2005 Salary Survey Results
Consulting, other careers luring emergency department managers — and it’s not all about money
In a trend that promises to create a serious challenge for EDs for the foreseeable future, talented ED managers are being lured away from their positions to alternative career paths. And, say observers, while compensation may be one factor, it is far from the only factor.
In fact, according to the ED Management 2005 Salary Survey, a larger percentage of ED physician and nurse managers find themselves in higher income ranges. For example, while 16.42% of survey respondents in 2004 reported annual gross income of between $80,000 and $89,999, this year 23.08% said their income fell with that range.
The figures for those making $90,000-$99,999 rose from 5.97% of respondents to 13.85% of respondents; for those making $100,000-$129,999, the increase was from 10.45% of respondents to 13.85%.
While conventional wisdom might indicate that the more lofty salary ranges are the exclusive purview of medical directors, that’s not entirely true, notes Michael Uhl, RN, MSN, CEN, NREMT-P, a former ED manager who now is a health care consultant with Deloitte Consulting in Cincinnati. "It varies by market but, for example, I’ve seen nurse managers making six-figure incomes down in the Miami, FL, area," he says.
Diana S. Contino, RN, MBA, a consultant for MedAmerica, a Laguna Hills, CA-based emergency physician management company, agrees. "I have colleagues who are making significantly higher incomes [than they used to]," she observes.
If it isn’t money, then what is causing ED managers — especially nurse managers — to leave the field?
"There are a couple of things we’re doing to nurse managers," says Contino. "For one, the complexity of the job has increased relative to the human resources side: hiring and firing, dealing either with union environments, or utilizing a lot of temporary staff."
The operations side of the ED also has become more complex, she says. "This is due to overcrowding, the complexity of the types of patients we are seeing, and the technology," she explains. Formerly, ED managers had to handle only labs reports, radiology reports, blood pressure tests, monitors, and defibrillators, she says. "Now, you are managing an incredible amount of software technology," Contino says. "Computers have to constantly be repaired or replaced, and there is technology for scheduling, reporting tools for payroll, and so forth."
Managers are much more accountable from a financial point of view, as well as for productivity measures, she says. "Many directors do this without secretarial support," Contino says.
It all lands on . . . the nurse manager’
EDs today are short-staffed, echoes Mike Granovski, MD, CPC, FACEP, head of Medical Reimbursement Systems, a medical billing company in Stoneham, MA. "Nurses work harder, then they call in sick," he says. "There are more staff shortages, and morale drops. All of this lands on the desk of the nurse manager."
Uhl believes the trend toward managers leaving is from a combination of factors, including being lured away to a position with better hours and less than 24-hour, seven day-a-week responsibilities. "Money is a driver, but it’s not the largest one," he says.
The survey results seem to bear this out. Nearly 35% of the respondents reported working 46-50 hours a week; 19.7% reporting working 51-55 hours; and 13.64% reported working 56-60 hours.
"And that only includes the time they are on-site or at the facility," Uhl points out.
Younger managers, especially, want more balance in their lives, notes Mike Williams, MPA/HAS, president of The Abaris Group, a Walnut Creek, CA-based emergency care consulting firm. "Not only do they have to deal with complaints, staff turnover, and so forth to a greater degree than they used to, but many EDs are isolated," he says. When those ED managers have a problem, he notes, they are on their own.
Money not the answer
Not surprisingly, since money is not the key issue for ED managers’ leaving their positions, it is not the only answer to keeping them, either.
"Five years ago, it was all about the money and being compensated fairly," says Williams. "Today, I see managers who will leave their position, or consider a new position more strongly, simply because of lifestyle issues."
Contino agrees. "If you look at other industries, department managers oversee about 10 people in their departments," Contino says. "Some ED managers manage 150 people in an ED that sees 50,000 patients a year. They can go ahead and pay $120,000, but how long do you want to do this when you can go [somewhere less stressful] for the same money?"
What other changes might convince these managers to stay? "You need a second tier of management or an additional management team — clinical support, lead technicians, or nursing supervisors who are shift supervisors," Contino suggests.
Uhl concurs. "They are not getting enough assistant managers underneath them," he asserts.
The experts agree that nurse managers are more likely to experience this degree of stress and the desire to seek career options than ED medical directors. "The typical medical director is a bit more removed from the front line," Williams says.
Williams adds that while this trend is happening more with nurses, he is seeing the same characteristics with physicians who take call to the ED. "Still, I don’t see droves of physicians leaving looking for alternative occupations and lifestyles," he says.
Where they’re going
The first thing that comes to mind when one thinks of ED managers seeking alternative positions is consulting, and indeed, that is a path many are choosing. However, it is certainly not the only path.
"Some managers are not going into consulting because they cannot travel," explains Contino. For those who can, "They can make the same or better money, depending on the firm," Contino says. Some of the "pros" of such positions include having the opportunity to see several different systems and observe different ways people are approaching similar issues and problems, she says.
Are consultants also stressed?
Stress levels in consulting are different — i.e., wondering where the next project is going to be — but they are not necessarily lower, she notes. "I think the bottom line is, in any environment where you feel supported, that you actually can make difference and have a pretty cohesive team and support to get the job done, stress levels are lower," Contino says.
For managers who can’t travel, "some are just going back to staff positions, where they can make good money and have flexible schedules," says Contino. And, it’s not necessarily for less money than they made as ED managers, she adds. "It depends on your experience level, but some staff nurses are making really good money — but it’s still a lot of hours," she says.
Other options that offer comparable income include sales representative positions with pharmaceutical companies, Contino says. If you prefer to stay at home, there are also several options available. "Nurses are hired to do home coding for EDs, call center work, telephone triage, and so forth," Contino notes.
Mangers might consider moving out of the clinical realm and into a health care-related field, whether that’s utilization review, product management work for an insurance company, or for a billing company, Granovski suggests.
Williams says, "I’ve met a whole spate of people who have gone to work for drug manufacturers or equipment companies, or other health care supportive devices. They seem be very stimulated about the environments they can go to without the pressures."
How much money can they earn? "For the most part, they can make equal or better money working for device manufacturers," says Williams.
In consulting, they can do considerably better, meeting or exceeding their previous income in about half the time. "That’s a no-brainer for the right nurse with the right consulting arrangement," he says.
ED is difficult area to fill
Has all of this movement into other fields led to a shortage of ED nurse managers? Contino says it has. "Not a week goes by that I don’t get an e-mail from someone looking to fill a position," she says. "Some of my colleagues say the ED and OR are some of the hardest positions to fill."
Williams won’t go quite that far. "ED nurse manager positions all get filled, but it now takes four or five months, while four years ago the position would have been filled within a month," he observes. "Candidates now spend a lot more time [checking out] a hospital."
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