By: Marcus J. Hopkins, ADAP 340B Consultant
Did you know?
Almost all but two of the ten highest-paying professions in the United States are in the medical field. The two professions that are not inherently medical in nature are airline pilots and Chief Executives. On the U.S. News list of the top ten jobs, Chief Executive salaries rank 10th, with a median annual salary of $206,680 (U.S. News, 2025).
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| Photo Source: Lown Institute |
Apparently, U.S. News hasn’t met very many hospital CEOs. In particular, CEOs running the hospitals raking in millions of dollars from the lucrative 340B Drug Pricing Program—which is designed to help poor patients.
Hospitals are vital services filled with people who literally save lives every day, and at the top of the pile sits the Chief Executive Officer, ostensibly responsible for ensuring their hospital can keep the lights on and the patients alive and well. It’s a critical job that requires expertise and understanding of not only the healthcare space, but of business, management, finance, and publicity.
Of the 63 hospitals that ADAP Advocacy has audited since 2023, not a single CEO earned a salary so little as $206,680. Instead, across all 63 hospitals, the average CEO compensation package was $3,378,461—just a bit higher than the figure on the U.S. News list.
Now, obviously, U.S. News’ report considers all CEO positions across all sectors, but it raises the question of whether U.S. News needs to adjust its methodology.
It’s no secret that CEO pay at hospitals has long outpaced the incomes of the people working in those hospitals—people who often work significantly more extended hours and hold in their hands the literal lives of other human beings. In fact, a 2023 report from the North Carolina State Health Plan for Teachers and State Employees found that the CEO pay of just 11 of North Carolina’s non-profit hospitals was the equivalent of what those same hospitals would pay to hire 572 nurses (North Carolina State Health Plan for Teachers and State Employees, 2023).
The NC State Health Plan report highlights just how severe those pay gaps are, particularly at a time when wage growth for non-physician roles is slowing due to hospital system consolidation (Prager & Schmitt, 2021). More damning was that, during the COVID-19 pandemic, hospital CEOs gladly accepted exponential pay raises at these hospitals. In contrast, hospital staff—the individuals responsible for saving lives—were instructed to make do with insufficient supplies and personal protective equipment (Shabad, 2020).
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| Photo Source: North Carolina State Health Plan for Teachers and State Employees |
The issue with CEO compensation, in general, is that CEOs tend to demand high compensation packages, particularly for companies and organizations that generate billions of dollars in revenue annually, and boards of directors often feel compelled to accept those demands. If they don’t want to pay that much, the candidate can simply walk away and find it elsewhere.
The non-physician employees who provide the bulk of care in hospitals don’t have that luxury.
Imagine if nurses and other hospital support staff demanded starting salaries of just $100,000 a year. They would be laughed out of the room, their demands would be rejected, and they would be accused of putting money ahead of patients. In fact, it wasn’t until 1974 that non-profit hospitals were allowed to form labor unions (National Labor Relations Board, n.d.), and even then, they could only do so if they agreed not to strike.
When nurses strike, as with teachers, the argument is made that they are being selfish for striking. The criticism reflects: How DARE they put the lives of patients at risk?! Never mind that there have been critical nursing shortages for most of the past decade, and that shortage is expected to get considerably worse by 2030 (University of St. Augustine for Health Sciences, 2024). These shortages are driven by several factors, including (but not limited to):
- A rapidly expanding aging population, which grew from 41 million people in 2011 to 71 million in 2019 (a 73% increase; Paavola, 2020)
- An aging Registered Nurse (RN) population that is starting to retire, with more than 25% of all RNs saying in 2022 that they would leave or retire from the field within five years (Rosseter, 2024)
- Nurses not being located where the shortages are greatest
- Job stress, fatigue, and burnout (University of St. Augustine for Health Sciences, 2024)
Meanwhile, the CEO HCA Healthcare—the largest health system in the United States—gladly accepted a compensation package totaling $23,799,137, while the median HCA employee earns $60,082 (Brusie, 2025). This new compensation package increases the HCA CEO-to-worker pay ratio from 356 to 1 in 2023 to a staggering 391 to 1.
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| Photo Source: Vecteezy |
The reality is that, while hospital CEOs have important jobs, they should never have become the stars of the show. Unfortunately, there are no data available that can demonstrate whether or not revenues received from the 340B Drug Pricing Program—a program created to ensure that poor patients were able to access low-cost medications and healthcare services by reinvesting those revenues into increasing access and affordability for those patients—have been used to increase the compensation packages of CEOs or other executives.
We argue that 340B dollars, regardless of the covered entity eligible to receive them, should be directly tied to improving access and affordability for patients. One way to improve services, for example, would be to use those funds to hire more nurses. Or increase the pay of the existing nurses. Or keep rural hospitals open instead of closing them and consolidating them.
There are a lot of moving parts in this debate, but the reality is that we’ve allowed CEO pay at 340B-eligible hospitals to get entirely out of hand. And if we don’t get a handle on the problem, soon, the companies that foot the bill—pharmaceutical companies—are going to refuse to participate.
References:
Brusie, C. (2025, May 05). HCA CEO pay gap widens in 2024; The eye-popping compensation of high-paid hospital CEOs. Bellevue, WA: Nurse.org: News. https://nurse.org/news/hospital-ceo-pay/
National Labor Relations Board. (n.d.). 1974 Health Care Amendments. Washington, DC: National Labor Relations Board: About NLRB: Who We Are: Out History. https://www.nlrb.gov/about-nlrb/who-we-are/our-history/1974-health-care-amendments
North Carolina State Health Plan for Teachers and State Employees. (2023, February 14). Hospital executive compensation: A decade of growing wage inequity across nonprofit hospitals. Raleigh, NC: North Carolina State Health Plan for Teachers and State Employees. https://www.shpnc.gov/nonprofit-hospital-executive-pay-report/open
Paavola, A. (2020, April 07). 266 hospitals furloughing workers in response to COVID-19. Chicago, IL: Becker’s Hospital Review: Finance. https://www.beckershospitalreview.com/finance/49-hospitals-furloughing-workers-in-response-to-covid-19/
Prager, E. & Schmitt, M. (2021). Employer consolidation and wages: Evidence from hospitals. American Economic Review, 111(2), 397-427. http://dx.doi.org/10.1257/aer.20190690
Rosseter, R. (2024, April). Nursing Workforce Fact Sheet. Washington, DC: American Association of Colleges of Nursing: News & Data: Fact Sheets. https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet
Shabad, A. (2020, May 04). North Carolina is low or completely out of certain critical supplies of PPE. WNCN Charlotte: Articles: News: Health: Coronavirus. https://www.wcnc.com/article/news/health/coronavirus/north-carolina-low-completely-out-critical-supplies-ppe/275-560d5b3e-172c-4e07-bf1d-f0e4524a5190
U.S. News. (2025). Best-Paying Jobs. Washington, DC: U.S. News: Money: Careers: Best Jobs: Best-Paying Jobs. https://money.usnews.com/careers/best-jobs/rankings/best-paying-jobs
University of St. Augustine for Health Sciences. (2024, December 30). Nursing shortage: A 2024 data study reveals key insights. St. Augustine, FL: University of St. Augustine for Health Sciences: Blog. https://www.usa.edu/blog/nursing-shortage/
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.
