Gov. Daniel J. McKee is asking state lawmakers for permission to negotiate a higher salary for the job of state health director, which currently pays less than the average doctor in their first year out of residency training.
The health director post has been vacant since January 2022, when Dr. Nicole Alexander-Scott resigned. Five months later, Dr. James V. McDonald, then-interim health director, left Rhode Island and became health commissioner for New York State.
Now, the state’s second interim health director, Dr. Uptala Bandy, is poised to retire next month. And McKee has yet to name a permanent replacement.
“The fact that this job isn’t filled is a symptom of a much larger problem,’’ said Amy Nunn, executive director of the Rhode Island Public Health Institute, a nonprofit research group. “Most health department directors have stepped down since the pandemic because everyone was dramatically overworked and many people underpaid.’’
The COVID pandemic prompted the largest exodus of public health officials in the country’s history, leaving many states without critical leadership.
The public health emergency ended. But in Rhode Island, the leadership vacuum remains.
The state health director oversees a range of health and safety practices, from food safety in restaurants and grocery stores to medical standards in hospitals, health centers and doctor’s offices. And the director is at the center of responding to a public health emergency like the COVID pandemic.
But faced with a nationwide primary care shortage, finding qualified candidates for the top health department job has become increasingly difficult.
No national search
The governor has sole authority to appoint the health director. The McKee Administration confirmed that it did not conduct a national search, as done in Maine when its top health official left in 2023 to work for the U.S. Centers for Disease Control and Prevention.
The McKee Administration did not respond to a question about how many people applied for the health director’s job, though Olivia DaRocha, a McKee spokeswoman, said in an email that all of the applicants are “in-state.”
“As is often the case with senior level cabinet positions, candidates are often referred to the Administration based on their expertise and experience,” DaRocha said. “That was the case for this process.”
The governor so far has interviewed two candidates. “The discussion around the specifics of salary is ongoing,’’ DaRocha said.
The health director’s salary in 2022, when Alexander-Scott resigned, was budgeted at $150,764. Last September, after appointing a second interim health director, McKee submitted a salary schedule to state lawmakers that increased the health director’s annual salary to almost $175,400 effective last May.
The salary – $175,383 – is about $3,900 more than the 2022 median salary of $171,525 for state health directors in Rhode Island and five other similar sized states with centralized health departments, according to the most recent available data from the nonprofit Association of State and Territorial Health Officials (ASTHO). (The other states were Delaware, District of Columbia, Maine, South Dakota and Vermont.)
But the health director’s salary could still change. A bill pending before the House Finance Committee would allow the governor to determine the health director’s salary for 2024. As of Friday, no vote had been scheduled.
MD required
State law requires the health director to have an MD and at least five years full-time experience in health administration.
In Rhode Island, a doctor fresh out of medical residency training with no experience can earn a base salary of about $190,000 at a federally-qualified health center, according to Elena Nicolella, president and CEO of the Rhode Island Health Center Association (RIHCA). And that’s not including loan repayment programs, “signing bonuses and other enticements,” she said in an email.
And pay rises with experience. Nationwide, the median salary for a chief medical officer at federally-qualified nonprofit health centers in 2022 was $250,000, according to the latest report from the National Association of Community Health Centers. And compensation tends to be significantly higher, experts say, at the private nonprofit health systems.
“It’s hard to recruit someone,’’ said Nunn, of the Rhode Island Public Health Institute, “when they may be cutting their salary in half or even more for some people.”
One way to recruit more candidates for the job, Nunn said, would be to remove the requirement that applicants have a medical degree.
“Clearly the person needs to have a lot of background in health,’’ she said, “but there are other degrees that could be equally relevant like a doctoral degree in public health, someone with an MBA that understands healthcare administration career public servants who’ve been working in public health might also be good fit for the role.”
Of the five other states that ASTHO said has comparable health departments for measuring directors’ salaries, only South Dakota’s top health official has no MD. Secretary of Health Melissa Magstadt is a nurse with an MBA who was also a member of South Dakota’s House of Representatives. The top health officials in the other four states – Vermont, Maine, Delaware and the District of Columbia – all have medical degrees.
Removing the MD requirement for health director in Rhode Island would be a mistake, said Dr. Michael Fine, who was health director in Rhode Island from 2011-2015.
The health director is also chair of the state Board of Licensure Discipline, which oversees how all medical professionals practice – including physicians.
Fine recalled a case that came before the board when he was director that involved a surgeon who was operating on a seven-day-old baby with a rare congenital defect. The surgeon made a decision in the operating room, Fine said, to use a medical device in a way that it wasn’t designed to be used. And the board, he said, was considering disciplining the surgeon.
But when he read the surgical report, Fine said, he had the medical training to understand what the surgeon was attempting to do. “This surgeon in the OR realized that there was only one way to save this kid’s life,’’ Fine said. “And I turned to the folks in the department and said, ‘This surgeon is a hero!’’’
The governor’s office has provided no timeline for hiring a permanent health director. Dr. Bandy, the interim director, has notified the Administration that she plans to leave her post on March 31.
Clarification: A doctor fresh out of medical residency training with no experience can earn a base salary in Rhode Island of about $190,000. An earlier version of this story omitted the reference to residency training.