After a monthslong search, Cook County Health found its new leader right back at home, with the current interim CEO getting elevated Thursday to the permanent job.

The Cook County Board affirmed a search committee’s pick, appointing Dr. Erik Mikaitis to oversee management of Stroger and Provident hospitals, a network of more than a dozen clinics, and the county’s Medicaid managed care program, CountyCare.

He inherits a proposed $5.2 billion budget for 2025 and a workforce of roughly 7,600. Though the system has faced significant financial hurdles in recent years — including high costs for providing free care — 2025 is the first year in recent history the county’s health fund does not have a projected deficit.

CCH has struggled, however, to fill vacant positions and relied on costly agency staff to fill in the gaps, angering union leaders and some county commissioners. The system has 1,700 vacancies and plans to spend $200 million on agency staff by the end of this year, CCH spokeswoman Alexandra Normington said, and agency staff spending makes up about 18% of CCH’s budget for personnel.

In September, 1,345 agency staff worked at the system. The county made 1,667 employment offers through September this year. Of those, 1,007 accepted, and 631 external hires were brought on, Normington said.

On the same day the board approved Mikaitis’ appointment, commissioners introduced a non-binding resolution aimed at limiting the use of agency staffing to 20% of the budget for full-time employees for each job classification across CCH.

“Since 2018, CCH has awarded $500 million to private, out of state agency contracts, receiving exorbitant pay as they work alongside unionized workers,” said Dian Palmer, president of SEIU Local 73. Not only do some agency staff earn more than unionized workers, they “lack experience and institutional knowledge,” Palmer said, urging commissioners and Mikaitis to address it.

Mikaitis had been interim CEO since Israel Rocha, who helped lead CCH through the back half of the pandemic, left for a job at Kaiser Permanente in late 2023. His elevation is a return to a historic trend of physician leaders. CCH’s mission is to care for patients regardless of their ability to pay.

“The simple question that drives me is, ‘How can I make things better for both those we serve, and those who are doing the work?'” Mikaitis told commissioners Wednesday during a late hearing approving his appointment and compensation package.

Mikaitio joined CCH in 2022, charged with quality control and compliance. He was previously vice president and chief medical Officer for Franciscan Health Crown Point and medical director of Franciscan’s Accountable Care Organization in northern Indiana and south suburban Chicago. Mikaitis is an internal medicine physician who grew up on the city’s South Side. He also holds a business degree from DePaul University.

“We look forward to the continued growth and success of the hospital system under his leadership. In the 14 years that I’ve had this job, he will be the seventh leader. I teased him the other night by saying I hope he’s committed to this for the next decade,” because the system needs stable leadership, Board President Toni Preckwinkle told reporters after his appointment was approved.

Mikaitis’ annual salary will be $713,000 with the option of annual bonuses of up to 10%, subject to approval by the health system’s board.

There was far more board strife over the choice to lead the County Board’s Health and Hospitals Committee, a position that also traditionally guarantees a spot on the independent CCH board helping steer policy and form the CCH budget.

Commissioner Bill Lowry got the spot Thursday with Preckwinkle’s backing. But not before Commissioner Alma Anaya mounted her own campaign to win it in a face-off more befitting the raucous Chicago City Council than the usually low-drama County Board under Preckwinkle’s leadership.

Anaya, one of the board’s progressives and the current vice chair of the committee, had been de-facto leader since the late Commissioner Dennis Deer’s illness and death.

She made a full-court press to take over permanently in recent months, formally requesting the spot in August. Anaya sent a letter of support earlier this month to Finance Chairman John Daley and Preckwinkle signed by 55 fellow elected officials, including her mentor, U.S. Rep. Jesus “Chuy” Garcia.

Preckwinkle, however, wanted Lowry to get the post. Lowry is a close Preckwinkle ally believed by many commissioners to be her heir apparent as board president after Preckwinkle retires.

In a response letter shared with the board, Preckwinkle told Anaya the chairmanship “has traditionally been held” by a commissioner who represented either Stroger or Provident Hospital, a “long-standing practice” Preckwinkle said she was committed to. Lowry’s district includes Provident. That assertion rankled some fellow board members, who argued qualifications, not geography, should determine who leads committees.

The decision, Preckwinkle wrote to Anaya, “in no way reflects your remarkable dedication and service as vice chair of the committee.” She will remain in that position.