From the challenge of customer engagement to the possibilities offered by data
In order to exemplify the value of these Data Driven approaches, we have focused on dermatology as our first use case. The objective is to answer this question: how can a better understanding of the structure and evolution of medical demographics as well as the demand for care allow pharmaceutical companies to adapt their customer engagement models?
Based on several criteria: large population, declining density, aging specialists, looming practice changes, and of the 40 specialties we studied, dermatology ranks:
- 9th in number of practitioners in 2018, with a total workforce of 3918 specialists in 2018.
- 4th in workforce decline between 2013 and 2018, with a 6.3% decline.
- 6th in aging in 2018, with a 38.3% share of those over 60 between 2013 and 2018.
Our approach was based on the analysis of two main databases: Open Damir (data on health care reimbursements by AMELI) and Data.drees (data on health care practitioners and institutions). See our method at the end.
Key learnings about care supply and the impact on healthcare professional engagement
Decrease in workforce
Throughout the country, the number and density of dermatologists are decreasing year after year.
Between 2013 and 2018, there was a clear decline in the workforce: there were 4,104 practitioners in 2013, compared to 3,918 in 2018. The decline is therefore 4.5% in headcount. The density of dermatologists went from 6.3 dermatologists /100,000 inhabitants to 5.9 dermatologists /100,000 inhabitants, which presents a decrease of 6.3%. This decrease in care supply raises the question of the future capacity of the health system to care for patients. Given the growth and aging of the French population, but also the arrival of new therapies increasing the demand for care (atopic dermatitis for example), it will be necessary to find a way to increase the supply: who will take care of patients who cannot be seen by dermatologists and how to support these professionals in their increase in skills in this field / equip them to facilitate their practices?
The proportion of dermatologists over 60 is increasing every year.
The number of dermatologists over the age of 60 increased by 32.2% between 2013 and 2018. The share of dermatologists over 60 years of age increased by 10.6 points. The number of dermatologists under the age of 39 increased significantly (+22.2%), but the share stagnates (+3.8 points). In a process of engagement and support of physicians, this “aging” profile raises questions of adaptation of content and channels of information or medical education in comparison to digital natives who are more receptive to certain types of approaches.
Share of female dermatologists
Women represent about two-thirds of dermatologists and their share has been increasing since 1999. We are also seeing an aging population of these female dermatologists.
Women represented 69% of dermatologists in 2017, while they represented 45% of physicians across all specialties in the same year. The share of women in dermatology thus grew by 20% between 1999 and 2017. Those under 30 years of age are the smallest category and represent only 2.6% of dermatologists. The largest category was until 2017 when 50-59 year olds accounted for 30% of dermatologists. But since 2018, the share of those over 60 years of age has been the majority, as they represent 32% of dermatologists.
Here again, in an effort to engage and support physicians, this increasingly female profile raises questions about potentially adapting approaches. As women are considered to have a more closed mindset to medical visits, but they represent more than half of the dermatologists, the adaptation of information, support, and commitment methods is required.
The regions most at risk in terms of medical desertification, according to our multicriteria analysis, are: Corsica, Auvergne-Rhône-Alpes, Île-de-France and Centre-Val-de-Loire.
- Corsica: the share of physicians aged 60 and over is the highest in 2018: 60.5%. Between 2013 and 2018, Corsica has the largest increase of the share of 60 years and older with a rate of 23.1 points, a decrease in the share of 40 to 59 years of age by 15.4 points and a decrease in the share of less than 39 years of age by 7.7%.
- Auvergne-Rhône-Alpes: between 2013 and 2018, the density there fell by 10.5%.
- Ile-de-France: share of physicians aged 60 and over in 2018: 47.2%. Between 2013 and 2018, the density there falls by 9.5%.
- Centre-Val-de-Loire: in terms of changes in the number of practitioners over 60 years of age, it is the Centre Val de Loire that comes out on top with an increase in the number of dermatologists over 60 years of age by 76.0% between 2013 and 2018, a decrease in those aged 40 to 59 years by 38.7% and an increase in those under 39 years of age by 21.4%.
In light of this information, what adaptation should be made to the commercial and public affairs strategies in these regions? How can this disparity be translated into something other than a more or less significant field force? What local issues do these disparities raise for the healthcare sector, knowing that there are opportunities to work on collectively? (tele-expertise, etc.)
Status of dermatologists
The number of exclusive liberals is the highest, but decreasing, while the number of hospital employees and mixed employees is increasing. Half of the hospital employees are under 39 years of age, while those over 40 years of age prefer to work in private practice.
Between 2013 and 2018, the number of exclusive liberals decreased by 14.8% while the other three practice modes saw an increase: +21.5% for mixed, +15.2% for hospital employees and +4.7% for other employees. Exclusive independents are the most numerous. The under 39s are much more present in hospitals than other age categories (they represent 47.1% of hospital employees). The over-60s are mainly self-employed (70%). The 40-59 year olds are also predominantly self-employed (62.2% of them work in private practice).
It is necessary to anticipate the evolution of the modes of practice, in particular the drastic decrease in the number of independent dermatologists, in order to find a solution to preserve the supply of care in areas far from hospitals.
Learn more about Data Driven approaches and Data Driven strategies >
Key learnings on patient profiles and impact on care pathways
A slight increase in visits
Despite a slight increase in the number of consultations (+ 4.5% of care per capita between 2016 and 2019), the behavior remains stable: the demand is slightly increasing.
With a decrease in the number of health professionals in dermatology and an upward trend in demand, the question of saturation of the supply of care arises in France, particularly with regard to the decrease in the supply of care mentioned above.
Women consult more
More than half of dermatology consultations are for women (although the number of consultations among young adults is decreasing) and the proportion of people over 60 years of age is clearly increasing.
Beyond a relatively stable number over the years, we note that the share of consultations by women is higher than half: more than 56% of care is performed for women. This difference in parity is especially visible among young adults and reduces with age.
Contrary to the distribution of the number of consultations by sex, which seems constant, the number of consultations by age is not. Indeed, there is a clear emergence of the number of dermatology consultations for people over 60 years of age, and a decrease in the number of consultations for young people aged 20 to 30 years. The aging of the population is a factor in this phenomenon but does not explain it in its entirety.
This patient profile was defined using the Ameli database, which collects anonymized data. With additional information to follow the patient pathway, with pseudonymized data, it would be possible to better understand the demand for care for each of the typical profiles.
In any case, a rather female and increasingly older patient base represents a patient segment with specific needs. The challenge for manufacturers is to increasingly support doctors in their dialogue and in the management of specific patient segments.
An outflow of patients
In some regions, an exodus of patients is more pronounced than in others and would be due to edge effects (at the borders) as well as a lack of practitioners in these regions.
- 35% of consultations for people living in the Centre-Val-de-Loire region are made outside this region.
- 26% of consultations for people living in the Auvergne-Rhône-Alpes region are made outside this region.
- 26% of consultations for inhabitants of Pays-de-la-Loire are made outside this region.
It would be interesting to study these indicators at a more detailed level in order to better understand the causes and potential opportunities in terms of the organization of care at the local level. Once again, these regional analyses point to the possibility of a project to optimize care pathways to be carried out collectively in the region in order to better serve the needs of the populations in these territories.
Read also : Health data: which models for tomorrow? – Alcimed Position Paper
From observation to customer engagement opportunities for pharma players
In dermatology, while demand is increasing slightly, the supply of care is decreasing. The distribution of practitioners by age group and by region is uneven across the country, and the challenges of renewing the supply of care are to be expected. All of these analyses provide opportunities for laboratories to define their engagement strategies in order to best adapt to the specificities of their clients. They can also help local ecosystems to improve territorial care.
Our results pave the way for further data analysis, depending on the identified needs. Other use cases are possible, such as:
- Establishing a methodology for estimating the risk of medical desertification by region.
- Calculation of the availability of consultations (or waiting time before consultation) for a given pathology, according to its epidemiology. Recommended care and distribution of practitioners by region and by practice mode.
- Or a predictive tool for the distribution and future number of dermatologists in 5 and 10 years, in order to anticipate the territories that present a strong risk of medical desertification.
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The methodological approach of Alcimed
To answer these questions, we used two open access databases, both compiled by public agencies, namely:
The use of these open access databases allows us to carry out demographic studies with a fine granularity:
- 5 or 10 year age groups
- Data on regions or even departments
- Activity modes divided into four categories
- Possible overlap of variables related to age, gender, location and modes of practice
About the author,
Michael, Data Scientist in the Alcimed’s Healthcare team in France