Concerns around executive pay in the non-profit healthcare sector have intensified as hospitals attempt to balance resources for patient care with rising administrative expenses. In a time where transparency and accountability are essential in healthcare, a recent study sheds light on executive salary patterns in non-profit hospitals across the United States, exposing complex links between financial performance and pay, as well as notable regional differences in pay increases.
A group of researchers led by Dr. Micah Ngatuvai carried out an in-depth review of executive pay at a sample of non-profit hospitals from various regions. This study, published in Cureus, analyzed years of data, revealing clear patterns in pay growth for executives and how these trends relate to the hospitals’ financial performance. The research team gathered information from publicly available filings required for tax-exempt organizations. These documents provide a glimpse into how the financial success of hospitals may influence what they pay their top executives.
The findings showed a steady increase in executive salaries over the years. Total pay for executives grew substantially, with the rate of increase varying by region. For instance, hospitals in the Southern United States reported the highest increase, while those in the Midwest had a smaller rise. Even though executive compensation rose across all regions, there were no statistically significant differences in the rate of increase between them. Dr. Ngatuvai commented, “While we observed significant pay increases overall, the variations across regions reveal complex factors beyond simple financial performance metrics that drive executive compensation.” This regional variation suggests that factors beyond revenue alone play a role in deciding executive salaries.
Key financial indicators—hospital revenue, total assets, and income—each showed a strong positive relationship with executive pay. Hospitals with higher revenue generally tended to provide higher pay packages for executives, reflecting a close connection between revenue and compensation. A similar relationship was found with assets, while income had a slightly less direct impact. Interestingly, changes in these financial indicators over time did not correspond with changes in executive pay, indicating a complex and indirect relationship between a hospital’s financial growth and executive earnings.
Looking closer at individual hospitals, there were stark differences in executive pay levels. Some major hospital systems had the highest overall compensation, where executive earnings were notably larger than at smaller institutions. By contrast, other hospitals maintained relatively modest pay scales for their executives, highlighting a broad gap in executive pay across the sector.
The study also explored the potential consequences of rising executive compensation, especially as it relates to overall healthcare costs. Researchers found that the upward trend in executive pay mirrored the steady rise in administrative expenses throughout the healthcare sector, a trend that was sped up by the COVID-19 pandemic. During the pandemic, administrative costs grew considerably more than expenses for direct patient care. This imbalance raises important questions about where non-profit hospitals are prioritizing their funds, particularly as pay for doctors and other medical staff has remained stagnant or declined—a trend that has only worsened in recent years. This contrast is especially noticeable in certain medical fields, like orthopedic surgery, where inflation-adjusted reimbursements have sharply decreased for specific procedures.
Although these findings bring attention to financial gaps in healthcare, the authors stress that their study is not intended as a critique of specific compensation decisions. Instead, the goal is to highlight trends that could inspire further discussions on healthcare policy. “Our findings underscore the need for transparent, equitable compensation practices that align with the mission of non-profit healthcare institutions to serve communities effectively,” noted Dr. Ngatuvai. This perspective suggests that policy adjustments may be needed to ensure that pay practices in non-profit hospitals are in line with their commitment to community care, especially given the rising costs of healthcare and the steady decrease in pay for other essential healthcare staff.
Taken together, this study offers new insights into executive pay trends in non-profit hospitals and how these trends relate to the hospitals’ financial health. With healthcare costs continuing to rise, the researchers advocate for ongoing studies into what drives executive pay and how these trends impact hospital staff retention, daily operations, and the quality of care provided to patients. These findings call for thoughtful policy discussions on fair and balanced resource distribution within non-profit healthcare organizations.
Journal Reference
Saipale L, Ngatuvai M, Dertinger JE, Hansen J, Tihista M, Purcell R. Dollars and Disparities: Unraveling Executive Compensation Patterns in American Non-Profit Healthcare. Cureus, 2024. DOI: https://doi.org/10.7759/cureus.70911
About the Authors
Dr. Micah Ngatuvai is an orthopedic surgery resident at Texas Tech/WBAMC. After completing his undergraduate degree in Business Management at Southern Utah University, he further developed his administrative expertise through an MBA program before pursuing his medical education. Dr. Ngatuvai’s research interests include orthopedics, diversity initiatives in healthcare, and medical business administration. His current work focuses on advancing orthopedic care while promoting inclusive practices in medical education and patient care.
Dr. Josh Hansen is an orthopedic surgery resident preparing to pursue fellowship training in joint reconstruction. After completing his undergraduate studies at Utah State University, he earned his medical degree from the Uniformed Services University of Health Sciences. Currently training at Texas tech/WBAMC in El Paso, Tx, Dr. Hansen’s research interests focus on joint reconstruction techniques and healthcare business innovation. His work investigates the intersection of clinical outcomes and healthcare delivery systems, with particular emphasis on advancing surgical techniques in joint replacement. Beyond his clinical duties, Dr. Hansen maintains an active role in resident education and is involved in several ongoing research projects examining modern approaches to arthroplasty.
Dr. Richard Purcell serves as Department Chair of Orthopedic Surgery at William Beaumont Army Medical Center in El Paso, Texas, where he specializes in complex hip and knee reconstruction. After receiving his medical degree from the Uniformed Services University of Health Sciences, he completed his orthopedic surgery residency through the National Capital Consortium at Walter Reed National Military Medical Center. He further refined his expertise through fellowship training in Adult Reconstruction at the prestigious Hospital for Special Surgery/Cornell Medical Center. Dr. Purcell has distinguished himself both in academic medicine and military service, notably providing critical surgical care to victims of the Kabul airport bombing in Afghanistan. His research contributions span diverse areas including bone ingrowth, military orthopedics, external fixation, and pain management protocols in hip arthroscopy. As a recognized leader in joint reconstruction, he continues to advance the field through his clinical excellence, research, and dedication to both civilian and military patient care.
Landon Saipale is a fourth-year medical student at Central Michigan University College of Medicine, bringing a unique perspective through his background in economics and finance. After completing his undergraduate studies at the University of Utah with a dual degree in Economics and Finance, he has developed a strong passion for research in healthcare economics and its implications for medical practice. His research interests focus on the intersection of financial systems and healthcare delivery, with emphasis on how economic trends shape the future of medicine.
