Will your salary be cut in half?

Affiliations can be mean bad news — Be proactive

(Editor’s note: In this first part of a two-part series, Same-Day Surgery discusses the things you need to do to protect your position in the event that your facility affiliates with another one. In next month’s issue, we discuss the steps to go through when considering an affiliation and how to avoid the problems associated with looser affiliations.)

One day you’re an administrator who’s making $80,000 a year. The next day your surgery center has a new owner, and you’re a part-time employee who makes $40,000 a year.

Think it can’t happen in your field? As one same-day surgery administrator has found out, it already is happening, says Scott Becker, JD, CPA, partner at Ross and Hardies in Chicago.

"The pay rates from the national companies aren’t nearly the same as in physician-owned centers," Becker warns.

The times, they are a changin’. When the same-day surgery industry started in the late 1970s, the focus of managers was to concentrate on their program, says Pamela J. Wayne, RN, MPH, regional vice president of the Surgery Center Division for Southern California and Arizona of Healthsouth Corp. in San Diego.

"You can’t function like that anymore," Wayne says. "Today, everything is about partnerships, consolidations, working with people you never thought you’d work with — working with people you’d thought you’d be in competition with for the rest of your life."

Today, hospitals, surgery centers, and physicians who perform surgery are joining together through mergers, consolidations, and other types of affiliations. The reasons are many, says Douglas Rich, president of Tribrook/AM&G Management Consultants in Westmont, IL, a firm specializing in ownership and operations issues for hospitals and freestanding ambulatory surgery centers. In a recent hospital survey by Tribrook/AM&G, only 12% of respondents said they expect to remain unaffiliated by the year 2000.

If you enter into affiliations without doing your homework, you could jeopardize your job. Consider these tips from same-day surgery affiliation experts:

1. Develop an external perspective. The key now is to focus on external factors, such as changes taking place within your community, rather than internal factors, such as the day-to-day management, Wayne says. "When you start doing that, you’re in a much better position to evaluate partners," she says.

Today’s successful same-day surgery managers must have their fingers on the pulses of physicians, patients, hospitals, and same-day surgery corporations, Wayne says.

"You almost have to have a national perspective these days," she says. "It also means politics: You have to get into and understand what’s coming down the pike. What’s going on with national health care? Who’s on the [congressional] committees? What’s on the news?"

Become involved in community organizations and attend meetings, Wayne suggests. "Get up earlier, read magazines, and stay on top of current trends," she advises.

Managers, including nurses, need to move beyond the day-to-day clinical operations, Wayne advises.

"You have to be a marketer, a strategic planner, know the business side, the community, the political side," she says. "This will make or break people."

Ask these questions, Wayne suggests: What do I read? What am I learning about the business side? What professional associations do I affiliate with?

"You have to network, network, network," she says. "We’re no longer little one-house operations. If an individual doesn’t want to get out and learn the new trends and new ways of managing, I think they’re doomed to failure."

2. Broaden your clinical experience. urses and other same-day surgery staff need broader clinical experience, Becker advises.

Hospitals hold an advantage over many ASCs because they offer employees the opportunity to work with a broad range of procedures. Such experience can be invaluable in the event that an affiliation puts an employee out of work.

"If a nurse is going to work in an ASC, make sure it’s a busy and strong one — Make sure it’s financially strong and running lots of cases and doing well," Becker says. "And the nurse manager should provide access to all types of learning experiences."

3. Adjust to new organizational structures. Becoming part of an affiliated organization may mean someone new is setting policy, giving orders, and even hiring and firing employees. It may be a different ballgame, particularly for nurse managers who are accustomed to working with a local close-knit group of physicians who own a surgery center.

"If there are several joint owners, you may have a great relationship with the doctors, but you have to be concerned about someone at the management company or the hospital who overrides surgeons," Becker says. "Now, if your center is 10% physician-owned, the relationship with the surgeons may mean a heck of a lot less than it used to. "

In the past, administrators have had a huge amount of autonomy and clout, he says. "They reported to physicians. They kept the board happy," Becker says. "But when the hospital becomes an investor, and you have fights with the hospital administrator or the hospital’s director of surgical services, instead of your position being completely secure, you have a completely new constituency to worry about. And it’s the same with national companies."

4. Obtain commitment upfront to secure your position.

Nurse managers of many same-day surgery programs have seen their responsibilities and salaries grow over the years, which puts them in a precarious position in the event of an affiliation, Becker says. Many of these nurse managers manage personnel and market the program’s services and may have seen their salaries rise as high as $80,000, he says.

Those wages are higher than nurse salaries at most surgery centers operated by national chains, Becker warns.

To secure your position before an affiliation is formed, obtain a commitment (a "golden parachute") from the current owners that you’ll be guaranteed a position and your current salary from six months to two years.

"That will give you the opportunity to demonstrate your worth to new owners and also conduct a job search over a reasonable amount of time," Becker says.