Intersectionality in healthcare leadership: a scoping review on the career experiences of racially and ethnically minoritised women health professionals.

Background: The underrepresentation of women in positions of leadership, policy, and decision-making is a persistent issue within the healthcare workforce. Disparities in representation are particularly pronounced for women with minoritised racial and ethnic identities. Ensuring the equitable advancement of women into health leadership requires moving beyond approaches that homogenise the experiences of women to addressing the distinct needs of women with intersecting identities. This scoping review sought to summarise the existing evidence on the impact of the intersection of gender and race/ethnicity on the workplace experiences, career journeys, and leadership attainment of women health professionals with minoritised racial and ethnic identities.

Methods: This scoping review was completed using Arksey and O'Malley's five-stage methodological framework. A comprehensive search identified peer-reviewed papers and grey literature. Inclusion criteria followed an a priori protocol, with no restrictions on publication date, geographic location, or healthcare setting. The search was limited to the English language. A deductive content analysis approach was used to categorise data according to the three forms of intersectionality: structural, political, and representational. Additional categories focused on the psycho-emotional impacts of experiences and women's agentic responses.

Results: Of the 4043 sources identified, 57 were included in the review. Findings show that racially and ethnically minoritised women in healthcare more frequently described experiences of race-based inequities. This underscores the salience of racialisation in their experiences of marginalisation, an aspect often obscured by gender-only analyses. Current Diversity, Equity, and Inclusion initiatives were reported to have limited effectiveness in addressing the challenges faced by REM women in their careers. These initiatives often lack targeted and impactful strategies to counteract racial and/or gender-based discrimination, provide meaningful support, and promote equitable access to advancement and leadership opportunities. Findings highlighted the prioritisation of Eurocentric/Western knowledge, the prevalence of institutional Whiteness, and practices of tokenistic inclusion. Disproportionate workload allocations, and the burden to consistently outperform White women counterparts, were reported. Persistent exposure to microaggressions, racialised stereotypes, and organisational reluctance to confront racism were also noted. Psychological and emotional challenges, including burnout and internalised oppression, were highlighted. Agency, resilience and resistance were demonstrated through strategic disengagement, professional development, reframing challenges as growth opportunities, forming diversity networks, and advocating for minoritised colleagues.

Conclusion: Advancing gender equity in health leadership requires targeted efforts to address and dismantle racism. Key solutions include integrating antiracism education, recognising non-Western leadership styles, and establishing safe and robust accountability mechanisms. Most evidence in this review reflects the experiences of African American women, underscoring the prevalence of US-centric research. Future studies should investigate other geopolitical contexts.