In Part 1, we looked at how California’s largest nonprofit hospital systems bring in billions in revenue — all while paying their top executives millions of dollars per year.
Now, let’s take a closer look at where those dollars aren’t going: to frontline staff, struggling patients, or the communities these hospitals claim to serve. At Art of Being ILL, this series isn’t about blame. It’s about conversation, education, and shining light on the things we often take for granted in healthcare. I’m not pointing fingers — I’m just inviting dialogue.
The pay gap between hospital executives and staff is hard to ignore — especially at nonprofit institutions. While CEOs at systems like Sutter Health and Cedars-Sinai earn $5 to $13 million per year, the people delivering direct care — nurses, aides, technicians — often face:
Wage stagnation
Short-staffing and burnout
Unsafe patient loads
Increased turnover and reliance on expensive travel nurses
Hospital systems argue that high executive pay is necessary to attract experienced leaders. But if the mission is truly service, shouldn’t competitive wages for frontline caregivers come first?
By law, nonprofit hospitals are required to offer community benefit — including free or reduced-cost care for low-income patients. Some do better than others. For example, Cedars-Sinai expanded its charity care in 2020 to include patients earning up to 400% of the federal poverty level.
However, many other systems:
Spend less than 2% of their revenue on charity care.
Use aggressive billing and collection tactics.
Send unpaid bills to collections — or even sue patients.
For tax-exempt institutions, it’s hard to reconcile these practices with a mission of community health.
Let’s follow the surplus:
2023 Net Income: $1.17 billion
Investments: Facility upgrades, technology, and expanding care access.
2024 California Region Revenue: $13.2 billion
Reported Growth: Increases in provider fee revenue and admissions.
Spending Focus: Capital improvements and system growth.
Most nonprofit systems justify these surpluses by pointing to building renovations, launching surgical centers, or building financial reserves. But what’s often missing is investment in underpaid frontline staff or expanding meaningful charity care that actually reaches underserved communities.
These financial choices have real human impact:
Staffing Crisis: Burned-out nurses are leaving the profession in record numbers.
Financial Strain: Patients delay care or rack up crippling debt.
Community Gaps: Communities miss out on programs like mobile clinics, housing partnerships, or mental health services.
A billion-dollar surplus might renovate a hospital’s lobby, or it could fund hundreds of community health workers. Where the money goes — matters.
Transparency is power. Here’s how to take action:
1. Research Your Local Hospital Look up your local hospital’s IRS 990 filing on the ProPublica Nonprofit Explorer. Focus on executive pay, charity care, and community benefit sections.
2. Ask the Right Questions
How much of the hospital’s revenue goes to charity care?
What’s the CEO paid compared to staff wages?
What specific programs are supporting your community?
3. Support Policy Reform Advocate for stronger state oversight and reporting rules. Some states already require minimum community benefit spending.
Nonprofit hospitals don’t have shareholders — but they do have choices. And those choices affect patients, staff, and public trust. If these institutions want to maintain tax exemptions, they must prove that their surpluses are being used in service of people, not profit margins.
Because healthcare should be about healing — not hoarding.
As always thanks for being here, it really means a lot. One small voice or share means the difference for many. I’d love to hear your thoughts — feel free to leave a comment, like, and share.
Be sure to follow artofbeingill.com for more reflections and resources. For personal questions or collaborations, reach out at artofbeingill@gmail.com.
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