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A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
If you sometimes wonder whether all the hard work is worth it, you're in good company. Many surgical administrators are working very long hours, aren't at all sure they're adequately paid and in many cases admit they're on the lookout for other employment opportunities.
Asked what factors they'd find most attractive in a new job, the 2nd and 3rd most common responses (behind more money) for both ASC and hospital administrators are less stress (50% and 47.2%, respectively) and more support (34.1% and 37.4%). By contrast, only a handful say they'd welcome more responsibility (10.3% and 11.7%).
The good news is that many facility leaders have found ways to ease the pressure. "It takes a while, but you must learn to lead 2 separate lives," says Diane Elmore, RN, administrator at Metro Surgery Center in Phoenix, Ariz. "Work is work and home is home. Stay at work and complete the task but do not take it home with you."
The importance of maintaining work/life balance is a theme that rang repeatedly through our 2014 salary survey. Simply put, the job will swallow you whole if you let it, say respondents.
"Don't live and breathe the surgery center," says Melinda Cain, RN, BSN, MHA, CNOR, CASC, administrator of the Good Samaritan Surgery Center in Mount Vernon, Ill. "Take time for yourself and family." "Don't let it take over your life," adds Ralania Tignor, BSN, RN, CNOR, surgery center manager at Chickasaw Nation Medical Center in Ada, Okla. "Make sure you still make time for your family." "Focus on your personal life when you're off the clock," echoes Dianne O'Connell, RN, MBA, director of surgical services at Frisbie Memorial Hospital in Rochester, N.H. "Leave your work stress at work."
SIX FIGURES
Most Facility Managers Earn Between $80,000 and $110,000
Running a surgical facility nets a 6-figure salary for about one-third of our 533 survey respondents. Here's how they answered when we asked them to report their 2013 pre-tax annual income.*
| Salary | ASCs | Hospitals |
| Less than $50,000 | 6.7% | 5.5% |
| $50,001 to $60,000 | 4.6% | 8.7% |
| $60,001 to $70,000 | 11.0% | 9.8% |
| $70,001 to $80,000 | 11.9% | 14.8% |
| $80,001 to $90,000 | 13.3% | 16.9% |
| $90,001 to $100,000 | 14.2% | 12.0% |
| $100,001 to $110,000 | 13.3% | 10.9% |
| $110,001 to $120,000 | 7.5% | 3.3% |
| $120,001 to $130,000 | 5.2% | 2.7% |
| $130,001 to $140,000 | 2.3% | 3.8% |
| $140,001 to $150,000 | 2.6% | 2.2% |
| More than $150,000 | 7.2% | 9.3% |
* Responses include any bonus and overtime pay, if applicable.
Source: Outpatient Surgery Magazine Reader Survey, December 2013, n=533 (349 ASC administrators, 184 hospital-based leaders)
When was the last time you had a raise?
| Last raise | ASCs | Hospitals |
| Within the last year | 43.5% | 50.0% |
| 2012 | 24.2% | 23.9% |
| 2011 | 11.5% | 9.2% |
| 2010 | 8.4% | 3.8% |
| 2009 | 1.7% | 3.8% |
| 2008 | 1.4% | 2.7% |
| 2007 | 1.4% | 2.2% |
| 2006 | 1.4% | 0.0% |
| 2005 or earlier | 0.6% | 0.5% |
| Never | 5.8% | 3.8% |
Others point out that no matter how hard you work today, tomorrow is likely to be both another challenge and another opportunity: "Time lost with family cannot be recaptured," says one. "The work you leave today will be waiting for you tomorrow." "Do your best and leave knowing you did your best," says another. "What you can't get done today will be on your desk tomorrow." "When you've put in a full day, go home," urges another. "Tomorrow is another day."
Or, in the words of another manager: "Leave work-related issues at work. Do your 8 and hit the gate!"
Following you home?
Easier said than done? For some, the answer is clearly yes.
"My job does not stop once I walk out the door, unfortunately," says Jane Diezi, RNC, MSN, MSHA, director of clinical services at the Charlotte Surgery Center, in Port Charlotte, Fla. "The demands are still there even late in the evening when things go wrong with the building or equipment."
"I'm the only full-time clinical staff member in my surgery center, so even when I take a day off or am on vacation I am inundated with phone calls and messages to put out fires and problem-solve," says Jenny Brallier, RN, surgery center director of the Center for Surgical Care in Florence, Ky.
So what can you do if the job insists on following you home, no matter how hard you try to shoo it away?
"Say no or set time limits, when needed," offers DeeDee Warren, RN, nurse administrator at the Tri-City Surgery Center in Prescott, Ariz.
Several others warn that the belief that you have to handle everything yourself, or the temptation to do so, can be a trap — one to avoid at all costs.
"Don't be afraid to delegate responsibilities," says Amy Hites, BAPS, RN, director of the CDH Endoscopy Center in Willoughby, Ohio. "It is impossible to do it all yourself." "You cannot please all of the people all of the time," says Ms. Elmore. "Be sure you surround yourself with good people."
"Train your staff, delegate and supervise instead of doing everything by yourself," advises Maria E. Pescasio, BS, administrator of the Chugay Cosmetic Surgery Medical Center in Long Beach, Calif. "You must learn to delegate responsibility to your team members, so choose a strong team!" says Renee Flynn, RN, clinical director of the Fairfax (Va.) Colon & Rectal Surgical Center. "Remember that you're just one person and you can only do so much in a day. Delegate!" echoes Amy Holzen, BSN, operations manager at the Front Range Endoscopy Centers in Colorado Springs, Colo.
The key, says Jay Wright, MSN, RN, unit director at UPMC St. Margaret in Pittsburgh, Pa., is to make sure you don't get caught in a never-ending cycle. "Don't focus all your energy on putting out fires," he advises. "You must first develop the team around you to avoid starting them in the first place."
ON THE LOOKOUT
Ready to Make a Move?
A good number of the surgical facility leaders that we surveyed are looking to leave their posts in search of greener pastures. What would make them leave? More money and less stress, according to our 2014 salary survey.
Are you generally "on the lookout" for other employment opportunities?
| ASCs | Hospitals | |
| Yes | 37.5% | 50.3% |
| No | 62.5% | 49.7% |
What factors would most likely influence your decision to change jobs?*
| Factor | ASCs | Hospitals |
| More money | 69.2% | 70.6% |
| Less stress | 50.0% | 47.2% |
| More support | 34.1% | 37.4% |
| Different location | 25.5% | 30.1% |
| Less responsibility | 18.9% | 12.3% |
| More autonomy | 16.9% | 18.4% |
| More responsibility | 10.3% | 11.7% |
* Respondents could check more than one answer.
Source: Outpatient Surgery Magazine Reader Survey, December 2013, n=533 (349 ASC administrators, 184 hospital-based leaders)
You can't please 'em
After all, you have to be the eye of the storm — the unruffled oasis of calm at the center of the maelstrom, regardless of the heavy winds constantly blowing around you. Asked what the biggest stressors are, many administrators cite the sources of all that hot air.
"Not having the physicians stand behind me when I make a decision that's best for the business and not them," says Sharyn Wilde, business office manager for the Alameda Surgery Center in Burbank, Calif.
"Trying to balance what's the best decision for the ASC versus what the surgeons want, which is not always the best, cost-effective method of doing things," says Stephen T. Williams, MPA Health Care Administration, administrator of CarePlex Orthopaedic Ambulatory Surgery Center in Hampton, Va.
"Physicians who complain about issues that most often are a result of poor communication on their part," adds David E. Ferguson, MA, BSN, BBA, assistant clinical director at Kaiser in Ontario, Canada.
Also high on the list? Government regulators.
"The increase in documentation [is] to the degree that more time is spent at the computer than at the bedside with the patient," says Cathy Albright, RN, CNOR, RNFA, first assistant at Aultman North Surgery in North Canton, Ohio. "The focus of our care and responsibility to give quality care to our patients is lost in the computer abyss!"
"[It's] the continued government involvement in how a medical facility should operate," says Ms. Elmore. "[They] pass laws specifically for our environment but they don't pass laws to accommodate these changes. For example, why don't they tell manufacturers and suppliers to supply smaller amounts of medications if they are to be single-use only. We're wasting more and paying the same price. It is difficult to accept wasting when there are constant complaints about the cost of healthcare."
"You need multiple job titles to meet Medicare rules," says Henry Rey Jr., RN, USAF, quality assurance inspector and nurse manager/surgical director at Schulze Surgery Center in Savannah, Ga. "Medicare needs to restructure the standards to allow small organizations to meet requirements. The current standards place a financial strain on small centers that don't have the same staffing resources as a hospital."
And, of course, there are those who seem mainly concerned with scrutinizing your facility's earnings and holding your feet to the fire if they don't like what they see.
"The partners," says Beverly Kirchner, BSN, RN, CNOR, CASC, president at Genesee Associates in Highland Village, Texas. "They're always looking for improved bottom lines so they have more money in distribution, but they do not always work with me to decrease costs and obtain the bottom line they want."
"Unrealistic expectations of owners regarding cost containment," says Cynthia Gress, CRNA, MSN, CCRN, administrator at Saint Charles Surgical Pavillion in Jasper, Ind. "The successful efforts we've made to decrease spending and costs, while maintaining excellent patient care and satisfaction are unappreciated."
Ultimately, if it isn't one thing in particular that's graying or thinning your hair, it's everything.
"There is no room for error," says Ms. Hites. "Managing staff. Keeping up with all the changing regulations. It's very stressful when you know many people's jobs rely on you."
"I never feel caught up or completely finished," says Rebecca F. Spehr, RN, administrator of the Peachtree Orthopaedic Surgery Center at Piedmont in Atlanta, Ga. "Meeting constant deadlines, juggling several things at one time — at the end of the day, realizing the amount of work that is left to do and putting it back in my file cabinet for the next day. This happens every day."
"Being a woman," offers another director. "Having to prove everything I say is hindering my productivity."
Blowing off steam
Achieving adequate work/life balance is surely a key to contentment, but even when the demands make that a challenge, there are other ways to lower your blood pressure, as several readers point out.
"Exercise and do yoga to relieve stress," suggests one. "Find an outside-of-work hobby like fitness or yoga classes to help reduce stress after work," says another.
Many point to the importance of paying attention to your own health, not just the health of others.
"Take care of yourself, exercise and eat well," says Michele DiLucente, RN, MSN, CNOR, director of the North Surgery Center at the Children's Hospital of Pittsburgh (Pa.), adding, "I need to follow my own advice."
"Exercise, eat right and sleep well," adds Patty Crook, BSN, RN, infection prevention RN at GI Associates & Endoscopy Center in Jackson, Miss. "Life is too precious to be in a job you don't enjoy."
"Get regular exercise for your mental health as well as your physical health," urges Terry Baartman, BSN, surgery director at St. Mary's Regional Medical Center in Enid, Okla.
And little things can make a big difference, say others: "Do not eat at your desk. Join the staff or eat out if time allows," says one. "I take a walk during my lunch break," says another. "Pick your battles, breathe deeply, enjoy your family, have a glass of wine, find the humor in each day and laugh," offers a third.
In fact, you might find that laughter is the best anti-stress medicine of all.
"Find time for a joke or fun-loving prank," advises one surgical leader. "Take another breather and then back at it. Rest, pray, rejuvenate, re-gather your thoughts and have fun."
JOB SATISFACTION
Are You Fairly Compensated?
Are you paid enough? Only 27% of ASC administrators feel confident that their pay adequately reflects their positions. A higher percentage of hospital decision-makers (47%) feel the compensation is appropriate, but more than half either think otherwise, or say they don't know, according to our annual online salary survey.
When facility leaders start thinking about the number of hours they work, the responsibility they shoulder and the stress they have to endure, only 12.7% of ASC leaders describe themselves as extremely satisfied, and only 8.8% of their hospital peers feel the same way — though most are at least "satisfied."
The survey numbers shift dramatically, however, when broken down by overall pay. In short, those making $100,000 are generally at least satisfied (85.6% in ASCs; 74.6% in hospitals), whereas those making $70,000 or less are much more likely to characterize themselves as either generally or very dissatisfied (52.6% in ASCs; 50.0% in hospitals).
Clearly, money matters, even if it's not the only consideration. Or as one respondent puts it, "I like my job but would also love a bigger paycheck!"
'I make less per hour than my staff'
Many say they long for the days when their pay was directly tied to the hours they put in, including those now-just-a-memory overtime hours.
"As a manager, I have a salaried position," says Rebecca Watts-Kallin, RN, perioperative services manager at United Hospital System in Kenosha, Wis. "I take home less now than when I was a coordinator paid hourly plus overtime." "My hours are very long most weeks," says another manager. "If you figure into my salary the amount of hours I work, often I make less per hour than my staff."
"I made more money as a staff nurse in the hospital 3 years ago than I do as the center director," says Amy Hites, BAPS, RN, director at the CDH Endoscopy Center in Willoughby, Ohio. "The amount of responsibility and stress running the entire center is enormous and I don't feel I am adequately compensated."
"For the amount of hours I put in as director, I would make more as a floor nurse without the extra responsibilities," adds Tonia Mandio, RN, director of nursing at Inland Valley Surgery Center in Temecula, Calif.
Magic words?
Other managers say that in the absence of a few more bucks, a few pats on the back from the people who write the checks would boost their enthusiasm.
"They maintain the attitude that I will just make everything happen for them and I really only hear from them on problems. I'd like to have them show a little more thoughtful gratitude," says a business office manager.
"We did amazing on our last survey and I didn't even get a thank-you from 2 of the owners," says another, "much less a raise or bonus."
"I feel like I am being taken advantage of," argues another manager. "My job has transitioned from nursing supervisor to office manager and administrator without recognition or a pay raise. I have obtained 3 certifications in the past 3 years without any recognition. I still work as an OR nurse when needed and I have not had a raise in 3 years."
Determining worth
Of course, what's adequate and what isn't when it comes to compensation is largely subjective.
"I believe that my salary is in line with my location, job duties, and responsibilities," says one facility leader. "We all think we should be paid more. It all depends on your effectiveness within your position and how you deal with the stress of the position."
But what's fair? When we asked whether administrators are fairly compensated, compared with positions of similar responsibility in other industries, roughly a third of you said you didn't know. And it's true. Apples-to-apples comparisons are hard to find.
You probably realize that you're surrounded by the highest-paid professionals in the country. Anesthesiologists top the list with a mean annual salary of $232,830, according to the Bureau of Labor Statistics. Next come general surgeons, at $230,540 a year, followed by obstetricians and gynecologists at $216,760. In fact, the 9 highest-paying positions are all in healthcare. Coming in at No. 10 are chief executives, at $176,840 per year.
But what about other positions of responsibility? Natural sciences managers, who supervise the work of chemists, physicists, and biologists, and coordinate activities like testing, quality control and production, clock in at $154,610 annually. Gaming managers, who plan, direct and coordinate gaming operations in casinos, pull down $137,280. IT and systems managers are paid an average of $131,940. For HR managers, the average is $124,180. Somewhat lower down on the list are compensation and benefits managers ($115,620), commercial pilots ($97,400) and front-line supervisors of sales workers ($78,010).
Ultimately, it's a question of perspective. Loving your job goes a long way, whether you make $50,000 a year or $150,000 a year.
Or as Karen Gabbert, RN, BSN, center director for the Surgery Center of Kansas in Wichita, puts it: "Who's to say what is adequate compensation for what we do? I was hired to do a job and it is my passion to do it to the best of my ability. I am eternally grateful for the opportunity to work where I do and with the people that surround me every day. It isn't always all about the money."
— Jim Burger
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Source: Outpatient Surgery Magazine Reader Survey, December 2013, n=533 (349 ASC administrators, 184 hospital-based leaders)
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