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MARKETINSIGHTS
Market Profile of U.S. Orthopedic SurgeonsMarket Insights Report
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
For more information about this report, please contact:Jack Schember, Director of Marketing, email: [email protected] phone: 949-476-2051 x 1259
Overview: Profile of U.S. Orthopedic SurgeonsOrthopedic Surgeons by Number, Region and Move Rate 1
Practice Size and Patient Volume 3
Ownership, Affiliations and Specialty Associations 4
Affiliations to Hospitals for Admitting Privileges 5
Government Insurance Acceptance 5
IHS Employment and ACO Participation 6
Physician Access and Drug Sample Acceptance Rates 7
Electronic Health Records Adoption Rate 8
Annual Compensation of Orthopedic Surgeons 8
Promotional Spend Towards Orthopedic Surgeons Q4 2014 - Q3 2015Channel Mix - Details, Samples and Meetings 9
Total Product Details 9
Market Profile of U.S. Orthopedic Surgeons
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
1
5k
0
10k
15k
20k
25k
30k
35k
40k
201520142013201220112010
35,74236,11535,17734,16532,80234,372 35,74236,11535,17734,16532,80234,372
Source: SK&A, Dec 2015
Number of Orthopedic Surgeons in the U.S.
Introduction An orthopedic surgeon has been educated and trained in the diagnosis and treatment of diseases and injuries of the musculoskeletal system. An orthopedic surgeon is either a medical doctor or a DO who has completed a five-year residency focused on surgical treatment.
The most common treatment areas are spinal disorders, arthritis, sports injuries, trauma, fractures, bone tumors, and cerebral palsy. An orthopedic surgeon may complete additional training with a spine fellowship and specialize in spine surgery.
Orthopedic surgeons work closely with other healthcare providers and often serve as consultants to other physicians. They may practice in an orthopedic or multispecialty group, in a solo practice, or as a hospital system employee.
Orthopedic surgeons are key targets for the medical device and diagnostics industry; but they are difficult to pin down. Engagements and details are difficult, owing to the surgeons’ frequent movement from offices to hospitals to surgery centers.
Orthopedic Surgeons by Number, Region and Move Rate The number of orthopedic surgeons in the U.S. dipped slightly in 2015 after four years of sustained growth. Today there are about 35,742 physicians who named orthopedic surgery as their primary or secondary specialty. They are very likely (60%) to have a secondary specialty. Of the top 20 physician specialties by number of practitioners, orthopedics ranked seventh, just behind cardiovascular surgeons. They practice at 11,552 medical sites.
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
2
20152014201320122011201020092008
5%
0%
10%
15%
20% 18.2%
15.0%
12.4%
11.8% 12.1%
14.5%
12.4%12.0%
18.2%
15.0%
12.4%
11.8% 12.1%
14.5%
12.4%12.0%
13.4%12.3% 12.0%
11.9%13.4%
13.6%
15.6% 15.4%
13.4%12.3% 12.0%
11.9%13.4%
13.6%
15.6% 15.4%
All PhysiciansOrthopedic Surgeons
Source: SK&A, Dec 2015
Orthopedic Surgeons Move Rate(deceased, moved, retired)
The southern states have the highest concentration of orthopedics. One-third of the country’s orthopedics are located in the south. But as a percent of population, the northern states have the highest number of practitioners.
Orthopedics moved to new locations, took new jobs, retired, passed away or made other professional changes at an average rate of 13.45% annually over the past 6 years, a number consistent with the average physician move rate of 13.55%. Orthopedics are trending towards job stability.
8,8147,502
11,177
8,249
West includes AK & HI
Source: SK&A, Dec 2015
U.S. Orthopedic Surgeons by Region
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
3
Practice Size and Patient Volume Orthopedic surgeons tend to favor mid-size practice settings. Nearly half (47.5%) prefer to practice in locations where there are between 3 and 10 physicians. Conversely, about 30% pull towards the largest of the large practices with 11 doctors and beyond. Three physicians practicing together as a business meet SK&A’s definition of a medical group.
1
No. of Doctors Per Office
2
3 to 5
6 to 10
11 to 25
26 plus
7.1%
23.6%
25.5%
22.0%
8.7%
13.1%
Office Size of Orthopedic Surgeons
1 2 3-5 6-10 11-25 26+ Total
4,676 3,098 7,878 9,100 8,450 2,541 35,742
Source: SK&A, Dec 2015
1 to 50
51 to 75
76 to 100
101 plus
32.6%
16.9%
6,02311.2%
39.3% 11,66114,044
4,014
Source: SK&A, Dec 2015
Daily Patient Volume
Orthopedic specialty offices are quite busy when it comes to patient visits and consultations. The pie chart below represents patient visits per practice location. Most practices (39.3%) see at least up to 50 patients per day.
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
4
500
0
1000
1500
2000
2500
3000
3500
Physical Medicine/Rehab Specialist
Podiatrist Family Practitioner
Internist
3,482
2,976
1,929 1,758
3,482
2,976
1,929 1,758
Source: SK&A, Dec 2015
Top 4 Specialty Associations
Ownership and Specialty AssociationsOrthopedic surgeons maintain a low level of independence compared to other specialties. Just 25% designated themselves to be independent or solo practitioners. About 56% said they are tied to either hospitals or health systems. In our survey, about 19% did not indicate their ownership status.
Orthopedics are closely aligned with other practitioners in their office setting. About 3,500 orthopedics indicated they are most associated with internists, which is not surprising considering the invasiveness of many orthopedic surgeries. Physical medicine and rehabilitation specialists also are common partners with orthopedics.
Health System Owned29.7%
Hospital Owned26.1%
Independent25.0%
Source: SK&A, Dec 2015
59.4%Yes
40.6%No
Have a secondary specialty?
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
5
0% 20% 40% 60% 80% 100%
Medicaid
Medicare
Orthopedic Surgeons All Physicians
92.7%
84.3%
66.1%
66.3%
Source: SK&A, Dec 2015
Medicare & Medicaid Aceptance
Affiliation to Hospitals for Admitting PrivilegesNearly 10% of orthopedics have no affiliation to hospitals, presumably conducting their operations and treatments solely in outpatient surgery centers. The trend towards outpatient service is gaining favor. About 40% of orthopedics are affiliated to just one hospital, while 50% are affiliated to two or more.
Affiliation to Hospitals No. of Doctors % of Total
0 3,418 9.6%
1 14,256 39.9%
2 12,054 33.7%
3 4,254 11.9%
4 1,760 4.9%
Source: SK&A, Dec 2015
Government Insurance AcceptanceOwing to the high cost of their complex treatments and rehabilitation, orthopedic surgeons are more likely to accept government insurance plans and navigate reimbursement than the average physician. Nearly 93% will accept Medicare and 66%, Medicaid.
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
6
New York-PresbyterianHealthcare System
Community HealthSystem Inc
Cleveland ClinicHealth System
Partners Healthcare System
Kaiser Permanente 331
165
157
139
130
Source: SK&A, Dec 2015
Top 5 IHS Employing Orthopedic Surgeons
Cleveland Clinic Cigna ACO
WellStar Health Network
Advantage Health Network &Florida Blue Cross Blue Shield
Montefiore Accountable CareOrganization & United HealthCare
Frederick Integrated Healthcare Network ACO 199
162
160
146
145
Source: SK&A, Dec 2015
Top 5 ACOs with Orthopedic Surgeon Participation
29.1%Yes
70.9%No
Percent OrthosPart of IHS
23.4%Yes
76.6%No
Percent OrthosPart of ACO
IHS Employment and ACO ParticipationEmploying more than 7,900 MDs and DOs in 800-plus medical offices, Kaiser Permanente is the largest employer of health professionals among integrated health systems. Kaiser hires the most number of orthopedics, double the number of the next top employer. Most orthopedics, however, remain independent.
At least 23% of orthopedics are participating in accountable care organizations (ACOs). While newcomer Frederick in Maryland is not one of the largest ACOs in terms of total physician enrollment, it has the highest number of orthopedics in its network.
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
7
Physician Access and Drug Sample Acceptance RatesOrthopedics are somewhat restrictive when it comes to details from sales representatives. One-quarter (25.5%) flat out will not meet with a rep. Another 55.2 % will see a rep but require an appointment up front. About 16% allow walk-ins any time.
Drug rep drops off drugs
Both
No preference or unknown
3.8%
34.8%
13.9%
47.5%
Source: SK&A, Dec 2015
Drug Sampling Preference
Access any time
Call for appointment
No access
Unknown
3.5%
25.5%
15.8%
55.2%
Source: SK&A, Dec 2015
Physician Access
In terms of sampling preferences, 14% expect a direct drop-off at their office, while close to half will accept either a drop-off or mail delivery. With their busy surgery schedule, it’s hard to pin down an orthopedic for an interaction or sample signature.
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
8
0%
10%
20%
30%
40%
50%
60%
70%
80%
20152014201320122011
19,284 21,12924,166 25,709 24,954
58.8% 62.0%68.7% 71.2% 69.8%
Source: SK&A, Dec 2015
EHR Adoption Rate
Electronic Health Record Adoption of Orthopedic SurgeonsOrthopedics’ adoption rate growth over the past three years has remained flat at an average of 70%. Even so, they remain ahead of other physicians in terms of software usage and office automation.
Annual Compensation or Orthopedic SurgeonsAcross the seven workplace types, orthopedics earn an average of $400,000 per annum, making them among the very highest paid surgeons. Solo practitioners earn the least, understandably, but those employed in healthcare organizations are bested by multispecialty group doctors.
Compensation by Practice Setting
Multispecialty Group Practice $459,000
Healthcare Organization $449,000
Single Specialty Group Practice $442,000
Hospital $397,000
Outpatient Clinic $388,000
Solo Practice $348,000
Academic, research, military $319,000
Source: Medscape’s Orthopedics Compensation Report 2014
SK&A 2601 Main Street, Suite 650 Irvine CA 92614 800-752-5478 www.skainfo.com
©2016 SK&A and its affiliates. All rights reserved. Trademarks are registered in the United States and in various other countries.
9
Samples
Meetings
Mailings
Detailing
0
$1M
$2M
$3M
$4M
Q3 2015Q2 2015Q1 2015Q4 2014
Source: IMS Health ChannelDynamicsTM, Dec 2015
Promotional Spend to Orthopedic Surgeons, by Channel
Promotional Spend Q4 2015 to Q3 2015 Channel Mix and Detail SummaryOrthopedics are sought-after targets for medical device and diagnostics providers. The industry’s preference is to detail the surgeons, but they also invest heavily in sponsored meetings and curricula and some direct mailings. Compared to the pharmaceutical industry, promotional spending and activity from the med-device manufacturers is minor. In a rolling annual forecast provided by IMS Health ChannelDynamicsTM, about 80,400 details or engagements were performed on orthopedic surgeons, with the second quarter of 2015 being the most voluminous period. The panel reported on the promotional activity of 38 manufacturers.
Source: IMS Health ChannelDynamicsTM, Dec 2015
14,514
18,552
26,816
20,528
14,514
18,552
26,816
20,528
Q3 2015Q2 2015Q1 2015Q4 20140
5k
10k
15k
20k
25k
30k
Total Product Details(in units)