2008 Salary Survey Results

New responsibilities, new roles are coming for occ health

Managers should take advantage of these new career opportunities

When it comes to occupational health salaries, "there is certainly not exponential growth, but it is not static, either," says Robert R. Orford, MD, CM, MS, MPH, president of the American College of Occupational and Environmental Medicine. Orford is consultant and former chair of the Division of Preventive Occupational Medicine at Mayo Clinic Arizona in Scottsdale.

According to the 2008 Occupational Health Management Salary Survey, 35% of respondents fell into the $60,000 to $69,000 range, with 10% earning less than that amount. Another 20% earn between $70,000 and $89,000, and just 10% make over $90,000. Nearly half of respondents (40%) reported a 1-3% increase in salary in the last year, and 30% received a 4-6% increase.

The survey, which was administered in July and tallied, analyzed, and reported by AHC Media, publisher of Occupational Health Management, identifies some of the factors impacting salaries and benefits in occupational health. For the 2008 report, 194 surveys were disseminated. There were 20 responses, for a response rate of 9.7%.

Other key findings of the survey:

About one-third of respondents (37%) work 40 hours or less per week. Another one-third work between 41 and 45 hours, with 16% putting in 46 to 50 hours.

One quarter of respondents have worked in occupational health for only 1-3 years, with another 20% in the field for 4-6 years.

The vast majority of respondents (68%) supervise a small staff of 1-3 employees.

Three-quarters of respondents said they had no changes in the size of their staff in the past year, while 15% had gained positions and 10% lost positions.

Praise and promote yourself

To move forward, occupational health professionals need to "toot our own horns," says Kay N. Campbell, EdD, RN-C, COHN-S, FAAOHN, president elect of the American Association of Occupational Health Nurses (AAOHN).

"People don't like to praise themselves. I like to think that what we are really doing is shining the light on the programs and services we offer, which enhance employee health for productivity and high performance," says Campbell.

Today's occupational health professional needs to hone his or her marketing skills and show value, or "if we don't, the programs will not survive," says Campbell. Above all, programs need to be aligned with the company's mission, she says. "It truly is marketing and selling, as with any product or brand. Every time we turn on a TV we see marketing and sales in front of us. We need to have that hat on as well, in order to sell the services we know are beneficial to our clients," says Campbell.

When managers consider the bottom line, they typically think about absenteeism or worker's compensation costs. "What they don't think as much about is managing people's non-work related health, which is probably impacting the bottom line more," says Campbell.

There is the cost to the company of lost time and disability, but lack of productivity or engagement could end up costing the company far more, says Campbell. "We are seeing much more of that and have been for some years," she says.

Health promotion programs, such as smoking cessation, fitness or wellness, which aim to "keep healthy people healthy" don't end up getting as much attention as they should, says Campbell. "At the end of the day, probably about 80 to 90% of people who come to work every day need to be supported so they maintain their health. Sometimes we forget that," she says.

If companies don't support those activities, employees are more likely to get sick and become less productive, says Campbell. How can you show the return on investment for these programs? "Get some qualitative studies, or even stories from employees about how much better they feel when they lost 10 pounds of weight, or are able to go the gym in the middle of day," suggests Campbell. "Get a manager who has taken their team and really pushed the notion of eating well and exercising during the day, to talk about how their team feels more creative and productive. That's a great success story to share."

Employee benefits is new role

While occupational health professionals are still concerned with the traditional workplace hazards, they are becoming much more involved in the nuts and bolts of employee benefits packages.

"As the costs of health care have increased, employers are needing to get professional advice in order to help them make decisions," says Orford. "And who better to get the advice from, than from an occupational health nurse or physician who they've already got employed on their staff?"

In past years, this was almost exclusively the role of human resources, but as health care plans become more complex, occupational health professionals are more often playing key roles. Orford says to remember that senior management often lacks knowledge in this area.

Orford gives an example from a few years ago, when he saw a CEO who had abnormal findings on a heart exam that required further medical evaluation. Orford urged him to double check whether the insurance would cover a coronary angiogram, which was about $17,000, and advised him that the results would possibly lead to the need for a coronary bypass. "He said he was sure his insurance would pay for it, but I told him to check, that he was making a bit of a leap," says Orford.

When the exam found a bypass operation was needed, costing $50,000 to $70,000, the CEO again said his insurance would cover it. This time Orford urged him to check with his insurer immediately, and he learned otherwise. "Here was a CEO spending $2.5 million on health care costs for his employees and thought he had a personal relationship with insurance vendor as the guy writing the check," says Orford. "He quickly learned that he had to follow their rules too."

Orford points to this story as an example to show that CEOs often don't comprehend the fine details of negotiating health care plans. An occupational health nurse or doctor should be "in the mix," he says, to ask questions such as, "Did you consider this? Will they cover this? Do you want to include dental benefits or not?"

Even the vocabulary of health care insurance can be daunting, he says, with terms such as "copays," "coinsurance," and "deductibles" often confused.

Even if you are not asked to be involved, Orford says to come forward and volunteer your expertise. "Find out who in your company has that responsibility currently - normally, it's either HR [human resources] or the finances department, and speak with that individual to see if there is a role for you," says Orford. "You could become a member or advisor of the benefits committee and play a very helpful, useful role for the company."

Managers tend to be focused on the bottom line and looking for the least expensive plan without considering all the aspects. You can prevent them from making this mistake. "The cheapest plan might not be the cheapest plan for your company, although on paper it has the lowest dollar cost," says Orford. "When implementing that plan, you may end up with higher level costs because the plan is not going to cover certain things that are likely to happen." The employee might be unable or unwilling to cover these costs, which would result in a reduction in their productivity, employment termination, or other outcomes that in the end will increase costs for the employer.

When assessing employee benefit plans, consider your health risk assessment data, the size of your company, the age of your employees, and what kind of claims you have had in the past, says Orford. "You don't want to buy a plan and then find out that your diabetics or people with prior heart disease or other pre-existing conditions aren't going to be covered," he says.

Insurers can modify plans to some degree based on employee demographics. "My guess is that right now probably not a lot of them do that, but it's becoming easier as our data systems become more refined," says Orford.

Share wellness expertise

Occupational health professionals are getting "much more involved" in the area of health and productivity in the workplace that has evolved in the past few years, says Orford. "They are the ones helping to choose, and in some cases design, health risk assessment tools," he says.

Also, occupational health professionals are negotiating with the providers of services such as area health clubs to get good deals for their employees. "That is something that just didn't occur a few years ago, but it is happening much more frequently today," says Orford. "The occupational health professional is trying to think creatively how to improve the health of their employees."

He gives the example of setting up signs in the employee cafeteria suggesting that workers ask for a half serving instead of a full portion. "The occupational health nurse or physician would be working with the cafeteria people to get that into place, to try to direct employees to lower calorie choices," he says.

If there is a change in senior management such as a new chief executive officer, chief financial officer, or HR manager, Orford advises meeting with that individual to talk about health and wellness. "Expand the corporate officer's understanding of this whole area," he says. "Studies have shown that if you implement well done programs, you will save about $3 for every dollar you invest. If you can put it in financial terms, it quickly becomes apparent that it isn't a cost to the company to implement wellness benefits."

"Resurgence" is likely

Orford says the problem is that some companies don't comprehend the value of a broad occupational health program. "They see it only as looking after Joe's back when he gets injured lifting something. And an emergency medicine doctor can probably handle that. They don't understand all the other things you do."

Some companies will send out every injury to a clinic for care, without looking at occupational medicine from a broader perspective. "You run a risk of increasing your costs, because you are just reacting to everything," says Orford. "Unfortunately if you're just sending people out to the clinic to get patched up, you are never really going to have the knowledge to prevent those injuries."

Orford recalls a physician who saw an employee with an unusual illness related to a certain chemical. "I talked to the patient's manager and asked him if he had any other people with the same condition, and he said he didn't think so," he says.

After Orford researched the company's absenteeism and termination records, he identified seven cases of employees who were on extended medical leave or terminated with an illness related to the particular chemical. "The manager wasn't even aware there was a problem," he says. "If the occupational health professional can see a pattern like that, then you can do something about it. But if these individual cases are being seen by different doctors, nobody is going to put it together."

Occupational health has undergone a major shift in the last 20 years, with many companies downsizing or even eliminating these departments, but if you focus on injury care alone, long-term costs will end up increasing, says Orford. "I think it is going to occur to companies over the next few years that they need to get that expertise back in-house again," he says. "My guess is that we will see a resurgence at some point, after the current recession over, to start building up again in this area."