The C-Suite Swindle: How are so many healthcare workers struggling?

Hospital systems like to brag about how many people they employ in their state, but having a status of “employed” is not enough to maintain standards of living. Workers need to be paid well enough to not only survive but thrive – after all, nobody would want their healthcare team to be struggling so much so that it could impact their care. 

One thing the COVID-19 pandemic highlighted is just how many healthcare workers we have in this country. The most recent Census data shows around 22 million workers in the industry, around 14% of the entire workforce. With repeated hospital worker strikes across the nation over the past year, it’s worth asking: How are so many vital workers struggling to make ends meet?

Essential healthcare support workers are undervalued and underpaid

While physicians and nurses are unquestionably at the core of most healthcare teams, they comprise less than 20% of all essential healthcare workers and they receive the most accolades. According to GlassDoor, the average physician at a large health care center like Massachusetts General Hospital can expect a yearly income in the hundreds of thousands. This is not the case for residents, who start off at a 70k salary and work insane hours leading to burnout. But what about the other workers who are vital to hospital functioning and are also on the frontlines of the pandemic?

Pharmacy technicians, crucial to ensuring accurate medication dispensing, take in less than 50k per year at MGH on average. Same with their mental health counselors, oral and maxillofacial surgical assistants, and anesthesia technicians, to name a few. That’s not enough money to live in your own apartment in a state like Massachusetts, nevermind if you have kids or dependents. 

Other healthcare support positions such as janitors, food prep, and home health workers pay even less. The nearly 7 million person workforce has a median hourly wage of $13.48, which amounts to less than 30k per year assuming no time is taken off. An estimated 81% of these workers are women, and 46% are Black or Hispanic. These jobs are crucial to a safe, effective healthcare system. If a Massachusetts-based worker has two kids, they qualify for MassHealth (Medicaid). Why have we built a system that pays essential workers so little that they need state assistance to survive?

The C-Suite Swindle

At the same time as essential workers are underpaid, hospital CEOs are lining their own pockets. According to our analysis from earlier this year, the average nonprofit hospital CEO makes 8 times what workers make. The least equitable hospitals have a pay ratio of more than 60:1. 

Compensation is primarily derived from the volume of patients coming through the hospital doors, also called “heads in beds.” As that number rises, worker wages tend to increase – but not nearly at the same rate as CEO pay. Location is also a factor but it is clear that the pay ratios between the C-suites and the workers on the actual frontlines are atrocious across the board. Even worse, hospitals engage in union-busting and present paltry offerings like gift vouchers to the hospital cafeteria and pizza parties to frustrated employees rather than just raising wages and hiring more workers to relieve staffing shortages.

Hospitals also spend an inordinate amount of money on facilities and expansion. When the Cleveland Clinic built a new multispecialty hospital in Abu Dhabi, they spent an estimated $2.5 billion. Meanwhile, their phlebotomists are paid less than 30k per year, below the national average. Our analysis found that Cleveland Clinic’s pay equity ratio for this year was 34:1. Their CEO was paid $3.3 million in 2019, including compensation as CEO of the Cleveland Clinic. That breaks down to about $1273 per hour. In comparison, their workers without advanced degrees are paid $38 per hour. If the nonprofit system is neither paying their workers fairly nor investing in their communities the same way their communities have invested in them, it seems clear that these systems are swindling nearly everyone outside of the C-suite.

We need to deeply evaluate our priorities and values when it comes to the workers who keep us alive and healthy. They should not feel simultaneously overworked and underpaid while they hold the fate of another in their hands. Hospitals can’t function without all of their employees at every level, from the person cleaning the floors to the person cutting a patient open for surgery. We deserve a health care system that takes care of all of us.