Navigating the Path to Healthcare: School Rank and Its Impact on Care Occupation Choices across Gender and Social Class

Our paper examines how the intersection of gender and social class withing educational institution shape career trajectories in healthcare occupations, a sector traditionally dominated by women. We explore how students' relative academic performance within their school (measured as ordinal rank within the school’s grade distribution) influences their occupational choices, considering both gender and social class differences. Using Swedish administrative data on students who completed ninth grade between 1990 and 1997, we assess how relative school rank, alongside individual ability, affects access to prestigious healthcare professions.

Preliminary findings indicate that school rank strongly predicts entry into the medical profession, with higher-ranked students significantly more likely to become doctors. However, gender differences are pronounced: women’s healthcare career outcomes, especially in female-dominated roles like nurses and nursing assistants, are more sensitive to school rank than men’s. Additionally, social class plays a pivotal role, as students from higher social class backgrounds are more likely to become doctors, particularly when they occupy top positions in their school’s grade distribution. In contrast, students from lower social class backgrounds with lower school ranks tend to pursue nursing assistant roles.

By addressing the intersection of gender and social class, our study contributes to the theoretical frameworks of cumulative and compensatory social characteristics in educational attainment. Our findings highlight how educational systems reinforce both gender and social class inequalities in access to higher education and prestigious careers, particularly in the healthcare sector. By linking students' school experiences to occupational sorting, we shed light on how educational systems perpetuate both gender and social class inequalities in access to prestigious careers.