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AbstractPurpose -The purpose of this paper is to analyze the conditions for career advancement in healthcare management and examine factors that may be impeding gender equity. Design/methodology/approach -The authors assess gender differences in the odds of being promoted to senior management by: analyzing the relative impact of individual, organizational and family level variables in accounting for gender inequity; examining gender differences in experiences of perceived gender discrimination and sexual harassment, as well as attitudes regarding gender equity in senior management; and by exploring gender differences in aspirations for senior management. ANOVA, x 2 and logistic regression were used to analyze data from 685 respondents to the 2006 Gender and Careers in Healthcare Management Survey. Findings -Women were significantly less likely to be promoted to senior management, even after controlling for individual, organizational and family level characteristics. One third of women healthcare managers in our study reported perceived gender discrimination in the past five years. Less than half of male healthcare managers were supportive of increasing the proportion of women in senior management positions, while over 80 percent of women were. Among those not yet promoted women were significantly less likely than their male peers to aspire to senior management positions.Research limitations/implications -The cross-sectional nature of the data do not allow for the precise testing of the causal direction of observed relationships. Originality/value -Objective and subjective measures of gender equity were evaluated. The authors' broad approach demonstrated that factors restraining gender equity operate on multiple levels and highlights the relative importance of family factors.