Abstract
Objective:
To gain firsthand accounts from female physician leaders in academic medicine to better understand the challenges and success factors they have encountered in order to provide insights to early-career female physicians and inform organizations about the challenges faced by female physicians to build better systems and processes to support them in achieving more satisfying and fulfilling careers within an academic setting.
Method:
This qualitative research study is based on interviews with female physician leaders. Participants were selected based on their scores in multi-rater leadership assessments taken within the past three years, all ranking in the top 30% across four capabilities: Inspiring Values, Engaging Colleagues, Bold and Forward Thinking, and Driving Results. Coding and thematic analysis were used to categorize the challenges and success factors.
Results:
Data analysis revealed challenges experienced by these female physician leaders, including gender bias, time constraints, family responsibilities, change and innovation, self-doubt, and exclusion from networking. The strategies identified for navigating these challenges and achieving high performance included support from family and colleagues, building relationships and networking, maintaining a positive attitude, making powerful choices, seizing opportunities, finding value, meaning, and purpose, continuous learning, strategic planning, and gaining recognition.
Conclusion:
Challenges for female leaders in academic medicine are prevalent and evolve alongside changes in health care. Success factors can be generated at an individual level, such as attitudes, making powerful choices, and networking. However, societal and organizational support, including assistance with family responsibilities and providing opportunities, feedback, and mentorship, has also been identified as crucial.
Introduction
The number of female physician leaders in academic medicine has increased during the past decade.1–2 However, multiple factors continue to act as barriers to career advancement for female physicians. These include (1) situational factors, such as family responsibilities, where females often face challenges balancing professional and family obligations, along with environment factors such as gender bias, bullying, and stereotyping;3–5 and (2) professional advancement challenges, where lower proportion of females achieve higher academic rank.6–7 This is impacted by the lack of institutional resources or insufficient mentorship and sponsorship opportunities that hinder career growth for female physicians,8–9 leading to gender inequalities. This leads to disparities in recognition and opportunities through awards, grants, and panel representation, and article acceptance rates where females encounter biases in publishing and peer review process 10 perceptions and leadership qualities.
Females experience misidentification by colleagues despite demonstrating strong leadership capabilities, as they may be viewed less favorably due to perceived “masculine” traits.11–12 Female physicians in academic medicine persist through career transitions, demanding patient care, leadership roles, scholarly activities, caregiving responsibilities, and other professional and personal obligations. To address these challenges, they are far more likely than men to work part-time, with even greater differences observed among women with children. 13 In addition, female physicians are often assigned to more work or service that is important but less likely to lead to career advancement. 14 In addition, social role theory posits that men tend to exhibit more agentic behaviors such as assertiveness, self-reliance, and ambition, while women tend to demonstrate more communal behaviors like empathy, nurturing, and kindness. 15 Consequently, men frequently occupy higher status and leadership positions, whereas women are less likely to hold leadership roles due to societal perceptions that may be incongruent with gender norms. 16
Female leaders are under constant pressure to provide evidence of their suitability, walking the fine lines of demonstrating both the agentic behaviors and communal behaviors in their leadership roles, especially in academic medicine, where male counterparts dominate leadership positions. 17 It is within this ecosystem that female physician leaders find themselves expending additional efforts managing others’ perceptions while navigating their professional and personal identities. Although the challenges are widely recognized, there is limited literature capturing the firsthand experiences of women physician leaders in academic medicine. This study aims to explore and understand the common obstacles they encounter in academic medicine, as well as the factors that contribute to their success. Addressing these challenges is crucial for achieving gender equity in academic medicine. By recognizing and mitigating these barriers, we can foster an inclusive environment that promotes the advancement of female physicians.
Methods
The study was deemed exempt via the expedited IRB review process, as it presents no more than minimal risk, does not involve any vulnerable populations, and includes protocols to de-identify participants.
Participants
Invitations to participate in the research were sent to 33 female physician leaders at all Mayo Clinic sites, including the health systems, who held formal leadership roles within department or division level at the time of the study. Participants were selected based on multi-rater leadership assessment scores taken within the past three years. The assessment takes a 360-degree view of the leaders’ behaviors using a seven-point scale. The tool was developed by an outside vendor based on Mayo Clinic’s leadership competencies. The tool has been used for more than 1000 leaders for over 15 years and has been validated against institutional leaders’ performance ratings.
The number of raters ranged from 12 to 20 clinical and administrative staff, with only those who engaged regularly with the leaders invited to provide input. All participants ranked in the top 30% across all four capabilities of Inspiring Values, Engaging Colleagues, Bold and Forward Thinking, and Driving Results. The top 30% were selected for this study, as this is the benchmark the institution considers high potential. Out of 33 invited, 24 agreed to participate in the study. They represented various length of service specialties, age groups, races, and ethnicities. All formal leadership roles held in organization are listed in Table 1. Informed consent was obtained via email.
Demographics: Academic Rank, Length of Service, Specialties, and Leadership Role of Study Participants
Data Collection and Analysis
Semi-structured interviews were conducted virtually using either Zoom or Microsoft Office Teams platforms between March 2023 and May 2023, with each interview lasting between 30 and 60 minutes. Researchers relied on a set of preconstructed questions (Table 2) and probed as needed. Interviews were recorded and transcribed within the virtual platform. Researchers used the open coding method and grouped them to construct categories using Excel. The researchers engaged in initial coding separately and met multiple times to make sure that generated categories aligned with the purpose of the study, were exhaustive, and were mutually exclusive. The coding methods used were descriptive coding, process coding, and values coding described by Merriam. 18 The analyzed data underwent multiple peer examinations to ensure a holistic interpretation was presented. 19
List of Interview Questions
Results
Categories and sub-categories emerged from the narratives
Three major categories (Challenges, Success Factors, and Critical Leadership) and 24 sub-categories emerged from the narrative analysis. To ensure the lived experiences of participants were thoroughly represented, this article focuses on the first two categories: Challenges and Success Factors (Table 3).
Categories and Subcategories and Their Frequency
Participant narrative results
Challenges
Gender bias: Gender bias was the most frequently reported challenge. Participants described navigating colleagues’ behaviors and expectations shaped by gender stereotypes. These challenges manifested in various ways, including feeling pressured to meet the expectations of being likable and pleasant, undervalued, or voiceless. They faced a narrow range of acceptable behaviors compared with male leaders and learned to navigate the delicate balance between assertiveness and approachability. Many expressed frustration with unequal organizational support for women’s leadership development and limited professional networking opportunities outside of work.
Some participants, self-identified as “people pleasers,” struggled to accept universal approval was not attainable. They described “walking a tightrope” as not required of men. They were perceived as either too soft or too aggressive. When female leaders exhibited strength and directness, colleagues showed less tolerance than for male counterparts (see Appendix quote 1).
Opinions expressed by men were often more valued, making it harder for female counterparts to have their voices heard or to be established (see Appendix quotes 2–5). Participants noted that women were frequently steered toward roles with limited career advancement potential. Participants also reported that other colleagues often expressed excessive concern about workload or other responsibilities when they shared interest in taking on additional roles or seeking promotion, as if female colleagues were not able to handle the work. Within this context, they recognized the need to take ownership of career-building decisions and to advocate for strategic opportunities.
Some individuals expressed mixed feelings about diversity and inclusion strategies aimed at intentionally promoting women and minorities. Junior staff members observed growing gender diversity in leadership, compared with senior staff.
Time: Participants consistently struggled to balance clinical duties, academic responsibilities, and family obligations—often working seven days a week. Administrative tasks, such as meetings and documentation, diverted time away from direct patient care and research. Participants emphasized the importance of prioritizing work that brought personal fulfillment and meaning rather than merely fulfilling obligations. Some individuals chose to work during their free time, embracing a lifestyle that found joy in the work itself. Junior staff reported particular challenges establishing research initiatives without adequate academic support. In contrast, senior staff described gaining more control over their schedules through part-time work arrangements, time-management strategies, and creative ideas to support female leaders (see Appendix quotes 6–7).
A strong desire to please others and the struggle to say no compounded time pressures. Participants perceived themselves as highly responsible caretakers, feeling responsible for solving problems and supporting colleagues, often at personal cost. Developing the skills to say no respectfully, without fearing exclusion from future opportunities, became critical in navigating these complexities (see Appendix quote 8).
Change and innovation: Participants highlighted the rapid pace of technological advancements, and the balance between preparing for the future and accepting it would be impossible to be an expert in every domain. While they were actively engaged in developing solutions by collecting data, utilizing data analytics, and making evidence-based decisions, they recognized the mounting pressure to prepare for the future and embrace AI technology in daily work underscored the need for continuous adaption and learning (see Appendix quote 9).
Family responsibilities: Nearly all the participants faced the intricate challenge of balancing family responsibilities alongside their professional obligations. Some placed immense pressure on themselves to achieve perfection in all aspects of their lives, from managing a household and childcare to elder care while maintaining professional excellence. Strategic career planning and prioritization were essential. Deliberate decisions about outsourcing tasks, managing costs, and optimizing family time—such as choosing convenient, healthy meals—reflected intentional trade-offs that supported both family well-being and career success (see Appendix quote 10).
Self-doubt: Unwarranted self-doubt hindered participants’ willingness to assume leadership roles. They often felt unprepared or considered themselves too young or inexperienced despite strong credentials. Navigating organizational dynamics, especially when coming from outside the organization, proved challenging. The internal pressure to avoid mistakes sometimes led to hesitancy in taking leadership positions. Participants sometimes perceived themselves as less competent than how others viewed them, despite experience and education.
Exclusion from networking: Female physicians often encountered limitations in networking both inside and outside of work. Their socialization patterns were influenced by individual personality traits and sociability. Some felt excluded from casual conversations and interactions that their male counterparts engaged in, especially in hallways or other informal settings. Conversely, more extroverted women actively made effort to build relationships and seize opportunities to socialize (see Appendix quote 11). Some participants grappled with power dynamics when interacting with senior male colleagues or mentors and feeling intimidated.
Success factors
Analysis identified 11 success factors shaping participants’ professional trajectories: support from colleagues and family, relationships, attitude, making powerful choices, seizing opportunities, value/meaning/purpose, learning, strategy and planning, recognition, effort/hard work, and digital transformation.
Support from colleagues and family: Robust professional and personal support networks were central to success. Collegial relationships fostered resilience and provided emotional and practical assistance, particularly for those balancing work and family demands. The camaraderie among colleagues provided encouragement during difficult times. Having a trusted confidant within their professional circle and being part of a cohesive team significantly enhanced their professional experiences. Peer support was particularly vital for those balancing the demands of the profession while raising children and helped them feel less isolated and more empowered (see Appendix quote 12). The active endorsement and encouragement from department chairs emerged as a pivotal factor. Their leadership advocacy, mentorship, and the organizational culture valuing diversity, equity, and inclusion enabled women physician leaders to thrive. Flexible schedules and reduction in full-time equivalents allowed them to excel both professionally and personally (see Appendix quote 13). Spousal and extended family support played a crucial role in sustaining career progress, particularly during childrearing years. Sharing domestic and emotional responsibilities helped participants maintain professional focus. Relationships and networking (mentorship and sponsorships): Meaningful professional relationships, including mentorships, sponsorships and networking, were key success drivers. Participants shared that relationships with colleagues and connections outside their organization provided not only emotional support but also access to new career opportunities. Most of the participants underscored the importance of mentorship and sponsorship and recognized they are two distinct yet complementary forms of support that significantly influenced their career trajectories. Mentorship provided guidance and holistic support, while sponsorship involved active advocacy—championing participants for roles and opportunities. Sponsors’ influence opened pathways to critical projects and leadership exposure (see Appendix quote 14). Attitude: Attitude emerged as a critical factor, cited by 79% of the participants. As these women navigated their early career years, they understood the importance of maintaining a positive outlook. They viewed each day as an opportunity for growth (see Appendix quote 15). Persistence became their mantra. Instead of dwelling on past mistakes or failures, they adopted a forward-looking approach. In times when resources were scarce or unexpectedly withdrawn, persistence became a lifeline. When there was no alternative, they simply pressed forward, demonstrating resilience and determination (see Appendix quote 16). By focusing on the marathon rather than the sprint, they sustained their energy and resilience. In addition, for those with children, participants highlighted the importance of positivity, reframing challenges, and being fully present as they worked through different seasons in their lives. (see Appendix quote 17). These women embraced a growth mindset. Instead of concealing gaps in their knowledge, they acknowledged them openly. Being comfortable with vulnerability allowed them to seek guidance, ask questions, and learn from others. Instead of striving for perfection, they recognized that imperfections were steppingstones to success, and accepting that allowed them to release the burden of seeking unattainable standards (see Appendix quote 18). They understood that mistakes were part of the journey and imperfections did not define their worth. When things did not go exactly as planned, they remained flexible. Accepting their own fallibility was liberating, and self-compassion became their ally (see Appendix quote 19). Making powerful choices/delegation: Intentional decision-making shaped 21 of the 24 participants’ success. Participants viewed their calendars as strategic tools—prioritizing essential tasks, protecting personal time, and safeguarding against overcommitment. By declining early morning meetings unless absolutely necessary, they were able to start their days intentionally. Setting boundaries, such as not checking emails on weekends and at night, helped them preserve their well-being. These deliberate decisions helped prevent burnout and ensured sustainable productivity (see Appendix quotes 2021). Saying “no,” or recognizing when to decline commitments, was also crucial. This helped avoid overcommitment and protected their well-being, allowing these female physicians to focus on identified priorities. Delegating both professionally and domestically freed time for high impact work. This included saying “yes” to outsourcing certain housework tasks, liberating professionals from mundane chores. When adding new tasks to their plate, conscious efforts to rotate out of existing responsibilities was also important. By periodically reevaluating their current duties, these female physician leaders ensured a balance and sustainable workload. Seizing opportunities: Participants recognized the pivotal role of seizing both expected and unexpected opportunities. These opportunities not only facilitated learning and growth but also expanded their professional networks. Active engagement and visibility increased their likelihood of being considered for new roles. While they remained selective to align opportunities with personal and professional goals, flexibility and openness to unplanned paths proved equally important (see Appendix quotes 22–23). Value/meaning/purpose: Approximately 71% of participants highlighted the significance of value, meaning, and purpose in shaping their perception of success. Connecting daily work to organizational missions or personal values transformed careers into vocations. Many intentionally integrated their passion into their professional roles while maintaining family as a top priority (see Appendix quotes 24–25). Learning: As technology advances, staying abreast of developments, particularly in digital health and artificial intelligence, is crucial. This involved venturing into the unknown and embracing novelty, trying new approaches, and engaging in programs and training to enhance their leadership skills. Strategic planning: Participants highlighted the importance of looking ahead, prioritizing, and preparing to ensure alignment with long-term goals. A few participants emphasized the distinction between managers and leaders, noting effective leaders have foresight beyond the day-to-day management. Recognition: Although less frequently mentioned, recognition was noted. Positive feedback, particularly for early-career leaders, reinforced confidence and professional growth (see Appendix quote 26).
Discussion
Obtaining firsthand accounts from female physician leaders in academic medicine offers insights relevant to early-career physicians and organizations seeking to enhance support for women in leadership. This qualitative study found female physician leaders encountered multifaceted challenges throughout their professional career trajectories. From the analysis of the 17 sub-categories under Challenges and Success Factors, three main themes emerged, along with the strategies participants described for navigating these challenges: (1) addressing gender bias; (2) visibility and networking; and (3) balancing time and family responsibilities.
Addressing gender bias was described as requiring both individual and organizational effort. Participants emphasized the importance of institutional support and collegial encouragement that recognizes competence and fosters confidence. Participants discussed the value of developing self-efficacy and resilience by maintaining positive attitudes, persistence, and embracing mistakes. Visibility and networking were reported as key elements in advancing leadership trajectories. Participants noted that intentionally cultivating professional relationships within and beyond their organizations enhanced recognition, access to mentorship and sponsorship, and awareness of career opportunities.
Balancing professional and family responsibilities was characterized as an ongoing process that required deliberate decision-making and supportive structures. Participants described relying on personal, familial, and organizational supports to make informed choices aligned with different career stages.
In summary, Figure 1 illustrates the relationship between the six most frequently mentioned challenges and the nine success factors that participants identified as instrumental in overcoming these obstacles. Together, these factors contributed to their reported sense of professional growth and personal fulfillment.
Six challenges and nine success factors.
While these findings offer meaningful insights into the experiences of women leaders in academic medicine, several limitations should be considered when interpreting them. Because all participants were from a single academic medical institution, the perspectives captured may reflect the specific culture, policies, and leadership structures of that environment. Broader sampling across institutions could reveal additional variations in organizational climate or resources influencing women’s leadership experiences. Furthermore, as interviews were conducted by multiple interviewers, subtle differences in interviewing style or rapport may have influenced the depth or focus of participants’ reflections. Nonetheless, the consistency of the core themes across interviews suggests that the identified challenges and success factors are likely transferable to similar academic medical settings.
Conclusion
Female physician leaders who confront challenges head-on and achieve their career aspirations can provide invaluable guidance for junior female physicians. Success factors can be generated at an individual level, such as attitudes, making powerful choices, and networking. However, societal and organizational support, including schedule flexibility to balance family responsibilities and providing growth opportunities, feedback, and mentorship, have also been identified as crucial.
While challenges for female leaders in academic medicine are prevalent and evolve alongside changes in health care, the ability for organizations to develop targeted interventions and support systems specific to women may be perceived as too risky or legally noncompliant in today’s political environment. Yet, the findings from this research confirm female physician leaders do experience unique challenges based on gender. Unlike men who self-identify as leaders early, women often require explicit encouragement to pursue leadership roles. 20 Organizations willing to address the needs of the female physician by understanding their unique challenges and success factors to help them thrive can create an environment that supports women to have a more satisfying and fulfilling career.
Authors’ Contributions
M.L.B.: Conceptualization (equal); data curation (equal); formal analysis (equal); investigation (equal); methodology (colead); project administration (lead); resources (equal); supervision (colead); validation (equal); visualization (supporting); writing—review and editing (lead). J.Y.K.: Conceptualization (equal); data curation (equal); formal analysis (equal); methodology (colead); investigation (equal); resources (equal); supervision (colead); validation (equal); visualization (lead); writing—original draft (lead); writing—review and editing (supporting). A.K.L.: Conceptualization (equal); data curation (equal); formal analysis (supporting); investigation (equal); methodology (supporting); resources (equal); validation (equal); visualization (supporting); writing—review and editing (supporting). M.D.M.: Data curation (supporting); formal analysis (supporting); investigation (equal); writing—review and editing (supporting). C.L.M.: Data curation (supporting); formal analysis (supporting); writing—review and editing (supporting).
Footnotes
Acknowledgment
The authors would like to thank the research participants who shared their time and insights, which were crucial to the success of this study.
Author Disclosure Statement
All authors can confirm there are no conflicts of interest. All coauthors have seen and agreed with the contents of the article, and there are no financial interests to report. We certify that the submission is original work and is not under review at any other publication.
Funding Information
This research received no funding from any agency.