The 2009 Healthcare Purchasing News OR Management Salary Survey, which garnered 205 respondents across various management titles, revealed that, on average, 63.9 percent of respondents saw their annual base salaries increase over their 2008 earnings – and those who did earned a respectable 3.5 percent increase, on average. The 2009 median income across all OR management titles was $77,890, representing a notable increase over last year’s average of $65,614. And while the percentage of those who experienced a pay hike in 2009 fell short of the 84.5 percent who reported increases in 2008, one could still reason that a majority salary increase bodes well for the profession and underscores the value that facility executives place on those in OR management positions.

The fiscal challenges faced by the healthcare industry don’t appear to be negatively impacting OR management professionals’ perceptions of job security, either. Nearly 94 percent of respondents indicated that they feel either very secure or somewhat secure in their current positions (48.8 percent and 43.9 percent, respectively) – percentages closely aligned with 2008 findings. Part of that perceived security may be linked to increasing responsibilities, which helps make OR management professionals even more indispensable to resource-constrained healthcare institutions.

Indeed, the survey revealed that OR managers and directors, whom represented 41.5 percent of survey respondents, tackle their fair share of day-to-day responsibilities. Sixty percent of respondents work in ORs with 30 or more employees and with ten surgical suites.

Surgical services directors commanded the highest median 2009 salaries at $94,107, a significant jump over the $83,289 average reported in 2008. Their wide-ranging responsibilities certainly appear to justify their top-earner status. More than half manage anesthesia services, pre-admission testing, OR supply distribution and purchasing, and endoscopy, and nearly three-quarters (74 percent) also manage outpatient surgery. Eight-four percent oversee the sterile processing function and a full 90 percent are responsible for the post-acute care unit.

Salary by Job Function - Median Salary $77,890

"All of those [cost centers or functions listed] report to me, plus PreOp Admissions, the PreOp clinic, Anesthesia, PACU overflow unit, as well as [the] OR," said Nancy Cotton, RN, MSN, CNOR, director of surgical services for John Muir Health, Walnut Creek, CA. "We are all taking on more administrative functions within existing cost centers. Our facility is quite sophisticated with many tools available for financial analysis, program development, performance improvement initiatives and scorecard reports just to name a few."

The "doing-more-with-less" mantra appears to be popular amongst OR managers, as well. "I definitely feel secure in my job, but a big part of that is because I’m wearing so many different hats these days and have a bigger share of responsibilities," said one nurse manager who works for a Phoenix-based ambulatory surgery center. "We have a hiring freeze right now and there are empty positions that, in the past, would have been filled. But with the economy the way it is and more people not wanting to spend money on healthcare – especially for elective procedures – we’re not able to justify the hiring." Although her facility also has a freeze on all raises and bonuses, she said her 2009 annual base salary is still "substantially more" than the $62,500 average for OR managers in surgery center settings that was indicated in the 2009 salary survey.

Salary vs. Number of OR Suites

While surgery center employees often follow a set Monday through Friday schedule and don’t typically work extended hours, some managers and their staff are pulling double-duty with sister facilities, and even becoming educated in other patient care areas to broaden their professional reach.

"We’re doing a lot of cross-training in different departments, including a pain management area within our facility," the surgery center OR manager explained. "If we’re slow, we can step in and do what’s needed [elsewhere]. That’s one way to improve job security and keep our per diem nurses and full-time [staff] busier."

Of course, hospital OR managers, whom earned roughly $90,000, on average, also bear a great deal of responsibility in that role.

Salary vs. Kind of Facility	Salary vs. Location and Type of Facility

"Our OR manager has 24/7 management responsibility for our OR," said Becky Stewart, assistant vice president of surgical services for St. David’s Medical Center in Austin, TX. As an OR management veteran, Stewart herself has seen significant changes in the profession over the course of her years of service.

"We’re certainly not a static market. The dynamics of who we are, what we do and how we do it are always changing, and there’s even been evolving expectations from the patients we serve," she reasoned, adding that increasing hospital competition for surgical volume is another factor that’s impacting facilities these days.

As one might expect, many in OR management positions have logged a good many years in the surgical services discipline. On average, survey respondents have 19 years experience in the OR – 11.5 of them spent at their current facility.

Although there are certainly newcomers moving into management positions, the survey revealed that the median age of OR management professionals is 53, and 39% of respondents have worked in the OR for 30-plus years – findings that seem to demonstrate a trend in career longevity, and at the same time, a potential need for younger management-focused OR staff who can step in and assume the role when their predecessors hang up their hat. Only 8.8 percent of 2009 survey respondents have worked in the OR environment for just two to five years, and only 2 percent of those surveyed have spent two years or less in the discipline. Also of interest is that only one respondent fell in to the 26-30 year age bracket, and only 10.7 percent comprised the 31-40 age category, as opposed to 29.9 percent of respondents age 41-50. Retirement has eluded the 2.4 percent of respondents in the 66-70 age bracket, and four survey participants are still working in their 70s.

OR Professional's Report Directly to:

"I’ve been in an OR leadership [position] for 30-plus years – three of them at St. David’s," said Stewart. "Most of us, I’d say, got our start in the OR and then worked our way into the management side over time. It’s not usually something that happens overnight."

Those with material management-type duties were well represented in this year’s survey. Approximately 7 percent of those who responded to the survey carry OR material manager titles and another 12.9 percent serve as OR material coordinators – titles that earn a median salary of $57,833 and $52,750, respectively. But these individuals aren’t the only ones bearing purchasing-related responsibilities. Some 82 percent of respondents recommend or specify products and equipment for purchasing, 68 percent are involved in product evaluation, 58 percent determine equipment and product need; 53 percent belong to a purchasing group or committee, 38 percent approve and/or authorize OR purchases, and 12 percent are involved in other aspects of purchasing. Only 2 percent of respondents revealed that they play no role in their organization’s purchasing process.

Salary by Years in OR vs. Years at Current Facility

The list of products and equipment purchased or specified by the OR is extensive. More than 90 percent of survey participants play a role in the purchase of surgical supplies and equipment, drapes and surgical instruments; 88 percent are involved in surgical gown and table purchases; 86 percent specified gloves; 76 percent indicated custom procedure trays; and 72 percent assist with the purchase of disposable kits and trays. Beyond that, more than half of participants indicated that their department plays a role in the purchase of needlestick safety devices, masks and respirators, smoke evacuators, sterility assurance products, bandages and dressings, protective wear, lighting systems, safety eyewear, endoscopy-related products, disinfectants and sterilants, and orthopedic supplies.

Given the wide range of supplies and equipment routinely used by the OR, one might expect that many facilities would be implementing instrument tracking and OR inventory management programs to better manage their investments. That’s not necessarily the case, however, according to the survey results. A full 75 percent of respondents revealed that their hospital does not use an instrument tracking/utilization program, and nearly the same percentage (73 percent) are not using an automated OR inventory management solution. Even those that do have automated solutions in place may not be using them effectively.

"We have a system, but it’s definitely not being used to its fullest potential," admitted the surgery center manager. "That’s definitely something we’ll need to improve on moving forward."

Fortunately, more facilities appear to be making formal infection tracking programs a priority. Sixty-eight percent of survey respondents indicated that they have such a program in place and 63% of them use software-based systems.

Salary by Region & Gender

The infection control department at John Muir Health is part of the quality management department, and Cotton noted that the infection control committee is interdisciplinary and very well established. "We have metrics that include national benchmarks and report on all infections throughout our facilities on a monthly basis," she explained. "The information is invaluable."

Not unlike past OR management salary surveys, pay scales varied sometimes significantly based on region, educational background and gender.

The highest overall earners work in the Pacific region, drawing a median annual base salary of $90,795, followed by those in the Central region at $82,500. Those in Mountain, Northeast and Southeast regions earned lower salaries, coming in at $73,333, $72,734 and $73,203, respectively. Interestingly, females (whom represented 72 percent of respondents) earned more than their male counterparts in every U.S. region, except Mountain (male survey participants earned $2,000 more than females there). The biggest gender-pay gap was seen in the Northeast, with females earning an average of $74,583, compared to males who earned roughly $9,000 less. In the Southeast, females earned $74,259, whereas males earned $67,500. A nearly $3,000 gap was revealed in Central states ($83,068 for females and $80,114 for males). The Pacific region had the narrowest gap, with female respondents earning just $406 more than male OR management professionals. Those working in urban facilities earned a median annual base salary of $82,383 in 2009, followed by those in suburban facilities ($78,106) and rural facilities ($73,867).

Educational background also continues to weigh heavily into the salary equation. Nearly one-third of respondents (33.2 percent) hold an Associate’s degree and earn a median annual base salary of $71,654 – a significant jump over last year’s salary of $67,685 for those with the same educational background. Those with Bachelor’s degrees (accounting for 32.2 percent of survey participants) earn a median salary of $78,712 (up from a reported $72,616 in 2008), and as expected, the 21.5 percent with a post-graduate degree command the highest salaries — $102,273 (up substantially from the $93,947 reported in 2008). Although high school graduates earn the least, the $51,852 figure reported in the 2009 survey is notably higher than last year’s median reported salary of $42,803.