Physician Outlook: Urology

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1 Physician Outlook: Urology Spring 2013 Overview Urologists treat among the largest number of patients in any physician specialty, yet pessimism overshadows their outlook in the next 1-2 years, based on the most recent Qessential Physician Confidence Index (QPCI) score that has been calculated. At 80.8 (where 0 means no change in the number of patients or medical technology access), it trails the overall physician index of These specialists currently see an average of 316 patients a month (the mean is 253), and while a majority expect they will see the same number of patients next year, nearly three-quarters (73%) expect it will be more difficult a year from now to get access to newer medications, devices and procedures for their patients than it is today. Electronic health records (EHR) also represent a threat to their business, with half (50%) of urologists believing this will result in a decrease in the number of patients they see. A review of other data gathered in the QPCI study reveals further insights into this mindset. The data show a high concern that the medical device tax included in the Affordable Care Act will raise device prices and reduce device options at their hospital. Consequently, they will be more likely to use moderately priced rather than state-of-the-art medical equipment in their practice. The added costs represented by EHR and likely cost increases as a result of the medical device tax are squeezing

2 these physicians. Since they are more likely to be in single specialty and solo practices than other specialties, these additional costs appear to be having a disproportionate impact on urologists. One urologist from Hawaii said that EHR limiting the number of patients I can see in a day would have the biggest impact of any issue on the practice in the next year, while another from New York said, electronic records slowing down the office leads to less patients, less money, and hiring more people to figure it out. These concerns may be behind the dramatic shift in employment patterns expected through Whereas in 2011, 70% of urologists were employed at independent (physician-owned) private practices, a proportion that changes only slightly in 2013 (69%), but drops dramatically to just 54% in The rapid growth in hospital-owned practices is largely behind this shift in addition to the % who indicate they will retire or leave full-time active practice entirely. For many urologists, hospital ownership will be necessary in order to meet the challenges of today s healthcare market, but it will come at a price. Many expect this trend will reduce their discretion in terms of device selection and drug usage. Traditionally urologists have prescribed a higher percentage of brand name prescription medications. In 2011, 52% of prescriptions written by these specialists were for branded medications. By 2015, when the proportion of urologists in private practice is in sharp decline, just 39% of prescription medications will be brand name. This will still be among the highest proportion of brand name prescriptions written by any specialty, but the

3 impact of increasing cost pressures and regulations are clear. This could result in a dramatic shift in the way both medical devices and pharmaceuticals are marketed and sold to urologists. Outlook Challenging times are certainly ahead for the urology market, but there are potential opportunities as well. In medical devices, sales may be slower for newer, innovative technologies, but moderatelypriced, existing technologies will still be needed to service the large number of patients these doctors see. Moreover, the expenses associated with EHR implementation may fade in concern as more urologists are employed by hospitals which have greater resources for this initiative, and this could create other opportunities for devices. Still, hospital employment is also likely to mean that committees or administrators are more involved in purchase decisions, requiring sales representatives to develop multiple relationships at a single institution, since the physician will no longer be the only (or even the primary) decision maker. Pharmaceutical companies will continue to be challenged in an environment where brand name medications represent an increasingly smaller share of prescriptions that are written. Still, nearly 40% of prescriptions written by urologists are still expected to be brand name in 2015, and if newer medications can treat conditions that would otherwise require more invasive therapies, branded prescriptions will continue to be offered to patients before surgical options. Methodology Results based on a minute online survey conducted by Qessential Medical Market Research in April A total of 191 urologists responded and serve as the basis for data in this paper. About QPCI The Qessential Physician Confidence Index (QPCI) is a national economic indicator of physician attitudes that affect the purchase of medical devices and pharmaceuticals. The QPCI uses data from interviews with more than 2,500 physicians as inputs to a quantitative model for measuring attitudes about expected patient volume (QPCI-V) and medical technology access (QPCI-T). QPCI results are released on a semi-annual basis, with all measures reported using a scale of 0 to 200, where 0 indicates no change from current economic trends. Based on similar measures of consumer confidence, QPCI data will be used as a leading indicator of micro and macroeconomic trends. For example, when the QPCI is high it is anticipated that sales of medical devices and pharmaceuticals will be growing. When the QPCI is low, it is anticipated that these sales will be flat or decline. About Qessential Qessential Medical Market Research is a leading full-service research provider dedicated to the pharmaceutical and medical device industries. We provide turnkey solutions in qualitative and quantitative studies as well as support services that include the most successful non-panel recruiting service for healthcare professionals in the market today. In addition, we offer exceptional analytical services to uncover hidden insights in data to create actionable market intelligence. For more information, please contact Isabelle Smith or visit our website at

4 Appendix: Urology Q2- What is your primary medical specialty? While you may have more than one area of expertise, please indicate the one that constitutes your primary specialty. Q7. Do you specialize in pediatric care?

5 Q8. How many years have you been in active clinical practice, post-residency? Q9. What percent of your practice time is spent in direct patient care (vs. research or administrative work)?

6 Q. The hospital I am most closely associated with is a/an Q11. The hospital I am most closely associated with is

7 Q12. Which of the following best describes your practice? Q13. Which of the following best describes your employment status in 2011, 2013, and what you expect it will be in 2015?

8 Q14. What percent of your time is spent in each of the following settings? Q15. In which state do you primarily practice?

9 Q5- How many patients do you personally see in an average month? Q6- Looking ahead to one year from now, do you expect to personally see more patients, less patients, or about the same number of patients on a monthly basis compared to today?

10 Q17. Please indicate how much you agree or disagree with each of the following healthcare issues. Q18. An Electronic Health Record (EHR) or electronic medical records are being implemented in hospitals and medical offices throughout the country. Please indicate how much you agree or disagree with each of the following EHR related statements.

11 Q19. What do you think the impact of full implementation of EHR will have on the number of patients you see? Q20. By what percent do you think your number of patients will increase/decrease due to EHR? Q21. What do you think the impact of full implementation of EHR will have on the number of medical procedures you perform? Q22. What percent do you think your number of medical procedures will increase/decrease due to EHR?

12 Q23. What do you think the impact of full implementation of EHR will have on your personal income? Q24. By what percent do you think your personal income will increase/decrease due to EHR? Q25. Please indicate how much you agree or disagree with the following statements.

13 Q26. Please indicate the percentage of brand name (not generic) medications you have or will prescribe in each of the following time periods. Q27. Looking ahead to one year from now, how easy or difficult do you feel it will be for you to access newer medications, devices, and procedures for your patients?

14 Q28. What trend or development do you believe will have the biggest impact on your practice in 2013/2014?

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