market profile of u.s....

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


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.


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


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


Nearlyhalfofdermatologistssee50orfewerpatientsperday,correspondingtothenumberofsoloorsmallpractices.


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


Ownership, Affiliations and Specialty Associations

Dermatologistsmaintainarelativelyhighlevelofownership,withoverhalfbeingindependent.Over40percentofphysiciansintheU.S.areemployedbyIHSsorhospitals.Incomparison,lessthanafifthofdermatologistshavemovedtowardsintegratedhealthsystemsorhospitals.


Top 4 Specialty Associations

About15percentofdermatologistsareassociatedwithinternists,and10percentareassociatedwithfamilypractitioners.


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


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%


Government Insurance Acceptance

DermatologistshaveahigheracceptancerateofMedicarerelativetothegeneralphysicianpopulation,butamuchlowerrateofMedicaidacceptancecomparedtotheircounterpartsinotherspecialties.


85.5%

73.1%

93.7%

42.3%

0.0% 50.0% 100.0%

Medicare

Medicaid

Dermatologist Medicare and Medicaid Acceptance

Dermatologists

AllPhysicians


IHS Employment and ACO Participation

Employingover9,000MDsandDOsin33hospitalsand900+medicaloffices,KaiserPermananteisthelargestemployerofhealthcareprofessionalsamongintegratedhealthsystems.Thesystemhiresthemostnumberofdermatologists,twiceasmanyasthenexttoptopemployer.


Atleast15percentofdermatologistsparticipateinACOs.WhileHealthChoiceofUtahisnotoneofthelargestACOintermsoftotalphysicianparticipation,ithasthehighestdermatologistparticipationinitsnetwork.NextinplaceisPaloAltoMedicalFoundationCignaACO,whichhasanetworkofover580facilitiesandover3,300totalparticipatingphysiciansin2014.


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


Physician Access and Drug Sample Acceptance Rates

Dermatologistslikesalesreps.Only10percenthaveano-seepolicy,muchlowerthantheaverageno-seerateof28.5%.Nearlyhalfwelcomesalesrepstodropbyanytime.


Intermsofsamplingpreferences,two-thirdsofdermatologistsliketoreceivedrugsamplesbybothmailorsalesrepdrop-off.


45%

43%

10%

2%

Physician Access

accessanytime

callforappointment

noaccess

unknown

17%

65%

15%

3%

Drug Sampling Preference

NoPreferenceorUnknown

Both

Drugrepdropsof fdrugs

Mail


Electronic Health Record Adoption of Dermatologists

Dermatologistsareamongthespecialtieswithrelativelyhighelectronichealthrecords(EHR)adoptionrate.At63percent,EHRadoptionrateofdermatologistsisinlinewiththegeneralphysicianpopulation.


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


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.


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)


Channel Mix – Details, Samples and Meetings

Ahugeproportionofpharmapromotionalspend-75percent-wenttowardsdetailing.Comparedtothischannel,pharmaspentconsiderablylessonthenextmostpopularchannel–only17percentonsamples.


Total Market Details

Inthelastfourquarterstherewereover2.5milliondetails.Correspondingtothespikeinpromotionalinvestmentsin2014Q3,moredetailstookplaceduringthisquarter.


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)


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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