“This is definitely an attractive role for those who are younger,” says Brian P. McDonough, MD, CMIO at St. Francis Hospital in Wilmington, Del. “For those who are young and familiar with technology, there is an opportunity to take an active role in improving quality of patient care.” He also says the shift to younger CMIOs could be because “many organizations are turning to hospitalists as CMIOs, many of whom are younger.”

The age shift is “surprising,” says Donald L. Levick, MD, MBA, CMIO at Lehigh Valley Health Network in Allentown, Pa., adding it is probably due to “a combination of the younger physicians making choices and that many more organizations are hiring CMIOs and related positions and selecting younger physicians who may be more computer savvy.”

Maureen Gaffney, RN, MHS, CMIO and senior vice president of patient care services at Winthrop University Hospital in Mineola, N.Y., is “seeing more practitioners moving towards alternative roles earlier in their careers—administrative, physician advisors and technology associated roles. It is refl ective of the changing healthcare environment and declining reimbursement.”

Workload expectations

Last year, almost three-quarters of respondents expected no change in their workload. This year, that number is way down, but still, 51 percent expect no change. One-quarter expect some increase. Levick attributes these numbers to “the changing workload and responsibilities. With ICD-10, meaningful use [MU] and ACOs [accountable care organizations], a lot of pressure is being placed on the clinical information systems, and therefore, on the CMIO.”

What percentage of time do you spend on CMIO duties?

“I am surprised by those who expect no change in their workload,” says McDonough. “It is definitely an increasing time commitment for many people.” However, it’s possible that respondents already have experienced increases in their workload and are now just maintaining that high level.

According to survey results, the amount of time spent on CMIO duties for practicing physicians is greater than 90 percent for 24 percent, and less than 50 percent for almost 19 percent. Last year, those numbers were 33 percent and 20 percent, respectively. “As more organizations create CMIO positions, many may start at 50 percent positions and increase [this effort] over time,” says Levick.

Fifty-one percent expect no change in the amount of time they spend on CMIO duties in the coming year, which surprises Gaffney. “As more and more organizations engage in rapid adoption of EMR to take advantage of the MU incentives, we should expect to see more time devoted by the CMIOs,” she says. “I also see the role of the CMIO changing and becoming less of an advisory and provider liaison to more of an administrative role. More CMIOs are now responsible for informatics departments, which demands more time.”  

Small salary changes

Changes in salary since last year are minor, according to our survey. The number of those on the highest end of the scale remained about the same as last year, but there was a shift in the lower pay categories. Slightly more earn a salary of $100,000 or less (14 percent compared with 12 percent last year) and the exact same amount—17 percent—as last year make a salary of $300,000 or more. Twenty-six percent earn salaries between $100,000 and $200,000 compared with 24 percent last year; and 43 percent make between $200,000 and $300,000 compared with 47 percent last year.

What percentage of salary increase do you expect during 2012?

When it comes to expected salary increases, again there were some minor differences, which may indicate the value of the CMIO to healthcare organizations, an improving economy—or perhaps both. Two-thirds (66 percent) expect an increase this year compared to 61 percent last year. However, 24 percent expect a 0 to 2 percent increase and 27 percent expect a 2 to 4 percent increase, compared to 20 percent and 25 percent, respectively, last year. 

Do you expect to receive a bonus in 2012?

These numbers suggest that CMIOs are demonstrating value to institutions and therefore, CMIOs anticipate financial recognition, says McEnery.

The question of whether CMIOs will receive a bonus in 2012 indicates a few improvements since last year. Overall, 53 percent expect a bonus this year, compared with 45 percent last year. More than one-quarter (27 percent) expect a bonus greater than last year’s, compared with the 20 percent last year who said they were expecting a greater bonus than what they received the previous year.

Do you anticipate changing positions in the next 12 months?

“Since many of these positions are part-time positions with practicing physicians,” says Levick, “they may not be compensated the way most executive positions are—with goal-driven incentives.”

Moving on?

Although sixty-three percent of respondents do not expect to change positions this year, McEnery is “candidly surprised at this number as that suggests that 37 percent are expecting to change positions.” Physicians generally are not very mobile, he says. “There is a certain number of physicians that move around, but it’s not done lightly. Once you’ve established a practice, it’s hard to move. It’s a life-changing event.” Non-physician CMIOs that, therefore, do not see patients may have more mobility.

How many years have you been employed in your current position?

It appears that some of our respondents from the past already have moved on. Last year, 9 percent had been in their position for 10 or more years. This year that number is just 4 percent. However, those employed in their current position for less than one year is just 14 percent, compared with 23 percent last year.

When we look at how many years respondents have been employed by their present employer, the largest group has been there just one to three years (26 percent), followed by four to six years (21 percent).

Overall, the 2012 CMIO Compensation Survey “shows that there is a breadth of people in the role,” says McEnery. “There isn’t one single definition—it depends on the practice setting and the experience of the person which is reflected in the salary breakdown.”

It will be interesting, he says, to see whether people decide to follow a CMIO career path right out of medical school. Now that there is a medical informatics specialty, “there is more of a sance of that occurring over time.”

Salary satisfaction dips

Perhaps the most surprising figure to come out of this year’s CMIO Compensation Survey is the number of respondents who said they are somewhat or very dissatisfied with their salary.

Up from last year by five percentage points, the increase in those dissatisfied with their salary might “reflect the overall stress of implementation of EMR and achieving meaningful use benchmarks,” says Kevin W. McEnery, MD, deputy division head of informatics for diagnostic imaging at MD Anderson Cancer Center in Houston.

Brian P. McDonough, MD, CMIO at St. Francis Hospital in Wilmington, Del., agrees. “The workload is growing. I wonder if [the dissatisfaction] is a reflection of a greater clinical workload.”

The numbers probably reflect CMIOs feeling overburdened, says Maureen Gaffney, RN, MHS, CMIO and senior vice president of patient care services at Winthrop University Hospital in Mineola, N.Y. “In addition to managing teams of people to ensure a safe implementation of systems, some CMIOs are now being held accountable for the fiscal responsibility of attaining the meaningful use (MU) dollars that organizations are counting on to contribute to their bottom line. This is new ground for CMIOs. In addition, an evolution is occurring in the roles of the CMIO and CIO. The CMIO is now the visionary and driving the strategic plan. Having a clinician coordinating the efforts changes the CIO functionality dramatically.” 

Salaries and Dissatisfaction

Those dissatisfied with their salary are more likely to make less.

Donald L. Levick, MD, MBA, CMIO at Lehigh Valley Health Network in Allentown, Pa., also is surprised by the increase in dissatisfaction. “Given that most physicians choose to go into informatics from a clinical position, I would expect a higher satisfaction rate.” The dissatisfaction could be related to overall disgruntlement, he says, or the changing role and increasing responsibilities, especially the type of responsibilities. “The CMIO role is more about strategy and expanding roles, less about being the physician champion. It may be that these people are moving into more uncomfortable roles.”

The rate of dissatisfaction could, of course, be related to lower salaries. A breakdown of the numbers shows that the dissatisfied are more likely to make less, and those physician executives are less likely to make more. It’s somewhat understandable that they are dissatisfied when almost twice as many (27 percent compared with 14 percent) make less than $100,000 and only a fraction (3 percent compared with 17 percent) make more than $400,000. They also are much more likely to work for an academic medical center (34 percent compared with 17 percent), are just as likely to be a licensed physician, more likely to be female (24 percent compared with 13 percent) and more have been in their current position for less than three years (55 percent compared with 69 percent).

One surprising difference between the satisfied and dissatisfied is the length of employment at the current employer. Overall, 37 percent of respondents have been at their current employer for 10 or more years compared with 45 percent of the dissatisfied. This could be attributed to the old adage, “You’re never a hero in your own hometown,” says Levick. “Those who have evolved into their role at their organization may face the hurdle of familiarity and complacency. They may be seen as the IT doctor or the EMR doc and not as one of the strategic leaders of the organization. Those who are brought in from the outside come with the aura of credibility.”

The Fine Print: The 2012 CMIO Compensation Survey includes answers from all qualified respondents who took the survey in the 47-day period from Nov. 21, 2011 to Jan. 6, 2012. A total of 217 people responded. All values are approximate.