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Business Unit Manager Salary – The COVID-19 pandemic continues to wreak havoc on the lives of OR managers, according to the 2020 annual OR Manager Salary/Career Survey. Many new developments related to the pandemic have occurred and continue to evolve since the spring and early summer, when the survey was deployed. However, the concerns raised by many respondents are still valid and are likely similar to those of many of their peers nationally.
When asked how the pandemic has affected facilities and staff, respondents put staffing-related issues (eg, leave, reassignment) and reduced surgical volume at the top of the list (sidebar, “COVID-19 Effects”). In addition, 30% of managers reported a lower surgical volume in the past 12 months, compared to 18% in 2019. That 30% figure is not far from the 36% who reported lower volume in 2010, reflecting the effects of the recession of 2008 reflected.
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Despite reduced surgical volume and turnover in staff caused by the pandemic, the survey also reveals some positive trends. Compensation has improved: 78% of managers earn salaries of $100,000 or more annually, up from 65% in 2019, and 46% report total compensation of at least $150,000 or more, compared to 36% last year. And although stress levels are high, OR leaders remain a satisfied group, with 77% viewing their jobs favorably (vs. 70% in 2019).
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Despite a decrease in overall mobility, staff transitions plague nearly one-quarter of OR leaders, with 22% reporting increased RN turnover in the past 12 months (vs. 34% in 2019), and 24% reporting increased ST- turnover (against 29% in 2019). The average turnover rate was 8% for RNs and 7% for STs.
These numbers are strikingly different from a decade ago, when only 7% of respondents experienced increased RN turnover and 10% reported increased ST turnover. In 2010, the average turnover rate was 7% for both RNs and STs.
The percentage of open full-time equivalent (FTE) positions for RNs in the past 12 months increased for 30% of respondents, down from 37% last year; the number of open positions remained the same at 51%, up from 41% last year. Overall, 23% reported no open RN positions, compared to 27% last year. The average number of currently open RN positions was 6.
A third of OR leaders said the percentage of open FTE positions for STs increased in the past 12 months, similar to the 34% reported last year; slightly more than half (52%) said it has remained the same, up from 47% in 2019. Overall, 29% had no open ST positions (vs. 32% in 2019). The average number of currently open ST positions was 4.
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Again, the picture was much different in 2010, when only 11% reported an increase in open FTE positions for both RNs and STs, and the percentage of those reporting no vacancies was significantly higher: 54% for RNs and 65 % for STs. The average number of open positions was 2 for both RNs and STs.
The most reported change in personnel in the past 12 months was the reduction in the use of overtime, which increased from 34% in 2019 to 43% this year. In second place, with 36%, was hiring more direct care staff – slightly less than 40% last year, but similar to 2018 (35%) and 2017 (34%). More than a quarter (27%) reduced use of agency and travel staff, up from 20% last year. Almost a quarter (23%) of respondents required staff to take time off without pay, compared to just 14% in 2019 and 19% in 2015; but this percentage was 24% in 2017 and 39% in 2010.
More than 20 OR leaders answered “other” to this question, with most specifying changes related to COVID-19, such as furloughs and staff redeployment.
Recruiting skilled OR nurses remains a challenge, with nearly two-thirds (63%) saying the difficulty has increased in the past 12 months, compared to 67% in 2019. Only 8% said it was easier (vs. 5% last year). OR leaders have better luck with new or inexperienced OR nurses: 31% (vs. 28% in 2019) said it has been easier to recruit this group; only 15% said it was more difficult, down from 26% in 2019.
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Recruiting was somewhat easier 10 years ago, when 26% of respondents felt that recruiting experienced OR nurses was more difficult.
When evaluating candidates, 64% of OR leaders require an associate degree in nursing (ADN), compared to 59% in 2019 and 57% in 2018, and 41% require a baccalaureate degree in nursing (BSN), compared to the 45% reported last year and 44% in 2018. Only 10% require certification (versus 12% in 2019), and 6% do not require a degree or certification, down from 10% last year.
As in 2019, more than half (56% vs. 51% last year and 38% in 2015) of respondents find it harder to recruit STs, and only 12% said it was easier, compared to 9% in 2019 and 17% in 2015.
Almost half (46%) of respondents said that surgical volume increased in the past 12 months, compared to 40% in 2019. The pandemic may have affected the higher percentage of those who reported an increase (30% against 18% in 2019).
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ERAS remains the most popular of the care model options asked about in the survey, with 46% (vs. 53% in 2019) saying it has been implemented or is planned to be implemented in the next 6 months. The next highest was Accountable Care Organizations (25%), followed by clinically integrated networks (17%) and the PSH (15%).
Artificial intelligence (AI) has exploded over the past year, so we asked respondents about its impact on surgery in general and on their own organizations. In total, 214 OR leaders responded to this open-ended question, with most reporting that AI has no or minimal impact on their organization. However, a few are already using it. One noted: “[It] will be used to start our new total joint program. AI will be used to select patients who can go home the day of surgery. Another OR leader reported: “[It is] currently helping to predict which patients will be able to go home after surgery instead of staying in the hospital.”
Several commented on the potential value of AI, including reducing length of stay, predicting case times more accurately, and improving scheduling, which in turn could improve productivity and revenue. Other comments were:
We also asked how the migration of traditionally outpatient procedures (eg, total joint, spine, and cardiac procedures) from the hospital to ambulatory care settings affected OR leaders and their organizations. Again, 214 responded. Most do not see many effects, although some expect that to change in the future.
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Others report reduced volume, and some are in transition so they can’t respond. One respondent called the trend “disruptive, challenging,” and another said it had been “financially devastating.”
Some trends have changed quite a bit over the past 10 years, while others have remained relatively stable. However, COVID-19 continues to have a dramatic impact on the healthcare industry. While it’s hard to know what different OR manager jobs will look like a year from now, it’s safe to say that skills like resilience and creativity will be more important than ever to lead teams through these challenging times.
Cynthia Saver, MS, RN, is president of CLS Development, Inc, Columbia, Maryland, which provides editorial services to health care publications.
Data for the OR Manager Salary/Career Survey was collected from April 14 to June 5, 2020. The survey list consisted of OR directors, managers, or similar positions within hospital ORs. The survey was concluded with 265 usable responses. The margin of error is ± 5 percentage points at the 95% confidence level.
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OR Manager thanks those who generously took time to complete this year’s survey. We appreciate your help in gathering this information, which will be useful to your colleagues around the country.
A total of 214 respondents answered the question, how has COVID-19 affected your facility and your staff? More than two-thirds (68%) reported reduced case volume, often because elective surgical procedures were discontinued. OR leaders noted volume reductions as high as 90%.
Understandably, volume reductions have resulted in significant financial losses. For example, one OR leader reported “$25M loss in revenue due to no elective surgery rule and impact on other OR services (lab, radiology, pharmacy, etc.).”
More than half cited staff attrition from COVID-19, with furloughs, reduced hours and reassignments the most common effects. Three OR leaders noted that staff had retired or resigned because of the pandemic.
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Some staff took earned paid leave to avoid furloughs. Reported areas of redeployment for RNs included emergency departments and medical/surgical units, and one OR leader noted that the postanesthesia care unit was converted to an ICU for COVID-19 patients, which required the hiring of contract ICU nurses . Sample comments included:
But there was a note of optimism, with one respondent saying: “The facility has been affected financially, but we will rebound.”
As we enter a new decade, it’s a good time to revisit some of the past business manager survey results.
This year, the percentage of respondents with a business manager fell slightly, from 43% in 2019 to 36% this year. Although that is much higher than the 29% reported in 2015, it is only slightly higher than 2010’s 34%.
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