From a pure "what we've budgeted" standpoint you're likely correct. But that budget included paying their CEO several million in salary, and several more million in bonus structure. Not to mention other executives who were making relatively similar pay. This wasn't some big company either. They had 12 facilities in the state, and each maybe had 50 employees. So at the most, including corporate, they had just north of 600 employees.

For these small market healthcare-focused companies (not really hospitals, not really clinics) they're always barely making money. But it's not because they aren't bringing money in. It's because they're incredibly poorly managed. They're super top heavy, and they always pay frontline staff like shit. It's why we saw the incredible rise of the traveling nurse in the past 10 years (and especially during covid), where nurses could make 5x traveling than what they could with a typical FTE job.

You tell me why a facility would rather pay a traveling nurse the equivalent of $300k per year + fees to the placement company for 12 months instead of hiring an FTE at slightly above market rate, which is more like $100-$120k? It's because they have zero ability to make long term decisions and middle management is completely powerless. Managers in these types of business are 100% middle men. They have no autonomy to do anything. Even hiring and firing takes several layers of corporate oversight.

I largely agree that it sounds like these problems are business/management problems.

It seems that there is also a labor shortage for good managers.

If a business is already top heavy, how do you get better managers? The traditional argument would be to pay more and get better talent. This honestly seems like a hard problem to solve.