Exploring the Challenges Facing Women Leaders in Health Care

Women are often subject to preconceived notions that they are less capable of being a strategic leader, preventing many from ascending to top leadership positions in health care. Keeping these biases in mind and being strategic can help women transcend this obstacle and achieve their career goals.

If you’re a woman executive working in today’s complex health care setting, you likely face many challenges on the job that make it difficult to advance your career to the next stage. That’s because women in leadership roles often meet resistance when they try to assert their authority or demonstrate the same management traits that are commonly encouraged in men.

Training a New Generation of Health Care Leaders

This is the double bind for women, according to Linda Kaboolian, PhD, the program director for Emerging Women Executives in Health Care, which is offered through the Harvard T.H. Chan School of Public Health.

Through the program, Kaboolian and her colleagues educate participants on the practices women need to enhance their leadership skills and effectiveness. The program also looks at barriers women face on the job and guides participants on maneuvering within their organizations’ framework to move their careers in the desired direction.

Considering the Landscape

For women with high career aspirations, the road to the top is a steep one—and perhaps a more precarious ride because of their gender. A 2013 report by Rock Health called “Women in Healthcare” provides a good snapshot of the current situation: Although woman make up the majority of the health care workforce, they hold only 19 percent of hospital CEO positions, and they head only 4 percent of health care companies. In addition, an updated version of the Women in Healthcare report published in 2017 found that close to half of all female respondents working in health care believed it would take 25 years or longer to achieve gender parity on the job.

This is despite the fact that “the call for women as heads of organizations has never been louder,” Kaboolian says. She cites the results of a 2016 global study conducted by the Peterson Institute shows that having women leaders in the head positions of top management is linked to significantly increased profitability. Nonetheless, she says that it is particularly hard for women to advance in health care organizations.

Although women make up the majority of the health care workforce, they hold only 19 percent of hospital CEO positions, and they head only 4 percent of health care companies.

“First, women are typically promoted into service oriented executive positions where promotion to the C-Suite is less likely. Even when women are in jobs that would lead them to advancement, they are less likely to achieve top positions even when they are judged to be more competent than their male counterparts.”

This is because of the “double bind” in how women are evaluated, she stresses.

In other words, success for women really comes down to the fact that they are judged not only on their technical ability and achievements, but also on how well their performance and image match the expectations of what a female and a leader should be, and how they find the balance between the two categories, which are often at odds with one another in the minds of decision makers.

The Bias That Exists

Part of the problem is an implicit bias in the heads of the people who do the promoting, Kaboolian explains. Since health care leaders traditionally have been men, women often do not match the image of how the decision makers view a top leader; thus, this can lessen the chances that women will be promoted into these coveted positions.

When women have been promoted to leadership positions, it has largely been in areas that are most closely associated with service-oriented functions, which are considered more feminine rather than operational and strategic functions, which are considered more masculine.

“The medical field is still a gendered profession in that for a very long time it was male dominated,” Kaboolian says. “It is also very hierarchical. Together the expectations of what it has meant to be leader in the health care industry has been defined by male examples and images. When women have been promoted to leadership positions, it has largely been in areas that are most closely associated with service-oriented functions, which are considered more feminine rather than operational and strategic functions, which are considered more masculine.”

Additionally, there are regional variations in what is considered. Kaboolian points to the political arena and the expectations that exist around gender and region; while the expectations exist for both sexes, most say that for women, the implications are much bigger. “Many studies show that for women politicians in the United States, there are regional differences as to what are acceptable images,” Kaboolian says. “In the South, the acceptable image of a female politician is typically much more stereotypically feminine, with makeup and the hair done. In New England and the West Coast, the women in politics are more androgynous, without frills. There is nothing wrong with either, but it is just a difference,” she points out.

What this means, then, is that if you are a woman trained in one part of the country and you move elsewhere, or you are practicing in a culture with firm notions of what is appropriately male and female, you might find you have more or less bandwidth. “The important thing for women is to know what the expectations are and to make choices that are appropriate for their ambitions and goals,” she stresses.

Success for women comes down to the fact that they are judged not only on their technical ability and achievements, but also on how well their performance and image match the expectations of what a female and a leader should be.

Further, this concept extends to the behaviors exhibited by women. “When women try to assert themselves in a leadership role, again they are not meeting the expectations of what is expected from a woman and they often experience backlash against their authority and competence,” Kaboolian says.

What Women Can Do

The good news is that women leaders who feel they are getting the short end of the stick don’t have to sit back and simply accept their situation. Rather, taking a strategic approach can be helpful in allowing them to efficiently move along their desired career path to those top goals.

Kaboolian offers the following suggestions for women who want to create a comprehensive strategy to maximize their leadership capacity:

  • Understand that developing as a leader requires identifying and understanding both your strengths and your weaknesses and working on both;
  • Recognize that advancement within organizations requires an alignment of your own path and the strategic direction of the organization;
  • Remember that health care is a dynamic industry seeking innovation and leaders who can improve both care and the bottom line;
  • Realize that there are critical points in a woman’s career where advancement is possible – being prepared to step up at that time is imperative;
  • Keep in mind that even with the right skills, if you don’t change your thinking, you may be holding yourself back.

Small Gains Can Lead to Big Change

The good news is that becoming aware of gender inequities that exist can be the first step in trying to change things for the better.

“Once women in medicine become aware of the problem, they see opportunities differently, see challenges differently, and ask for different things,” Kaboolian says. “My colleagues and I get such great satisfaction from helping people develop mentally toward conscious management skills they need to help them get where they want to go.”

Further, it’s important to note that such skill sets are certainly not limited to women. Many of the ways that leaders must assess their situations, define the expectations, and develop effective ways to navigate within the organizational framework can be important elements of success for both genders, she stresses.


Harvard T.H. Chan School of Public Health offers Emerging Women Executives in Health Care, a leadership development program for women to master the skills needed to lead complex health care organizations. To learn more about this opportunity, click here.