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Counties fight doctors’ salary cap

By Christine Jordan Sexton
4/21/2009 © Health News Florida

At the eleventh hour, the Florida Association of Counties is scrambling to undo a budget provision that would cap salaries of future employees in county health departments.

That would make it impossible for the health departments to offer competitive salaries to attract the doctors and dentists who serve the poor and uninsured, the counties say.

For example, said Gary Mahoney, acting secretary of administration for the Department of Health, the going rate for a dentist is about $105,000 but the restriction in the budget would offer only $65,000 without special legislative approval.

“It creates a real difficulty in running a clinical operation,” Mahoney said.

Sen. J.D. Alexander, R-Lake Wales and chairman of the Senate budget committee, defended the move, saying it was important that lawmakers keep tabs on spending.

But the language has drawn opposition from both Republicans and Democrats, from both rural and urban areas. Sen. Durell Peaden, chair of the Senate health spending committee, conceded that the proposal has not yet been finalized.

“We’re still working on this,” said Peaden, R-Crestview.

With less than two weeks to go in this year’s session, legislators remain far apart on reconciling their differences in spending, especially since the Senate budget includes a $1-a-pack hike in taxes on cigarettes that the House budget does not.

If the stalemate does not end soon, it could force legislators to go into overtime, or schedule a special session to deal exclusively with the budget.

State lawmakers’ effort to gain control over staffing in county health departments began when they learned last month that a handful of doctors and dentists were earning between $221,000 and $477,000 a year in contracts with health departments.

“They must be working 48 hours a day to be making that much,” Peaden said at the time, according to the

Sarasota Herald-Tribune.

DOH employees explained that in some counties, there are too few physicians accepting Medicaid, forcing low-income people to seek help through county health departments. And there are growing numbers of uninsured who seek help there.

The state covers just 30 percent of the county health departments’ funding, says Heather Wildermuth, lobbyist for the Florida Association of Counties. The other 70 percent comes from counties, federal grants and revenue from the practice.
One effort that the budget language would kill is the forming of partnerships between counties and federally qualified health centers to hire professional staff, pooling resources to cover the cost. Currently eight counties – Duval, Palm Beach, Citrus, Liberty, Sarasota, Hernando, Osceola and Gulf – have such arrangements.

Gulf County Commissioner Bill Williams says that when the partnership in that tiny Panhandle county began in 2002, the health department doubled its staff in 90 days, hiring 22 people. The federal center is in the same building as the county health department.

The program, Williams said, would never have gotten off the ground if the rate bands now being considered by the Legislature were in place.

The Legislature’s effort to control the number of positions and salary amounts “sounds like good business practice,” he said. “But what they’re missing is the creativity part of it and how we can reach out and maximize our programs.” 

--Contact Christine Jordan Sexton.