Staff Reporter

At a recent convention for health care workers in Ft. Lauderdale, Fla., the conversation turned to a discussion of the nation's best doctors.

Gary Barg, editor-in-chief of Today's Caregiver, a trade magazine, remembers standing in a group with several people from around the country: Ohio, New York, Illinois.

One name kept popping up that of Dr. Keith Black, chief of neurosurgery at Cedars-Sinai Medical Center and known for his compassion as well as technical brilliance in the operating room.

"Everybody knows him or knows of him," Barg said. "There's this worldwide referral network happening because of the media and because of the Internet. Outstanding doctors from L.A. can be a household name in Peoria."

And it's not just Black who has sprung from local prominence to national fame. There's Dr. Arnold Klein, alternately known as the "King of Botox" and "Collagen King of Beverly Hills," who has gained notoriety as pop star Michael Jackson's dermatologist. There's also Dr. Hillel Laks, a cardiologist at the UCLA Medical Center, who performed the first heart transplant in Southern California and has tended to the tickers of the world's rich and famous for years.

These elite physicians and many others are featured in this year's Who's Who Health Care, The Specialists, which spotlights some of L.A.'s best doctors in 20 different specialty fields (listing begins on page 16). For a variety of reasons, Los Angeles has far more than its share of brilliant medical specialists, so being selected as No. 1 in a specialty field in L.A. is an especially impressive achievement.

Some of the factors considered included the doctors' reputation among other top specialists in their field, major research breakthroughs, surgical success rate, complexity of surgical procedures undertaken, utilization of cutting-edge technologies, bedside manner and extent of service to the patient community.

Simply put, what makes these physicians so special is a combination of innate talent, a desire to learn and a dedication to the art of healing.

"I think they see value in what they do, and I think they're consumed by it," said Dr. Brian Johnston, a trustee with the Los Angeles County Medical Association.

The work of these and numerous other physician specialists has launched Los Angeles into the upper echelon of medical communities when it comes to having the best and brightest talent.

"In competition with L.A., you have the New York metropolitan area, the San Francisco Bay Area, and to a lesser extent some other cities like Boston and Chicago," said Peter Boland, a health care analyst with Boland Health Care in Berkeley.

Physician specialists are attracted to Los Angeles for a variety of reasons.

First off, there's the number of medical schools in the area five within 100 miles of downtown Los Angeles, or half the state's entire total. Of these schools, UCLA and USC have highly regarded residency programs for specialties like cardiology and neurology.

"Where you do your residency is the single biggest determination of where you end up living after that," Boland said.

In addition, several L.A. hospitals give physicians a chance to do cutting-edge research, as well as patient care.

"Hospitals that are affiliated with medical schools give physician specialists lab space and people to work in their laboratories," said Dr. Gerard Frank, president of the Los Angeles County Medical Association. "They have the chance to start up a meaningful research program and that has to come with the (recruitment) package."

Finally, there's that old standby, the weather along with all the cultural and recreational amenities of an urban center.

"A very highly trained specialist is not going to go out to the boonies," Frank said. "Many of these people are married to professionals lawyers, scientists or other doctors. In a rural area it's not always possible to maximize two career opportunities."

Surprisingly, it's not always money that brings the cr & #269;me de la cr & #269;me to Los Angeles. Sure, rumors abound that many of the city's top docs are making seven- or eight-figure annual salaries, but preeminent hospitals in New York also throw that kind of cash a physician's way.

"It's like the old studio system," Barg said. "Everybody is trying to get the same stars."

And while New York and possibly San Francisco might be able to match L.A. on salary, or research opportunities, once all factors are weighed, L.A. is tough to beat as a haven for nationally and internationally renowned medical specialists. Once those specialists establish themselves here, patients from around the globe fly in to receive treatment from them. And that can provide a mighty boost to a hospital's bottom line.

There were 609 liver transplants in California in 1996, according to the Office of Statewide Health Planning and Development (the most recent year available). The average charge per operation? $250,880. That same year, there were 271 heart transplants, each procedure costing an average of $239,950.

The services of these elite physicians do not come cheap, but many of them contract with health maintenance organizations, theoretically opening up their services to the ill who are not multimillionaires.

"Every one of them to some extent is involved in HMOs," Frank said. "Now what exact percentage of their patients are from HMOs, I can't tell probably not very many. When you're taking patients from all over the world, obviously these are not all going to be HMO patients."

Many doctors, not just the elite specialists, would prefer to deal with cash-paying patients or those with less-restrictive health insurance plans than with HMO patients. But elite specialists can better afford to limit the number of HMO patients they treat, and still maintain a patient load that's as big as they wish.

Those patients with dire circumstances will probably get first attention from a specialist. After all, what specialist could resist simultaneously transplanting an artificial lung and a baboon's kidney into the body of a rock star?

But most must settle for being seen, at least initially, by a member of the support staff. As for patients, their decision about which specialist to see is often largely determined by their primary care physician, many of whom refer patients to specialists they know through professional connections.

"If your primary doctor is trained at UCLA, they'll tend to push them toward UCLA superstars," said Frank. "The same thing goes on with USC, Loma Linda and UC Irvine."

In addition, Frank said, the diversity of Los Angeles creates a strong network between minority primary care doctors and minority physician specialists. Patients facing severe health problems usually prefer to be treated by a specialist who can speak their language.

"Primary docs who can find a Hispanic specialist to refer patients to are golden," Frank said.

And as for the "God complex" that afflicts some stellar doctors, those in the medical community say that such egomaniacs are the exception, not the rule.

"Some of the very best are soft-spoken about their accomplishments," said Darc Keller, chief executive of the Los Angeles County Medical Association. "They frequently express their profound amazement about what they feel in terms of helping people, combining their skills with compassion and seeing their patients progress through very serious illnesses."

One story that is repeated about a prominent local cardiologist serves to illustrate the low-key attitude of the city's elite doctors. The cardiologist walked into his mechanic's shop to pick up his car after he had some work done. The mechanic greeted him and starting joking about the repair work.

"Hey, I did the same thing to your car that you do to people," the mechanic teased. "I fixed its valves."

"Yes, that's right, you did," the cardiologist replied, smiling. "But next time try it with the engine running."

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