BACKGROUND: The percentage of women graduating from U.S. medical schools has increased dramatically over the past 30 years, but the distribution of women and men across faculty ranks in academic medical centers has remained nearly unchanged. Women remain underrepresented in the senior ranks of academic medicine. The purpose of the study was to evaluate the work environment at Duke University Medical Center, with particular emphasis on gender climate. METHODS: An independent firm conducted structured focus groups and administered questionnaires, analyzed through conjoint analysis. Focus groups were stratified by rank and included the following groups of women: medical students, residents, fellows, junior faculty, senior faculty, and women in fields with few women. RESULTS: The conjoint analysis demonstrated that the women placed high value on the quality of their personal and work lives and rated these as more important than other traditional markers of career success, such as stature of their institution or earnings potential. Discussions during the focus groups elaborated on what "quality of personal and professional life" meant. They described a need for career efficiencies that allow individuals to excel professionally while also honoring their personal values and responsibilities. The discussions also suggested that similar problems have increasing importance for men. CONCLUSIONS: The results suggest that institutions should provide more alternative models of success and increase flexible work options. Future studies of women in academic medicine should explore the role of value conflict in career development in academic medicine and probe the idea that the priorities articulated by the women in these focus groups may reflect the values of a generation as much as they do gender.