Gender parity in sports medicine; present imperative not future aspiration

Abstract

Gender disparity persists in sports and exercise medicine (SEM), with women comprising only 27% of the faculty of SEM (FSEM) membership. While existing literature explores the barriers women face in progressing within SEM, less attention has been given to when and why female medical students disengage from the specialty pathway. This viewpoint article analyses data from the National Undergraduate SEM Society (USEMS), University SEM Committees and National Health Service England to track gender differences at various career stages. FSEM membership data was also reviewed to assess representation at the consultant level. Over the past 5 years, 46.8% of USEMS members and 48.6% of University SEM Committee members have been women. In contrast, at the Foundation doctor level, female USEMS membership figures drop to 24% and only 20.1% of SEM training applications submitted between 2021 and 2023 were by women. Despite strong engagement at the undergraduate level, few women pursue specialty SEM training, indicating that external barriers may be discouraging them from continuing. More research is needed to understand the specific factors leading to this disengagement so that appropriate steps can be taken to prevent it.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Women face significant barriers in sports and exercise medicine (SEM), including a lack of mentorship, limited leadership opportunities and exclusion from elite sports roles. Research has primarily focused on career progression challenges rather than early-stage disengagement.

WHAT THIS STUDY ADDS

• This viewpoint highlights that female medical students show strong initial interest in SEM but disengage before applying for specialty training. The findings suggest that external barriers, rather than a lack of interest, are driving under-representation.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICY

• Understanding when and why women leave the SEM pathway could inform targeted interventions, such as mentorship programmes, structured recruitment processes and diversity initiatives. Addressing early disengagement is crucial for achieving gender parity and ensuring a more inclusive, representative speciality.

Viewpoint

Paris 2024 was the first Olympics to achieve full gender parity, with athlete quota places distributed equally.¹ This was in contrast to previous games, particularly those of Paris 1900, when women were first allowed to compete. Of the 997 athletes participating in those Olympics, only 22 were women.¹

Medicine in the UK has made similar strides. Medical schools first admitted women in 1868.² However, today the number of licensed doctors and medical school entrants comprises more females than males (50.04% and 60%, respectively).^{3 4}

The Faculty of Sports and Exercise Medicine (FSEM), the UK’s governing body for sport and exercise medicine (SEM), was established in 2006 and has therefore had considerably less time to achieve equality.⁵ However, despite its recent statement that it is committed to equity, inclusion and diversity (EDI),⁶ FSEM reveals only 27% of its members identify as female.⁷ Similarly, only 26% identify as persons of the ‘global majority’. However, this viewpoint focuses solely on gender, as ethnicity is a separate issue with separate causes and potential solutions. It is also written from a UK-centric perspective; however, the globality of the studies referred to demonstrates that gender parity is of international concern.

Much literature exists exploring the issues facing women already working in SEM and the reasons they are not enjoying career progression. For example, Tsukahara et al analysed survey responses from 1193 SEM physicians in 51 countries and found female sports doctors had been sexually harassed or had their judgement questioned twice as frequently as their male peers.⁸ An Australian study highlighted that women in elite sport work 14% more unpaid hours than their male counterparts and that most SEM roles lack transparent recruitment processes, meaning women are not considered for them.⁹ Anderson et al’s editorial observed that female first and last authorship on scientific publications is less than 25%.¹⁰

Clearly, research is important to understand such issues and improve career progression for females working in the specialty. However, this viewpoint questions whether the underrepresentation of women in SEM is fully understood and instead investigates the stage in their careers at which female doctors may disengage from the specialty. This viewpoint aims to explore this using a variety of data sources from different UK career points.

Methods

Membership and committee data from the National Undergraduate SEM Society (USEMS) and National Health Service (NHS) specialty recruitment data were used to track gender differences at various stages from medical school, through foundation training to SEM applications.11,13

USEMS is supported by FSEM and the British Association of SEM to promote SEM to interested medical students and recently graduated doctors, known in the UK as ‘foundation doctors’. It is the sole representative group for such medical personnel and therefore provides the most robust means of assessing specialty interest at this level. USEMS does not keep a membership register but maintains a mailing list requiring new sign-ups to answer demographic questions. That list was used to identify the percentage of members identifying as female at the undergraduate and foundation levels.

There is a USEMS national committee (generally comprising doctors in the first 2 years of postgraduate work) and various university SEM committees nationwide. The gender makeup of those committees over the past 5 years was reviewed based on publicly available information.

NHS specialty recruitment data¹³ were used to investigate the percentage of SEM specialty training applications made by women and the number of offers women receive. In the UK, applications are made after at least 5 years of postgraduate work, and completion leads to qualification as an SEM consultant.

Finally, results from the FSEM EDI survey were used, in which respondents indicated their gender.⁷ These members are senior doctors who have completed SEM postgraduate examinations and maintain paid membership of FSEM.

Results

The percentage of male and female doctors involved in SEM at different member time points is presented in table 1; figure 1 also illustrates this. The gender breakdown of SEM committees over the past 5 years is presented in table 2.

Table 1. The number of USEMS medical students and foundation doctors as of February 2025, SEM applicants and offers between 2021 and 2023 and FSEM members in 2024.

	Males	Females	Percentage of females
USEMS Members—medical students	41	36	46.8
USEMS members—junior doctors	19	6	24.0
SEM applicants	111	28	20.1
SEM specialty training offers	16	5	23.8
FSEM members	31	84	27.0

FSEM, Faculty of SEM; SEM, Sports and Exercise Medicine; USEMS, National Undergraduate SEM Society.

Figure 1. Bar graph showing the percentage of female USEMS medical students and foundation doctors as of February 2025, SEM applicants between 2021 and 2023 and FSEM members in 2024. FSEM, Faculty of SEM; SEM, Sports and Exercise Medicine; USEMS, National Undergraduate SEM Society.

Table 2. The gender breakdown of the USEMS committee and UK University committees over the past 5 years.

	USEMS committee		University committees
	Males	Females	Males	Females
2020/2021	5	6	24	38
2021/2022	7	2	45	27
2022/2023	4	4	46	33
2023/2024	5	3	47	44
2024/2025	7	2	64	72
Total over 5 years	28	17	226	214
Percentage over 5 years	62.2	37.8	51.4	48.6

USEMS, National Undergraduate Sports and Medicine Society.

Discussion

The results suggest that, despite female students being equally interested in SEM at the undergraduate and foundation levels, they are disengaging before applying for specialty SEM training. This suggests that external barriers, rather than disinterest, are driving female underrepresentation. Understanding exactly when and why women disengage from SEM is crucial for creating a more inclusive specialty that better serves all doctors, athletes and patients.

What needs to be done?

First, there is an urgent need for qualitative research targeting undergraduates and foundation doctors to identify why females who have shown interest in SEM are not pursuing a career in it. Until barriers to entry are identified and addressed, the SEM community cannot take meaningful steps towards equality and/or ensure young women interested in the field have the support and opportunities needed to thrive.

Second, while this viewpoint is not focused on the promotion and females already working within SEM, much of the literature relating to the issues they face is highly relevant. For example, Anderson et al list various actions that could be used to achieve gender parity, including mentorship, equal distribution of work and enhanced female inclusion in research, publications and conferences.¹⁰

FSEM’s EDI statement specifically refers to ‘recruitment strategies that…provide equal opportunities for growth…’.⁶ However, there is no detail about what strategies have been implemented and/or their success rates.

Accordingly, surveying female physicians already working within SEM is recommended to identify the barriers to gender equality they experience. Thereafter, appropriate strategies can be agreed and adopted to ensure they maximise their career progression. This should also encourage women to pursue careers in SEM in the first place. The more visible female role models there are, enjoying successful careers and challenging stereotypes, the more attractive and accessible such careers appear to others. Greater representation of women in SEM leadership could also shift workplace culture perceptions, improve mentorship opportunities and create a more inclusive training environment.

Finally, if gender parity is FSEM’s aim, they could consider adopting targets. Schaefer advocates clear target-setting and refers to World Rugby’s aim of women holding 40% of high-performance coaching roles by the 2025 World Cup.¹⁴

This viewpoint does not consider the use of quotas because they can reinforce perceptions that women have not been selected on merit, leading to a further undermining of their legitimacy within SEM. However, targets have been successfully used in many professions, and it is submitted that using them could hugely impact gender parity. For example, in 2016, NHS Improvement set a target of gender balance by 2020 across all NHS Boards. While parity was not achieved, figures did jump from below 40% to nearly 45% in just 3 years.¹⁵

Why does this matter?

Addressing gender disparity is not just about fairness; it is about improving SEM as a whole.

Schaefer talks about the ‘unique perspectives’ females can offer from their personal sport and exercise experience.¹⁴ Alison Rose, ex-international marathon runner and now physiotherapist to top UK athletes like Keeley Hodgkinson, endorses this, attributing her success to the fact that ‘they realise that I get them’.¹⁶

In addition, there are various health issues disproportionately affecting female athletes. For example, anterior cruciate ligament injuries and concussions are up to six times and twice as likely, respectively.17,19 As more females participate in sport at higher levels, medical issues and rehabilitation factors unique to them will become increasingly important. Clearly, it is not suggested that male practitioners are incapable of caring for female athletes. However, doctors offering as broad a range of perspectives as possible is in the best interests of not just athletes but the medical profession and society as a whole. Better care, team diversity and workplace culture are just some of the realisable benefits.

It could be argued that other specialities are heavily dominated by one sex (eg, trauma and orthopaedic surgery (males) and obstetrics and gynaecology (females)) and that SEM’s gender disparity is not unique. It is acknowledged that this viewpoint does not investigate levels of postuniversity disengagement in other specialities.¹³ It is also acknowledged that there may be reasons some specialities are less suited to gender parity. However, according to Sport England, the percentages of people participating regularly in sport are not grossly disparate, and therefore, it is difficult to argue that females are disinterested and/or that SEM is a specialisation which is incapable of equality.²⁰

Conclusion

The stated intention of the organisers of the 2024 Paris Olympics motto was to host a wide-open Games where everyone felt welcome. SEM in the UK remains far from achieving such inclusivity and equality.

While it is important that strategies are implemented to ensure women within SEM progress in line with their male counterparts, it is critical that qualitative research is carried out to understand why more female doctors are not entering the specialty in the first place and to implement targets to address this.

This viewpoint’s data clearly shows there is gender parity at the undergraduate level, which corresponds to interest and participation in sport generally. The challenge for SEM is to ensure that such female engagement is not wasted and that, like the Paris organisers, it opens its arms wide and ensures that everyone feels welcome.