Gender and Pay Gaps in Paramedic Services Leadership in Ontario, Canada

Research suggests that women are underrepresented in healthcare leadership and often earn less than men. This may be true in the emergency medical services (EMS) as well, but research on the subject is limited and specific data in Canada is scarce. This study aimed to estimate the gender and income distributions among leadership within Ontario's paramedic services.

We abstracted records for leadership positions (e.g., superintendent, commander, deputy chief, chief) from the Ontario Public Sector Salary Disclosure List. Two raters independently assessed the presumed binary gender of each individual, resolving discrepancies through consensus. Interrater agreement was measured using a kappa statistic. Chi-square tests compared the proportions of men and women at different leadership levels (entry, middle, executive). Income distributions were compared using parametric and non-parametric tests, stratified by leadership level.

Our search yielded 863 individuals from 49 (out of 54) paramedic services. Interrater agreement on presumed gender was 95% (κ = 0.87, p < 0.001). After resolving discrepancies (n = 43), we achieved complete agreement for 855 individuals (98%). Among the sample, 655 (76%) were presumed to be men. Women held 23% of entry, 35% of middle, and 15% of executive leadership roles. Within the leadership pool and compared to men, women were twice as likely to hold a middle leadership role (Odds Ratio [OR] 2.00, 95% Confidence Interval [CI] 1.35-2.98, p < 0.001) but less likely to hold an executive leadership position (OR 0.54, 95% CI 0.33-0.87, p = 0.012). Median income distributions were comparable at the executive level (p = 0.327), but lower for women at the middle and entry leadership levels, earning $0.90 (p < 0.001) and $0.95 (p < 0.001) for every dollar earned by men, respectively. Gender accounted for 1.7% of the variance in total earnings.

Our findings suggest the existence of both gender and pay gaps in leadership, the reasons for which are not immediately apparent and warrant further study.