Intuitive Surgical (ISRG) stock: not cheap but a buy anyway

Intuitive Surgical (NASDAQ: ISRG) stock price has silently outperformed the market in the past decade. It has risen by over 700% since 2014 while the benchmark S&P 500 (SPX) index has risen by about 150% in the same period. It has also outperformed the tech-heavy Nasdaq 100 index in this period.

Intuitive Surgical is a company that most Americans have never heard about because it is not consumer-facing. But it is a firm that most doctors and surgeons have interacted with over the years. This is evidenced by its strong revenue growth, which has moved from $2.3 billion in 2015 to over $6.8 billion in the trailing twelve months (TTM).

Intuitive Surgical has also become a highly profitable company. Its net income stood at $1.3 billion in 2019 and then dropped to $1.06 billion in 2020 as the pandemic intensified. During the pandemic, surgical procedures and hospital visits retreated as most people stayed at home. Its TTM net profit stood at over $1.57 billion.

Intuitive Surgical sells important devices that are used in surgical procedures. Its core product is known as the Da Vinci Surgical System, which is made up of the surgeon’s console, patient-side cart, 3DHD vision system, firefly, and the Da Vinci integrated table motion.  

It costs for between $0.5 million and $2.5 million depending on model and specifications. The company also sells instruments and accessories, learning, and field services. In addition to equipment sales, the company also earns recurring revenue from its customers. For example, it earns between $600 and $3,500 of instruments and accessories per surgical procedure.

Intuitive Surgical stock price has done well over the years for three main reasons. First, as mentioned, the company has demonstrated strong revenue and profitability growth over the years. Second, it has strong recurring revenues that are easy to predict. This revenue accounts to over 70% of its total.

And finally, it operates in an industry that is difficult to disrupt. For one, before a device similar to Da Vinci hits the market, it needs to go through a long period of testing and FDA approval. Intuitive also has an 80% market share and strong relationships with practitioners. There is also training cost that many hospitals may want to avoid when switching to a new customer. 

The challenge for investors, especially people like Warren Buffett, is that Intuitive Surgical is not a cheap company. It has a total market cap of over $115 billion and a forward PE ratio of 58.89, higher than the sector median of 19.35. Its trailing PE multiple of 61.58 is higher than the sector average of 18.97. 

Therefore, the company is priced for perfection. However, as we have seen with the likes of Nvidia and Shopify, a company can remain in an overvalued level for a long time as long as it can maintain its growth.

ISRG chart by TradingView

Turning to the weekly chart, we see that the ISRG share price has been in a strong uptrend in the past few months. It has remained above the 50-week and 100-week Exponential Moving Averages (EMA). It is also attempting to retest the key resistance at $357.80, its highest point on July 11th last year.

The shares have also formed an inverse head and shoulders pattern, a popular bullish sign. Therefore, the outlook for the stock is bullish, with the initial resistance point to watch being at $357.80, which is about 8.45% above the current level. A move above that level will see it jump to an all-time high of $369.56.

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