Trauma Care at Palomar Hit by Strike : Hospital: Walkout by orthopedic surgeons will close North San Diego County’s only trauma center. Pay for treatment of indigent patients is at root of dispute.

North San Diego County’s only trauma center was scheduled to close early today as the hospital’s orthopedic surgeons went on strike over a pay dispute, declaring that negotiations had failed.

In a show of defiance after working without a contract since June, Palomar Medical Center’s seven orthopedic surgeons launched their boycott, capping what had been stormy negotiations that began during the summer.

The doctors’ strike is a virtual copy of the walkout earlier this month at Scripps Memorial Hospital in La Jolla. There, the hospital’s four neurosurgeons went on strike, shutting the trauma center to head-injury cases for five days until Scripps officials agreed to foot the bills when patients are too poor to pay. But, in Palomar’s case, officials decided to send all trauma victims to other centers, said Paul Simms, a deputy director with the county’s Department of Health Services.

The orthopedic surgeons at the Escondido hospital refused to discuss their current salaries or their demands, saying only that they wanted to be treated fairly. Nationwide, however, orthopedic surgeons are one of the highest paid medical specialists and earn a gross income of $466,070 annually, according to Medical Economics, an industry analyst.

Orthopedic surgeons repair broken bones and severely injured muscles.

“We are the work horses of trauma because our operations are longer, and we have more . . . operations than the trauma surgeons,” said Dr. Paul Milling, spokesman for the orthopedic surgeons and chairman of Palomar’s orthopedic section. “We are not being treated fairly.”

In explaining his reluctance to clarify the doctors’ demands or their current income, Milling said: “No matter what number you put down, people are going to think the doctor makes too much money. . . . But we are not being treated fairly.

“Since we have more operations, this exposes us to greater health risks like AIDS, hepatitis and liability. Traumas usually occur at night and on weekends, and this disrupts our families, lifestyle, and our practice, since we have to leave our office during the day at a 30-minute notice. It is not good for our personal health with long, late hours and then try(ing) to operate on private patients the next day.”

But officials at Palomar tell a different story. In July, Palomar offered the orthopedic surgeons a new contract that included a $520 stipend for each 24-hour on-call shift, a figure that represented a 5% increase over the previous stipend. The money would be paid whether or not the doctors were actually called to the hospital for trauma cases, said spokeswoman Nancy Sayre.

The increase was agreed upon by the orthopedic surgeons and approved by the Palomar Pomerado Health System Board of Trustees, she said. But, in early September, Milling approached Palomar and said the 5% increase was insufficient, she said.

Milling said Monday that Palomar’s orthopedic surgeons should receive the same pay as those at Sharp Memorial Hospital. He declined to name that amount. Sharp officials were unavailable to comment on their pay scale for orthopedic surgeons.

At Palomar, orthopedic surgeons are able to collect 39% of their bills with trauma cases, Milling said. This same problem, also cited by striking doctors at Scripps, is at the center of the pay dispute and raises the question: Who should bear the financial burden of caring for indigent patients?

As a result of the failed negotiations, county health officials closed Palomar’s trauma center as of 12:01 a.m. Tuesday. Patients normally tended by the hospital will be diverted to one of the county’s five other trauma centers. But Palomar is the only center in the North County area, covering 1,400 square miles, stretching north to Riverside County and including Julian, Escondido, San Marcos, Fallbrook and Vista.

The nearest trauma center is Scripps in La Jolla, about 15 miles away, said Ron Yardley, a county health spokesman.

Hospital administrators say the trauma program has been a financial drain.

“The trauma program . . . will at best break even this year,” said Tony Noronha, senior vice president of Palomar’s finance and business development department. “The program started in 1985, is still operating at a cumulative loss. We are attempting to be fair to all our trauma physicians and base stipends on what the market will bear.”

Hospital officials said they asked Milling and the other orthopedic surgeons to continue their services while an agreement was hammered out. “But they were unwilling to do so,” said Thomas Spindler, Palomar’s administrator.

County health officials say the problem results from unfair distribution of state funds.

“Lack of equity in the distribution of the state’s general fund money is the single most significant barrier to adequate compensation for hospitals and specialists,” said Simms of the county’s health services department.

In San Diego, where one in four patients has health insurance, and throughout California, industry officials said, the problem will only worsen in the months and years ahead.

“It’s going to spread to the trauma system throughout California,” said Jim Lott, president of the Hospital Council of San Diego and Imperial Counties. “If we don’t do something about our uninsured patient problem, we are going to find fewer and fewer physicians willing to take on-call (duty).”

How 12 Fields Rank in Income ORTHOPEDIC SURGEONS GROSS: $466,070 NET: $237,120 OBG SPECIALISTS GROSS: $384,030 NET: $202,430 OPHTHALMOLOGISTS GROSS: $408,750 NET: $200,000 ANESTHESIOLOGISTS GROSS: $221,150 NET: $184,620 GENERAL SURGEONS GROSS: $268,060 NET: $147,920 EMERGENCY PHYSICIANS GROSS: $162,270 NET: $142,920 PSYCHIATRISTS GROSS: $164,170 NET: $113,750 INTERNISTS GROSS: $215,510 NET: $110,860 PEDIATRICIANS GROSS: $221,470 NET: $107,810 GPs GROSS: $165,830 NET: $96,910 ALL SURGICAL SPECIALISTS GROSS: $362,100 NET: $198,650 ALL NON-SURGICAL SPECIALISTS GROSS: $219,180 NET: $130,420 ALL MDs GROSS: $249,580 NET: $141,720

HOURS PER WEEK ORTHOPEDIC SURGEONS: 61 OBG SPECIALISTS: 61 OPHTHALMOLOGISTS: 50 ANESTHESIOLOGISTS: 60 GENERAL SURGEONS: 61 EMERGENCY PHYSICIANS: 51 PSYCHIATRISTS: 51 INTERNISTS: 60 PEDIATRICIANS: 60 GPs: 53 ALL SURGICAL SPECIALISTS: 60 ALL NON-SURGICAL SPECIALISTS: 60 ALL MDs: 60 Source: Medical Economics