• Annie Koempel, Melissa K Filippi, Madeline Byrd, Anam Siddiqi, Andrew Bazemore, and Yalda Jabbarpour.
• American Board of Family Medicine, 1648 McGrathiana Parkway, Lexington, KY 40511, United States.
• Fam Pract. 2024 Dec 4.

BackgroundDespite the increasing presence of women in US medical schools over the past 25 years, gender equity in medical leadership remains elusive. This qualitative study delves deeper into definitions of institutional leadership roles, who they are designed for, and how women currently contribute in unrecognized and uncompensated leadership positions.MethodsWe recruited family physicians who responded to the American Board of Family Medicine 2022 or 2023 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women's experiences through the stages from residency to workforce. A qualitative researcher used Zoom to interview 25 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed utilizing NVivo software following an Inductive Content Analysis approach.ResultsThree themes emerged from the data. First, the nature of institutionally recognized leadership positions was largely perceived as bureaucratic and disciplinary, which did not appeal to most participants. Second, women engaged in leadership roles that increased practice efficiency, improved working conditions, and added to their emotional labor-without remuneration. Third, women experienced a tension between work and family, but this did not impact their long-term career goals-which remained focused on patient care or lower-level leadership positions.ConclusionIncreasing the number of women in leadership positions can be achieved through innovative leadership models that prioritize collaboration, flexibility, and work-life balance. Organizations must revise definitions of leadership to expand it to include the valuable, unrewarded work women undertake that advance their goals and overall patient health.© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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