The inverted gender pyramid in career progression among GCC physicians: implications for health workforce policy

Gender equity in the health workforce is central to health systems policy and planning. In the Gulf Cooperation Council (GCC) countries, women constitute most of medical graduates, yet their representation at advanced medical career levels is lower than men, reflecting an inverted gender pyramid. Quantitative evidence across GCC countries remains limited. We examined the gender differences in physicians' career progression among medical graduates of a regional medical school serving multiple GCC countries.

A cross-sectional observational analysis was conducted using a pre-existing dataset of medical graduates from the College of Medicine and Health Sciences at Arabian Gulf University, Bahrain. Eligible records required gender, nationality, career level, and years since graduation. The sample included 685 graduates. Career progression was defined as advanced versus entry or mid-career level. Characteristics were compared by gender in bivariate analysis using chi square tests. In addition, adjusted odds ratios were estimated using multivariable logistic regression. A p < 0.05 was considered statistically significant.

Females comprised most of the medical graduates (57.7%). However, male physicians more frequently achieved advanced career levels than their female counterparts (50.3% vs. 43.0%, p = 0.027), with no significant gender differences in career years (p = 0.518). In adjusted logistic regression model, male physicians had higher odds of attaining advanced career progression compared with females (OR 2.253, 95% CI 1.377-3.686, p = 0.001).

An inverted gender pyramid was apparent, with women overrepresented among medical graduates but underrepresented among advanced medical career levels. The pattern is consistent with growing international evidence of gender inequities in the medical profession. There is an urgent need for health policy action that improves promotion transparency and formalizes leadership pipeline progression.