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October 31, 2019

Why few health care executives are women—and 3 ways to fix it

Daily Briefing

    Most entry-level health care employees are women, but because of a "broken rung" in the career ladder, women make up a much smaller percentage of employees at the highest levels, according to a recent report from and McKinsey & Company. Here's how experts suggest tackling the issue.

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    Survey details

    LeanIn.Org and McKinsey have released the report, called the Women in the Workplace report, annually since 2015.


    For this year's edition, 329 companies that collectively employ more than 13 million people shared data or completed a survey about their HR practices. The researchers also surveyed more than 68,500 employees about their experience in the workplace. The latest report is based not only on this year's data but also on an analysis of trends since the survey began four years ago.

    Key findings

    The health care industry has the highest percentage of women in entry-level roles of any industry, according to this year's report.

    In a sample of 22 companies, including hospital systems and other providers, researchers found that women make up 75% of employees in the lowest-level roles. Those roles include home health aide, nurse, and entry level physician.

    Meanwhile, at the highest levels of these companies, women make up only 33% of executives, while men make up the remaining 67%.

    Is the problem the 'glass escalator'?

    Julie Silver, a physician and professor at Harvard Medical School, said the reason women don't occupy higher-level roles in health care "is not because they don't want the positions" or "because they don't work hard enough." Data shows that women ask for promotions and raises at about the same rate as men and that women exit the workforce at similar numbers as men as well.

    Instead, according to Janette Dill, a professor of health policy and management at the University of Minnesota, the explanation for the disparity might be that there seems to be a "glass escalator" for men when it comes to getting promoted in health care. "When men go into female-dominated occupations, they earn higher wages than women, they find more opportunities, and they're fast-tracked into management positions," Dill said.

    The disparity in promotions between men and women is evident at the first "rung" of the health care career ladder, the report shows. While women make up 75% of entry level workers—the bottom "rung" of the ladder—women make up 69% of managers—the next "rung" on the ladder.

    Part of the reason women struggle to get considered for higher-ranking positions in health care is that there is less mobility in health care than in other sectors, with higher-ranking jobs requiring strict credentials and education requirements in health care, the Wall Street Journal reports.

    Dill said, "If you think about sectors like retail or fast food, there's more space for people to move into management without needing additional education." By contrast, in health care, most management or director roles require at least a bachelor's degree or master's degree in health administration, which can be a barrier for women who want to move up, Dill added.

    The report authors observed the "broken rung" as a trend throughout the work world that was not limited to health care.

    Fixing the broken rung

    Broadly, Kevin Sneader, global managing partner at McKinsey, said that "repairing the broken rung is the key to creating significantly more leadership opportunities for women."

    The career website Glassdoor reports that there are a few ways to address the problem as an employee.

    The first step is to make management and human resources team aware of the broken rung problem. "Make them aware of the issue and ask follow up questions like, 'Is this something we're looking at in our company,'" Glassdoor suggests. By pushing for the issue in your company, you can evaluate whether the "broken rung" problem is a fixable aspect of company culture or something you can overcome.

    Another way to address the problem is to invest in mentorship programs between employees and managers that could help women in lower-level positions move up to management positions, according to Glassdoor.

    You can also take control of your potential to get promoted by learning about the other roles in your organization, Glassdoor reports. "This helps you to build a case for why you deserve the promotion in the first place and it will help ensure that you meet the requirements," according to Glassdoor (Weber, Wall Street Journal, 10/15; Gooch, Becker's Hospital Review, 10/15; Jackson, Glassdoor, 10/15; Fuhrmans, Wall Street Journal, 10/15; McKinsey/ survey, accessed 10/30).

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