He could be hard-hit financially by the fact that his state has decided not to expand Medicaid through the PPACA. It can be tough for a hospital leader to find a place for his or her organization in this rapidly evolving world of scale and value seeking.
Further, the healthcare industry is morphing toward being less hospital-centric, and that means healthcare leadership is morphing along with it. Talent is needed that can develop sticky ways to interact with, and ultimately better serve, the patient in a more holistic manner than hospitals are used to operating.
That's a bigger deal than it seems—as coordination of care with entities outside the hospital becomes increasingly more important, talent is following the trend. Hospitals are not a growth industry anymore, and increasingly talent doesn't see hospital leadership as an end in itself, career-wise. In many respects, given the increasing pressure in the job and reduced autonomy and responsibilities, maybe it's not even a means to an end anymore.
Finally, there are simply fewer CEO jobs out there. If you lose your job as a CEO, there are fewer landing spots.
A well-worn joke is that the NFL stands for "not for long" if you don't produce. Hospital leaders these days understand that better than most.