Three Kern Medical Center doctors were the three highest-paid county employees in the entire state of California in 2012, far outstripping counterparts in public hospitals in Los Angeles and Santa Clara counties.
Kern Medical Center orthopedic surgeon Arturo Gomez topped the list, making about $1.04 million last year.
He was followed by Dr. Andrea Snow, at $828,287, and Chief of Surgery Dr. Maureen Martin at $753,465.Martin took a voluntary pay cut early this month, as did two other physicians, in response to the hospital's financial troubles.
The California State Controller's Offices' newly-updated database of all public city and county employees reports that the next-highest paid county employee in the state is a doctor at Valley Medical Center in Santa Clara County who made $658,521 in 2012.
Of the top paid 25 employees in the state, nine of them are KMC doctors -- more than any other county including the seven in Santa Clara County and the five in Los Angeles County.
Of Kern County's 50 highest paid employees last year, 45 were medical staff at KMC.
Supervisors said Tuesday that, given KMC's severe financial problems, pay for the hospital's doctors must be revisited. But a hospital administrator said KMC's doctors' pay reflects fair compensation for the days and nights they spend working to keep up with the demand for their services.
"We need to have a payroll review over there," said Supervisor Mick Gleason. "Cost control has to be paramount in everything we do over there."
Supervisor Leticia Perez said that physician pay has to be on the table as the county debates how to turn Kern Medical Center's financial crisis around.
"We are making dramatic and significant changes at KMC -- to better the organization," Perez said. "It's good to revisit these contracts."
County fiscal watchdogs also pushed for review as well.
"It caught our attention that KMC doctors are the three highest paid county positions in the state, and of the top six, four are KMC doctors," Jenifer Pitcher with Kern Citizens for Sustainable Government told the board Tuesday. "As you move forward with KMC and the mess that is before you, please look at this information."
Earlier this fall supervisors learned that fiscal mismanagement that spanned years at KMC had resulted in the build up of a massive $64 million gap between the state and federal funds the hospital believed it was owed and what it was likely to be paid.
The fiscal erosion had forced the county's general fund -- its largest, most versatile pool of operational cash -- to pour more and more cash into KMC to staunch the hospital's fiscal bleeding.
Supervisors fired former KMC CEO Paul Hensler, moved new financial management into the fiscal department, created a select chairman's committee to suggest solutions at the hospital and hired Mercy hospital's executive Russell Judd as the new CEO at KMC.
But the fiscal crisis is far from over.
If changes to doctors' pay are implemented it would be only the newest twist in a long struggle to control physician compensation at the hospital. Kern County Administrative Office analyst Elsa Martinez said doctors' pay was changed in 2011 because the way doctors were previously paid was less transparent.
In 2011 the county implemented a productivity-based pay system that allowed doctors to make more money the more work they did.
Before, doctors were paid a flat rate for taking care of indigents - people who can't pay their bills - and then were able to collect the money that people with insurance paid for their care.
Those "professional fees" were not reported as part of doctors' pay.
On top of that they were able to operate their own private practices outside KMC.
Now the county pays doctors for services rendered no matter if the patient is indigent or insured. The more work you do, the more you get paid, Martinez said.
Lisa Ohlfest, administrator of KMC's clinics and physician practices, said the public hospital's physicians make so much money because they work a lot and are paid by their productivity.
"This isn't like we're just paying them to pay them, it'sbecause they're really working hard," she said.
For example, she said Gomez and Snow were the only two orthopedic surgeons at KMC at the time these pay amounts were earned.
"Gomez and Snow were here day and night seeing patients so that's why they're getting paid as if they're two orthopedic surgeons since they were (each) doing the work of two orthopedic surgeons," Ohlfest said.
The hospital has since hired a third orthopedic surgeon to alleviate the workload but that seems to have brought the hospital more orthopedic patients. When patients go to another emergency room in town, if there isn't an orthopedic surgeon available at that hospital the patient may be referred to KMC, where one of the three is always on duty, Ohlfest said. But demand builds up and there's often a long wait to see those doctors and a backlog orthopedic surgeries.
Martin, as chair of the surgery department, is also extremely busy. She covers for other surgeons and does very complex surgeries, Ohlfest said. All four doctors who appeared on the state's top 10 list did trauma work.
Ohlfest said the 10 highest paid county employees last year, all KMC doctors and a radiologist, did not have private practices on the side.
She said the hospital's productivity compensation model helps recruit doctors to Bakersfield, which can be a harder sell to physicians who can choose to work in bigger metropolitan areas with more amenities.
"Somebody comes here and you say, 'OK now you have to cover trauma 24/7 and you never get to see your family and you'll never get to eat again, lunch again, but you're gonna make a million dollars,' they're gonna say, 'Well, OK, that might be worth it,'" Ohlfest said.