Gender-Based Barriers in the Advancement of Women Leaders in Emergency Medicine

A Multi-institutional Qualitative Study

Emily M. Graham, BSN; Meganne N. Ferrel, BS; Katie M. Wells, MD, MPH; Daniel J. Egan, MD; Casey Z. MacVane, MD, MPH; Michael A. Gisondi, MD; Boyd D. Burns, DO; Troy E. Madsen, MD; Megan L. Fix, MD


Western J Emerg Med. 2021;22(6):1355-1359. 

In This Article

Abstract and Introduction


Introduction: Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups.

Methods: An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions.

Results: The overall response rate was 55.23% (95/172). The faculty response rate was 54.1% (59/109) and residents' response rate was 57.1% (36/63). Significant levels of resiliency were reported, with a mean score of 4.02. Childbearing and rearing were not significant barriers overall but were more commonly reported as barriers for faculty over residents (P <0.001). Obstacles reported included a lack of confidence during work-related negotiations and insufficient research experience. Notably, 68.4% (65/95) of respondents experienced gender discrimination and 9.5% (9/95) reported at least one encounter of sexual assault by a colleague or supervisor during their career.

Conclusion: Targeted interventions to promote female leadership in academic emergency medicine include coaching on negotiation skills, improved resources and mentorship to support research, and enforcement of safe work environments. Female emergency physician resiliency is high and not a barrier to career advancement.


Gender disparities exist in academic emergency medicine (EM). Differences in compensation, slower career advancement, fewer tenured faculty positions, and discrimination are some of the challenges faced by women. These disparities have persisted for decades, despite increasing numbers of women entering the field and obtaining university appointments.[1,2] Levels of career attrition are also higher when compared to men, which may also reflect a lack of career mentors, differences of support within and outside the workplace, gender bias, and discrimination.[3–6] Heightened awareness of these disparities by individuals and institutions may facilitate solutions and ultimately improve patient care.[7,8]

As gender disparities are multifaceted, solutions from several vantages may be required to make an impact. Noteworthy interventions to reduce gender disparities in academic EM have been promoted in recent years. Professional society organizations are increasing awareness of gender disparities and developing leadership and career advancement resources for women. Additionally, numerous universities established resiliency centers, career mentoring programs, and policies to promote diversity, equity, and inclusion.[9,10] Further defining the intrinsic factors contributing to gender disparities in medicine is also being explored by several specialties. Some of these factors include women physician wellness, resiliency, and risks of burnout.[11–13] However, despite these efforts, significant gender disparity in academic EM persists. There also remains a gap in our understanding of the specific drivers of gender disparity in academic EM.

The objective of this multi-institutional survey study was to evaluate the degree of intrinsic motivators and extrinsic factors that impact the career trajectories of women in academic EM at the trainee and faculty level. By quantifying these factors, the experiences of women in academic EM can be better understood and may help identify areas needing continued improvement to better promote gender equality.