Chief physician pay: why averages and top figures diverge
With chief physician salaries, the average, the pay band and the top figure tell different stories. The cost debate needs comparable data instead of individual headlines.
The debate about chief physician salaries often follows a simple pattern: one especially high figure is cited and then used to explain rising healthcare costs. Current figures from individual hospitals, however, show how easily such conclusions go astray. Average, pay band and maximum measure different things – and they can move in opposite directions at the same time.
Kantonsspital Aarau reports the remuneration of 130 senior physicians in salary classes for 2024. Thirty-six people were between 200,000 and 300,000 francs, 50 between 300,000 and 400,000, 26 between 400,000 and 500,000, 13 between 500,000 and 600,000, and five between 600,000 and 700,000 francs. The highest reported figure was 698,300 francs.
A top figure does not describe a distribution
The maximum states what one individual received. It does not show how the other salaries developed, nor how many full-time positions stand behind the statistic. Conversely, an average can fall even while the highest salary rises – for instance when the group grows, when its composition changes, or when the lower pay bands are more heavily staffed.
Medinside also points to data from the Psychiatrische Dienste Aargau. There, the average total remuneration of chief physicians dropped from 375,900 francs in 2020 to 371,400 francs in 2024, while the highest figure in 2024 stood at 439,600 francs. These numbers do not contradict each other. They simply answer different questions.
Comparability remains the biggest problem
Hospitals do not use the same categories everywhere. “Chief physician”, “senior physician” and “lead physician” can involve different responsibilities and levels of employment. Remuneration may include base salary, variable components, fees from private practice, function allowances or pension contributions. Without a precise definition, a comparison between two hospitals is uncertain.
Time adds a further dimension. The frequently cited BASS study commissioned by the Federal Office of Public Health (BAG) examined incomes from earlier years. It provides important foundations, but it does not fully capture today's hospital landscape. A national statement about a current “salary explosion” would require uniform data across several years, functions and levels of employment.
High salaries are a cost issue – but not the whole cost issue
Senior physicians' remuneration is part of personnel costs and is therefore legitimate to scrutinise. Hospitals compete for specialised staff, carry management and on-call responsibility, and generate differing revenues depending on the specialty. These factors explain differences, but they do not automatically justify every amount.
At the same time, individual top payments must not be equated with the development of all healthcare spending. According to the Federal Statistical Office (Bundesamt für Statistik), hospital revenues rose by 3.6 percent to 36.60 billion francs in 2024; the wage bill increased by around 660 million francs, or 3.0 percent. That does not show which share went to chief physicians, nor that their salaries caused the increase.
Transparency needs better metrics
A usable publication should at minimum state the number of people and full-time equivalents, the median, the average, the ranges, the maximum, and which remuneration components are included. An identical definition over several years is just as important. Only then can it be seen whether a change stems from higher salaries, more senior positions or a new group structure.
The political question is therefore not merely whether a single chief physician earns a lot. It is what remuneration is defensible for responsibility and market conditions, how it is controlled, and what measurable share it has in hospital costs. Without comparable data, the debate remains prone to two exaggerations: treating top figures as proof of a general explosion, or reading falling averages as a complete all-clear.
