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If your continuing education plan keeps slipping, the explanation you have probably reached for is a personal one. Not disciplined enough. Not motivated enough. Should have registered for that training months ago.
The research tells a different story. When investigators study why clinicians postpone or skip continuing education, motivation barely appears. What shows up, in study after study, is structure: the cost of training and the time to complete it. Understanding that changes both how you should feel about your unfinished CE plan and how you should choose your next training.
In a national survey of US physicians, nurse practitioners, and physician assistants, O'Brien Pott and colleagues (2021) examined what actually drives the choice of continuing education activities and providers. Cost and the ability to learn at one's own pace ranked among the strongest factors shaping which options clinicians choose. Not prestige. Not marketing. Cost and pace.
An earlier cross-specialty national survey found the same pattern from a different angle. Cook and colleagues (2017) studied the factors influencing physicians' selection of professional development activities and identified cost and time as two of the most influential considerations in whether a given activity gets chosen at all. In other words, before a clinician ever evaluates the content of a training, two filters have already done most of the deciding: can I afford this, and can I fit it into my life?
A 2022 mixed-methods study by Reis and colleagues followed clinicians through the implementation of an online continuing education platform and asked what got in the way. The dominant barriers were lack of time and the perception of work overload. Clinicians described being entitled to training time on paper that they could not actually take, because there was nowhere for their patients to go if they stepped away.
One finding in that study deserves particular attention from therapists: participants described a guilt spiral. Training gets postponed because of workload, the postponement produces guilt and a sense of failing, and that emotional weight makes the next attempt harder to start. If that sequence sounds familiar, it is because the structure producing it is familiar. It is not a character flaw. It is a workload problem wearing a motivation costume.
These studies surveyed physicians and allied health clinicians broadly, not therapists specifically. We think it is important to say that plainly rather than round the findings up to a population they did not study.
That said, the structural pressures these studies document, heavy caseloads, constrained budgets, training time that exists in policy but not in practice, are at least as present in mental health as anywhere in healthcare. Therapists navigating full caseloads, stagnant reimbursement rates, and a rising cost of living are living inside the exact conditions this research describes. The findings translate; the caveat is simply that the translation has not yet been formally tested in a therapist-only sample.
If cost and time are the documented barriers, then the practical response is to choose trainings engineered around them:
There is a harder implication here, and it points at organizations like ours. If the field has known since at least 2017 that cost and time are the gatekeepers of clinician development, then providers face a choice: design around those barriers, or profit from them. Deadline-driven pricing, inflated list prices waiting for a dramatic discount, and formats that demand more time than they respect all fall into the second category.
We think the first category is the only defensible one. It is why every TTI training in our on-demand catalog can be paused and resumed around a real caseload, addressing the time barrier the research documents. And it is why we moved a dedicated catalog of trainings to dynamic pricing, where prices adjust with the market rather than holding still while the economy does not. We explained that decision in full in why we changed how we price our trainings.
Across multiple national surveys of clinicians, cost and time consistently rank as the two biggest barriers. Related factors include work overload, inflexible training formats, and training time that is technically available but practically unusable because of caseload demands.
The evidence base cited in this research area indicates that e-learning approaches produce comparable results to face-to-face formats on learner knowledge and satisfaction. Online formats also directly address the two documented barriers, cost and time, which for many clinicians makes them the difference between completing meaningful training and postponing it indefinitely.
Work with the barrier instead of pretending it away. Choose on-demand formats you can complete in 30 to 45 minute segments, schedule those segments like you would schedule a client, and pick one deep training per year rather than scattering effort across many. Planning ahead also matters; a simple annual CE plan removes the deadline scramble that makes time pressure worse.
Remove both barriers at once
TTI's free, on-demand CE library covers EMDR, trauma treatment, nervous system work, and more. No cost, no schedule, no fluff.
I'm Claiming My Free CE TrainingsCook, D. A., Price, D. W., Wittich, C. M., West, C. P., & Blachman, M. J. (2017). Factors influencing physicians' selection of continuous professional development activities: A cross-specialty national survey. Journal of Continuing Education in the Health Professions, 37(3), 154-160. https://doi.org/10.1097/CEH.0000000000000163
O'Brien Pott, M., Blanshan, A. S., Huneke, K. M., Baasch Thomas, B. L., & Cook, D. A. (2021). What influences choice of continuing medical education modalities and providers? A national survey of US physicians, nurse practitioners, and physician assistants. Academic Medicine, 96(1), 93-100. https://doi.org/10.1097/ACM.0000000000003758
Reis, T., Faria, I., Serra, H., & Xavier, M. (2022). Barriers and facilitators to implementing a continuing medical education intervention in a primary health care setting. BMC Health Services Research, 22, Article 638. https://doi.org/10.1186/s12913-022-08019-w
