Seven of California's 10 top-paid county employees work at San Joaquin County General Hospital, each earning upward of $689,000 in 2017, according to the latest wage report released by the California State Controller's Office.
Two physician managers – Dr. Moris Senegor, a neurosurgeon, and Dr. Frank Kennedy, a trauma surgeon – earn more last year than the chief executive officer of UC Davis Medical Center and the chief investment officer at the California Public Retirement System. Senegor’s wages totaled $1.15 million; Kennedy’s, $1.07 million.
San Joaquin General CEO David Culberson said that a number of factors affect physician’s wages at the facility. For instance, he said, the hospital employs a limited number of physicians in some specialties. In the case of neurosurgeons, he said, there are three on staff and, because the hospital is a Level III trauma center, it must staff a neurosurgeon 24 hours a day, seven days a week.
“We don’t have a training program here, so we don’t have the fellows and the faculty members that are able to respond to neurosurgical needs,” Culberson said. “Basically, what that means is we’re having our physicians in-house 24/7 for trauma and anesthesia.”
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Consequently, he said, over the course of a year, the neurosurgeons each will work 60-plus hours a week. A good chunk of the surgeons’ wages is for call pay over and above their regular 40-hour week. Each surgeon manager also receives a stipend to compensate for management duty, Culberson said.
“As you add more physicians, the need for that extra call pay would go down,” Culberson said. “If you had six doctors covering 365, they’re paid a whole lot less than if you have three doctors covering 365.”
In cases like that, there’s opportunity for doctors to build large private practices or do other things to earn income outside the hospital setting if they wish, Culberson said. The data from the state controller's office noted that Dr. John P. Gruen, the chief physician of neurological surgery at the larger Los Angeles County-USC Medical Center earned $669,768, but L.A. county officials did not have specifics on this surgeon-manager's workload or whether he worked in private practice.
Senegor’s base pay was $607,902 in 2017; his other pay was $545,029. "Other pay" is a catch-all that includes call pay but also payments for car allowances, meeting stipends, incentive pay, bonuses and other types of contracted payments. Kennedy’s base pay was $322,972 last year; his other pay, $731,991.
That other pay also may include pay to physicians who hold more than one board certification. For instance, Kennedy, a graduate of the University of Southern California's Keck School of Medicine, has practiced more than 20 years and, according to his license details at the Medical Board of California, is board-certified in surgery and surgical critical care. But two highly paid San Joaquin General neurosurgeons – Drs. Abbas Bahari and Azeem O. Oladunjoye – do not list any board certifications in their licensing details.
Other public workers in California, such as athletic coaches, physicians and surgeons in the UC system, earn as just much – even two to three times – the wages that Senegor and Kennedy do. Typically, though, they work at medical institutions that rank highly in national surveys for quality.
San Joaquin General did not earn a ranking on the CareChex quality ratings of 110 neurological surgery departments, but other county hospitals did, including L.A. County-USC (ranked 110th) and Santa Clara Valley Medical Center (59th). UC-affiliated hospitals on the list included UCSF Medical Center (25th), Ronald Reagan UCLA (18th) and UC Davis Medical Center (56th).
Culberson said that San Joaquin General, based in French Camp, fulfills a critical role, serving 800,000 residents and numerous motorists in a county that sees high traffic along Interstates 5, 205, 580 and state highways such as 4, 12 and 99. Between crime and traffic incidents, Culberson said, the hospital sees an average of 300 trauma cases a month.
The Sacramento Bee asked veteran compensation consultant Paul Dorf, founder and chairman of Compensation Resources, about what goes into determining what physicians are paid. He said tax-exempt hospitals typically require an independent, outside panel to review prevailing market wages and provide a recommendation to the board of directors about salaries.
While a hospital's chief executive can make recommendations on wages, he said, the board must have data that back up the recommendation. Dorf said this documentation is critical in case anyone challenges physician pay in court. Without supporting data, the doctor could end up having to pay excise taxes or perhaps penalties on the excess wages.
In order to determine prevailing wages, Dorf said, consulting companies like his would review wage surveys prepared by three different organizations. He reviewed one such survey and noted that it showed that 94 neurosurgeons working at hospitals in the western United States reported average regular wages of $888,731.
This figure, he said, does not include added pay for on-call shifts or for department head stipends. Neurosurgeons in the 25th percentile of that wage survey earned $639,000 in regular pay, while those in the 75th percentile earned $1.07 million.
Dorf said, in reviewing the wages released by the state controller, that San Joaquin County may be getting a bargain. Although that’s just one wage survey, which he said includes a lot of data, he would review three such surveys before helping a client create a salary strategy.
“We also look at whether the doctor is acting as the head of a department,” Dorf said. “Is he the medical director? Is he or she is board certified? Do they have different board certifications? There is usually add-on salary that goes with that.”