McKee calls for salary flexibility to help fill state health director role

Dr. Jim McDonald’s skillful explanations of complicated public health topics during the COVID-19 pandemic showing how the virus spreads with a jar of jelly beans in one viral video propelled him to stardom among Rhode Islanders. 

His explanation for why Rhode Island has gone without a permanent state health director for more than two years is a lot simpler, and doesn’t require visual aids. 

“It’s not rocket science, it’s the salary,” said McDonald, who worked for 10 years for the Rhode Island Department of Health, including as its interim director for the first half of 2022. He resigned in July 2022, citing family health problems. 

Salary played no part in his decision to leave, he said in an interview on Friday. 

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A $70,000 pay difference exists between what McDonald earns now as New York state health commissioner and what he would have made for the same job in Rhode Island, based on the $150,000 RIDOH director salary included in Rhode Island’s fiscal 2024 budget. 

The state’s last permanent health director, Dr. Nicole Alexander-Scott, was paid even less at the time she stepped down in January 2022: $143,000 according to the state payroll database. 

Health leaders have long lamented the noncompetitive salary for Rhode Island’s top doctor relative to other states and the private sector. Gov. Daniel J. McKee appears to finally be listening. 

McKee as part of his revised fiscal 2024 budget unveiled in January along with the proposed fiscal 2025 budget, called for exempting the RIDOH director salary from the annual public hearing and legislative review process that sets department director pay. Instead, McKee proposed setting the RIDOH director salary himself for 2024. 

It’s a rare, but not unprecedented move — the same exemption was given in 2023 for the salary for the R.I. Department of Children, Youth and Families director, a post that went four years without a permanent director until the hiring of Ashley Deckert in May 2023. Deckert earns $180,000, according to the state payroll database. 

McKee’s proposal for the RIDOH director does not include an actual salary or indicate that giving the governor salary-setting power would guarantee higher earnings. 

Olivia DaRocha, a McKee spokesperson, said in an email Friday that the proposal offers “salary flexibility,” citing the “ level of expertise needed in a competitive marketplace.” 

Four other state cabinet jobs are also without permanent leaders: the R.I. Department of Corrections, the Office of Energy Resources, the Office of the Health Insurance Commissioner and the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, according to information from the Department of Administration.  

But RIDOH faces extra pressure, not just because it’s the longest running vacancy, but because the temporary leader is on her way out. 

One day after McKee unveiled his budget proposal, Dr. Utpala Bandy submitted her resignation notice. Bandy, who was tapped as interim state health director in June 2023, will retire from state service on March 31, according to the Jan. 19 letter to Richard Charest, Secretary of the Executive Office of Health & Human Services (EOHHS). The letter, which was obtained by Rhode Island Current, does not explain why she is retiring. 

The average tenure of a state health director is usually about three years, said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officers. However, Rhode Island is an outlier in the length of time it has gone without a permanent health director. 

“They tend to be somewhat sought-after positions because there’s a lot that can be appealing or compelling in one of these roles,” Plescia said.  

Even after the COVID-19 pandemic, which prompted a mass exodus of public health leaders, there are still many who would relish the opportunity of a leadership role at a state health department, especially amid an influx of federal funding and an improved public recognition of the importance of public health, Plescia said. 

News reports detailed political blowback and even death threats against public health officials nationwide during the pandemic, but McDonald said he never had a negative experience with state officials or residents in Rhode Island. Instead, he was treated like a local celebrity, stopped by people on the street who recognized him from televised press briefings. 

Alexander-Scott, McDonald’s predecessor, referred inquiries for comment to the current state health department spokesperson. Her resignation letter offered little explanation for her decision to step down after seven years on the job. 

But some believe tensions between Alexander-Scott and McKee over masking policies and responses to new variants may have prompted her to leave. 

“State health departments used to be kind of sacrosanct,” said Dr. Michael Fine, who served as state health director from 2011 to 2015. “Under COVID, we saw all these examples where all of a sudden, that authority didn’t matter and the governors felt like they were going to dictate what was going to happen to protect public health.” 

And the perceived undermining of a state health director’s authority could be one reason why Rhode Island can’t find a replacement, Fine said. 

Like McDonald, Fine also pointed to a noncompetitive salary as a “huge challenge.” 

Of the half-dozen states with a centralized state health department and a population of less than 2 million people, the average director salary was $186,397, according to information collected by the Association of State and Territorial Health Officers.  

Fine agreed that Rhode Island’s health director needed more money, but wasn’t sure McKee’s proposal to exempt the salary from annual legislative review for a single year was the answer. 

“What happens after that year is over? Does it revert back to a lower amount?” Fine asked. 

Unlike most cabinet level positions, the state health director works under a fixed, five-year contract. State law requires the position be filled by someone with a medical degree, as well as a certificate or degree in public health or board certification in a medical specialty, and a minimum of five years of experience in health administration. 

Chris Gadbois, CEO of nonprofit Carelink Inc. and past board president of the Rhode Island Public Health Association, said the terminal degree requirement could limit the pool of potential candidates, especially given the existing salary. 

But Fine and McDonald both stressed the importance of academic and professional requirements for the job, which includes managing a 500-person staff with a nearly $320 million annual budget, and a wide-ranging set of responsibilities ranging from community health services to oversight of hospital sales and mergers in addition to responding to crises like a pandemic. 

Even before he took over as interim health director, McDonald recalled the long hours and constant stress of working for RIDOH when COVID-19 hit. 

“You start every day at 5 a.m. and end at 10 p.m.,” he said, adding that the only day he did not work in 2020 was on Christmas. “It’s just a marathon of hours and there weren’t enough resources to solve the problem.” 

Running New York’s health department, a post to which McDonald was named in January 2023, feels like a breeze by comparison, mostly because the immediate crisis of COVID-19 has dissipated. He gets out of work by 5 p.m. most days, spending his evenings working out and hanging with his family. Each weekend, he visits his mom, who has Alzheimer’s disease, in a nursing home, and hosts his dad for dinner. 

McDonald still makes TV appearances to talk about public health efforts, though he has yet to employ a jar of jelly beans.  

“I tend not to worry about the politics or really about anything other than what is the best advice I can give as the state doctor,” he said. “I approach every conversation the same way.” 

Despite the stress that the Rhode Island gig entailed, McDonald spoke highly of his time in the Ocean State, including interactions with state leaders and health officials. He never felt the “interim” of his title weakened his authority or ability to get things done. 

But Fine, who also served as an interim director before he was appointed as permanent RIDOH head, described an opposite experience. 

“When you’re an interim, you’re basically a babysitter,” he said. “I saw my role as interim as just not messing it up, making sure we can get through the day. I wasn’t planning and thinking for the future.” 

That kind of visionary leadership and authority is more critical than ever for the state’s struggling health care landscape, which has been crippled by workforce shortages and a series of failed hospital mergers and sales. 

Rhode Island is also unique in that, unlike other states, there are no city or county public health officials, said Dr. Jody Rich, a professor of medicine and epidemiology at Brown University. 

“Most states have a whole army in charge of public health,” he said. “We have one person for the entire state, which is just shameful.” 

Rich wasn’t convinced that a higher salary was the answer to Rhode Island’s difficulty in hiring a permanent health director, pointing out that higher pay doesn’t always correlate to higher-quality candidates. 

Instead, Rich emphasized the need for McKee to prioritize public health, and respect a health director’s authority on the subject, to attract a qualified candidate. 

Since McDonald left and Bandy was named interim director, the administration has interviewed two candidates for the job, both of whom were referred from within the state, DaRocha said. 

Asked about next steps in the search now that Bandy has also put in her notice, DaRocha said hiring a new director was a “top priority” for the administration. She did not give details on the timeline but said the process was “ongoing.” 

McKee’s request to exempt the RIDOH director salary from annual review requires the legislature’s approval. 

In a joint statement, House Speaker K. Joseph Shekarchi and Senate President Dominick Ruggerio remained noncommittal. In a joint emailed statement Friday, they said McKee’s proposal “will be considered as part of the overall budget process.” 

 Nancy Lavin is a staff writer for the Rhode Island Current.