- Since late 2011, there have been several waves of job cuts, geographical job shifting along with organizational restructuring and department outsourcing across many Vanguard hospitals. This includes, but is not limited to: accounting, payroll, information systems, middle management and directors, hospital transporters, hospital interpreters, patient advocates, and chaplains. This was cited as being because of decreases in patient volume and in government reimbursement funding.
- During the 2012 fiscal year for the Chicago Market hospitals, no employee merit raises nor matches to employee retirement were made. But, during the following fiscal year (2013) the Chicago Market President was awarded 28,559 shares of stock in the company.
- Inconsistency across market hospitals. Depending on the market you hired in, there may be no standardized training program for your position. Many employees must "hit the ground running".
- A non-exempt person hired as per diem (registry) without benefits who then transfers into a part-time or full-time position with benefits is offered a lower hourly rate than what they were hired with. Additionally, unless you are hired as an exempt salaried employee, negotiating with Vanguard recruiters is often difficult and lengthy.
- Depending on the market, Vanguard serves its employees as it's own health insurance firm by using their own staff physicians as plan providers. However, many physicians physically located across the hospitals are not Vanguard employees, but are part of their own medical group or are independent contractors. Additionally, some of the health insurance coverages are minimal to non-existent.