Knowledge is power

Editor's note: Chris Lee is president of MedQuery, a Chicago research firm. Michael Schulte is vice president, client service at MedQuery.

Recruiting medical professionals and those with rare medical conditions is arguably some of the most challenging recruiting there is for market research. Physicians often have numerous subspecialties that are not always obvious. For example, neurology has several subspecialties including movement disorder specialists, MS specialists, migraine specialists and neuro-oncologists. Not every neurologist treats the same diseases. So when a client says they need to speak to neurologists, who do they really want? Will you know how to find the right person?

Within hospitals, there are hundreds of different titles of people with overlapping responsibilities, making it very challenging to determine the right respondent. If a client asks for the person who makes decisions about new products, it could be the medical director of the department, the administrative director of the department, the CFO, COO, director of materials management, director of pharmacy, chairman of the pharmacy and therapeutics committee and on and on. Who does the client really want you to speak to and how do you know they are the right person for the market research project?

For patient research, it is even more challenging. Most diseases are rare within the general population and many are extremely rare. It is not uncommon to research diseases that are as rare as one person in 1,000 with the condition or even one in 10,000. At that level, it is very difficult to find a panel of any size. So now what? What recruiting methods can be used? Can the project even be recruited? Should you just pass on the job?

The point is, medical market research often requires a significantly higher level of understanding of the respondent than many other types of market research. The risk of overestimating screener qualifying incidence and the time it will take to field a project is much higher than typical.

So how you make difficult medical recruiting like this easier? By taking the time to focus on several key topics at the beginning of any medical project, you can dramatically improve the chances of obtaining high-quality respondents, staying on-deadline and under-budget.

Here are seven tips for your next medical market research project:

1. Learn about the disease. 

This seems like an obvious statement to research the disease but in our many years of medical recruiting, we are consistently surprised at how little the client sometimes understands their marketplace. It is also not uncommon for a drug manufacturer or medical device maker to assign the market research project to a relatively junior project manager who is leaning on their vendors to help them design the screener questions. The point is, never assume the client knows what they need. Do your homework.

Nowadays, it is very easy to find information by Googling the titles or medical conditions needed. Wikipedia and various medical sites such as WebMD can quickly provide all the information you need.

Depending on the respondent audience you need, don’t limit your research to just the disease. Make sure you understand who treats the disease, where it is treated (hospital, clinic, etc.) and with what medications or interventions.

2. Research the titles needed.

As noted earlier, a lot of different medical personnel can be involved in product decisions. Unlike researching the disease, it is a bit more difficult to learn about the structure of hospitals or medical clinics on the Web, but you can definitely learn some key details. Most hospitals have a “find a physician” search function that allows you to input keyword searches. Using our neurology example again, if you type in “migraines” you will be able to find out who exactly treats migraines and start to learn more about their subspecialties and background, which will help significantly to determine the feasibility and screener for the project.

To better understand a hospital staff’s roles and responsibilities, it is helpful to find an org chart that lays out all of these details. With a little digging on the Internet, you should be able to find the org charts for several different hospitals. We recommend reviewing a university hospital, a larger community hospital and a smaller community hospital to see how they compare and differ. Some hospitals are also part of multihospital systems or integrated delivery networks. Depending on the requirements of your project, you may want to research to this level as well.

3. Carefully estimate screener incidence.

To ensure a successful recruit, perhaps there is no more important topic than estimating what percentage of respondents will qualify for your research project. A common type of question that is often a problem is when a patient needs to be on a certain medication or the physician must prescribe a certain level of the medication. Clients almost always overestimate the usage. In fact, your client is much more likely to overestimate how many people will qualify in general.

The screener-qualifying percentage can have a significant impact on any market research project, but particularly for rare titles and diseases. A study can quickly become unrecruitable if the estimate is wrong. The worst time to tell a client you can’t do their project is after it starts, so the more accurately you can estimate this at the beginning of the project, the better.

A suggestion that has worked well is to come to an understanding with your client about the expected incidence and set the price and timelines accordingly; but provide an alternate scenario as well. For example, let’s assume your client believes 80 percent of potential respondents will pass the screener. Certainly provide pricing for this scenario but then include language such as “If the screener incidence falls below __ percent, we might need to revisit the termination points on the screener or reprice the project.” This at least gives you a talking point if and when things don’t go as well as planned.

Obviously this idea is not unique to just medical market research, but because some of the titles and diseases are so rare, it is not rare for a job with an expected screener incidence of 50 percent to come in at 5 percent. In other words, you will now need to screen-in 10 times the number of respondents, with all the related costs involved.

Spending a little more time on the front end analyzing the likely screener incidence can save you a lot of time and money on the back end.

4. Understand the field agency’s level of expertise.

If you need to hire a field company to find the respondents for you, don’t assume because they recruit medical respondents that they can actually recruit the respondents you need. You would be amazed at how little medical panels are geared towards rare diseases specifically. For example, hemophilia is a disease that only 10,000 people have in the United States. As a result, there are only 270 hemophilia specialist physicians in the entire country. Many panel companies would count up their general hematologists in their panel, tell you they can get as many as you need and send out invitations to all of their hematologists, assuming they treat the disease, when in fact you really need to be targeting the 270 physicians. The result is likely a disaster.

Make sure to ask the fielding agency to tell you what they know about the disease, how many studies they have managed in the disease category and whether they are subcontracting the work – a very common practice, particularly for rare diseases and an additional step that can cause an oversight like this to happen.

5. Remember that participation rates are key to gauging project feasibility.

In medical market research, the participation rate among medical professionals overall is only about 7 percent. We are often surprised by how different the clients’ perspectives are about participation, often with expectations that one in four (or more) will participate in their project. Even within well-managed opt-in panels, the participation rate in market research is still only about 20 percent for medical professionals.

The reality is that medical professionals are very busy and very well-paid. When dealing with rare categories, this becomes especially important to carefully assess how many will be able to participate overall.

We would suggest getting a copy of the American Medical Association’s counts by specialty nationally. It is a great starting point to know the total universe and apply participation rates and screener incidence to see how many can be recruited before you talk to your client about how many you can get for them.

6. Assess your client’s call list prior to pricing.

When a client provides a recruiting list, it is critical to verify how many records you will be receiving and how accurate the contact information is before pricing the project. Applying the 7 percent participation rate, you would need at least 13 records for every respondent you need and that assumes they all pass the screener. If the client’s list is not accurate, the ratios above will drop even more.

Often, smaller-sized client lists require traditional phone recruiting in addition to a typical panel company sending out e-mails. For this reason, applying the 7 percent participation rate to any client list will guarantee you have a fairly accurate assessment of how many can be recruited before you commit to a project, even when phone recruiting and other alternate methods of recruiting are required.

7. Assess feasibility with extremely rare patients.

Probably the hardest recruit of all is the extremely rare patient (one in 10,000 or fewer). Panels are usually non-existent. Physician referrals are difficult and in these cases the doctor may only have a handful of patients anyways. Support groups and association leads are limited at best.

So do you just pass on the job or how do you assess what can be done with this type of project? In our experience, these projects almost always have to be recruited using “guerrilla” recruiting techniques of referrals via support groups, associations, social media and other networking techniques. Unlike a panel, where it is easy to project the participation rate, these types of methods are very hard to predict for effectiveness. So how do you determine how many you can recruit?

Interestingly, the incidence of the disease can provide a fairly accurate predictor of how many can be recruited. When conducting medical research, investigators almost always assess the incidence of a disease in terms of a population of 100,000. For instance, a quick Google search identifies that Type 2 diabetes, a relatively common condition, occurs in about 800 per 100,000 people in the United States. Chronic lymphocytic leukemia, on the other hand, is a very rare disease with an incidence of about 10 per 100,000.

Using these figures as a rough estimator, you can then convert these figures to approximate how many respondents you can recruit – 800 Type 2 diabetes patients and 10 hemophilia patients.

This estimation is by no means scientific but in many years of recruiting medical diseases, we can tell you that this is a fairly accurate method to give you a quick assessment of feasibility when you are writing your proposal.

Avoid unpleasant surprises

If you consistently address these seven topics at the beginning of a project, you will find your pricing will be more accurate, your timelines will stay on target, you will avoid unpleasant surprises along the way, keep your client happy and make difficult medical recruiting easy.