Healthcare delivery in the United States is an enormous industry and is made up of many levels and types of workers. When one thinks of “healthcare worker,” doctors and nurses are likely the first types of workers that come to mind.
Historically, doctors have been predominately male, and nurses female. However, things have changed over the years, and many kinds of career opportunities have opened for nurses. Nurses are extremely fortunate in that there are many career opportunities to choose from. Clinical specialty areas vary greatly, as do the steps on the clinical ladder; nurses can work at the bedside, advance to leadership and management roles, earn advanced degrees, and even work in information technology and executive-level positions.
While nurses enjoy a high level of academic and career mobility, unfortunately, gender inequality still rears its ugly head in the workplace. This not only affects nurses, but all different roles in healthcare as well. The following points describe the gender inequality that still exists in the healthcare industry.
Career Opportunity
According to the Bureau of Labor Statistics (BLS), 78.5% of healthcare workers were female (2017). However, women in executive-level roles are significantly less prevalent. In a report published by the American College of Healthcare Executives, only 26% of CEOs overseeing hospitals were women.
There are a few theories as to why women are not as prevalent in executive-level positions, and it’s usually not related to struggles at the top, but rather issues that pop up along the way to a higher-level position. The Glass Ceiling Commission identified factors that prevent women from achieving executive-level positions:
- Societal barriers- for example, gender bias and/or career ambition that is not supported or fostered
- Governmental barriers- for example, paid leave policies for parents or caregivers
- Internal business barriers- for example, the lack of female mentors in executive-level roles
- Business structural barriers- for example, being unable to “network” in order to promote
Pay Disparity
Equal pay between men and women in healthcare is still a problem. Despite having equal education and experience, women in leadership roles still earn 20% less than men in the same role. Additionally, the Journal of the American Medical Association (JAMA) found that female physicians also earn, on average, $20,000 less than their male counterparts. Pay disparity can happen in any area, or not at all. For example, in the JAMA’s report, two of the participating academic centers and the radiology specialty did not experience pay disparity. The New York Times published an article outlining JAMA’s findings and included a table on physician pay disparities based on specialty.
Pay disparity can occur for several reasons. First, women are less likely to be skilled in negotiation strategies. Employers may be aware of this, and therefore offer a lower salary. Also, women may be deterred by the “social cost” of negotiating; that is, strong negotiation skills are not “characteristic” of women.
General gender bias also plays a part in pay disparity. The stereotype that women are less productive during childbearing years as priorities change is still prevalent and can deter employers from offering better pay.
Workplace “Bullying”
Bullying does not just happen in the schoolyard. It can also happen in the workplace. Workplace bullying can include:
- Verbal abuse
- Threatening behavior or language
- Isolation
- Humiliation
Yes, workplace bullying still occurs in healthcare, as it remains a hierarchical environment. In fact, The Occupational Safety and Health Administration (OSHA) reports that a whopping 59 percent of registered nurses and nursing students experience verbal abuse in a twelve-month period. Additionally, the victims of workplace bullying are more likely to be female physicians and unmarried female employees with less education.
Male-dominated specialty areas can be more prone to sexism and workplace “bullying” towards women. In these areas, women are less likely to be in lead or supervisory positions and not taken seriously by their male peers. Some are outright demeaned, in front of co-workers as well as patients.
Male nurses also face sexism. Some male nurses report feeling “dumped on” with a heavier patient load, more obese patients, etc. The theory is that they are stronger and can, therefore, handle the assignment. Peers may harass male nurses for wanting to get into certain specialties, such as OBGYN or women’s health. Male nurses who wish to advance their scope and become DNP-level nurse practitioners in women’s health are especially vulnerable to harassment; they might face jokes and “teasing” from coworkers for their specialty choice.
It’s important to recognize that workplace bullying, regardless of it is between genders or elsewhere, can lead to medical errors and compromise patient safety. Those being harassed often feel a great deal of stress and anxiety, which can lead to fatigue and the inability to think critically. Patients deserve better.
Moving Forward
So what next? How can the culture shift towards equal career opportunity, pay, and recognition? First, organizations need to realize that having more female leaders is an advantage. Along with bringing in higher revenue, women tend to have more of a transformational leadership style which supports the team approach to problem-solving. This leads to higher productivity and retention.
Organizations should also employ strategies that help women obtain leadership positions. For example, launching mentoring or career development programs, or having senior executives mentor women. This leads to higher job satisfaction and retention as well.
The American College of Healthcare Executives also lists recommendations that help promote female leadership. One recommendation is that women should be integrated into various committees and boards within a company. Not only does it promote inclusion and job satisfaction, but having more than a few “token” females can change the culture within an organization and promote gender equality.
Improving flexibility is another way organizations can improve gender inequality in healthcare. Work-life balance is crucial for both men and women, with women often shouldering more household responsibility. Offering flexible hours, the option to work remotely, and sabbaticals may help recruit and retain more female leaders. Onsite childcare and eldercare programs are also cost-effective in the long run and may reduce absenteeism and retain female staff.
Employers should also employ a zero-tolerance policy for sexual harassment as it poses a serious threat to gender equality (as well as legal action) in an organization. Promoting women to executive-level roles within the organization rather than hiring from the outside is another way to foster gender equality in the workplace.
Equal pay for equal work sounds simple, but there are a few ways to improve this in healthcare. First, companies should bring in more female leadership. Pay gaps tend to close with more women in executive-level roles.
Employers should also consider pay transparency. Internal monitoring of promotions and raises can help ensure they remain unbiased. Similarly, learning opportunities and opportunity to advance should be available to all employees.
Women can also work to improve their negotiation skills. Negotiating is an art form, and there are many learning opportunities to hone these skills, including books, workshops, and formal courses. Women need to recognize their worth and advocate for it as well.