- By Mar-Vic Cagurangan
For some doctors, GMH is paradise
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.
While taxpayers are constantly burdened with additional taxes to support GMH, Landstrom lamented that “a large chunk of these taxes have gone into GMH administration issuing physician service contracts outside competitive procurement required by Guam law.”
Landstrom also noted a significant expansion in new physician administrative positions at GMH over the last eight years that persists under the new administration.
“It appears that revenue increase to GMH from the well-intentioned increase in taxes by the previous administration has been deflected to non-competitive procurement of physician service contracts and to newly created hospital physician administrative positions,” Landstrom said. “This drains GMH of revenues needed to be used for facility maintenance, operations, supplies, equipment and ancillary services. This has and is currently adversely impacting patient care and compliance with CMS the main financial supporter of GMH.”
While people hired for unclassified positions get sweet deals from the administration, many employees are demoralized by what they called “lack of fair treatment.”
“Those who are politically connected get special contacts and GMH is paying such large amounts of money that they always say the hospital does not have. Regular employees get the short end of the stick. Just recently, they cut the fringe benefits for nurses. They are not allowed to do overtime anymore,” according to a hospital insider, who requested anonymity.
According to Deloitte’s 2018 audit report, GMH employees have not received their retroactive salary step increases — which were put on a freeze on Oct. 12, 2011 and lifted on March 13, 2013 — as of September 2018. In 2003, the government established a merit system — similar to one created in 1991— that would offer bonus for employees. “As of September 2018/2017, GMH recorded merit payable of $0,” Deloitte said.
Some administrative positions do not require a full-time presence at the hospital, the GMH source said. “Dr. Vince Duenas used to be in charge of professional support as a part-time position. We met with him once a month. Now, they have turned this into a fulltime position,” the source said. “And creating another oversight over the nursing division is redundant. The director of nursing has been doing this job over the years with no problem.”
At ICU, the source said, “a consulting physician does not have a primary responsibility because there are ICU physicians on a 12-hour shift.”
“Some of the doctors holding unclassified positions get full time salaries doing only part-time work at the hospital. They would come in for an hour and go back to their private practice,” the GMH source said. “The rest of the full-time staff cannot do that. Can nurses, for example, leave their posts to take a part-time work outside of GMH? Of course not.”
Following is a response from Dr. Tuan Nguyen
Interventional Radiology call is not compensated. Mainland radiologists are paid $350 or more to take call. Weekend call can be as high as $2,000. We chose to take call without compensation as a service for the public. ENT, general surgery, urology, podiatry are compensated. We chose not to.
Since 2015, pathologist has earned three pay raises. Radiologist has not and we have not asked for one. The higher income for IR is because advanced procedures bring in high revenue, as much as $15,000-$20,000 each. They may require expensive equipment and supplies. Coding/billing correctly is of tantamount importance.
Cutting costs by reducing salaries is foolish. More radiologists to do more procedures is self sustaining. Look at GRC as the model. It has been said that the senior radiologist there earns $10 million dollars a year. He now controls GRC, GMH and GMRC. Already, insured patients are diverted to GRC, leaving patients with no insurance and no ability at GMH.
This has happened twice before when GRC had the GMH contract. The new administration has been induced by various incentives. History will repeat itself.
GMH allows physicians two weeks and three days of paid vacation a year. The norm is around 10 weeks a year. That is worth about $120,000. GRMC offers much more paid leave. My new mainland job pays more for less hours. Time off is 17 weeks a year. GMH does not overpay. Working there has other rewards and satisfaction. Please do research and get the facts straight. There are problems at GMH, but it is not at the physician level.
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