Health Care's Leadership Gap: Why Women Disappear at the Top

Roxanna Gapstur did not set out to run a hospital system. She started as an oncology nurse, drawn to the work of caring for cancer patients, and only gradually moved into leadership roles as colleagues asked her to take on more responsibility. Over twenty-five years, she climbed through the ranks of hospital operations and health system management, eventually becoming senior vice president at a large Midwestern integrated health system. In 2019, she became CEO of WellSpan Health, serving central Pennsylvania. Her path was unusual not because of her ambition but because she made it to the top at all.

Healthcare is a field built on women's labor. Three-quarters of entry-level healthcare workers are women. They staff the bedside, manage patient care, build the relationships that hold the system together. Yet something happens as women move up. At the C-suite level, women represent only 32 percent of executives. Among those few women in the highest ranks, only 4 percent are women of color. The gap is not a pipeline problem in the traditional sense—there is no shortage of women entering the field. The problem is that women disappear.

Cathy Jacobson, CEO of Froedtert Health in Milwaukee, has watched this pattern for forty years. "It still is a disappointment to me that [women] disappear as we get to the top," she said. The numbers bear out her frustration. According to McKinsey's 2022 Women in the Workplace report, female executives in healthcare are leaving at accelerating rates. Between 2021 and 2022, the attrition rate for women in C-suite positions more than doubled, from 6.4 percent to 16.6 percent. The steepest drop in female representation occurs at the vice president level—a critical rung where leaders prepare for executive roles. In 2022, 61 percent of senior management positions were held by women, but only 45 percent of vice president roles were, a sixteen-point plunge.

The timing is not accidental. Women's most intensive career-building years—the mid-twenties through mid-thirties—overlap almost exactly with the years when many women start families. Jacobson made her leap to CEO before having children, which she acknowledges gave her an advantage. But she recognizes the bind that traps so many others. "If you want a family, you're right smack in the [middle] of that," she said of the overlap between ambition and parenthood. When companies fail to support women navigating both, "you lose people" at the moment they are most needed in the pipeline.

The barriers women face are not subtle. A 2023 Yale study of healthcare workers during COVID found that women reported unequal opportunities for advancement in salary, promotions, and job opportunities. One respondent described being passed over for leadership positions by less-qualified men with less seniority. Another noted "blatant favoritism" toward male colleagues even when female applicants had more experience and had performed more work. These are not isolated complaints. They reflect a pattern of discrimination that persists even in an industry where women are the majority.

Some healthcare leaders are working to break the pattern. Stephanie Conners, CEO of BayCare in Florida, emphasizes that retention depends on giving every employee genuine opportunity to develop and advance. "As leaders, we have to truly adapt our thinking in the sense of what our team members expect from us, how we retain them and how we ensure that we are giving them what they need to be their best self," she said. The pandemic accelerated this reckoning. Workers across healthcare—particularly women—began prioritizing work-life balance and personal time. Companies that did not adapt lost staff.

Flexibility matters enormously. More than 142,000 working women surveyed for Newsweek's 2024 ranking of America's Greatest Workplaces for Women cited flexibility as a major factor in choosing an employer. Women are historically more likely to work part-time, and many balance caregiving responsibilities outside work—children, aging parents, education. Heather Helle, president and COO of Bayada Home Health Care, notes that women often avoid profit-and-loss roles because those positions demand extensive time and travel, incompatible with family life. The solution is not to push women into inflexible roles but to create structures where women can advance while managing all aspects of their lives.

Gapstur credits her rise to mentors who saw potential in her and gave her opportunities and challenges. She emphasizes that mentorship and sponsorship are critical, particularly because women tend not to self-promote and often hesitate to apply for roles they do not feel perfectly qualified for. "In many cases, there's no one who's perfectly qualified for that role, but if you're willing to learn and you're a go-getter and you're willing to take a risk, you might do great," she said. The female CEOs now leading major health systems are working to return that favor, ensuring the pathway for future female leaders is not only intact but free of unnecessary obstacles. The question is whether the industry will move fast enough to keep pace with the women it is losing.