Examining wage drivers for nurses and physicians in Swiss hospitals: a retrospective observational study with repeated measurements

Holzer et al. BMC Health Services Research (2025) 25:1450 https://doi.org/10.1186/s12913-025-13589-6 BMC Health Services Research Open Access RESEARCH Examining wage drivers for nurses and physicians in Swiss hospitals: a retrospective observational study with repeated measurements Sarah Holzer1, Michael Simon1, Giusi Moffa2, Olga Endrich3, Ulrike Muench4, Michelle McIsaac5 and Jana Bartakova1,6* Abstract Background Patient safety and quality of care depend on well-trained, motivated staff. Competitive wages are critical for staff satisfaction and retention. Understanding the factors that affect nurses’ and physicians’ wages is the first step to tackling these factors and improving retention and recruitment while reducing shortages. The aim of this study was i) to describe the distribution of nurses’ and physicians’ wages and potential drivers; and ii) to investigate which drivers are most strongly associated with nurses’ and physicians’ wages in Swiss acute care hospitals. Methods We used de-identified routine data from the Federal Statistical Office, covering Swiss acute care and specialized hospitals from 2014 to 2020. We conducted descriptive analysis and examined potential wage drivers, including gender and nationality, among nurses and physicians using mixed-effects models. We included an average of 164 (161–173) hospitals annually and a total of 524,263 nurses and 176,896 physicians over seven years. Results Descriptive findings revealed variations in wages, workforce demographics, and hospital characteristics. Nurses’ mean monthly wages ranged from 5,920 CHF − 7,720 CHF per FTE, and their mean ages varied from 38.6–42.3 years depending on hospital type. Registered nurses (RNs) were the largest nursing group, with university hospitals employing the highest proportion (75.7%) and the smallest hospitals the lowest (64.6%). For physicians, mean monthly wages ranged from 13,900 CHF − 17,300 CHF, and their mean ages varied from 37.7–44.3 years depending on hospital type. For role distributions university hospitals had more residents and medical students (52.6%), while the smallest hospitals had more senior physicians (32.9%). Inferential analysis showed that nurses’ age, RNs’ proportion, and the physicians’ wages were associated with nurses’ wages. Resident physicians’ and medical students’ proportion, as well as nurses’ wages, were associated with physicians’ wages. Conclusions Findings on age as a nurses’ wages driver suggest that careful allocation of resources and implementing remuneration policies, such as merit-based systems that reward factors beyond years of experience, may help in retaining and recruiting staff. Further research using individual wage information is essential to gain deeper insights into the health workforce wage landscape and its drivers in Swiss hospitals. *Correspondence: Jana Bartakova Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Holzer et al. BMC Health Services Research (2025) 25:1450 Page 2 of 15 Keywords Acute care hospitals, Nurses, Physicians, Wage, Human capital, Gender, Pay models Background The delivery of high-quality care by well-trained and stable health workforce, particularly health professionals such as nurses and physicians, is of high importance to ensure patient safety [1–5]. However, hospitals worldwide are confronted with a significant challenge in terms of retaining and recruiting these professionals. The WHO estimates a global shortage of 14.7 million health workers in 2023 [6]. In Switzerland, a significant portion of the health workforce is approaching retirement age, and many are retiring early [7]. The combination of insufficient new entrants and the early turnover of early-career health workers due to undesirable working conditions leads to increasing pressure for the remaining staff [8–10]. The reasons for turnover are common to both professions, but in nursing in particular, early departure is often driven by low wages and a perceived lack of occupational status [11]. In the case of physicians, a lack of available training positions, work-life imbalance and difficult working conditions, lead to a lack of motivation to remain in the medical profession [12, 13]. Health workforce turnover has been further exacerbated during the COVID-19 pandemic, with workers leaving due to challenging conditions, including longer working hours, excessive job demands, turbulent work environments and exposure to potentially morally harmful events (e.g. deciding to turn off a ventilator) [14, 15]. While the impact of the pandemic on the health workforce is not yet fully understood, initial findings from the US indicate a significant and ongoing increase in workforce turnover, which may have long-lasting consequences [16]. The shortage of health workers has significant economic costs, including the constant need to recruit and train new staff. It puts a strain on hospital resources, requiring experienced staff to take time away from patient care to train new recruits. This disruption not only affects the quality of care, but also compromises patient safety [17]. As a result, the shortage of skilled workers has become one of the biggest challenges to ensuring high-quality healthcare [8–10]. In order to ensure the long-term sustainability of the health sector, it is essential to develop and implement effective strategies that will retain the expertise of experienced health professionals while also attracting new workers [18–21]. Remuneration in the form of wages is one of the important factors in attracting and retaining nurses and physicians in hospitals [20, 22]. Human capital theory [23] offers a framework for understanding wage differentials based on individual characteristics. According to this theory, wages are influenced by the value of the human capital that individuals bring to their jobs. Human capital refers to the attributes of individuals that enhance their productivity and economic value, including formal education, specialized training, work experience, and individual performance. 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