2012 Salary Survey Results

Nurse manager salaries remain stable, but experts say upward pressure on physician compensation could accelerate in the coming years

While 2012 has been a year of uncertainty in health care, as both the Supreme Court and voters made judgments on whether provisions of the Accountable Care Act will continue to unfold, salaries for ED leaders have remained relatively stable, according to the results of the 2012 ED Management Salary Survey.

In this year’s survey, more than 60% of respondents indicated they received salary hikes in the 1% to 3% range; nearly 9% reported receiving increases of 4% to 6%; and about 4% of respondents said they received salary increases of 7% to 10%. About a quarter of respondents, 26.09%, said there was no change in their salary this year, and there were no reports of salary decreases.

These figures are comparable to data from the 2011 Salary Survey. A year ago, 40% of respondents reported receiving salary hikes in the 1% to 3% range; 15% reported hikes of 4% to 6%; and 5% reported salary increases of 7% to 10%. However, last year, 10% of respondents noted that their salaries actually decreased.

While the economic recovery is expected to continue this year, Diana Contino, RN, MBA, FAEN, senior manager, Deloitte Consulting, Los Angeles, CA, observes that unemployment remains high, resulting in a reasonable pool of candidates applying for managerial jobs. “As personal and family financial stability improves, we will see more experienced managers retiring, but right now there are many ready to apply for these vacant positions,” she explains. “Administrative teams are concerned about declining reimbursements and potential increases in costs; therefore, significant increases in salary are not likely.”

Contino adds that rewarding managers based upon performance continues to be a prevailing trend. “Often these bonuses are tied to the overall organizational achievement of goals such as customer satisfaction scores, infection rates, or The Center for Medicare and Medicaid Services’ (CMS) core measures,” she says.

Increasingly, salaries linked to metrics

India Owens, RN, MSN, CEN, NE-BC, FAEN, director of Emergency Services at Franciscan Alliance, Inc., in Indianapolis, IN, agrees that compensation is increasingly being linked to metrics for both nurse and physician leaders. For example, she and the ED medical director she works with share a score card that contains both nursing and physician metrics, but they are both held accountable for the results.

Owens has also observed some moderation in nursing salaries. “We adjust the starting salary for staff nurses once a year, and in the past, we could see those go up by as much as 6% year over year, but now the hikes are in the 2% to 3% range,” she says. “Salaries for nurse leaders are actually going up more than that, in my experience, and I think a lot of that has to do with the increasing pressure on nurse leaders.”

For instance, where nurse leaders used to be able to focus primarily on clinical components, Owens notes that they now must also be able to analyze data and motivate staff to achieve organizational goals. “These days you have to be a project improvement guru who can change processes to deliver better financial metrics and move patients through faster,” she explains. “You have to understand what is contributing to your bottom line and what may be causing productivity measures to fluctuate.”

To cover all of these bases, Owens has actually divided the ED nurse manager responsibilities between two people. “I have a clinical manager who manages quality and throughput processes and I have an operations manager who oversees retention, turnover, and the financial components,” she says.

Contino observes that health care organizations continue to look for managerial candidates with MBAs or some business background. “Magnet hospitals may also require MSN degrees. Many nurse and physician directors are obtaining dual degrees such as MSN/MBA or MD/MBA,” she explains. “Additionally, leaders need knowledge of informatics and a broad understanding of health care technology.”

Work-life balance is a concern

While there are plenty of qualified candidates for these types of nurse manager jobs in the greater Indianapolis region, Owens has found that nurses with advanced degrees are often reluctant to take on manager roles requiring 24/7 accountability. This makes it tougher to find nurse manager candidates with both the skills and personality traits to inspire and support the staff nursing team.

“This is a tough business; it is hard every day out there because it is physically taxing, it is emotionally taxing, and I need those nurses to be all smiles and patient-centered,” says Owens. “No matter what they get from the patient, they need to be tolerant, caring, and compassionate, and unless my manager is tolerant, caring, and compassionate, and can restore staff nurses — build them up and make them feel good about the care they are delivering — then in a very short time they will be operating in an emotional vacuum, and then they won’t be able to deliver that caring compassion and my patient satisfaction scores will plummet.”

Offering nurse manager candidates an acceptable work-life balance is challenging, given all that they are expected to do, acknowledges Owens. Indeed, more than 30% of the respondents to the Salary Survey reported that they work 56-60 hours per week, on average. Another 26% reported that they work 51 to 55 hours per week. Only about 26% of respondents worked 50 hours a week or less, and about 17% reported that they worked more than 60 hours per week.

There is growing recognition in the nursing community that high-pressure environments and long shifts are not conducive to good patient care, and Owens is taking steps to ensure that her nurse managers act accordingly. “I am trying to infuse the message that while this is a 24/7 accountability job, I expect them to take time off and I expect them to take care of themselves,” she says. “That is the carrot that will draw quality applicants here. I will tend to their work-life balance.”

More than 43% of respondents to this year’s Salary Survey reported that their gross annual income was in the $100,000 to $129,999 range; just over 17% indicated their annual income was in the $90,000 to $90,999 range; and 26.09% said they made $130,000 or more. These figures are in line with the results from the 2011 Salary Survey, which yielded very similar results.

With continuing pressure on health care organizations to improve efficiency and weed out excess expenditures, Contino anticipates that most managers will not see their salaries rise beyond modest cost-of-living adjustments in the coming months, although managers are likely to see an increase in responsibilities. “Cost reduction is a major area of focus for hospitals and health systems,” she says. “Salary increases may occur in organizations that have successfully increased operational efficiency, automated processes, and have some competitive pressures; however, these increases may come in the form of bonuses.”

Physician leader salaries rising

The compensation picture for physician leaders in the ED is somewhat brighter, according industry experts. “I have seen upward pressure on ED physician leader salaries over the past year, which is consistent with the overall trend in physician compensation,” explains William Cole, MD, FACEP, chief executive officer of Premier Physician Services, based in Dayton, OH. “Demand for quality physician leaders is increasing and the supply is decreasing. This allows physician leaders to choose a geographic location and work balance that fits their lifestyle.”

However, Cole also observes that hospital clients are demanding more from the medical director role. “Education, training, and experience are becoming requirements for physician leaders who, not unlike the staff physicians, are few in numbers,” he says. “Premier Physician Services is addressing this changing landscape through our internal Medical Director Leadership Academy which cultivates and trains our future physician leaders.”

Emeryville, CA-based CEP America has a similar training program for physician leaders. Mark Spiro, MD, FACEP, the organization’s president and chief operating officer, explains that leaders have to be clinically competent in order to gain the respect of their colleagues, but they also, increasingly, have to have excellent communications skills. “You have to be able to motivate people to make changes, and you do that by having open and honest communications and by having a clear vision,” says Spiro. “We have found that even some very green clinicians, maybe one or two years out of residency, can be a successful director if they are able to communicate, collaborate, and motivate, since we have the support of senior leaders to guide them in other areas.”

Cole adds that today’s physician leaders spend more time forecasting impending changes in health care and how they will impact patient care. “This includes working with hospital leadership to find ways to meet specific goals and criteria,” says Cole. “I have found that hospitals are looking to ED physician leaders to help them see around the corners and develop plans to stay ahead of uncertain changes.”

Physician leaders have also taken on the responsibility of working with trade groups to make sure emergency medicine gets a fair shake when it comes to reimbursement, says Cole. “I also believe physician leaders are taking on more of the burden of physician recruiting and staffing due to the supply and demand issues of ED physicians,” he says.

Cole predicts that ED physician leader salaries will continue to rise, and he suggests this trend may accelerate as health care reform takes hold. “I believe this upward pressure will be the result of the duties and responsibilities of these leaders increasing under the Affordable Care Act,” he says, noting that the aging of the population and the surge in the number of people who will be insured under health reform will drive up volume in the ED. “Dealing with the penalties for ED bounce backs and unnecessary readmissions within 30 days discharge from the hospital, ED physician leaders will have the unenviable task making sure patients get the highest quality of care in the lowest cost setting.”

While many health care organizations prize physicians with some business training or background, Spiro says he is much more interested in physicians who have more of a collaborative skill set. “Fifteen years ago, you could focus just on ED leadership. You still had to cooperate with the hospital, but you really were much more of an island, whereas now — and even more so in the next three or four years — it is going to be much more a collaborative skill set that is needed. That collaboration will need to be across all medical specialties.”

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