These findings are available in SK&A’s latest Physician Access study, an ongoing survey of U.S. medical offices to determine policies for allowing healthcare industry sales-rep access to physicians and other prescribers. SK&A has been measuring industry access to physicians since June 2007. The recent study is based on telephone interviews with 213,616 medical sites representing 632,000 physicians. SK&A surveys its Office-Based Physician database every six months from its Research Center in Irvine, California.

In the past year, access to physicians has stabilized overall, suggesting that pharmaceutical marketers may have found the right mix of personal and non-personal promotion, according to Dave Escalante, SK&A VP of data and information solutions.

The percent of physicians who require or prefer appointments has increased significantly in the past year, from 38.5% in December 2008 to 49.6% in December 2009, according to the survey. The number of physicians who restrict access altogether has remained unchanged in the past 12 months at about 23%.

The report found specialty physicians are less likely to grant sales reps access than general practitioners. The top-three accessible physicians are allergists/immunologists (4.4% no-see rate), diabetes specialists (7%), and gynecologists (7.5%). The least accessible physicians are diagnostic radiologists (91.8% no-see rate), pathologists (91.7%), and neuroradiologists (91.5%).

Offices with fewer patients seen daily are less likely to host sales reps. Sites with a daily patient volume of one to 10 have a no-access rate of 28.9 percent and those with a daily patient volume of 31-40 have a 13.6 percent no-access rate.

Health system- and hospital-owned offices are less likely to grant sales reps access than offices not part of a health system or owned by a hospital. Health system- and hospital-owned offices have no-access rates of 30.3% and 29.5%, respectively. Non-health system and hospital-owned offices have no-access rates of 21.5% each.

Larger practices are less likely to grant sales reps access. Offices with one to two physicians have a no-access rate of 13.4% while offices with 10 or more physicians have a no-access rate of 42.1%.

Physician offices in the Western U.S. are least likely to allow sales reps access. The South had the lowest no-access rate with 19.4%, and the West had a 28.2% no-access rate.

Houston numbers 2,170 physicians across 385 sites, according to SK&A. Meanwhile, San Antonio numbers 1,607 physicians across 332 sites, Fort Worth numbers 1,029 physicians across 303 sites, and Austin numbers 974 physicians across 137 sites.

Why is this? High skin cancer rates? Dust lung? The preponderance of bull-riding injuries?

Actually, as the Wall Street Journal Health Blog reported in 2008, “In the last three years, 7,000 doctors have moved to Texas. So many doctors want to practice there that the state has had trouble keeping up with the requests for licenses.”

Due, according to this opinion piece in the WSJ, to a clampdown on damages in malpractice suits.

But these clusters are major population centers, and Texas is a big state. Despite all the doctors in places like Houston and San Antonio, The Texas Tribune reported in January that, “Dozens of rural Texas counties have no primary care doctors, no hospitals, no pharmacies. Many Texans live more than an hour from basic medical care. Some border communities have so little health care that U.S. citizens cross over into Mexico to get it.”

The article explains the discrepancy as the “payer mix” problem: “Rural Texans, who are older and poorer on average than urban Texans, are often uninsured or on Medicare. Some are undocumented, particularly along the border. They aren’t profitable patients for doctors, pharmacists or hospitals struggling to stay in business in isolated communities.”

According to this December 2009 article in The Dallas Morning News, legislators in Washington tried to make a difference by getting some relief for the rural healthcare system written into the Senate and House healthcare reform bills in the form of higher Medicare reimbursements for some rural health programs and geographic areas and added resources to recruit providers to rural areas.

With passage of healthcare reform now on the rocks, however, even that help looks uncertain. Meanwhile, nonprofit rural clinics are struggling to fill the gap.

The Partnership for Prescription Assistance is also doing what it can. A year ago today the partnership announced that its “Help is Here Express” bus tour would be making stops in various cities throughout Texas in order to help uninsured and financially-struggling Texans access information on programs that provide prescription medicines for free or nearly free.

The Partnership for Prescription Assistance is a nationwide effort sponsored by America’s pharmaceutical research companies providing a single point of access to more than 475 patient assistance programs that help those who are uninsured or struggling financially. Nearly 200 of the programs are provided by pharmaceutical companies.

OneKey is a telephone-verified database that provides customers with healthcare practitioner and organization data including affiliations for group practices and hospitals. Following the acquisition, the OneKey service will now also allow customers to benefit from updates by SK&A research associates who make 6,000 telephone calls each day verifying and maintaining healthcare data.

“Customers will receive a strong combination of access to high-quality data with continual proactive updates to the data,” says Bill Buzzeo, VP and general manager for compliance and OneKey Solutions, Cegedim Dendrite.

According to Mr. Buzzeo, SK&A has stood out from its competitors as the only U.S. data provider to pharmaceutical companies that uses this type of model.

“It is generally recognized that between 15% and 18% of healthcare professionals will change locations in a 12-month period,” Mr. Buzzeo told Med Ad News. “By adding SK&A’s healthcare contact and site data and unique, proactive methodology utilized to ensure the high quality of this data, Cegedim Dendrite has a strong complement to our existing U.S. OneKey service offerings, further solidifying our customers’ effectiveness in the market.”

Founded 26 years ago, SK&A researches and maintains contact profiling information for more than 2 million healthcare practitioners, including 800,000-plus prescribers. Executives believe that the integration into the Cegedim Group will enable SK&A to significantly expand its market opportunity within the life sciences industry.

The newly acquired company will be commercially branded as SK&A, A Cegedim Company, and will be integrated into Cegedim Dendrite’s OneKey business unit. Dave Escalante, SK&A’s current president and CEO, will continue to lead the unit. SK&A will maintain its current operations headquartered in Irvine, Calif.

“Based on the opportunities and business plans ahead, we don’t anticipate any major or large scale changes to the number of staff,” Mr. Buzzeo told Med Ad News. “However, as with all companies, certain limited actions may occur to avoid duplication of roles as the business landscape changes and the operations of the two companies become integrated.”

The deal was finalized Jan. 7, 2010 by internal financing. These activities represent annual revenue of about $15 million and will be part of the consolidation scope of Cegedim Group for 2010.

In this iteration of its survey, SK&A found that office managers wield as much influence as lead physicians in determining the policy for allowing industry sales reps to visit with physicians. Of the medical practices that allow visits, 48% of respondents said the office manager sets the policy while 47% said the lead physician sets the policy. Another 5% of survey respondents said the policy is established at the group headquarters level. Moreover, 97% said their sales rep visitation policy has been in place for two or more years.

“Establishing a great business relationship with the office manager is imperative for sales reps trying to meet physicians face-to-face,” says Dave Escalante, president and CEO of SK&A. “In nearly half of the medical offices surveyed, the office manager is the literal gatekeeper to seeing the physician. To provide enhanced support for their sales teams, pharmaceutical, biotech, medical device, and medical equipment companies are executing non-personal promotion marketing campaigns, primarily through direct mail and e-mail, to educate the office manager on the value of their company’s products and services.”

Although access to physicians has remained stable, the percentage of physicians who require or prefer appointments to be set for meetings jumped from 38.8% to 48.4% during the same time period. Meanwhile, 22.7% of physicians refuse to see sales reps at any time. Specialty physicians, such as pathologists and radiologists, are much more likely to restrict access than general practitioners.

13% of group practices have general policies to restrict access to physicians at all their office locations, and 7% have these policies at some locations. When medical practices are owned by hospitals, sales reps can expect more obstacles in reaching physicians. The survey found 29.3% of practices owned by hospitals have “no-see” policies. Medical practices owned by health systems are slightly more restrictive. The survey found 34.6% of these practices have “no-see” policies.

The larger offices are, the harder it will be to see physicians. Physicians in larger practices, as measured by number of doctors, are less accessible than those with fewer physicians in practice. No access jumps from 13.7% in offices with one to two physicians to 42.2% in offices with 10 or more doctors.

Finally, regionally, the West is most restrictive with a 28% no-access rate, followed by the East (23%), the North (21.7%), and the South (19.5%).

These findings were based on telephone interviews with 224,895 medical practices representing 649,331 doctors. The physician list is available for sale to assist healthcare marketers in appointment setting and connecting with prescribers. SK&A says custom reports based on geography, specialty, practice ownership or sizes are also available, upon request.

In a recent study, researchers with SK&A Healthcare Information Solutions found that 15.2% of U.S. physicians move to a new location or practice, retire, or pass away each year.

According to SK&A researchers, aerospace medicine and chiropractors are the biggest movers. The top five movers also include hepatologists, adolescent medicine specialists, and geriatricians. (Editor’s Note: Aerospace medicine? In case you’re wondering, physicians in this area are responsible “for the determination and assessment of the health, safety, and performance of persons involved in air and space travel” – go to the Aerospace Medical Association for more information.)

Meanwhile, diabetes specialists are the least likely to move and thus most stable. Other physician segments in the bottom five are orthopedic reconstructive surgeons, plastic surgeons, dermatopathologists, and pediatric critical care specialists.

The report ranks 88 specialties by their annualized change rate and is based on telephone interviews by the SK&A Research Center with about 224,000 medical practices representing about 650,000 physicians. SK&A has sorted the data in two ways: alphabetically by physician specialty and by move rate. The full complimentary report is available for download from SK&A.

According to research conducted by SK&A, a provider of healthcare information solutions and research, the percentage of physicians who require appointments crept up from 31.4% to 38.5% between June and December 2008. This according to a survey of U.S. medical practices designed to determine their policies for allowing healthcare industry sales representatives access to physicians and other prescribers. Meanwhile, the percentage of physicians who forbid sales-rep access altogether rose from 22.3% to 23.6%.

Dave Escalante, president and CEO of SK&A, notes that today’s field sales forces are facing increased limitations, as their influence on prescribers is being highly scrutinized. He believes that there is an opportunity for marketing and sales to understand these trends and the advantages of the many more touch points available to reach and educate physicians beyond the traditional office call.

When it comes to interacting with physicians, however, the key is becoming not so much how a rep gets the attention of the physician once he or she is in the office. Rather, how does the rep secure the all important appointment now increasingly necessary to get in the door in the first place. I asked Mr. Escalante what he would suggest to reps looking to make sure they’re booked on the physician’s crowded calendar.

“The keys to the kingdom are held by the receptionists and office managers,” Mr. Escalante told me. “One of the best ways for a sales rep to get an appointment is to maintain existing relationships with these people, build new ones, and understand emerging access policies and the site and group level.”

Physicians across every type of practice are moving towards placing restrictions on sales-rep access. For example, about 40% of general practitioners said they require appointments versus 33% who said so six months earlier. The same is true for specialty physicians: 36.6% now require appointments compared with 28.31% last June.

SK&A found that physicians working in group practices that are owned by health systems or hospitals are less likely to see sales reps and more likely to require appointments than those who are working in independently owned practices. The survey found 34.7% medical practices owned by health systems have “no-see” policies and 52% require appointments. When a medical practice is owned by a hospital, sales reps can expect more obstacles trying to reach physicians. The survey found 31.2% of practices owned by hospitals have “no-see” policies and 44.6% require appointments.

Physicians working in offices with 10 or more practicing physicians are more likely to restrict access than physicians working in smaller offices of one to two doctors. 14% of group practices have a general policy to restrict access to physicians at all their office locations.

Also, access to physicians varies by region, with physicians practicing in the Southern U.S. being the most accessible and the Western U.S. being the least. The survey found major Metropolitan Statistical Areas may not follow the regional trend. In the San Francisco MSA, for example, physician access is more than 56% more restrictive than the regional average.