Wellness Contact

Delivered January 26th, 2018

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Wellness Professionals - Appointment Rates.

There is a wide variation in the price that a wellness professional typically receives per appointment, according to an overview of seven types of practitioners.  For this study, we looked at the typical per-session cost for nutritionists, natureopaths, massage therapists, acupuncturists, chiropractors, sex therapists and pelvic floor therapists.

Based on an overview of the sources, we found that prices are impacted most by what type of specialty is being practiced.  The highest potential prices found in our overview are for natureopaths and pelvic floor therapists, though higher levels of training and a specialized practice can lead to higher prices across the list of practitioner types.

Overview
For many of the specialists listed here, there are different fees for the initial visit and for subsequent follow-up visits.  In these cases, the initial visit will be more expensive.

There is often a wide range of price within a particular specialty.  Most often, the factors influencing this are the educational level of the therapist and whether the therapy requires something unusual.  As detailed below, price can also be impacted by the region of the country where the therapist operates.

The costs used in this report are calculated on a per-session basis.  The standard for a session length is typically an hour, judging by an overview of all the sources used. However, a session can last for as little as 15 minutes and up to 90 minutes. 

1. Nutritionist 
The price for a nutritionist can vary significantly based on factors like education, reputation and location.  Some sources list a cost for a follow-up appointment as low as $50.  Meanwhile, a one-hour initial consultation with a registered dietitian, or RD, can cost up to $200.

On average, the sources suggest that a typical appointment costs between $60 and $100. However, as noted above, hiring an RD could lead to a per-visit cost of $150 or $200.

2. Natureopath
There is also a wide variation in the costs for natureopath.  Looking at the sources as a whole, we can place a broad range of $100 to $300.  

Typically, natureopath offer an initial visit at one price and follow-up visits at a lower price.

For instance, one clinic used in the data set cost $190 for initial visit for one hour and $100 for follow up visits.  Another clinic charged $250 for first visits and $135 for subsequent visits.

3. Massage Therapists
The average price of a massage therapist runs between $70 to $100 per visit.

As is the case with most of the specialists listed here, several factors can affect price.  For message therapists, common factors include duration, location, travel costs, specialized massage, add ons and packages such as those offered at corporate events. 

4. Acupuncturist 
The initial cost for a visit with an acupuncturist will typically run from $75 to $95, though it is possible to find sessions for lower, with $60 also being quoted as a potential low-end price. The initial visit will usually include an acupuncture session and medical consultation. 

The price drops for subsequent visits.  Routine visits typically cost between $50 and $70.

5. Chiropractors
The price range for chiropractors is possibly the widest among the specialists listed here.  Price can be affected by the training of the practitioner and what kind of services the customer requires.  Additionally, location plays a role in the price a chiropractor charges.  For instance, average fees are highest in the South, around $70 per session, and lowest in the Midwest, at $60.

In terms of the range, a session with a chiropractor could be as cheap as $30, but could run to up to $200, again depending on what is being done and the level of training needed.  On average, a general vertebrae adjustment costs $65, according to a recent survey in Chiropractic Economics magazine.

6. Sex Therapists
There are fewer sources available dealing with sex therapists.  However, one general estimate put the average cost at about $80 to $100 per hour.

A second sampling taken in the Chicago area suggested a similar price range, from about $80 to $150 per hour.  An overview of the sources suggests that location may influence prices for this specialty as well.  Also, a review of the sources suggests that any potential clients should look into the local laws governing this specialty.

7. Pelvic floor therapist 
Pelvic floor therapists are considered physical therapists.  Like chiropractors, there is a wide range of price points offered in this specialty.  The price can run from $50 to $350, depending on several factors.  The most common variables affecting price include the length of the session, the service provided and the individual provider.

While there is a wide variation in potential per-session costs, the average session typically costs between $60 and $80. 

Conclusion
A review of the seven types of wellness practitioners included in this study found that there is a wide variation in the per-session rates.  Prices ranged from $30 to up to $350, depending on the type of the practitioner, the training level of the practitioner and the type of service provided.  There was often a price difference between an initial visit and subsequent follow-up visits for certain specialties, with the initial visit being somewhat more expensive.  Price was also influenced by the region of the country.

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Wellness Professionals - Business Costs.

Based on the available information regarding the business costs for wellness professionals, the average total cost of an office space is $54,697. The average cost for new patient acquisition is estimated to be between $314 and $348 per patient for print and media advertisements. For online campaigns, the average cost per patient drops to $149 a patient. Other significant cost hurdles for wellness providers to consider when opening a practice are equipment related costs, insurance costs, and labor costs. Below is a detailed breakdown of the cost calculations. 

Office space expenseIn an article published by the Entrepreneur, the costs of office space were examined for 11 major US cities. Assuming that the practice would be set-up in a major US city, an average from the 11 cities was taken and came out to be $38.93 per sq. foot. 

To gain insight into the total costs, an attempt was made to find the average office size for a wellness provider. According to the findings, the average office size for a chiropractor is anywhere between 1,200 and 1,500 sq. ft. Though the average office size can vary, a chiropractic design firm by the name of Crossfields estimates that the minimum sq. footage  needed is 1,405 sq. ft. These figures were included based on the fact that chiropractors are considered to be wellness professionals.

Using the minimum sq. footage estimated by Crossfields times the average cost per sq. foot, the estimated cost for an office would be $54,697. According to the NCMIC Group, a professional solutions company, the average annual lease for a chiropractor is $15,519. Notably, this cost can vary significantly depending on the metropolitan area of the wellness office. For instance, the average cost per sq. foot in New York is $74.00 while the average cost in Atlanta is $20.97 per sq. foot. 

To keep office space costs down, commercial real estate professionals suggests that individuals should do three things when leasing: (1) outsource the office set-up, (2) choose properties that need little work, and (3) choose a space that matches their needs closely. 

Patient Acquisition CostsAdvertisements for new patient acquisitions are another expense that can vary depending on the choice of advertisement. No reports could be found on advertising costs related to wellness professionals alone, however, we were able to find estimated costs for healthcare professionals. Assuming that the costs would remain relatively the same for wellness providers as it would any other healthcare professionals, the reported estimates were used. 

Based on the numbers provided in the MD Connect report, print and media marketing is more costly than online marketing. Medical providers who decide to advertise through print spends around $314 per patient and those who advertise through the media spend an average of $348 per patient. Healthcare professionals who use online campaigns typically spend $149 per patient. Additionally, online marketing generally has a higher return on investment. 

Other Operational Costs to ConsiderReportedly, office space is considered to be the most capital-intensive expense. Outside of office space, other capital-intensive expenses include equipment, employee-related costs, malpractice insurance, and workers' compensation. 

Costs related to equipment and labor can vary greatly depending on the size of the practice and the type of practice. When it comes to labor, a smaller practice only needing a medical receptionist would spend approximately $2,150 a month. This is based on the national pay average of $13.44 for medical receptionists. Equipment is a little harder to estimate due to the wide varieties of equipment used across the different wellness professions. A holistic health care provider may feel inclined to purchase equipment such as ultrasound machine which cost $3,500 or a light therapy machine which can cost $7,000. A separate report published by the NCMIC Group shows that a chiropractor who decides to lease equipment will spend $4,489 annually. 

Insurance costs can also vary depending on practice size. Per the NCMIC Group, a chiropractor will spend an average of $1,728 annually for malpractice insurance. For workers' compensation, Insureon, a national insurer for healthcare providers, estimates that the median policy premium is around $702.50. 
ConclusionIn summary, the most capital-intensive expenses when starting a wellness practice are office space, patient acquisition, equipment, labor, and insurance. The average costs per sq. ft. is $38.93 and the average office size can range from 1,200 to 1,500 sq. feet. Patient acquisition costs can vary greatly depending on the style of marketing chosen. Print and media tend to be more expensive with costs ranging from $314 to $348 per patient, respectively. Online campaigning, on the other hand, can cost an average of $149 per patient. Equipment also has a wide variation of costs depending on the type of practice. For a chiropractor, leasing equipment can easily cost $4,489 for each year of operation. Malpractice insurance for chiropractors can typically cost $1,728 annually and the median premium for workers' compensation is $702.50. Labor is one that has the greatest variance because it can depend on staff size and position. For a small practice in need of a medical receptionist, the average monthly costs could reach $2,150 or higher.

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Wellness Professionals - Number of Wellness Professionals in the United States.

OverviewBy defining wellness providers as nutritionists, naturopaths, massage therapists, acupuncturists, chiropractors, sex therapists, and pelvic floor therapists, the estimated number of wellness providers in the United States is between 251,691 and 316,932. Below, I will explain how we came to this approximation. 

When available, we used data from the Bureau of Labor Statistics for accurate numbers. We also used data from Data USA, a visualization tool for industries based on nine surveys for federal and state government data. Data USA was created by Deloitte, Datawheel, and Cesar Hidalgo, Professor at the MIT Media Lab and Director of MacroConnections. 
NutritionistsThe Bureau of Labor Statistics (BLS) reports 68,000 dietitians and nutritionists as of 2016. 

Data USA reports 89,223 current dietitians and nutritionists. 
Naturopathic DoctorsWe could not find a source stating how many naturopathic doctors (NDs) are in the United States, but the American Association of Naturopathic Physicians (AANP) lists 600 NDs on their website. This list may be an underestimate since not all NDs may have been included. 
Massage therapistsThe BLS reports 160,300 massage therapists as of 2016. 

Data USA reports 124,905 current massage therapists. 
AcupuncturistsThe National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) reports 16,741 licensed acupuncturists in the United States; however, only 47 states and DC require NCCAOM certification for licensure, so this number might be an underestimate. 
ChiropractorsThe BLS reports 47,400 chiropractors as of 2016. 

Data USA reports 40,533 current chiropractors. 
Sex therapistsThe American Association of Sexuality Educators, Counselors and Therapists (AASECT) lists 732 sex therapists in the United States and 55 sex counselors. This list may be an underestimate as not all sex therapists and counselors may have been included. 
Pelvic floor therapistsThe American Physical Therapy Association's  (APTA) Section on Women's Health lists 125 physical therapists who treat for male pelvic health, pediatric pelvic health, pelvic pain, and pelvic oncology. Practitioners must pay to be featured on this site so this is an understatement. 

The  Herman & Wallace Pelvic Rehabilitation Institute's "Pelvic Rehab" tool lists 1,881 pelvic rehabilitation practitioners in the United States. 
CalculationsUsing the low end of each estimate per provider, we calculate:

68,000 nutritionists + 600 naturopathic doctors + 124,905 massage therapists + 16,741 acupuncturists + 40,533 chiropractors + 787 sex therapists and counselors + 125 pelvic floor therapists = 251,691 wellness providers.

Doing the same using the high end of each estimate:

89,223 nutritionists + 600 naturopathic doctors + 160,300 massage therapists + 16,741 acupuncturists + 47,400 chiropractors + 787 sex therapists and counselors + 1,881 pelvic floor therapists = 316,932 wellness providers.
ConclusionBased on data from the Bureau of Labor Statistics, Data USA, and various associations of wellness providers, we estimate there are between 251,691 and 316,932 wellness providers in the United States. 

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Wellness Professionals - Market Trends

Over the past 10 years, the wellness provider market, also known as the complementary and alternative medicine (CAM) provider market, has grown significantly in order to satisfy customer demand. Influences driving this demand include increased household income and the essential nature of CAM therapies, the increasing acceptance of CAM providers services by employers and medical insurance companies and the extensive access consumers have to online medical information and alternative therapies. 

FindingsAccording to the National Health Interview Survey (NHIS), in 2007, approximately 38.3% of American adults and 11.8% of American children, received some form of complementary and alternative medicine (CAM). Age-wise, 44.1% of adults aged between 50 and 59 years identified as using CAM. With regard to ethnicity, the most common group to use CAM was American Indian/Native Alaskans, with 50.3% of this ethnic group identifying as CAM customers, followed by patients of White ethnicity with 43.1%. The most used provider-based therapies were chiropractic & osteopathic (8.6%), massage (8.3%), yoga (6.1%%) and diet-based therapies (3.6%). Also in 2007, massage and acupuncture were reported to be the two fastest-growing CAM therapies in the U.S. with growth rates of 12.4% and 8% respectively.

In 2010, a survey of more than 1000 Americans over the age of 50 was conducted, which found that 27% used the services of some type of CAM provider, including massage therapy, naturopathy, acupuncture and homeopathy. The study also found that women were more likely to use CAM, including the services of wellness providers and the use of natural health products, with a 51% usage rate compared to 43% for men.

In 2012, $14.7 billion was earned in revenue through visits to CAM practitioners. Annual out-of-pocket expenditure for these visits was valued at $433 per person, more specifically, $442 for adults and $291 for children. From 2011 to 2015, the revenue earned by CAM providers increased by 14%. In addition, according to the NHIS, 33.2% of U.S. adults used complementary health approaches, 11.6% of children age 4 to 17 used complementary health approaches and the most commonly used complementary approach was natural products, such as dietary supplements not including vitamins and minerals. In 2012, 17.7% of adults and 4.9% of children age 4 to 17 used natural products.

The NHIS is conducted every 5 years, thus the results for the recently completed 2017 survey should be available in the second quarter of 2018. However, a survey conducted by the Pew Research Center stated that 20% of US adults have used alternative medicine instead of traditional and an additional 29% have used it in conjunction with traditional medicine. And, "Roughly one-third (34%) of people who say they never take over-the-counter medications say they have tried alternative medicine instead of conventional medical care".

In 2017, the US alternative healthcare providers market was valued at $16 billion, demonstrating an annual growth of 4% from 2012 to 2017. Approximately 217,527 businesses were in operation within the industry, employing 277,805 wellness healthcare professionals. Other estimates on the 2017 spend on complementary healthcare practitioners value the revenue at $14.7 billion. 

Market DemandConsumer demand for CAM providers has been driven by a number of factors including finance and access to information. As previously mentioned, annual out-of-pocket expenses for CAM practitioner visits by American adults in 2012 was $442. The reason for this, correlated by statistics, seems to be a result of increased household income. The mean per person for adults within a household earning less than $25,000 per year was $435, while it was $590 for adults in households with an income over $100,000 per year.

In 2017, an identified influential factor on market demand was that CAM therapies are of an essential nature, as are all medical services, and consumers are less likely to cut costs when it comes to their health compared to other areas of spending. Another driving factor is that more and more employers and insurance companies are recognizing CAM providers within their health benefit schemes. Furthermore, the aging US population will continue to increase demand within the industry as consumers seek alternative therapies to treat growing pain and illness that comes with age.

Additionally, as consumers access to information increases, particularly online, people are becoming more informed regarding health topics, concerns and alternative therapies. The growth of online health support communities has also flourished, allowing consumers to connect, share experiences and make recommendations about therapies used. Furthermore, this added knowledge has changed the way patients interact with practitioners as they now want their own research confirmed and aren't coming into a consultation with no information at all. Therefore, the market is opening up for wellness providers who have an online presence and make the most of engaging with patients and the public to provide health advice, information and consultations.

Market SupplyThe supply of wellness providers is spurred by the relative ease in which new operators can start businesses. Sole practitioners can begin operations with minimal capital and can begin practice from a rented or owned office or facility, or can provide services in patient's homes, other medical centers or hospitals. Additionally, in some states, there are minimal licensing, training or educational requirements. In support of this, employment figures from 2011 to 2015 show that CAM providers increased during this period by 19%. 

Market ShiftsIn 2005, a shift was recognized which saw more CAM therapies begin to be integrated into conventional medical practice, known as integrative medicine. This concept is based on the provision of providing comprehensive care for patients, including the use of collaborative and interdisciplinary therapies. This shift continues to stimulate growth in the market today as more and more conventional clinicians accept non conventional therapies as an adjunct to traditional medicine. 

While the exact number of wellness providers nationwide has not been compiled online or made publicly available, the number of hospitals and medical clinics incorporating CAM therapies under the integrative or functional medicine banner, are also increasing throughout the entire country. Particular interest in the services of wellness providers has been sparked in California, shown by the growth of therapy demand at the University of California's clinic. In the past year, the University of Florida's teaching hospital began offering traditional Chinese medicine and homeopathy, while Duke Health in North Carolina, has a rapidly growing center for integrative medicine. Furthermore, the University of Florida's Shands Hospital states that it does not provide with complementary or alternative medicine for patients, instead it offers integrative medicine. 

ConclusionOutlined is the history of the wellness provider market over the past 10 years, trends in consumer demand and provider supply, as well as a notable market shift with growing awareness and interest in the integrative or functional medicine approach.

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Wellness Professionals - Market Size and Any Changes.

When researching the below-listed markets, I found that most segments are growing. However, there are some notable exceptions, which are listed below.

Please note that in many cases, there is no information that breaks out consumers by gender or that breaks out pregnant women versus non-pregnant women. In all markets, I did specifically stay away from products that are solely for men or solely for pregnant women and triangulated figures to give you estimates whenever possible.

I used the most recent data available in all cases, staying within the last 2 years whenever possible, but expanding to include older stats in the absence of more recent data. I also included older data, when available, to show growth over the last 5-10 years.
Medical expenses Currently, adults (male and female) in the United States pay $3.4 trillion per year for medical care, which breaks down to $10,345 per person per year spent on healthcare on average as of 2016. This is an increase from $9,596 as of 2012 and $7,700 as of 2007. Experts predict that number could go as high as $14,944 in 2023.

As of 2016, $486 billion was spent on out-of-pocket medical costs, which means we've seen an 8% increase since 2011 if you take health insurance out of the equation. On average, women pay 69% more for out-of-pocket medical costs. 

In addition, a 2014 report notes that women spent $25 billion annually for over-the-counter medications.
Exercise/fitnessThe global market for fitness and exercise was $390 billion as of 2014. 

In the United States alone, the fitness products market is expected to be $2.272 billion in 2018. Experts also expect a 6.4 % annual growth rate from 2018 to 2022. The largest sub-segment in this market segment was wearables, which is expected to be a $1.653 billion market in the U.S. in 2018. The fitness app market is expected to be $711.2 million in the U.S. in 2018.

In total, about 20% of Americans are members at health clubs (such as gyms), paying $54 per month on average. The "budget" category is growing fast thanks to franchising. In 2015, this gym category grew by 69%. However, 11% spent over $100 per month and 6% spend over $150 per month to be gym members. The total market for health clubs/gyms was $25.8 billion in 2015, which represents a 6.1% growth over 2014.

In the female active wear market, we are also seeing growth. Nike reported that they expected growth to $7 billion as of 2017, which represented 20% of their total revenue and a 12% growth rate. Under Armor is also reporting fast growth in the female category, expecting to see $1.8 billion in sales by 2019, which is an increase from $410 million in 2017. (Please note that we can assume these reported numbers are global, not U.S. only.) The total active wear industry in the United States is $80 billion. Growth in the female active wear category is expected to be 5.7% from 2017 to 2020, while growth is expected to be 4.3% for the rest of the active wear market.
Massage/Acupuncture/Meditation When looking at the full "alternative health" market, $14.7 billion is spent annually on complementary practitioners in the United States versus $2.7 billion spent on self-care options. In total, Americans spend $30 billion annually on alternative health as of 2012, which does include some overlap with other market segments on this list, including supplements. Another report notes that the "complementary and alternative medicine market" was worth $40.32 billion as 2015, including magnetic intervention, mind-body/yoga, acupuncture, and botanicals.

The massage services industry was worth $16 billion, with a 7.1% growth rate from 2012 to 2017, which is predicted to continue through 2022. A 2016 survey reported that 32% of adults received at least one massage in the last five years, with 19% reporting that they received a massage in the last year. This number is even higher for women; 22% reported receiving a massage in the past year.

According to the National Certification Commission for Acupuncture and Oriental Medicine, there was a 32% growth in acupuncture patients from 2002 to 2007. As of 2012, one study found that about 1.2 million women in the U.S. received acupuncture treatment within the past year. The average cost is $94 per visit, with noting that they had 2 to 10 treatments in the past year. So, we can calculate:

(2 to 10) x $94 = $188 to $940 per person per year

1.2 million women x ($188 to $940) = $225.6 million to $1.1 billion total market for female patients

In some cases, insurance pays for the acupuncture costs, while in other cases, women incur these expenses out-of-pocket.

As of 2015, the U.S. "meditation and mindfulness" market was worth nearly $1 billion. This grew to $1.1 billion as of 2016. According to reports, 37% of female entrepreneurs meditate, as opposed to 27% of male entrepreneurs. Among the general public, women are twice as likely as men to meditate. If men and women spend about the same amount on meditation products and services on average, this would mean that the women account for 2/3 of the $1.1 billion market, or about $733 million.
Skin Treatments The skin care market brings in $17.13 billion in the United States alone. However, this is one market that is expected to decline, with an overall -0.5 % CAGR from 2018 to 2021. 65% of women report using skin care products daily, and 82% report using skin care products several times per week, as opposed to 64% of men.

Anti-aging products still account for the biggest sub-segment, but sales were down by 6.3% from 2014 to 2015. Another huge category, lip balms, also saw a decline or 3% from 2014 to 2015. 

The fastest-growing sub-segment in skin care is cleansers, with saw a 4.6% increase from 2014 to 2015 and reached a total market share of $1.8 billion in 2015. Moisturizers are also on the rise, up 2.9% to a total of $765 million as of 2015. This may be due to the rising number of men using these products.

One strong trend in the skin treatments segment is the use of organic ingredients. The overall organic beauty category is expected to grow 74% from 2013 to 2018. 16% of women report they use organic skin care products almost exclusively.
Nutritional/Vitamin Supplements In 2018, Americans are expected to spend $13.9 billion on vitamins and supplements. This is up from $12.8 billion as of 2012.

Sales in the U.S. increased by $6 billion between 2007 and 2012, with continued growth of 5%+ through 2017.

 77% of women take supplements, as opposed to 65% of men. If women and men spend the same on supplements, on average, that would mean that women make up 54% of the market (77 / 142 x 100).

54% of the $13.9 billion market means that the female market is worth $7.5 billion. 

The prenatal vitamin market was around $291.2 million as of 2015, which cuts into this number a bit, but still leaves the total market at over $7 billion.
Stress Management Regimes Americans reported an all-time average high stress level of 5.1 out of 10 in 2017, with women twice as likely to be stressed as men. 4% of the population has issues with anxiety, and again women are almost twice as likely to be affected as men. This gap is even bigger for women under the age of 35.

 2.4 million sleep quality/diet monitoring/stress management products are expected to be sold in 2018, up from 1.8 million in 2017, and just 100,000 in 2013. No data is available regarding a dollar amount for this specific market since stress management is often lumped into other categories.
Feminine HygieneThe feminine hygiene product market is a $5.9 billion industry, with the average women spending between $150 and $300 per year on disposables. This market is expected to grow 3.1% annually. 

However, it is noted that there is a growing trend to move away from traditional disposables to more eco-friendly and cost-effective products, such as reusable pads and menstruation cups.
Sex The sexual wellness market in the United States (which includes sex toys, contraceptives, lubricants, erotic lingerie, and more) is expected to grow by 9.73% annually from 2016 to 2020. The sex toy market alone is currently a $15 billion category, which is expected to be $50 billion by 2020.

A report by one sex toy company, Lovehoney, showed that 44.4% of their sales were to female customers. If this holds true for the entire industry, it would mean that $6.6 billion of the $15 billion category can be chalked up to female consumers.
Wellness-Oriented Foods In the United States, the total healthy eating/weight loss segment was $277 billion, with women accounting for $125 billion of that market.

This market is rapidly changing. 94% of adults in one survey noted that they do not see themselves as "dieters," while 77% think that diet products do not live up to health claims and 61% believing that diets are not healthy. However, Americans do still spend about $33 billion every year on weight loss products. About 89 million women are dieting at any given time.

Specifically for cleanses, I was able to find that the fresh-pressed juice industry has grown to $3.4 billion, which includes juice cleanses but also every day juicing purchases. 

Expanding this search to look at other wellness-related foods and diets, the allergen-free category has seen a 30% growth rate, and "functional foods" is a huge trend. This includes high-fiber foods (36% growth), protein-heavy foods (32% growth), foods made with whole grains (30% growth), and foods with added calcium, vitamins, and minerals (29-30% growth).

Plant-based foods are also a growing category within this segment, with $3.1 billion in sales in 2016. Within this category, vegan dairy alternatives saw $700 million in sales, a 20% increase, whereas the sale of cow's milk dropped by 5%.
ConclusionIn conclusion, we are seeing a shift away from older ideas of beauty and wellness to a more holistic, natural approach. Sub-markets such as anti-aging skin care and diet products are declining, while most other categories are on the rise. The female athletic apparel sub-market is a good indication that women are spending more money on their health and wellness in general, outpacing the overall population.

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Wellness Professionals - Usage and Engagement

In the United States, 33.2% of adults and 1.6% of children used wellness-based medicine in 2012. Natural products were the most used method of wellness-based medicine with 17.7% of adults and 4.9% of children using this approach. While the information was available stretching as far back as 1999, more current details past 2012 were unavailable. This is largely a result of the fact that the National Health Interview Survey (NHIS) is conducted every five years with the latest installment yet to be released. After an extensive search, a lot of the data presented after this time frame typically refers back to this national study. Despite this, it is reported that changes in usage were usually seen in terms of specific products or practices rather than an overall change in the wellness-based medicine category.

Functional/wellness based medicine usageAccording to the NHIS conducted in 2012, "33.2% of U.S. adults used complementary health approaches." This percentage falls within a similar range to the 35.5% and 32.3% reported in 2007 and 2002 respectively. The report also revealed that 1.6% of children aged 4-17 in the United States used these complementary health practices. Approximately 59 million people in the U.S. spent $30.2 billion annually out-of-pocket on these wellness-based health approaches.

The study categorizes complementary health approaches into two subgroups: mind/body practices and natural products. Mind/body practices include yoga, meditation, massage, and more. Natural approaches include the use of cranberry, echinacea, fish oil, melatonin and more.

Natural products are the most used category with 4.9% of children aged 4-17 and 17.7% of adults choosing this approach. Children used fish oil and melatonin the most. Fish oil was used the most by adults as well followed by "probiotics or prebiotics, and melatonin." Both age groups used chiropractic or osteopathic manipulation, yoga, massage therapy, and meditation for the mind/body category.


A list of the top 10 most common practices among adults in 2012 is provided below.

Natural products — 17.7% 
Deep Breathing — 10.9% 
Yoga tai chi, or Qi Gong — 10.1% (9.5% for Yoga)
Chiropractic or Osteopathic Manipulation — 8.4% 
Meditation — 8% 
Message — 6.9% 
Special Diets — 3% 
Homeopathy — 2.2% 
Progressive Relaxation — 2.1% 
Guided Imagery — 1.7% 


This NHIS study is conducted every five years and the most recent update occurred in September 2017. This update took the form of an update to the 2012 findings and not an entirely new report. With this being the case, more recent findings were unavailable.

MIND AND BODY USAGEIn terms of mind/body practices, the percentages change for children. 

Chiropractic or Osteopathic Manipulation — 3.3% 
Yoga — 3.1% 
Meditation — 1.6% 
Massage Therapy — 0.7% 

Although fewer children engage in these practices than adults, the number of children who are using these practices is increasing. It is reported that "112,000 more American children used chiropractic or osteopathic manipulation in 2012 than in 2007." This is in line with the 429,000 and 202,000 more children that used yoga and meditation respectively in 2012 than in 2007. Massage therapy was the only approach to decline in this time frame by 194,000 children.

In 2016, 26.27 million people aged 6 and up practiced yoga. Over the 13-year period from 1999-2012, yoga use by adults increased from 5% in 1999 to 9.5% in 2012. Progressive relaxation, massage therapy, and guided imagery declined during this time frame. In 1999, progressive relaxation was used by 5% of adults but this figure dropped to 2% in 2012. 

Guided imagery increased slightly from under 2% in 1999 to above 2% in 2007 but then dropped back down to below 2% in 2012. Massage therapy has seen the most growth and declines during this time period. This practice decreased from about 6.5% in 1999 to 5% in 2002 and then increased to above 8% before dropping to under 7% in 2012. Acupuncture stayed at about 1-1.5% over the course of 1999-2012. 

NATURAL PRODUCTSOverall there was not a significant change in the use of natural products from 2007-12. It was reported that 17.7% of adults and about 5% of children used natural products. The changes that occurred were mostly in terms of specific product usage rather than a noticeable change in the category as a whole. For example, during this time period, adults more than doubled their use of melatonin. Below is a list of the top 10 most commonly used natural products used by adults and children. 

ADULTS:

Fish oil/Omega-3 fatty acids — 7.8% 
Glucosamine and/or chondroitin — 2.6% 
Probiotics/Prebiotics — 1.6% 
Melatonin — 1.3% 
Coenzyme Q10 — 1.3% 
Echinacea — 0.9% 
Cranberry (pills, capsules) — 0.8% 
Garlic supplements — 0.8% 
Ginseng — 0.7% 
Ginkgo biloba — 0.7% 


CHILDREN:

Fish oil/Omega-3 fatty acids — 1.1% 
Melatonin — 0.7% 
Probiotics/Prebiotics — 0.5% 
Echinacea — 0.4% 
Glucosamine and/or chondroitin — 0.1% 
Combination herb pill — 0.1% 
Cranberry (pills, capsules) — 0.1% 
Garlic supplements — 0.1% 
Ginseng — 0.1% 

Over the 10-year period from 2002-12, fish oil has had the most consistent increase in use. Fish oil was used by above 2% of adults in 2002, under 5% in 2007, and then 7.8% in 2012. Ginseng and ginkgo decreased in 2007 from about 5.5% and 4% in 2002 to about 2.5% and just above 1% respectively. Both products continued to decline to 0.7% in 2012. 

Glucosamine and/or chondroitin was used by under 3% of adults in 2002 which increased to just above 3% in 2007 only to drop back below 3% in 2012. Echinacea has had the most significant decline. This natural product was used by under 8% of adults in 2002 before dropping down to just above 2% in 2007. The product then continued to decline in use to 0.9% in 2012. Melatonin and probiotics both increased slightly from 2007-12 from about 0.5% to above 1%.

In terms of sales, natural products like probiotics and fish oil saw significant increases over the course of eight years from 2003-11. Probiotic sales reached just under $800 million and fish oil sales were just under $1.2 billion. Melatonin sales increased to about $200 million, Glucosamine and/or chondroitin sales decreased to above $700 million, and Echinacea dropped from just under $200 million to about $100 million. Sales for the other commonly used natural products stayed within the $200 million to just under $100 million range.

REASONS FOR WELLNESS-BASED APPROACHESAdults choose to use natural approaches to treat their health issues and for their overall wellness. It is reported that more than 85% of adults "use natural products for wellness while 40%" use this approach to treat their health conditions. Over 90% of adults practice yoga for wellness and over 15% use it to treat health issues. In terms of spinal manipulation, over 50% of adults use it for wellness and more than 65% use it to treat their health conditions. 

More than two-thirds of those who used yoga, spinal manipulation, and natural products together reported "improved overall health and feeling better as a result of using" these approaches. Pain is another common reason for using complementary health approaches in the US. Of those who took part in the NHIS survey, "more than half had some pain during the 3 months" prior to the survey.

CONCLUSIONIn conclusion, 33.2% of adults and 1.6% of children used wellness-based medicine in 2012 in the United States. Natural products were the most commonly used method of wellness-based medicine with 17.7% of adults and 4.9% of children choosing this method. Over the course of 1999-2012, usage changes occurred in terms of specific methods and products. For example, melatonin use more than doubled among adults in 2012.

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Regulatory Operations - Medicare Services

The Center for Medicare and Medicaid Services (CMS) does not accept Electronic Medical Records (EMRs), providing reimbursement only when Electronic Health Records (EHRs) are submitted. Record systems must be certified according to standards outlined by CMS and their use must be in accordance with CMS guidelines. The use of a certified EHR system allows a practice or hospital to enroll in the Quality Payment Program, which impacts payments based on performance benchmarks.

Below you will find our research concerning CMS and the use of that organization of EHRs versus EMRs.
EHR VS EMR, DEFINITIONS AND DIFFERENCES
According to PracticeFusion, an EMR essentially acts as a digital version of the traditional medical chart. They are not designed to be shared, instead they are meant to stay within the individual practice. Alternately, EHRs are digital records of health information, providing a more comprehensive health overview. Moreover, it is one that shares in real-time, easily accessed from anywhere in the world.

According to CMS, and EHR consists of a patient's medical history over time, able to include all the data relevant to persons care, including demographics, progress notes, problems, medications, vital signs, immunizations, laboratory data and radiology reports. Utilizing EHRs instead of EMRs allows for an enhancement of the relationship between patient and provider. That provider will also have a greater ability to treat their patient with accuracy.
CMS REQUIREMENTS FOR EHR SYSTEMS
For an EHR system to be certified, the medical entity must conduct or review a security risk analysis to ensure alignment with CMS guidelines. Those rules were set in place due to one of the mandates CMS has declared for EHR system compliance, that it protects the patient's electronic health information. Encryption of data by eligible providers and hospitals also must align with CMS standards.

 HealthcareIT provides a detailed guide for implementing a certified EHR system and maintaining it according to CMS guidelines to remain certified. Part of achieving and maintaining certification are training personnel and achieving meaningful use. The steps are completed with "continue quality improvement. The last two indicate the mindset within CMS, that an EHR system is never done, but always a work in progress as they strive for the best care possible.
QUALITY PAYMENT PROGRAM
Medical practices and hospitals with a certified EHR system may be eligible to participate in the Quality Payment Program. Within this program, there is a choice between Advanced Alternative Payments and the Merit-Based Incentive Payment System. Within these two programs, payments can go up, down, or stay at the same level based on the performance data submitted. The Merit-based program is elective and offers greater margins of improvements to payments.
ConclusionCertified EHRs are mandatory for those practices attempting to work with CMS. Implementing these systems, as well as maintaining them, does take work, but it has the benefit of providing better ability to care for patients. Furthermore, the Quality Payment Program provides incentives to constantly improve

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Regulatory Operations - Medicare Rates and Private Practice Providers.

In California, physicians and doctors are free to set their fees and prices to whatever they wish. There are 41 075 physicians in California and the mean charge-to-Medicare ratio, or amount charged more than what Medicare covers, is 2.5. This means that, on average, doctors in this state charge 250% the amount that is paid by Medicare in California. However, this is the median and it changes vastly by field. The following values are based on a national survey, but the placement of fields should be consistent and reflective of California. The values given are medians for that field as well, and so the ratio varies around the given number.
Highest Charge-to-Medicare FieldsThese are the fields in which the fees associated with the physician exceeds the amount covered by Medicare by the largest ratio in the United States. The highest ratio is 5.8, charged by anesthesiologists. Their fees are 580% of those covered by Medicare. Next is interventional radiologists, who charge 450% the coverage of Medicare.

The next highest charges are those who practice emergency medicine, pathologists, and neurosurgeons. These three groups have a median charge of 400%. Last in the highest charging fields is diagnostic radiology. Physicians in this field charge 380% more than what Medicare covers.
Lowest Charge-to-Medicare FieldsFollowing are the fields of medicine in which physicians generally charge the lowest ratio to Medicare coverage. Family practice doctors charge 180% more than what is covered, as do dermatologists. The ratio of charge to Medicare for allergists, immunologists, and psychiatrists is 1.7 i.e. 170% of the covered cost. General practitioners, or GPs, have the lowest median ratio in the nation. They have a charge-to-Medicare ratio of 1.6, or 160%.
Patient Volume and Medicare ReimbursementStatistics for the patient volume of specified fields were unable to be found. They have not been published in the articles and journals associated with Medicare. Likewise, if there are practices that get additional reimbursement from Medicare, details of this could not be found. It can be assumed that some fields get a larger sum of money contributed by Medicare. For example, even though neurosurgeons charge far more in excess than GPs, Medicare can be assumed to pay a larger net amount of money to the surgeon. It is likely that the reimbursement rates are static for each field defined by Medicare as there was no mention of anything otherwise.
ConclusionOn average, physicians in California charge 250% more than what Medicare pays for their services. This does not seem to be affected by patient volume or any other metric; reimbursement rates are static. The highest charging fields, by fee-to-Medicare ratio, are anesthesiologists, radiologists, emergency doctors, and neurosurgeons. In contrast, the physicians that charge the lowest ratio are family doctors, allergists/immunologists, dermatologists and general practitioners. 

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Practice Operations - Marketing spend

Based on our collective research findings, we estimated that an OBGYN practice likely allocates between 2% and 10% of their total budget towards marketing as these figures are in alignment with the marketing spend recommended by consultants and healthcare industry-wide averages. 

Our findings also suggest that OBGYN practices are relying on a mix of traditional and digitally-focused channels of marketing. These include channels, such as marketing brochures and referral marketing on the traditional side, and website and mobile marketing on the digital side. 

The most common methods of marketing being used by medical practitioners today are website marketing and social media marketing at 86% and 77% respectively. However, the use of these channels for marketing has somewhat decreased since 2015. The marketing channels that have shown the most increase in use by healthcare providers since 2015 are mobile marketing and marketing within online communities.
Methodology In order to answer your question, we first began by looking for quantitative, hard data that provided direct insight related to your specific question. However, after searching extensively through industry reports, marketing surveys, and trusted media sites, we were unable to locate any publicly available, quantitative data which provided insight with regard to OBGYN marketing spend or marketing channel use specifically. Therefore, we broadened the scope slightly to include insights regarding medical practices, in general, with the assumption that there is likely little variation between these results and individual specialties. This research method returned much more significant and relevant results. 

Next, we searched for any qualitative insights regarding OBGYN practices specifically, which could be used to compare against the quantitative insights we found regarding all medical practices in general. We were able to find such qualitative insights from marketing consultants who specialize in OBGYN marketing and from trusted media sites featuring OBGYN best practices. 

We also attempted to locate annual and financial reports from OBGYN practices in order to examine some case studies of the specific marketing spend of these practices; however, as most OBGYN practices appear to either be private practices or linked to larger health systems, which do not publish marketing breakdowns by specialty, this information was severely lacking. Therefore, to determine the marketing spend of OBGYN practices, we referred once again to information pertaining to the overarching umbrella of general medical practices as we assume that the marketing spend of OBGYN practices likely falls within the average range of marketing spend by all types of medical practices in general. 

Since we were unable to find a wealth of readily available information pertaining to OBGYN practices specifically, we have compiled relevant findings and have made a few assumptions to help triangulate an answer to your question. Below, you will find a deep dive of our findings. 
Patient acquisition costOur research findings provided insight on the average patient acquisition cost for a medical practice. Although this information is from 2014, we have included it here as we felt it may still be insightful for you. The "PAC is the amount [spent] on marketing, divided by the number of new patients [...] acquired that month." The cost of patient acquisition varies depending on location. This article recommends that $14 or less is an ideal PAC for a practice located in "smaller towns and rural areas." The PAC will be higher in metropolitan areas. Whitecoat is a medical marketing firm. On their website, they state that practices generally have PACs between $15 and $150 per patient.
Marketing budgets Findings from Deloitte, published in the Wall Street Journal, state that on average, companies spent around 11% of their total budget on marketing and this figure is 10% for companies within the healthcare industry. Companies generally spend about 7.5% of their total revenue on their marketing efforts. 

In looking at medical practices specifically, consultants typically recommend that no less than 2-3% of the practices gross revenues should be allocated for marketing in order to "keep a consistent level of patient flow happening." Bakerlabs recommends that if a practice is either struggling or their rate of growth is stalling, then the practice should allocate 4-5% of their gross revenues towards marketing and any practice looking to increase their rate of growth should allocate no less than 5% of their gross revenue towards marketing. Given this information, a practice that has a gross revenue of $1.3 million per year would spend $26,000-$39,000 on marketing annually. If that same company spends 4-5% of their gross revenue on marketing, they would spend between $52,000 and $65,000.  

Typically, medical practices are spending between 2% and 15% of their total revenues on their marketing efforts and within this range, there are a number of variables which determine the individual percentage, including "local competition, practice size," new doctors joining the staff, the practice's growth rate preference, and their specialty. 
Marketing channels We analyzed a few case studies of OBGYN marketing strategies to determine which channels they were focusing their marketing efforts on. Through these case studies, we identified how OBGYN's are marketing using informational brochures and also partnering with other practices by providing them with referral folders that contain "provider bio cards, OB and GYN services, and financial and insurance information." OBGYNs are also utilizing their websites and creating blogs to serve as marketing tools. 

A company that specializes in OBGYN marketing strategies recommends the following channels as a focus for these practices: websites and online, print collateral (e.g. brochures, fact sheets), print (e.g. newspapers, magazines), radio, television, PR, "physician liaison training, [and] office staff marketing training." 

Med Aesthetics Group states that most OBGYNs "either don't have a site or their site is difficult to navigate" and suggests that Yelp is a powerful marketing tool for OBGYNs, as is Google Local marketing, since this tool gives local results for people searching specifically for OBGYNs in their area. This firm also states that OBGYNs ideally focus on SEO marketing with regard to their websites and that PPC marketing is the "fastest and surest way of bringing new patients" to a practice. They also state that social media marketing is currently underused in the OBGYN specialty and that this is the result of an overall lack of information pertaining to the topic (specifically targeting OBGYNs). 

With regard to medical practices in general, our research findings revealed the following set of data, which analyzes the digital marketing strategy of healthcare organizations, according to a survey of 230 healthcare marketing professionals who represented various healthcare organizations. The vast majority of these organizations fell into the categories of healthcare systems, ACMs, and community hospitals. 

The following figures represent the number of survey respondents to say that their organization utilizes the following marketing strategies and channels: 
Website - 86% 
Social media marketing - 77% 
Online - 73% 
Images and videos - 73% 
eNewsletters - 69% 
Paid search - 72% 
Email - 64% 
Blogs - 60% 
Content marketing - 58% 
Infographics - 51%
Retargeting ads - 43% 
Online reputation management - 52% 
Mobile marketing - 42% 
Marketing automation - 30% 
Online communities - 36%
Programmatic buying - 30% 
Geo-fencing - 30% 
SMS text - 25% 
Dark posts on Facebook - 21% 
Real-time marketing - 21%

The use of the following channels and strategies by healthcare organizations has increased since 2015: online reputation management, mobile marketing, marketing automation, online communities, programmatic buying, geo-fencing, text message marketing, dark posts on Facebook, and real-time marketing. For the remaining strategies and channels mentioned above, use of these by healthcare organizations has decreased since 2015. 

With regard to social media and online channels specifically, Facebook, local websites, Pandora, Twitter, news websites, online video sites, online ad networks, Pinterest, and Snapchat are the digital channels most used by these healthcare organizations. Only 2% of the respondents said that they do not advertise online at all. 

Conclusion In closing, although we were unable to find a significant number of insights which reflect the OBGYN marketing spend per year and the channels that they use, we have utilized any available findings tied together with relevant insights from the overarching medical practice industry to make some educated assumptions that help to answer this question. 

In doing so, we assumed that an OBGYN practice likely allocates between 2% and 10% of their total budget towards marketing. We further assumed that OBGYN practices rely on a mix of traditional and digitally-focused channels of marketing. These include channels such as marketing brochures and referral marketing on the traditional side, and website and mobile marketing on the digital side.

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Part

Practice Operations - Landscape of Technical Products.

OVERVIEWThere is a wide variation in the costs and price points of the various electronic products that enhance practice operations of billing and scheduling in healthcare facilities. For this study, we looked into in-market products offered by four specialist companies which include; Athena Health, Practice Fusion, eClinical Works and CureMD. 

Based on the overview of the sources, we found that the costs and price points were impacted by the robustness of the product, implementation and maintenance as well as the physician's costs. 

The information has been compiled in that attached spreadsheet as requested, but below is a deep dive into each of the companies providing electronic products for practice operations. 

1. Practice Fusion INC.The company's product is known as Practice Fusion EHR 3.7 which is an ONC certified EHR. The price points of this practice varies with the problem list and nature of solution provided. Additionally, the professional physician practice for implementation is charged between $85,000 and $162,000. Practice Fusion as a company started in 2005 and over time, the company has grown in size and currently boosts of professional membership of well-trained staff ranging from 200-500 in number. Additionally, to-date the company has successfully performed over 30,000 practices as it aims to dominate the market captures. Moreover, the Practice Fusion undertakes OBGYN Practices that it works with ICD-10 coding.

2. Athena Health INC. The company's product is referred to as Athena Health EHR. The Price points and costs listed vary with the solution provided with most solutions ranging between $200-$500. Athena Health Inc. started in 1997 and has seen the company grow considerably to have an estimated net worth of $30.8 Billion. Currently, the company has a market size of over 5,282 professionals working for it as well as 100,000 providers across its vast network. The company offers all forms of OBGYN practices. 

3. EClinical WorkseClinical works boosts of two robust software products which are eClinical Works EHR and eClinical Works EHR with Practice management. The company's price points include; the initial on-site practices training of between 1-9 providers. Additional implementation fees apply for extra providers. Moreover, the fees apply per patient statement as well as per eClinical Messenger transaction. However, airfare is not included and hence, is billed separately. The costs charged on EHR are $449 per month and $599 per month for EHR with Practice Management. 

The company has grown over time since its inception in 1999 and has an estimated net worth of about $440million. The size of the company is served by over 5,000 professionals and has a market capture of about 130,000 providers. Interestingly, nationally recognized OB/GYN Leaders choose eClinical Works' Comprehensive Electronic Health Record Solutions for about 165 providers across 52 Locations in the U.S.

4. CureMD
CureMD is a top ranking EMR and EHR medical records solution provider. The price points of CureMD EHR varies among various providers and are commonly charged on a monthly basis. The costs of the various products are; 
i. Practice Management-$195/month per provider.
ii. Electronic Health Records-$295/month/provider
iii. All in One-$395/month/provider
Additionally, the billing services are priced at 4 percent of the collection. 

CureMD has a huge market size served by between 500 to 1000 professional employees. The company started its operations in 1997 and has rapidly grown across the various States in America. The company has a market capture of about 30,000 practices. Additionally, CureMD provides OBGYN practices which obstetricians use to digitize the operations and processes.

Conclusion
A review of the four companies that provide EHR products and services included in the study reveals that the price points and costs vary considerably. The costs involved include; installation, implementation,training among other price points. The entry of the companies into the American market has also been rapid and has seen more providers and specialists readily assessing EHR products and services.  

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Practice Operations - Key Business Facts

The attached spreadsheet details the company size, growth, market share and OBGYN products or services offered by electronic medical record (EMR) providers Practice Fusion, Athena, EClinicalWorks, CureMD, Allscripts Professional and NextGen Healthcare. A summary of our findings has been provided below.

MethodologyWe have endeavored to provide the most recent data possible pertaining to financials and market share. As it was not specified in the research brief, we have included revenue, employee numbers and practice reach for each of the companies to define the company size. As financial figures were most prevalent among publicly available data, we have used annual revenue figures to determine the growth of each company. 

Furthermore, market capture was also not defined so we have taken this to mean both market penetration (reach of clinics) and market share (based on revenue). The market penetration was published regarding practice reach but data pertains to 2016 as the 2017 report is behind a paywall. We have also calculated financial market shared based on each company's revenue (using 2016 as all companies did not have 2017 financial data available) and the 2016 EMR market value of $28 billion. All market share figures have been calculated using the following equation = 2016 company revenue / 2016 market revenue x 100. Please note, details of growth or historical financial data is not publicly available for CureMD, therefore, figures have not been provided.

Finally, we have used official websites and software review sites to determine if each companies product offerings encompass the OBGYN field, with the remark of "yes" or "no" and minimal additional details as available. All figures and any calculations made have been detailed below and all findings have been added to the attached spreadsheet. Please note, any statistics stated as estimates or approximations are based on published figures, not our own estimates.

SummaryPractice FusionCompany Size:
2016 revenue: $54 million 
2017 revenue: $34 million (Jan to Sep)
 200 employees (estimated)
 30,000 practices	

Growth:
 13% (2016)
 -10% (Jan to Sept 2017, compared to same period in previous year)

Market Capture:
Revenue: 0.19% (calculated)
Practice: 6.5% 

OBGYN Focus:
 Yes, ICD-10.


Athena EMRCompany Size:
2016 revenue: $1.08 billion 
 5,282 employees
 106,000 medical providers	

Growth:
 17.10% (2016)	"

Market Capture:
Revenue: 3.86% (calculated)
Practice: 3.7% 

OBGYN Focus:
 Yes, OB/GYN workflow.

eClinicalWorksCompany Size:
2016 revenue: $440 million 
 5,000 employees
 80,000+ facilities

Growth:
9.56%* (2016)	 
*Calculated: 2016 revenue — 2015 revenue / 2015 revenue 

Market Capture:
Revenue: 1.57% (calculated)
Practice: 10.3%	

OBGYN Focus:
 Yes, as well as the healow Mom smartphone app.

CureMDCompany Size:
2016 revenue: $30 million (estimated)
 837+ employees
 30,000+ practices	

Growth: 
Unknown	

Market Capture:
Revenue: 0.11% (calculated)
Practice: Unknown

OBGYN Focus:
 Yes, including decision support dashboards.

Allscripts ProfessionalCompany Size:
2016 revenue: $155 billion 
 7000+ employees
 45,000 physician practices	

Growth:
 11.79% (2016)	

Market Capture:
Revenue: 0.55% (calculated)
Practice: 8.2% 

OBGYN Focus:
 Yes, unique OB/GYN capabilities are included in their products

NextGen Healthcare**NextGen Healthcare is a subsidiary of Quality Systems, Inc. According to the most recent annual report, Quality Systems, Inc is publicly known as NextGen Healthcare and all product offerings relate to EMR. Therefore, all financials used pertain to Quality Systems, Inc. 

Company Size:
2016 revenue: $492.48 million 
2017 revenue: $509.62 million 
 2,800 employees (approx.)
 90,000 providers (approx.)

Growth:
 0.46% (2016)
 3.48% (2017)	"

Market Capture:
Revenue: 1.76% (calculated)
Practice: 5.4%	

OBGYN Focus:
 Yes, for OB/GYN and Women’s Health

Additional informationThe electronic medical record (EMR) market was valued at $28 billion in 2016 and $29.55 billion in 2017.

ConclusionThe company size, growth, market capture and OBGYN products or services offered by electronic medical record (EMR) providers Practice Fusion, Athena, EClinicalWorks, CureMD, Allscripts Professional and NextGen Healthcare has been detailed in the attached spreadsheet. A summary of our findings has been provided along with our methodology and all calculations.

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Part

Practice Operations - One Medical

 One Medical, founded in 2007 and headquartered in San Francisco, California has an estimated 866 employees from its 7 locations — San Francisco Bay area, New York, Washington, D.C., Boston (2 location), Chicago, Los Angeles, and Phoenix. The company's services include primary care, pediatrics and family medicine, same-day care, integrative health, prenatal care, onsite labs, travel health, flu-shots, and women’s health. Of the 866 employees, about 285 of them are primary care doctors and physicians. These physicians were categorized according to their specialty — family medicine, adult medicine, internal medicine, pediatrics and mental health. The company also offers a "24/7 telemedicine services" which comprised 126 Virtual Medical Team doctors. 

PRIMARY CARE DOCTORS
One Medical operates in 7 cities in the United States. From the company website's database, there is a total of 285 primary care doctors. According to an article released by Business Insider in 2016, One Medical "oversees a network of 250-plus primary care specialists." These physicians are categorized according to their specialty which is summarized below.

Family Medicine: 163 total (SF-76, NYC-37, Boston-3, LA-6, Chicago-6, Phoenix-16, Washington DC-19)

Adult Medicine: 39 total (SF-14, NYC-8, Boston-3, LA-3, Chicago-0, Phoenix-1, Washington DC-10)

Internal Medicine: 73 total (SF-37, NYC-13, Boston-2, LA-4, Chicago-2, Phoenix-4, Washington DC-11)

Mental Health: 5 total (SF-4, NYC-1, Boston-0, LA-0, Chicago-0, Phoenix-0, Washington DC-0)

Pediatrics: 5 total (SF-2, NYC-3, Boston-0, LA-0, Chicago-0, Phoenix-0, Washington DC-0)

OTHER SERVICE PROVIDERS
The estimated numbers of other service providers like nurses, nutritionists, naturopaths, phlebotomists and others are also from available profiles on LinkedIn. The company has a total 868 profiles of employees on LinkedIn. This number is perfectly almost equal to the estimated employees listed in Craft database which is 866.

Nurses: 91 employees, i.e. nurse practitioner, RN, and family nurse
Phlebotomists: 98 employees 
Chiropractors: 9 employees 
Naturopaths: 8 employees 
Nutritionists & Dieticians: 2 employees 

For Lab Technicians, there are no profiles found for this post. The total identified other service providers in One Medical is 208.

NON-SERVICE PROVIDERS
The estimated non-service providers such as physician assistants, business operations, and strategy related jobs, and software engineers are also based on identified LinkedIn profiles.

Physician Assistants: 57 employees  

Business Operation, or any business and operation related posts: 118 employees 

Business Strategy, or any business and strategic posts: 108 employees 

Administrative Associates: 24 employees 

Software and any technology related jobs: 80 employees 

VIRTUAL MEDICAL TEAM
One Medical provides 24/7 telemedicine services "that takes your calls any time of day or night." Providers who work in this group is called "Virtual Medical Team". This team provides answers and solutions via phone and email. Services offered includes; 1) live medical advice over the phone, 2) answer quick email follow-up questions, 3) assist in determining whether one needs to come into the office, 4) help schedule appointments when needed, 5) prescription renewal requests, and 6) interpret lab results.

From the company website's database, the Virtual Medical Team comprised of 126 doctors and physicians in almost all kinds of specialties. Their Washington D.C. center has 17, San Francisco has 29, Los Angeles has 15, Boston has 15, New York City has 24, Chicago has 15 and Phoenix has 11.

CONCLUSION
One Medical has over 850 employees from all its 7 locations in the United States. About 285 are primary care doctors and physicians, and about 208 are service providers such as nurses, chiropractors, nutritionists, naturopaths, and phlebotomists. There are about 126 doctors who provide service in the company's telemedicine section.

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Practice Operations - One Medical Malpractice Lawsuits

It is not possible to find out if One Medical has had any malpractice lawsuits levied against it and therefore the information about specific lawsuits against GYNs was not found. It is possible to look up this information about a doctor at a specific location, but not about the whole company. In addition, in some states, this information requires payment. Some useful information about lawsuits against OB/GYNs has been included. Statistics specific to GYNs without the OB component were not available. OB/GYNs have legal action taken against them more than any other medical specialty. The majority of the cases have to do with perceived injury caused by the OB/GYN to the patient, or failure to diagnose or treat. Settlements have varied over the years, but OB/GYNs are one of the most expensive specialties overall for payouts.

OB/GYN LAWSUITS 2015
Though the majority of physicians will be sued, OB/GYNs are involved in lawsuits more often than any other specialty. OB/GYNs are sued quite frequently at least once in their careers, at a rate of 89% for male providers and 81% for females in 2015, with an overall rate of 85%. The majority of the lawsuits in 2015 were for an abnormal injury to the patient (36%), failure to diagnose (22%), or failure to treat (15%). 45% of these lawsuits were settled with the patient receiving no money, 23% received between 0-$100,000, 16% received between $100,001-$500,000, 9% were awarded $500,001-$1,000,000, and only 4% were given $1,000,001-$2,000,000. A 2017 survey found the same rate of 85%. 

OB/GYN LAWSUITS 2017
A 2017 survey found the same overall rate of 85% of OB/GYNs being sued. Most of the lawsuits were similarly for complications (34%), poor outcome (21%), and failure to treat (19%). The outcomes of the lawsuits were quite different with 33% of patients receiving $100,0001-$500,000, 27% being awarded 0-$100,000, 18% were given $500,001-$1,000,000, 12% getting over $2,000,000, 7% receiving $1,000,001-$2,000,000, and only 3% without a financial settlement. 

OB/GYN LAWSUITS 2006-2015
From 2006-2015, OB/GYNs have the highest number of lawsuits of any medical specialty with over 10,000 providers sued. The average settlement over the same period was over $400,000, totaling $13,000,000.

CONCLUSION
Information about One Medical malpractice lawsuits and specifically lawsuits levied against GYNs was not found. Various statistics on lawsuits against OB/GYNs, monetary amounts, and other useful information have been included. 85% of OB/GYNs will be sued during their careers. Many settlements have been awarded to these patients for a total of $13,000,000 between 2006-2015. 