Gender and Sexual Minorities in the Healthcare Professions: A National Analysis of Diversification and Wage Inequalities

A growing body of literature has quantified gender inequalities in healthcare professions, including gendered wage gaps, despite women representing 70% of the global health workforce. Statistical and taste-based discrimination have been postulated to account for differences in professional earnings among women versus men. Empirical studies from different countries indicate women physicians earn less than men due to “unexplained” factors, often attributed to consequences of gender discrimination, including fewer opportunities for career advancement among women in the traditionally male-dominated medical profession. Gender wage gaps also persist in female-dominated professions such as nursing, associated with accelerated promotions and other workplace rewards favouring men. The evidence base is less clear on wage disparities in terms of intersecting dimensions of gender and sexual diversity (GSD). In Canada, the 2021 Census became the first large-scale data source (in this country or anywhere) collecting information on both sex at birth and gender identity, along with same-gender couples, allowing to distinguish gender and sexual minority individuals. Approximately 0.3% of the adult population were enumerated as transgender or non-binary, and 1.5% of census families represented same-gender or transgender/non-binary couples. This novel observational study leverages the de-identified census microdata to describe GSD in the Canadian medical and nursing professions, as identified through the National Occupational Classification. First we will assess whether the healthcare workforce reflects the population it serves in relation to GSD. Second, we will apply regression-based Oaxaca-Blinder models to structurally decompose differences in mean earnings (logged) by gender and GSD, controlling for other professional and personal characteristics (e.g., education, hours worked, racial/ethnic origin), along with what proportions of the earning gaps remain unexplained by the measured predictors — a residual commonly attributed to statistical evidence of discrimination. Results will enhance understanding of whether gender wage gaps in health labour are exacerbated or attenuated by intersecting GSD identities.