Missouri's top public salaries: Doctors get paid while sleeping

Saturday, August 6, 2011 | 6:39 p.m. CDT

JEFFERSON CITY — As a doctor at one of Missouri's psychiatric institutions, Hungi Sripal has been paid thousands of dollars while sleeping on the job. His around-the-clock wages helped make Sripal the state's highest paid employee, earning more than double the governor.

In fact, Sripal is one of 50 state workers who were paid more than Gov. Jay Nixon and the state's seven Supreme Court judges during the recently concluded budget year, according to figures provided to The Associated Press under an open-records request. Like Sripal, almost all those employees are physicians for the Department of Mental Health. And like Sripal, many got extra pay for working all day and all night — no matter whether they were sleeping or simply relaxing on the job.

The Department of Mental Health defends the wage arrangement as a necessary price to pay to entice skilled professionals to work undesirable hours attending to sometimes unstable patients at institutions that might be more than an hour away from the doctors' homes in Missouri's major metropolitan areas.

"I understand that the first glance looks bad, but I do think that we're actually managing the money pretty well to take care of the patients," said Jay Englehart, the medical director at the Southeast Missouri Mental Health Center where Sripal works.

Missouri's legislative budget leaders told the AP they were unaware of the physicians' special salary arrangements in the Department of Mental Health. Lawmakers raised concerns about both the size of the paychecks — Sripal's pay was $320,598 last fiscal year — and a potential lack of transparency in how taxpayer dollars are spent. They pledged to question mental health officials about the salaries at future legislative hearings.

"In this time of underemployed professionals because of the national economy, that really does seem to be a lot of money," said Senate Appropriations Committee Chairman Kurt Schaefer, R-Columbia.

The salaries of state employees have come under heightened scrutiny at the Missouri Capitol during several years of tight budgets. Most state workers have gone without pay raises. The House Budget Committee, in particular, has attempted to reduce the wages of certain upper-level officials in Nixon's administration, but the budget ax generally has spared those in advanced-degree professions such as the physicians at the Department of Mental Health.

Records obtained by the AP from the state Office of Administration show the state paid more than 68,000 people during the fiscal year that ended June 30, with amounts ranging from as little as a few dollars and cents to Sripal's six-figure peak. Nixon's salary of $133,821 ranked 58th among government workers, just behind that of Missouri's seven Supreme Court judges. Forty-six of the top 50 worked for the Department of Mental Health. The list does not include earnings for employees at state universities, whose paychecks come from the institutions and not directly from the state. If university salaries were included, the $2.35 million salary of University of Missouri football coach Gary Pinkel would dwarf that of both the governor and the Department of Mental health physicians.

Sripal's salary is listed as $114,014 in the 2009-2010 official state manual. But Missouri's online financial tracker shows he actually was paid more than $300,000 in both of those years. His total wages ballooned over his base salary because physicians at the Farmington facility get an extra $80 per hour when they serve as the on-site, on-call doctor on nights and weekends. Sripal was paid for more than 2,500 hours of nights and weekends last fiscal year, according to department records.

At times, he responded to patient emergencies. But he also could have passed his time in a room equipped with a refrigerator, microwave, telephone and a place to sleep. Reached at work by the AP, Sripal said he often chooses the extra shifts.

"There are so many other people (in the private sector) who make more than what I make," Sripal said.

The extra pay Sripal receives on nights and weekends would be fairly typical if he were a psychiatrist. According to the U.S. Bureau of Labor Statistics, psychiatrists in Missouri earn an average of $81 an hour, or $168,680 a year.

But officials at the Mental Health Department said it can be difficult to entice physicians to work in rural communities such as Farmington, which is about an hour south of St. Louis. The facility houses approximately 300 people, including about 130 committed because of sexual offenses. About four-fifths of the total population is there under court order.

"Unlike the private sector, when we have a shortage of physicians, we can't simply opt to close some of these units," said Mark Stringer, director of the department's Division of Comprehensive Psychiatric Services.

To fill a vacancy in Farmington, the state currently is paying $200 per hour for a temporary psychiatric worker, Englehart said. Staff physicians take turns sleeping at the facility because the combination of patient needs and the remote location make it impractical for an on-call physician to remain at home in the St. Louis area, he said.

"Yeah, we do have some of the highest paid employees in the state, but that is partly because they're working many, many hours, and it's because we provide great service here," said Englehart, whose total wages of $209,619 ranked 11th among state employees.

The governor's office declined to make Nixon available for an interview about the salaries at the Department of Mental Health.

Schaefer and House Budget Committee Chairman Ryan Silvey both acknowledged the state's need to offer attractive salaries to certain professionals but expressed reservations about the wage arrangements at the Department of Mental Health.

"Does it concern me as a conservative that we have government salaries that high? Absolutely," said Silvey, R-Kansas City. "Is it possibly a necessary evil to provide the services? Possibly."

Schaefer said he's aware of plenty of physicians, lawyers, engineers and other professionals who are not working as much as they would prefer, which he said calls into question the department's justification for paying its physicians extraordinary wages to work after normal business hours.

The two legislators expressed an even greater concern that their budget committees weren't informed of the department's extra-pay policy, and that it was not transparent from employees' base salaries how much they actually are making.

"The fact they're being reported at $114,000 but they're really making $320,000 — that's a concern," Silvey said.

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Corey Parks August 7, 2011 | 7:23 a.m.

They all seem grossly over paid considering they are state workers.

(Report Comment)
Mark Foecking August 7, 2011 | 12:11 p.m.

However, they're physicians, and specialists to boot, so $300,000/year isn't an outrageous amount of compensation for them. Perhaps it is elsewhere (and that's a whole 'nother discussion) but for the here and now, it's not unreasonable.

Salaried employees are supposed to be paid a certain amount to do a certain job. Hours are irrelevant. I'd simply call them salaried employees ,and not worry about whether they sleep on the "clock" or not.


(Report Comment)
Ricky Gurley August 8, 2011 | 8:45 a.m.

I am with you, DK. I don't even look at it as "being paid for sleeping". I look at it as being paid for being on call, and having to be away from their home, ergo at work.

I have no problem with this type of arrangement.

Ricky B. Gurley.

RMRI, Inc.
(573) 529-0808

(Report Comment)
Mark Huddleston August 13, 2011 | 8:35 a.m.

This is ridiculously sensationalized. You know who else gets paid to sleep? Fire fighters... They also get paid to eat, play video games, work out, etc. It's a step beyond being on call. It's being there! If you are there and ready to work when needed who cares whether you are sleeping? If a firefighter or doctor is on a 24 hour shift do you really want them NOT sleeping?

(Report Comment)
Vinnie Iuppa August 13, 2011 | 8:23 p.m.

This story is a bit ridiculous. I mean, he "could have passed time" in a room equipped for sleeping? That is some hard hitting reporting. I believe that the author "could have passed time" writing a quality article with good research, but clearly regurgitating a study without any critical thought was what he decided to do.

I realize that $300,000 is a lot to be paid for a year of work but I think being the only doctor working at a hospital with 300 patients with severe psychological disorders through a 24 hour shift sounds like the kind of job that deserves the salary. I'm sure Mr. Sripal may have slept at some point in the year but in between being woken up every 15 minutes, threatened by mentally ill patients, spat on, and physically assaulted, he may have needed a catnap.

(Report Comment)
Daniel Jordan August 14, 2011 | 8:58 a.m.

These comments are pretty thoughtful and rational.
I don't think that was the reaction the author intended.

(Report Comment)
Ken Fine August 14, 2011 | 4:12 p.m.

Both the reporter and the editors fell down on this hatchet job. It has a sensational and breathless lead, but there's no story here. You owe Dr. Sripal and your readers an apology.

It is *common* practice for doctors to be compensated hundreds or thousands of dollars when they are on call. A fair article would have stated this. The doctor isn't being "paid thousands of dollars while sleeping on the job," he's being paid thousands of dollars to WAKE UP as required and work at odd hours. In the case described, it's even more appropriate, because the doctor is required to drive to a small town far far away from the places he would rather be, and stay on-site for the duration of call.

It is *common*, indeed nearly universal, for doctors and doctors-in-training to have what's called a "call room" where they can sleep (badly) when they are at work overnight and they are not tending to the direct needs of patients. The call room is a fixture of every university's academic medical center and most every hospital that exists. A fair article would have noted this.

A salary of $300,000 is a *common* salary for a specialist who has spent anywhere between six and ten years training after college, amassing loan debt or being paid poorly the entire time. I don't find the $300,000 salary nearly so ridiculous as the $114,014 salary that is apparently doctor Sripal's base pay. Many doctors finish their training late in their '30s with literally hundreds of thousands of dollars of debt to pay off. Their salaries in public and private practice are justified. The market sets the price.

For the record, I am not a doctor nor a part of the medical practice, but I'm familiar with the challenges of people who are.

This is a poorly-researched article weakly written by someone unfamiliar with the basics of medical practice. You owe it to yourselves and your readers to figure out how to avoid publishing items like this in the future.

(Report Comment)
Joy Mayer August 14, 2011 | 4:22 p.m.

These are fascinating comments. Thanks, everyone, for weighing in and providing such insights.

I sent an email to David Lieb, the Associated Press reporter who wrote this story, alerting him to what you guys have said and inviting him to weigh in.

Joy Mayer, Columbia Missourian

(Report Comment)
Jimmy Bearfield August 14, 2011 | 5:50 p.m.

"A salary of $300,000 is a common salary for a specialist who has spent anywhere between six and ten years training after college, amassing loan debt or being paid poorly the entire time."

Seems high, based on the specialists I know. For example, my urologist makes $210K 15+ years after his residency.

(Report Comment)
Ken Fine August 14, 2011 | 6:18 p.m.

Mr. Bearfield says, "[A 300K salary] seems high, based on the specialists I know."

Not really. A specialist I know well with a surgical subspecialty analogous to your urologist started at 294K base straight out of residency and is earning 312K one year out of training. This specialist was also offered in excess of $1000 a night to take call for some of the positions she applied for. This is with six years of training following four years of medical school. Base salaries of 300K for specialists are not uncommon even in publicly funded institutions, such as the UC schools.

The typically defensive reaction by the reporter would be to come back with an average of what Missouri's psychiatrists make to justify the contention that Dr. Sripal's salary is somehow unusual or excessive. But an average of all Missouri psychiatrist's salaries is not the right comparison. What you need to compare are the salaries of Missouri physicians who are willing to drive way the heck out to underserved areas and spend all night working. In some cases the reimbursement for these positions is very high in both public and private practice, because nobody qualified is willing to do the job otherwise. Unlike many other professions, medical practitioners can often earn more money by getting out of big cities and working in rural or underserved areas.

The reporter mistakenly believes he has written some kind of meaningful exposé. He hasn't, but his giddiness unfortunately leaks out in prose that should buried way back on the Op/Ed page, not in a credible AP news article.

(Report Comment)
Jimmy Bearfield August 14, 2011 | 6:47 p.m.

"A specialist I know well with a surgical subspecialty analogous to your urologist started at 294K base straight out of residency and is earning 312K one year out of training."

My urologist must be underpaid, considering that he doesn't just diagnose prostate cancer and meatal stenosis all day. Instead, he's often transplanting kidneys.

(Report Comment)
Ken Fine August 14, 2011 | 7:31 p.m.

Your urologist could undoubtedly make a lot more money with a different employer or context. But your urologist may have a specific job location, patient population, or working environment that s/he considers more important than pay.

Dr. Sripal is being compensated to work in a location and with a patient population that other doctors are not flocking to. The amount he is earning does not seem out of order with other stories of underserved areas I've heard of: I've seen hard offers of about $470,000 base, no call required, for specialists who are willing to head far, far out into the boonies and serve small cities that really need doctors. As hard as it may be to believe in this economy, it is often very difficult for hospitals to recruit and retain folks for these positions. It is cheaper to pay someone almost a half a million bucks as incentive to work than it is to helicopter patients to and fro -- or deny them necessary treatment. Market realities drive the compensation.

(Report Comment)
Jimmy Bearfield August 14, 2011 | 8:02 p.m.

"Market realities drive the compensation."

I agree, including with the corollary: The era of such compensation is rapidly drawing to a close. Enough citizens and politicians are clamoring for "affordable" health care — shorthand for "My premiums should cover everything but never be higher than my cable bill." — that all physicians will have to take deep pay cuts. That would mean compensation of $60K-$100K, if Europe is any guide. Such is the new market reality.

No wonder there were so many surveys showing that 40%+ of physicians say they plan to quit or retire if the health care reforms became law. They know it means that single payer is a matter of when rather than if and that a single payer has the ultimate pricing power.

Will that mean a shortage of physicians? We'll see, I guess. Med schools currently have several applicants for every available slot. How many of those applicants are willing to put in that amount of effort for $60K-$100K rather than two or three times that? Quite a few, I suspect, considering that many, many people take out big loans and go to school for six years or more with the knowledge that it might be decades or never before they make $100K.

(Report Comment)
Ken Fine August 14, 2011 | 8:42 p.m.

"I agree, including with the corollary: The era of such compensation is rapidly drawing to a close...That would mean compensation of $60K-$100K, if Europe is any guide."

Taking this discussion out of the realm of ferocious commentary on the AP's lazy article and into a friendly conversation: I'm unconvinced that the era of such compensation will end anytime soon.

#1: examine the salaries of the biggest HMOs out west, in Washington State and California. The HMO( branded and repackaged as something besides a big bad HMO) is often cited as a model the future of health care: with efficiencies of scale, streamlined administrivia, and an emphasis on "health maintenance". The base salaries offered to physicians by these systems are excellent. Moreover the doctors that serve some of the largest HMOs effectively belong to collectives that negotiate compensation on physician's behalf. The "future" has arrived in the form of these health maintenance systems, but the future as yet isn't so bad for working doctors.

#2: the American system of medical education continues to churn out a finite number of specialists, and typically demands much more training than European systems. My understanding is in the UK, doctors can begin their practice not too long after their primary medical education: there is not the same requirement for a long residency or residency+fellowship. The limited number of American specialists and extremely steep barrier to entry in time and tuition $ assures compensation will stay high for most specialists.

#3: People don't tend to be so price-sensitive when seeking out someone who they know may need to take sharp things and cut them open.

#4: Innovative health care is something that people and governments will pay a lot for going forward. Consider Dendreon's recently-approved Provenge treatment: it costs $93,000 for three infusions of this immunotherapy. Not only did the FDA approve Provenge, but the government agreed to pick up the tab for Medicare holders. Provenge isn't a cure for prostate cancer, but it substantially improves the quality and length of life for people suffering from this disease. Even in these tough economic times we are collectively finding the means to make this and other expensive therapies available to patients. American's desire to live and thrive isn't going away soon. Health care system is something Americans will be willing to directly or indirectly pay for.

The climate for some primary care physicians may change as they face competetive pressure from nurse practioners and the like, but it is hard for me to envision how the skillsets of medical specialists will be so quickly or easily devalued. There's too much demand and too much at stake.

(Report Comment)
Jimmy Bearfield August 14, 2011 | 9:22 p.m.

"#3: People don't tend to be so price-sensitive when seeking out someone who they know may need to take sharp things and cut them open."

Only when they have that choice. When a private insurer or a single-payer government is calling the shots, they get what that entity is willing to pay. That's the price sensitivity that matters. Hardly a week goes by without a news report about how [insert insurance company] or Medicare/caid wouldn't pay for a certain drug, another night in the hospital, etc. One way to cut costs is by reducing compensation or at least keeping it flat.

Specialists who are unwilling to operate (no pun) in this forthcoming paradigm might consider moving to some country that realizes the potential of medical tourism. My bet is on Costa Rica or another Latin American country simply because it's a shorter flight than Southeast Asia, where medical tourism seems to be centered these days.

(Report Comment)
Sally Willis August 15, 2011 | 10:19 a.m.

Another hospital starts Dr.'s out at 97,500.00 a year as a heart spec. but working with the mentally ill is another ball game all together!

(Report Comment)

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