Establishing Salary Benchmarks for Occupational s Working in Family Health Teams Recommendation from the Profession January 2010 The Ontario Society of Occupational s (OSOT) is extremely pleased that the occupational therapy profession forms part of the new Family Health Teams structure and is committed to working the Ministry of Health and Long-Term Care (MOHLTC) to ensure the success of the Family Health Teams concept. We share enthusiasm for the MOHLTC goal of collaborative interdisciplinary excellence in primary health care. The Society has been asked to provide recommendations to assist in the formulation of salary funding benchmarks for an occupational therapist in a Family Health Team. We offer the following recommendation and rationale with a goal of assisting the Ministry to attract qualified occupational therapists who will lend meaningful experience and strength to the FHT, enabling increased diversification of service programs and increased efficiency and cost-effectiveness in the Team s ability to meet the needs of the people it serves. RECOMMENDATION: The Ontario Society of Occupational s recommends that occupational therapists employed by Family Health Teams in Ontario be compensated on the basis of a 37.5 hour work week within a salary that recognizes experience and contribution in a range between $70,200 and $78,000 per annum. Additionally, a competitive benefit program, paid vacation and support for continuing professional development would complement the total compensation package. BACKGROUND AND RATIONALE: In formulating our recommendation the following have served as guiding principles to the process. We acknowledge the following will be taken into account; 1. The budgetary restraints of the Family Health Team organization 2. The nature of work of the Family Health Team setting 3. The historical total compensation relativities that exist within the health care professions in Ontario. E.g. nurses, social workers 4. The relative total compensation received by OTs elsewhere in the health sector in Ontario. E.g. OTs in hospitals, CCACs 5. The need to attract and retain the appropriate levels of OT experience and capabilities
Occupational s and Family Health Teams Occupational therapists will be newly funded in the province s Family Health Teams. For the purposes of benchmarking salary ranges, it is important to consider the practice characteristics expected of professionals who will be attractive recruits to join interdisciplinary, collaborative teams that assume key roles to develop new, comprehensive community-based chronic disease management and self-care programs, emphasize health promotion, illness prevention and early detection/diagnosis; provide system navigation and care coordination, linking patients to other parts of the health care system; and to provide patient-centred care where the patient is a key member of the team. (from Roadmap to Implementing a Family Health Team, July 2009, MOHLTC) OSOT proposes that occupational therapists working in Family Health Teams will need to; work autonomously, perhaps as a sole OT, effectively promoting and sharing the contributions occupational therapy can make to the effective management of patient needs on an individual, roster and community level. work in both a clinic and community-based environment have strong program development skills and competencies be collaborative, interprofessional team players with strong communication skills have knowledge of the community and community resources to support the health and well-being of FHT patients. be an expert generalist whose knowledge base is substantiated with experience The diversity of services that an occupational therapist may provide in a Family Health Team is a significant factor relating to compensation. It is anticipated that patients with more complex health issues and/or co-morbidities will form the key focus of OT attention. Although incomplete, and offered only to provide example of the types of services an OT could provide for patients of a FHT, the following list underlines the diversity of skillsets and experience base required of a FHT occupational therapist; Mental health support, counselling or psychotherapy Screening of children with learning problems Chronic pain management Assessment for driving safety Home safety assessments for seniors Wheelchair/mobility consultation/assessment Assistive device consultation/assessment Assessment for long-term care placement Assessment for disability tax credit Chronic disease self management programs Falls prevention programs Aging at home education, consultation, assessment, Cognitive/perceptual assessments Assessments for independent living Support/education for caregivers 2
For all the above reasons, OSOT recommends that ideal candidates for FHTs would be experienced clinicians with community based experience with demonstrated leadership and program development skills. Assumptions made in relation to benchmarking OT salaries in FHTs In formulating recommendations relating to salary benchmarks for OTs in Family Health Teams, the Society has worked with the following assumptions which should be considered as essential qualifiers to the proposed salary range. a) it is essential to consider the salaries of occupational therapists working across all health sectors when factoring a range for OT compensation in FHTs. b) roles that require autonomous, program development focused practice with a strong understanding of the context of community based practice and resources are best suited for clinicians who bring experience to their employer. To this end, OSOT recommends a minimum of 3-5 years experience. c) Health professionals that travel to client homes and workplaces assume, by the nature of their work, an element of risk that is not consistent across all practice environments. Risks related to travel or unknown or unforeseeable conditions or situations in a client home are factors that should be considered in benchmarking salaries of professionals who travel to serve clients in their own environment and insurance needs of the FHTs. d) competitive compensation for occupational therapists working in a FHT would be based on both a salary and an employment benefits package. This notwithstanding, the Society acknowledges that there may be situations and opportunities for which a FHT may contract an independent contractor to provide OT services. We have not addressed a contractual model per se. e) Annual cost of living adjustments are important commitments to ensure that salaries retain value and are competitive. OSOT makes the assumption that there will be regular review of salary benchmarks across all professional groups. To this point, we clarify that the Society has been limited in our review to salary information that to some extent is dated by virtue of data collection dates. f) The Society makes the assumption that costs related to various work related items such as the following would be assumed by the FHT; o o Workspace clinic space, desk, computer, filing space Travel mileage reimbursement for community based assessment, treatment based on existing benchmarks g) There are 4500 occupational therapists reported registered with the College of Occupational s. Unemployment is not a significant factor in the profession. Salaries can be expected to compete with other publicly funded practice sectors as well as the private sector marketplace. 3
What do Ontario Occupational s earn? The Society has relied on the following data sources; OSOT Member Compensation Survey 2008/2009 Ministry of Health and Long-Term Care Family Health Team Guide to Interdisciplinary Provider Compensation, May 2009 Developing a Provincial Compensation Structure, Final Report Submitted to: Association of Ontario Health Centres, Hay Group Health Care Consulting, July 2009 a) OSOT Member Compensation Survey 2008/2009 The Ontario Society of Occupational s collects compensation data submitted voluntarily by members in their annual membership renewal process. As membership renewal occurs in October of each year, the referenced data is largely representative of input in October 2008 and is based on responses of 2637 practising occupational therapists who work across the province. 50% of respondents reported their primary work to be in the publicly funded health care system, 41% reported funding in the private sector health care system and 9% reported funding for their roles came from other sources. It should be asserted that the data collection mechanism is voluntary. The data reflects compensation on the basis of an hourly range. There are some inherent flaws in these processes which can be overlooked for the purposes of the Society which is to gather a general picture of OT compensation and trends over time. It is difficult, however, to be exact in interpretation. For example, hourly ranges span $4/hour a difference that can be quite substantive (e.g. $65,520 72,800 represents one band selection). Given these restrictions for accurate data interpretation we urge consideration of this data in relation to other data considered. Key findings of the 2008 2009 survey identify; The most commonly reported range of compensation reflected on a per hour basis was $36/hour - $40/hour ($70,200 - $78,000, based on 37.5 hours/week) across all employment settings and experience ranges for salaried respondents (See Table 1 below) The most commonly reported hours of paid work per week was 37.5 Benefits offered to salaried/contract positions in private/public sectors (see Table 2 below) Hourly wage by practice setting, job title (see Table 3 below) Amongst self-employed OTs who charged a mileage rate, the most common rate indicated by respondents was between $0.41 0.60/km. 4
Table 1: Hourly Wage Reported by Members Employed in Publicly and Privately Funded Sectors Wage Public Private Total $0-$19 0 0 0 $20-$25 7 0 7 $26-$30 90 24 114 $31-$35 309 69 378 $36-$40 482 71 553 $41-$50 48 39 87 $51-$60 2 9 11 $61-$70 5 4 9 Over $70 2 4 6 Total 945 220 1165 Table 2 Benefits The data survey asked members to check all of the employment benefits that applied to them. Therefore, multiple selections were allowed. 5
Table 3: Hourly Wage by Practice Setting, Job Title This section shows a breakdown of the hourly wage received by occupational therapists based on work setting, job title Please note this includes private and public sector responses. Community Setting Institutional Environment Other Wage Staff Senior Manager/ Director Staff Senior Manager/ Director Staff Senior $0-$19 / hr 1 1 0 0 1 0 0 0 0 $20-$25 / hr 8 1 0 3 0 0 0 0 0 $26-$30 / hr 113 9 2 114 6 2 26 2 0 $31-$35 / hr 249 15 7 333 13 1 45 3 1 $36-$40 / hr 179 19 14 510 21 11 29 7 1 $41-$50 / hr 48 15 15 41 16 24 11 6 9 $51-$60 / hr 18 4 9 7 0 5 3 2 4 $61-$70 / hr 3 2 5 5 2 3 1 0 3 Over $70 / hr 3 2 8 0 3 4 0 1 8 Total 622 68 60 1013 62 50 115 21 26 Total by setting 750 1125 162 Manager/ Director b) MOHLTC Guide to Interdisciplinary Provider Compensation The May 2009 Guide to Interdisciplinary Provider Compensation for Family Health Teams does not reference occupational therapy. However, this reference was reviewed to consider the benchmarks provided for other health professionals employed by FHTs. In 2006 a similar guide was published that included reference to occupational therapists. Salaries reflected in this guide are dismissed as dismally outdated but it is noted that amongst other health professionals, occupational therapists and social workers were ranked with the same minimum salary. Interestingly the maximum salary for each of these professions differed by $10,200 with social workers potentially earning considerably more than an occupational therapist. We trust that this differential reflects the acknowledgement of the master level training which is now noted in footnote 9 of Appendix A (page 6) of the 2009 guide. It would be our assumption that this recognition would now extend to occupational therapists who are also educated at the masters level. c) Hay Group Report to Association of Ontario Health Centres In July 2009 Hay Group Health Care Consulting undertook a review of compensation levels for Ontario Community Health Centres for the purposes of establishing 6
compensation levels as a provincial sector in the new LHIN environment. They conducted; A salary review of management and non-management positions to support the development of a provincial salary structure (note, OT was not included in the specific review survey) A market review of positions typically unionized, based on cost of living increases union contract negotiations and available salary data A review of selected benefits and hours of work A review of supplemental market data using published sources Their final report recommends a provincial compensation program that has, we believe, relevance to the Family Health Team sector. Amongst the review findings that are relevant to benchmarking OT compensation in FHTs, we note; On an overall average, Community Health Centre (CHC) compensation maximums are below market ( 16 organizations representing a cross section of types of community agencies and other broader public sector organizations) by 14% The 50 th percentile reported by the market for the cost of benefits was 23% of payroll In comparison to data accessed from the Ontario Hospital Association Salary Survey, on average, the CHC compensation maximums are below the hospital sector market by 16%. In comparing CHC data to the OHA data, a salary maximum for OT in the CHC sector was compared to the 50 th percentile of the OHA data. The occupational therapist salary maximum was 15% below the OHA P50. ( $65,103 as compared to $77,025) Recommendations Further to review of the OSOT compensation survey data and the OHA data reflected for OT in the Hay Report, we believe that it is fair to extrapolate that a common salary range for occupational therapists in Ontario is based commonly on a 37.5 hour work week and is $70,200 - $78,000. This acknowledges that some OTs will make more and some less but that this range can be substantiated by data. This is consistent with the OSOT data that reports the most common hourly rate range across all sectors and experience is $36 - $40 per hour. We note the MOHLTC Guidelines suggest that Family Health Teams may establish a benefit package for employees which may include, but is not limited to, extended health and dental care, accidental death and disability, vision care, and/or a registered pension plan. OSOT would position that this is critical to attract health professionals who are typically provided such benefits or are compensated in lieu. Paid vacation commensurate to hospital sector policies would be an expectation. Compensation/accommodation for professional development is a benefit noted as the fourth most common employment benefit in the OSOT survey. The Hay report 7
references the cost of benefits reported by the 50 th percentile of the studied market to be 23% of payroll of the organization. RECOMMENDATION: The Ontario Society of Occupational s recommends that occupational therapists employed by Family Health Teams in Ontario be compensated on the basis of a 37.5 hour work week within a salary that recognizes experience and contribution in a range between $70,200 and $78,000 per annum. Additionally, a competitive benefit program, paid vacation and support for continuing professional development would complement the total compensation package. 8