Doctor contracts at county-owned Kern Medical Center have sparked controversy for years.

On Tuesday, Kern County supervisors will debate a new compensation plan designed to tie physician pay to physician work.

Understandably, said Kern Medical Center CEO Paul Hensler, the issue has some at the hospital nervous.

"The physicians are very cautious," he said.

Impacts would be greatest on specialists who have a less-structured time commitment to the hospital.

Emergency room doctors work their shifts in the ER and get paid for them.

But a surgeon's work is more closely tied to the surgeries they perform.

So Hensler said the system that has been developed tries to account for service to KMC in a fair way that rewards hard work while acknowledging the realities of a doctor's job. Each doctor will negotiate his or her own contract with the hospital but all start on the same footing.

The system, for example, uses national statistics as a benchmark for compensation.

"If they choose not to be productive, then we just don't pay them as much," Hensler said. "If someone puts in the (national) median effort, they will get median compensation."

A big part of the plan will be how professional fees -- the money earned for a specific operation or procedure -- are handled.

Professional fees are currently collected from patients by the doctors. Indigent and uninsured patients generally do not pay.

Under the new system, Hensler said, the county will bill professional fees and doctors will be compensated by the hospital at the same rate no matter who their patient is.

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