11 Hospital CEO Salaries Equal 572 Nurses, NC Pay Inequality Report Finds

A ground-breaking report out of North Carolina has found that the pay of only eleven hospital CEOs in the state is equivalent to what those same hospitals would pay to employ 572 nurses. The “Hospital Executive Compensation: A Decade of Growing Wage Inequity Across Nonprofit Hospitals” report states that non-profit hospital executives have “enriched themselves” while simultaneously “fueling a crisis of health care affordability in North Carolina.”

As Nurse.org’s examination of nursing shortages by state shows, North Carolina is on the low end of salaries for nurses while also being a state that’s only projected to meet 92% of its demand for RNs. 

By 2030, Nurse.org estimated that the state of North Carolina will need 9,550 RNs. The North Carolina Institute of Medicine's Task Force on the Future of the Nursing Workforce estimates this could be as high as 12,500 by 2033. Even more concerning, the state has a high RN-to-population ratio.

And that thing may just be a lack of support, workload stress and burnout, and low pay as the report revealed that the hospital CEOs they examined all doubled their paychecks in less than five years, much faster than previously thought. 

“Existing research had gravely underestimated the growth of wage inequity across nonprofit hospitals,” the authors concluded. 

>> Click to See the Top Online MSN Programs

11 CEOs Salaries = 572 Nurse Salaries

The report revealed that the pay of 11 CEOs in North Carolina’s non-profit hospital system — a total of $37.7 million in 2019 — was equal to how much 572 RNs in the same state were paid. On average, RNs in North Carolina hospitals made a yearly salary of $67,730 in 2019. 

Additionally, while North Carolina nurses were asked to work with critically low supplies, the report noted that many of the state’s hospital CEOs accepted pay increases. The highest-paid North Carolina CEO during the pandemic, the report revealed, was Atrium CEO Gene Woods, who was paid $9.8M in 2021. 

In the same year, UNC Rex CEO Wesley Burks received $3.1 million in pay and Cone CEO Terry Akin accepted a $2.9 million paycheck. 

The report made a direct connection between the lack of financial support that went into supporting nurses and the nursing shortage that exists today in North Carolina. For instance, today, some parts of North Carolina are predicted to reach “crisis” levels of low RNs in areas like hospitals and other healthcare settings. 

The Asheville Watchdog reports that declining nursing school enrollment and nurses’ increasing workload with “high patient-to-nurse ratios” are considered to be potential contributing factors to the state’s growing nursing shortage crisis—all while hospital CEOs accepted higher paychecks. 

The looming nursing shortage in North Carolina is so serious, in fact, that The North Carolina Institute of Medicine recently launched a Task Force on the Future of the Nursing Workforce for the state. The task force was created in order to help create broad-scale and practical steps for supporting the nursing workforce in North Carolina. 

About the Report

The report was born, in part, by North Carolina state treasurer Dale R. Folwell, CPA, inviting researchers to study how much CEOs were getting paid within North Carolina.

The report looked at hospital CEOs from North Carolina’s nine largest hospital systems, including:

• Atrium

• Mission

• Novant

• UNC

• Vidant

• Duke

• Cone

• WakeMed

• Wake Forest Baptist Health

• Advocate Aurora Health (merged with Atrium Health)

Some of the key takeaways from the report captured just how much hospital executives are bringing home financially:

• Across the state, North Carolina hospital executives received $1.75 billion from 2010 to 2021.

• Of those funds, the CEOs received 20% of that.

• Hospital executives did not cut their own paychecks during COVID but claimed $1.5 billion in COVID relief funds. 

• Hospital executives also can earn money in other ways, which are not always tracked transparently, such as UNC Health CEO William Roper, who made $5.5 million by sitting on other organization boards. 

The report also found that the state hospitals received considerable tax breaks and exemptions, especially during COVID, but did not disclose how those funds were used and did not give out acceptable charity donations as is expected from any organization claiming “non-profit” status.

How Nurses are Affected

The report connected the dots between the lack of available funding that went into direct nursing care, especially during the pandemic. 

“There is disturbing evidence that hospital executive pay is not meaningfully linked to either patient safety or nonprofit hospitals’ charitable mission,” the report added, pointing to patient safety measures that “declined severely” during the pandemic, including a drastic increase in healthcare-associated infections, patient safety events, and falls. 

Investigations also looked specifically into how RNs were affected. For instance, the report explained that Ronald Paulus, a CEO with Mission Health, saw his own paycheck increase by a staggering 726% while the average nurse’s wage only raised by 14.8% in the same time frame. 

The report did concede that nurses received “significant” wage gains during the pandemic but added that half of the nurses considered leaving the profession amid widespread burnout.

And finally, the report pointed to the fact that some of the hospitals are strategically hiding executive pay and warned that continuing CEO wages without funding the state’s health care plan could be disastrous. For instance, the authors noted that HCA Healthcare rejected increasing quality metrics for executive pay, writing it “would not provide meaningful information to stockholders, would not be a good use of the Company’s resources, and is unnecessary.”

Each hospital system was analyzed by the report, and ultimately, the author concluded that “hospital prices and hospital executive compensation have soared in the past decade, and patients are paying the price.”