Women have long found a path toward advancement in healthcare and life sciences—from Virginia Apgar, who developed a standard in the 1950s to assess newborn health, to Tu Youyou, who earned the Nobel Prize in medicine in 2015 for her discovery of a treatment for malaria.1 Women currently account for more than half of all entry-level employees in the sector and have made progress in advancing to management, according to our previous analysis of women in healthcare.
However, the COVID-19 pandemic has created a seismic shift in the workforce, with a specific impact on women. Millions of Americans have resigned from their jobs, and many have cited unmanageable workloads or a need to care for family as important factors in their decision. The healthcare sector is no exception.2 Our most recent analysis is based on the seventh annual Women in the Workplace data (for 2021), by McKinsey and LeanIn.Org. That research looks at drop-offs in female representation, promotion rates, and external hiring at the highest levels in healthcare; at the barriers to advancement for women of color;3 and at threats to recent gains (see sidebar, “About the research”). In many cases, these outcomes are correlated with the effects of the COVID-19 pandemic, including reports of increased responsibilities at home and higher levels of burnout.4 Parents in particular struggle with both of these problems. For example, our analysis shows that women in healthcare are twice as likely as men to cite parenthood and increased home responsibilities as reasons for missing out on opportunities for promotion.
In previous work, we have discussed how COVID-19 could reshape the broader healthcare workforce and the potential impact of that shift on women. In this article, we start with the good news: in 2021, women in healthcare had higher representation at the managerial level and lower rates of attrition than they did in previous years. We also focus on the looming challenge of retention and on the risk that women of color will miss out on advancement opportunities. Finally, we offer strategies for improving retention and representation, as well as a goal to prepare for the shift to the next normal in an era of endemic COVID-19.
Women in healthcare are twice as likely as men to cite parenthood and increased home responsibilities as reasons for missing out on opportunities for promotion.
Reasons to celebrate
As a whole, healthcare continues to outperform other sectors in the representation of women, who make up more than two-thirds of entry-level employees in healthcare organizations (Exhibit 1). We identified three important shifts in 2021: increased representation of women at specific managerial levels, lower rates of attrition among women in healthcare than in other sectors, and increased external hiring of women at specific levels of the pipeline.
In healthcare, the representation of women at the senior-manager or director level improved by four percentage points on average, to 53 percent, in 2021. That is 18 percentage points higher than the average across all sectors. The gap in female representation in healthcare between managers and senior managers or directors was smaller than it had been in 2019.
Lower rates of attrition
On average, in 2021 women left jobs in healthcare at lower rates than women in other sectors, men in healthcare, and women in healthcare in previous years. In particular, the female attrition rate at the C-suite level was approximately half of what it was in 2019 (Exhibit 2). While many factors probably contributed to this outcome, our employee sentiment survey indicates two possible reasons: more women than men reported being somewhat or very happy with their companies, and more women than men would recommend their companies as great places to work. In addition, fewer women of color in healthcare management roles had left by the beginning of 2021 than had in 2019.
Increased external hiring
Hiring from outside an organization can be one strategy to increase representation. In 2021, external hiring of women at the manager through vice-president (VP) levels increased in healthcare from 2019. These numbers compare favorably with the averages across all sectors, in which women account for 34 to 47 percent of external hires.
Despite the reasons to celebrate women’s success in healthcare, critical challenges remain. The ongoing stress of the COVID-19 pandemic threatens to undo progress in promotion and attrition rates, potentially setting female representation and advancement in healthcare back by several years. If women leave the workforce, miss out on promotions, or both, that will hinder efforts to reach gender parity in the C-suite.
We examine three crucial areas: drop-offs in representation at specific levels of the pipeline, in promotion rates, and in external hiring; barriers to advancement for women of color; and potential threats to recent gains in female representation, including increased home responsibilities and levels of burnout, correlated with the COVID-19 pandemic.
Drop-offs in representation at specific levels of the pipeline
The representation of women declines at each successive step, from the entry level (67 percent) to the C-suite (29 percent). Representation drops particularly sharply—by eight to 11 percentage points—at each level from manager to senior vice president (SVP). Clearly, promotion rates, retention, and external hiring have not kept pace to improve representation at more senior management levels.
While promotion rates for women in healthcare were on average on par with or slightly lower than those for men through the SVP level, the gap between men and women was larger in the C-suite (Exhibit 3). Previously, women had been promoted at higher rates to the SVP and C-suite levels: an 8.3 percent promotion rate for women to the C-Suite in 2019, compared with 0.8 percent in 2021. This effect can compound over time, resulting in lower representation for women at the highest levels.
External hiring is one of the quickest strategies to increase the representation of women at the top. There is room for improvement here: external hiring of women in healthcare is on par with the share of women already in healthcare organizations, and men account for a larger share of external hires than women from the VP level through the C-suite (Exhibit 4). External hiring of women in C-suite positions in particular decreased to 33 percent in 2021, from 42 percent in 2019. Across all sectors, women make up 36 percent of external hires. As a result, current external-hiring trends are likely to further widen the gaps in female representation, especially in senior levels.
Barriers to advancement for women of color
In healthcare, women of color make up almost a fourth of entry-level positions but occupy only 5 percent of C-suite ones. The attrition rates for women of color at the level of manager (28 percent) and senior manager or director (17 percent) are particularly alarming. Attrition among women of color at the entry levels will probably hurt representation at more senior levels in future years.5 Compared with White women, White men, or men of color, proportionally more women of color reported spending time on diversity, equity, and inclusion (DEI) efforts, but they are the least likely to say that these efforts are well resourced at their companies. They also are the least likely to report that their managers consistently created an environment where people can discuss challenging topics.
Respondents to our survey said that they frequently do not feel supported in their DEI work—in fact, 16 percent of women reported that when they spoke out against bias, they experienced retaliation. A larger share of women than of men reported taking on DEI work. Fifty-one percent of women said that they carved out time to learn about the experiences of women of color by reading, listening to podcasts, or attending events. Only 35 percent of men did.
In the COVID-19 era, employed women have faced increasing pressures and challenges, according to results from our employee experience survey. Women across all sectors have shouldered more household responsibilities, and more women reported feelings of burnout.
The problems are seemingly more acute for women in healthcare, who have fewer opportunities to work remotely, report feeling greater pressure to prioritize work over family, and seem to be “pushing through” burnout and missing fewer workdays than women in other sectors. Although this may have been celebrated in moments of crisis, executives and organizations can evaluate how to encourage women in healthcare to recharge. Otherwise, they may find that the pandemic’s headwinds are correlated with, if not causing, a more challenging path for women to become top executives in healthcare (Exhibit 5).
The employee experience survey indicates that women in healthcare feel burned out at work more frequently than men do and have missed more days of work as a result (Exhibits 6 and 7). The recent increase of burnout levels in healthcare may raise attrition in the future. In 2021, levels of burnout for women in healthcare resembled those of women in other sectors: across all levels, the same proportion of women (42 percent) in healthcare and all other sectors reported “often/almost always” feeling burned out at work. However, women in healthcare appear to be pushing through this burnout: six percentage points fewer women in healthcare than in all other sectors reported that they had missed one or more days of work as a result of burnout, stress, or mental-health issues. Over time, women who do not take time off to address their mental health may leave.
In addition, our 2021 employee experience survey found that 53 percent of women and 47 percent of men in healthcare reported feeling stressed at work in the past few months.6 Thirty percent of women in healthcare reported feeling “pressured to work more” in the past few months, compared with 25 percent of men in healthcare. As the pandemic continues, these challenges may be worsening, especially for nurses. McKinsey’s survey of nurses, conducted in February 2021 and in November 2021, reflected the strain.7 The November 2021 results indicated that more than 32 percent of surveyed nurses may leave their current positions providing direct patient care within the year—a substantial increase over 22 percent in the spring. Of nurses reporting an intention to leave, 60 percent said that they had become more likely to do so after the start of the COVID-19 pandemic. Since the pandemic began, a higher proportion of female than male nurses have said that they are likely to leave.
This finding is consistent with a recent McKinsey survey conducted across employees in healthcare and social assistance: in mid-2021, 36 percent of the respondents said that they were at least somewhat likely to leave their current jobs within the next three to six months. Forty-two percent of the healthcare and social-assistance workers who had already quit did so without having new jobs.
The experience survey data paint an unprecedented picture: women are nearing a tipping point, and their professional advancement is being affected. If these challenges are not addressed, they could jeopardize the progress that women in healthcare have made in recent years.
Actions to take
Employers can consider three specific actions to retain and promote women in healthcare: mitigate attrition; use open positions to advance DEI goals, with external hiring and equitable promotions as mechanisms for change; and maintain a deliberate focus on opportunities for women of color.
Employers can take several steps to mitigate attrition: for example, they can ensure reasonable workloads, encourage clear boundaries for availability, and provide greater flexibility at work (such as flexible working hours, options to transition to part-time work or to a more time-flexible role, or remote-work options). Women said that these factors could dissuade them from reducing their hours or leaving the workforce.
In addition, people-focused managers can be trained to recognize and acknowledge the additional burdens of the pandemic period and to connect team members with relevant support resources. Appropriate steps might include communicating consistently about mental-health counseling benefits and stress management programs. In healthcare particularly, employees may feel pressure to be available 24/7. Thirty percent of women (and 23 percent of men) said that helping employees to set boundaries for availability would be a meaningful action for employers to take.
This is, of course, in addition to best standard-practice elements of a superior employee experience. These include social experience (people and relationships, teamwork, and social climate), organization experience (purpose, technology, and the physical environment), and the work experience (work organization, work control and flexibility, and growth and rewards)—as described in our previous work.
Use open positions to advance DEI goals
If your company faces rising attrition rates, look at the potential opportunities: stability is a goal, but open positions can be a chance to evaluate ways of making promotions and external hiring more equitable.
As we show in our previous work on women in healthcare, helpful actions include bias training, objective criteria for evaluation and promotion, diverse slates for promotions, and greater transparency and reporting. Requesting a diverse selection of candidates for open roles can be a powerful driver for change at every level. When two or more women are put forward for consideration, the odds that a woman will be promoted rise dramatically.8 It is equally important to ensure that women and people of color within the organization are ready now or ready soon to fill these openings. In addition to preparing internal succession candidates, companies may want to reexamine external hiring, including whether it is an adequate component of specific recruitment efforts.
If multiple leadership roles in an organization or team are open, it is especially important to take a holistic perspective. In these situations, think about building the best leadership team as a whole—with leaders whose perspectives, experiences, and backgrounds complement one another and reflect the broader employee, customer, or patient populations—rather than making a series of independent hiring decisions. These senior placements are a visible signal of organizational priorities to the rest of the workforce.
Maintain deliberate focus on opportunities for women of color in healthcare
Companies may consider comprehensively examining their evaluation and promotion processes, when biases and barriers often disproportionately affect women of color. In addition, they may pay careful attention to retaining critical talent and to addressing the reasons that women—particularly women of color at the manager, senior manager/director level—cite for reducing their workloads or for leaving.
If healthcare companies truly wish to improve the representation of women of color, they may choose to hold managers and senior leaders more accountable by making the diversity of their organizations more transparent or making diversity goals a component of performance reviews (for example, sponsorship of lower-tenured colleagues from underrepresented groups).
No matter their gender, race, or career dreams, healthcare workers join the sector with a desire to help people recover from illness and to live healthy lives. Yet the past two years have taken a toll on employees, and in particular those on the front lines of the pandemic. Gender parity and proportionate representation of women of color in healthcare at the top levels remains aspirational. Although there are reasons to celebrate, healthcare stakeholders may consider what they can do to rebalance the scales. While we cautiously watch the experience of women in healthcare during the ongoing pandemic, we feel optimistic about the healthcare sector’s potential to remain a leader in the representation and experience of diverse leaders.