Brigham struggles to lure a star surgeon

Hospital officials held serious talks with Dr. Patrick McCarthy of the Cleveland Clinic, Dr. Robert Robbins of Stanford University, and Dr. Randolph Chitwood at East Carolina University -- all household names in the world of cardiac surgery. With McCarthy, the hospital got as far as making a formal offer.

All three candidates cited low fees from insurance companies and the high cost of Boston housing, as well as not wanting to uproot families, said Dr. Michael Zinner, the Brigham's chief of surgery. And at least two of the three candidates earn higher salaries than the Brigham would offer, he said.

Chitwood, according to East Carolina University, earns $950,000 annually, while the most experienced and productive heart surgeons at Harvard's teaching hospitals earn around $500,000.

Stanford also offered Robbins the chance to run a new heart center, while East Carolina agreed to move ahead with a $160 million to $210 million cardiovascular disease research institute that will be headed by Chitwood.

These are huge investments that are not part of the Brigham's strategic plan, either because of the cost or because they allow surgeons to work outside traditional department channels.

"It's not that Harvard has lost its luster," said Zinner, who is interviewing a new round of candidates. "It has incredible luster. It's just that no one is going to come just for the Harvard name."

Surgeons at the Brigham and other Massachusetts hospitals said the unusually prolonged search illustrates a growing concern that physicians' salaries and financial perks such as money and space for research in other states are outpacing those here, making recruitment of star physicians difficult. Many community hospitals are having trouble recruiting surgeons, too.

The Harvard name used to overcome these obstacles. But as other academic medical centers have become national powerhouses in their own right, Boston's prestige and intellectual reputation is no longer always enough. "People wonder, `Why should I come to Boston when the cost of living is 50 percent higher and I'm going to take a 30 percent pay cut?' Not everyone thinks going to Harvard is going to Mecca," said Dr. John Mayer, a cardiothoracic surgeon at Children's Hospital, another Harvard facility.

Hospitals in Chicago and San Francisco also are struggling to recruit heart surgeons, said Dr. Robert Replogle, chairman of the advisory council on cardiothoracic surgery for the American College of Surgeons, a Chicago-based physicians' organization. Because heart patients more often are being treated with less invasive procedures like angioplasty, overall surgery cases are declining, he said, and surgeons may be unwilling to risk starting fresh.

The Center for Studying Health System Change, a nonprofit research organization in Washington, D.C., has tracked medical care in 12 communities, including Boston, since 1996. When researchers visited Boston last spring, president Paul Ginsburg said, they "heard a lot more complaining about recruitment" than anywhere else.

Blue Cross and Blue Shield executives said they're aware of physicians' concern about fees, but that they pay more than Medicare, the government insurance program for the elderly, for most services. But doctors say that because of the dominance of managed care, private insurers pay less than in some other regions. Zinner said that doctors at teaching hospitals have been slow to organize into groups with clout to negotiate higher fees. The Brigham's physician organization formed just two years ago.

In addition, Harvard Medical School imposes a salary cap on doctors. The cap grows about 4 percent annually and is now $532,000 for a full professor. The cap was intended to keep doctors from focusing solely on increasing their earnings from treating patients, and neglecting teaching and research. Hospitals must get permission from their own boards and from medical school dean Dr. Joseph Martin to exceed the cap. Sometimes, hospitals get around it by offering doctors deferred compensation.

According to a Health System Change survey two years ago, specialists of all kinds in the Boston area earned an average of $166,000, compared to $219,000 nationally. But that survey may not capture all money earned from research or consulting, which Boston physicians may do more of because many work for teaching hospitals.

According to the American Association of Medical Colleges, cardiac surgeons who are full professors, the highest rank, earn an average of $422,000 from all sources of income in the Northeast -- far more than in the South but less than in the Midwest and West. But the group does not have separate figures for Massachusetts.

At the Brigham, Massachusetts General Hospital, and Beth Israel Deaconess Medical Center -- Harvard's largest cardiac surgery teaching programs -- the most experienced and busiest heart surgeons earn $400,000 to $500,000. Medicare and private insurers pay the hospitals' surgery departments, which take out money for overhead and administration, and then distribute salaries to surgeons based on productivity, research, and other factors. It's possible for surgeons to supplement the salaries a little with outside consulting, Zinner said.

But even so, he said, it's rare for a surgeon to reach the salary level of some job candidates.

At the Brigham, Dr. Lawrence Cohn, the longtime cardiac chief, has continued to run the cardiac surgery department while also taking on the job of running the hospital's physician organization. Despite the hiring delay, Brigham surgeons did 1,690 heart operations last fiscal year, 80 more than the previous year.

The three surgeons the Brigham was looking to hire didn't return telephone calls from the Globe.

Chitwood, who earns $950,000 from all sources of income, has a far larger slate of responsibilities than he would directing the Brigham's six-surgeon cardiac program. An expert in complex heart valve surgery, he also directs the heart center at University Health Systems in Greenville, N.C., which includes cardiac ICUs and cardiac catheterization labs.

The Cleveland Clinic would not disclose McCarthy's salary. The Clinic's chief of cardiac surgery, Dr. Delos Cosgrove, earned nearly $1.8 million in 2001, according to public records.

A heart-transplant specialist, McCarthy directs the clinic's heart-failure program. The Cleveland Clinic does far more heart transplants than does the Brigham. A Clinic spokeswoman said McCarthy's "reasons for turning down the position at Brigham and Women's had nothing to do with salary," but she declined to elaborate.

Stanford also would not release Robbins's salary, but a spokeswoman confirmed that the university and hospital were working to complete plans for a heart center for him to run.

Liz Kowalczyk can be reached at kowalczyk@globe.com.