Highly skilled women reaching the top: a cost-free achievement? Analyzing the gender promotion gap in the medical profession

This paper investigates the gender promotion gap in a particular highly skilled profession, that of physicians. The following analyses are based on a dataset of more than a thousand doctors working in Italy, a country in which hospitals play a central role in the national health care system. Given a three-step career ladder—first level, vice, and head—this research finds that women are 8% less likely than men to be promoted from the first level to vice, whereas no significant disadvantage is found in the promotion from vice to head. This suggests that the vertical segregation is due more to a sticky floors mechanism than to a glass ceiling effect. Moreover, no motherhood penalty occurs. Private organizations appear to be more gender equal than public ones and similar, albeit weaker, findings come from the analysis of the specialties, cautiously suggesting that the male-dominated area of surgery is more gender equal than the female-dominated area of medicine. These findings point out that women in highly skilled professions may encounter fewer obstacles to promotion than in the general labor market. Furthermore, they may encounter fewer obstacles within the most competitive organizations and specialty areas than across the profession in general. This is not, however, because of a greater number of opportunities, but because they represent a highly selected and career-oriented population. These results shed light on the costs of such achievement for women, both in terms of effort and in terms of equality among women themselves.