Clearing House on Public Health

July, 1947 Clearing House on Public Health Salary Information STATEMENT BY EXECUTIVE BoARD ON SALARIES OF PUBLIC HEALTH ADMINISTRATORS The American Public Health Association for more than 15 years has concerned itself with the problem of professional qualificatiols ror public health workers. The time has arrived for the Association to state what these services are worth. The health officer's position is a key position affecting all other public health specialties. Therefore this declaration begins with a consideration of compensation for medical administrators.* 1. The compensation for physicians employed full time by health departments in the United States in a full-time administrative capacity during 1947 should be adjusted to be not less than the following scales which take into account the net income of physicians in private practice. a. Physicians with an M.D. degree from an approved medical school, followed by an interneship, plus a Master's degree in public health and not less than 2 years of fulltime experience under supervision, should receive a minimum annual starting salary of $8,500, with regular increments to $10,000 and $12,000 whether employed as a health officer or in another full-time administrative position. In positions of particularly heavy responsibility this level should exceed $12,000. b. Physicians with an M.D. degree from an approved medical school, with an interneship and with 2 or more years of successful full-time experience but without graduate training should receive an annual starting salary not less than $6,000 whether employed as a health officer or in another full-time responsible administrative position. Physicians otherwise quali- * See official report of the American Public Health Association on Educational Qualifications of Health Officers. A.l.P.H., 36, 8 (Aug.), 1946. Reprints available free from Associatiqp. [916] fied who have achieved notable success and who have had many years of fulltime experience in a well organized health agency should be considered as fully qualified to serve as health officers or bureau heads, even though lacking formal academic training. Provision should be made in such cases for regular increments to $10,000 and $12,000. In positiois of particularly heavy responsibility this level should' exceed $12,000. 2. These represent minimum basic salary recommendations aimed to approximate the income which men and women of good qualifications presently receive in private practice and in industry. There are areas in the United States where coit of living and/or heavy responsibilities require higher minimum levels. NEW YORK TImES NOTICES PUBLIC HEALTH SALARIES You will remember that Dr. Winslow's editorial in the April Journal was the opening gun of our campaign to make the fac-ts about inadequate public health salaries known to the voting public. The New York Times used this editorial for an article of April 27, 1947, discussing salaries of the New York City Health Department. This article pointed out that one-sixth of the budgeted positions in the ciety health department were vacant, that turnover among separate groups of employees varied from 12 per cent among health inspectors to 47 per cent among statisticians and veterinarians. Before the war normal turnover was reported to be between 5 and 10 per cent. In 1947, Commissioner Israel Weinstein reports, turnover is only about half of what it was in 1946. This is due in part to the fact that all' employees had a $300 annual increase on January 1. Even though public health

nurses had a second such increase, there are still 200 nurse vacancies in the department, or nearly one-fourth of the total budgeted positions. SALARY INFORMATION Vol. 37 917 SALARY DATA IN " PUBLIC HEALTH NURSING " Public Health Nursing of the National Organization for Public Health Nursing is keeping the subject of salaries for public health nurses before its readers. The March issue (p. 225) had two articles, one on public health nursing salaries in nonofficial agencies, another on nurse vacancies in public health agencies. Twelve nonofficial agencies each employing 30 or more nurses reported salaries. Salaries for director of nurses ranged from $4,200 to $9,500, with the median at $5,000. The lowest amount paid assistant directors was $3,320, the highest $5,640. Educational directors were paid from $3,000 to $4,540; generalized supervisors from $2,400 to $3,660, and generalized field nurses from $1,800 to $3,180; practical nurses from $1,560 to $2,040. An analysis was also made of percentages of salary increases in the various types of nursing positions in the period 1945-1947. Increases in salaries of generalized field nurses ranged from less than 1 per cent in one agency to 37 per cent in another. Six of the agencies increased salaries more than 20 per cent, only one less than 10 per cent. In general there were larger increases in the lower grades of positions than in the higher. Included also in this issue of Public Health Nursing is a summary of a recent study of public health nursing salaries and vacancies by the U. S. Public Health Service. WHAT OUR READERS SAY In this issue we have a number of comments from Journal readers. Space forbids the publication of complimentary letters such as "I think such an attempt on the part of the Association to assist states and localities will be of inestimable value." We shall try, however, to publish all letters that throw light on the nature of the problem and the recommendations, direct or implicit, for its solution. A study of this month's correspondence reveals a number of knocks in the personnel machinery that may need attention along with necessary salary increases. Perhaps some of the correspondence will suggest that there needs to be a high grade community health education job on the value of public health service to the community. Has any one, for example, tried the technique that local housing authorities have used so effectively, namely illustrating graphically what poor health service, like poor housing, costs the community in epidemics, in infant deaths, in loss of working days, in later mental and other hospital care, even. in police and fire protection? Does a community expect its policemen to have an outside source of income? Should it expect its nurses and sanitarians to eke out inadequate incomes with week-end jobs-and incidentally to decrease their efficiency in their public health jobs? Another letter may suggest the virtues of an integrated budget that does not divide the employees into the sheep, goats, and sheep-goats of state, city, and state-city employees. Perhaps this, too, is a matter of citizen education in the desirable content of city health ordinances and state public health laws. State grants-in-aid to the community health department should not preclude an integration of the community's health program and personnel. A number of letters from readers follow: E. V. Thiehoff, M.D., Commissioner of Health, Peoria, Ill.: "The question of salaries is becoming more more and more a serious problem in the Peoria a

918 AMERICAN JOURNAL OF PUBLIC HEALTH City Health Department. We have tried to meet the increased cost of living by making an approximate 10 per cent increase in salaries during the past year for all staff positions except division heads. Then again we have increased the vacation period with pay this year from two to three weeks for all employees. Now we are proposing to go on a 40 hour, 5 day work week. This will give employees an opportunity to add to their present salaries by securing additional employment elsewhere over week ends. Nurses can make $10 for 8 hour duty in our local hospitals, and some of our nurses are already doing this on Saturdays and Sundays. " In spite of all that we have done, we are losing personnel because of what they consider as inadequate salaries. There is dissatisfaction on the part of many who are still with us. Our present salary range for public health nurses is from $145 to $210 per month, the lower salary being paid to beginning nurses with no public health experience or training. However, nurses just out of hospital training are offered $200 per month for a 40 hour week in one of our local hospitals. We cannot compete with that. One can easily appreciate how a nurse who is paid $150 per month in this department would find it difficult to make ends meet after having a salary deduction made for income tax plus a 3.5 per cent deduction as a contribution toward the Municipal Retirement Fund. After paying $10 per week for a room (apartments run much higher), and considering the high cost of food and clothes, there is not much left for insurance, recreation, etc. Certainly a nurse could not buy a car at present prices with such a salary. In fact, we are losing nurses, who are being paid as much as $185 per month, because they cannot get along on that amount and because they can get much more in doing hospital floor duty. "The range of salary for our sani- Sb July, 1947 tarians varies from $145 to $245 per month, depending upon training and experience. This of course does not include the director of the Division of Sanitation who is an engineer. The lowest salary now received by our sanitarians is $190, while the highest being paid is $225 per month. One can see that it would be difficult for a man with a family to live under acceptable standards on $190 per month. All of our sanitarians have outside sources of income to add to their salary which we pay, either by them or by wives working. "The range of salary for clerks is $80 to $150. We pay $120 as a starting salary to steno-clerks with experience. We are proposing to increase the salaries of all clerks and sanitarians by $10 per month, the salaries of our laboratory personnel by $15 per month, and the salaries of all nurses by $50 per month. The latter will mean that our salaries for nurses will vary from $195 to $260 per month. The new nurse with no public health training or experience will receive $195. However, this is still in competition with the $200 which she can get doing floor duty in a hospital. Then, too, in a hospital position there is no salary deduction made as a contribution toward a retirement fund. I find that the young nurse would rather have the cash than make the contribution for retirement, although in this city it is matched with an amount equal to twice what she pays and the entire amount draws interest and is paid to an individual leaving our employment. " I say advisedly that we are proposing these salary increases, for we have no money with which to pay the increases. After all, although our running costs have increased materially, our income or financial support has remained the same. Our department is supported by a one mill tax, plus certain state and federal funds. The latter are being reduced; therefore our only

SALARY INFORMATION Vol. 37 919 hope for securing more money with which to pay higher salaries is to secure an increase in tax funds by vote of the citizens. This is a very difficult thing to do. So shall we continue our present staff at present salaries and expect to lose a number of employees, or shall we cut the number of personnel, and cut our program, so as to be able to pay higher salaries? Do you have the right answers? Any help that your 'Clearing House' can give us would be appreciated." Wilson T. Sowder, M.D., Florida State Health Officer, has sent the Clearing House information about medical officers' salaries in Florida that may be both of interest and value to others. Between September, 1945, and March, 1947, official state and local health departments lost 20 full-time physicians -6 to private practice, 5 to other health agencies, and the remainder for other reasons-unknown, death, and retirement. During the same period it recruited 39 full-time physicians of whom 11 had had no previous public health experience; of the 28 with experience, 9 had had previous experience in Florida and 19 in other states. Only 4 came from other state health departments. As of March 1, 1947 there were 12 full-time physicians on the staff of the State Health Department and 38 in county health departments. The annual salaries of 11 were $7,200 or more; 21 received $6,000 or $6,600, and 18 received $5,700 or less. Only 6 were without formal public health training or without experience prior to September, 1945, and of the 6, 2 had had inservice training of 3 months or longer. In addition Dr. Sowder writes: "At the moment we have two vacancies for physicians at the state level and one at the local level, but we are losing two excellent health officers within the next few months. We will be opening several new county health departments on July 1, and our total need for health officers at that time will be about 8. " So far we have had no difficulty filling positions for sanitary engineers or sanitation personnel but we plan considerable expansion in this field on July 1. "We share a chronic shortage of nursing personnel along with the rest of the country, amounting to 15 to 20 per cent vacancies. The quality of applicants is not too good. We are also short of laboratory personnel and these positions are hard to fill. " We are fortunate in Florida in that none of our salaries are limited by statute as is the case in many states and, as a matter of fact, in some state agencies in Florida. Under our law the salaries of county health department personnel are set by the State Health Officer with the approval of the Board of County Commissioners. There is no definitely established procedure for setting the salaries of central office personnel, but it is customary to get the Board's approval for such increases particularly for the higher salaries. When it was decided to set salaries as high as $8,400, the Board felt it best to discuss the matter with the Governor although this was not required by law. " Two newspaper stories, one in June, 1946, and the other in January, 1947, indicate that it is sometimes a good policy for a state health officer to pay salaries higher than his own. It seems to have worked very well here twice but I have no plans for trying it again in the immediate future." William P. Scarlett, M.D., Health Officer, Little Rock, Ark.: " The employees of the Little Rock City Health Department are paid by the state and the city. We operate under a budget set up by the State Health Department according to Merit System Classification. The city matches funds allocated by or through the State Health Department. At the present time the state's

920 AMERICAN JOURNAL OF PUBLIC HEALTH July., 1947 contribution is somewhat greater. Some of our employees are paid entirely by the state, some entirely by the city, and some by both. " Due to the high cost of living, the city gave a mass increase to all city employees in September, 1946. Those earning $200 a month or less received a 12 per cent increase, those earning from $200 to $300, 7.5 per cent, and those earning more than $300, 5 per cent. Those paid entirely by the state were not included and those paid in part by the state received an increase only on the wage paid by the city. This caused a lot of ill feeling-e.g., an attendant received a nice increase in salary-more than some of the trained workers received who were being paid by the state and the city. The nurses who receive all their salary from the state received no raise at this time. "January 1, 1947, the Merit System for State Health Department employees was revised upward a step or so and personnel was classified accordingly. The mass city raise put some of our employees above the Merit System Classification. Those paid entirely by the city have profited, those paid by the state and* the city will not receive periodic increases from the state until they have absorbed the increase given by the city. Many of the employees paid entirely by the city cannot meet the minimum qualifications under the Classification plan. " In December, 1945, we lost an efficient well trained chief nurse because we could not raise her salary. She had been with our department for more than 5 years before going to school to complete her B.S. in Public Health Nursing. She was the first chief nurse of our department and had helped develop our nursing program. At that time $2,400 was the top salary. She resigned a couple of months after her return because she felt that she was worth more since she had received her degree. I believe I am correct when I say she had been with the State Health Department seven years before she came to the city. She was paid entirely from state funds after she became Chief Nurse of the City Health Department. " We are losing an efficient secretary June 1, primarily because her salary has not been adjusted for two years to the Merit System' Classification. The state feels the city should add the amount needed and the city stipulates salaries only by ordinance. We will not be able to replace the quality and quantity of work this person does at the salary she receives. She has been with the department 41/ years. "During the war years we did not have a sanitary engineer. The state budget is set up at $3,300 for a Senior Sanitarian. Last fall we had the opportunity of employing a well trained sanitary engineer and were successful in getting a city ordinance passed enabling the city to pay $3,600. "Last year it was also necessary to start paying a PBX operator two steps up instead of the starting salary, while we have a clerk who has been with the department for more than 5 years and does practically the same work but receives a smaller salary. "The salary for the director of the local health department is now $6,000 per annum. The state pays its share, but city ordinance has not been revised to meet the Merit System Classification. I could cite other cases in the department similar to mine. " The City Comptroller has passed the word for all departments to cut budgets 10 per cent. We are certainly trying to do this without cutting salaries, but there is no way I know of to raise salaries from city funds at the present time."