Introduction The issue of underrepresentation of women in medical leadership roles, particularly in their retention and long-term engagement, is a pressing challenge in healthcare. Despite advancements in women’s initial entry into these roles, their sustained presence and advancement in leadership roles have been relatively underexplored. This narrative literature review aims to addresses this significant gap, focusing on the retention of women in medical leadership. The review aims to uncover the factors that influence their long-term commitment and progression in these roles. Understanding these challenges is essential for fostering a diverse and inclusive leadership culture in healthcare, which is vital for meeting the varied needs of patients and enhancing organisational effectiveness. This review endeavours to provide insights into the retention strategies that can support the continuous growth and presence of female leaders in healthcare.

Aims and objectives of the research project or activity This narrative review primarily aims to investigate the factors affecting the retention of women in medical leadership positions, an area that has received less attention in research compared to their initial recruitment into such roles. Specific objectives include: 1) To assess the extent of female underrepresentation in medical leadership across various healthcare systems; 2) To identify and analyse the key factors contributing to this gender disparity, encompassing policy, organisational culture, and individual-level challenges; 3) Evaluating the effectiveness of strategies and interventions designed to enhance this retention and ongoing engagement of women in these positions. Through addressing these objectives, this review seeks to fill a critical gap in the literature and contribute to a more comprehensive understanding of gender inclusivity in medical leadership.

Method or approach This narrative review employs an exploratory and interpretative methodology, focusing on the theme of women’s retention in medical leadership roles. The search encompasses key academic databases including PubMed, MEDLINE(Ovid) and Scopus, alongside grey literature and reports from healthcare organisations, ensuring a broad spectrum of viewpoints. A narrative review approach allows for the inclusion of a diverse range of studies. The selection criteria were designed to prioritise studies and articles that directly address the unique challenges and solutions associated with retaining women in medical leadership positions. The search was narrowed to articles published between 2003 and 2023 in order to capture current workforce trends, whilst maintaining a comprehensive review. A total of 193 materials were initially identified to be potentially relevant for the review. A total of 19 articles were found to match the inclusion criteria and were subsequently reviewed.

Findings The findings from this narrative review underscore that the retention of women in medical leadership roles is influenced by a complex range of factors. Structural barriers, such as limited progression opportunities beyond initial leadership roles and insufficient retention-focused policies are significant. Culturally, deeply ingrained gender stereotypes and biases within professional environments create formidable challenges. On a personal level, balancing professional growth with personal life commitments emerges as a pivotal issue. This review highlights various promising strategies for mitigating these challenges, including leadership development programs tailored for retention, ongoing mentorship and sponsorship initiatives, as well as organisational policy reforms aimed at supporting the long-term engagement of female leaders. However, there is a notable gap in rigorous, long-term evaluations of these strategies, pointing to the need for more comprehensive research into their effectiveness. These findings suggest that a multifaceted approach, distinct from strategies that solely focus on entry-level barriers, is essential for retaining women in leadership positions within the medical field.

Key messages The central message of this review is the vital need for a strategic emphasis on the retention of women in medical leadership roles, a crucial yet underemphasised aspect of fostering inclusive healthcare leadership. This review advocates for the development and implementation of targeted strategies and policies specifically geared towards supporting the long-term engagement and career progression of women in such roles. Recommendations include specialised leadership training programs, continuous mentorship and sponsorship opportunities, along with organisational policies that foster work-life balance and career sustainability. By highlighting the advantages of a diverse and inclusive leadership, this review urges healthcare institutions and policy- makers to actively confront the unique challenges associated with retaining women in medical leadership positions. Such focused efforts are essential not only for achieving gender equity in leadership but also for enhancing healthcare delivery through a leadership structure that truly reflects the diversity of our medical workforce and patient population.