title: Gender inequalities in the medical profession: are there still barriers to women physicians in the 21st century?
abstract: OBJECTIVE
  To analyze women's advancement compared with that of men and to determine whether advancement in hierarchical status differs from advancement in the professional recognition achieved by women from 1996 to 2008.
  
  
  METHODS
  A retrospective study was carried in Hospital Clínic in Barcelona. We analyzed data on temporary and permanent positions, hierarchy, promotions, specialty, age, and sex among the participants.
  
  
  RESULTS
  The female-to male ratio among trainee medical specialists was higher than 1 throughout the study period. After completion of specialist training, the proportion of women with temporary contracts more than doubled that of men. Less than 50% of women achieved permanent positions compared with 70% of men. For permanent non-hierarchical and hierarchical positions, the female-to-male ratio gradually decreased from 0.5 to below 0.2. Although more than 50% of trainee specialists were women, the number of female consultants remained 25% lower than that of men. In 2008, the final year of the study, the percentage of women who had achieved the grade of senior consultant was one-third that of men (29.5% of men vs 10.9% of women; p<0.0001).
  
  
  CONCLUSIONS
  The significant differences in medical positions held by men and women illustrate the 'leaky pipeline phenomenon', consisting of a disproportionately low number of women achieving leading medical positions. The full potential of the increasing number of women physicians will not be reached without continuing efforts to improve the hospital medicine environment.
authors.affiliation: Nephrology and Renal Transplant Service, Institut Clínic d'Urologia i Nefrologia, Hospital Clínic, Barcelona, Spain; Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS). Electronic address: parriza@clinic.ub.es.
authors.forename: Pilar
authors.initials: P
authors.lastname: Arrizabalaga
authors.affiliation: Department of Public Health, University of Barcelona, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Abellana
authors.affiliation: Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS).
authors.forename: Odette
authors.initials: O
authors.lastname: Viñas
authors.affiliation: Hemotherapy and hemostasis, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Biomedical Investigation Institute August Pi i Sunyer (IDIBAPS).
authors.forename: Anna
authors.initials: A
authors.lastname: Merino
authors.affiliation: Department of Public Health, University of Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D010822:Physicians, Women / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Gender identity; Género; Hospital; Medical staff; Médicos