Dr. Benjamin Hu wanted Whidbey General Hospital to pay him $325,000 a year. He got $325 a day.

The hospital district Board of Commissioners approved a recommendation this month to offer Dr. Hu, the island’s only urologist, a contractual agreement to pay him to spend more days on-call.

It’s not what Hu wanted. In May, Hu told the board that he would close his practice by the end of June unless the hospital bought his practice, hired him as an employee and paid him a $325,000 annual salary.

Hu is facing financial pressure that physicians in rural areas and small communities across the nation have to contend with. The double whammy of inadequate Medicare reimbursement and rising overhead — particularly malpractice insurance — is forcing doctors to move to more lucrative areas or refuse certain patients, especially those on Medicare.

Hu said he’s not sure this new agreement will work out, but he’ll wait to the end of the year to look at his finances and make a decision. It’s still a possibility that he will close his clinic.

“A lot depends on what happens with Medicare,” he said, adding that Congress is considering further reductions in Medicare reimbursement payments to doctors.

In the meantime, Hu hopes to continue negotiating with the hospital to find a long-term solution to providing urology services on the island.

Hospital CEO Scott Rhine said he carefully considered Hu’s proposal, but he felt it wouldn’t be in the best interest of the hospital.

“Hospitals have learned over the course of 10 to 15 years,” Rhine said, “that it’s not the best idea to invest capital into buying physicians’ clinics.”

Rhine pointed out that most doctors on the island are private practitioners and are not employed by the hospital. While Hu is an excellent physician, Rhine felt that the “employment model” would not work best in his case.

Instead, Rhine recommended that the hospital pay Hu a rate of $325 per 24-hour day for excess call coverage.

Under current hospital bylaws, Hu and other sole physicians in a specialty are required to provide 10 days per month for emergency hospital call. In other words, they have to be “on call” for those days in case of an emergency.

Rhine explained that Hu can choose to be on call for as many days a month he wants, beyond the required 10 days.

If Hu chooses to handle 10 extra days a month, for example, he would make an extra $39,000 a year.

Losing Hu would be a big blow to the hospital, not to mention his 1,800 patients. A staff urologist at the hospital is a mandatory requirement of the hospital’s Cancer Care Accreditation.

While Rhine was able to avert, or at least delay, a crisis from Hu leaving, he can’t solve the larger problems facing rural hospitals. One of the biggest problem comes from the federal government and can only be fixed by the federal government. It’s Medicare, the federal health care insurance program for people over 65.

The amount doctors receive for treating Medicare patients is dictated by a complex formula and fee schedules that differ by areas in the country. Congress has cut reimbursements over the last few years. Doctors in Washington receive among the lowest reimbursements in the nation. According to a New York Times report, Medicare reimbursement for doctors in many cases does not even cover the cost of providing the care.