Worth Every Penny


Surgical leaders master a diverse skill set and continue to push patient care forward in the face of mounting responsibilities.

Running a surgical facility during the pandemic requires wearing many hats while keeping several balls in the air and numerous plates spinning. Norma Bacon, administrator at the New England Surgery Center in Beverly, Mass., knows the drill all too well. She recently ticked items off her daily to-do list: check the facility's bank account, touch base with the staff, review the case schedule, tackle the mounting stack of papers on her desk, organize the facility's bills, meet with the physician owners, review payroll records and pause, deep breath...

"Well, you get the picture," laughs Ms. Bacon, who felt like she was close to treading water just before the pandemic hit. Instead, she's adrift in a sea of additional responsibilities, including keeping tabs on the facility's COVID-19 binder that contains current guidance from the CDC, Medicare and the state department of health — no easy task considering the directives change constantly. She wrote and rewrote the facility's pandemic response plan on the fly, and spent considerable time filling out numerous applications to secure stimulus money provided by the CARES Act. All the while, she's been going back and forth with the state and dealing with red tape to get approval for a new OR the center wants to build.

"I once tried to keep track of what I do on a daily basis," says Ms. Bacon, "and gave up because I didn't have enough time to do that."

Her experience isn't unlike the 452 surgical leaders who responded to Outpatient Surgery's annual salary survey. They took on more of a workload for similar or even reduced take-home pay, while dealing with the added stress of leading staffs during the pandemic's most difficult days.

According to the survey, 11% of ASC respondents and 14% of HOPD respondents reported reduced income in 2020, while 37% of ASC respondents and 19% of HOPD respondents reported no change in income. All told, nearly half of ASC respondents and a third of HOPD respondents didn't sniff a pay raise. That's a sharp contrast from the 2019 survey, when only 28% of ASC respondents and 22% of HOPD respondents reported they hadn't received a raise, with just a tiny sliver of those receiving lighter paychecks.

Many of last year's reductions in pay can be attributed to the disruptive early stages of the pandemic, when elective surgeries were halted across the country and facilities scrambled to stay afloat. "During the months we were shut down, I was working from home and took a 25% pay cut," says Leah Reyes, RN, nurse administrator at Dallas Surgi Center.

Matthew Moore, BSN, RN, director of nursing at Comprehensive Spine & Pain in Villa Rica, Ga., also took a personal hit because of the elective surgery shutdown. "I'm an hourly employee," he says, "and it affected my pay by about $20,000."

LEADING BY EXAMPLE Dan Stannard, RN, BSN, makes the rounds to check in with staff and meet with patients.   |  Red Hills Surgical Center

Still, according to the survey, surgical leaders remain generally happy with their paychecks. There was, however, some understandable downward shifts in mood due to the past year's stress. When respondents were asked how satisfied they are with their compensation considering the demands of their position, 56% of ASC respondents and 50% of HOPD respondents were either "extremely satisfied" or "generally satisfied." In 2019, those figures were 75% and 56%, respectively. Meanwhile, the number of "generally" and "extremely" dissatisfied leaders rose, from 15% for ASC respondents in 2019 to 24% in 2020, and from 26% to 31% for HOPD respondents.

It's difficult to imagine a more passionate, dedicated group of people than healthcare professionals, but the last year has placed extraordinary physical, mental and financial strain on many in the industry. About one-third of ASC and HOPD respondents say the pandemic caused them to consider leaving health care or retiring earlier than they had planned.

"I've been a nurse for 34 years, and an administrator for 15, and this has been the toughest year of my career," says Wende Dixon, RN, BSN, CNOR, CASC, administrator at Mohawk Valley Endoscopy Center in Utica, N.Y. She took a 20% pay cut when her center shut down for two months in the early stages of the pandemic. "I'm thinking more seriously of retiring now than I ever have before," she says.

For Christa Watson, RN, BSN, PHN, surgical services manager at Westfields Hospital and Clinics in New Richmond, Wis., the past year felt like it would never end. "The amount of time spent resetting surge plans and having other departments unravel them has been exhausting," she says. "Staff and physicians are burnt out."

North Pinellas Surgery Center in Dunedin, Fla., remained open on Fridays for urgent cases during the first eight weeks of the pandemic. Upon fully reopening, Linda Nelson, MSN, RN-BC, the facility's administrator, went back to working her usual 40 to 50 hours during the week, but is now checking COVID test results on the weekend.

SOURCE: Outpatient Surgery Magazine online survey, November-December 2020. Based on 452 responses (301 ASC leaders, 151 HOPD leaders).

Being responsible for 45 employees keeps Ms. Nelson on her toes. Most days she can be found completing staff evaluations, ordering supplies and dealing with vendors, staffing issues or physician concerns. Her nursing background even lets her jump in to help start IVs on occasion.

MOVING ON Pamela Borello, BS, RN, CNOR, CSSM, decided to become a traveling nurse after spending many years as the leader of hospital outpatient surgical departments.   |  Pamela Borello

The pandemic has also increased the frequency of "mini-crises" Ms. Nelson has to manage. For example, some patient test results don't come back soon enough for cases to proceed as scheduled, and she's dealing with the constant threat of staff exposure to COVID. "It's feast or famine," she says. "Everything happens all at once or not at all, although lately it seems like it's all at once."

Kris Sabo, RN, executive director and administrator at the Pend Oreille Surgery Center in Ponderay, Idaho, says it's difficult to gauge how much more work she's doing because of the pandemic, although she mentions having to keep the center's Facebook page constantly updated with the latest steps the facility has taken to ensure patient safety.

Ms. Sabo serves as the center's infection preventionist, a role that has increased in importance and responsibility over the past year. She also developed the center's pandemic emergency preparedness plan and has kept it updated as directives from federal and local authorities remain fluid. She spent countless hours applying for the facility's Paycheck Protection Program loan. She's responsible for assessing which new profitable procedures to add, and a private equity firm is interested in partnering with the facility, so she's also trying to orchestrate the sale. Her plate is overflowing.

When the center's ownership didn't agree to Ms. Sabo's request for a raise, she decided to give herself something with perhaps more value: time. She takes Wednesdays off, but her cellphone buzzes constantly with updates and questions from her staff.

Ms. Sabo plans to retire in June. "I've been doing this for 11 years, and it never gets easier," she says. "There's always something that needs to be done right away. When you're younger, that's exciting. When you're older, you long for a calmer routine."

More than money

READY FOR ANYTHING Every day is filled with unique challenges and "mini-crises" to manage, according to Linda Nelson, MSN, RN-BC.   |  Cody Arnold

Dan Stannard, RN, BSN, has led the bustling, multispecialty Red Hills Surgical Center in Tallahassee, Fla., for two years. As the ASC's administrator, Mr. Stannard is grateful that every day is a new challenge and that he constantly gets to meet new patients. Still, managing his 45-person staff and working with physician owners isn't always easy.

Even though every minute is a whirlwind at work, Mr. Stannard is able to shut off at the end of the day and go home to his wife and two children. That perk, of course, comes with a caveat. "As the administrator, all things — clinical, financial and everything in between — fall on me, so everyone knows that I'm always a phone call away if needed," he says.

Mr. Stannard was the director of nursing at Red Hills before he became administrator two years ago. So, while dealing with the pandemic for half of his tenure as administrator has been taxing, it's also allowed him to remain part of the operation's clinical team. "I've been doing a lot of the swabbing of patients to test them for COVID-19, and I performed pain injections before Christmas while subbing for nurses who were off for the holiday," he says. "I still truly enjoy interacting with patients."

Pamela Borello, BS, RN, CNOR, CSSM, has been a traveling nurse for three months after calling it quits on a nearly 20-year career as a surgical leader at HOPDs. Ms. Borello believes her previous salary was less than what it should have been, but on par with peers across the country.

She worked cases on a weekly basis to ensure her circulating and scrub skills stayed current, and enjoyed leading unengaged and difficult staff members — along with the challenge of getting them to focus more on their work and collaborating with their coworkers. She always tried to instill a positive attitude and consistent work ethic in the OR, especially during trying times. That was more challenging as staffs became generationally diverse, according to Ms. Borello.

Now, she's enjoying newfound freedom as a traveling nurse, as she's able to pick and choose locales and contracts. This month, she begins a new assignment in the Virgin Islands for less pay than she could have gotten elsewhere. "I'm going there to enjoy the beauty, not to make the most amount of money possible," she says. "I also like that I'm not the leader in these positions, so I don't have to handle the administrative side of things. I'm able to just enjoy providing patient care and learning new things at new places, which I haven't done in a long time."

For many of the surgical leaders who responded to the survey, patient care is payment enough. "The absolute best part of my job is watching staff interact with patients," says Julie Maiden, director at Surgical Eye Center in Greensboro, N.C. "It's the little things that make me proud and leave zero doubt that I'm where I need to be."

For others, professional and personal gratification comes from working for the greater good. "I love the feeling of being a part of something bigger," says Josephine Moreno, RN, BSN, BHA, director of surgical services at Pacifica Hospital of the Valley in Sun Valley, Calif. "I enjoy making a difference from behind the scenes, and like seeing the entire team working together to care for patients in our community."

It's difficult to put a price on personal fulfilment and individual leaders ultimately have to decide what their work is worth to them, according to Ms. Sabo. "I helped build my facility up from a dirt lot to where it is now," she says. "That's been extremely gratifying."

Ms. Sabo and her husband plan on road tripping around the western United States when she finally steps away from fulltime employment later this year. She's considering consulting for the center to guide the staff through the reaccreditation process and help her replacement find their footing. She could also work on a per diem basis when fulltime staff members are on vacation. "There are ways to stay involved, without having to be responsible," she says.

Like many surgical leaders, Ms. Sabo doesn't want to walk away from a facility she considers her own and a career she loves. A paycheck eases the stress of long hours and the constant pressure to provide quality patient care with an eye on the bottom line, but there's more to being a surgical leader than pulling down a nice salary. Money is ultimately a poor motivator, especially in a profession where passion, purposefulness and pride pay off. OSM

Who's Calling the Shots?

The majority of the 452 surgical leaders who responded to our salary survey have been in their current positions for five years or less. There was a rather equitable spread in terms of ages, with the HOPD group trending slightly older. More than one-third of respondents are working more than 50 hours per week, which isn't surprising considering the unprecedented demands they've endured over the past year.

— Outpatient Surgery Editors

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