Sage Journals: Discover world-class research

Abstract

Background:

Black women in academic medicine face challenges in career advancement due to systemic inequities shaped by their gendered racial identity. Despite systemic barriers and significant underrepresentation, many persist and thrive by drawing on personal, cultural, and communal resources to navigate and succeed in their professional journeys. This study applies intersectionality, gendered racism, and Black Feminist Thought to examine how Black women faculty in academic medicine navigate intersecting systems of oppression, centering their lived experiences and strategies for resilience, well-being, and career advancement.

Methods:

A qualitative study using a descriptive phenomenological framework was conducted to explore the lived experiences of 18 Black women in academic medicine across seven institutions. Participants were selected through purposive sampling. Semistructured interviews were conducted, transcribed, and analyzed using thematic analysis informed by inductive coding strategies.

Results:

Five key themes emerged: community support, mentorship and sponsorship, spirituality, resilience, and pathways for future generations. These themes reflect the holistic strategies Black women faculty employ to navigate and advance their careers.

Discussion:

Findings expand on the existing literature, highlighting the adaptive coping strategies Black women faculty employ to sustain their well-being and professional growth in the challenging environment of academic medicine. It further underscores the urgent need for strengthened institutional support and resources to promote the retention and success of Black women faculty.

Conclusion:

This study underscores the resilience of Black women faculty in academic medicine and calls for further research and institutional action to address systemic barriers and support their sustained professional success.

Keywords

Black women academic medicine coping mechanisms resilience intersectionality

Background

Black women (BW) in academic medicine confront persistent barriers to career advancement due to systemic inequities shaped by gendered racial identity.^1–8 Within academic medicine, representation remains critically low. A 2024 Association of American Medical Colleges report found that BW comprise only 2.4% (4,996/210,764) of all full-time medical school faculty.⁹ Looking closely at academic ranks exposes further disparities: BW represent just 2.9% (2,958/101,824) of assistant professors, 2.2% (957/43,981) of associate professors, and only 1.1% (462/43,900) of full professors.⁹ Disparities persist even as nearly half of medical school graduates are women.¹⁰ Additionally, BW constitute 64% (1,133/1,758) of Black medical school graduates, suggesting that expanded pathways into medicine have not translated into equitable progression through hiring, retention, and faculty ranks.^10,11

Challenges faced by BW and other underrepresented groups in academic medicine are compounded by pervasive systemic institutional barriers that shape their professional environments.^12–25 Barriers operate through biases in recruitment, hiring, promotion, intensified scrutiny of performance, and inequitable access to critical resources such as startup packages, grant funding, and mentorship.^7,12–25 BW’s scholarship is often devalued, co-opted, overlooked, or misrepresented and treated as peripheral to “traditional” academic metrics.^15,21,23 Misrecognition diminishes opportunities for authorship, grant success, and leadership roles resulting in their work being dismissed as less rigorous, further marginalizing their intellectual presence.^15,21,24,25 These dynamics create environments where BW are hyper visible as symbols of institutional commitment to diversity and yet invisible as experts and decision makers.^12–25 The “minority tax” imposes an added burden on BW faculty, who are disproportionately expected to shoulder service obligations such as committee work, diversity initiatives, and mentoring.^{12–17,19–27} Although this labor is critical to advancing institutional missions, it may not be compensated or considered in promotion criteria.^12,21,25,27 The cumulative effect results in workloads that constrain time for scholarly productivity, which in turn slows career progression, heightens burnout, and narrows advancement opportunities.^{16,19,21–25} Furthermore, BW have less access to effective mentoring relationships, making it difficult to navigate the complex structures of the field, including the promotion and tenure processes, creating a cycle that limits their ability to thrive in academic medicine.^{1,7,12–17,19–25}

The underrepresentation of BW in academic medicine affects faculty diversity, which is vital in the institution’s mission for innovation and learning in medical education and health care delivery.^26,28 Their presence is particularly important for addressing health disparities and advancing biomedical research. Although studies vary on the extent of the relationship between physician racial and gender background and the quality of care provided to patients from similar backgrounds, there is consistent evidence that a more diverse medical workforce improves patient satisfaction and health outcomes.^29–31

While research on women and faculty of color has grown, BW continue to be overlooked as a distinct group. Their experiences have often been combined with those of Black men or White women, based on the assumption that they share similar challenges due to racial or gender identities.^32–34 Such aggregation obscures the sociocultural factors that shape their lives and the distinct ways they encounter bias, exclusion, and institutional neglect.^35,36 Despite these challenges, BW persist, lead, and innovate in institutions that are often unwelcoming or hostile.³⁷ However, there is a significant gap in understanding the strategies they use to navigate their professional journeys.^13,15

Theoretical Framework

Intersectionality, gendered racism, and Black Feminist Thought (BFT) guided the overarching study’s exploration of the challenges and strategies observed among BW faculty in academic medicine.^8,38–47 Intersectionality delivers a comprehensive framework that situates BW’s experiences within broader systems of power and oppression, highlighting how race, gender, age, and other social factors intersect to create compounded barriers.^8,39–47 Moreover, structural intersectionality extends this perspective: focusing on how institutional policies, practices, and structures shape inequitable conditions.^39–41,48 Rather than attributing disparities solely to individual characteristics, intersectionality emphasizes how access to resources, institutional support, and broader environmental factors influence career progression and sense of belonging.

Essed and Collins extend intersectionality by showing how institutional practices perpetuate racism and sexism in life, with Essed’s theory of gendered racism specifying how forces converge in everyday institutional contexts to create unique challenges for BW.^40,41 Essed identifies key processes: BW’s experiences are often marginalized or overlooked in broader discussions about race or gender, leading to lack of recognition; they face pressure to suppress or regulate responses to discrimination, compounding psychological stress; and structural inequalities are legitimized through institutional norms and practices, reinforcing systemic exclusion.^40,49 Interlocking experiences of systemic racism and sexism shape the professional trajectories of BW and influence the strategies they employed.^40,50

Similarly, Collins’ BFT centers BW’s epistemologies as essential sources of knowledge and insight.⁴¹ Emerging from this framework is epistemic exclusion, the systemic devaluation or marginalization of BW’s scholarship.²⁴ Epistemic exclusion may manifest formally through devaluing research that utilizes community-engaged qualitative techniques, and informally through the dismissal of research focused on marginalized populations.^15,24 BFT names and challenges these dynamics emphasizing that intellectual labor and lived experiences are crucial to reimagining academic spaces. Importantly, BFT highlights the agency and self-definition affirming legitimacy within systems that often marginalize their contributions.

Using these frameworks, the Sources of Strength study explored four research questions: (1)

Are BW faculty in academic medicine subject to gendered racism?

(2)

How have they coped with and persisted through these experiences?

(3)

What institutional resources, policies, and procedures exist to counteract gendered racism?

(4)

What lessons can be drawn from these experiences to inform the retention and advancement of BW faculty in academic medicine?

This article explores how BW faculty cope with and persist through gendered racism, a comparatively underexamined dimension of their experiences in academic medicine. Centering these coping strategies aligns with BFT’s focus on agency and self-definition, offering a strengths-based perspective of ingenuity, resistance, and ability to sustain their careers within systems that often undervalue them.^41,50

Methods

This qualitative study involved semistructured interviews with BW faculty in academic medicine at Assistant Professor level or higher, who had been in their positions for at least 3 years, to reflect on factors influencing long-term career persistence.⁵¹ Purposive sampling was used to intentionally select participants with direct and relevant experience on the issues being studied.⁵² Eighteen participants were identified and recruited through email invitations, professional conferences, and referrals from other participants until achieving thematic saturation.

Interviews were conducted virtually, lasting approximately 45–60 min. A semistructured moderator’s guide ensured consistency across interviews and explored participants’ career pathways, institutional support, experiences of gendered racism, coping strategies, and recommendations for improving the climate. Guided by BFT and intersectionality, the interview guide was designed to center participants’ lived experiences and to elicit how gendered racism shaped the professional environments in which they worked, including the interaction of institutional structures and interpersonal dynamics in academic medicine (Fig. 1).

FIG. 1.

Interview guide questions.

All members of the research team conducted at least one interview. Interviews were audio-recorded and transcribed verbatim using professional transcription services. All transcripts were reviewed for completeness and cross-checked against interviewer notes for accuracy. Personalized identifiers were given and maintained to protect confidentiality.

Data were analyzed using reflexive thematic analysis to identify, code, and interpret patterns in coping strategies by all of the authors.⁵³ All researchers first reviewed the transcripts independently. Transcripts were then reviewed collectively within two assigned coding groups (Group 1: KF, VF, DW, RA; and Group 2: VF, DL, SW), with each group meeting multiple times to compare codes, discuss discrepancies, and reconcile differences through consensus. The senior author participated in both groups to support continuity across the coding process. Following this process, the first and senior author reviewed all transcripts and interview notes in three additional rounds using NVivo qualitative data analysis software and the finalized codebook. Review cycles were spaced over time to allow for reflection between readings before final coding decisions were made.

The university’s institutional review board approved the protocol, and signed informed consent was obtained before any research commenced.

Researchers positionality

The research team included four BW faculty or scholars, one Black man faculty member, and one Black woman medical student, all experienced in academic medicine and health sciences. Team members brought expertise in health equity and qualitative research and represented a range of professional roles and career stages, which informed interpretation while remaining attentive to variation in participants’ experiences. Embracing BFT, the authors emphasize that researcher neutrality is unrealistic and value lived experience as a source of knowledge. Our work incorporates an intersectional lens as we examine how power dynamics shape both participants’ experiences and the research process, including data collection and analysis. Additionally, by centering gendered racism, we aimed to frame reflexivity as a methodological strength that enhances transparency, accountability, and analytical rigor.

Results

Eighteen faculty, from seven public and private institutions, participated in the study, including MDs, PhDs, and MD/PhDs at the assistant, associate, and professor levels (Table 1).

Table 1.

Participant Demographics and Academic Roles (N = 18)

Characteristic	Number of participants (N)
Degree type
MD	9
PhD	7
MD/PhD	2
Years at institution	3–21 years
Academic rank
Assistant professor	8
Associate professor	7
Full professor	3
Primary academic track
Clinical	5
Research	6
Teaching	2
Integrated (clinical/research/admin)	5

Demographic information of the study participants, including degree type, years at the institution, academic rank, and academic track.

Experiences of gendered racism

Participants were asked about the presence and impact of gendered racism in their professional lives. All participants agreed that gendered racism exists within academic medicine, although the nature and intensity of their experiences varied. Participants described a spectrum of experiences ranging from overt and interpersonal forms of bias to more subtle, structural, and institutional manifestations, as well as instances in which they did not report direct encounters but remained aware of gendered racism within their professional environments.

As detailed in Table 2, participants’ accounts revealed that gendered racism was not experienced as isolated incidents but as a set of recurring and interrelated conditions shaping their professional contexts. Structural inequities, professional exclusion, and interpersonal disrespect were often described as cumulative rather than episodic, while intersectional erasure and underrepresentation intensified feelings of invisibility and isolation. These experiences of gendered racism provide a contextual foundation for understanding how BW faculty navigate their professional environments. Additionally, interviews revealed five central themes: Community Support, Mentorship and Sponsorship, Spirituality, Resilience, and Pathways for Future Generations. Themes reflect the strategies and insights that participants identified as crucial for success and well-being in their professional journeys.

Table 2.

Representative Experiences with Gendered Racism

Subtheme	Representative quotes
Structural Pay and Resource Disparities	“I was once told that men get higher salaries because they have families to support.” (P7); “I was underpaid for five years… I had to try to prove that right for five years you have been underpaying me three shifts a month times five years to get that money back.” (P11); “Yes. There are women who are at my level… all of them have a whole lot more resources, power, positions than I do… who provide those positions of power and resources don’t view me in the same way. And equally, the white women do not view me as deserving as them.” (P18)
Professional Exclusion and Devaluation	“I will go to meetings… I would say something… one of my male colleagues would say the exact same thing everybody would be like, “Oh, this is a great idea.” (P16); “Perhaps I don’t know if it’s intentional… a Black male faculty said because I’m a female in academic research he would not invite me for a beer. Many years later I thought back and was like, oh, I get it now… when men get together for a drink of beer that’s a time to decide they want to collaborate, and by my being a female I’m never going to be invited to those kind of scenarios.” (P5)
Intersectional Erasure	“So, I definitely believe that there are certain experiences that black women have that are unique to black women. And I definitely feel that there are some disparities that come as a result of that.” (P4); “… she said this shows you that women’s issues are more important than race issues and I was like wow I really see that people don’t always see this intersection.” (P9); “I’ve heard two men say…’ Right now we should just focus on race.” (P15)
Underrepresentation, Isolation, and Tokenization	“I mentioned before about the opportunity of a leadership position… and again just thinking about that in terms (of gendered racism)… I can’t say for sure, but I’m just even wondering if there could have been some effects in terms of that related to that request for that particular position.” (P1); “I struggled to know I’m trying to think of specific examples and part of it is because… particularly with whom I subspecialty there are so few URM individuals.” (P6)
Interpersonal Disrespect and Hostility	“I can’t believe you’re having another baby…” (P12) “ The white resident gets so angry (with me) because he felt that I did not address the issues to his satisfaction … literally spits in my face.” (P13) “I have an employee. He was just giving me a hard time. He was just not listening. He was just not with what I was asking him to do in terms of punctuality…” (P8) “… And then it came to me that I had insolated myself against such things. I curated my academic life so that I didn’t have those experiences that often. And when I felt like I might be having that experience, I cut off the person immediately. Because I was in a position of power to do so.” (P17)

Community support

Participants emphasized the role of community support, within and outside institutions, in fostering their professional success. Community (family, friends, colleagues, and allies) creates safe spaces where BW can share experiences openly, without fear of judgment or misunderstanding. One participant captured the value of community saying,

“Community looks like support, understanding, having sort of like-minded ideas. […] it’s really been instrumental in keeping me going….” (Participant 3)

Importance of community connections in navigating academic medicine countered feelings of isolation and created spaces of empathy and solidarity. Specifically, allies who encouraged authenticity rather than pretense were valued:

“Having allies is really critical, allies that you don’t have to code switch for and having a sounding ear.” (Participant 12)

Another participant emphasized how essential support systems were to her daily life, explaining,

“I have an amazing support system both through the university and outside of the university. My colleagues, I could talk to them about anything, personal or professional. And that just makes such a difference.” (Participant 15)

Participants emphasized the importance of resisting isolation, especially when facing challenges. “You’re not alone and your experience is real and valid” (Participant 6) became a reminder for many, reinforcing the importance of community solidarity. This insight highlights that struggles are shared, and connecting with others who face similar challenges is crucial for personal growth and collective success.

Beyond academic and professional support, family played a pivotal role in sustaining participants’ motivation and resilience. Participants described family members as an unwavering source of strength and encouragement. One participant shared,

“I could climb a mountain by the time I’m finished talking to her. My mom is amazing in terms of boosting your spirits.” (Participant 16)

Mentorship and sponsorship

Mentorship and sponsorship were central to participants’ success, providing guidance, advocacy, and protection as they navigate academic medicine. A participant reflected,

“Dr. [College Mentor], who is still one of my mentors, …a single, BW with three children… and she was kickass and wonderful. She said, “[Subject’s Name], we need you as a scientist…you have a skill for inspiring others and bringing them on board.”(Participant 13)

Sponsorship, by contrast, involved intentional use of positional power to advance participants’ careers. One participant described,

“…my chair intervened on my behalf when I was a junior faculty member because I was telling people no all the time that I could not participate in committees… you tell them to come to me first and he like protected me so much that it was amazing.” (Participant 9)

Spirituality

Spirituality served as an intrinsic source of strength and peace, sustaining participants throughout careers. Prayer was described as a practice that offered composure and inner strength. One participant explained,

“How I’ve coped is prayer. Just kind of withdrawing and talking to God […]asking for understanding and strength to deal with it.” (Participant 3)

One participant described spirituality as an anchor that affirmed confidence and purpose.

“Your gift will make room for you…The gift that God has given you will be shown. You just have to take your time and let it be shown. You don’t have to make people know what your gift is, they’ll see it, give it time.” (Participant 10)

Through spiritual practices, participants found a way to reconnect with their sense of self and anchor themselves outside of institutional and professional expectations.

Resilience

Resilience emerged as a theme of persistence and adaptability in the face of institutional challenges. Participants described resilience as an intentional process of learning, adjusting, and striving toward their ambitions despite barriers. One participant explained,

“Not giving up. If it doesn’t work out one way, I’m going to figure out another way. If that didn’t work, who can I ask? What can I do?” (Participant 2)

For others, resilience meant redefining success on their own terms and challenging the unspoken norms of academia. One noted,

“There’s a certain rule of law. But in terms of understanding what your place is and how to sit in academia, you have to blow all of that up and find a place that celebrates… so that you can lean in and be yourself. (Participant 17)

Participants acknowledged the emotional toll of maintaining resilience in demanding institutional environments. As one participant shared,

“This job I have is definitely an occupational hazard. I know this has taken years off my life, and that’s why it’s so important that I’m doing things that are really important to me and giving myself space to just say, ‘Okay, everything I have been pouring out to everybody else, I deserve to be able to give that to myself as well.” (Participant 12)

Pathways for future generations

Participants expressed a sense of responsibility to create pathways for future generations of BW entering academic medicine. This commitment was grounded in leaning into one’s voice and speaking life into oneself despite institutional barriers, a necessary act of self-preservation that allowed participants to continue showing up for others. As one participant reflected,

“I think to be verbal, to be respectful, but also to be verbal, to not be afraid to use my voice, to recognize that with my identity comes power.” (Participant 14)

By affirming their own worth in spaces that often undermined it, participants found purpose in transforming their experiences into guidance for those who would follow. Mentorship became a key expression of this commitment, viewed as a reciprocal process that nurtured both mentor and mentee. As one participant shared, “They (students) make me feel like I can make a difference in people’s lives.” (Participant 5)

For some, staying in academic medicine provided a meaningful way to do this. One participant highlighted,

“I love mentoring young people, and I like to stay on the cutting edge of medicine. I feel like that’s where things happen… It’s in academic medicine. That’s where you stay closest to updates in your field, and that’s where you […] touch the future of medicine. And really make a difference to young people coming behind you.” (Participant 4)

Mentoring the next generation helped participants feel their efforts were meaningful, not only helping others succeed but also reinforcing their own sense of purpose.

Discussion

This study describes how BW in academic medicine identified practices that sustained their well-being and supported their career advancement, despite frequently encountering the intersecting challenges of gendered racism. Grounded in BFT’s emphasis on self-definition as a form of resistance, participants’ narratives throughout this study position BW as world builders. Through this world-building, participants construct networks and spaces that enable self-preservation and cultivate conditions for thriving amid institutional betrayal and marginalization.⁵⁴ Importantly, this study extends existing literature by shifting focus from individual persistence to the structural conditions that necessitate and benefit from BW’s adaptive labor, revealing how practices such as resilience, community support, mentorship and sponsorship, spirituality, and “paying it forward” operate simultaneously as forms of resistance and as compensatory responses to institutional failure.

Participants consistently emphasized resilience as essential for remaining in academic medicine. Viewed through the lenses of gendered racism and structural intersectionality, the necessity of resilience exposes how racism and sexism operate simultaneously yet unevenly shaping how exclusion is experienced and navigated across institutional contexts.^39,50 Participants’ experiences varied by specialty, department, intersecting identities, and institutional culture, demonstrating that BW are not a monolith, even as they navigate common manifestations of gendered racism. Yet across this variation, what remained most insidious was the isolation produced by the ordinary, structurally embedded nature of gendered racism and the expectation that BW will absorb its impact through resilience. In this context, resilience is continually required not because adversity is unexpected but because institutions repeatedly fail to honor their stated commitments and values to support faculty success equitably, which disproportionality burdens BW. Framed through BFT, resilience emerges not as evidence of institutional success, but as evidence of normalized harm.^37,40,41,54 Community support emerged as a vital source of stability, helping participants navigate the challenges of academic medicine. This aligns with existing research showing that such networks provide a sense of belonging, empathy, and psychological safety and help mitigate isolation and stress.^13,49,55,56 Many participants described environments that lacked transparency in decision-making, insufficient departmental support, and marked by persistent microaggressions, reflecting patterns of epistemic exclusion in which their perspectives and expertise were routinely undervalued.²⁴ These dynamics created environments where recognition, promotion, and psychological safety were inconsistent or absent. Through a BFT lens, participants’ accounts illustrate how community support operated as an intentional response to epistemic exclusion, enabling collective sense-making and providing spaces of psychological safety where performative vigilance was not required.^13,24,41 BW constructed spaces for themselves, consisting of family, friends, trusted colleagues, and other BW faculty. These spaces provided affirmation where institutions eroded confidence, clarity when institutions provided silence, and respite where institutions demanded performance in hostile environments.

All participants identified mentorship and sponsorship as essential to career advancement in academic medicine. This emphasis aligns with existing research demonstrating that effective mentoring facilitates career progression, provides space to discuss challenges, and expands networks.^{26,49,57–60} Despite its importance, many participants described institutional contexts marked by incomplete or inconsistent information about advancement and often navigated these processes without structured guidance, requiring them to independently seek out mentors and sponsors. Within this context, gendered racism operates structurally through institutional assumptions that familiarity with hidden norms and advancement processes is inherent, illustrating how structural intersectionality organizes institutional power to unevenly shape access to career guidance, protection, and advancement.^7,36,39,40 Against this backdrop, mentors and sponsors functioned as protective infrastructures. Participants described mentors helping them navigate career milestones, offering candid insights into hidden institutional norms, and affirming their scholarly identities. Sponsorship operated alongside mentorship, with sponsors using their positional power to advocate for advancement, protect from inequitable service demands, and increase access to resources. Participants described intentionally cultivating mentorship and sponsorship relationships within and beyond their departments, in the absence of formal institutional pathways, thereby placing BW in the position of securing guidance and advocacy.

Spirituality and Pathways for Future Generations offered additional sources of grounding and purpose. These practices align with BFT’s emphasis on collective responsibility and self validation as foundations for healing and protection.^35,41 Similar to previous research, spirituality functioned as an internal well, an anchoring practice offering clarity, comfort, and a reminder that gifts and purpose were sources of power.^61–63 Participants described prayer and faith practices that helped them regain perspective and remain connected, enabling them to maintain a sense of identity not contingent on institutional validation. Their investment in paving the way for future generations complemented this grounding in spirituality. Guiding, mentoring, and encouraging other BW entering the field gave participants direction and affirmed the value of their presence in environments where recognition was inconsistent. Together, these practices illustrate how BW draws on deep sources of purpose to imagine and shape more equitable futures, even in the absence of meaningful institutional change.

Despite the utility of participants’ strategies, structural barriers and inadequate institutional responses still fail to address the root causes of exclusion. Yet, institutions continue to benefit from the relational and emotional labor BW expend to compensate for institutional shortcomings.^64–68 These concerns take on greater urgency now, as diversity, equity, and inclusion initiatives are dismantled.⁶⁴ Such rollbacks erode already limited support structures, diminish funding opportunities, and further intensify the minority tax as the very strategies BW relies on become harder to sustain. Furthermore, coping with exclusionary or inconsistent institutional practices is not benign; sustained exposure can undermine well-being, disrupt career trajectories, and decrease the likelihood that BW remain in academic medicine. Without structural change, those who build the networks and spaces needed to navigate such environments face escalating risks of burnout, disengagement, and attrition.

Advice to institutions

Addressing challenges should not be left to the individual but requires institutional leadership.^66,67 Participants offered recommendations to institutions to help them effectively address the challenges they encounter (Table 3).

Table 3.

Recommendations for Institutions

Recommendations	Rationale	Supporting quotes
Conduct structured exit interviews to understand reasons for departure and redesign policies and climate.	Participants emphasized that institutions must actively ask why people leave and use that information to drive systemic reform.	“I think the one thing every institution can do is look at the people of color who have left the institution, and ask them why… Ask them why, and then work backwards.” (P10)
Foster transparency and accountability in decision-making with input from individuals with lived experience.	Participants stressed the importance of safe, judgment-free spaces and open communication to reveal concerns that might otherwise remain unspoken.	“… having discussions of what’s going on… a safe space where you’re not judged.”(P2); “Open communication… people can’t address a problem they don’t know about.” (P4)
Revise promotion and tenure guidelines to recognize a broader range of scholarly labor.	Participants identified the need for transparency, clear career pathways, and timelines for promotion and tenure attainment.	“… you have every right to know what are the average years before somebody is promoted; is there some support and mentoring from other persons of color, other Black faculty members that are here?” (P11)
Commit to workforce diversity that reflects the student body and broader population.	Participants stressed the value of representation for strengthening belonging and improving student experiences.	“You’ve gotta have people… who represent the community… students see people that look like you.” (P3); “Institutions should demographically reflect… the student pool… and preferably general population.” (P5)
Ensure equitable distribution of institutional tasks and address harmful climate behaviors.	Participants noted that repeated harmful behavior undermines climate and requires formal accountability and remediation.	“…these institutions have people who have been round for a long time who continually make the climate awful and they don’t do anything about it …” (P9); “… we need to figure out a way to make sure we’re addressing it (gendered racism) in a in an appropriate manner in a efficient and timely manner.” (P1)
Ensure contributions of diverse faculty inform leadership decisions and resource allocation.	Participants described the need for policies that recognize caregiving demands, advancement pathways, and qualitative climate feedback.	“Child care, elder care those types of policies are critical… “ (P12);

Limitations of the study

The authors noted limitations to the study. Although participants were recruited from both private and public institutions, the relatively small number of participants from each institution restricts the broader community applicability of our findings. Participants were generally open but sometimes cautious in their responses due to fears of institutional retribution. Participants were not provided with the opportunity to review or validate interpretations due to study design considerations, which may limit our ability to verify that the analysis fully captured participants’ intended meanings.

Conclusion

This study highlights experiences of BW in academic medicine, focusing on the intersectional challenges of race and gender. Future research should investigate the long-term effects of challenges to their career paths, including the role of early experiences and institutional support. Understanding these factors will clarify the barriers and facilitators of success. Additionally, academic institutions must address systemic issues affecting BW faculty and implement targeted interventions to enhance their professional success.

Ethical Compliance

All procedures involving human participants were conducted in accordance with the ethical standards of each postsecondary institution. The study was reviewed and approved by the University of Louisville Institutional Review Board, which served as the lead institution and received subsequent approval from the Institutional Review Boards (IRBs) of collaborating partner institutions. IRB approval for this study was granted under protocol number 20.0208.

Authors’ Contributions

K.F. provided input to the study design, led project administration including study implementation, data collection, and took primary responsibility for drafting and revising article, and approved the final version. S.W. provided input on study design, supported data collection, participated in data analysis, contributed critical edits to the article, and approved the final version. D.L. provided input on study design, supported data collection, participated in data analysis, contributed critical edits to the article, and approved the final version. R.A. supported data collection and participated in data analysis and approved the final version. D.W. supported data collection and participated in data analysis and approved the final version. V.F.J. was the senior author and supervised all aspects of the study design and implementation, article development, writing, and revisions and approved the final version.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Abbreviations

References

Fisher

, Rodriguez

, Campbell

. A review of tenure for Black, Latino, and Native American faculty in academic medicine. South Med J, 2017; 110(1):11–17; doi: 10.14423/SMJ.0000000000000593

Robert

. Women and academic medicine. Acad Med, 2020; 95(10):1459–1464; doi: 10.1097/ACM.0000000000003600

Crown

, Berry

, Khabele

, et al. The role of race and gender in the career experiences of Black/African American academic surgeons. Ann Surg, 2021; 273(5):827–831; doi: 10.1097/SLA.0000000000004502

Ludmerer

. Seeking parity for women in academic medicine: A historical perspective. Acad Med, 2020; 95(10):1485–1487; doi: 10.1097/ACM.0000000000003556

Graham

, Ferrel

, Wells

, et al. Gender-based barriers to the advancement of women in academic emergency medicine: A multi-institutional qualitative study. West J Emerg Med, 2021; 22(6):1355–1359; doi: 10.5811/westjem.2021.7.52826

Lewiss

, Silver

, Bernstein

, et al. Is academic medicine making mid-career women physicians invisible? J Womens Health (Larchmt), 2020; 29(2):187–192; doi: 10.1089/jwh.2019.7732

Clark

, Shergina

, Machado

, et al. Race and ethnicity, gender, and promotion of physicians in academic medicine. JAMA Netw Open, 2024; 7(11):e2446018; doi: 10.1001/jamanetworkopen.2024.46018

Bowleg

. The problem with the phrase women and minorities: Intersectionality as an important theoretical framework for public health. Am J Public Health, 2012; 102(7):1267–1273; doi: 10.2105/AJPH.2012.300750

Association of American Medical Colleges. Faculty roster: U.S. medical school faculty - 2024 report. 2025. Available from: https://www.aamc.org/data-reports/faculty-institutions/report/faculty-roster-us-medical-school-faculty [Last accessed: June 30, 2025].

10.

Association of American Medical Colleges. Press Release: New AAMC data on medical school applicants and enrollment in 2024. 2025. Available from: https://www.aamc.org/news/press-releases/new-aamc-data-medical-school-applicants-and-enrollment-2024#:∼:text=In%202024%2D25%2C%20women%20comprised,of%20declines%20among%20both%20groups [Last accessed: November 24, 2025].

11.

Association of American Medical Colleges. 2025 Facts: Enrollment, graduates, and MD-PhD data. 2025. Available from: https://www.aamc.org/data-reports/students-residents/data/facts-enrollment-graduates-and-md-phd [Last accessed: November 24, 2025].

12.

Balzora

. When the minority tax is doubled: Being Black and female in academic medicine. Nat Rev Gastroenterol Hepatol, 2021; 18(1):1; doi: 10.1038/s41575-020-00369-2

13.

Johnson

, Konopasky

, Wyatt

. The power with us: Experiences of resisting oppression among Black women physicians in academic medicine. Adv Health Sci Educ Theory Pract, 2025; doi: 10.1007/s10459-025-10455-2

14.

Mahoney

, Wilson

, Odom

, et al. Minority faculty voices on diversity in academic medicine: Perspectives from one school. Acad Med, 2008; 83(8):781–786; doi: 10.1097/ACM.0b013e31817ec002

15.

Pololi

, Cooper

, Carr

. Race, disadvantage, and faculty experiences in academic medicine. J Gen Intern Med, 2010; 25(12):1363–1369; doi: 10.1007/s11606-010-1478-7

16.

Rodriguez

, Campbell

, Pololi

. Addressing disparities in academic medicine: What of the minority tax? BMC Med Educ, 2015; 15(1):6; doi: 10.1186/s12909-015-0290-9

17.

Sotto Santiago

. What gets lost in the numbers: A case study of the experiences and perspectives of Black and Latino faculty in academic medicine. Dissertation, University of Denver; 2017. Available from: https://digitalcommons.du.edu/cgi/viewcontent.cgi?article=1000&context=he_doctoral [Last accessed: May 15, 2025].

18.

Kaplan

, Raj

, Carr

, et al. Race/ethnicity and success in academic medicine: Findings from a longitudinal multi-institutional study. Acad Med, 2018; 93(4):616–622; doi: 10.1097/ACM.0000000000001968

19.

Ajayi

, Rodriguez

, de Jesus Perez

. Prioritizing equity and diversity in academic medicine faculty recruitment and retention. JAMA Health Forum, 2021; 2(9):e212426; doi: 10.1001/jamahealthforum.2021.2426

20.

Bonifacino

, Ufomata

, Farkas

, et al. Mentorship of underrepresented physicians and trainees in academic medicine: A systematic review. J Gen Intern Med, 2021; 36(4):1023–1034; doi: 10.1007/s11606-020-06478-7

21.

, Linden

, Zeidan

, et al. Overcoming barriers to promotion for women and underrepresented in medicine faculty in academic emergency medicine. J Am Coll Emerg Physicians Open, 2021; 2(6):e12552; doi: 10.1002/emp2.12552

22.

Russel

, Carter

, Wright

, et al. How do academic medicine pathways differ for underrepresented trainees and physicians? A critical scoping review. Acad Med, 2023; 98(11S):S133–S142; doi: 10.1097/ACM.0000000000005364

23.

Childs

, Yoloye

, Bhasin

, et al. Retaining faculty from underrepresented groups in academic medicine: Results from a needs assessment. South Med J, 2023; 116(2):157–161; doi: 10.14423/SMJ.0000000000001510

24.

Settles

, Jones

, Buchanan

, et al. Epistemic exclusion of women faculty and faculty of color: Understanding scholar(ly) devaluation as a predictor of turnover intentions. J High Educ, 2022; 93(1):31–55; doi: 10.1080/00221546.2021.1914494

25.

Nguyen

, Chaudhry

, Desai

, et al. Gender, racial, and ethnic inequities in receipt of multiple national institutes of health research project grants. JAMA Netw Open, 2023; 6(2):e230855; doi: 10.1001/jamanetworkopen.2023.0855

26.

Bath

, Brown

, Harris

, et al. For us by us: Instituting mentorship models that credit minoritized medical faculty expertise and lived experience. Front Med (Lausanne), 2022; 9:966193; doi: 10.3389/fmed.2022.966193

27.

Faucett

, Brenner

, Thompson

, et al. Tackling the minority tax: A roadmap to redistributing engagement in diversity, equity, and inclusion initiatives. Otolaryngol Head Neck Surg, 2022; 166(6):1174–1181; doi: 10.1177/01945998221091696

28.

Ibrahim

. Diversity in medical faculty and students. JAMA Netw Open, 2020; 3(9):e2015326; doi: 10.1001/jamanetworkopen.2020.15326

29.

Chapman

, Kaatz

, Carnes

. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. J Gen Intern Med, 2013; 28(11):1504–1510; doi: 10.1007/s11606-013-2441-1

30.

Saha

, Beach

. Impact of physician race on patient decision-making and ratings of physicians: A randomized experiment using video vignettes. J Gen Intern Med, 2020; 35(4):1084–1091; doi: 10.1007/s11606-020-05646-z

31.

Moore

, Coates

, Watson

, et al. It’s important to work with people that look like me: Black patients’ preferences for patient-provider race concordance. J Racial Ethn Health Disparities, 2023; 10(5):2552–2564; doi: 10.1007/s40615-022-01435-y

32.

Greenwood

, Hardeman

, Huang

, et al. Physician–patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A, 2020; 117(35):21194–21200; doi: 10.1073/pnas.1913405117

33.

Gomez

, Bernet

. Diversity improves performance and outcomes. J Natl Med Assoc, 2019; 111(4):383–392; doi: 10.1016/j.jnma.2019.01.006

34.

Snyder

, Upton

, Hassett

, et al. Black representation in primary care physician workforce and its association with population life expectancy and mortality rates in the US. JAMA Netw Open, 2023; 6(4):e236687; doi: 10.1001/jamanetworkopen.2023.6687

35.

Hine

. The future of Black women in the academy: reflections on struggle. In: Black Women in the Academy: Promises and Perils. ( Benjamin

. ed.) University Press of Florida: Gainesville, FL; 1997; pp. 327–339.

36.

Wingfield

. The modern mammy and the angry Black man: African American professionals’ experiences with gendered racism in the workplace. Race Gend Class, 2007; 14(1/2):196–212.

37.

Thomas

, Witherspoon

, Speight

. Gendered racism, psychological distress, and coping styles of African American women. Cultur Divers Ethnic Minor Psychol, 2008; 14(4):307–314; doi: 10.1037/1099-9809.14.4.307

38.

Choo

, Ferree

. Practicing intersectionality in sociological research: A critical analysis of inclusions, interactions, and institutions in the study of inequalities. Sociol Theory, 2010; 28(2):129–149.

39.

Crenshaw

. Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Rev, 1991; 43(6):1241–1299; doi: 10.2307/1229039

40.

Essed

. Understanding Everyday Racism: An Interdisciplinary Theory. Sage Publications: Newbury Park, CA; 1991.

41.

Collins

. Learning from the outside within: The sociological significance of Black feminist thought. Soc Probl, 1986; 33(6):S14–S32; doi: 10.2307/800672

42.

Bowleg

. When Black + lesbian + woman ≠ Black lesbian woman: The methodological challenges of qualitative and quantitative intersectionality research. Sex Roles, 2008; 59(5–6):312–325; doi: 10.1007/s11199-008-9400-z

43.

Harvet Wingfield

. “Reclaiming our time”: Black women, resistance, and rising inequality: SWS presidential lecture. Gender & Society, 2019; 33(3):345–362; doi: 10.1177/0891243219835456

44.

Ahmed

, Jones

. Unveiling Intersectionality: Identity and Difference in a Female Immigrant’s Narrative. Law Research Journal, 2024; 2(3):48–57.

45.

Sharp

, Hixson

, Stumpff

, et al. Understanding the experiences of Black women medical students and residents: A narrative review. Front Public Health, 2022; 10:879135; doi: 10.3389/fpubh.2022.879135

46.

Jerome

, Fassiotto

, Maldonado

, et al. Barriers and facilitators to the success of Black academic physicians. J Racial Ethn Health Disparities, 2025; 12(6):4067–4081; doi: 10.1007/s40615-024-02201-y

47.

McCall

. The complexity of intersectionality. Signs (Chic), 2005; 30(3):1771–1800; doi: 10.1086/426800

48.

Chellappa

. Intersectional inequities in academia. Lancet, 2023; 401(10382):1076; doi: 10.1016/S0140-6736(23)00229-5

49.

Garrett

, Williams

, Carr

. Finding their way: Exploring the experiences of tenured Black women faculty. J Divers High Educ, 2023; 16(5):527–538; doi: 10.1037/dhe0000213

50.

Lewis

, Williams

, Peppers

, et al. Applying intersectionality to explore the relations between gendered racism and health among Black women. J Couns Psychol, 2017; 64(5):475–486; doi: 10.1037/cou0000231

51.

Creswell

, Poth

. Qualitative inquiry and research design: choosing among five approaches, 4th ed. SAGE Publications: Thousand Oaks, CA; 2018.

52.

Rai

, Thapa

. A study on purposive sampling method in research. Kathmandu Sch Law J, 2015; 5(1):8–15.

53.

Ahmed

, Mohammed

, Nashwan

, et al. Using thematic analysis in qualitative research. J Med Surg Public Health, 2025; 6:100198; doi: 10.1016/j.glmedi.2025.100198

54.

Woods-Giscombe

, Williams

, Conklin

, et al. A scoping review of the concept of resilience among African American women. Arch Psychiatr Nurs, 2023; 46:107–120; doi: 10.1016/j.apnu.2023.04.008

55.

Chilakala

, Camacho-Rivera

, Frye

. Experiences of race- and gender-based discrimination among Black female physicians. J Natl Med Assoc, 2022; 114(1):104–113; doi: 10.1016/j.jnma.2021.12.008

56.

West-Livingston

, South

, Mabins

, et al. When screens become mirrors: Black women in medicine find belonging through social media. AEM Educ Train, 2021; 5(Suppl 1):S98–S101; doi: 10.1002/aet2.10669

57.

National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Board on Higher Education and Workforce; Committee on Effective Mentoring in STEMM. The Science of Effective Mentorship in STEMM. ( Dahlberg

, Byars-Winston

., eds.) National Academies Press: Washington, DC; 2019.

58.

Fleseriu

, Lim

DST

. Mentorship in academic medicine: Truth is in the eye of the beholder. Nat Rev Endocrinol, 2023; 19(7):373–374; doi: 10.1038/s41574-023-00846-z

59.

DeCuir-Gunby

, Johnson

, Edwards

, et al. African American professionals in higher education: Experiencing and coping with racial microaggressions. Race Ethn Educ, 2020; 23(4):492–508; doi: 10.1080/13613324.2019.1579706

60.

Grant

, Oyedeji

, Gilmore

. Paving the way for increased representation of Black faculty in academic medicine: The role of mentoring. The Hematologist, 2022; 19(6); doi: 10.1182/hem.V19.6.2022611

61.

Mattis

. Religion and spirituality in the meaning-making and coping experiences of African American women: A qualitative analysis. Psychol Women Q, 2002; 26(4):309–321.

62.

Starks

, Vakalahi

HFO

, McPhatter

. Spirituality: A sustaining force among women of color academics. J Relig Spiritual Soc Work, 2014; 33(2):131–147; doi: 10.1080/15426432.2014.900363

63.

Lewis-Burton

. I Am Who I Am: Spirituality and Black Women Faculty at Predominantly White Institutions. Dissertation, Indiana State University; 2019.

64.

Hopkins-Kotb

. What Black women in medicine stand to lose in the US’s war on diversity, equity, and inclusion. BMJ, 2025; 388:r134; doi: 10.1136/bmj.r134

65.

Hill

, Artiga

, Pillai

, et al. Elimination of federal diversity initiatives: Implications for racial health equity. KFF; 2025. Available from: https://www.kff.org/racial-equity-and-health-policy/issue-brief/elimination-of-federal-diversity-initiatives-implications-for-racial-health-equity/ [Last accessed: November 24, 2025].

66.

Esparza

, Simon

, London

, et al. Experiences of leaders in diversity, equity, and inclusion in US academic health centers. JAMA Netw Open, 2024; 7(6):e2415401.

67.

Ender

, Golembiewski

, Orellana

, et al. Changing the face of academic medicine: An equity action plan for institutions. Clin Transl Sci, 2022; 6(1):e78; doi: 10.1017/cts.2022.408

68.

Acosta

. Achieving excellence through equity, diversity, and inclusion. 2020. Available from: https://www.aamc.org/news/achieving-excellence-through-equity-diversity-and-inclusion#:∼:text=and%20fully%20empowered.-,The%20ultimate%20goal%20is%20to%20ensure%20that%20people%20from%20all,able%20to%20truly%20attain%20excellence [Last accessed: November 24, 2025].

Sources of Strength: Black Women Faculty Navigating Academic Medicine

Abstract

Background:

Methods:

Results:

Discussion:

Conclusion:

Keywords

Background

Theoretical Framework

Methods

Researchers positionality

Results

Experiences of gendered racism

Community support

Mentorship and sponsorship

Spirituality

Resilience

Pathways for future generations

Discussion

Advice to institutions

Limitations of the study

Conclusion

Ethical Compliance

Authors’ Contributions

Footnotes

Author Disclosure Statement

Funding Information

Abbreviations

References