Macro Trends: What Influences Orthopedic Surgeon Decision Making?

There are multiple factors that affect physicians’ decision making. It is well known that changes in healthcare have affected the way medical devices are chosen in the hospital. Hospital purchasing best practices have improved, and are conducted with a higher level of sophistication. New methods have been developed to require compliance to GPO/IDN contracts. Hospitals plan to employ more physicians¹ (estimates place the percent of employed orthopedic surgeons at 49 percent²), reduce the number of physician preference items, and increase the number of products under contract. Value Analysis Committees require proof that a product is truly a physician preference item using clinical studies, with evidence of unique features that truly impact outcomes or reduce hospital costs.

Although the orthopedic surgeon may not be king any longer, s/he is still a critically important figure in the court of the healthcare decision-making process for medical devices. In our research, we often look to our sister industry, pharmaceuticals, to see what it is seeing to understand how it is managing the changes that are creating so much turbulence in the U.S. healthcare system.

Pharmaceutical marketing delivers value to physicians by providing regulated scientific and educational information about new medications. As seen in Chart 1, physicians use their own judgment, experience and many other sources of information to determine which medications to prescribe their patients. Pharmaceutical marketing still plays an important role in providing information to balance other factors, such as healthcare system use management programs that emphasize promoting on-contract products. Thirty eight percent of physician respondents in the study indicated that colleagues and peers influence their prescription choices a great deal. This shows that the money invested in pharma-to-physician speaker marketing programs is still a viable investment in promotion that impacts physician decision making.

What Factors Influence Physicians in Recommending Diagnostic Tests or Procedures? The Practice of Choosing Wisely
Although the Choosing Wisely⁴ campaign is championed by almost all of the major medical societies, common practices in most U.S. medical specialities lead to overtesting and overtreatment. In a Medscape survey, physicians were asked if the Choosing Wisely initiative would lead to more lawsuits. As seen in Chart 2, 37 percent believe that the Choosing Wisely program will result in a higher level of lawsuits, while 24 percent said the program would not, and 39 percent were uncertain.

What Are the Most Often Cited Reasons for Physician Lawsuits?⁶
In a Medscape survey (n=3,985) physicians were asked about the alleged root cause of the lawsuit. Top answers included:

• Injuries or death during surgery;
• Post-op infection;
• Late or misdiagnosis of cancer;
• Misdiagnosed cardiac emergency;
• Birth defects or fetal death;
• Nosocomial infections;
• Falls in the hospital; and
• Medication errors.

The Orthopedic Arm of the Medical Device Industry Doesn’t Have the Big Marketing Budgets of Pharma
This means the medtech industry needs another strategy. What if you told your R&D department that a reduction in the potential for lawsuits was part of the marketing specification for a new product? This is medtech whitespace and a good place to start for medtech innovation. 

Editor’s note: Readers are invited to submit market data and trend questions to Maria Shepherd. Periodically, selected questions will be presented in this column, with answers from Maria. Send your questions to [email protected].

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Maria Shepherd has 20 years of leadership experience in medical device/life-science marketing in small startups and top-tier companies. After her industry career, including her role as Vice President of Marketing for Oridion Medical, where she boosted the company valuation prior to its acquisition by Covidien, Director of Marketing for Philips Medical and senior management roles at Boston Scientific Corp., she founded Data Decision Group. Data Decision Group provides marketing and business strategy and innovation research for the medical device industry. The firm quantitatively and qualitatively sizes and segments opportunities, evaluates new technologies, provides marketing services and assesses prospective acquisitions. Shepherd has taught marketing and product development courses, was recently appointed to the board of the Aligo Medtech Investment Committee (www.msbiv.com) and can be reached at 855-343-3100 ext. 102 or at [email protected]. Visit the website at www.ddecisiongroup.com.

References

1. Massmedic.org
2. http://www.aaos.org/AAOSNow/2015/Mar/managing/managing6/?ssopc=1
3. Source: KRC Research, Survey of Physicians on Pharmaceutical Information, Commissioned by PhRMA, March 2008.
4. http://www.choosingwisely.org/
5. http://www.medscape.com/features/slideshow/public/malpractice-report-2015?nlid=93274_1521&src=wnl_edit_medp_wir&uac=123692CK&spon=17&impID=921866&faf=1#page=11
6. http://www.medscape.com/features/slideshow/public/malpractice-report-2015?nlid=93274_1521&src=wnl_edit_medp_wir&uac=123692CK&spon=17&impID=921866&faf=1#page=11
7. Malpractice Risk According to Physician Specialty, N Engl J Med. 2011 August 18; 365(7): 629–636.