Career Attainment among Healthcare Executives: Is the Gender Gap Narrowing?

Health care occupations are expected to be among the fastest growing professions in the next ten years. With such incredible growth expected in employment and wages, and with women’s participation in the industry remaining strong, are women in the health care industry, particularly those in health care administration, experiencing a narrowing of the gender gap? This paper briefly reviews various theories of career success as they relate to the gender gap in executive level positions in healthcare administration and synthesizes the findings of a longitudinal study of the career attainment and attitudes of male and female healthcare executives. For the first time in almost two decades, a positive trend has been seen in the career attainment of women in health care administration. A 2006 ACHE study found an increase in the proportion of women relative to men who achieve CEO status. Women and men have similar levels of experience and education and experience similar levels of satisfaction with their positions. These findings suggest an increased commitment by healthcare organizations to integrate more women into leadership positions and to make the organizational culture more family friendly. However despite having attained equal levels of education and experience, a gender gap in salary levels still exists. Although women have made progress in attaining executive level positions, organizational structural factors rather than human capital factors contribute to the gender gap within healthcare executive management. Career Attainment among Healthcare Executives: Is the Gender Gap Narrowing? Health care occupations are expected to be among the fastest growing professions in the next ten years growing by 30.3% and adding 4.3 million jobs between 2004 and 2014. With such incredible growth expected in employment and wages, are women in the healthcare industry, particularly those in executive levels of healthcare administration, experiencing a narrowing of the gender gap? Women have made some progress in entering the managerial ranks of U.S. healthcare in recent years but not at the highest levels. For example, in one of the healthcare management’s largest professional societies, the proportion of women managers increased from 13 percent in 1983 to 36% in 2001 (Weil and Mathis 2001). Although women compose 78 percent of the healthcare industry’s workforce and are the largest consumers of healthcare, they remain underrepresented in the top echelons of management and executive leadership positions (Lantz 2008). Strong leadership and increased diversity are prominent issues in today’s health services workforce; however, surprisingly little progress has been made to close the gender gap in healthcare leadership especially among the nation’s top hospitals. A recent 2005 study of the Solucient 100 top hospitals, considered to be the highest quality and leading institutions in the Forum on Public Policy 2 United States, revealed that of the 474 chief administrators only 24 % were women. In addition, nearly one third of these hospitals employed no female chief administrators, and another one third employed one female chief administrator. Female chief administrators were more likely to be a CIO (chief information officer) or CHR (chief human resources officer) rather than CEO, COO, CFO or CMO (chief medical officer). At first glance, a woman’s prospects for a career in healthcare administration appear encouraging. More than half of the recent graduates of health administration master’s programs are women. Initially, most post-master’s salaries are comparable with those of male graduates. Unfortunately, opportunities for promotion and financial benefits seem to decrease for women and expand for men as their respective careers advance (Walsh and Borkowski 1995). This paper briefly reviews various theories of career success as they relate to the gender cap in executive level positions in healthcare administration and synthesizes the findings of a longitudinal study of the career attainment and attitudes of male and female healthcare executives. It argues that although women have made progress in attaining executive level positions, organizational structural factors rather than human capital factors contribute to the gender gap within healthcare executive management. Theories of Salary and Career Mobility Disparities Differences in salary and career mobility have been addressed repeatedly in the professional literature as separate and distinct factors. Economic, organizational, and psychological theories as well as human capital and organizational theories have been developed to explain these issues and why they are treated as separate problems. Economic theorists suggest that wage and career opportunity differentials may be attributable to interrupted employment cycles. Periods of employment inactivity due to child rearing, responsibility for aging family members, or involuntary unemployment inevitably affect career mobility and future earnings. Increased family obligations may preclude women from accessing opportunities in the organizational structure. Frequently, these increased demands necessitate interruptions in the employment cycle with a concomitant loss or obsolescence of skills, higher absenteeism, and restrictions in number of hours worked. Salary differentials and advancement, therefore, are perceived as a market response to a transient work history (Corcoran and Duncan 1979). Forum on Public Policy 3 In contrast, psychological theories suggest that career advancement and subsequent earnings are affected by the psychological attributes of the individual. Consequently, the ability to be a team player or to network effectively with others are cited as key ingredients for success within the organization (Terborg 1977). Men and women may consider different factors to be more important to career success than do men. Morrison, White, and VanVelsor (1997) found that women felt that a desire to succeed or willingness to work was critical to organizational success while men considered these attributes as instrumental to career advancement. Several studies have suggested that career aspiration level may affect career advancement. Haddock and Aires (1980) found that men aspire to higher positions than women aspire to, while Harlan and Weiss (1982) argue that aspiration levels are not necessarily lower, but different for men and women. Walsh and Borkowski (1995) found that although men had higher career aspirations than women, actual expectations of career attainment were virtually identical for men and women. Fahey, Myrtle, and Schlosser (1998) also found that more women than men claimed to have fulfilled their career aspirations. Finally, organizational theories emphasize the structural and behavioral dimensions within the organization that can affect mobility. This approach suggests that the centrality of a person's position to those in influence or the ability to acquire appointment to key organizational committees contributes to advancement. Organizational variables may profoundly influence the ability of women to succeed within the organization. Pazy (1987) found that while women were more likely to use formal organizational career management systems than men for career advancement, access to informal networks and mentors may be more crucial for career advancement. Women and men were found to develop separate networks, with men forming the dominant organizational coalition. Only those women whose immediate workgroups included both men and women were well-integrated into the male networks. This integration was crucial since advancement is related to centrality of position and degree of integration into the maledominated network (Brass 1985). More importantly, the male network may provide access to mentors within the organization. Two generic theories of career success have dominated the generic management literature and have been applied to healthcare management. The first theory, the “human capital” theory of career success, hypothesizes that individuals have time, effort, and individual assets, or human capital such as education, experience, skills, and personal characteristics, which we bring to the Forum on Public Policy 4 job. It is the amount and effectiveness of the human capital that one has and expends on the job that is the main determinant of career success. The human capital approach argues that woman either have less human capital than men (i.e., less experience, less skills) or use some of their human capital on home and family issues therefore, having less to expend at work. The second theory, “organizational structure,” hypothesizes that there are barriers within the organization that work either for or against career success. Organizational structures, systems, processes, and policies directly or indirectly help or hamper career success. Many of these barriers are explicit barriers, such as discrimination and unfair hiring practices, have been acknowledge and outlawed. Many of the less explicit, more transparent and implicit barriers, such as the glass ceiling and old boys’ club, which bar women and minorities from the highest level of management in organizations, may still exist. While each of these theories may contribute to explanations of gender differences in business management, few studies have investigated the specific extent to which these distinctions currently exist in healthcare administration.