Dr. Jim McDonald expertly explains complex public health topics during the COVID-19 pandemic and shows how the virus spreads in a jar of jelly beans . one viral video — catapulted him to stardom among Rhode Islanders.
His explanation for why Rhode Island has been without a permanent state health director for more than two years is much simpler and requires no visual aids.
“It's not rocket science. It's a paycheck,” said McDonald, who spent 10 years at the Rhode Island Department of Health, including as interim director in the first half of 2022. He resigned in July 2022. Due to family health issues.
He said in an interview Friday that salary had no influence on his decision to resign.
Based on the $150,000 salary of the RIDOH director, who is included in Rhode Island's health commissioner position, this is the amount that Mr. MacDonald currently earns as New York state health commissioner and what he would have earned for the same job in Rhode Island. There is a salary difference of $70,000 between the amount and the amount paid. Budget proposal for fiscal year 2024.
The state's last permanent health director, Dr. Nicole Alexander Scott, earned an even lower salary when she resigned in January 2022, at $143,000, according to the state's salary database.
Health leaders have long lamented the lack of competitive pay for Rhode Island's top doctors compared to other states and the private sector. It looks like Gov. Dan McKee is finally listening.
McKee as one of his FY2024 supplementary budget Announced in January with the 2025 budget proposal, it called for exempting RIDOH executive salaries from the annual public hearing and legislative review process that determines department heads' salaries. Instead, Mr. McKee proposed setting the RIDOH director's salary for 2024 himself.
This is a rare but not unprecedented move. A similar exemption was granted to the salary of the director of the Rhode Island Department of Children, Youth and Families in 2023. The position lasted four years without a permanent director until Ashley Deckert was hired. In May 2023. Deckert earns $180,000, according to the state's payroll database.
It's not rocket science, it's pay.
– Dr. Jim McDonald, former Interim Director of the Rhode Island Department of Health, current New York State Health Commissioner
McKee's proposal for RIDOH directors does not include actual salaries or indicate that giving the governor salary-setting authority would guarantee higher incomes.
McKee spokeswoman Olivia D'Arocha said in an email Friday that the proposal provides “pay flexibility.” The level of expertise required in a competitive market. ”
Four other state cabinet positions also lack permanent leaders: Rhode Island. The Department of Corrections, Department of Energy Resources, Office of the Commissioner of Health Insurance, and Department of Behavioral Health, Developmental Disabilities, and Hospitals, according to information from the Department of Administration.
But RIDOH faces additional pressure. That's not only because it's the longest-running vacancy, but also because the interim leader is stepping down.
What happens after March 31st?
The day after McKee announced his budget. Dr. Utpala Bandi has submitted his resignation. Bundy will be named interim state health director in June 2023 and will retire from the state position on March 31. According to a letter dated January 19th To the Executive Secretary Richard Charest Department of Health and Human Services (EOHHS). The letter, obtained by Rhode Island Current, does not explain why she is retiring.
The average tenure for a state health director is typically about three years, said Dr. Marcus Plescia, chief medical officer for the Association of State Health Officers. But Rhode Island is an outlier in the length of time it has been without a permanent health director.
“There's a lot that's appealing or compelling about one of these roles, so they tend to be somewhat popular positions,” Plescia said.
Even after the coronavirus pandemic, prompted a mass exodus Plescia said many public health leaders still welcome the opportunity to take a leadership role in state health departments, especially amid an influx of federal funding and increased public awareness of the importance of public health. said.
While news reports have detailed political backlash and even death threats against public health officials across the country during the pandemic, McDonald said he has never had a negative experience with state officials or residents in Rhode Island. He said there was no such thing. Instead, he was treated like a local celebrity, stopped by people on the street who recognized him from his televised press conferences.
MacDonald's predecessor, Alexander Scott, referred questions to the current state health department spokesperson for comment. Her resignation letter offered little explanation for her decision to step down after seven years on the job.
However, some believe that tensions between Alexander Scott and Mackie over masking policies and the response to new variants may have prompted Mackie to resign.
“State health departments used to be kind of sacrosanct,” said Dr. Michael Fine, who served as state health director from 2011 to 2015. And governors felt they were going to dictate what happens to protect public health. ”
And the perceived erosion of the state health director's authority may be one reason Rhode Island is unable to find a replacement, Fine said.
Like MacDonald, Fine said uncompetitive pay is a “big challenge.”
Among the six states with centralized state health departments and populations of less than 2 million people, the average director salary was $186,397. Information collected by Association of State and Territorial Health Officials.
Temporary changes raise questions
Fine agreed that Rhode Island's health director needs more funding, but he's not sure McKee's proposal to exempt salaries from the annual legislative review for one year is the answer. I couldn't have it.
“What happens when the year is over? Will it go back to the lower amount?” Fine asked.
Unlike most cabinet-level positions, state health directors serve on a fixed five-year contract. State law requires standing Must be staffed by an individual with a medical degree, certificate or degree in public health, or board certification in a medical specialty and at least five years of experience in the health care field.
Chris Gadbois, CEO of the nonprofit CareLink Inc. and former president of the Rhode Island Public Health Association, said the terminal degree requirement made him a potential candidate, especially given his existing salary. He said that there may be restrictions.
However, both Fine and MacDonald emphasized the importance of academic and professional requirements for the job. That includes managing a staff of 500 people with an annual budget of about $320 million and a wide range of responsibilities ranging from community health services to hospital oversight. In addition to responding to crises such as the pandemic, the company will also deal with divestitures and mergers.
Even before taking over as interim health director, McDonald recalled the long hours and constant stress of working at RIDOH during the COVID-19 outbreak.
“Every day starts at 5 a.m. and ends at 10 p.m.,” he said, adding that the only day he didn't work in 2020 was Christmas. “It would just take hours and we didn't have enough resources to fix the problem.”
MacDonald's run at the New York City Department of Health, which he was appointed to in January 2023, feels easy by comparison, largely because the immediate coronavirus crisis has passed. He finishes his work by 5pm almost every day and spends his evenings exercising and playing with his family. Every weekend, he visits his mother, who has Alzheimer's disease, in a nursing home and invites his father over for dinner.
McDonald still appears on TV to talk about his public health efforts, but he has yet to use a jar of jelly beans.
“I don't really worry about politics or anything other than the best advice I can give as the state's physician,” he said. “I approach every conversation the same way.”
Despite the stress associated with performing in Rhode Island, McDonald praised his stay in the Ocean State, including his interactions with state leaders and health officials. He never felt that his title “interim” diminished his authority or ability to get things done.
But Fine, who also served as interim director of RIDOH before being appointed permanent director, described a contrary experience.
“When you're a temporary worker, you're basically a babysitter,” he says. “I tentatively thought my role was just to make sure we got through the day without making a mess. I wasn't planning or thinking about the future.”
This kind of visionary leadership and authority is more important than ever for the state's struggling health care environment, crippled by workforce shortages and a series of failed hospital mergers and divestitures. There is.
one man army
Dr. Jody Rich, a professor of medicine and epidemiology at Brown University, said Rhode Island is also unique in that unlike other states, it doesn't have a city or county public health authority.
“In most states, the entire military is in charge of public health,” he says. “It's absolutely disgraceful that there's only one in the whole state.”
Rich is not convinced that the solution to Rhode Island's difficulty hiring a permanent health director is to raise salaries, noting that higher salaries do not necessarily correlate with higher quality candidates. He pointed out that there was no.
Instead, Rich emphasized the need for McKee to prioritize public health, respect the health director's authority on the issue and attract qualified candidates.
DaRocha said the administration has interviewed two candidates for the position since McDonald resigned and Bundy was appointed interim secretary, both of whom received referrals from within the state.
Asked about the next steps in the investigation, since Bundy also filed a notice, D'Arocha said hiring a new board member was a “top priority” for his administration. She did not provide details on the schedule, but said the process was “ongoing.”
Mr. McKee's request to exempt RIDOH directors' salaries from the annual review requires parliamentary approval.
In a joint statement, House Speaker K. Joseph Shekarchi and Senate President Dominic Ruggerio did not change their stance. In a joint statement emailed Friday, the companies said McKee's proposal “will be considered as part of the overall budget process.”
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