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. 2025 Jun 2;38(5):684–689. doi: 10.1080/08998280.2025.2510044

Authentic leadership in clinical practice: barriers and benefits for female academic physician leaders

Lindsay Mathys a, Michael Dewsnap a,✉, Medha Narwankar b
PMCID: PMC12351734  PMID: 40821491

Abstract

Background

Female academic physician leaders (FAPLs) encounter challenges in their leadership roles, including gendered leadership expectations or fear of judgment, impacting their ability to express authenticity. This study examined FAPLs’ perceptions of authentic leadership, factors shaping their leadership behaviors, and how authenticity influences their effectiveness as a leader.

Methods

Using a convergent mixed-methods design, 40 FAPLs at Texas A&M University College of Medicine were invited to participate. Nine completed the Authentic Leadership Questionnaire (ALQ), and 10 participated in semi-structured interviews.

Results

Quantitative analysis revealed the strongest alignment with moral/ethical leadership dimensions, with a significant difference (P < 0.05) in decision-making based on core values. Qualitative thematic analysis emphasized authenticity’s role in fostering trust, empowerment, and a positive workplace culture. However, participants reported suppressing authentic behaviors due to hierarchical constraints or fear of being perceived as weak. Authenticity was easier with career experience and mentorship from female leaders. While authenticity promoted collaboration and psychological safety, maintaining professional boundaries remained a challenge.

Conclusion

FAPLs value authenticity but face various barriers. Experience, mentorship, and institutional support are crucial in fostering environments where FAPLs can thrive. Future research could explore the impact of authentic leadership on workplace cultures within academic medicine.

Keywords: Academic medicine, authentic leadership, female physician leaders, physician leadership, relational transparency

CME

CME Information: https://ce.bswhealth.com/BUMC_Proceedings_CME_info

Credit Claim Process: To claim CME for this activity, read the entire article and go to ce.bswhealth.com/2025BUMC_Proceedings_Sep_women. You will register for the course, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.

Dates for credit claim: September 1, 2025, to September 1, 2026.

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Authentic leadership is a contemporary leadership approach and a growing area of research focused on the perception of leaders as “genuine” or “real.”1 In the wake of national financial instability, such as the 2008 financial crisis, trust in established approaches to leadership declined across various sectors. Within healthcare, authentic leadership gained attention, during the COVID-19 pandemic. Nursing specialist Constantino-Shor highlighted the role of authenticity in leadership as a means to promote transparency and stability amidst uncertain work conditions, such as limited protective equipment and evolving knowledge about the SARS-CoV-2 virus.2 Similarly, authentic leadership has been noted in the nursing and medical literature as a helpful leadership approach in fostering effective, accountable, and adaptable work environments.3,4

As challenges within healthcare continue to emerge and approaches to leadership continue to evolve, so do the demographics and challenges specific to those within healthcare leadership roles. For example, according to the Association of American Medical Colleges’ 2024 fall matriculant data, female medical school matriculants outnumbered their male counterparts, accounting for 56.8% of incoming students.5 Literature has pointed to the hope that the continued increase of female medical students could also increase the presence of women in academic leadership roles.6 Nevertheless, this has not been the case. While women comprised 48% of resident physicians, they held only 29% of full professorships, 25% of department chairs, and 27% of medical school dean roles as of 2023.7 Even in specialties such as obstetrics and gynecology and pediatrics, which are 86% and 72% female, respectively, only 38% and 41% of respective department chairs were women.7

Beyond underrepresentation in leadership roles, female physicians report greater workplace challenges compared to their male peers. The American Medical Association found that female physicians are more likely to feel disrespected and undervalued than their male physician counterparts.7 Many female physician leaders attribute these disparities to systemic barriers such as balancing career and family responsibilities, biases in how assertiveness is perceived, and unconscious biases that influence the leadership selection process in academic medicine.6

This study investigated the lived experience of female physicians in leadership roles within undergraduate academic medicine, the barriers to leadership these women face, and their perspectives on authentic leadership. Using a convergent mixed-methods approach, we received authorization to administer the Authentic Leadership Questionnaire (ALQ) alongside open-ended interviews.8 Our goal was to explore how female physician leaders perceive themselves as authentic leaders and examine how relational transparency, a key subcomponent of authentic leadership, influences female physician leaders’ leadership effectiveness within undergraduate medical education.9

METHODS

This study employed a convergent parallel mixed-methods design involving a multiphased approach to data collection and analysis.10 This study incorporated both quantitative and qualitative methods to explore the experiences of female physician leaders in undergraduate medical education at Texas A&M University College of Medicine (TAMUCOM).

Eligible participants were limited to female physicians (MD or DO) holding leadership positions within undergraduate medical education at TAMUCOM. This included administrative faculty leaders (i.e., associate or assistant deans, course directors, committee members), department chairs, clerkship directors, and the medical school dean. Based on demographic data obtained from TAMUCOM, the eligible population of female academic physician leaders (FAPLs) for this study was approximately 40.

First, participants completed the 16-item ALQ assessing four major subcomponents of authentic leadership: transparency, morals/ethics, balanced/processing, and self-awareness. In their responses, participants rated their leadership style based on a 5-point Likert scale (from 0, “not at all,” to 4, “frequently if not always”). Participants who opted in completed a 45- to 60-minute semistructured Zoom interview, which was recorded, transcribed, and anonymized. Interviews focused on participants’ leadership experiences, perceptions of authentic leadership, and leadership efficacy (Supplemental Material).

Study participants were recruited via email with Texas A&M University institutional review board–approved (IRB2024-0419) communications and necessary protocols such as informed consent. Interview transcripts were reviewed for accuracy, after which all transcripts and ALQ responses were anonymized and securely stored on an institutional cloud server accessible only to the research team. Any identifying information was removed prior to data analysis.

ALQ responses were analyzed using a paired t test, to identify significant differences between the four subcomponent scores, and calculated means. The qualitative analysis followed a five-step thematic process. This process involved two researchers familiarizing themselves with interview responses, making research notes, extracting statements from each interview, grouping these statements into shared units of meaning, thematically clustering these meaning units, and finally developing composite themes and descriptions based on shared meanings. To enhance the trustworthiness of the qualitative phase of analysis, two independent researchers reviewed and cross-checked analyses at multiple stages to resolve any discrepancies through discussion and increase credibility.11–13

This convergent mixed-methods approach enabled quantitative and qualitative exploration of female physician leaders’ experiences, providing a more comprehensive understanding of how authentic leadership manifests in undergraduate medical education.

RESULTS

Nine FAPLs completed the ALQ, yielding a 22.5% completion rate, while 10 FAPLs completed the qualitative interviews (25% completion rate). A calculation of the average scores for each ALQ scale (Transparency, Moral/Ethical, Balanced/Processing, and Self-Awareness) emphasized the role each scale plays in the female physician leadership style. Specifically, participants indicated implementing leadership items in the transparency, balanced/processing, and self-awareness categories “fairly often” on average, while items in the moral/ethical category were “frequently, almost always” implemented (Table 1). Notably, an ALQ question about displaying emotions stood out with a dominant “sometimes” response and the lowest response mean (2.2). Meanwhile, a moral/ethical question about core values had the highest mean response, with participants unanimously stating “frequently, if not always” (4.0).

Table 1.

Participant responses on the Authentic Leadership Questionnaire (n = 9)

Scale Mean score Definition of score*
Transparency 2.8 Fairly often
Moral/Ethical 3.5 Frequently, if not always
Balanced/Processing 3 Fairly often
Self-Awareness 3 Fairly often
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*0 = Not at all, 1 = Once in a while, 2 = Sometimes, 3 = Fairly often, 4 = Frequently, if not always.

Further analysis compared each ALQ scale category to each other in order to define which one of the two was more significantly used to judge the female physician leadership style. A paired t test analysis was conducted to compare the four leadership subcomponents. Among the six pairwise combinations—transparency versus moral/ethical; transparency versus balanced/processing; transparency versus self-awareness; moral/ethical versus balanced/processing; moral/ethical versus self-awareness; and balanced/processing versus self-awareness—a significant difference (P < 0.05, 0.001) was observed only when comparing the responses to the moral/ethical perspective and self-awareness subcomponents (Table 2). This difference implies that a greater number of participants consistently relied on moral/ethical components of leadership as compared to self-awareness.

Table 2.

Differences in participants’ scale responses for the Authentic Leadership Questionnaire (n = 9)

Comparing responses of scales P value
Transparency vs Ethics 0.70
Transparency vs Balanced 0.27
Transparency vs Self-Awareness 0.11
Ethics vs Balanced 0.17
Ethics vs Self-Awareness 0.001
Balanced vs Self-Awareness 0.40
Open in a new tab

Regarding the qualitative analysis phase across the five open-ended interview questions (Supplemental Material), a total of 214 statements were extracted from the 10 interview transcripts and categorized into four primary themes (Supplemental Material). Participants noted that authentic leadership fosters confidence, passion, and fulfillment within their leadership roles, while emphasizing a value-driven leadership style as part of their personal approach. Participants also stated that authentic leadership creates trust, strengthens teams, and improves mentorship, yet barriers such as hierarchical structures, gender biases, and fear of judgment often constrained their ability to lead authentically.

Relational transparency, one of the four categories evaluated by the ALQ, emerged as a double-edged sword—enhancing mentorship and advocacy while requiring careful boundary management. On the one hand, relational transparency enhanced participants’ ability to be more holistic mentors and better advocates. Embracing vulnerability and transparency within themselves encouraged communication, connection, and support with followers. “When you’re authentic, other people tend to be more authentic and show those vulnerabilities.… They are more likely to feel supported.” One participant spoke about how her authenticity motivated others to “go the extra mile,” while others mentioned empowering followers, particularly as role models or mentors. However, some participants encountered misinterpretations of their transparency. One FAPL noted that when being transparent, she was seen as “more of a whiny person rather than a leader advocating.” Several other participants reported that boundaries were necessary to “preserve the leadership role” and to maintain professional distance.

In their closing remarks, the participants chose to emphasize the unique barriers female leaders face. Responses highlighted the fear of judgment for participants’ authentic responses, as well as the difficulties faced when balancing a leadership role among other familial roles. Despite these challenges, one participant argued that balancing such gender roles makes FAPLs uniquely qualified to be effective leaders, since FAPLs’ “ability to manage families and manage work is hugely undervalued…. A lot of what [FAPLs] do dovetails into leadership.” This same participant stated that female leaders also bring a more collaborative perspective, making them “more understanding and accommodating to differences, and accepting and supporting of those [differences].” In their conclusion, participants emphasized the need for greater institutional support for authentic leadership among female leaders in academic medicine. They also stressed the importance of modeling authentic leadership, especially among female leaders, to create a more inclusive and supportive professional environment.

DISCUSSION

This study explored the lived experiences and leadership perceptions of FAPLs, highlighting a strong alignment between authentic leadership values and moral/ethical principles. Participants scored highest on items related to ethical leadership on the ALQ, mirroring qualitative findings that emphasized the centrality of personal values, integrity, and transparency in leadership. The thematic analysis revealed a predominance of “personal approach” statements, underscoring the central role of personal principles in shaping leadership priorities. While authenticity was widely valued, barriers to transparent and emotionally expressive leadership emerged. Such barriers were largely shaped by gendered expectations and hierarchical structures. Participants also described the empowering effects of authentic leadership on their teams and the essential role of mentorship, especially for women and underrepresented groups. Despite the challenges, authentic leadership was consistently viewed as a means of fostering healthier work environments, promoting retention, and improving psychological well-being within academic medicine.

FAPLs demonstrated a strong commitment to authentic leadership, as reflected in both high ALQ scores—particularly in the moral and ethical leadership domain—and qualitative interviews emphasizing value alignment and transparency. The predominance of “personal approach” statements and the unanimously highest-rated ALQ item about acting according to core values underscore how authenticity is grounded in personal morality and serves as a guiding force to clinical decision-making and fostering team-based care.14–16 However, participants rated themselves significantly higher in moral/ethical domains than in self-awareness, potentially reflecting discomfort with how others perceive them. The “fear of judgment” emerged as the primary barrier to relational transparency, with participants expressing concern about being seen as “weak” or “less professional” than their male colleagues. These fears mirror existing literature on the narrower behavioral expectations imposed on women in leadership, who often experience heightened scrutiny when exhibiting relational or emotional authenticity.17,18 Many participants described self-monitoring their behavior to align with traditional masculine leadership norms. While enhancing perceived credibility, the participants noted that their self-monitoring behavior constrained their authenticity as leaders.17,19 This tension was particularly pronounced in emotional expression, which received the lowest ALQ transparency score. Participants noted suppressing emotions to avoid being labeled “whiny” or overly sensitive, reflecting a broader cultural association between emotionality and incompetence in female leaders.18,20,21 Such stereotypes, reinforced not only by patients but also by fellow healthcare professionals, can diminish autonomy and change how women leaders are treated.22,23 Although several participants reported greater freedom to lead authentically with seniority, early-career leaders felt increased pressure to conform to rigid expectations. These findings align with research suggesting that exposure to authentic female leadership role models and participation in targeted leadership development programs may enhance confidence and self-efficacy, helping women navigate hierarchical barriers.19,24–26 Together, these insights reveal the complex interplay between authenticity, gender norms, and institutional power structures, underscoring the need for systemic support to enable women leaders to lead authentically without professional risk.

Despite these constraints, FAPLs overwhelmingly described authentic leadership as a transformative force in building healthier, more cohesive workplace cultures. Authenticity facilitated trust, transparency, and open communication, with several participants noting that their leadership style encouraged collaboration, reduced turnover, and contributed to more sustainable, supportive environments. One participant reflected that leading authentically fostered a culture where “people were more willing to help each other” and “stayed longer.” This data point aligned with findings from the American Association of Critical-Care Nurses, which lists authentic leadership as a cornerstone of a healthy work environment.27 Broader research corroborates these observations, linking authentic leadership to improvements in team psychological well-being, organizational commitment, and retention, particularly during times of stress such as the COVID-19 pandemic.28–33 Several participants noted that leading authentically left them feeling more “fulfilled” and “inspired,” even when working harder, reflecting studies that show how authenticity can mitigate burnout and enhance both personal and teamwide morale.34–37 Moreover, authenticity was described as a impactful tool for empowering followers. Transparent and values-driven leadership gave team members greater voice, enhanced psychological safety, and encouraged shared decision-making—findings consistent with existing literature on empowerment and team engagement.31,38,39 Authentic leaders were also seen as catalysts for leadership development in others, inspiring followers to pursue formal leadership roles themselves.40 This sense of responsibility extended to mentorship, with participants emphasizing the importance of serving as role models for future generations of women in medicine.

Yet, the underrepresentation of women—especially women of color—in senior roles remains a persistent barrier. A 2023 study found that the lack of female mentorship is one of the most significant obstacles to women’s career advancement in medicine, and only 19% of department chairs across Liaison Committee on Medical Education–accredited institutions are women.24,41 Participants echoed these concerns, noting that visible leadership from women in male-dominated or competitive specialties signals to others that “these things are possible,” reinforcing the critical role of representation in creating pathways to leadership. Women division chiefs in academic medicine have noted that continued growth of women in leadership would be more supported by the acceptance of authentic leadership styles.26 Participants in our study echoed a similar sentiment, advocating for greater institutional investment in authentic leadership development tailored specifically to female leaders, a recommendation supported by research about leadership training programs that significantly improve confidence, agency, and career advancement.25

At the same time, participants acknowledged the paradox that the same transparency that builds trust can also blur boundaries and increase workload. Women leaders are often perceived as more accessible and emotionally available, leading to disproportionate emotional and logistical demands—a trend supported by electronic health record data showing that female physicians receive significantly more staff and patient messages than their male colleagues.42 These dynamics highlight the need to balance authenticity with boundary-setting to prevent overextension and role strain. Ultimately, these findings affirm that authentic leadership—when supported by institutional structures that recognize the gendered and hierarchical challenges women face—can be a powerful driver of equity, empowerment, and retention in academic medicine.

This study was limited by several factors. First, the sample size for both the ALQ (n = 9) and qualitative interviews (n = 10) was relatively small and drawn exclusively from a single institution, limiting the generalizability of the findings. Completion rates were 22.5% and 25%, respectively. Additionally, not all participants completed both components of the study; two interview participants did not complete the ALQ, and one ALQ respondent did not participate in the interview phase. This discrepancy limited the direct integration of qualitative and quantitative findings for certain participants. Another limitation was the lack of demographic data related to participants’ years of experience or cultural background, which may have influenced perceptions of authentic leadership. While some participants described increasing authenticity with seniority or after gaining more professional confidence, the study design did not allow for a systematic comparison based on career stage. Similarly, cultural expectations around leadership, such as hierarchical versus individualistic models, were referenced by some participants but not thoroughly analyzed due to the scope of the study. Future research could benefit from incorporating these variables to better understand how external and internal influences shape authentic leadership in medicine.

In closing, while FAPLs value authenticity as a driver of ethical leadership, trust, and team cohesion, barriers that hinder utilization exist. Barriers such as gendered expectations, hierarchical structures, and lack of mentorship often constrain FAPLs’ ability to lead transparently. Future research should explore how authentic leadership manifests differently between female and male leaders through comparative ALQ analyses and structured interviews, and whether these differences influence professional outcomes, mentorship effectiveness, and institutional culture. Longitudinal studies assessing leadership across career stages—and even within residency—could clarify how experience, mentorship, and institutional support shape authentic leadership over time.43 Investigating how specialty-specific cultures and medical hierarchies affect these dynamics will be crucial, as will addressing the persistent mentorship gap that may limit authentic leadership development for early-career female leaders.5–7,19,24 Research should also examine the design and impact of authentic leadership development programs tailored to medical trainees and junior faculty, particularly those from underrepresented groups. Finally, studies should examine how race, ethnicity, and other aspects of identity intersect with authenticity in medical leadership to promote a more inclusive and representative academic culture. Together, these future directions may help academic institutions cultivate more equitable and supportive environments where authentic leadership can thrive beyond gendered leadership, across diverse identities and roles.

Supplementary Material

Supplemental Material
UBMC_A_2510044_SM0642.docx (32.6KB, docx)

Funding Statement

This study received financial support from the Texas A&M College of Medicine Department of Humanities for licensed purchase and use of the Authentic Leadership Questionnaire from Mind Garden Inc. Beyond this purchase, there are no other financial disclosures related to this work or conflicts of interest. Data for this study is stored on a secure institutional drive.

Disclosure statement/Funding

This study received financial support from the Texas A&M College of Medicine Department of Humanities for licensed purchase and use of the Authentic Leadership Questionnaire from Mind Garden Inc. Beyond this purchase, there are no other financial disclosures related to this work or conflicts of interest. Data for this study is stored on a secure institutional drive.

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Supplementary Materials

Supplemental Material
UBMC_A_2510044_SM0642.docx (32.6KB, docx)

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