space, each accounting for 45.5% of deals to-date with educational institutions comprising the remaining transactions (9%). Industry participants with mobile learning and virtual class offerings have particularly piqued buyer interest, with premium valuations being paid for interactive capabilities such as on-demand help and instruction, gamified platforms, and simulations. In August, Surgical Science Sweden (OM:SUS) acquired Simbionix USA for an enterprise value of $305 million, equivalent to 7.4x revenue. Simbionix provides simulation, training, and education services for medical professionals, specializing in robotics-assisted surgery simulation. The acquisition complements and strengthens Surgical Science's Education business with simulation services in the endovascular, urology, orthopedics, and ultrasound areas.
In 2021, Blueprint Test Preparation completed several transactions in the Medical Education sector, including Cram Fighter and Med School Tutors which provide time-saving study planning tools for the USMLE, COMLEX, and Shelf exams with expert tutoring and residency consulting. Additionally, Blueprint acquired Rosh Review, a leader in high-stakes test preparation and continuing education for medical students, physicians, physician assistants, nurse practitioners, and nurses. The complementary acquisitions serve the life-long educational needs of professionals, beginning with their medical programs and continuing throughout their medical careers. A leading investment bank in the Education & Training industry, Capstone Partners served as exclusive financial advisor to Rosh Review during its transaction.
High-Stakes Exams Drive Demand for Medical Test Preparation
Becoming a board-certified medical professional requires a serious educational commitment, with a typical process taking 11 to 16 years, including four years of college (undergraduate school), four years of medical school, and anywhere from three to eight years of area-specific training depending on the student's intended specialty. Throughout this process is a series of high-stakes exams students must pass in order to advance to the next stage, with a minimum of five tests regardless of specialty. As each exam covers independent material, demand for tailored test preparation solutions has increased considerably.
Path of Medical Education
Becoming a board-certified medical professional requires taking 11 to 16 years of training and includes series of high-stakes exams.
Source: Capstone Research
According to Technavio, The U.S. Test Preparation market is forecasted to reach $10.7 billion by 2024 recording a 6% compound annual growth rate (CAGR), with the largest share of the growth (34%) driven by test preparation offerings for university, medical school, and other higher education exams.3 The increasing number of tests administered, and credits required in the pursuit of licensure has necessitated the services of test preparation providers covering the following exams:
- Medical College Admission Test (MCAT): The MCAT serves as a standardized exam for prospective medical students in the U.S., Australia, Canada, and Caribbean Islands and marks the first test required post-undergraduate studies. Admission officers interpret MCAT scores to determine if the student holds the foundational concepts and reasoning skills necessary for medical school. The test includes four sections: Biological and Biochemical Foundations of Living Systems, Chemical and Physical Foundations of Biological Systems, Psychological, Social, and Biological Foundations of Behavior, and Critical Analysis and Reasoning Skills. The number of MCAT exams administered in 2021 to-date has exceeded 80,000 and is set to outpace 2020 (100,000 exams), fueling demand for MCAT test preparation providers.
Of note, former Capstone client, Blueprint Test Preparation, a provider of MCAT tutoring and test preparation services, acquired CramFighter, a provider of USMLE study plan techniques and MedSchoolTutors, a provider of technology-enabled MCAT tutoring and advising. Blueprint also launched two new MCAT products, MCAT Live Online (January 2021) and MCAT Flashcards (May 2021) to bolster its online course offerings and mobile-friendly test preparation materials, according to the company's website.4
All students, regardless of specialty, must complete four years of medical school after passing the MCAT exam and application process. Technology-enabled higher education institutions serving healthcare fields have been well-situated to capture heightened demand at this initial stage of medical education, with students selecting accredited schools as a platform for a successful career. In February, Capstone advised American Sentinel University, an elite higher education institution providing high-quality, online advanced degree certification programs in the Healthcare industry, on its sale to Generation Partners-backed Post University. “We are very pleased about becoming part of Post University and believe this merger is in the best interest of our students to ensure growth and innovation in light of the rapidly changing healthcare and higher education landscape. While we are a thriving institution today, joining Post University will make us stronger with access to enhanced support, expertise, and resources. We believe our students, faculty, staff, healthcare partners, and schools using our digital simulations will all benefit from this agreement,” commented Mary Adams, President of American Sentinel University, in Capstone's press release.
Clear winners in the Online & Continuing Medical Education industry have incorporated services aligning with multiple steps in the medical education process, generating high levels of customer retention as students can utilize the same provider in each phase. Of note, MedSchoolCoach, a technology-enabled provider of medical school admissions consulting and tutoring for the MCAT and USMLE, has coached more than 15,000 students on admissions and the exams administered throughout medical school, according to the company’s website.5 By implementing this end-to-end education model, MedSchoolCoach has garnered a 98% client satisfaction rate with more than 500,000 coaching hours logged.
- United States Medical Licensing Examination (USMLE): The USMLE is a three-step examination for medical licensure in the U.S., assessing a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills that constitute the basis of safe and effective patient care. Step 1 is typically taken at the end of the second year of medical school (M2) and emphasizes the knowledge of basic sciences including anatomy, biochemistry, immunology, and pharmacology. Step 2 CK (Clinical Knowledge), taken in the fourth year of medical school (M4), ensures that an examinee is competent to practice medicine under supervision through an understanding of clinical sciences, health promotion, and disease prevention. Step 3 represents the final exam in the USMLE, assessing if first year residents are capable of practicing medicine unsupervised.
In July 2021, the USMLE Composite Committee reduced the number of attempts allotted to examinees for each step from six to four to protect the integrity of the exam and more closely align the attempt limits imposed by state medical boards.6 This policy change has amplified the importance of test preparation for the USMLE, positioning accredited providers as attractive targets in M&A. In a recent example, Truelearn acquired Picmonic for an undisclosed sum (June). Picmonic develops a visual learning platform with animated test preparation resources for medical exams such as the USMLE, COMLEX (Comprehensive Osteopathic Medical Licensure Examination), and NCLEX (National Council Licensure Examination) for nursing students. The acquisition enhanced Truelearn's interactive capabilities and broadened its suite of digital course offerings.
- Board Certification Exams: Although there is no legal requirement for a medical professional to be board-certified, the majority of hospitals, clinics, and private practices require students to complete a board certification exam to demonstrate expertise in their medical field following their residency or fellowship program. The American Board of Medical Specialties (AMBS) is the recognized leader in developing and setting the gold standard for physician specialty certification in the U.S., with more than 920,000 certified physicians in 40 specialty fields, according to its 2019-2020 Board Certification Report.7 AMBS awarded 31,933 new specialty certificates in 2020, an increase of 12% compared to 2016, exemplifying the widespread adoption of board certification requirements among healthcare providers.
Leading medical exam preparation and CME provider, Rosh Review, announced four new specialty board exam offerings throughout 2020 for emergency nurse, OB/GYN, internal medicine, and psychiatric-mental health nurse practitioner certifications, according to the company's website.8 Rosh Review's digital platform provides learning material in more than 25 specialty areas for medical students, physicians, physician’s assistants, nurses, and nurse practitioners, available via its web and mobile applications. Founded in 2011, the company has utilized its subscription-based business model to grow its customer base to more than 250,000 learners in 2021.
BoardVitals, a provider of test preparation services for the USMLE and board exams, has also capitalized on the tailwinds of board certification requirements with enhanced digital capabilities such as mobile applications for iOS and Android (launched January 2021). As a result, BoardVitals' subscriber base has exceeded 30,000 physicians since its inception in 2012, according to the company's website.9 The company has also continued to expand its online question bank with the launch of its full-length practice board exams for general practitioners and specialty physicians.
State-Mandated Continuing Medical Education Credits Produce Lifelong Students
Participation in accredited CME helps physicians meet requirements for maintenance of licensure and certification, credentialing, membership in professional societies, and other professional privileges. Almost all (48) states mandate specific CME requirements that must be completed every one to two years, depending on the state's license cycle, in order to remain compliant with the states’ governing medical board. As this offers a high degree of revenue visibility for industry participants, CME providers have become optimal targets in M&A. Of note, NexPhase-backed KnowFully Learning Group acquired ChiroCredit in August. ChiroCredit offers online CME for physical therapists, podiatric and naturopathic physicians, and other healthcare professionals. KnowFully, a leading provider of end-to-end professional education in the Accounting, Finance, and Healthcare sectors, pursued the acquisition to strengthen its PharmCon division with high quality, easily accessible CME offerings and support medical professionals throughout the entirety of their career.
CME companies with digital capabilities have been at the forefront of the sector, delivering elevated levels of education content and certifications. US HealthConnect, a global medical education and CME provider, has demonstrated this with more than 12,000 on-demand education programs deployed across six continents through its proprietary platform.10 US HealthConnect serves more than five million healthcare professionals through ten operating subsidiaries including Global Learning Collaborative and Prova Education. Leading CME provider Northstar Creative (NSCI) Group also utilizes digital learning with TotalCME, integrating online and live programming optimized for the modern, mobile healthcare professional. TotalCME includes MedEd On The Go, a mobile application for published CME content, and Impact, offering more than 100 certified, on-demand lectures per year.11
1. Association of American Medical Colleges, "The Complexities of Physician Supply and Demand…," https://www.aamc.org/media/54681/download?attachment, accessed September 21, 2021.
2. U.S. Bureau of Labor Statistics, "Healthcare Occupational Outlook," https://www.bls.gov/ooh/healthcare/home.htm, accessed September 21, 2021.
3. Technavio, "Test Preparation Market in U.S.," https://www.technavio.com/report/test-preparation-market-size-in-us-industry-analysis, accessed September 22, 2021.
4. Blueprint Test Preparation, "Product Launches," https://blueprintprep.com/press-release/product-launches, accessed September 22, 2021.
5. MedSchoolCoach, “MedSchoolCoach By The Numbers,” https://www.medschoolcoach.com/, accessed October 12, 2021.
6. United States Medical Licensing Examination, "Change to the USMLE Attempt Limit Policy," https://www.usmle.org/attemptlimit.html, accessed September 22, 2021.
7. American Board of Medical Specialties, "AMBS Board Certification Report 2019-2020," https://www.abms.org/wp-content/uploads/2020/11/ABMS-Board-Certification-Report-2019-2020.pdf, accessed September 22, 2021.
8. Rosh Review, "What's New," https://www.roshreview.com/blog/, accessed October 4, 2021.
9. BoardVitals, "BoardVitals News & Company Updates," https://www.boardvitals.com/blog/category/news/about-board-vitals/, accessed September 22, 2021.
10. US HealthConnect, “US HealthConnect News,” https://www.ushealthconnect.com/#news, accessed October 12, 2021.
11. TotalCME, “Our Products,” http://www.totalcme.com/, accessed October 12, 2021.
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