The Gender gap in the Tuscany Regional Health System

BACKGROUND: According to the Italian Ministry of Health, the presence of women in the National Health System has increased. While women now represent the majority (69%) of healthcare workers (HCW) in Italy, and females make up 50% of medical doctors, only 18% of health unit directors are women. In Tuscany, there are 56.207 HCW, 72% of which are women. The objective of this study was to investigate the role of gender in the healthcare workforce, taking into account the issues of sharing caring responsibilities. METHODS: Between January and February 2022, the Tuscany Regional Institute for Economic Planning conducted a cross-sectional study among its HCW. An internally validated questionnaire was sent to the HCW to investigate working life, in particular schedule shift (fulltime or parttime) and night shifts; data were collected online anonymously and then analyzed with STATA. We performed logistic regression adjusting for age, gender, having children (<14 yo) and caring for a family member. RESULTS: 15.631 HCW answered the questionnaire: 76% were female, 23% were male and 1% preferred to not specify their sex. 73% of women and 65% of men have at least one child. 18% of women and 13% of men have at least one child and care for a family member. Those who have at least one child (adjOR=1.52 95%CI 1.26-1.83) or care for a family member (aOR 1.49 1.27-1.75) are more likely to work part-time, especially women (aOR 2.33 1.87-2.91). Moreover, those who have at least one child (aOR=0.90 0.83-0.97) or care for a family member (aOR 0.89 0.82-0.96) are less likely to work the night shifts, especially women (aOR 0.90 0.83-0.98). CONCLUSIONS: Our analysis shows that under the same conditions, women end up sacrificing their work more than their male colleagues. It is necessary to implement policies that encourage equitable sharing of caring responsibilities, fostering fairer work opportunities for women in the health system, including in positions of leadership, to overcome the gender gap. KEY MESSAGES: • The gender gap persists in the health personnel system. • It is necessary to encourage equitable sharing of caring responsibilities, ensuring women hold leadership positions.