OR Manager
2020 Career & Salary Survey

Recruiting experienced OR nurses remains a challenge, with nearly two-thirds (63%) saying 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 are having 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.

Recruiting was a bit easier 10 years ago, when 26% of respondents found recruiting experienced OR nurses to be 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), comparable to the 45% reported last year and 44% in 2018. Only 10% require certification (vs 12% in 2019), and 6% don’t require either 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 are finding it more difficult to recruit STs, and only 12% said it was easier, compared with 9% in 2019 and 17% in 2015.

Nearly 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 reporting an increase (30% vs 18% in 2019).

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 all, 214 OR leaders responded to this open-ended question, with most reporting that AI has had no or minimal impact on their organization. However, a few are already putting it to use. One noted: “[It] will be used to start our new total joint program. AI will be used to select patients who will be able to go home the day of surgery.” Another OR leader reported: “[It is] presently helping predict which patients can go home after surgery instead of staying in the hospital.”

Several commented on the possible 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:

• “I see it as a positive thing: I think this pandemic has shown us what we can do. Hope we expand on this more.”
• “Reading about AI brings many questions about how soon it will take over healthcare, especially radiology and other tech type jobs. It may eliminate rural healthcare workers.”
• “Will affect diagnostics for years to come; will be used in GI endoscopy to analyze polyps and polyp removed borders.”
• “Eventual elimination of surgical tech jobs to be replaced by AI.”
• "It can help take out the guesswork and perfect certain things to provide safer quality care utilizing data to analyze and act upon.”

We also asked how the migration of traditionally inpatient procedures (for example, total joints, spine, and cardiac procedures) from the hospital to ambulatory care settings was affecting OR leaders and their organizations. Again, 214 responded. Most are not seeing many effects, although some anticipate that could change in the future.

Others report decreased volume, and some are in transition so were unable to respond. One respondent called the trend “disruptive, challenging,” and another said it had been “financially devastating.”

Some trends have changed rather a lot in the past 10 years, whereas others have stayed relatively stable. However, COVID-19 continues to have a dramatic impact on the healthcare industry. Although it’s hard to know how different OR managers’ jobs will look a year from now, it’s safe to say that skills such as resiliency 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 healthcare publications.

Data for the OR Manager Salary/Career Survey were collected from April 14 to June 5, 2020. The survey list comprised OR directors, managers, or similar positions within hospital ORs. The survey was closed with 265 usable responses. The margin of error is ±5 percentage points at the 95% confidence level.

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.

In all, 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 had been stopped. OR leaders noted volume reductions as high as 90%.

A few respondents reported they were back in business or shared changes they had implemented:

• “Almost total shutdown in March. Now we are testing every patient, so this has allowed us to reopen.”
• “We are more cognizant of infection control practices; social distancing implemented, not allowing family to wait in lobby or be in treatment area.”

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 OP services (lab, radiology, pharmacy, etc).”

More than half cited staffing fallout from COVID-19, with furloughs, reduced hours, and redeployments the most common effects. Three OR leaders noted that staff had retired or resigned because of the pandemic.

Some staff took earned paid leave, thereby avoiding furloughs. Reported areas for 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 hiring contract ICU nurses. Sample comments included:

• “We had to reduce hours for each employee by 10% for the months of April and May and continuing into June unless our caseload warrants full time.”
• “Furloughed 50% of staff.”

Thirteen OR leaders noted the psychological effects of the pandemic on staff, citing anxiety, fear, and frustration:

• “It has caused increased stress and tension among staff members. They seem to be more stressed in dealing with patients as well.”
• “The staff are overworked, tired, emotional, and exhausted.”
• “There has been tremendous stress: staff deployed to other units and working out of their comfort zones; increase in dealing with death and dying, without families present.”
• “Morale has been taxed.”
• “Staff morale is low; a lot of anxiety and stress.”

Six respondents cited supply difficulties, including insufficient personal protective equipment.

Perhaps one comment summed up the general feeling of many: “Devastated.”

But there was a note of optimism, with one respondent saying: “The facility has been impacted financially, but we will rebound.”

Compared to 2019, more OR leaders are satisfied with their total compensation (60% vs 51%); nearly two-thirds (65%) are satisfied with their benefits, comparable to 61% from 2019. Most leaders are satisfied with both the top leadership of the organization (57%) and their own boss (67%). Job satisfaction has had longevity among OR leaders. For example, in 2015, 75% were satisfied with their jobs, and 65% were satisfied with their own boss.

OR leaders report big gains in staff, patient, and physician satisfaction. For example, the favorable rating for staff engagement increased from 51% in 2019 to 70% this year (vs 63% in 2015), and physician engagement rose from 49% to 65%. It’s interesting to speculate whether the teamwork required to respond to the pandemic may have boosted these percentages. Reported patient satisfaction with OR services rose from 77% last year to 85% this year, compared to 82% in 2015.

What is the one thing about your job that keeps you up at night? In all, 214 OR leaders answered that question. Staffing concerns topped the list of comments, cited by 37% of respondents, and staffing popped up in some of the comments related to the COVID-19 pandemic. For example, having to furlough staff was the second most common worry. Other COVID-19 concerns related to supplies and testing.

Sample staffing comments that many OR leaders could likely identify with include:

• "Staffing is the single biggest issue that I have the most problems resolving”
• “Lack of experienced staff”
• “Trying to make sure staff, including surgeons and anesthesia providers, are happy, which reverts back to patient satisfaction outcomes.”

Sample COVID-19 comments include:

• “Having enough PPE [personal protective equipment] to cover for COVID-19”
• “COVID-19 testing availability/viability/etc”
• “A large COVID spike”
• “Ramping back up for the backlog of surgical cases after COVID-19”
• “How do I keep my patients and staff safe during the pandemic?”
• “How to recover from COVID-19…what pieces will we be picking up, and can we survive as a business?”

One person summed up many others’ concerns as: “With the ever-increasing amount of change, will [we] be able to keep up and continue to keep patients safe? Will caregivers stay engaged? Will they stay with us? Will they be able to step up during this crisis? Can we help them so that they don’t burn out?”

The third most common group of worries were related to regulation and patient safety. One respondent said: “regulations and never-ending pressure of litigation or fines for infractions.”

Other areas of concern include finance, volume, physicians, and equipment. Some expressed concerns for their own future, such as: “Will I have a job tomorrow in this changing climate?” and “How long can I keep this up?”

Not everyone worries; 16 OR leaders said nothing keeps them up at night.

The average surgical volume was 4,510 procedures annually (compared to 5,115 in 2019), but there was a wide range of responses (250 to 30,000).

The uptake of care models—Accountable Care Organizations, joint ventures, Enhanced Recovery After Surgery (ERAS), Perioperative Surgical Homes, and dual-license facilities—was once again low. In all, 57% (vs 63% in 2019 and 59% in 2018) either do not have or do not plan to implement them in the next 6 months. Of those who had at least one of the care models or planned to implement, ERAS topped the list at 19%, followed by a joint venture with physicians and a management company or with physicians and hospitals (13% each).

In an open-ended question, we asked how the migration of traditionally inpatient procedures (for example, total joints, spine, and cardiac procedures) from the hospital to ambulatory care settings was affecting ASC leaders and their organizations. Of the 51 who responded, 21 reported no or minimal effects. A few are planning to implement these procedures, and others are already adding them to their services. Sample comments include:

• “This is a great migration. The biggest struggle is changing the mindset of employees who aren’t familiar with such a model and are, understandably, nervous about the change. We have already created a total joint program from the ground up, which staff found very exciting. We are currently working on pricing out vascular services for our center.”
• “Provides opportunities for growth, but is difficult to grasp as a small, freestanding ASC with the nearesthospital 45 minutes away.”
• “We are embracing it with open arms, ready to train, employ, and bring on employees trained for such procedures.”
• “Has increased, but reimbursement is so low, may stop doing these procedures.”

Four ASC leaders mentioned that COVID-19 has affected plans for initiating these procedures.

Most ASC leaders have yet to see the impact of artificial intelligence (AI). When asked about the effect of AI on surgery in general and on their own organizations, half of the 51 respondents said it hadn’t played a role, and four others said the effect was unknown. A few commented on AI’s potential:

• “I believe it will help meet a younger population here in Hawaii to reach the remote patients on outer islands who wouldn’t otherwise have access to the available care on other islands.”
• “There is a place for AI in complex surgery. It could be used in an ASC but is much too expensive right now.”
• "Will impact the way we provide service.”
  Only one ASC leader reported currently using AI, but did not specify how.
  

In all, 41% of respondents work in a physician-owned ASC, and 28% in a hospital-owned facility. A total of 72% work in a multispecialty ASC, with the remaining based in a single-specialty facility.

The most common single specialty was orthopedics (32%), followed by ophthalmology (21%) and gastroenterology (16%). Orthopedics was also the most common specialty among multispecialty ASCs (94%), followed by general surgery (76%), gynecology (68%), and ophthalmology and otolaryngology (both 62%). Nearly half of respondents (46%) added a specialty not on the list of options, with podiatry the most common.

The number of specialties remained the same for 61% of ASC leaders, although more than one-quarter (26%) reported an increase.

The effects of the pandemic have left ASC leaders with unprecedented challenges to face. Working with staff to regain volume and achieve financial stability will be a prime goal. It remains to be seen what long-term changes COVID-19 will have on ASC leaders and their teams.

Cynthia Saver, MS, RN, is president of CLS Development, Inc, Columbia, Maryland, which provides editorial services to healthcare publications.

ASC leaders rank patient satisfaction with OR services the highest among satisfaction measures (94%, comparable to the 92% from 2019).
The next highest was staff engagement, which at 79% was a bit higher than the 72% figure from 2019.

Slight upticks in satisfaction were seen with benefits (59% vs 58% in 2019), top leadership in the organization (65% vs 63%), and support provided by your own boss (67% vs 62%). Only two areas showed a slight decline in satisfaction since 2019: total compensation (53% vs 56%) and physician engagement (59% vs 63%).

Overall demographics are listed in the infographic (p 28). The average age of the respondents was 52 years, a year younger than the 53 years for nurses reported in the 2017 National Nursing Workforce Survey.

A total of 36% of ASC leaders hold a baccalaureate degree in nursing as their highest level of education, down from 42% in 2019 and 48% in 2010; 29% hold a master’s degree, comparable to last year’s 30%. (Just 14% held a master’s degree in 2010.) No respondent had a doctorate degree. The most common titles were administrator/administrative director (38%), followed by director (33%), and nurse manager (20%).

Just 20% of respondents say they have 5 years or less experience, whereas 26% have 26 years or more of experience, and 56% have more than 10 years under their belts. These numbers suggest a need for succession planning.

Not surprisingly, ASC leaders work hard, with 36% spending 41 to 45 hours a week on the job; 30% spend 46 to 50 hours. Nearly one-quarter (24%) work more than 50 hours a week, and only 10% work fewer than 40 hours.

A total of 43% of respondents reside in the South, 23% live in the Midwest, 19% in the West, and 15% in the Northeast.