Some doctors receive generous salaries from the cash-strapped public hospital. Why does GMH need a full-time hand surgeon? Dr. Landstrom asks.
Physicians in the United States made a median salary of $192,930 in 2017, according to USNews.com. The best-paid 25 percent made $208,000 that year, while the lowest-paid 25 percent made $109,280. The states and districts that pay physicians the highest mean salary are South Dakota ($282,980), New Hampshire ($271,040), North Carolina ($270,610), New Mexico ($266,920), and Alabama ($264,860).
In California, a state with a population of 39.6 million, the average physician’s annual salary is $201,860, according to glassdoor.com. Another website, salary.com, indicates that the average physician salary in the Golden State is $228,438—the range typically falls between $197,762 and $255,528, depending on the city.
A general surgeon in the United States makes an annual average salary of $266,00 and a neurosurgeon, $401,428, according to payscale.com.
At the Guam Memorial Hospital—which serves a population of 160,000— one does not have to be a neurosurgeon to earn that figure — or even more. The hospital’s staffing pattern shows at least two radiology doctors receive more than half a million a year in compensation packages.
Based on GMH’s staffing pattern for July 2019, Dr. Miran Ribati, a radiologist, is the top earner, with a base salary of $478,400 plus $140,044 in retirement and medical benefits— for a total compensation package $618,444.32. The August 2019 staffing pattern shows Ribati’s benefits packaged reduced to $12,885.86, pulling his total pay package down to $491,288.86.
Prior to being hired at GMH on Nov. 13, 2017, Ribati was a neuroradiology and interventional radiology fellow at the University of Texas Medical Branch Galveston, Texas, where he also worked as diagnostic radiology resident. Based on his LinkedIn profile, Ribati became the chairman of GMH Radiology Department in April 2019, and concurrently director of Vascular and Interventional Radiology.
Besides Ribati, the other half-a-millionaire at GMH was Dr. Tuan Nguyen, who was hired on March 24, 2015. According to the March 2019 staffing pattern, Nguyen had a base salary of $480,001.60 plus $148,879.64 in retirement and health insurance benefits, for a total of $628,881.24. Nguyen was the former chairman of the GMH Radiology Department. According to his LinkedIn profile, Nguyen managed “a department of 12 radiologists.” His subspecialty includes IR, neuroradiology and general diagnostic radiology. Nguyen is no longer listed in GMH’s monthly staffing pattern since April.
Dr. Joleen Aguon, a pulmonologist, gets paid a total of $487,200 for three fulltime positions: assistant associate administrator of medical services, director of Intensive Care, Critical Care and Progressive Care Units; and concurrently director of Respiratory Services and Consulting Intensivist. Based on her contract with GMH, Aguon receives $187,200 for her unclassified position as assistant associate administrator of medical services overseeing nursing and professional support divisions.
Besides her salary for the administrative position, Aguon also receives an annual salary of $300,000 under a separate contract signed last year with the previous administration. The contract allows Aguon “to keep all billings for professional services.”
Other GMH physicians who are receiving the neurosurgeon-level salary are Dr. Jared Carlson, general surgery, $448,691; Dr. Heu Sung Young, ER, $430,714; Dr. Johnny Kim, EMS, $432,822; Dr. Aaron Johansen, ER, $426,245; and Dr. Mary Anne Legaspi, ER, $429,209. The amounts all include the fringe benefits.
Physicians in the $300,000-plus range include, Dr. Jeffrey Cruz, internal medicine, $352,840; Dr. Rengaraju Ramasay, internal medicine, $351,654; Dr. Golda Sol Fernandez, internal medicine, $350,608; Dr. John Taitano, internal medicine, $346,819.72; Dr. Edward Blouts, internal medicine, $348,166.
In an interview last year, former GMH administrator Ted Lewis said some doctors who maintained private practice are allowed to bill patients they treated at GMH, on top of the fulltime salary they received at the government hospital. Hospital officials later confirmed this practice, which they said depended on the terms of the physician’s contract with GMH.
Based on Deloitte’s fiscal 2018 audit of GMH finances, the hospital’s personnel cost went down from $80.9 million in 2017 to $69.49 million, as result of “staff turnover in all divisions as well the inability to recruit and retain staff.”
“The shortages of certain physician specialists as well as specialty care nurses, both locally and nationally, are expected to continue to grow over the next several years and competition from mainland hospital as well as local private hospital continues the upward pressure on the cost of employing physicians and nurses,” Deloitte’s report states.
But more than the salary rate, it is the hospital’s hiring practices that some in the medical community find anomalous.
Dr. Jerone Landstrom, a hand surgeon, noted that GMH does not locally advertise job positions for physicians. Thus, off-island notices for job openings shut the door on local physicians for employment opportunities at the government hospital, he said.
Landstrom also noted that GMH follows its internal policy for hiring medical professionals outside of Guam’s procurement law. His attorney Jeffrey Cook, husband of Gov. Lou Leon Guerrero, cited a 2004 Supreme Court decision, which held that although GMH has its own procurement process in place, “the GMH administrator must also satisfy the requirements of the Guam Procurement Law. This language makes it clear that the Guam Supreme Court has made a determination that GMH must follow the Guam Procurement Law in the procurement of professional services.”
Despite the Supreme Court ruling, Landstrom said, GMH fails to issue solicitations that would allow other physicians to bid for professional services being sought. “All these contracts have been granted from behind closed doors and hidden from the public because GMH administration feels that they do not need to follow Guam procurement law,” Landstrom said. “This has allowed GMH to grant physician service contracts to physicians that are politically connected or because of perceived entitlement at the expense of the tax payers of Guam.”
Landstrom also questioned the hospital’s decision to create fulltime positions for certain specialty practice that are unsustainable, such as hand surgeon.
Since 1997, Landstrom said he had been taking hand call at GMH. “I came in, maybe, once a year to replant a thumb. And one time in my career, I came in to reattach a penis— that will never happen again in my career,” he said. “They cannot afford a fulltime employed hand surgeon; it does not pay for itself.”
Yet, GMH has hired Dr. Jared Carlson as a fulltime hand surgeon for an annual base salary of $350,000. Based on his contract signed on Dec. 14, 2016, a bulk of Carlson’s duties involve administrative work, budget planning, consultation, attending meetings and participation in the hospital’s efforts required for accreditation by the Joint Commission.
Carlson could not be reached for comment as of this writing.
“I can do his job for less than half the amount the hospital is paying Dr. Carlson,” Landstrom said.
On Nov. 21, 2017, Landstrom received a call from GMH to attend to a patient who needed a follow-up treatment for hand amputation because Carlson, to whom the patient was referred, was not available.
Earlier this year, Landstrom offered a hand call service to GMH, but Dr. Annie Bordallo, associate administrator for medical services, turned down his offer, saying the hospital does not have enough load to support hand call. “So she basically said what I have been telling them,” Landstrom said.