Average Salary Expense in Rural and Urban Hospitals in 2022 Compared With 2018, by Hospital Characteristics

This study compares labor costs at rural and urban hospitals before COVID and examines whether pay grew differently across hospitals. It identifies hospital characteristics linked to staffing costs and what they reveal about financial resilience during unexpected disruption.

Key Findings:

The study compares median wages for rural hospitals and urban hospitals from 2017–2018 (pre‑COVID) to 2021–2022 (post‑COVID) to assess how the pandemic may have affected rural–urban wage disparities.

The median average salary expense per full-time equivalent (FTE):

• Was uniformly higher in urban areas than rural hospitals across all categories of net patient revenue, system affiliation, hospital ownership, and number of acute care beds.
• Was higher for hospitals with higher net patient revenue, system affiliation, or not-for-profit status.

The 2018-22 percentage change in median average salary expense per FTE:

• Was generally higher in rural (vs. urban) hospitals and system-affiliated (vs. independent).
• Was highest among hospitals with 51-100 beds (vs. larger and smaller).
• Was not particularly associated with net patient revenue; the smallest rural hospitals saw the largest increase, and the smallest urban hospitals saw the smallest increase.

While urban hospitals consistently had higher median average salary expenses per FTE across all categories, rural hospitals experienced a greater percentage increase in salary expenses from 2018-2022, which is likely due to greater staffing challenges and pressure to stay competitive in the health care workforce.