2011 Salary Survey Results

Salaries stabilize, although experts say demand for ED physicians is such that organizations are having to dig deep to lure in medical directors

Despite continuing turbulence in the health care industry, the past 12 months have been a period of relative stability as far as compensation is concerned among leaders in the ED, according to respondents to the 2011 ED Management Salary Survey. This follows a year in which salaries finally began to inch up after several years of stagnation.

In the 2011 survey, 40% of respondents indicated that they received salary hikes in the 1%-3% range, and 30% saw no change in their compensation levels. Just 15% saw hikes in the 4%-6% range, with 5% reporting increases of 7%-10%. However, the news is not all positive, as 10% of respondents indicated that their salary decreased during the past year.

The 2011 results are similar, although not as rosy as last year, when 45% of respondents reported salary hikes of 1%-3%, and 15% reported even larger increases. Furthermore, there were no reports of decreases last year.

Nurse managers see increased responsibilities

While the data suggest there has been little change in compensation levels, there is no question that the industry continues to look for ways to reduce costs, and experts anticipate that this pressure is likely to impact nursing salaries one way or another. "Organizations are concerned about future revenues and the likelihood of payment reductions. Meeting regulatory requirements is routine for our industry, but the costs associated with implementing and maintaining an Electronic Health Record (EHR), upgrading or replacing systems to prepare for ICD-10 and Meaningful Use are significant. As a result, health systems are placing significant emphasis on performance improvement and cost reduction. Leaders are standardizing, reducing variability across departments/hospitals and the automating workflows to drive improved outcomes or increased efficiencies. In some organizations this has led to the elimination or consolidation of some positions. This is a trend that will most likely continue into the future," explains Diana Contino, RN, MBA, FAEN, senior manager, Deloitte Consulting, Los Angeles, CA.

In addition, many ED nurse managers are seeing their responsibilities increase into new areas. For example, at Denver Health Medical Center in Denver, CO, the last time there was any change in compensation levels for ED managers was 2006, observes Nancy Klock, MBA, the administrative director of the ED. However, she says the health system now expects nurse managers to take more responsibility for the financial aspects of operating the ED.

"In the past, it was all clinical and staff scheduling, but now we are expecting nurse managers to be aware of their budgets, to be able to explain variances, and to be able to understand what the financial impact is when they assign a nurse overtime. They need to be able to support why that was the right thing to do," explains Klock. "This is very much a shift in expectations."

The health system is providing added support to nurse mangers to help them gain more business acumen. However, Klock acknowledges that some of the ED nurse mangers are struggling with the added responsibilities, and there has been some turnover in the upper ranks. Furthermore, when interviewing new applicants for ED management slots, the health system is definitely looking for financial expertise. "Several of the applicants we are looking at are either in the final stages of getting an MBA or they have already received the degree," she says.

In addition to business acumen, organizations want their ED managers to be personable and to possess good judgment in a multitude of areas, says Contino. "The bottom line is that the ED manager needs to not just be strictly focused on operations, he or she needs to be strong with finance, strong with community outreach, and strong with physician relationships," she says. "Further, if the individual is at the director level, organizations want him or her to be able to hire and identify good clinicians to work in the department."

With all of these expectations, it is not surprising that most ED mangers put in long hours at the hospital, according to this year's data. Among all respondents, 30% reported working between 46 and 50 hours per week, 10% reported working 56-60 hours per week, 15% said they worked 61-65 hours per week, and 5% said they typically work more than 65 hours per week. Just 10% of respondents reported working less than 40 hours per week.

Opportunities abound for ED medical directors

Despite such working conditions and the increasing demands on nurse managers, the supply of qualified candidates is plentiful, says Contino. Why? Because the faltering economy has forced many nurses who had left the profession or were working part time to seek full-time work. This has given organizations plenty of options to choose from when seeking nurse managers to work in their EDs, she says.

However, organizations are having a much more difficult time finding physicians to become directors of emergency services or to fill ED medical director posts, observes Tommy Bohannon, divisional vice president, hospital-based recruiting, for Irving, TX-based Merritt Hawkins, a physician search and consulting firm.

"If you go back four or five years, we were recruiting ABEM [American Board of Emergency Medicine]-certified physicians in the $160 to $175 per hour range and having a reasonable degree of success [finding good candidates]," says Bohannon. "Now, generalizing as much as I can, it is virtually impossible for us to get interest from ABEM-certified physicians for anything less than $200 per hour."

In some cases, organizations have to offer physicians as much as $245 per hour to lure them away from their current practice to a new opportunity, says Bohannon. "There has been so much publicity and conversation regarding how in-demand these physicians are, and there is this glut of patients who are flocking to the ED, maybe because they don't have insurance or maybe because they don't have a primary care doctor," he says. "Whatever the case is, demand in the ED has increased to the point where [ED physicians] know they could pick a spot on a map and find a job there if they wanted to."

Bohannon explains that he hasn't seen much change over the past year in stipend levels for physicians who serve as medical directors — the $30,000 or $40,000 they get on top of whatever everyone else receives to serve in that role. "Where we are really seeing a difference during the last 12-18 months is in that initial package that is required to recruit someone," he says.

Further, groups that have had a fairly stable group of physicians for several years and then find themselves having to recruit for the first time in a while may find that they need to re-adjust compensation levels upward. "Because they have to offer more on the open market, it causes them, for parity purposes, to change the way they are compensating their existing physicians," adds Bohannon.

Regional differences diminish

Among respondents to the Salary Survey, which included both nurse managers and physician managers, 40% said they earned between $100,000 and $129,000 per year, and 30% said they earned $130,000 or more per year. Only about a third of respondents indicated that they earned less than $100,000 per year.

However, Bohannon points out that with regard to physician compensation, there are so many variables involved, that it can be difficult for survey data to capture all the nuances. For example, he notes that there are differences in the way shifts are structured, the number of hours a physician chooses to work, and the levels of coverage involved. In addition, he points out that compensation can vary, depending on the acuity level of a facility.

Further, Bohannon says regional differences in compensation levels are lessening. "The prevailing trend has been that everybody has come closer to the middle," he says. "I have been here 13 years, and we used to see a pretty significant disparity between the different regions of the country, but that is not as much the case anymore."

However, with ED physicians in high demand, smaller groups or hospitals that may only have one or two sites are having a tougher time finding directors because they can't offer the geographic options that large, multi-site groups have, says Bohannon. "That ends up decreasing the pool of available candidates," he adds. "But the biggest issue [driving compensation] is simply increased demand for their services."

Personality traits increasingly important

As is the case with nurse managers, organizations are looking for ED managers who have the personality traits needed to deliver good customer service, but these attributes have been prized for some time in the emergency medicine field, stresses Bohannon. "Most administrators are acutely aware that the ED is the front door to their hospital, and for the vast majority of patients, that is where their first interaction with the hospital occurs," he says. "So there has always been that customer service awareness, but there is more of that now."

Further, as more hospitals move to a hospitalist-type model, organizations want ED managers who are capable of working effectively with colleagues throughout the organization. "There is a lot more emphasis on the flow of the patient, and how you can get the patient from the ED to an inpatient bed in the quickest amount of time and do it in such a way that there is good communication and a solid handoff between the ED and the hospitalist group," says Bohannon, noting that he expects to see even more emphasis on these aspects of organizational agility and relationships with other physicians as bundled payments and Accountable Care Organization (ACO) models continue to proliferate. "You are going to see these qualities become more and more important as the leaders of these different pods need to interact effectively with their counterparts in other service lines."

Editor's note: To compile the 2011 ED Management Salary Survey, a total of 389 surveys were distributed, 20 surveys were returned and tabulated, for a response rate of 5.14%.

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