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Most health care risk managers are seeing their incomes hold steady or increase slightly, but the traditional career paths are fading away. If you want to hang onto a successful career, you need to develop your skills and make yourself desirable in the new marketplace.
Previous years have shown an upward trend in income, but this year’s results suggest that risk managers’ incomes are about the same as last year’s and the year before. In this year’s survey, risk management directors report a median income of $65,000, about the same as last year. (Previous surveys had slightly different income brackets for respondents to choose, but the results are different only by $2,500.) Last year’s median income was $62,500, the same as for 1999. In previous years, the median income for directors of risk management was in the high $50,000 range. Some of the increase in recent years has been attributed to the dramatic changes in risk managers’ job descriptions.
As in most years, the survey shows that about half of the respondents reported an increase of 1%-3% in their income from the past year, though that figure is down slightly to 39%. A solid 30% reported a 4%-6% increase. About 17% reported no change, and the rest reported a decrease. Twenty-one percent report that their staff size has increased in the previous year, while 18% report that it has decreased. The rest report no change.
Risk managers still are working long hours. Thirty-seven percent report that they work 46-50 hours per week, and 14% report that they work 51-55 hours per week. Two percent even found the time to fill out the survey while working more than 65 hours per week.
Geri Amori, PhD, ARM, FASHRM, risk manager with Fletcher Allen Health Care in Burlington, VT, and president of the American Society for Healthcare Risk Management, says health care risk management still is a promising career, but it’s not the career that many of you entered years ago. Anyone who expects to continue and thrive in the field must take heed of the dramatic changes in health care and act quickly to adapt, she advises. The changes have been heralded for years as they gradually crept into health care, but Amori says they are now here.
"Traditional risk management, as we’ve known it, is not a place we want to be anymore," she says. "We need to position ourselves in whatever way we can to be leaders, and particularly to participate in the patient safety arena. That means improving our skills sets, our epidemiological base, our way of thinking — everything that has to do with being proactive in risk management."
Amori expresses a certain degree of urgency when she talks about the need for risk managers to change their way of thinking and to change their position within the health care community. This message has been delivered for a long time, but she says it is no longer just a good idea. It’s what you have to do if you want to keep your job.
"We are seen in many circles as being reactive, the Band-Aid people who step in when something goes wrong," she says. "That’s the old style of risk management and the health care community has left that behind. Everyone wants to see a very proactive approach, and anyone who clings to the old idea of risk management is going to be undesirable to employers. Part of the problem is that we’re too damned tired from all the reactive stuff we manage to spend time on being proactive, but we’ve got to find a way around that."
Risk managers must become leaders within the health care organization, not just middle managers, and they must seize opportunities for authority and responsibility, Amori says. The increasing focus on patient safety is a terrific opportunity, but many risk managers are being passed up, she says. Amori says risk managers are the perfect candidates to be patient safety officer but you probably won’t get the position unless you lobby for it — and aggressively.
"That position rightly should go to risk management because that is what we’ve always done, ensure the safety of patients," she says. "But that position is going to other people, new people, and that scares me because it means we’re not being seen as proactive."
Amori says that word, "proactive," seems to be the key to a risk manager’s future. It is the exact opposite of the stereotype that some health care leaders have of risk managers and it fits the new attitude in the entire industry. While most risk managers aren’t eager to take on yet another duty after years of having more responsibilities dumped on their desks, Amori says the patient safety manager is one role you should seek. In many ways, she says, the risk manager title is being phased out and the patient safety manager is taking over. Whether you move into that role or you wave goodbye as someone new comes in will be determined largely by how you develop new skills.
"To be really useful, you need to be seen as knowledgeable in risk and insurance financing, and you need to be able to show the correlation between proactive risk management, which is really proactive patient safety and the reduction of costs and the protection of assets of the organization," Amori says. "Cost benefits analysis needs to be something we do on a regular basis."
There is reason to be optimistic, says Fay Rozovsky, JD, MPH, DFASHRM, a risk management consultant in Richmond, VA. She says many risk managers are rising to a higher level in their organizations, which she calls an extremely positive trend. The higher positions give risk managers more opportunity to be a real player in the organization and have more influence. But the transition can be challenging, she says.
"It’s one thing to be a middle manager, and it’s another thing to be an officer in that facility," she says. "That kind of advancement is sporadic right now, and much of it is add-on work, which is a concern for those who thought they were stretched already. When you have a whole redesign of your position, that’s better. You end up with a the total portfolio for risk under your umbrella, not just the clinical risk side."
The new components in that portfolio probably will include insurance purchasing, risk transfer, safety, and security. And you’ll only get that position if you show that you have the skills necessary to manage those issues. Rozovsky urges risk managers to study statistics and quality management, along with insurance. She also points that out health care organizations are finding captive markets much more attractive lately, so a risk manager who can work with a captive market will find more career opportunities.
And remember, it may not be your current employer who can make it possible for you to advance in your career. If you are interested in moving up to a senior management position and taking on more responsibility, you may have to look elsewhere, Rozovsky says.
"Keep up the lifelong learning," she says. "The value that risk managers bring to the table is the knowledge they have, their ability to identify emerging risks in ways that bring value to the organization and ways that reinforce the value of having such an individual in house."
Amori says risk managers need to acknowledge some cold hard facts about their position in the health care industry. It is easy for an experienced risk manager to become complacent and feel like you are working hard, and you probably are, but that’s not enough these days. Amori says you must become what the employer wants, even if that’s not what you’ve worked so hard at all these years.
"Health care is changing, and employers are looking for something different," she says. "If we’re not value-added, risk managers will be displaced."
Though it is a stereotype, many health care professionals see risk managers as the naysayer who points out what can or did go wrong without contributing much toward how to do things right. That image will sink a risk manager’s career, she says.
"We can’t be seen as obstreperous and difficult. Rather, we need to be seen as anxious to learn and help the organization," she says. "We need to put on a positive face."
Rozovsky agrees with that advice but emphasizes that the future is bright for risk managers who are willing to adapt. She says you have to "determine what skills you have and what skills you can acquire, then match those up with the organization in just the right way. It’s not going to be a situation where any risk manager can take on any risk management job."
Though titles like "patient safety officer" are becoming more common and could one day overtake "risk manager," Amori says that day is not yet here. She does see many risk managers moving into positions like chief risk officer or a similar title, overseeing risk management for multiple facilities or networks. That kind of promotion can come with a substantial increase in income, but Amori says there are relatively few of those positions available. And even if you can snag one of those, all of the other changes in risk management still apply at that level.
"This is not a time to be complacent if you want to have a decent career years from now," she says. "We have to discourage risk managers from being the nice little person in the corner who just deals with bad things when they happen. If risk managers want to build a career for themselves, they need to become leaders — and that means getting out of your comfort zone."
The exclusive 2001 Healthcare Risk Management Salary Survey was mailed to about 1,500 readers in the June 2001 issue. A total of 252 were returned, for a response rate of 17%. The results were tabulated and analyzed by American Health Consultants, publisher of HRM.