OR Manager
2019 Career & Salary Survey

Turnover continues to trouble OR leaders, with more than a third (34%) reporting that the turnover rate for RNs has increased in the past 12 months, and only 16% reporting a decrease. The percentage of RN turnover in the past 12 months ranged from 0 to 75%.

ST positions are slightly less troublesome, with 29% of respondents reporting an increase in turnover. And there was a glimmer of good news: 18% said ST turnover has decreased, up from 11% last year. It will be interesting to see if that trend holds.

For both RNs and STs, about half (50% and 53%, respectively) of respondents reported turnover has stayed the same. The percentage of ST turnover in the past 12 months ranged from 0 to 70%.

The percentage of open full-time equivalent (FTE) positions for RNs in the past 12 months again increased for more than a third (37%) of participants (the same as last year and comparable to 33% reported in 2017), with only 21% (vs 17% in 2017) reporting a decrease. More than a quarter (27%) said they have no open RN positions (the same as last year), but nearly one-fourth (23%) said they have five or more—similar to the 21% reported in 2018.

The percentage of respondents reporting an increase in ST open FTE positions declined from 37% in 2018 to 34% this year. In all, 19% reported a decrease, the same as in 2017 and slightly higher than the 14% reported in 2018. Nearly a third (32%) of respondents said they have no open ST positions, essentially unchanged from 33% in 2018. Only 10% said they have five or more open ST positions, the same as last year.

A total of 313 respondents provided usable data for the question on how surgical volume has changed over the past 12 months. In all, 18% reported volume has decreased, the same as in 2018, with the percentage of decrease ranging from 1% to 75%. The percentage of increased volume ranged from 2% to 50%. Of those who provided a percentage for the increase, 67% said it was 10% or less. (Most OR leaders reporting an increase did not provide a percentage, so that figure should be interpreted cautiously.)

ERAS was the most popular of the care model options in the survey, with more than half of participants (53%) saying it has been implemented or planned to be implemented in the next 6 months. The next highest was Accountable Care Organization (33%) followed by Clinically Integrated Networks (20%) and the Perioperative Surgical Home (12%).

Optimal care delivery depends on reimbursement, and more than 300 of respondents shared their “biggest concern” in this area. Payer mix topped the list, with more than 75 mentions. For example, one person noted, “Payer mix for our population is a concern as a large portion of the population surrounding our small community hospital has Medicaid.”

Bundled payments and documentation requirements weren’t far behind. Most respondents believe bundled payments are insufficient to cover costs, and loss of reimbursement can occur with the increasingly complex documentation requirements. “My biggest concern about reimbursement today is meeting documentation requirements,” one respondent noted.

Another respondent summed up the situation by saying, “Reimbursement continues to decline, capital cost continues to escalate, and documentation has become too complex.”

Other concerns included not receiving reimbursement for new technology, decreased reimbursement for critical access hospitals, and proper filing of claims.

About two-thirds (65%) of OR leaders earn an annual salary of $100,000 or more, continuing a pattern seen over the past 3 years (66% in 2018; 69% in 2017; and 66% in 2016).

The most frequently reported total compensation range was $120,000 to $149,999 (24%), followed by $100,000 to $119,999 (18%). Only 11% earn $200,000 or more, and only 9% earn less than $80,000.

OR leaders who responded to the survey supervise an average of 102 clinical and 42 nonclinical employees and oversee an average of 14 ORs, up slightly from 11 in 2018, but the same as 2017. The most common job titles are director (37%) and nurse manager (30%), with 14% of respondents reporting their title as administrator/administrative director. 

Departments that OR leaders most commonly oversee in addition to the OR are central sterile processing (56%), postanesthesia care unit (PACU, 55%), preoperative area (51%), outpatient/same-day surgery (44%), GI/endoscopy (47%), preadmission services (43%), and anesthesia support personnel (39%). Since 2015, the percentages for those supervising outpatient/same day surgery, GI/endoscopy, PACU, and materials management for the OR have declined fairly steadily.

Only 16% of OR leaders manage an annual operating budget of less than $2.5 million, down from 26% last year, and only 10% manage an annual operating budget of $75 million or more, up slightly from 7% in 2018. Most respondents (21%) oversee an operating budget of $10.0 million to $24.9 million.

As was the case in 2018, responses to the question about responsibility for the annual capital budget were fairly evenly divided among all categories, with the highest percentage (22%) managing a budget between $2.0 million and $4.9 million. In all, 16% manage a capital budget of less than $250,000, the same as last year, and slightly more than half (52%) manage a capital budget of $1.0 million or more a year.

Overall demographics are listed in the infographic. The average age of the OR leaders who responded to the survey is 51, similar to the average age of 53 for nurses overall, according to the 2017 National Nursing Workforce Survey.

Nearly half (47%) of OR leaders have a master’s degree as their highest level of education, up from 40% last year and the same as in 2014. Most of those with master’s degrees are in nursing (30%) rather than business (10%) or another area (7%).

About a third (34%) earned a bachelor’s degree as their highest level of education. The number of respondents who have a doctorate ticked upward from 6 to 17 but remains a low percentage (5%). Only 10% list diploma or an associate degree in nursing as their highest education level.

As in previous years, most respondents (60%) work in a community hospital; a third call a teaching hospital their work home.

A total of 163 respondents provided usable data for the question on how surgical volume had changed over the past 12 months. The average surgical volume was 5,115 annually, but there was a wide range of responses (80 to 100,000), making interpretation difficult.

The number of specialties over the past 12 months has remained stable for most OR leaders (73%), with only 23% reporting an increase, nearly the same as the 24% reported last year.

The uptake of care models—Accountable Care Organizations, joint ventures, Enhanced Recovery After Surgery (ERAS), Perioperative Surgical Homes, and dual-license facility—remains low. Nearly two-thirds (63% vs 59% in 2018) of respondents do not have and do not plan to implement them in the next 6 months. Of those who have one of the care models or plan to implement, the top pick was some form of joint venture (18%), followed by ERAS at 16% (up from 11% in 2018).

When asked about their biggest reimbursement concern, ASC leaders most commonly mentioned payer mix and bundled payments. Representative comments include:

• “Medicare and Medicaid reimbursement not enough to cover expensive supplies or implants.”
• “Insurance companies more difficult to deal with (requiring more documentation for precertifications and denying payment after surgery performed).”
• “Increasing cost of supplies (mainly implants) and bundled payments not reflecting some of those increased costs.”

Total compensation, like salary, also declined slightly this year, although the most frequently reported annual total compensation range remained the same: $120,000 to $149,999 (reported by 23% this year and 28% in 2018).  Fewer than half (42%) earn $120,000 or more, down from 51% in 2018, and only 3% earn more than $200,000.

Hospital OR leaders continue to earn more than their ASC counterparts. In all, 43% of hospital leaders earn salaries of $120,000 or more, compared with 31% of ASC leaders. Last year, these percentages were 43% and 37%, respectively. In the case of total compensation packages, 42% of ASC leaders earn $120,000 or more, far below the 60% of hospital OR leaders in that range.

The average number of full-time equivalent (FTE) employees that ASC leaders supervise is down from previous years (32 vs 37.34 in 2018 and 39.83 in 2017). They supervise an average of 25 clinical and 7 nonclinical staff. Most respondents (77%) manage one to five ORs, a slight uptick from the 73% reported in 2018. Overall, most (24%) manage two ORs, and 7% manage more than 10 ORs, up from last year’s 3%.

Nurse manager and director were the most common position titles (32% and 30% respectively), with 25% reporting titles of administrator or administrative director.

Most OR leaders (18%) report an annual operating budget of $1.0 million to $1.9 million, whereas in 2018, the most common choice was a range of $5.0 million to $9.9 million, cited by 14% of respondents. The second most frequently chosen option (12%) was $3.0 million to $4.9 million. More than two-thirds (67%) reported no change in the annual operating budget during the past 12 months, comparable to last year’s 70%, and 27% reported an increase (up slightly from 23% in 2018).