Women in health care

25 Aug 2021

Curtain Hug

Healthcare workers are on the front lines in a global pandemic: its professionals are performing
essential roles, including caring for victims of COVID-19, ensuring patients have access to the
right care, and developing a vaccine and treatments. Healthcare professionals are receiving
overdue recognition for their contributions, but it has come at a tremendous price: longer hours,
increased stress and burnout, and, for those on the front lines, a greater risk of exposure and
infection.
Healthcare continues to outperform other industries in female representation at all levels of the
talent pipeline (Exhibit 1). Women account for 66 percent of all entry-level healthcare
employees—an increase of three percentage points since last year—compared with 49 percent
across all US industries. While the share of women declines in more senior roles, moving to 30
percent of C-suite positions, healthcare still outperforms all industries. In healthcare, the
sharpest decrease in the share of women occurs at the jump from manager to senior manager
(a drop of 10 percentage points). This pattern diverges from other industries, where the
steepest decline (also 10 percentage points) happens earlier in the talent pipeline, at the first
step up to manager—also known as the “broken rung” of the ladder. One possible explanation
for this divergence between healthcare and other industries is the nature of promotions at
different levels, as the drop is most significant in payer and provider organizations. Nursing, for
example, requires a large manager workforce (on every floor and department of the hospital),
and advancement from a nurse to floor or unit manager involves less formal promotion
procedures. At the step up to senior manager, promotion panels are often introduced and
additional qualifications are often required, which could contribute to the large drop in female
representation.
Despite the obstacles to advancement, women in healthcare have a relatively positive outlook
on their careers: nearly 75 percent of women report being happy with their careers compared
with around 69 percent of men. This sentiment increases as women rise through the ranks: at
entry levels, 71 percent of women report being happy, a figure that increases to 91 percent at
the SVP level. The perception of equal opportunity may be a contributing factor. While 18
percent of women (the same level as last year’s survey) report that gender may have played a
role in missing out on promotions, raises, or chances to get ahead, 68 percent do not believe
gender had an impact (14 percent report that they are unsure). This finding is notable: our
quantitative analysis found that men are generally promoted more than women. Moreover,
organizations are taking action at the top to increase female representation. The external hiring
of women rose in the C-suite across healthcare organizations, from 33 percent in 2017 to 42
percent in 2018, a significant year-on-year increase (Exhibit 2). This progress may align to last
year’s call to action, since external hiring is one of the quickest levers to improve female
representation, especially at the top.
This progress is encouraging, but leaders should not assume that obstacles have been
dismantled. Indeed, trends such as external hiring may be a bandage over more systemic
barriers—such as promotion and the imbalance of line and staff roles—that are preventing
women from parity, especially at senior levels. Consider that across the healthcare industry,

women are promoted at similar but slightly lower rates than men until the SVP level. While these
differences might seem negligible, they compound and can result in the much lower female
representation at more senior levels. Promotion rates of women for senior roles seem to reverse
this trend, but they believe the fact that there are far fewer women to consider for promotion.
The types of positions that women hold—and the distribution across line and staff roles1 —may
also play a part. In providers, for example, women represent approximately 80 percent of entry-
level frontline workers, such as nursing positions, which are often predominantly female.
However, this representation decreases across the pipeline, until women make up only about 30
percent of line roles in the C-suite.PMP organizations have the lowest share of women in line
roles across the pipeline. Although they have more parity at the entry level—women represent
52 percent of entry-level line roles—they fill just 21 percent of the C-suite line roles. This
distribution can be problematic, as employees in line roles are often afforded more opportunity
for career progression and compensated more highly. In healthcare, the biggest obstacle to
women’s progression comes when making the leap from manager to senior manager, where
female representation falls by 10 percentage points overall. The discrepancies in promotion
rates create significant barriers for representation of women in more senior roles that cannot be
adjusted with external hiring alone. To compound the challenge, attrition is fairly even by level
across men and women, but a gap of around 1.5 percentage points exists for women at the SVP
and C-suite levels. The challenges that women as a whole face are magnified for women of
color. Across healthcare industries, the share of white women in entry-level positions starts at 46
percent, gradually declining to 25 percent at the C-suite . Women of color account for 20 percent
of entry-level representation, but by the C-suite their share has dropped to just 5 percent. As
with women overall, the sharpest decline for women of color is seen at the transition from
manager to senior manager. Compare that with the figure for white men, who are able to
increase their share of roles nearly two and a half times as they move from entry-level to senior
positions. By contrast, the percentage of men of color at roles throughout the industry stays flat,
at about 11 percent. While men of color have the lowest representation initially and are likely an
“only” more often, their career paths do not narrow across the talent pipeline in the same way as
white women and women of color.
This is an auspicious time for gender and healthcare research. After several decades of
dormancy, a range of policy and institutional drivers for change have awakened interest in
gender issues. Although presently we are more likely to be disturbed by nightmares of
gender-insensitive care than soothed by dreams of care that is finely and fully attuned to
gender, it is now at least possible to visualize a future where health systems are
gender-sensitive and the benefits this may bring.