By Phil Galewitz, The Palm Beach Post, Fla.
May 1–Here’s one way for a hospital to overcome the shortage of brain surgeons, particularly those willing to handle emergencies: Hire them and make them millionaires.
That’s what Martin Memorial Medical Center is doing.
The nonprofit Stuart hospital pays each of its two neurosurgeons $1 million a year, making them by far the institution’s highest-paid employees, according to its latest tax return.
The salaries are a reflection of the difficulty hospitals in Palm Beach County and the Treasure Coast have in finding neurosurgeons, particularly those willing to take emergency patients, local health officials say.
Drs. John Afshar and John Robinson Jr. have worked exclusively as neurosurgeons at Martin Memorial for about 10 years. The hospital also covers their medical malpractice insurance premiums, which can exceed $150,000 a year.
Dr. Lloyd Zucker, a Delray Beach neurosurgeon, said $1 million is on the high end of compensation for his profession. But, “I think the market will bear what the market will bear,” he said when asked if the pay is reasonable.
When Zucker’s group tried to recruit a neurosurgeon last year, “you could not touch somebody for less than $400,000,” he said. Job candidates wanted malpractice insurance covered and a car allowance. And those prospects were fresh out of training.
Martin Memorial makes no apologies for the seemingly high salaries. CEO Richmond Harman, who receives a $439,000 annual salary according to the hospital’s latest tax return, for 2004, says the doctors are worth every penny. “They totally deserve it,” he said. “These guys are extremely busy.”
The two doctors performed 368 surgeries in the 12 months ended July 2005, with Ashfar handling 188 cases and Robinson doing 180, according to state data compiled by Intellimed International. Together, the doctors rang up nearly $20 million in billing charges for the hospital. (Few patients pay actual charges because insurers get discounts as much as 50 percent to 60 percent.) The doctors, who both declined requests to be interviewed for this story, are well-paid by nearly any measure. Last year, the median compensation for a neurosurgeon was $542,894 nationally and $704,957 in the Southern United States, according to the Medical Group Management Association.
Most brain surgeons don’t start working until they are at least 34 years old because they have to go to college for four years, medical school for another four, complete an internship for one year and then do a five-year residency training program. Some then do a one- or two-year fellowship.
Afshar and Robinson are two of only four neurosurgeons working in Martin and St. Lucie counties. The other two do surgery at St. Lucie Medical Center in Port St. Lucie and Lawnwood Regional Medical Center & Heart Institute in Fort Pierce, but are not employed by those hospitals.
Employing its own is just one way Martin Memorial ensures it has a neurosurgeon on call.
The hospital also coordinates its emergency call system with the two St. Lucie County hospitals so there is a better chance at least one neurosurgeon is on call each night. Because the neurosurgeons typically are on call seven days out of every month, there are only two or three days a month when a neurosurgeon is not available for emergencies.
Those days patients often get sent to hospitals in Palm Beach County, where a task force of doctors, hospital administrators and the county health district is trying to form a regional call system for neurosurgery and several other specialties where doctors shun ER work.
It plans to seek state and federal approval for any proposed system to be sure to be clear of any antitrust issues.
Lawnwood spokeswoman Beth Williams said the Treasure Coast hospitals were not worried about being accused of violating antitrust laws.
Finding neurosurgeons to cover emergencies has become increasingly difficult because the doctors are trying to reduce their liability because of increased medical malpractice insurance costs.
Additionally, most doctors don’t like to work as hospital employees because they believe they can make more money on their own and don’t want to have a boss.
Afshar, half of Martin Memorial’s neurosurgery duo, graduated from Georgetown University Medical School in 1987 and did his residency at its Washington hospital until 1995.
Robinson graduated from the University of South Florida Medical School in 1988. He completed his residency training at the Cleveland Clinic in 1994, then did a one-year fellowship at Allegheny General Hospital in Pittsburgh. He followed that with a one-year fellowship.
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