A series of publications over the last several years has highlighted the underrepresentation of women in multiple sectors of sport and exercise medicine (SEM). The overall number of women SEM physicians in the USA is about 27.5%, which remains disproportionally low compared with the number of women both in (37.1%) and entering (47.1%) medicine, with continued gaps in the number of women represented in societal and academic leadership as well as in head team physician roles.1 2 This editorial provides an update about women in sports medicine leadership, highlights the large discrepancy in elite team physician roles and suggests innovative steps to improve under-representation. There have been positive advances for women representation in academic leadership. The percentage of women sports medicine fellowship programme directors is about equal to the number of women in SEM, and there is no significant difference in academic rank between men and women.3 In academic societies, women accoun