2003 Salary Survey Results

While economic picture still lukewarm, there are some improvements for nurses, good job security

Documentation, other details key to improving physician income

Times still are tough for both physicians and nurses in emergency medicine when it comes to income and career opportunities, but there could be reason for optimism if the national economy continues its upswing.

In the meantime, the experts advise you to maintain the same strategies that have kept you afloat this long, and increase attention to some details that could make the difference between merely surviving and flourishing.

Michael Bishop, MD, an emergency physician with the Unity Physician Group in Bloomington, IN, who works with the American College of Emergency Physicians (ACEP) in Washington, DC, says the past year has brought little change in the economic situation faced by his fellow physicians.

"A lot of volumes are relatively flat, and payers are tightening up even tighter than they have been in the past, so revenues are down for a lot of practices," he says.

"Expenses are up, especially malpractice insurance, and revenues are flat or going down. So most of the groups I know are either flat or not doing as well as they have in the past," Bishop explains.

For nurses in the ED, things are looking a little brighter. Any time you have a nursing shortage, that tends to be good news for nursing incomes, says Donna Mason, RN, MSN, CEN, nursing manager for adult emergency services at Vanderbilt University Medical Center in Nashville, TN.

Mason also is on the board of directors of the Emergency Nursing Association in Des Plaines, IL. But that higher salary might come at a cost.

"Our facility just had a big salary increase about this time last year, and that always helps us get nurses. We have eight hospitals in our city, so there is a lot of competition for emergency nurses," she says.

"Of course, any time the salary goes up, that money has to come from somewhere else. We might have fewer capital dollars to spend, or you may find that you’re paying more for your health care benefit and your deductible."

The ED Management 2003 Salary Survey was mailed in July to 1,258 subscribers. There were 89 responses, for a response rate of 7%.

Here are career and salary trends for ED managers, based on the survey results:

More employees, still long hours in the ED

ED Management readers report a median income of $75,000, though 12% reported incomes of $130,000 or more. That is a reflection of the fact that most readers have a nursing background, with 52% reporting that an RN or BSN is their highest degree, and 9% are physicians.

Those incomes also reflect considerable experience in the field, as 38% of respondents report working in health care for 25 years or more. Another 15% have worked in health care for 22 to 24 years.

The largest portion of respondents, 43%, reported a salary increase of 1% to 3% over the past year, with 28% reporting an increase of 4% to 6% and a fortunate 9% reporting an increase of 7% to 10%. Another 10% reported no change in their income over the past year, and 3% reported a decrease.

While staffing continues to be a problem nationwide, it seems that EDs may be finding more bodies to fill the open positions.

Sixty-seven percent of respondents reported that the number of employees in their departments had increased over the past year, and 21% reported no change.

ED staff still are spending long hours at work, with 42% reporting that they work 46 to 50 hours a week, and another 19% reporting 51 to 55 hours a week.

Malpractice premiums hurting ED docs

Bishop says the situation is a worsening of the trends seen in the past few years. The continuing rise in malpractice insurance premiums is the biggest factor, he says, but the bleak picture also is affected by a trend toward higher copays.

"It’s harder to collect now, from just about all sources," he says. "And the economy still hasn’t really turned around yet, so physician practices are facing a tough battle on all fronts."

There is reason to think the economy is on the upswing, however, and Bishop says that could lead to a reversal of some of these trends if it gains momentum over the next year. In the meantime, he says emergency physicians must pay attention to the tried-and-true methods for getting the most out of their careers.

"It all comes through better reimbursement, and that’s why documentation of medical records is so important. We have to keep encouraging that because a lot of times services get provided but they don’t get documented well enough to code for those services," he says.

"I think it’s safe to say that nearly all emergency medicine groups are losing revenue they’re rightly entitled to because things could have been documented and coded better," Bishop points out.

The economic situation for emergency physicians seems to be pretty much the same across the country. Small practices, however, are having a harder time than they might have a few years ago, he says.

"Hospitals are wanting to cut back on subsidies, not wanting to give subsidies to those practices that need it, either because of lack of volume or an adverse payer mix," Bishop says.

"Many of the hospitals are stressed economically as well. It’s a lot harder to negotiate for subsidies or director’s fees than it might have been in the past in some places," he adds.

Bishop also says emergency physician practices should pay more attention to the "soft" factors such as patient satisfaction and throughput times, because those can have an effect on your practice’s payer mix.

Keep your patients happy, he says, and you might have a better mix of patients who pay.

"With [more than] 100 million visits in the country every year, patient satisfaction and appropriate documentation of those people who are going to pay or have someone paying on their behalf is just essential," he says.

"So many people who are unwilling or unable to pay that those who are paying become crucial to the economic viability of a physician practice. If you don’t pay attention to those patients, then you’ve got real problems," Bishop adds.

More nurses, but fewer support staff?

Mason notes that though the survey results show an increase in staff numbers, that probably reflects more nurses being hired by EDs but not necessarily other staff.

In fact, the extra cost of bringing in more nurses and the higher salaries they can command during a shortage might mean that your ED has to put up with fewer housekeepers, technicians, and other staff, she says.

"You have to do more with less," she says. "That puts the onus back on the nurses to take on that responsibility. Ten years ago, we wouldn’t have thought of doing our own breathing treatments, and now it’s routine."

Mason says it is generally a good time to be employed in emergency nursing. Job security, for instance, is rock solid right now because of the nursing shortage, she says.

"Hospitals are always cutting back, and nurses can be let go at any time, but it’s usually management, not the nursing at the bedside," she says. "If you want to work in nursing and actually be with the patient at the bedside, you’ve got lots of job security. You’re safe."

For nurses who want to improve their economic lot and future job prospects, Mason advises pursuing the nurse practitioner path.

Years ago, nurse practitioners were not highly desired, she says, and now her hospital holds job fairs to try to recruit them.

"They’re assisting the physicians, and that’s important at a time when physicians are not going into the field because they’re not compensated well," she says.

"It’s a wide open field. If I were young again and times were like they are now, that’s the direction I would go," Mason points out.

EDs still facing financial challenges

EDs are facing the same sort of economic challenges they have seen in past years, with shortages of staff and funding at the same time they are seeing increasing demands for service, Mason says.

Until the national economy’s turnaround gains momentum, EDs are likely to be strained even more, she says.

"When people are losing their jobs, you see more uninsured visiting your ED. And we’re seeing more people from other countries, poor, and uninsured," she says.

"Of course, we are the safety net for everyone. And more and more clinics are shutting their doors to people who don’t have insurance or can’t pay up front, so that puts the pressure on EDs," Mason explains. "Urgent care centers are closing everywhere. You can’t find one open after 5 p.m. now, so all of those patients come to us for help."

That also makes case management a growing career opportunity in the ED, she says. More EDs are hiring full-time case managers to help deal with a growing number of repeat, uninsured patients who use a lot of ED resources if not managed well, according to Mason.

Pursuing a path that will ensure you are valued in the field long after the current nursing shortage ends may be the best advice for emergency nurses, she says.

For physicians, Bishop says the best advice is to pursue reimbursement through optimal documentation. "Things are going to be tough no matter what, so you need to make sure you’re at least getting paid for everything you’re rightly owed," he says. "I think things are probably going to get a little tougher before the end."


For more information, contact:

  • Donna Mason, RN, MSN, CEN, Nursing Manager for Adult Emergency Services, Vanderbilt University Medical Center, 1211 22nd Ave., Nashville, TN 37232. Telephone: (615) 322-0160.
  • Michael Bishop, MD, Unity Physician Group, 1155 W. Third St., Bloomington, IN 47404. Telephone: (812) 333-2731.