Are You Being Paid Fair Market Value in 2008?

Introduction
During President Bush’s final State of the Union address January 29, 2008, he stated that Americans’ primary concern is the economic future of the United States. This has been evident in almost every aspect of our home life, from median home value prices declining, gasoline prices increasing, and weak economic growth. At our places of employment, coronary heart disease (CHD) direct and indirect costs have increased to an all-time high of $142.5 billion.¹ Hospitals are in need of finding ways to reduce cost without compromising care. Low-hanging fruit is to negotiate lower per unit costs of high-priced medical devices such as angioplasty balloons, stents, and defibrillators. Most centers have likely maximized this negotiation and have little room to make meaningful savings. The next step is to ensure cath lab efficiencies are maximized with regard to room turnaround, wait times, and staffing. After these flow charts have been implemented, now what?
Inflation rates have risen steadily the past 3 years, at a rate between 2.8% to 3.4%.² The goal of this survey is to bring light to what other cath lab professionals are making to ensure that fair market value is achieved in an ever-evolving health care environment.

Methods
In 2005, a salary survey was created and had published results.³ This same survey was used and slightly modified for 2007. We sent surveys across the United States to all subscribers of Cath Lab Digest (circulation approximately 16,000) and made the survey available on the Cath Lab Digest website, www.cathlabdigest.com. Data was collected online and analyzed using Microsoft Excel. We surveyed cath lab professionals from March 2007 to December 2007. When we closed acceptance of surveys, we had a total of 419 responses, a four-fold increase in responses from 2005. This, to the best of our knowledge, represents the largest and most comprehensive cardiac cath lab salary survey. One limitation of this survey is that the 20% of respondents with more than one credential were counted one time for each relevant credential category, meaning, for example, that a single holder of both the RN and RCIS (or RT and RCIS) was counted as both 1 RN (or RT) and 1 RCIS. This may account for some of the higher ranges for the RCIS salary and should be taken into consideration when reviewing the ranges of the RCIS salaries

Results
See salary survey data.

Discussion

This survey provided a very good representation of nurses, technologists, and registered cardiovascular invasive specialists (RCISs). There is crossover between the RCIS and nurses or technologists. However, the opportunity was afforded to see if a credential makes a pay difference. Managers seem to make up the minority of responses and that could very well be a result of the fact that Cath Lab Digest is not a management-specific journal and this population is not being captured. The responses were well distributed among the midwest and south central. Although the New England/Mid-Atlantic regions had a slightly lower response rate, there is still enough data to make meaningful conclusions. We noticed a lower Pacific coast response rate, which is consistent with the 2005 survey. Lastly, responders were more tenured, with equal splits between 1-10 years and 10+ years experience. (In other words, newbies are too busy studying to complete the survey.)

Credentialing has been a lingering issue in the field of invasive cardiology for years. Recently physicians have been required to sit for their boards; however, cath lab staff has not been required. All this could change in the future, as the CARE Bill is pushed further along the legislative process. In essence, the CARE Bill directs the Secretary for the Department of Health and Human Services, in consultation with recognized experts in medical imaging, to establish standards to ensure the safety and accuracy of medical imaging studies, as well as putting into place standards that pertain to the people performing medical imaging and radiation therapy. This bill, depending how it is passed, has the potential to put certain disciplines out of cath lab work. The RCIS credential and examination is being proposed as a unified credential for cath lab staff as a means of showing a minimum base level of knowledge for invasive cardiology. Credentialed RCIS salaries are reported here as higher than those of cardiovascular technologists (CVTs), which should also provide incentive for passing the RCIS exam. Of interest, in 2005, only 29% were required/encouraged to have the RCIS. In 2008, that number has increased to a total of 55% required/ encouraged (Figure 4a), thus showing that many cath labs are watching the CARE Bill unfold and are beginning to prepare for its potential implications. Unfortunately, for all the hard work put into preparing for the examination and passing, it is only rewarded 23% of the time. Compensation ranges from 5% raises to $1-$2/hour raises. This is a potential opportunity for cath lab managers/directors to reward staff for being the best that they can be in their profession.

On average, cath lab staff has the potential to make a very fair living based on their average salary. The highest paid position is manager/director, with the highest rates consistently on the Pacific coast, consistent with 2005. Technical staff in the lab salaries are led by nurses, followed by RCIS staff and technologists — here again, the Pacific coast has the highest salary. A more comprehensive analysis is found in the results section and provides a wealth of data for an individual to base comparisons of their salary to those of their peers. It goes without saying that being a manager in California is an economically and geographically envious position; still, it is important to remember that cost of living varies widely throughout the country and this is reflected in regional wage differences as well.

An area of concern arises in looking at annual incentive increases. The annual inflation rates since 2005 have been between 2.8% – 3.4%, for an average of very close to 3% annually. When looking at annual wage increases in our survey, 45% of responders fall below this rate, with 33% reporting no annual increase (Figures 7c and 7d). As hospitals look to cut costs, our hope is that wages are not an area of cost reduction.
As the field of invasive cardiology goes forward in the coming years, cath lab personnel are going to be tackling more complex procedures encompassing numerous disease states such as carotid artery disease, chronic total occlusions in the lower legs, aortic aneurysm repair and aortic valve replacements, to name a few. The advent of hybrid labs with the operating room staff are upon us. With hybrid labs comes hybrid staff, and more educational and technical demand. Our hope is that as competent staffing demands increase, so will wages for those highly skilled staff.

Conclusions
Currently, cath lab staff are a well-paid specialty overall, exceeding that of the national salary average. Annual increases in salary in almost half of our respondents falls below the United States inflation rate. Of note, physical demands, long hours, radiation exposure and exposure to blood and bodily fluids are hazards of the job. As the field moves forward with more technically complex procedures and staff are forced to become more cross-functional, fair salary increases should follow.

References

1. Heart Disease and Stroke Statistics—2006 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113:e85-e151.
2. Personal communication: Bryan K. Berry, Certified Financial Planner, citing the U.S. Department of Labor: Bureau of Labor and Statistics.
3. Cath Lab Digest December 2005. Available online at: http://cathlabdigest.com/issue /V13I12. Accessed February 13, 2008.