Hospital CEO Pay vs. Nurse Pay: What the Health Affairs Data Shows About the Growing Gap
By NurseCompensation Research Team · 2026-06-16 · 10 min read
A Health Affairs study found nonprofit hospital CEO wages grew 27.5% while the CEO-to-employee pay ratio rose to 12:1 by 2023. For-profit system CEOs earned $4.8M to $43M in 2025. Here is the complete picture.
The Health Affairs Finding
A study published in Health Affairs (2024) analyzed nonprofit hospital executive compensation and found:
- Average CEO wages grew 27.5% over the study period
- Average top executive wages grew 23.1%
- CEO-to-average-employee wage ratio: 10.2x in the base year, rising to approximately 12x by 2023 — an 18% increase in the pay gap
- Nonprofit hospital CEO compensation significantly exceeds that of nonprofit leaders in other sectors, where mean CEO pay hovers between $120,000 and $200,000
For context, the average staff RN earns approximately $101,420 (BLS mean, 2025). A hospital CEO earning 12x the average employee wage suggests CEO compensation in the range of $800,000-$1.5 million+ at many institutions — and much higher at large systems.
For-Profit Health System CEO Compensation (2025)
Fierce Healthcare reported 2025 executive compensation for publicly traded health systems:
- Highest-paid CEO: $43.1 million total compensation (Tenet Healthcare CEO)
- Range across major systems: $4.8 million to $43.1 million
- Prior year (2024) range: $6.9 million to $24.7 million
- Systems included: HCA Healthcare, Tenet Healthcare, Universal Health Services, Community Health Systems, Ardent Health
The nurse comparison: A for-profit system CEO earning $20 million earns what approximately 197 staff RNs earn collectively. The $43.1 million CEO earns the equivalent of 425 RN salaries.
Nonprofit Hospital CEO Data
CharityWatch tracks IRS Form 990 filings for nonprofit hospital executive pay:
- Memorial Sloan Kettering CEO: $6.98 million (FY 2024)
- City of Hope CEO: $5.46 million (FY 2024)
- Dana-Farber Cancer Institute CEO: $2.46 million (FY 2024)
- St. Jude Children's Research Hospital CEO: $1.84 million (FY 2024)
Healthcare Finance News reported that healthcare executive pay increased 4.6% in 2024, on par with the 4.4% growth rate the prior year — with system-level executives seeing the largest gains.
Growth Rate Comparison
The divergence becomes clear when comparing growth rates:
| Role | Pay Growth (approximate) |
|---|---|
| Nonprofit hospital CEO | 27.5% (Health Affairs study period) |
| Healthcare executives overall | 4.4-4.6% per year (2023-2024) |
| RN wages (inflation-adjusted) | 0.51% per year (Health Affairs, 2012-2023) |
| RN wages (nominal) | ~3-4% per year |
The headline: CEO pay grew approximately 93% over the past decade at nonprofit hospitals (per social media analysis of the data), while RN real wages grew approximately 5% over the same period.
North Carolina Deep Dive
The North Carolina State Health Plan partnered with Johns Hopkins University and Rice University to study executive compensation at the state's nine largest hospital systems:
- $1.75 billion paid to top executives from 2010 to 2021
- CEOs captured nearly 20% of that total ($350 million)
- CEO compensation doubled faster than previously believed during this period
- Systems studied: Atrium, Mission, Novant, UNC, Vidant, Duke, Cone, WakeMed, Wake Forest Baptist Health
What Drives Hospital CEO Compensation
The Medical Care journal study (published in PMC) found that nonprofit hospital CEO pay correlates with:
- System size (number of hospitals, beds, revenue) — the strongest predictor
- Profitability (operating margins) — higher margins = higher CEO pay
- Health system consolidation — mergers create larger systems, justifying higher pay
- Market competition for executives — hospitals compete with for-profit systems for leadership
Notably: quality metrics (patient outcomes, patient satisfaction, readmission rates) had minimal influence on CEO compensation by 2019, despite being a factor in 2012.
Why This Matters for Nurses
1. Budget allocation. Every dollar allocated to executive compensation is a dollar not available for staff nurse wages, staffing ratios, or workplace improvements. At a system employing 5,000 nurses, a $10 million executive compensation package equals $2,000 per nurse that could theoretically be redirected.
2. Transparency tool. IRS Form 990 filings for nonprofit hospitals are public record. Any nurse can look up their hospital's CEO compensation at ProPublica's Nonprofit Explorer or GuideStar. This data provides factual context for wage negotiations.
3. Union organizing catalyst. The CEO-to-worker pay ratio is frequently cited in nurse union organizing campaigns. SEIU, NNU, and NYSNA have all used executive compensation data in contract negotiations and public communications.
4. The moral argument has limits. While the pay gap generates legitimate public frustration, it's worth noting that even eliminating all executive compensation and redistributing it would add only $1,000-$3,000 per nurse at most facilities. The structural issues driving nurse wages (market concentration, payer mix, substitution effects) are larger than executive pay alone.
How to Find Your Hospital's CEO Pay
- Nonprofit hospitals: Search IRS Form 990 at ProPublica Nonprofit Explorer (free, public). Schedule J lists executive compensation.
- For-profit systems: SEC proxy statements (Form DEF 14A) are publicly filed and list all "named executive officers."
- Public/government hospitals: Often subject to state open records laws; compensation may be published by the state comptroller.
Sources: Health Affairs "Pay Gap Between Nonprofit Hospital CEOs And Employees Grew" (DOI: 10.1377/hlthaff.2024.01494), Fierce Healthcare 2025 for-profit executive compensation report, CharityWatch IRS Form 990 analysis (FY 2024 data), Healthcare Finance News executive pay growth data, North Carolina State Health Plan/Johns Hopkins/Rice University executive compensation study, Medical Care journal/PMC "Nonprofit Hospital CEO Compensation" analysis.