REPORTING FOR DUTY Joy Schmuckal, LPN, CST, a 70-year-old surgical scrub nurse at Northwest Michigan Surgery Center in Traverse City, Mich., hopes to work 2 more years before retiring.

Worried about retirement? You're not alone. Our 2014 annual salary survey found that despite a recovering economy, many are still feeling the effects of the recession — and it's especially hard on retirement-aged Baby Boomers who don't feel they've saved enough along the way to comfortably call it a career, and who feel forced to work into their golden years.

"There just isn't enough money to survive on a day-to-day basis as well as plan for the future," says Kathi Gascho, RN, BSN, CASC, director of nursing at the Camp Lowell Surgery Center in Tucson, Ariz.

In this year's salary survey, in which nearly 900 surgical facility leaders shared with us the size of their paychecks, a major theme emerged: Nearly one-third of the OR managers and nurses we surveyed are working into their golden years — some because they want to, others because they have to. One of the hardest things about retirement? "It's knowing when it's time to retire," says Jeanie Skibiski, CRNA, MHA, of Mercy Orthopedic Hospital in Ozark, Mo. "I know people in their 70s who want to keep working. I think when it's not enjoyable anymore is when you need to quit."

Download "2014 Salary Survey: How Does Your Paycheck Compare?" results for
Ambulatory Surgery Centers and Hospitals.

The squeeze on salaries
The economy may be on the rebound, but surgical administrators say they are still feeling the squeeze of the recession and rising healthcare costs on their paychecks.

"My company is not even keeping up with inflation," says one nurse.

"With the volatility of insurance companies and the steady decline in reimbursement rates, raises and bonuses are being seen less and less in positions of management," adds another.

More than half of ASC and hospital respondents (52% and 54%, respectively) received a raise within the last year. Yet, half of both groups of leaders say their salaries are largely staying the same when compared to the last couple of years, thanks in large part to rising costs and lower reimbursements.

"I am blessed to be in an occupation I am passionate about," says the CEO of one surgery center. "However, each year it takes hard work to succeed, as vendors increase costs and payors decrease payments at the same time as they are increasing premiums."

"The economy is different for us in healthcare. The ACA (Affordable Care Act) has seemed to hurt us in different ways," says Daniel Hauer, business manager for Canyon View Surgery Center in Grand Junction, Colo. "Most notably I've seen delays in payments from commercial carriers and much higher patient responsibilities that aren't being collected as easily. These financial challenges make employers hesitant when making 2015 budgets for salaries and bonuses."

Surgical administrators say they feel the days of large raises and bonuses are well behind them. As you can see in "2014 Salary Survey: How Does Your Paycheck Compare?" on page 32, most ASC and hospital facility leaders say they did not receive a bonus within the last year — 34% of ASC managers and a whopping 62% of hospital managers didn't receive a bonus — and those that did largely report that it was relatively modest: $2,500 or so.

Incomes are staying the same or slightly increasing, our survey shows, with the majority of survey respondents saying any change of total pre-tax income from 2013 to 2014 ranges from 0% to 3%. "I feel that the days of bonuses and raises are going to go away as institutions struggle with decreasing volumes," says one administrator.

The consensus among our respondents is that when you add up the responsibility, hours and work, salaries are not up to par. A majority work between 40 and 50 hours a week, survey results show. Those in ASCs are more likely to manage a center with an annual budget of $1 million to $3 million (34%), while many hospital leaders say their facilities' budgets are more than $30 million (32%). Many in both groups say they oversee less than 20 full-time equivalents (61% and 46%). For their work, ASC and hospital leaders say their annual pre-tax income for 2014 commonly ranged between $80,000 and $110,000 (37% and 44%).

"Managers are underpaid across health care," says one respondent. "Nurses do not get paid for what we do!" adds another.

'I see so many of my colleagues working longer'
Financial worries aren't only affecting surgical facility leaders' day-to-day affairs — they're also having a major impact on the graying workforce's retirement plans. The issue is an important one, as our survey shows most of those currently leading surgical facilities are at the cusp of retirement. When given age ranges from under 30 to over 80, about half of both ASC and hospital leaders are between 50 and 60 years old, and say that the ideal age to retire is between 65 and 70.

Just because that's their ideal age to retire doesn't mean they think it's going to happen. Roughly 28% of both hospital and ASC facility leaders say they will likely delay their retirement for various reasons, although concerns over finances and health insurance stand out.

"I would love to retire now, but cannot financially," admits one director of nursing. "Can't afford it," says one ASC materials manager from Arizona.

Health insurance is one of their biggest concerns. Several respondents say they wish there were a cheap option for supplemental insurance for nurses at age 62 to make retirement more feasible.

"Many of us would retire earlier and open up positions for new nurses (if health insurance would be provided for nurses after they retire)," said Deborah Reynolds, RN, center leader of the GI Endoscopy Center at Middletown, Ohio.

"It is unfortunate that so many nurses, who have given their entire adult lives to provide care to patients, do not have healthcare coverage as part of their retirement packages or at least some supplemental options," adds one respondent.

"I see so many of my colleagues working longer just due to the cost of health insurance and the fear of not having enough for medications," says Nancy Carter, RN, BA, CNOR, administrator of The Regional Eye Surgery Center in Kingsport, Tenn. "I think it's sad that people that have worked 30 to 40 years taking care of others have to worry about how they will manage and be cared for in their later years."

Surgical administrators are also concerned about having enough savings to last them through their golden years. About 40% of ASC and hospital respondents say their retirement nest egg isn't sufficient, yet the majority of both groups — about 36% each — have $250,000 or more saved. Several say that despite having decent savings, they don't think it will be enough because of inflation and the rising cost of living.

"I wish I'd have learned at a young age to manage my money and not let my money manage me," says DeeDee Warren, RN, nurses administrator at the Tri City Surgery Center in Prescott, Ariz. "Saving money should be a priority, but for most of Americans, it is an afterthought."

"Years ago I realized that a 401(k) was not going to be enough for retirement, but I didn't know how to invest and make my money grow," says one respondent. "Healthcare workers should learn all they can about making their money work for them."

Worse outlook for staff nurses
Surgical administrators aren't the only ones considering working into their golden years. Compared to facility leaders, ASC and hospital facility respondents say that their OR staff nurses are more likely to put off retirement (38% and 44%). The trend is higher, respondents say, as staff nurses with lower incomes may be forced to work longer.

"It seems to be a slight trend in that direction," says Anthony P. Johnson, MD, managing partner of the Jervey Eye Center in Greenville, S.C. "They love their job and benefit financially by working a little longer."

"With the economy the way it currently is, and the increase of living expenses and medical expenses, I am sure you will find many people will be retiring at a later age," says Tamlyn K. Small, CST, the ASC and materials manager at Women's Health Connection in Spokane, Wash.

While a higher percentage of hospital OR staff nurses are delaying retirement, many surgical leaders say that they've seen their nurses retiring early or on time because of the physical demands of the job — whether or not they're financially prepared.

"Nurses have retired as planned due to the physical demands in the surgical arena," says Christel Grazier, MS, BSN, RN, CNOR, director of perioperative services at the Reading Hospital in West Reading, Pa.

"They say they will not delay as they cannot take call any longer as they get older," says one hospital clinical director from New York.

Planning for the future
It's not all bad news, though. While many say that children, finances, healthcare coverage or the recession affected their retirement plans, several leaders say they plan to keep working simply because they want to.

"As long as I can contribute, I plan to continue to work. Working keeps a person active, young and thinking," says one administrator.

"I guess some would say that 65 to 70 is delayed retirement. I just don't know what I would do without my work," adds Betsy Hume, RN, director of the Berkshire Eye Surgery Center in Wyomissing, Pa.

The 71% that are planning to retire as planned say they're looking forward to relaxing, traveling and spending time with family — as well as getting out from an ever-changing, often-chaotic field.

"I've seen the better days of health care during my tenure, when it was fun to come to work," says one nurse manager at a hospital in North Carolina. "Now we are so restricted, and the fun and job enjoyment have dwindled. They say you know when it's time, and I can see that happening."

"I am tired of the changes in health care and am ready to get out," says one respondent. "Health care is changing so much that I see a lot of administration leaving early," adds another.

With retirement quickly approaching, several say they want to make sure that the younger generation is ready to take over and isn't left with similar financial and health coverage worries when their time for retirement comes.

"I certainly hope that the Millennial Generation is up for the challenge of the work that is ahead," says Kris Sabo, executive director and administrator of Pend Oreille Surgery Center in Ponderay, Idaho. "It will be tough to top the Baby Boomers for work ethic."

"We should start thinking of our young as they're coming up so they're not in the same boat," says Carol Cappella, RN, MSN, CNOR, clinical director of Delray Beach Surgery Center in Delray Beach, Fla. "With age comes wisdom."