The Data Behind the Data: Bi-regional Salary and Benefits Report
Monday, November 17, 2014
Posted by: Krista Chuscavage
By Lynn Gerlach, Development and Communication Manager, NWRPCA, and Andrea Martin, Workforce Development and Membership Director, CHAMPS
Every other year we undertake this significant study to help our health centers make informed decisions about recruitment and retention. Our goal is to provide market data for crafting competitive salary and benefits packages. The report is industry-niche-specific and appropriate for the health center workforce of our regions. We strive to identify helpful workforce trends specific to the recruitment and retention of a high-performing, mission driven workforce in the healthcare safety net. The newly released report is the fourth iteration of this bi-regional partnership, although each region (CHAMPS and NWRPCA) ultimately gets its own report.
In preparation for the 2014 study, we convened an advisory committee that met monthly over eight months. Their task? Review and update every job description to be used in the survey. Our goal was to ensure that everyone was reading from the same sheet of music, so to speak, allowing each center to report employee data under the most appropriate job title.
The “Region 18” view
Although the final reports are distinct from each other, each focusing on one HRSA region, it can be interesting to temporarily lump the ten states together and see what sort of picture emerges. We call this the “Region 18 view.” Of the ten states (AK, CO, ID, MT, ND, OR, SD, UT, WA, WY), the greatest number of health centers are located in Colorado, Oregon and Washington. Bi-regionally, 104 health centers submitted data, reporting a total of $713.8 million in wages for 2014, roughly $400 million in Region X and $300 million in Region VIII. The Northwest region reported 7,240 FTEs in 121 positions. The Mountain/Plains states reported 5,532 FTEs in 114 positions. Interestingly, Region VIII’s reported positions were 51% administrative, while Region X’s were 56% clinical.
We added a comprehensive benefits section to the survey this time, including data on insurance, retirement and pensions, leave time, and additional incentives. We also included point-in-time vacancy data for administrative and clinical leaders, provider staff, and mid-level staff. And we included data on turnover for administrative exempt and non-exempt staff as well as clinical providers, mid-levels and support staff.
Regions VIII and X are not identical; it helps to bear in mind some economic differences. According to the Missouri Research and Information Center, while CHAMPS members are located in a part of the country with an overall economic index just below the national average (98.1%), NWRPCA member centers are in an area a good bit above the national economic index (112.6%). Housing in the mountain and plains states tends to be at 102% of the national average, while housing in the Northwest is at 123% of the national average. And health care costs in the two regions? Region VIII is just above the national average at 101%. Region X is at 119% of the national average.
The average salary for a health center chief executive is about 12% higher in Region X, although the average length of time in service for the ED is about 6% higher in Region VIII. Interestingly, of the 98 CFOs reported in the study, Region X CFOs tended to be in their jobs, at the current reporting time, twice as long as Region VIII CFOs. Average years of service are almost identical across the two regions, however, for Dental Directors. The same is true for Family Practice Physicians without OB and for Pediatricians and PAs. Not surprisingly, in both regions the highest paid member of the clinical team is the Family Practice Physician with OB. The lowest paid is the Dental Hygienist. Nurse practitioners tend to be paid just about at the same rate as physician assistants. Considering the clinical team overall, pharmacists had the shortest time in service for this study.
Medical Assistants were, far and away, the most frequently reported position in the study, numbering 859 in Region VIII and 893 in Region X. Bi-regionally, the highest paid individual in the support team is the Registered Nurse. But who among this group tended to have the longest time in service? Medical Records clerks and billing staff/patient accounts reps.
Benefits packages were reported for eligible employees only, by staff type, and were based on health center policies regarding benefits. So, how many types of insurance plans are offered by our CHCs to eligible employees? Half of the Region X centers reporting indicated they offer five types of insurance to employees. Half of Region VIII centers offer four or five types of insurance. Forty percent of CHAMPS members provide full employee health coverage, and 48% offer partial coverage for the employee. In Region X, eligible employees are fully covered by 52% of reporting CHCs, and 48% provide partial coverage. Few CHCs in either region provide full health insurance coverage for family members: 14-15%. In fact, in both regions, 1/3 or more reported no coverage for family members. Dental insurance follows a similar path, with 28% of CHAMPS and 15% of NWRPCA members offering no contribution to dental insurance for the employee.
Other insurance is another story, though. In Region X, 77% of the reporting centers pay the full life insurance policy for the employee, and 67% pay the premium for disability insurance for the employee. In Region VIII, 65% offer fully paid life insurance and 50% offer fully paid disability insurance.
In both regions, 96% of reporting health centers offer a retirement/pension plan, mostly 401K and 403B programs. The most popular contribution arrangement is an employee match: 44% in Region VIII using this model, and 62% in Region X. As for time off, the average number of days allowed according to health center policies in Region VIII is 36.6, and the average in Region X is 44.4. Region VIII tends to favor the vacation/sick day/holiday plan while Region X tends to favor the PTO/Holiday plan. While CHCs in both regions offer the same number of paid holidays, overall, Region X centers tend to offer ten more vacation days than Region VIII, five more sick days, two additional personal leave days, and four additional days for the PTO bank. In Region VIII, the greatest amount of average leave time offered is for clinical mid-level staff. In Region X, the clinical provider staff wins the most average leave time.
What additional benefits do health centers offer? Just over half (bi-regionally) pay licensure fees, and more than 62% pay for continuing professional education. About 8% pay retention bonuses, bi-regionally. An employee is more than twice as likely to win a signing bonus in Region X, but significantly more likely to have professional association dues paid in Region VIII. Region X centers are much more likely to pay relocation expenses for providers, but the relocation payment in Region VIII tends to be just a little higher.
Vacancy and turnover
Vacancy data is interesting. Region X CHCs reported about twice as many average vacancies at the time of data submission than did Region VIII CHCs, although the reporting Region X CHCs tended to be larger, with more overall employees, than the reporting Region VIII CHCs. The smallest Region VIII health centers had three times the vacancies of their mid-sized and large counterparts. Region X CHCs were a little more consistent in vacancies, with the mid-size (40-140 FTEs) reporting the largest number or vacancies. Nearly half the reporting health centers in both regions indicated continuous vacancies in executive staff. The Region X frontier CHC is twice as likely to have continuous vacancies. Provider vacancies are reported at higher than a 50% rate in both regions – 69% in Region VIII. Region X reported a higher continuous vacancy rate for mid-levels than for clinical providers, however. Region VIII CHCs tend to recruit for a provider, on average, for six months, and Region X for over three months.
The Bureau of Labor Statistics reports a 29.4% turnover in general, nationally, for health care and social assistance industries. Our health centers do a little better than that, with a 22% overall turnover rate in Region X and a 20.6% rate in Region VIII. Considering all types of staff, viewed by size and type of health center, the centers with the smallest budgets (less than $7 million) and the rural health centers tend to have the highest turnover rates bi-regionally. Number of sites does not seem to influence the turnover rate significantly. In both regions, the highest turnover is in clinical support staff.
Region X’s 99-page 2014 report represents hours of data collection and reporting on the part of participating health centers, and months of data analysis and interpretation on the part of the CHAMPS staff. (NWRPCA contracts with CHAMPS to crunch the numbers and compile the report.) In the meantime, as data comes in, PCA staff in both regions “eye-ball” it and send it back for correction or clarification. Virtually every participating health center is asked to correct at least one data point. While that process goes on, the data “ages” for three months, per reported best practices.
To purchase the report
Both regional reports have now been distributed to the CHCs that participated. Non-participants and even non-health center entities may purchase the complete report by contacting one of the authors. For the Region VIII report, contact andrea@CHAMPSonline.org. For the Region X report, contact lgerlach@NWRPCA.org. The next biennial salary and benefits survey will be conducted in both regions in 2016.