Senior NHS trust managers earn an average salary of £147,500, new figures have revealed.
The report, from Incomes Data Services (IDS), also showed in 2008-2009 chief executives in the NHS were given a 6.9% pay rise on average.
This is more than double what nurses were offered; they got 2.75% in the same period and just 2.5% in April this year.
Senior managers in NHS trusts linked to a national pay agreement received a 2.2% rise in 2008/09.
Chief executives at NHS foundation trusts – some the subject of negative publicity in recent months following concerns about substandard care – received £10,000 more a year on average than those managing less "gold standard" trusts.
The IDS report was based on data from more than 380 NHS trusts in England, including primary care, mental health and ambulance trusts.
It showed the 6.9% pay increase for chief executives came on top of a 6.4% rise in 2007/08.
The report showed the highest-paid chief executive was at Guy's and St Thomas' in London, with mid-point total earnings of £270,000.
At Heart of England NHS Foundation Trust, the chief executive received £237,500 while at Cambridge University Hospitals NHS Foundation Trust, the chief executive was paid £217,500.
The figure was £207,500 at City Hospitals Sunderland NHS Foundation Trust.