The purpose of this article is to analyze the status of women in academic medicine, and to identify the institutional factors that may influence women's academic advancement in medicine. Many of these factors are viewed in a broad perspective, revealing the general challenges that women face in the academic world. This article is divided into three sections. The first is a review of the current status of women in academic medicine and it focuses on enrollment, selected specialties, rates of academic promotion and disparities in salaries between women and men. The second section addresses obstacles to the advancement of women in academic medicine and looks at mentorship, rigidity in career structures, sex discrimination, and the impact of family and domestic responsibilities. The third section proposes solutions for women pursuing careers in academic medicine. The content and foci of this paper are gathered from a variety of disciplines including sociology, psychology, gender studies and medicine. The suggestions for change included in this paper may be implemented across all of academia, not just in medicine, as they address common issues for all women.