Female Leadership in Emergency Medicine: A Narrative Review (1999-2024)

This narrative review explores the processes influencing female leadership in emergency medicine, focusing on clinical, academic, and strategic management, while identifying barriers and potential solutions.

Following SANRA guidelines, a systematic search of PubMed and ScienceDirect (1999-2024) was conducted. Out of 1897 articles, 47 were selected for thematic synthesis.

Although women make up 37-80% of EM physicians, they hold only 10-13% of leadership positions. Key barriers include persistent gender stereotypes, limited access to mentorship and sponsorship, and structural inequalities in promotion pathways. A further issue is the "glass cliff" phenomenon, whereby women are more likely to be appointed to leadership roles during periods of crisis. Current research predominantly focuses on academic and administrative leadership, thus leaving what appears to be a significant gap around "field clinical leadership" and real-time clinical team management. Nevertheless, evidence suggests that female-led teams perform as well as, or better than, male-led teams in crisis scenarios, even though women face more frequent challenges to their authority from peers. Institutional culture also influences leadership trajectories, with more supportive environments associated with greater confidence and representation of women leaders. Several interventions, including dedicated leadership development programs and structured mentorship initiatives, have demonstrated positive effects on leadership skills, career advancement, and institutional visibility for women in academic medicine.

Female underrepresentation in emergency medicine leadership is rooted in systemic issues. Future research must shift focus toward field leadership to better understand gender dynamics in high-stakes clinical environments. Inclusive institutional reforms and standardized training should help encourage equitable promotion practices and can be used alongside strategies to address unconscious bias and workplace discrimination, as well as formal mentorship programs.