Why Healthcare Construction and Facilities Hiring Is More Competitive Than Most Health Systems Expect
Health systems have been managing significant capital programs for over a decade, driven by facility consolidation, aging infrastructure, ambulatory care expansion, and the ongoing construction of new hospital towers and outpatient centers. In 2026, those programs are larger, more complex, and more concurrent than at any point in the recent past. The leadership talent required to execute them has not grown at the same rate.
The result is a hiring environment where health systems are competing not just with each other for experienced construction and facilities executives, but with academic medical centers, owners’ rep firms, and increasingly, the GC and CM firms that have built institutional practices around healthcare construction. Understanding that competitive landscape is the starting point for any CHRO, CFO, or VP of HR trying to fill a VP of Facilities, Director of Construction, or Director of Facilities Operations role in 2026.
The Capital Program Backdrop
The American Hospital Association estimates that U.S. hospitals spent over $55 billion on capital improvements in 2024, and that number is projected to grow through 2026 and beyond as systems address deferred maintenance accumulated during the pandemic years, expand ambulatory networks, and invest in new service lines. Community health systems, regional medical centers, and large integrated delivery networks are all running active capital programs simultaneously, which means demand for experienced healthcare construction and facilities leadership is broad and sustained, not concentrated in a few large markets.
The complexity of that capital work has also increased. Healthcare construction today routinely involves infection control protocols, ICRA compliance, occupied facility renovations, HVAC and clean room standards that exceed typical commercial construction, and regulatory environments that involve not just building departments but The Joint Commission, state health departments, and CMS surveyors. The Director of Construction or VP of Facilities who can navigate all of that is a more specialized profile than the person who filled that role fifteen years ago.
Compensation Benchmarks: What Health Systems Are Paying in 2026
Compensation for construction and facilities leadership at health systems has been moving upward, driven by competition and by the growing complexity of the roles. The following ranges reflect what Real8 Group is seeing across searches and candidate conversations in 2026.
Director of Facilities Operations
At community hospitals and mid-size regional health systems, Directors of Facilities Operations are typically earning between $175,000 and $225,000 in base compensation, with total compensation including benefits running 20 to 30 percent higher. At large integrated delivery networks with multi-site portfolios, the range moves to $200,000 to $250,000 and above for leaders managing significant square footage and plant operations complexity.
Director of Construction
Directors of Construction at health systems managing active capital programs in the $50 million to $200 million annual range are earning between $190,000 and $260,000, with the upper end of that range applying to leaders at large systems with program management responsibility across multiple facilities. Healthcare pays a consistent 10 to 15 percent premium over comparable roles at universities and cultural institutions, reflecting both the regulatory complexity and the competition from private sector employers.
VP of Facilities
VP of Facilities roles at regional health systems are currently ranging from $275,000 to $425,000, with the upper end applying to large integrated networks where the VP has accountability for both capital construction and facilities operations across dozens of sites. At academic medical centers with major research and teaching missions, the range extends further: top-of-market VP of Facilities and Chief Facilities Officer roles at flagship AMCs can reach $600,000 to $980,000 in total compensation when performance incentives and retirement contributions are included.
Who Health Systems Are Actually Competing Against
Health system HR teams often benchmark compensation against peer health systems, which is a reasonable starting point but an incomplete picture of who they are actually competing with for candidates. The experienced Director of Construction or VP of Facilities at a regional health system is also being recruited by:
Third-party owners’ rep firms that specialize in healthcare construction management. Firms competing for JLL Health, Skanska, Boldt, and Haskell program management contracts need experienced healthcare construction leaders and typically offer compensation that is competitive with or above health system rates, along with the variety of working across multiple clients rather than a single system.
Academic medical centers that are expanding their capital programs. AMCs consistently pay at the top of the healthcare range and offer the additional draw of academic affiliation, research adjacency, and institutional prestige that some candidates find compelling.
GC and CM firms that have built dedicated healthcare construction practices. Turner, Skanska, McCarthy, and others have institutionalized their healthcare divisions to the point where a construction leader who moves from a health system to a major GC’s healthcare group is a common career transition, not an unusual one. The compensation on the GC side at the Director and VP equivalent level often exceeds what health systems pay.
The Candidate Pool Problem Is Structural
The most experienced healthcare construction and facilities leaders in the market are not browsing job boards. They are currently employed on multi-year programs, often under contract commitments, and they are being contacted by multiple employers and search firms. The ones who are genuinely open to a move have specific reasons for considering it: a capital program winding down, a leadership transition at their current organization, a geographic opportunity, or a compensation gap that has not been addressed.
Health systems that post a VP of Facilities or Director of Construction role and wait for applications are not reaching this candidate pool. They are reaching candidates who are actively looking, which is a different group with different characteristics. Sourcing the employed candidate who is selectively open requires direct outreach, relationship development, and a genuine understanding of what that person’s current situation is and what would make a move worthwhile.
What This Means for Healthcare Organizations Planning a Search in 2026
If your health system is planning a construction or facilities leadership search in 2026, three things will determine whether it succeeds. First, your compensation range needs to be set against the current market, not what you paid the last person. Second, your sourcing approach needs to include active outreach to employed candidates, not just passive posting. Third, your timeline needs to be disciplined: the best candidates in this market will not wait through a six-month process.
Real8 Group places construction and facilities leaders at health systems, academic medical centers, and owners’ rep firms across the U.S. We understand the healthcare construction market, the compensation dynamics, and where the candidates who have done this work are currently employed. We work at the Director level through VP and C-Suite, without the large minimum retainers that firms like Spencer Stuart or Korn Ferry require, and we typically present a qualified candidate slate within two to three weeks of kickoff.
If you are planning a construction or facilities leadership search at a health system or medical center, learn how Real8 sources healthcare construction talent, review our search process, or contact us to discuss your search. You can also meet the Real8 team.
Real8 Group is a specialized executive search firm serving the real estate, construction, engineering, and facilities operations sectors across the U.S.
