A new report by ZS Associates looked at call reports for more than 200 pharmaceutical sales teams and found that reps’ access to physicians has declined steadily since the firm’s first report in 2008. In 2014, 49% of physicians in the U.S. placed moderate-to-severe restrictions on visits from pharma sales reps. This compares to 45% of prescribers who restricted rep access in 2013, 35% in 2012, and only 23% in 2008. Furthermore, the steady decline of representative access to physicians (as seen in the graph above) is spreading to previously “rep-friendly” specialties.
ZS Associates’ report, entitled AccessMonitor™, examined how often approximately 325,000 physicians and other prescribers meet with pharmaceutical sales representatives who visit them. The report then classified those doctors into one of three groups: 1) “accessible” (physicians who met with more than 70 percent of reps who call on them); 2) “access restricted” (between 31 and 70 percent); and 3) “severely access restricted” (30 percent or less). It also broke down the data into physician specialty and metropolitan area.
In terms of practice area, the firm reported a decline in rep access among a group of what they deem previously “rep-friendly specialties,” including dermatology, gastroenterology, and pediatrics. For example, about 84% of dermatologists and 63% of gastroenterologists were fairly accessible to reps in the 2013 report. In one year, those numbers dropped to 67% and 47% respectively.
In looking at the data by metropolitan area, ZS noted that even the most restrictive cities in 2013 tended to decrease their access for 2014.
Analysis:
ZS concludes that this decrease in physician access is driven by a number of factors. They argue that payer and provider consolidation creates a “payer-provider nexus,” where hospitals buy physician practices and mandate policies that restrict access. On a micro level, ZS also states that the decline is the result of greater demands on doctors’ time and an increasing number of younger doctors who “would rather receive the latest news and communicate with pharmacos via digital channels and their mobile devices.”
We also would note that uncertainty surrounding the Physician Payments Sunshine Act may be a part of the reason for the downturn in physician access. Physicians may worry about rep visits adding to their reportable transfers of value. Interestingly, the report notes that doctors have moved towards educating themselves through digital means and online learning. The costs of attending accredited continuing medical education programs, many of which are available online, are currently excluded from reporting under the current Final Rule of the Sunshine Act.
However, as we have reported on closely in the past few weeks, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove this exemption. This would be very detrimental to important educational programs, especially considering that physicians are closing off traditional information avenues potentially to avoid being scrutinized under the Sunshine Act.