Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide, 2018–2022

This brief examines how wages changed at rural hospitals from 2018–2019 to 2021–2022, focusing on geographic differences among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. By tracking salary expense per full-time equivalent (FTE) employee, it highlights the workforce and financial pressures rural hospitals faced as COVID disrupted care delivery and labor markets.

Key Findings:

• Census region: Salary growth was lowest in the West (11.98%) and highest in the South (21.77%). In 2022, average salary expense per FTE in 2022 was highest in the West ($80,578) and lowest in the South ($67,726).
• State: Oregon had the lowest growth (2.05%), while Georgia had the highest (24.76%). In 2022, Mississippi had the lowest average salary expense per FTE ($60,713), and Connecticut had the highest ($92,064).
• Medicaid expansion status: Non-expansion states saw lower salary growth (16.4%) than expansion states (20.8%). In 2022, non-expansion states also had lower average salary expense per FTE ($68,084 vs. $74,549).
• Core Based Statistical Area (CBSA): Growth was lowest in micropolitan areas and highest in metropolitan areas. In 2022, non-core areas had lower average salary expense per FTE ($69,133) than metropolitan ($75,471) and micropolitan ($75,399) areas.
• Frontier and Remote Area (FAR) code: Growth was lowest in area 2 (11.28%) and highest in area 4 (23.46%). In 2022, area 3 had the highest average salary expense per FTE ($77,075).