Market Profile of U.S. Dermatologists OneKey Market Insight Report OneKey is Superior Insights
Market Profile of U.S. Dermatologists Overview: Profile of U.S. Dermatologists Dermatologists by Number, Region and Move Rate Practice Size and Patient Volume Ownership, Affiliations and Specialty Associations Affiliations to Hospitals for Admitting Privileges IHS Employment and ACO Participation Physician Access and Drug Acceptance Rates Government Insurance Acceptance Electronic Health Records Adoption Rate Annual Compensation of Dermatologists Promotional Spend Towards Dermatologists Q1 - Q4 2014 Total Market Spend Promotions by ATC3 Drug Class Channel Mix - Details, Samples and Meetings Total Product Details Copyright Cegedim 2015, Market Profile of U.S. Dermatologists
Introduction Skin cancer is one of the most commonly diagnosed cancers in the U.S. According to the American Cancer Society, the most recent study on non-melanoma skin cancer in 2006 estimated 3.5 million cases diagnosed among 2.2 million people. Melanoma incidence rates have also risen rapidly over the past 30 years. In 2015, an estimated 73,870 new cases of melanoma will be diagnosed. These caseloads will be shared among 13,847 dermatologists, which make up only one percent of physicians in the U.S. Dermatologists are in great demand not only for the treatment of cancer, but also for skin conditions ranging from acne to psoriasis. The Affordable Care Act (ACA) has contributed to additional demand for dermatology services - dermatologists are among the top five specialists booked by ACA patients 1. This issue of the OneKey Market Insights series provides comprehensive details on this group of physicians including their participation in Integrated Health Systems and Accountable Care Organizations, physician access policies and top drug categories promoted to them. Dermatologists by Number, Region and Move Rate Dermatologists represent a very small number of the total number of physicians in the U.S. There are currently 13,847 dermatologists practicing across the country. Most dermatologists focus on a single specialty; only 13.5 percent have a secondary specialty. The number of dermatologists has certainly not kept up with demand. Since 2010, there has only been about a 10 percent increase in the number of dermatologists. Number of Dermatologists in the US 14000 13800 13600 13400 13200 13000 12800 12600 12400 12200 12000 11800 13,725 13,847 13,650 13,011 12,597 2010 2011 2012 2013 2014 1 No rush to high-cost care among newly insured Obamacare patients.(2015, Jan 15). Reuters. Retrieved from http://www.reuters.com/ article/2015/01/15/us-usa-healthcare-zocdoc-exclusive-iduskbn0ko1w920150115 Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 1
The southern states have the highest concentration of dermatologists. A third of the country s dermatologists practice in the south, outweighing the northern states by about 70 percent. U.S. Dermatologists by Region Dermatologists moved to new locations, changed jobs, retired or passed away at average rate of 9.6 percent annually for the past six years, lower than the average physician move-rate of 13.8 percent. Dermatologists Move Rate (Deceased, Moved, Retired) 20% 1 10% 18.2% 12.9% 15.0% 14. 12.4% 11.8% 12.1% 12.4% 9. 8.4% 8.0% 9.0% 10.6% 8.9% 0% 2008 2009 2010 2011 2012 2013 2014 All Physicians Dermatologist Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 2
Practice Size and Patient Volume Dermatologists generally seem to prefer smaller office settings. A vast majority nearly three quarters of dermatologists prefer to work in offices with five or less physicians. Nearly a third of dermatologists prefer to work as solo practitioners. Office Size of Dermatologists 14% 8% 26% 29% 18% 1 2 3 to 5 6 to 10 11 to 25 26 plus Office Size 11 to 26 or 1 2 3 to 5 6 to 10 Total (No. of Doctors) 25 more Total 4,088 2,517 3,618 1,906 1,079 639 13,847 Nearly half of dermatologists see 50 or fewer patients per day, corresponding to the number of solo or small practices. Daily Patient Volume 17% 23% 4 1 to 50 51 to 75 76 to 100 101 plus 1 Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 3
Ownership, Affiliations and Specialty Associations Dermatologists maintain a relatively high level of ownership, with over half being independent. Over 40 percent of physicians in the U.S. are employed by IHSs or hospitals. In comparison, less than a fifth of dermatologists have moved towards integrated health systems or hospitals. Top 4 Specialty Associations About 15 percent of dermatologists are associated with internists, and 10 percent are associated with family practitioners. Top 4 Specialty Associations 4000 3500 3,379 3000 2500 2000 1500 1000 2,184 1,335 956 500 0 Internist Family Practitioner Pediatrician Obstetrician/Gynecologist Affiliation to Hospitals for Admitting Privileges Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 4
Compared to other specialties, dermatologists have less affiliation to hospitals. A quarter have no admitting privileges at hospitals and less than half have admitting privileges to one hospital. Affiliations to Hospitals No. of Doctors % of total 0 3,705 26.8% 1 6,101 44.1% 2 3,181 23.0% 3 721 5.2% 4 139 1.0% Total 13,847 100.00% Government Insurance Acceptance Dermatologists have a higher acceptance rate of Medicare relative to the general physician population, but a much lower rate of Medicaid acceptance compared to their counterparts in other specialties. Dermatologist Medicare and Medicaid Acceptance Medicaid 42.3% 73.1% Dermatologists All Physicians Medicare 85. 93.7% 0.0% 50.0% 100.0% Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 5
IHS Employment and ACO Participation Employing over 9,000 MDs and DOs in 33 hospitals and 900+ medical offices, Kaiser Permanante is the largest employer of healthcare professionals among integrated health systems. The system hires the most number of dermatologists, twice as many as the next top top employer. Top 5 IHSs Employing Dermatologists Kaiser Permanente 168 Partners Healthcare System 81 University Of Utah Healthcare 59 University Of Texas Health System 53 Sutter Health 50 At least 15 percent of dermatologists participate in ACOs. While Health Choice of Utah is not one of the largest ACO in terms of total physician participation, it has the highest dermatologist participation in its network. Next in place is Palo Alto Medical Foundation Cigna ACO, which has a network of over 580 facilities and over 3,300 total participating physicians in 2014. Top 5 ACOs with Dermatologists Participation Health Choice Of Utah 59 Palo Alto Medical Foundation Cigna ACO Mount Auburn Cambridge Independent Practice Association MACIPA 45 49 St Lukes Episcopal Hospital Independent Practice Association Weill Cornell Physician Organization 38 37 Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 6
Physician Access and Drug Sample Acceptance Rates Dermatologists like sales reps. Only 10 percent have a no-see policy, much lower than the average no-see rate of 28.. Nearly half welcome sales reps to drop by anytime. Physician Access 10% 2% 43% 4 access any time call f or appointment no access unknown In terms of sampling preferences, two-thirds of dermatologists like to receive drug samples by both mail or sales rep drop-off. Drug Sampling Preference 3% 1 17% No Preference or Unknown Both Drug rep drops off drugs 6 Mail Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 7
Electronic Health Record Adoption of Dermatologists Dermatologists are among the specialties with relatively high electronic health records (EHR) adoption rate. At 63 percent, EHR adoption rate of dermatologists is in line with the general physician population. Electronic Health Record Adoption Rate of Dermatologists 70.0% EHR Adoption Rate 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2010 2011 2012 2013 2014 Dermatologists 38.0% 46.2% 55.0% 65. 63.0% All Physicians 36.1% 40.4% 45.6% 50.3% 61.0% Annual Compensation of Dermatologists Depending on where they work, there could be a huge discrepancy in the earnings of dermatologists. According to Medscape s 2014 dermatologist compensation report, physicians working in healthcare organizations or group practices earned significantly more than their counterparts who work in outpatient clinics or hospitals. The highest earning group made twice as much as those in the lowest earning group. Dermatologists Annual Compensation by Setting Multispecialty Group Practice $361,000 Healthcare Organization $336,000 Single Specialty Group Practice $323,000 Solo Practice $306,000 Academic $232,000 Outpatient Clinic $211,000 Hospital $169,000 Source: Medscape s Dermatologist Compensation Report 2014 Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 8
Pharma Promotional Spend Towards Dermatologists Q1- Q4 2014 Total Market Spend The pharmaceutical industry spent over $549 million promoting drugs to dermatologists during the last four quarters. Spending peaked slightly in Q3 2014, but remained fairly consistent in other quarters. Promotional Investment: Dermatologist Share of Total Spending ($M) 180 160 140 120 100 80 60 40 20 126 130 156 137 2014 Q1 2014 Q2 2014 Q3 2014 Q4 Source: Cegedim Strategic Data, U.S.Dermatologist Data, Jan 2015 Promotions by ATC3 Drug Class Nearly a fifth of pharma s total promotional spend went to topical anti-acne preparations. Next on the list of top drug categories promoted to dermatologists is plain topical corticosteroids about 13. of total spend went towards this category. % of Promotional Spend by ATC3 Class: Dermatologists 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 3% 4% 4% 4% 6% 4% 6% 4% 4% 4% 6% 6% 7% 7% 9% 9% 8% 14% 14% 14% 12% 19% 18% 19% 19% 30% 28% 30% 30% 2014 Q1 2014 Q2 2014 Q3 2014 Q4 D05B - SYSTEMIC ANTIPSORIASIS PRODUCTS D10B - ORAL ANTI-ACNE PREPARATIONS D05X - OTHER NONSTEROIDAL PRODUCTS FOR INFLAMMATORY SKIN DISORDERS L04B - ANTI-TNF PRODUCTS D05A - TOPICAL ANTIPSORIASIS PRODUCTS J01A - TETRACYCLINES AND COMBINATIONS D01A - ANTIFUNGALS, DERMATOLOGICAL D07A - PLAIN TOPICAL CORTICOSTEROIDS D10A - TOPICAL ANTI-ACNE PREPARATIONS OTHERS Source: Cegedim Strategic Data, U.S. Dermatologist Data, Jan 2015 Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 9
Channel Mix Details, Samples and Meetings A huge proportion of pharma promotional spend - 75 percent - went towards detailing. Compared to this channel, pharma spent considerably less on the next most popular channel only 17 percent on samples. % of Promotional Spend by Channel Mix - Dermatologists 100% 90% 80% 70% 60% 50% 40% 76% 7 7 7 SP DETAILING SAMPLES MEETINGS MAILING CLINICAL TRIALS 30% 20% 17% 17% 17% 17% 10% 0% 6% 7% 7% 7% 2% 1% 3% 1% 2% 1% 3% 1% 2014 Q1 2014 Q2 2014 Q3 2014 Q4 Source: Cegedim Strategic Data, U.S. Dermatologist Data, Jan 2015 Total Market Details In the last four quarters there were over 2.5 million details. Corresponding to the spike in promotional investments in 2014 Q3, more details took place during this quarter. Total Detailing on Dermatologists ('000) 800 700 600 589 622 729 610 Details ('000) 500 400 300 200 100 0 2014 Q1 2014 Q2 2014 Q3 2014 Q4 Source: Cegedim Strategic Data, U.S. Dermatologist Data, Jan 2015 Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 10
For more information about U.S. Dermatologists, please contact: Jack Schember, Senior Director of Marketing Cegedim Relationship Management Jack.schember@cegedim.com 949-476-2051 Cegedim Relationship Management Corporate Headquarters 1405 U.S. Highway 206 Bedminster, NJ 07921 908-443-2000 888-336-3748 www.cegedimrm.com Copyright Cegedim 2015, Market Profile of U.S. Dermatologists 11