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Climbing the Paycheck Ladder

Taking a breath may be priceless, but dollar amounts can be placed on the long hours respiratory clinicians work to ensure every inhale, exhale and all things in between run smoothly.

How much these tireless caregivers earn is the focus of ADVANCE's National Salary Survey of Respiratory Care Leaders. More than 1,050 people responded to our questionnaire, giving us insight into our readers' annual income, past raises, benefits and more.

It seems that recognition of the respiratory care field may be on the rise, but the salaries that accompany the managerial titles might not be as impressive.

"They are low," sighed Lawrence Mann, RRT, director of respiratory care, Lehigh Valley Hospital and Health Network, Allentown, Pa., after reading our results. "There's no way I'd work for that kind of salary, without incentives."


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Who Are You
Before getting knee-deep in dollars and cents, we first need to explain who answered our questions. The survey sample shows a field bursting with experience. Forty-four percent said they have 21 years or more under their belts; only 7 percent worked five years or less in respiratory care.

The majority of the respondents have managerial backgrounds; 50 percent hold the job title of department manager/director, and 20 percent are chief/lead/head therapists.

The largest number of people have the RRT credential (63 percent). Twenty-eight percent have a BS, and 11 percent have a BA, while a considerably smaller number indicate they go by MD or PhD (1 percent).

Respondents hail from across the country, but we heard the most from states in the East North Central region (Ohio, Indiana, Illinois, Michigan and Wisconsin) and the South Atlantic (Delaware, Maryland, Virginia, West Virginia, North Carolina, South Carolina, Georgia and Florida).

A little more than half (55 percent) work most frequently in facilities with 300 beds or less. Larger facilities with more than 300 beds employ 30 percent of respondents. Fifteen percent answered "not applicable."

An overwhelming majority (97 percent) works full time (35 hours or more per week), and most enjoy every minute of it. (See Figure 1 for full salary survey breakdown.)

Salary Stats
Now, let's get to the meat of money matters. Twenty-six percent of respondents list an average annual salary of between $50,000 and $59,999; 25 percent collect $40,000 to $49,999 in paychecks; and 18 percent make $60,000 to $69,999. Only 2 percent said they see six figures at the end of the year, and they've earned it as highly specialized pulmonologists or department managers/directors.

Among the most popular job title responses, average annual salary breaks down as follows:

  • facility administrator: $79,500
  • department manager/director: $67,374
  • durable medical equipment/home medical equipment dealer/owner: $65,269
  • chief/lead/head therapist: $56,152
  • "other," which includes popular fill-in answers like education coordinator, clinical coordinator, staff therapist and sleep technologist: $55,392.

Less variability exists with salary by specialty, with only about $10,000 to $15,000 separating the most common responses. Subacute care ($67,500), cardiopulmonary services ($63,401), and respiratory care ($63,124) perch near the top, while neonatology ($57,660), home care ($57,417), and pulmonary function testing ($53,045) round out the list. (See Figure 2.)

Having similar salaries across job specialties is an encouraging sign, said George Burton, MD, associate dean for medical affairs, Kettering Medical Center, Kettering, Ohio. "It shows if you do a good job in any area that's patient critical, you'll be compensated not only adequately but equally. There are no flavors of the month. There are no favorites."

Not surprisingly, average salary increases with experience. However, it appears to level off somewhat between 11 and 20 years at about $60,200. Rookies with five years or less earn $47,902; caregivers with six to 10 years make $54,621; and veterans with 21 years or more top out at $68,089. (See Figure 3.)

Gray hairs don't necessarily mean a higher paycheck, though. Salaries peak in the 56- to 60-years-old range ($67,734); they account for 6 percent of the total entries. The next wealthiest brackets went to 46 to 50 years ($65,980) and 51 to 55 years ($64,891), 25 percent and 14 percent of the submissions, respectively.

Location, Location, Location
When looking at salary by setting, skilled nursing and subacute care facilities lead the way with $72,643. Academic hospitals ($67,690), government/military hospitals ($65,661), and long-term care facilities ($64,316) follow. People who work in community hospitals, where 41 percent of respondents are employed, make $61,911, putting them in the middle of the pack. Last in this category went to home care agency/HME providers ($58,494), asthma clinics ($55,583), and sleep labs ($55,019). (See Figure 4.)

Moving on to facility size, a clear correlation exists between the number of beds and a higher average salary: one to 100 beds ($56,028), 101 to 300 beds ($64,713), 301 to 500 beds ($65,227), and 501-plus beds ($68,866). Smaller facilities pay, on average, about 14 percent less than larger facilities. (See Figure 3.)

Where your workplace is located also plays a factor. Pacific locals (those in Washington, Oregon, California, Alaska and Hawaii) cashed in the most annually ($70,304); and with $70,111, a close second went to the Middle Atlantic states (New York, Pennsylvania and New Jersey). The West North Central region (Minnesota, North Dakota, South Dakota, Missouri, Nebraska, Kansas and Iowa) had the lowest at $53,922. (See Figure 5.)

Metropolitan and suburban workers report nearly identical incomes: $64,156 and $64,040, respectively. However, rural employees average 10 percent less per year with $57,487. About one-third of respondents reported working in each area. (See Figure 3.)

In regards to salary by shift, daytime workers said they earned the most ($64,169). Eighty-three percent of respondents clock in during these hours. Next come employees with weekend or other special schedule ($58,900) and rotation of days and nights ($55,337). Overnight ($50,525) and evening ($47,650) take home the least.

Respondents report receiving an average of $4.64 extra per hour for working the night shift; weekend staff members get an average bonus of $5.98 per hour for their time.

Gender Gap
Lastly, the issue of gender offers a revealing statistic. We received a 50-50 split in the number of submissions between the sexes, but our results showed that men earn about 14 percent more than women ($66,778 vs. $57,207).

This fact doesn't surprise Valarie Dudley, MPA, RRT, director of respiratory care, University of California, Los Angeles, Medical Center. "But it still disgusts me," she said. "I think it's just rotten, but it's the way of the world. Women do not demand the salaries going in, and once they're in, they don't always make a case for correcting any lag they might have."

The Benefits of Benefits
Salary just constitutes one hunk of the big respiratory pie when a person looks into taking a job. A potential employee can dig into a nice benefits package as well.

"Hospitals are very competitive with each other regarding benefits," said Paul Montague, RRT, BA, director of respiratory care, University of Wisconsin, Madison.

Our survey results echoed this sentiment. Most enjoy the traditional benefits: vacation/sick days (94 percent), health insurance (87 percent), and life insurance (75 percent). Also, a sizable amount has tuition reimbursement (69 percent), disability (60 percent), and 401(k)/profit sharing (60 percent). A significantly smaller number receive malpractice/liability insurance (25 percent) and professional association dues (24 percent).

Dr. Burton was "pleasantly surprised" that so many employees have tuition reimbursement at their disposal. "That's somewhat of a new thing," he said. "Hospitals are offering to get people higher up the education ladder and certainly higher up the certification ladder."

Despite the large number of people receiving added incentives, only 13 percent said their employer pays for their medical benefits entirely. Seven percent said they're deducted from the paycheck (fully paid by the employee), and 70 percent said they're deducted from the paycheck (partially paid by the employee).

Age plays a big role in terms of when benefits and incentives concern workers the most, Dudley said. "As I interview younger people, it's amazing to me that they have no concern whatsoever about retirement benefits," she said. "As those people start to have families and begin to get older and think about retirement, then benefits become excruciatingly important."

Age doesn't discriminate when it comes to another important job aspect, though. People from all generations appreciate a good raise.

Almost two-thirds (61 percent) received their last salary bump in 2003, and 30 percent got that raise in 2002.

For most folks, it was in the 3 percent to 6 percent range (58 percent) or less than 3 percent (33 percent).

Promoting the Future
Often, larger pay raises come with a promotion. However, according to our survey, many people haven't seen a title change for a while - if at all.

Thirty percent said they haven't yet received a promotion, while another 30 percent got the nod in 2000 or before. Just 14 percent moved up a rung in 2003.

Montague doesn't see much managerial turnover in respiratory care. "When I got into the field in 1972, almost everyone was very young. I was in a department at a university hospital where almost nobody was over 30," he said. "What happened is the managerial jobs got filled with up-and-coming younger people years ago. There are a lot of managers with long tenure."

Respiratory care leaders have excellent job security "as long as you do your job," Mann added. "It's like any other business. You must perform well, meet your budgetary and other fiscal responsibilities, and improve the clinical role of your therapists."

However, Dudley urges caution when looking at the managerial job outlook. The current recruitment crunch can continue to have serious consequences.

"If there is too big a problem with recruitment, the managerial positions or the management director-type positions will go to someone other than a respiratory therapist. That would be unfortunate," she said. "However, if you can't recruit people, somebody has to do it."

Despite the shortage, Mann pays close attention when interviewing candidates, and he's still picky when it comes to hiring young people to forge the future of the field. At his hospital, it usually takes about 10 years to join the managerial ranks, although he's seen some young, motivated therapists slip into that role nicely.

"You're going to find those individuals - and they are out there - that it's not just their profession, it their avocation," he said. "That's what I look for. They are the people that come to you with the ideas to make a better department."

One serious issue may be keeping some of the best and brightest away, Dr. Burton said. "I think that people going into respiratory do see that other fields, such as nursing, are earning considerable more for the same amount of training and work. And that's discouraging."

Upper level nurses generally make between 10 percent and 20 percent more than respiratory managers. "It's a recognition issue," he said. "Nursing is said to be hospital-wide and service-wide. Respiratory therapists have their own little corner."

Dudley agreed: "Certainly, nursing is the 500 pound gorilla."

Uncertainty Ahead
Short-term, though, that primate might be losing some weight.

Montague has seen swift pay increases across respiratory care over the last three to five years, and he anticipates that trend continuing for another three to five years. But after that, things may get a little dicey.

"Health care spending in this country is rising so rapidly," he said. "Hospitals are going to have to find cheaper ways to get things done. There's only so much they can afford to pay without the system changing."

Also, because of the aging population, health care facilities currently run at very high censuses.

"That's why hospitals are full-throttle ahead. That's why pay raises are going up," Montague said. "At a certain point, our ability as a society to pay for this increase in health care services is going to shut off."

Mike Bederka is assistant editor of ADVANCE. Special thanks to Lori Wolfe, marketing research director of ADVANCE.

ADVANCE congratulates Jerry Edens, BS, RRT, MEd, clinical education coordinator at Cincinnati Children's Hospital Medical Center. He won the $100 drawing for completing our salary survey.


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