Salary Survey

Are you offering the right benefits in your ED? If not, employees may go to a facility that is

You might lose ED staff members to other facilities if you don’t offer the right health insurance plan.

The quality of the coverage in the specific plan is a key concern, according to Robert Suter, DO, MHA, FACEP, a member of the American College of Physicians Board of Directors and interim ED medical director at the Medical Center of Arlington (TX).

"People are quitting and changing jobs after changes in company health care insurance, if they do not like the new plan," he reports. "Usually, it is over very specific issues — like domestic partner coverage or specific doctors on a preferred provider list."

Doctors are focused on pension and profit-sharing, says Suter. "[They’re concerned with] pension because most seem to be planning to retire early; profit-sharing because they feel philosophically that they should be entitled to it, since they are the provider of the critical component of care the patient is seeking," he explains.

Physician managers also value "flex-time," says Suter. "They do not like working in a nine-to-five framework but rather enjoy the freedom of a flexible work schedule," he notes. "In part, this is necessary for physicians to work off-hours clinical shifts. This freedom’ is still difficult for most nurse managers to get at most hospitals, which tend not to be as tolerant of flex-time for nurse directors."

Benefits were covered in the ED Management 2000 Salary Survey, which was mailed in July to 1,131 subscribers. There were 98 responses, for a response rate of 8.7%.

Respondents ranked the following benefits as important or extremely important:

• medical coverage: 91%;

• 401k or other savings plan: 88%;

• pension plan: 88%;

• dental coverage: 74%;

• tuition reimbursement: 60%;

• life insurance: 59%;

• annual or semiannual bonus: 41%;

• profit-sharing plan: 27%;

• eye care coverage: 38%;

• child care: 6%;

• elder care: 2%.

Physicians looking for traditional benefits

About 75% of ED physicians are now employees, which is a significant change over last 10 years, notes John Moorhead, MD, FACEP, past president of the Dallas-based American College of Emergency Physicians. "Most used to be independent contractors, so they are now looking for fairly traditional kinds of benefits," he says.

Moorhead notes that although large sign-on bonuses are being paid due to the nursing shortage, benefit packages have stayed about the same once employees are hired. Employees also are being asked to pick up more of their health care cost, so in actual dollars, the amount of benefits is less, he says.

Benefits such as tuition reimbursement are increasingly important, says Marty Karpiel, MPA, ambulatory care consultant for the Karpiel Consulting Group in Long Beach, CA.

"Even more so than salary, the way you are treated and the workload [are] what’s important," he explains. "If we can redistribute workload so it’s not as much of a burden on staff, that is important for recruiting and retention."

Based on the results of the ED Management 2000 Salary Survey, here are several career and salary trends for ED managers:

1. Workload has increased.

Because physicians and nurses are overworked and less able to work at nonclinical activities, the average manager’s workload also has increased, Moorhead reports. According to the survey, 51% of ED managers work more than 50 hours a week.

"There is not as much support from the clinical side as we’ve seen in the past, so the management side is needing to pick up most of this on their own," he says. "Everyone’s working harder than in the past, with not much more compensation."

The trend of working more hours likely will continue, predicts Moorhead. "An increase in acuity, a trend toward more outpatient care, and an aging population are causing a tremendous increase for unscheduled medical care, and EDs are a natural site for that," he says.

2. Salary increases are disappointing.

The highest percentage of EDM readers (39.8%) report a salary increase of 1% to 3%."It shows that medical managers are pretty typical of the American public, in that they are not receiving much increases in salary," says Moorhead.

The most important figure for an ED manager is the starting salary, because after that salary is set, it is difficult to negotiate upward, says Suter. He notes that due to a shortage of qualified candidates, experienced managers can demand much higher wages than their predecessors could. "But once they’ve started, it is difficult to get big raises without threatening to leave — and the old adage on that is that you can only do it once.’"

3. Most EDs have added employees in the past year.

According to the survey, 56.1% of ED managers have seen the number of employees in their department increase in the past 12 months. "This is due to increasing ED volumes across the country," says Moorhead. "We are seeing more patients, and we need more nurses and physicians to take care of them."

4. More management positions are available.

Overall, there are fewer candidates for management positions, notes Suter. "People are realizing that it is increasingly difficult work compared to what it was 20 years ago."

There is a slightly higher turnover in ED management positions and more difficulty in recruiting people into those positions, Moorhead notes. "There are still a number of young physicians who find ED experience extremely valuable. On the academic side, it’s somewhat harder to recruit managers into chair positions."

There is relatively minimal or no income benefit to a being a chair vs. working the same hours as a clinician, Suter adds. "Older physicians and nurses are stepping down or not accepting promotions,’ and most younger folks aren’t interested," he says.

This makes room for young, ambitious potential managers who are looking for opportunity, says Suter. In contrast to other fields, medical people seem to be more reluctant to relocate than in previous years, he adds.

For those who have experience and a willingness to relocate, it is a seller’s market, Suter reports. "In some situations, experienced medical directors can name their own salary and benefits if willing to take difficult jobs where the contract is on the line or at risk," he says. "Proven nurse managers can be in an analogous situation."