Salary Survey-Income holding steady in occupational health, survey says
This year has been largely a good one for the occupational health field, according to the exclusive 1999 Occupational Health Management Salary Survey and leaders in the field. Most readers are reporting about the same income as in the past few years, but some changes in the occupational health field are creating career opportunities.
OHM is pleased to provide readers with the results of the 1999 survey. This exclusive report illustrates the various factors that may influence salaries and benefits among occupational health professionals. The 1999 OHM Salary Survey was conducted last summer. Questionnaires, response forms, and postage-paid envelopes were mailed to subscribers with the June 1999 issue of the newsletter. Of approximately 1,200 surveys mailed, 56 were returned in time to be included in this report, for a response rate of 5%. Surveys were tallied, analyzed, and reported by Ameri-can Health Consultants, publisher of OHM.
Occupational health directors are reporting a median income that is in line with the income reported for the past few years, though it is lower than the figure reported last year in the OHM survey. In this year's survey, occupational health directors, most of them nurses, report a median income of $57,500. (See "Salary Levels by Title," p. 2.) That is lower than the median income of $72,500 reported in 1998, but that figure was so much higher than the 1997 figure that it appeared to be a statistical aberration. The return to a more constant income figure in 1999 seems to confirm that the 1998 jump was not a reliable figure. Directors reported a median income of $52,500 reported in 1997, and a steady $47,500 in 1996, 1995, and 1994. Despite the statistical blip in 1998, the figures are trending upward over a five-year period.
Readers responding to the title "manager/coordinator" also reported $57,500 as their median income in 1999.
Unlike the trends of recent years, it seems that occupational health/employee health nurses are gaining some ground when it comes to income. The median salary for nurses who are not program directors was $42,500 in 1998, consistent with the 1997 and 1996 results. But this year's survey shows nurses reporting a median income of $55,000.
No matter the specific position, occupational health professionals surveyed report a median 1% to 3% increase in income over the past year. (See chart, p. 1.) This is the third year in a row that readers have reported that median increase in their incomes.
The 1999 survey also continues a trend with increasing staff sizes for occupational health programs. Fifty-seven percent of respondents reported that their staff size has increased in the past year, compared to nearly half reporting that in 1998 and in 1997. (See "Change in Number of Employees," p. 3.) One-third report no change in their staff size this year, and 9% say they have lost positions.
Those new staff positions apparently are not cutting work loads any, however. The 1999 survey shows that most respondents work 46 to 50 hours a week, the same as last year, but up from the median 41 to 45 hours a week reported as the median in 1997. Most OHM readers (78%) are women, and the median reported age is 41 to 45, both the same as last year.
The results indicate that the occupational health field is holding steady in terms of career opportunities, says the president of the American Association of Occupational Health Nurses in Atlanta. Association president Deborah DiBenedetto, MBA, RN, COHN-S, ABDA, notes however, that the field is changing in some ways that nurses should consider when planning future career moves. Despite the steady figures in the salary survey for the past few years, she says some occupational health nurses have been squeezed out of traditional settings only to find equally good jobs in other settings.
"We're seeing in some cases an erosion of jobs in the business setting as smaller and even some larger employers are trying to do more with less," she says. "Some jobs are moving to the external community. We're not losing jobs, but we're moving them to managed care and other settings."
As a companion development, some occupational nurses are becoming entrepreneurs and setting up their own businesses to serve the community that once employed them as on-site practitioners.
"There is an opportunity for the nurse to be involved in that wave of health care change that the public is endorsing," DiBenedetto says. "We can be involved in health care advocacy and health management. With our unique skills, the occupational health nurse is being sought by those third parties that desire that competency to round out their services to the community. We're working more in an interdisciplinary approach, combining our skills with others'."
DiBenedetto also sees occupational health nurses moving more toward the benefits arena, human resources management, and disability management. There has been some erosion of jobs in the traditional occupational health field, she says, mostly from the closing of companies. Even though the economy is good, some employers are being squeezed out by the emphasis on a global economy.
"There are lot of opportunities now, but they may not be defined so much in the way you traditionally think of occupational health, but there are great job opportunities out there," she says. "Those traditional jobs will still be around, but we're seeing a lot more opportunities in employee assistance programs, consultants, behavioral based consulting, and benefits. They could be gatekeepers for managed care in a benefits program, for instance, because the occupational health nurse understands the work force." The occupational health nurse in that situation can help the worker access benefits while at the same time encouraging a quick return to work, she says. DiBenedetto also points to these changes in the occupational health field:
• There are not enough people entering occupational health nursing to replace those who leave, she says. That may be attributable to the "graying of America" as baby boomers get closer to retirement and fewer young people enter the field.
• Employers will expect occupational health providers to have full access to the Internet and to be comfortable with accessing information.
Salaries overall are on the upswing for occupational health nurses, DiBenedetto says. Income may be holding steady or increasing slowly in the traditional occupational health roles, but some of the newer positions offer good salary increases.
"Occupational health nurses in these newer roles can have salaries in the $65,000 to $85,000 range," she says. "Managed care positions can go up to $125,000. If you look at some of the traditional compensation surveys, the occupational health nurse is really stuck at older compensation levels based on the traditional job. The managed care market structures salaries differently for occupational health nurses because the jobs are different."
Many occupational health nurses will not want to change from the traditional role to the one more suited for managed care and similar opportunities, DiBenedetto says. That is a perfectly acceptable choice for individuals, she says, but the profession as a whole has to respond to the new opportunities.
For occupational health physicians, there also are big changes in the works, but they are almost the exact opposite of the trend for nurses. Instead of moving away from the traditional occupational health setting, physicians are moving closer to the hospital-based occupational health program, says Edward Bernacki, MD, MPH, associate professor of medicine at the Johns Hopkins University School of Medicine in Baltimore and director of the division of occupational medicine. Bernacki also is second vice president of the American College of Occupational and Environmental Medicine in Arlington Heights, IL.
Physicians coming out of the Johns Hopkins residency programs easily find employment, and usually in the area they wanted, he says. Employment in corporations may be declining, but it certainly is picking up in health care institutions.
"The reimbursement for hospitals is so poor that workers' comp and other occupational health services look exceedingly good as revenue streams. There is a tremendous future in that area," he says. "I think employment is going to be damn good in the hospital setting in the next few years. Hospitals are realizing that occupational health is a good way to increase their cash flow."
Bernacki says physicians should look for hospitals or other providers that incorporate their occupational health programs into the overall financial strategy and see occupational health as a way to bring patients in for other profitable services. Not all hospitals see occupational health that way, and there will be much more opportunity there than in a hospital that does not see the program as such a strategic component.
He also expects more occupational health programs to partner with insurance programs to share the risk, thereby lowering the cost of some services and increasing profitability.
"That will increase the operating margins for the injury care portion of the business and make the occupational health program even more important as a part of the hospital's financial well being," Bernacki says. "The margins already are better than with Medicare, but they can be better if you partner with insurance companies to share some of the risk." n
For more information on occupational health salaries, contact:
• Deborah DiBenedetto, President, American Association of Occupational Health Nurses, 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. Telephone: (770) 455-7757. Web: www.aaohn.org.
• Edward Bernacki, Associate Professor of Medicine, The Johns Hopkins University School of Medicine, 600 N. Wolfe St./Billings 129, Baltimore, MD 21287-1629. Telephone: (410) 955-9213. E-mail: Bernacki@welch.jhu.edu.