Objective: This study examines various options that a faculty member might exercise to achieve work-family balance in academic medicine and their consequences for academic advancement. Method: Three data sets were analyzed: an anonymous web-administered survey of part-time tenure track-eligible University of Illinois College of Medicine (UI-COM) faculty members conducted in 2003; exogenous data regarding the entire UI-COM faculty; and tenure rollback ("stop-the-clock") usage by all tenure track-eligible UI-COM faculty from 1994 to 2003. Results: The data reveal a gender split in career-family balance priorities that affect academic advancement among part-time faculty. Women select part-time status for child care; men choose part-time to moonlight. Similarly, among all faculty members seeking tenure rollbacks, women request rollback for child care; men request rollback for other reasons. Among all faculty members, full-time men were more likely to be on the tenure track than any other group. Needs identified by the part-time faculty survey include improved mentoring in track selection, heightened awareness of options, such as tenure rollback, and provision of equitable benefits and opportunities. Conclusions: Policy changes, such as a prorated tenure track, are needed to support a family-friendly culture with flexibility throughout the career lifespan for both men and women medical faculty.