From the pages of
Sublette Examiner
Volume 2, Number 6 - May 9. 2002
brought to you online by Pinedale Online

Physician contract increase, EMT pay decrease?

by Cat Urbigkit

Physician contract increase, EMT pay decrease

Monday nightís Sublette County Rural Health Care District board meeting was a déjà vu of meetings past, complete with requests for an increase in the doctorís contracts, discussions of expansion of the Pinedale clinic and debates about what to pay the emergency medical technicians.

As they say, history is bound to repeat itself.

Dr. David Burnett presented his budget request for the Marbleton-Big Piney Medical Clinic. Included in the request was $1,000 for maintenance projects; countertops and carpet for the hallway and waiting room area for an unknown amount; chemical analyzer for $21,618; locking file cabinets for $7,000; surgical lamps for about $7,000; and $15,000 for a new computer network to make the clinic a turn-key operation.

Burnett also suggested a covered entry driveway to the emergency room door be constructed for ambulance use. RHCD board member liked this idea, suggesting that a similar entryway be constructed for the Pinedale Medical Clinic as well.

Board member Bob Dew suggested the covered entryway was more critical to the Marbleton location because the ER door faces into the prevailing wind. Board member Jim Greenwood pointed out that snow and ice build up at both clinics.

Burnettís list of budget items included a proposed $2,000-per-month increase for his clinic contract, currently at $18,500 per month. Burnett explained such an increase was needed to counteract decreased Medicare compensation which will cost his clinic an estimated $20,000 this year; a 45-percent increase in malpractice insurance; and the possibility of another 25-percent increase for health care coverage next year as well. Burnett said last year the board agreed to a $1,500-per-month increase in the clinic contracts last year, and that was the first such increase in about five years. Burnett said he spent that increase to help pay compensation to his nursing staff to match what the district was paying its EMTs.

"My nurses were not getting paid what you upgraded the EMTs and they requested, and I felt it only fair, to increase their call time to match what you were paying the EMTs to be on call," Burnett explained.

Dr. Judy Boyle of the Pinedale Medical Clinic then presented her budget proposal as well, ranging from $19,400 in vinyl wall coverings; $5,000 for office furniture; leasing a hematology analyzer for $752 per month for five years; storage carts or shelving for the ER for $3,000; and a crash cart with a defibrillator/monitor for $4,000.

Also on Boyleís request was $20,000 to fund "malpractice or assistance with getting locums physicians here since no physicians are interested in the job."

Boyle said she has talked to about 20 different physicians and has been unable to get someone to join her practice in Pinedale. A woman physician interested in the job will be visiting the county this weekend.

Two other options are for the summer period only, Boyle said, with one ER physician from Jackson possibly interested in working from June through September; and a Texas woman physician who may be interested in a three-month position. The biggest issue is covering malpractice insurance for these physicians, Boyle said.

In other business, Boyle noted that Burnett now has a stress-test machine in the Marbleton clinic. She suggested the board consider, with such expensive equipment, working something out so that the equipment can be utilized on both ends of the county. She suggested that she be able to stress-test patients at the Marbleton clinic.

Burnett said, "I have no problem if Dr. Boyle wants to come down and use the equipment for a stress test." Burnett said his only concern would be conflicting scheduling.

"If thatís what you choose to do, thatís fine with me," Burnett said. "Weíre personally too busy in day-to-day activities, if the shoe were on the other foot Ė it would be too inconvenient for me in terms of time away from patients for me to go to Pinedale even if it were available."

Boyle said the Pinedale clinic has no room for any more major medical equipment, and noted the next thing the board will have to consider will be expanding the clinic.

That brought up the issue of whether the clinic building belongs to the county or to the district. The county houses both the public health nurse and the county sanitarian in the western portion of the Pinedale clinic building.

Board Chairman Dave Racich said: "We have a lot of room in there ... thatís supposed to be our building. We donít want to evict anybody. The (county) commissioners need to step up and do something with that building."

The board agreed that it would visit with the county commission about how to resolve the space problems in the clinic.

Since Boyle wasnít present at the meeting when Burnett had proposed a $2,000-per-month increase in his contract amount, Burnett explained to Boyle his request, noting that for the funding to be equal, Boyleís contract would need to be upped as well, and noting the similarity with her $20,000 budget request for a locum physician.

The discussion of the amount of the doctor "subsidyí became intense and heated between the doctors and board members. Eiden listened to the doctors discussing the issues impacting their businesses, and then said, "Well when you see all these patients, donít you people get paid? ... Donít you make any money from these people?"

At one point, Burnett asked, "Do you know how much it costs to operate the clinic?" to which board member Walt Bousman quickly responded, "Iíd love to see the documentation."

Burnett said the costs in terms of payroll (excluding his wage) comes in at more than twice the subsidy amount. Burnett said while the subsidy has gone up, so has the cost of providing the services.

"But I donít think you fully grasp the cost of operating the clinic ..." Burnett said. "I get tired of hearing the argument if I get an increase in the subsidy, then that money is going in my pocket, because itís not."

Board member Jim Greenwood broached the last major item of contention. He said at the December meeting, in which he was not in attendance, the board approved a pay scale for EMTs that included a one-percent increase for every year served. Greenwood said it wasnít his intention when he agreed to set the pay scale for salaried EMTs to create government jobs. Greenwood said it is his intention to make a motion at the boardís next regular meeting to rescind the board vote allowing the one-percent increase.

Dew agreed with Greenwood, stating, "I think we were dreaming when we let that sneak through." Dew said the existing policy would allow someone who served 20 years as an EMT to be paid 20-percent more than his co-workers, for the same job.

The board will meet Monday, May 13, at 7:30 p.m. in Marbleton.

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