No country can ever truly flourish if it stifles the potential of its women and deprives itself of the contributions of half of its citizens. – Michelle Obama
The importance of utilizing all the human capital in a population is essential to the long-term success of any population group. While men and women in general are different physically, mentally, and socially, these differences are complementary. What one lacks, the other provides. However, there are only negligible differences in general intelligence (Wikipedia), so it is very unfortunate that most societies over time have relegated women to “lesser” roles. We sometimes forget that it has been only 100 years that women have been allowed to vote in the United States. Currently women make up the majority of the population (51%), account for 49% of the college educated workforce, and hold 52% of all professional jobs. And yet, “American women lag substantially behind men when it comes to their representation in leadership positions” (Warner and Corley, 2017).
More than 50% of graduates from US business schools are women, yet only 13% achieve C-suite status (SpencerStuart, 2017, Catalyst, 2109c). This statistic is symptomatic of the ongoing failure to recognize and value the talents and skills of women – just because they are women. One very successful business woman reflected that in her early years she was told by a “very important” CEO that she was too short, too smart, and too female! While this comment is inane, it does reflect the thought process of many males in the business world. The question is, what are the challenges that women face in their attempt to move up the ladder? Can these challenges be overcome? What can be done to help change the future for women to become leaders in organizations in all professions?
This paper reviews the societal, employee, and employer challenges for women in the 21st century with emphasis on the home care and hospice management field. Behavior and outcomes as well as barriers and possibilities for the future will be examined. Note: while the primary focus of this paper is the path to the CFO position, it is common for the CFO to be an entry path to the CEO position (SpencerStuart, 2017).
Education is an important consideration for professional employment and advancement in the home health care industry. However, education does not automatically lead to advancement to the executive level. To give some perspective, women earn more than half of the college degrees in accounting and hold more than half (60%) of the accounting and auditing positions in the US. In direct contradiction to this, women make up only 24% of partners and principals in CPA firms (Catalyst 2019a). As of January 2017, women hold only 61 CFO positions within the Fortune 500 companies (12.5 %) (SpencerStuart, 2017; Catalyst, 2019b).
Table 1 shows the gender and higher education difference between men and women holding management positions in a health care field. It is evident that regardless of the degree, women hold most of the administrative/middle management roles. So in an industry so clearly dominated by women, one would think that more women would occupy the CFO spot.
Table 1. Education and gender of those holding health care management positions.
Health/Health care administration/ management
Hospital & health care facilities administration / management
Long term care administrative /management
Source: National Center for Educational Statistics, 2016
Despite earning more degrees in finance, it has been shown that women are more involved than men in "specialized management" areas including those detailed in
Table 2 rather than general management (62% vs 50%). Often the general management track is more directly associated with advancement into senior leadership positions.
Table 2. Comparison of men vs women in specialized management areas.
Planning, Marketing, Quality Assurance
Continuum of Care (ambulatory, home and long-term care)
(American College of Healthcare Executives, 2012)
When it comes to positions of financial leadership, the need for formal education is a heavily weighted prerequisite but is not the only key indicator of CFO/CEO success. While basic accounting and financial literacy skills, hard "number crunching,” are necessary, they are not sufficient to do the job required. Modern businesses are seeking well-rounded CFO candidates with salient soft skills across a variety of domains. These are not skills learned easily in a classroom, but skills derived through the crucibles of experience and action (Deloitte, 2012). One would think the increased emphasis on soft skills would benefit the advancement of women, who tend to be stronger in this area, but unfortunately that is not yet the case.
Executive recruiter Nelson Mann notes, "A much more sophisticated skill set is now required of the healthcare CFO. Mann, a senior partner at Witt/Kieffer, a healthcare executive search firm stated, "Hospitals and health networks are looking for a more strategic, versus operational, executive – someone with the kind of background and expertise suited for a top leadership role" (Weldon, 2014). Because healthcare changes at such a rapid rate, there is truly no substitution for industry experience. Weldon added, “A future healthcare CFO will soon require it, along with having the qualifications of a CPA while thinking like an MBA.”
The need for the combination of industry experience and strategic and financial acumen is particularly important in the home health industry, which is comprised primarily of two entities: clinical operations and financial operations. These two are dependent on each other but at the same time are in some ways at cross purposes. The financial leader is interested in efficiency, metrics, cost savings, etc., with the thought to limit or control clinical expenses. The clinical leader is interested in efficacy, patient care and comfort, and care provider support, with cost factors less important. The clinical side of the operation tends to be heavily staffed with women. While they rise up through the ranks based on time and experience, they often don’t have sophisticated financial expertise and experience. The finance side is typically staffed by those strong in financial matters, but have limited clinical exposure. For several reasons that will become evident in this paper, the upper level managers in this group tends to be largely male. So, when the time comes to identify the CFO, money talks. Very often the finance person, even with limited clinical experience, wins out over the clinical person.
In the United States, women account for over half of the entry-level workforce in the financial services industry – a steep increase from two decades ago when men used to dominate the field. While this is a promising sign, women are still very much under-represented in top leadership positions. Women currently represent less than one in five positions in the financial services C-suite (McKinsey & Company, 2017). Why is this happening? It may be because women still face societal challenges in the work world that hinder their progress to leadership roles – not just in finance, but in all careers. While Americans feel gender equality in the workforce needs to be enhanced, most feel there are still several societal and traditional business practices that are problematic to women’s advancement. These challenges are not always understood or acknowledged by their male colleagues.
One of the societal challenges facing women more than men is managing a family and career. Many women take a break from their careers or choose not to pursue higher positions once they start a family or while raising children. With an increase in two-income households over the past two decades, men have been taking on more and more of the family matters. Still, a high percentage of women continue to carry most of the burden of balancing home and career. Additionally, women who stay home for a few years to raise their family and later re-enter the workforce usually have a hard time doing so (McKinsey & Company, 2017).
Due to the prevalence of gender inequality over the last three decades, there are significantly more men than women in senior-level positions. This in turn resonates with entry-level women who do not see their female peers in positions they can attain. Reports by McKinsey & Company (2017; 2018) noted the disparity between men and women in finance up the corporate ladder. While 51% of women were in entry-level jobs, only 18% of women were in the C-Suite. Conversely, 49% of men were in entry-level jobs, but 81% of C-suite executives were men.
Several studies show that women are often not provided mentorship or sponsorship when they enter the finance arena. As noted above, there are fewer women holding leadership positions that can serve as role models and in mentor roles. In addition, not all men are able or willing to serve as strong mentors for women colleagues. It is often difficult for males to understand the different challenges that females face as compared to male mentees, making them less effective. In the current #MeToo era, males may be reluctant to take on a close mentorship role with female colleagues. The lack of consistent mentoring leads women to believe they are either not capable of senior-level positions or that no one will advocate for them. Without this type of mentorship and sponsorship in the corporate pipeline, women have a much harder time being promoted than their male counterparts, and the numbers prove this is a chronic problem in the finance world. (McKinsey, 2017).
Just as in the equal pay for equal work controversy, women are often held to higher standards than their male counterparts. Despite similar accomplishments and productivity, women are frequently passed over for promotion. Therefore, women are less likely to ask for a promotion or apply for other leadership roles until they've met every perceived requirement on their mental checklist. Their male peers advance faster, gain more advanced experience quicker, and thus gain advantages for further promotions (McKinsey & Company, 2017; 2018).
Another challenge stems from how men and women have been brought up over the past three decades. Generally speaking, men tend to be much more confident in their abilities and in taking risks, while women are not. Sheryl Sandberg in her book Lean In (2013), speaks of the "imposter syndrome." Women with imposter syndrome tend to downplay their accomplishments, discount compliments on their work, and believe it's only a matter of time before someone figures out that they're not qualified for the position they hold. This type of thinking discourages women from asking for promotions and salary increases. They think it is safer to lay low so their perceived inadequacies will not be noticed. In contrast, men have been raised to be confident, to take risks, and to ask for what they want – and most do. Several studies have shown that this continues to occur in many areas in the corporate world where men are more likely to ask for promotions and thus move up the corporate ladder. This has led to male-dominated environments where women continuously try to fit in.
Finally, women deal with prevalent sexual harassment, sexism, and discrimination in the workplace much more than men do. Of women polled for the Women in the Workplace study (McKinsey & Company, 2017), 35% report stated they had been sexually harassed at some point in their careers. Sexism, also known as microaggressions, can take many forms in the workplace. Sometimes the person guilty of microaggressions doesn’t even realize they're doing it. Sexism can be as subtle as a man assuming a woman holds a more junior position than she does or as aggressive as stating something overly sexual or demeaning to a woman because she is a woman. In 2018, a McKinsey & Company study noted that 64% of women polled felt that they deal with microaggressions in the workplace. These actions lead many women to want to leave their job, not pursue higher level positions, or not deal with certain people in the office.
The percentage of women in the workforce has grown significantly over the years. According to the U.S. Bureau of Labor Statistics (Agarwal, 2018; Toossi and Morisi, 2017), the percentage of women's labor force participation has increased from approximately 18.4 million, or about one-third of the labor force, in 1950 to approximately 73.5 million, or about 46.8% of the workforce, in 2015, with the expectation that this growth trend will continue.
Despite this surge of women in the workforce, there continues to be a large gender gap in leadership positions amongst companies throughout the United States. For example, according to Catalyst, "Women in S&P 500 Companies (2019b), women make up 44% of the overall S&P 500 labor force, but just 26% of executive and senior-level officials and managers, and less than 6% of CEOs for those companies. Because of this inconsistency, there have been countless writings in recent years spotlighting the issues women face in the workforce. In response, employers have increased their focus on attracting, retaining and advancing all employees, particularly women (Agarwal, 2018; Caldecott, 2016). These efforts have produced many adaptations and achievements amongst employers throughout the country listed below. Note: Many of these efforts benefit male employees as well.
Flexibility - A greater focus on getting the work done without imposing a certain schedule or location in which to do such work. Flexibility allows women the ability to accomplish their professional goals while meeting the needs of their families (Adams, Barber, and Odean, 2016).
Mentorship - Many employers have implemented, or are in the process of implementing, programs for mentorship, coaching, and sponsorship for female employees. These types of programs help provide women a path for communicating their needs and goals, both professionally and personally, and have sponsorship from others to meet those needs and goals.
Education - Studies have shown that women tend to face unconscious bias in the workforce, which can hinder advancement in an organization. These biases are based solely on cultural factors without regard to actual performance measures. More and more employers are creating awareness of and education on this issue to ensure these biases are managed appropriately (Bhakata, 2019).
Policies and Procedures - Formal policies and procedures are also being adapted and improved to attract and retain women in the workforce. These include parental leave, health and wellness programs, paid time off, training programs, and childcare benefits.
Women, too, are doing their part to facilitate their progress toward senior leadership positions. Women are more willing to work for change in health care industries in order to better use their skills to achieve advancement. Many return to school later in their careers to obtain an advanced degree. Though still relatively few in number, more women now lead healthcare organizations across the country and sit at the head of the boardroom table. They embrace continuous learning and are not afraid to step out of their comfort zone to advance their careers. They are willing to ask questions and learn from their peers. Women have learned that life-work management means that you can be a mother, wife, and a leader in healthcare. Taking chances to reach their goals is an important part of their success (McKinsey & Company 2018).
Strategies for Further Improvement
One way to provide opportunities to increase the instance of women in key financial roles is to provide strategies for successful outcomes to both individuals and employers. These strategies address motivations, challenges, and barriers for the financial sector and identify areas of improvement opportunity to achieve the desired outcome.
In a study conducted by LeanIn.org and McKinsey in 2017, Women in the Workplace, entry-level finance employees were asked about their desire to be a top-level executive. Forty percent of the male employees had this desire, while only 26% of the female employees were interested in such a leadership role. The study reflected that of those that were not interested in a top-level position, 41% said they were not really interested in work, 40% felt there would be a challenge with work-life balance, 36% did not want the pressure of that kind of role, and 34% felt a leadership role was filled with too much politics (McKinsey & Company, 2017).
Considering the information obtained from the study referenced above, steps to improve women's role in key financial positions can be divided into two categories: individual strategies and employer strategies. Individual strategies are steps a woman can take to assume ownership and control. Women have the ability to make clear choices and decisions about their career and are accountable for the actions they take. Areas that the individual cannot change are likely to be areas that an employer can impact. Employer strategies are steps an employer can control and gives them the ability to improve the
opportunities for women, including female finance professionals, to be part of their executive team (Deloitte, 2012).
Individual strategies for female financial executives include the following (McKinsey & Company, 2017; Deloitte, 2012).
• Don't be afraid to take chances or try different things. Allow yourself to take some risks and to learn as much as you can about business/sector areas of interest. The earlier in your career you start doing this, the better! By doing so, you will become a more well-rounded, highly-versatile and valuable asset to an organization
• Develop the ability to communicate your worth and accomplishments. Working hard is a given – you can't reach the top without that – but you also need to have confidence that is visible to those around you. Know your value and what you bring to your employer or to a perspective organization. Communicate your worth to the right people.
• Assemble a support network and make strong connections with senior-level management.
As identified in the 2017 Women in the Workplace study (McKinsey & Company), many women do not aspire to top-level finance positions because they feel it is too political. Having a support system and connections to senior management are essential in managing and navigating office politics. A mentor will provide guidance and support through those situations, helping you continue on your career path towards success.
Employer strategies for female financial executives include the following. (McKinsey & Company, 2017)
• Promote and provide access to female role models. Provide opportunities for your staff to meet female role models or promote female industry networks to create a space for women in finance to meet and engage with one another.
• Intentionally assign female employees in a variety of projects or work roles that expand their horizons and allow them to learn more sophisticated skills and techniques that will prepare them for advancement.
• Within reason, allow or even encourage employees to take appropriate risks without fear of reprisals if they fail.
• Promote a qualitative versus quantitative approach on the expectations of top-level finance positions. Roles should focus on outcomes and quality of work rather than the number of hours spent completing tasks.
• Provide work-life balance opportunities. The Women in the Workplace (McKinsey & Company, 2017) study identified work-life balance as a deterrent for women wanting to excel to top-level finance positions. Employers can mitigate this barrier by offering an ala-carte menu of work-life balance options such as casual dress, flextime, telecommuting, and onsite childcare.
These are just a few steps individuals and employers can take, but even just a few steps can make a big difference. While the gender gap in finance at the executive level may be seen as a challenge, addressing it creates an opportunity. Women will now have the chance to lead, perhaps differently than their male colleagues have in the past. Subsequently, the industry as a whole may be impacted through business recruitment and retention tactics. While these challenges may be an uphill battle, the opportunities created outweigh the difficulties.
The pathway to key financial positions requires more than education and skill. Today’s financial leaders require a strategic mindset with the background and expertise of top leadership.
While women desire to position themselves to reach key financial leadership roles, the challenges of family obligations, work/life balance, gender inequality, and lack of available mentors stand in the way. However, women are adapting to the challenges by embracing continual learning, displaying confidence in the workplace, and returning to academic studies later in life to advance their careers.
Employers play a pivotal role in advancing women to positions of financial leadership. By allowing increased flexibility of work hours, developing mentorship programs, providing educational awareness of gender bias in the workplace, and improving company policies to accommodate women’s needs in the workforce, employers are recognizing the value of women in leadership.
Adams, R., Barbar, B., Odean, T. 2016. Family Values and Women in Finance on the internet at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2827952.
Agarwal, P. 2018. How can you Encourage More Women into Your Workforce on the internet at
Bhakta, A. 2019. International Banker, International Women’s Day: Being a Female CEO in the Finance World on the internet at https://internationalbanker.com/finance/international-womens-day-being-a-female-ceo-in-the-finance-world
Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Changes in women’s labor force participation in the 20th century on the Internet at https://www.bls.gov/opub/ted/2000/feb/wk3/art03.htm.
Caldecott, S. 2016. Yes, America’s Maternity Leave Sucks, but Here are 6 things US Companies are Doing Right on the internet at https://verilymag.com/2016/05/usa-maternity-leave-working-women-policies.
Catalyst, Women in Accounting: Quick Take., 2019a on the internet at https://www.catalyst.org/research/women-in-accounting.
Catalyst Pyramid: Women in S&P 500 Companies. 2019b on the internet at https://www.catalyst.org/research/women-in-sp-500-companies.
Catalyst, Women in Financial Services. 2019c on the internet at https://www.catalyst.org/research/women-in-financial-services.
Deloitte. (2012). The Journey to CFO: Perspectives from Women Leaders on the internet at https://deloitte.wsj.com/cfo/files/2012/06/us_cfo_wincfostudy_0909.pdf.
McKinsey & Company. (2017) Closing the Gap – Leadership Perspectives on Promoting Women In Financial Services on the internet at
McKinsey & Company. 2018. Women in the Workplace on the internet at https://womenintheworkplace.com.
National Center for Educational Statistics, Digest of Educational Statistics, Table 318.30. 2016. Bachelor’, master’s, and doctor’s degrees conferred by postsecondary institutions, by sex of student and discipline division on the internet at https://nces.ed.gov/programs/digest/d17/tables/dt17_318.30.asp.
Sandberg, Sheryl. 2013. Lean In: Women, Work, and the Will to Lead. New York, New York: Random House.
SpencerStuart, Fortune 500 CF0 Index (2017) on the internet at https://www.spencerstuart.com/~/media/pdf%20files/research%20and%20insight%20pdfs/fortune-500-cfo-index-report_032317.pdf.
Toossi, M. and Morisi, T. Women in the Workforce Before, During, and After the Great Recession on the internet at https://www.bls.gov/spotlight/2017/women-in-the-workforce-before-during-and-after-the-great-recession/pdf/women-in-the-workforce-before-during-and-after-the-great-recession.pdf.
Warner, J. and Corley, D. (2017). The Women’s Leadership Gap: Women’s Leadership by the Numbers. Center for American Progress on the internet at https://www.americanprogress.org/issues/women/reports/2017/05/21/432758/womens-leadership-gap.
Weldon, D. Healthcare Finance, Do CFO’s Still Need a CPA? (2014) on the internet at https://www.healthcarefinancenews.com/news/do-cfos-still-need-cpa.
Wikipedia. Gender Inequity on the internet at https://en.m.wikipedia.org/wiki/Gender_inequality.