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Market Profile of U.S. DermatologistsOneKey Market Insight Report
OneKey is Superior Insights
Copyright © Cegedim 2015, 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
Market Profile of U.S. Dermatologists
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 1
Introduction
SkincancerisoneofthemostcommonlydiagnosedcancersintheU.S.AccordingtotheAmericanCancerSociety,themostrecentstudyonnon-melanomaskincancerin2006estimated3.5millioncasesdiagnosedamong2.2millionpeople.Melanomaincidencerateshavealsorisenrapidlyoverthepast30years.In2015,anestimated73,870newcasesofmelanomawillbediagnosed.Thesecaseloadswillbesharedamong13,847dermatologists,whichmakeuponlyonepercentofphysiciansintheU.S.
Dermatologistsareingreatdemandnotonlyforthetreatmentofcancer,butalsoforskinconditionsrangingfromacnetopsoriasis.TheAffordableCareAct(ACA)hascontributedtoadditionaldemandfor dermatology services - dermatologists are among the top five specialists booked by ACApatients1.This issueof theOneKeyMarket Insightsseriesprovidescomprehensivedetailson thisgroupofphysiciansincludingtheirparticipationinIntegratedHealthSystemsandAccountableCareOrganizations,physicianaccesspoliciesandtopdrugcategoriespromotedtothem.
Dermatologists by Number, Region and Move Rate
DermatologistsrepresentaverysmallnumberofthetotalnumberofphysiciansintheU.S.Therearecurrently13,847dermatologistspracticingacrossthecountry.Mostdermatologistsfocusonasinglespecialty;only13.5percenthaveasecondaryspecialty.Thenumberofdermatologistshascertainlynotkeptupwithdemand.Since2010,therehasonlybeenabouta10percentincreaseinthenumberofdermatologists.
Source:CegedimRelationshipManagement,Jan20151Norushtohigh-costcareamongnewlyinsuredObamacarepatients.(2015,Jan15).Reuters.Retrievedfromhttp://www.reuters.com/article/2015/01/15/us-usa-healthcare-zocdoc-exclusive-idUSKBN0KO1W920150115
12,597
13,011
13,65013,725 13,847
118001200012200124001260012800130001320013400136001380014000
2010 2011 2012 2013 2014
Number of Dermatologists in the US
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 2
The southern states have the highest concentration of dermatologists. A third of the country’sdermatologists practice in the south, outweighing the northern states by about 70 percent.
U.S. Dermatologists by Region
Source:CegedimRelationshipManagement,Jan2015
Dermatologistsmovedtonewlocations,changedjobs,retiredorpassedawayataveragerateof9.6percentannuallyforthepastsixyears,lowerthantheaveragephysicianmove-rateof13.8percent.
Source:CegedimRelationshipManagement,Jan2015
18.2%15.0%
12.4% 11.8% 12.1%14.5%
12.4%12.9%
9.5% 8.4% 8.0% 9.0%10.6% 8.9%
0%
5%
10%
15%
20%
2008 2009 2010 2011 2012 2013 2014
Dermatologists Move Rate (Deceased, Moved, Retired)
AllPhysicians Dermatologist
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 3
Practice Size and Patient Volume
Dermatologistsgenerallyseemtoprefersmallerofficesettings.Avastmajority–nearlythreequartersofdermatologistsprefertoworkinofficeswithfiveorlessphysicians.Nearlyathirdofdermatologistsprefertoworkassolopractitioners.
OfficeSize(No.ofDoctors) 1 2 3to5 6to10 11to
2526ormore Total
Total 4,088 2,517 3,618 1,906 1,079 639 13,847
Source:CegedimRelationshipManagement,Jan2015
Nearlyhalfofdermatologistssee50orfewerpatientsperday,correspondingtothenumberofsoloorsmallpractices.
Source:CegedimRelationshipManagement,Jan2015
29%
18%26%
14%
8%5%
Office Size of Dermatologists
1
2
3to5
6to10
11to25
26plus
45%
15%
17%
23%
Daily Patient Volume
1to50
51to75
76to100
101plus
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 4
Ownership, Affiliations and Specialty Associations
Dermatologistsmaintainarelativelyhighlevelofownership,withoverhalfbeingindependent.Over40percentofphysiciansintheU.S.areemployedbyIHSsorhospitals.Incomparison,lessthanafifthofdermatologistshavemovedtowardsintegratedhealthsystemsorhospitals.
Source:CegedimRelationshipManagement,Jan2015
Top 4 Specialty Associations
About15percentofdermatologistsareassociatedwithinternists,and10percentareassociatedwithfamilypractitioners.
Source:CegedimRelationshipManagement,Jan2015
Affiliation to Hospitals for Admitting Privileges
3,379
2,184
1,335956
0
500
1000
1500
2000
2500
3000
3500
4000
Internist FamilyPractitioner PediatricianObstetrician/Gynecologist
Top 4 Specialty Associations
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 5
Compared to other specialties, dermatologists have less affiliation to hospitals. A quarter haveno admitting privileges at hospitals and less than half have admitting privileges to one hospital.
Affiliations to Hospitals No. of Doctors % of total0 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%
Source:CegedimRelationshipManagement,Jan2015
Government Insurance Acceptance
DermatologistshaveahigheracceptancerateofMedicarerelativetothegeneralphysicianpopulation,butamuchlowerrateofMedicaidacceptancecomparedtotheircounterpartsinotherspecialties.
Source:CegedimRelationshipManagement,Jan2015
85.5%
73.1%
93.7%
42.3%
0.0% 50.0% 100.0%
Medicare
Medicaid
Dermatologist Medicare and Medicaid Acceptance
Dermatologists
AllPhysicians
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 6
IHS Employment and ACO Participation
Employingover9,000MDsandDOsin33hospitalsand900+medicaloffices,KaiserPermananteisthelargestemployerofhealthcareprofessionalsamongintegratedhealthsystems.Thesystemhiresthemostnumberofdermatologists,twiceasmanyasthenexttoptopemployer.
Source:CegedimRelationshipManagement,Jan2015
Atleast15percentofdermatologistsparticipateinACOs.WhileHealthChoiceofUtahisnotoneofthelargestACOintermsoftotalphysicianparticipation,ithasthehighestdermatologistparticipationinitsnetwork.NextinplaceisPaloAltoMedicalFoundationCignaACO,whichhasanetworkofover580facilitiesandover3,300totalparticipatingphysiciansin2014.
Source:CegedimRelationshipManagement,Jan2015
50
53
59
81
168
SutterHealth
UniversityOf TexasHealthSystem
UniversityOf UtahHealthcare
PartnersHealthcare System
KaiserPermanente
Top 5 IHSs Employing Dermatologists
37
38
45
49
59
WeillCornellPhysicianOrganization
StLukesEpiscopalHospitalIndependentPracticeAssociation…
MountAuburnCambridgeIndependentPracticeAssociationMACIPA
PaloAltoMedicalFoundationCignaACO
HealthChoiceOf Utah
Top 5 ACOs with Dermatologists Participation
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 7
Physician Access and Drug Sample Acceptance Rates
Dermatologistslikesalesreps.Only10percenthaveano-seepolicy,muchlowerthantheaverageno-seerateof28.5%.Nearlyhalfwelcomesalesrepstodropbyanytime.
Source:CegedimRelationshipManagement,Jan2015
Intermsofsamplingpreferences,two-thirdsofdermatologistsliketoreceivedrugsamplesbybothmailorsalesrepdrop-off.
Source:CegedimRelationshipManagement,Jan2015
45%
43%
10%
2%
Physician Access
accessanytime
callforappointment
noaccess
unknown
17%
65%
15%
3%
Drug Sampling Preference
NoPreferenceorUnknown
Both
Drugrepdropsof fdrugs
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 8
Electronic Health Record Adoption of Dermatologists
Dermatologistsareamongthespecialtieswithrelativelyhighelectronichealthrecords(EHR)adoptionrate.At63percent,EHRadoptionrateofdermatologistsisinlinewiththegeneralphysicianpopulation.
Source:CegedimRelationshipManagement,Jan2015
Annual Compensation of Dermatologists
Dependingonwheretheywork,therecouldbeahugediscrepancyintheearningsofdermatologists.AccordingtoMedscape’s2014dermatologistcompensationreport,physiciansworkinginhealthcareorganizations or group practices earned significantly more than their counterparts who work inoutpatientclinicsorhospitals.Thehighestearninggroupmadetwiceasmuchasthoseinthelowestearninggroup.
Dermatologists Annual Compensation by SettingMultispecialtyGroupPractice $361,000HealthcareOrganization $336,000SingleSpecialtyGroupPractice $323,000SoloPractice $306,000Academic $232,000OutpatientClinic $211,000Hospital $169,000
Source:Medscape’sDermatologistCompensationReport2014
2010 2011 2012 2013 2014Dermatologists 38.0% 46.2% 55.0% 65.5% 63.0%AllPhysicians 36.1% 40.4% 45.6% 50.3% 61.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
EHR
Adop
tion
Rate
Electronic Health Record Adoption Rate of Dermatologists
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 9
Pharma Promotional Spend Towards Dermatologists Q1- Q4 2014
Total Market Spend
Thepharmaceuticalindustryspentover$549millionpromotingdrugstodermatologistsduringthelastfourquarters.SpendingpeakedslightlyinQ32014,butremainedfairlyconsistentinotherquarters.
Source:CegedimStrategicData,U.S.DermatologistData,Jan2015
Promotions by ATC3 Drug Class
Nearlyafifthofpharma’stotalpromotionalspendwenttotopicalanti-acnepreparations.Nextonthelistoftopdrugcategoriespromotedtodermatologistsisplaintopicalcorticosteroids–about13.5%oftotalspendwenttowardsthiscategory.
Source:CegedimStrategicData,U.S.DermatologistData,Jan2015
30% 28% 30% 30%
19% 18% 19% 19%
14% 14% 14% 12%
7% 9% 9% 8%
6% 5% 7% 5%6% 5% 5%
5%
5% 5% 5%5%
6% 5% 4% 4%
4% 5% 4% 4%
3% 4% 4% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014Q1 2014Q2 2014Q3 2014Q4
% of Promotional Spend by ATC3 Class: Dermatologists
D05B- SYSTEMICANTIPSORIASISPRODUCTS
D10B- ORALANTI-ACNEPREPARATIONS
D05X- OTHERNONSTEROIDALPRODUCTSFORINFLAMMATORYSKINDISORDERS
L04B- ANTI-TNFPRODUCTS
D05A- TOPICALANTIPSORIASISPRODUCTS
J01A- TETRACYCLINESANDCOMBINATIONS
D01A- ANTIFUNGALS,DERMATOLOGICAL
D07A- PLAINTOPICALCORTICOSTEROIDS
D10A- TOPICALANTI-ACNEPREPARATIONS
OTHERS
126130
156137
20406080100120140160180
2014Q1 2014Q2 2014Q3 2014Q4
Promotional Investment: Dermatologist Share of Total Spending ($M)
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 10
Channel Mix – Details, Samples and Meetings
Ahugeproportionofpharmapromotionalspend-75percent-wenttowardsdetailing.Comparedtothischannel,pharmaspentconsiderablylessonthenextmostpopularchannel–only17percentonsamples.
Source:CegedimStrategicData,U.S.DermatologistData,Jan2015
Total Market Details
Inthelastfourquarterstherewereover2.5milliondetails.Correspondingtothespikeinpromotionalinvestmentsin2014Q3,moredetailstookplaceduringthisquarter.
Source:CegedimStrategicData,U.S.DermatologistData,Jan2015
1% 1% 1% 1%2% 3% 2% 3%6% 7% 7% 7%
17% 17% 17% 17%
76% 75% 75% 75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014Q1 2014Q2 2014Q3 2014Q4
% of Promotional Spend by Channel Mix - Dermatologists
SPDETAILING
SAMPLES
MEETINGS
MAILING
CLINICAL TRIALS
589 622
729
610
0
100
200
300
400
500
600
700
800
2014Q1 2014Q2 2014Q3 2014Q4
Deta
ils ('
000)
Total Detailing on Dermatologists ('000)
Copyright © Cegedim 2015, Market Profile of U.S. Dermatologists 11
For more information about U.S. Dermatologists, please contact:
JackSchember,SeniorDirectorofMarketingCegedimRelationshipManagementJack.schember@cegedim.com949-476-2051
CegedimRelationshipManagementCorporateHeadquarters1405U.S.Highway206Bedminster,NJ07921
908-443-2000888-336-3748
www.cegedimrm.com
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