From struggles to solutions: understanding the barriers for female healthcare entrepreneurs Open Access

Entrepreneurship is widely recognized as a vehicle for economic empowerment, innovation and societal progress (Ranabahu and Tanima, 2022). However, for women entrepreneurs, particularly in male-dominated fields like healthcare leadership (Mousa et al., 2021), the entrepreneurial journey is often fraught with unique challenges shaped by gendered systemic, societal and cultural barriers (Al-Qahtani et al., 2022). These obstacles can hinder the establishment and growth of women-led ventures, demanding resilience and adaptability from female entrepreneurs navigating these complex dynamics.

This study investigates the intersection of gender and entrepreneurship within the healthcare sector, spotlighting the experiences of female entrepreneurs. By delving into their insights, strategies and recommendations, we hope to package advice for other women hoping to enter the market. The narratives captured provide a valuable resource for practitioners and academics alike as well as aspiring female entrepreneurs who can draw inspiration and practical guidance from their predecessors. Their voices not only highlight the resilience and adaptability required in entrepreneurship but also underscore the importance of creating a more inclusive entrepreneurial ecosystem.

By contextualizing these challenges within the broader framework of gender in management, this research highlights the imperative for creating more inclusive ecosystems that enable women entrepreneurs to thrive. In particular, this study builds on literature related to imposter syndrome, which refers to internalized doubt regarding one’s abilities despite objective competence. Research shows that over 40% of female entrepreneurs report experiencing imposter syndrome, which can negatively impact leadership efficacy and decision-making under financial pressure (Sun et al., 2024). This phenomenon disproportionately affects high-achieving women in professional roles, including entrepreneurship (Nadal et al., 2021), and informs both their financial behavior and interaction with investors. Imposter syndrome, though often framed as an individual psychological phenomenon, reflects broader systemic issues. It is more prevalent among high-achieving women in male-dominated fields like entrepreneurship and healthcare, where success is often judged by masculine norms (Ladge et al., 2019). High-achieving women often internalize systemic bias as personal inadequacy, a pattern well-documented in both professional and entrepreneurial contexts (Feenstra et al., 2020). These internalized doubts can result in cautious financial behavior, hesitancy in leadership and reduced pursuit of external funding opportunities (Chadwick and Dawson, 2024). These feelings can also contribute to over-preparation, burnout and reluctance to seek mentorship or capital (Hernanz et al., 2020).

The research question that drove this study was “How do gendered biases and internalized perceptions affect the ability of female entrepreneurs in the U.S. healthcare sector to secure venture funding, and what strategies do they employ to navigate these barriers?”

The literature highlights a complex intersection of gender bias, financial exclusion and structural barriers that shape the entrepreneurial landscape for women, particularly in healthcare. Gendered perceptions of leadership, financial competence and business commitment create persistent funding disparities, making it difficult for female entrepreneurs to scale their ventures (Kanze et al., 2018; Karlstrøm et al., 2023; Zhang and Chen, 2025)

In addition to these external constraints, emerging scholarship has drawn attention to how internalized psychological barriers – especially imposter syndrome – amplify these gendered inequities (Bravata et al., 2020). Imposter syndrome, described as the chronic doubt of one's achievements despite objective evidence of success (Clance and Imes, 1978), is particularly pronounced among female professionals operating in high-performance and male-dominated domains, such as entrepreneurship and healthcare (Feenstra et al., 2020).

Women who experience imposter syndrome often underestimate their leadership capabilities, project conservative financial forecasts and exhibit greater reluctance to pursue high-stakes funding opportunities, fearing exposure as incompetent or unworthy (Vergauwe et al., 2015). These internalized beliefs not only mirror but also reinforce the biases they encounter from investors, contributing to a self-fulfilling cycle of exclusion from capital markets (Nadal et al., 2021).

Importantly, imposterism among women founders is not merely a product of individual psychology but a reflection of structural socialization processes (Gibbs et al., 2018) and constant external questioning of women's legitimacy in business contexts (Kanze et al., 2018). As such, addressing funding disparities in healthcare entrepreneurship requires attention not only to investor behavior but also to the cognitive and emotional toll these environments impose on women entrepreneurs.

Studies consistently find that investors tend to frame questions differently based on the entrepreneur’s gender, asking men promotion-focused questions about growth potential while directing prevention-focused questions toward women, emphasizing risk aversion and downside protection (Kanze et al., 2018; Alsos and Ljunggren, 2017; Balachandra et al., 2017). This results in divergent funding outcomes, systematically disadvantaging female entrepreneurs in securing capital (Snellman and Solal, 2020; Zhang and Chen, 2025).

These patterns of questioning not only affect external investor behavior but also fuel internalized doubt among women entrepreneurs. Female founders frequently internalize repeated skepticism and risk-focused interrogation (which focuses on potential downsides and risk avoidance rather than growth potential) as indications of their own inadequacy, reinforcing imposter syndrome (Feenstra et al., 2020). Research shows that entrepreneurs who experience imposter feelings tend to undervalue their contributions, provide conservative revenue projections and avoid presenting visionary goals, fearing exposure as frauds (Vergauwe et al., 2015).

Investor homophily – where investors favor entrepreneurs of the same gender – further reinforces disparities in venture funding (Oranburg and Geiger, 2019; Koziol et al., 2025). While female investors are more likely to invest in female entrepreneurs, research suggests that startups led by women who receive funding from female investors struggle significantly more in securing follow-on financing (subsequent investment rounds after the initial funding) than those funded by male investors (Snellman and Solal, 2020; Karlstrøm et al., 2023). This phenomenon perpetuates a cycle of underfunding, wherein women receive initial capital at lower rates and then face additional difficulties scaling their businesses (Khurana and Lee, 2022; Koziol et al., 2025).

Additionally, masculine stereotypes of entrepreneurial success continue to shape investor decisions, reinforcing perceptions that male entrepreneurs are more capable of managing risk and achieving high growth (Balachandra et al., 2017; Titus et al., 2025). Even in high-stakes pitching environments, female-led teams are evaluated more favorably by male judges but do not receive proportionally higher investment commitments, suggesting that gender bias persists in funding allocations despite positive perceptions (Khurana and Lee, 2022; Karlstrøm et al., 2023; Zhang and Chen, 2025).

Beyond individual investor biases, systemic barriers limit female entrepreneurs’ access to crucial financial and professional networks, significantly restricting their ability to secure funding (Gompers and Wang, 2017; Alsos and Ljunggren, 2017; Constantinidis, 2021). Entrepreneurial finance remains a male-dominated space, with venture capital firms (funding from firms that invest in early-stage, high-potential startups in exchange for equity) and angel investor groups (wealthy individuals who provide early-stage capital to startups, often in exchange for ownership equity) disproportionately composed of men, reducing the likelihood that women will gain entry into key investment circles (Brush et al., 2018; Karlstrøm et al., 2023).

Social exclusion from informal investor networks not only restricts opportunity but also feeds imposter syndrome, as women are repeatedly reminded – explicitly or implicitly – that they are outsiders in these high-power domains (Feenstra et al., 2020). Repeated exposure to gendered barriers can erode entrepreneurial identity, leading women to question their legitimacy, minimize their expertise and avoid assertive engagement with financial gatekeepers (Hutchins and Rainbolt, 2017).

Studies show that lack of mentorship (Nixdorff and Rosen, 2010) and sponsorship is a key contributor to imposterism, particularly for women in business settings where leadership norms are incongruent with their gendered socialization (Bravata et al., 2020). Studies find that male entrepreneurs benefit from more informal mentorship and sponsorship networks, where business relationships are developed over time, leading to investment opportunities (Oranburg and Geiger, 2019; Constantinidis, 2021). Conversely, female entrepreneurs are often excluded from these informal deal-making processes, making it more difficult to secure early-stage investment (Koziol et al., 2025; Veckalne and Tambovceva, 2023).

Entrepreneurship remains deeply associated with traditionally masculine traits such as risk-taking, assertiveness and dominance, which disadvantages female entrepreneurs who may not conform to these stereotypes (Tonoyan and Strohmeyer, 2021; Thébaud, 2010; Balachandra et al., 2017). The research suggests that women entrepreneurs must demonstrate significantly stronger business metrics than men to gain the same level of investor confidence (Karlstrøm et al., 2023; Snellman and Solal, 2020; Zhang and Chen, 2025). As a result, female entrepreneurs must work twice as hard to prove competence, not only to skeptical investors but also to themselves – leading to overwork, perfectionism and avoidance of bold moves that could advance their ventures but risk failure (Vergauwe et al., 2015; Feenstra et al., 2020).

Financial market structures also reinforce gendered capital misallocation. Female-owned firms tend to receive significantly less credit and operate with lower levels of assets, despite having stronger profitability and better credit risk scores than male-owned firms (Morazzoni and Sy, 2022; Kanze et al., 2018; Alsos and Ljunggren, 2017). Studies estimate that removing the gender gap in business financing could increase economic output by 4%, underscoring the macroeconomic consequences of gender biases in capital allocation (Morazzoni and Sy, 2022; Veckalne and Tambovceva, 2023; Zhang and Chen, 2025).

Another structural challenge involves perceptions of entrepreneurial commitment, particularly among female entrepreneurs with young children. Investors and business partners often assume that women entrepreneurs will prioritize family obligations over business growth, affecting their ability to secure long-term funding and strategic partnerships (Tonoyan and Strohmeyer, 2021; Strohmeyer et al., 2017; Oranburg and Geiger, 2019). This phenomenon is especially evident in fast-paced industries like technology and healthcare, where aggressive market expansion and high-intensity work schedules are often seen as prerequisites for success (Eisenhardt, 1989; Balachandra et al., 2017; Karlstrøm et al., 2023). Female entrepreneurs in male-dominated industries face heightened scrutiny, with resource providers assuming they have lower levels of commitment, dependability and business acumen (Tonoyan and Strohmeyer, 2021; Thébaud, 2010; Titus et al., 2025).

These assumptions reflect broader gender role incongruity, where communal traits stereotypically associated with women – nurturing, relational and risk-averse – are perceived as misaligned with entrepreneurial leadership, which is coded as assertive, aggressive and growth-driven (Tonoyan and Strohmeyer, 2021). As a result, women who must visibly balance caregiving and entrepreneurship often experience heightened stereotype threat, which can trigger or intensify imposter syndrome (Feenstra et al., 2020).

Numerous studies demonstrate that women internalize external doubt when repeatedly exposed to subtle signals questioning their ambition or commitment (Clance and Imes, 1978; Neureiter and Traut-Mattausch, 2016). These imposter feelings manifest as self-silencing, over-preparation or risk avoidance, especially in high-visibility investment or partnership conversations (Vergauwe et al., 2015).

For women with caregiving responsibilities, the perceived need to overcompensate for presumed lack of dedication can lead to unsustainable workloads and reinforce internal doubts about belonging in high-growth venture spaces (Bravata et al., 2020). Moreover, these internalized concerns are not unfounded: investors often disproportionately penalize women for perceived work–life conflicts, even when male entrepreneurs experience similar personal obligations (Titus et al., 2025).

As a result, women may preemptively lower their funding targets, decline pitch opportunities or avoid seeking aggressive venture growth in order to “stay under the radar” – behaviors strongly associated with the behavioral outcomes of imposter syndrome (Feenstra et al., 2020). Even when women exhibit equal financial and strategic competence, they must fight both external skepticism and internal doubt, which together restrict access to investment and stifle the full expression of their entrepreneurial potential. Women tend to be judged through a relational and communal leadership lens, which may lead investors to question their ability to scale ventures effectively (Balachandra et al., 2017; Koziol et al., 2025). Even when they exhibit equal financial and strategic competence as their male counterparts, they often face more intense scrutiny (Snellman and Solal, 2020; Zhang and Chen, 2025).

Failure is an integral part of entrepreneurship, yet women entrepreneurs face disproportionately negative consequences when their ventures fail (Simmons et al., 2024; Singh et al., 2015; Politis and Gabrielsson, 2009; Alsos and Ljunggren, 2017). Research shows that entrepreneurial failure is more likely to be interpreted by investors as a lack of competence in women, while men are often granted narratives of resilience or market misfortune (Titus et al., 2025). Female entrepreneurs who experience business failure are (1) Less likely to secure future investment – investors are more hesitant to fund female entrepreneurs who have previously failed than their male counterparts (Pistilli et al., 2023; Zhang and Chen, 2025). (2) More likely to internalize failure as personal incompetence – women attribute business failure to personal shortcomings rather than external market forces, leading to greater psychological barriers to reentry (Politis and Gabrielsson, 2009; Singh et al., 2015). Finally, (3) Held to stricter reentry standards – female entrepreneurs attempting to start new ventures must demonstrate stronger business plans and more financial traction than men to regain investor confidence (Alsos and Ljunggren, 2017; Karlstrøm et al., 2023).

This heightened failure stigma discourages entrepreneurial persistence among women, resulting in lower long-term business participation rates than men (Marlow and McAdam, 2013; Koziol et al., 2025; Zhang and Chen, 2025). Furthermore, failure is disproportionately penalized for women, discouraging entrepreneurial reentry and contributing to lower participation rates over time (Singh et al., 2015; Pistilli et al., 2023).

This qualitative study used a purposive and snowball sample of women over the age of 18 to ensure a diverse representation of female healthcare entrepreneurs. Institutional Review Board approval was received prior to contacting any participants. Professional organizations such as the American College of Healthcare Executives and Women in Business assisted in reaching these participants. Inclusion criteria included identifying as a woman, being over 18 years of age and having attempted to raise capital for a healthcare venture. About 19 participants were interviewed, with recruitment ceasing upon achieving thematic saturation – the point at which no new codes or themes emerged (Hennink et al., 2017). This sample size was deemed sufficient to capture a broad range of perspectives while ensuring depth of analysis.

Each interview lasted between 30 and 60 min and followed a semi-structured format, allowing participants to elaborate on key themes related to funding, gender bias and entrepreneurial decision-making. Interviews were conducted via Zoom or phone, depending on participant preference. Women were interviewed once. All interviews were audio-recorded and professionally transcribed.

The audio of the interviews was saved and converted into written transcripts. Two researchers (Researcher A and Researcher B) independently coded each transcript using both deductive and inductive techniques. To ensure coding consistency, we calculated inter-rater reliability on an initial subset of transcripts using Cohen’s kappa, which indicated substantial agreement (>0.70). Discrepancies were reviewed by a third researcher (Researcher C), who facilitated consensus through careful examination of the data and codes. After coding, the research team collaboratively grouped codes into broader categories, refining deductive themes, identifying emergent themes and integrating findings. Reflexivity was maintained in team meetings to discuss how researchers’ backgrounds and assumptions might influence the coding and theme development (Olmos-Vega et al., 2023). Thematic saturation was assessed continuously during data analysis and formally confirmed after reviewing the final three transcripts, none of which yielded new codes or insights. This confirmed that the sample was adequate to address the research question.

Data analysis was conducted in Dedoose (2021), a software tool that facilitated coding, organization and thematic mapping. Ethical approval for the study was obtained from the Texas Woman’s University Institutional Review Board. All participants provided informed consent, and their confidentiality was safeguarded by anonymizing transcripts and securely storing data. A summary table of the thematic categories (Table 1) and their relative prevalence across participants is included to illustrate the breadth of coverage; this approach offers transparency without relying on raw frequency counts, which are not standard in qualitative analysis (Nowell et al., 2017).

While the sample size of 19 is large by standards in qualitative research, particularly studies involving underrepresented or specialized populations (Hamilton, 2020), several limitations must be acknowledged. Participants were primarily recruited through professional organizations, which may introduce selection bias – those affiliated with such groups may possess higher levels of social capital, confidence or access to funding networks than the broader population of female healthcare entrepreneurs. This could shape their experiences and perspectives in ways that do not fully capture the diversity of barriers faced across the field. Additionally, although we aimed for variation, the sociodemographic characteristics of the sample (e.g. race, age, educational background and previous entrepreneurial experience) may influence how gendered financial barriers are perceived and navigated. These limitations suggest that future studies should pursue broader recruitment strategies and more demographically diverse samples to assess how intersecting identities shape entrepreneurial finance outcomes.

Findings from this study reveal that women healthcare entrepreneurs face a range of challenges shaped by both structural and internalized gender dynamics. The data indicate that gender bias, risk aversion and missed opportunities due to self-doubt are the most pressing barriers to securing investment. Barriers were identified as both external/systematic and internal/individual, influencing how women navigate the entrepreneurial landscape.

A predominant theme emerging from participant narratives was the differential treatment women encountered in investor meetings. Several participants described investor skepticism regarding their leadership capabilities and growth potential, particularly in contrast to male entrepreneurs. Women were frequently required to over-justify their qualifications, with investors often directing risk-oriented questions at them rather than engaging in discussions about market opportunities and business scalability.

One participant succinctly described this experience:

Another participant highlighted how the presence of a male co-founder shifted investor perceptions:

Bias was not limited to interactions with male investors. Surprisingly, some participants observed that female investors also exhibited a more conservative approach when evaluating women-led ventures. This phenomenon may be linked to the internalized misogynistic pressures that female investors face in a male-dominated industry, making them more risk-averse in their funding decisions (Nadal et al., 2021).

Another critical barrier identified was risk aversion – both in how women assessed their own funding decisions and how they were perceived by investors. Many participants expressed a preference for bootstrapping (self-funding a business without external investment) rather than pursuing external capital, citing concerns over loss of control and the restrictive terms often imposed by venture capital firms.

One entrepreneur reflected on her experience:

Similarly, another participant noted how female investors often displayed greater caution when evaluating women-led startups:

This dynamic suggests that both investor-side and entrepreneur-side risk aversion contribute to funding disparities for women in healthcare entrepreneurship. Women's inclination toward financial conservatism, compounded by investor skepticism, results in fewer opportunities to access early-stage capital.

Beyond structural biases, internalized gender expectations also shaped the fundraising experiences of women healthcare entrepreneurs. Participants reported experiencing imposter syndrome, which often led to cautious financial projections and hesitation in pursuing investment opportunities.

One participant described her struggle with self-confidence in the pitching process:

Imposter syndrome was frequently mentioned by participants as a reason for holding back during investor pitches or choosing more conservative funding approaches. This is consistent with studies showing that women with imposter fears often downplay their entrepreneurial identity, avoid high-stakes financing, and experience lower perceived legitimacy (Ladge et al., 2019). This reflects what Vergauwe et al. (2015) identify as a common behavioral outcome of imposterism: conservative self-presentation to avoid perceived exposure. One shared how imposter syndrome initially prevented her from seeking capital:

Such narratives underscore how internalized self-doubt, shaped by gendered socialization and repeated external questioning, becomes a self-reinforcing barrier to entrepreneurial risk-taking (Feenstra et al., 2020). The entrepreneurs' stories reflect what Hutchins and Rainbolt (2017) term the “confidence gap” – a discrepancy between actual and perceived competence, often maintained by a lack of validation in institutional and investor environments.

These missed opportunities are not merely individual lapses in confidence; they are cognitive responses to a system that repeatedly undermines women’s legitimacy, further entrenching gender disparities in entrepreneurial finance.

A flow diagram of the barriers is below (Figure 1).

Despite these challenges, participants identified strategies they found effective in navigating the fundraising process. These strategies align with broader discussions in gender and management research, highlighting the role of networking, confidence and resilience in overcoming structural barriers.

Participants overwhelmingly emphasized the importance of networking and warm introductions in gaining access to funding opportunities. Several interviewees noted that breaking into investor circles required intentional relationship-building efforts.

Another participant reflected on the informal yet gendered nature of networking dynamics:

These findings reinforce existing research suggesting that access to high-net-worth individuals and investor communities is often gendered, necessitating strategic networking approaches for women entrepreneurs (Ojo, 2023) because they are often unable to access traditional networking opportunities (Lucas, 2006).

Confidence was identified as a key factor in influencing investor perceptions. Several women reported shifting their communication styles to project greater confidence, a shift they believed positively impacted fundraising outcomes.

Another participant noted the need to present with authority:

These reflections highlight the gendered expectations around leadership and confidence in entrepreneurial spaces. Women must often consciously adjust their communication styles to align with investor expectations, an adaptation that reflects broader discussions in gender and management research.

Finally, participants emphasized that resilience was crucial to navigating the fundraising process. Many described their experiences with rejection, emphasizing the importance of persistence in securing investment.

Another participant framed rejection as an inevitable part of the process:

These insights align with broader research emphasizing that entrepreneurial success is often contingent on persistence, particularly for women navigating gendered barriers in investment and leadership contexts (Figure 2).

The findings of this study reinforce and extend existing research on the gendered challenges faced by female healthcare entrepreneurs, highlighting the intersection of systemic barriers, investor biases and internalized perceptions that shape their entrepreneurial experiences. However, these challenges are not experienced uniformly across all women. The intersectionality of gender with race, socioeconomic status, immigration background, disability and age creates layered disadvantages that shape access to funding, networks and legitimacy in distinct ways (Dy et al., 2017). The barriers identified – including gender bias in investment, conservative financial behavior, risk aversion and the self-perception of entrepreneurial competence – align with prior scholarship while also shedding new light on how these dynamics manifest in the healthcare sector, a field where women are well-represented as professionals but underrepresented as business owners and investors.

A predominant issue that emerged in this study was the differential treatment experienced by women entrepreneurs in investment settings. Participants repeatedly described investor skepticism regarding their leadership capabilities and growth potential, often encountering funding discussions that were heavily focused on risk mitigation rather than opportunity. This mirrors the findings from Kanze et al. (2018). Participants in this study highlighted how this bias was exacerbated when they lacked a male co-founder, suggesting that gender not only influences investor confidence but also shapes perceptions of credibility within entrepreneurial teams.

Beyond investor skepticism, the study revealed that many female entrepreneurs displayed a distinct preference for bootstrapping over seeking external capital, citing concerns about the power dynamics inherent in venture capital relationships. This preference for self-financing aligns with previous research indicating that women tend to approach entrepreneurial finance with greater caution, often due to a desire to maintain control and avoid potentially biased investor interactions (Gompers and Wang, 2017; Snellman and Solal, 2020). While bootstrapping was often framed as a strategic choice, several participants admitted that their hesitancy to engage with investors stemmed from fears of not appearing “legitimate enough,” a classic manifestation of high-visibility environments (Neureiter and Traut-Mattausch, 2016; Bravata et al., 2020). Notably, this study provides additional nuance by revealing that female investors, who might be expected to act as allies, often exhibit a similarly conservative approach when evaluating women-led ventures. These findings support Zhang and Chen (2025), who argue that female venture capitalists may adopt more risk-averse investment strategies when assessing female-led startups, potentially due to pressures to conform to male-dominated investment norms. Consequently, women entrepreneurs face a paradox: they struggle to secure funding from male investors due to gendered assumptions about leadership and risk, while also encountering hesitation from female investors who may feel additional pressure to justify their investment decisions.

Many participants described how internal doubts, conservative financial projections, and hesitancy in pursuing high-risk funding strategies influenced their fundraising outcomes. A number of participants noted that male entrepreneurs often projected highly ambitious revenue forecasts during investment pitches, whereas women felt compelled to provide more conservative, “realistic” numbers. This discrepancy is significant because investors tend to respond more favorably to entrepreneurs who present bold visions for growth, reinforcing the cycle in which women entrepreneurs are perceived as having less ambitious ventures, regardless of their actual market potential (Alsos and Ljunggren, 2017; Karlstrøm et al., 2023). Moreover, participants who were younger or had caregiving responsibilities described heightened scrutiny about their long-term entrepreneurial commitment – an issue compounded by age and motherhood stereotypes. These findings align with research on the “maternal wall” and gender role incongruity, where female entrepreneurs with children are perceived as less dedicated and more risk-averse (Tonoyan and Strohmeyer, 2021).

The long-term implications of these barriers were particularly evident in discussions of entrepreneurial failure. Participants described how failure was often viewed as an irreversible judgment of their competence rather than a learning opportunity, making it more difficult for them to secure reinvestment or start new ventures. Unlike their male counterparts, who often receive second chances from investors following a failed venture, women entrepreneurs must work significantly harder to regain investor confidence, as documented by Pistilli et al. (2023). The compounding effect of this bias not only discourages entrepreneurial persistence but also reduces the likelihood that women will take the necessary risks associated with high-growth ventures.

The insights from this study highlight the urgent need for structural changes in investment evaluation criteria and broader reforms in entrepreneurial finance. While participants identified strategies such as networking, confidence-building and persistence as helpful in navigating these challenges, individual solutions cannot fully overcome deeply embedded systemic biases. Addressing these disparities requires institutional changes (Muntean and Ozkazanc-Pan, 2015), such as the standardization of investment evaluation frameworks to reduce subjectivity in funding decisions, as suggested by Koziol et al. (2025). Additionally, expanding formal mentorship and sponsorship networks for women entrepreneurs is crucial, given that exclusion from high-net-worth investor circles continues to restrict their access to funding (Constantinidis, 2021). There is also a pressing need to reassess risk metrics in evaluating women-led ventures, recognizing that financial conservatism does not equate to lower growth potential, as highlighted by Morazzoni and Sy (2022).

Overall, this study reinforces the deeply ingrained gender biases, structural barriers and self-perception challenges that shape the experiences of female entrepreneurs in healthcare. Despite the persistence of these barriers, women entrepreneurs have demonstrated remarkable resilience by leveraging strategic networking, confidence-building and adaptive fundraising techniques to navigate these challenges. However, these strategies alone cannot fully close the gender gap in entrepreneurship. Meaningful structural and cultural change is required to ensure a truly equitable investment landscape – one that values women-led ventures based on their true economic potential rather than gendered assumptions about risk and leadership.

Concrete institutional reforms could support this shift. For example, implementing standardized, bias-resistant evaluation rubrics that emphasize objective performance indicators – such as customer acquisition, market traction and team credentials – can reduce subjective assessments. Anonymous pitch reviews, investor bias training and incentives for firms that meet gender-diverse investment targets could further support equitable funding practices. Expanding the diversity of investment committees and offering public–private funding matches for women-led ventures are additional steps that could systemically reshape entrepreneurial finance norms.

This study underscores the deeply ingrained gendered barriers that continue to shape the entrepreneurial experiences of women in healthcare, particularly in securing investment and navigating systemic biases. These findings collectively highlight that women healthcare entrepreneurs face persistent and multifaceted challenges in navigating the entrepreneurial finance landscape. Investor bias – manifested through prevention-focused questioning and assumptions about leadership competence – remains a core obstacle. Internalized self-doubt, shaped by impostor syndrome and repeated external skepticism, further constrains women's willingness to pursue external capital and contributes to a preference for bootstrapping. Limited access to informal investment networks and the gendered dynamics of investor–entrepreneur relationships restrict opportunities to scale ventures, even when female investors are involved. Moreover, failure is disproportionately stigmatized for women entrepreneurs, who are less likely to receive second chances and more likely to internalize business setbacks as personal shortcomings.

Key insights from this study include:

1. Investor perceptions and questioning styles continue to disadvantage women, who are judged more on risk and proof than on potential.

2. Impostor syndrome significantly influences women's financial behavior, often leading to conservative projections and missed funding opportunities.

3. Access to capital remains highly gendered, with both male and female investors perpetuating cautious or biased approaches to women-led ventures.

4. Entrepreneurial failure is judged more harshly for women, with long-term effects on reentry and reinvestment prospects.

Despite these barriers, participants identified strategies for navigating the investment landscape, including intentional relationship-building, assertive pitch framing, and persistence in the face of rejection. However, these individual efforts are not sufficient to overcome entrenched structural inequities. A more equitable investment environment will require:

1. Standardized and bias-resistant evaluation frameworks,

2. Expanded mentorship and sponsorship pathways and

3. Targeted support for second-time female entrepreneurs to reduce the long-term effects of failure stigma.

By addressing these structural gaps, the entrepreneurial ecosystem can better recognize and support the full potential of women-led ventures in healthcare and beyond.

Future research should continue exploring the long-term impact of these gendered barriers, particularly by examining how different funding strategies affect the success trajectories of female entrepreneurs. Comparative studies analyzing the performance of bootstrapped female-led firms versus venture-backed counterparts could provide valuable insights into how funding disparities translate into business outcomes. Additionally, further investigation into gendered investor behavior – especially the role of female investors in shaping funding outcomes – could yield important policy implications for reducing gender bias in venture capital and equity financing. Given that entrepreneurship does not exist in isolation, future work should also examine how intersecting factors such as race, socioeconomic background and industry specialization further compound or mitigate these disparities.

Ultimately, fostering an entrepreneurial landscape that fully values and supports women-led ventures requires a fundamental shift in investment culture, policy frameworks and industry norms. By continuing to document, analyze and address these barriers, researchers, investors and policymakers can contribute to a more equitable and sustainable ecosystem – one where female entrepreneurs in healthcare are recognized, funded and empowered to drive meaningful innovation and growth.