The Hidden Power Brokers: How Leaders Open Doors in Academic Medicine

Behind almost every successful academic physician stands someone who quietly made a phone call, put a name forward for a national committee, or insisted that a rising star be invited to speak at a prestigious symposium. This behind-the-scenes advocacy is known as sponsorship, and it is one of the most powerful yet least visible forces shaping careers in academic medicine. Unlike mentoring, which focuses on advice and skill development, sponsorship involves leaders actively spending their own professional capital to advance someone else’s career. A new qualitative study published in the Journal of General Internal Medicine offers one of the most detailed looks to date at how leaders in academic medicine actually think about and practice sponsorship, revealing both the promise of this career-shaping activity and the structural gaps that leave it inconsistent, untracked, and vulnerable to bias.

The research team, led by Mia F. Williams, MD, MS, and Rachel Schwartz, PhD, of the University of California, San Francisco, together with Colleen A. McGourty, Crystal Liang, and Mitchell D. Feldman, conducted semi-structured qualitative interviews with fifteen leaders within a large academic Department of Medicine. The participants ranged from division and section chiefs all the way up to the dean’s office, capturing perspectives from those who control access to many of the opportunities that determine advancement in medical academia. The researchers used an inductive thematic analysis approach, coding the interview data to identify patterns in how leaders described their sponsorship practices, their understanding of the sponsor role, the principles guiding their decisions, and their views on what institutions could do better.

Perhaps the study’s most striking finding is its universality: every single leader interviewed engaged in sponsorship. Yet their conceptions of what sponsorship meant varied widely. Some leaders saw it simply as an embedded part of their leadership responsibilities, something they did routinely without special reflection. Others described it as a passion and a core mission, framing sponsorship as central to their identity as leaders and to their obligation to cultivate the next generation of academic physicians. This variation matters, the authors argue, because sponsorship often occurs out of sight, without metrics or tracking mechanisms, which means the distribution of sponsored opportunities may depend heavily on each individual leader’s style, awareness, and priorities rather than on any consistent institutional standard.

What drives a leader to sponsor one faculty member over another? The interviews surfaced several recurring factors. Familiarity with potential sponsees loomed large, including their previous and potential performance and the clarity of their career goals. Leaders described watching for faculty who demonstrated excellence and ambition, then deliberately connecting them with opportunities such as leadership roles, high-profile projects, and introductions to influential colleagues. Another prominent theme was equity in the distribution of opportunities. Some leaders consciously worked to spread sponsored chances across their faculty rather than concentrating them on a favored few, while others acknowledged that sponsorship naturally flows through relationships and networks, raising questions about who gets noticed and who remains invisible.

That network dependence emerged as a double-edged sword in the findings. Leaders emphasized that effective sponsorship relies on robust professional networks and institutional influence, their own accumulated social capital being the raw material they spend when they vouch for someone. As one theme captured in the study’s title suggests, leaders described sponsorship in vivid terms of access: they can open doors that remain closed to others. But social capital is unevenly distributed, and prior research cited by the team, including a 2024 scoping review by Schwartz, Williams, and Feldman, has questioned whether sponsorship actually promotes equity in career advancement in academic medicine or instead amplifies existing disparities. Studies of gender differences in sponsorship, including work on National Institutes of Health grant recipients and on women in anesthesiology and emergency medicine, suggest that men are more likely to be sponsored into positions of influence, and that women and faculty from underrepresented groups often face narrower pathways to the networks that sponsorship requires.

The leaders themselves recognized this tension. Interviewees highlighted the inherent bias embedded in sponsorship practices, acknowledging that informal, relationship-driven advocacy tends to favor those who resemble the sponsors or who already move in the same professional circles. Several participants called for additional infrastructure to support equitable sponsorship, arguing that institutions cannot rely on individual goodwill alone to level the playing field. This aligns with a growing body of literature arguing that mentorship is not enough: as Ayyala and colleagues wrote in Academic Medicine in 2019, career advancement in academic medicine requires deliberate sponsorship structures, and Gottlieb and Travis argued in 2018 that the time for formal sponsorship models is now.

Even the most committed sponsors in the study faced significant barriers. Inadequate time was the most commonly cited obstacle; sponsorship is labor-intensive, requiring leaders to make introductions, advocate in meetings, and follow through on commitments, all on top of clinical, research, and administrative duties. Uncertainty about best practices compounded the problem, with leaders unsure whether they were sponsoring effectively or fairly. A lack of institutional support rounded out the barriers: because sponsorship is invisible and unmeasured, leaders receive little recognition for doing it well and no feedback when they fall short. The result is a system in which the engine of career advancement runs on personal initiative rather than institutional design.

The study’s conclusions point toward concrete reform. Williams and her colleagues call for explicit definitions of sponsorship, transparency about how sponsored opportunities are allocated, and institutional support structures that make sponsorship visible, accountable, and equitable. Practical implications could include tracking who receives sponsored opportunities, training leaders in sponsorship practices, building formal sponsorship programs that pair faculty with senior advocates, and embedding sponsorship expectations into leadership job descriptions. Such measures, the authors argue, are essential to promote equitable career advancement, particularly for women and underrepresented minority faculty who research shows are less likely to benefit from informal sponsorship networks. In a field where positions of power remain disproportionately concentrated, the difference between a mentor who advises and a sponsor who opens the door may be the difference between a stalled career and a leadership role.

For the broader scientific and medical community, the study is a reminder that career pipelines are not built on merit alone. The invisible labor of door-opening shapes who becomes a department chair, who sits on national panels, and whose research gets amplified. Making that labor visible is the first step toward ensuring it serves everyone. As academic medicine confronts persistent disparities in its leadership ranks, this research suggests that the question is no longer whether leaders should sponsor their faculty, since all of them already do, but whether institutions will finally build the scaffolding to make that sponsorship deliberate, transparent, and fair.

Subject of Research: Sponsorship roles and practices among leaders in academic medicine and their impact on equitable faculty career advancement

Article Title: “I Can Open the Door”: Sponsorship Roles and Practices in Academic Medicine

Article References: Williams, M. F., Schwartz, R., McGourty, C. A., Liang, C., & Feldman, M. D. (2026). “I Can Open the Door”: Sponsorship Roles and Practices in Academic Medicine. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10573-6

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10573-6

Keywords: sponsorship, academic medicine, mentoring, career advancement, faculty development, workforce diversity, gender equity, leadership, qualitative research, professional networks, Open, Door