SI-BONE (NYSE:SIBN) Q4 2018 Earnings Conference Call Transcript
Mar 07, 2019 • 04:30 pm ET
Jeffrey W. Dunn
evidence. Starting with our sales force. We finished the fourth quarter with 45 mature reps in our US direct sales organizations -- organization. These sales reps are highly technical in their skill set with meaningful spine or interventional pain experience. Our direct reps are further supported by clinical support specialists, or CSSs, who assist in case coverage. At the end of the fourth quarter, we had 22 CSSs, most of our CSSs are -- were added during the second half of 2018 to capture new sales opportunities from exclusive payer coverage decisions.
In 2019, we're focused on growing sales in new territories through the addition of direct sales reps and are -- and on more deeply penetrating existing territories through the addition of CSSs. To that effect, we plan to add 15 to -- 10 to 15 direct sales rep during the year to large or unpenetrated territories. We also plan to aggressively increase our number of CSSs, adding 25 to 30 new specialists throughout the year to support smaller and rapidly growing territories. This will bring the ratio in the US of mature direct sales reps to CSSs, close to 1:1. To support these expansion efforts, we increased our number of US regions from seven to 10 by promoting three of our top direct sales reps to regional sales directors during the first quarter of 2019.
The additional sales management from our top talent will be critically -- critical to effectively scale the US sales organization. We expect that these efforts will, in combination, enable us to both expand our US field coverage and increase mature rep productivity from where it is today. In the United States, our mature direct sales reps have an average run rate of over $1 million. However, in time, we expect a mature rep to ramp towards $1.5 million in sales, and with the support of clinical support specialists, a territory could grow to over $2 million.
In addition to our US sales force expansion, our medical affairs team is focused on training, educating and supporting new surgeons. Our education program trained surgeons on the anatomy, diagnosis and treatment of SI joint dysfunction. Additionally, our programs educate nurse practitioners and physician assistants who are often the first providers to see patients suffering from back pain and SI joint dysfunction. There are 7,500 spine surgeons in the United States, which includes orthopedic spine surgeons and neurosurgeons.
During the fourth quarter, we had about 450 active surgeons, which is defined as a surgeon who has performed a procedure in the last three months. By the end of 2019, we expect to increase this number to 550 active surgeons through these educational efforts. During the quarter, we also executed on our commitment to expand into adjacent markets with the FDA clearance of our iFuse Bedrock technique. The technique is for use in adult deformity surgeries in accordance with our existing indications of use. It allows the surgeon to place one iFuse implant on each side of the