Gender disparities in career among internal medicine physicians: evidence from a national survey of members of FADOI

Despite notable progress in the representation of women in medicine globally, significant gender gaps in salary and career advancement persist. In 2014, women accounted for 41.2% of doctors across OECD countries, with Italy (40.3%) aligning closely with this average. While Italian Ministry of Health data show that female representation in the National Healthcare System has further increased to approximately 69% by 2021, professional progression remains asymmetrical. The primary endpoint of this study was to examine gender-based inequities in leadership roles and career trajectories within Italian internal medicine. In 2024, we conducted a nationwide survey among hospital internists affiliated with the FADOI (Italian Scientific Society of Internal Medicine). Data were collected via an online platform with a 20% response rate. We analyzed the distribution of senior clinical and managerial positions, controlling for observed professional characteristics and demographics. Our findings confirm a significant “glass ceiling” effect. Despite their predominance in the workforce, women occupy only 26.8% of general management and chief of medicine positions. Furthermore, women remain markedly underrepresented in the leadership of complex healthcare structures (37.4% female vs. 62.6% male). These vertical disparities are accompanied by horizontal inequalities, including a persistent gender pay gap and structural barriers related to work-life integration and organizational culture. Although the trend points toward greater gender participation in the workforce, this has not yet translated into equitable representation in top-tier positions. The results underscore the necessity for targeted institutional reforms to dismantle the systemic barriers hindering women’s career progression in internal medicine.