Persisting disparities between the sexes in academic medicine have been the experience of many and have been well-documented objectively in recent years both by female and male authors.1-4 Although the situation is undoubtedly improving, there is still a long way to go, in particular with respect to career opportunities and more prestigious leadership positions.1, 5, 6 This article will convey some of our personal experiences and insights that we have gathered throughout our long careers within the lymphoma field as pathologist, hematologist, and clinical oncologist respectively, and discuss these in light of published literature. A number of great women of the past and present have made brilliant careers within this field, but they tend to be unique. It is worrying that the process of lowering gender inequality seems to stagnate at mid-level positions. Here, we would like to address the issues facing female doctors. What are the issues that may be encountered when aiming for promotion, academic advancement, leadership opportunities, and improved financial rewards? As inspiring as the role models of those women with brilliant careers may be, this is not necessarily the aim of a “career” neither for women nor for men. In our opinion, a career should be the opportunity to achieve a position in the medical field of one's own choice and abilities, not determined by restrictions put there by convention or tradition. Advocacy programs in the academic environment aim at change toward gender equality, with the best of intentions. However, the generation that is now embarking in their career, the millennial generation, increasingly seem to expect that the course of their lives can and should be planned. However, the rational minds tell us the contrary, as does daily practice. Then what may determine how choices are made and careers develop? Looking at the careers of others and of ourselves, we realize that two aspects are essential: encounters with those who inspire us and taking the opportunities, also the unexpected, as they happen to come across by chance. In the latter part of the 19th century the first women to qualify as medical doctors began to appear. These were legendary, exceptional women in medicine who paved the road for next generations. For many years, the percentage of female medical students stagnated at 20%, only gradually starting to rise from the mid-1970s. After the early 1990s, the rise went steep to reach a predominance of female medical students up to almost 70% in the last few years.7 The choices of various specialty trainings are, however, unequally distributed with a significant dominance of female representation in gynecology, pediatrics, and dermatology as well as in pathology next to the specialties that are traditionally regarded as “female” such as general practice, family and community medicine.7 Specialties regarded as “hard core medicine” such as cardiology, emergency medicine, and general surgery are still significantly underrepresented. A study of 6030 faculty from 265 academic medical oncology, radiation oncology, and surgical oncology programs found that women constitute 35.9% of total faculty, a disparity that was even higher at the leadership level.1 The social perception today that there is feminization of the medical profession as a whole is not true, but unfortunately, this perception has led to an underappreciation and lower status of the profession. This especially holds true where women are overrepresented, while “male specialties” are relatively spared. The impact of status is not only observed in society, but also within the hospital and academic hierarchy and reflected in inequality in wages.8-10 Nasty, but what should we do about it? The road toward change is to speak up when being confronted with gender-biased decisions and unequal career opportunities and building support groups to create momentum. At the national and international level these now constitute a critical partner for policy makers. In our experience, local peer-groups are essential to achieve changes at the local level, University or Institution, while playing a role in protecting the position of the individual, who could be a vulnerable target in an academic arena of power. Thereby, female mentors can have a pivotal role as may the male colleagues of today's generation. Would it be a solution to install quota on female participation at higher academic positions as has been suggested in various countries? Opinions differ on this. On one hand this may seem attractive as it will forcibly increase numbers. But will it help acceptance of appointed women at the positions? Probably not. In fact, special treatment for women may only serve to reinforce an old-fashioned male/female pattern of behavior. This would be unwanted, and an active female strategy is to be preferred. Ambitious women who engage themselves in research and do a major part of the work, including data collection, protocol and manuscript writing may often find that a man is ready to position himself as principal investigator, first author, presenter etc., even when less qualified.11, 12 While first authorships are very important early in a career, last authorships are even more so to support career development toward independent and more prestigious clinical and research positions. Currently last authorship often falls automatically to the senior group leader. Therefore, women will need to learn to promote themselves and put themselves forward. It does not work to wait to get invited. It takes some effort to get the credit for one's work. To quote a female applicant for a position as head of department: “God grant me the confidence of a mediocre man.” Obviously, we do not encourage anybody to overinflate their egos, but you will need to think and plan ahead to get just and fair recognition for your contributions. Thereby, the role of the mentor and organization should not be underestimated by providing effective mentorship, clear expectations for advancement and transparent and objective criteria for promotion and tenure. For a young physician starting a career in medicine good mentoring is increasingly essential to effectively find a way in the complex, competitive world of academic medicine and research, and in making the best fitting choices to fulfill one's potential. Here we would like to discuss some opportunities and pitfalls in the relation between mentor and mentee. With respect to terminology (we found out that the term is used somewhat differently in various countries) there are two types of mentorships. One is the mentor as a supervisor/instructor, who can provide guidance on how to acquire the necessary knowledge and experience, give advice on what activities to prioritize, and provide guidance on how to get started in research on an appropriate subject as well as acting as a formal supervisor for a PhD thesis. The other aspect is a more personal one and refers to support on how to shape one's attitude toward patients and colleagues and how to find the best position in the academic arena as a young medical professional and especially as a young female doctor. This latter mentor may be an important personal role model. It is a privilege to encounter such a trusted inspirational mentor and we personally regard this as a gift of fate. The supervisor/instructor on the other hand is a formal position with formalized duties, commitments, and expectations. The gains for the mentee are obvious as she/he receives education, training, and scientific guidance, but she/he should realize that the mentor/mentee relationship is reciprocal.13 For the mentor/supervisor, mentorship is a career step that contributes to career advancement and may be a formal criterion for promotion and tenure. In view of this career interest, the (female) mentor should be aware of two pitfalls: ghost advising and hostile takeover. Young medical colleagues or PhD students frequently chose a supervisor based on (his) major, international reputation. Understandably, the mentor relation is regarded as a significant steppingstone toward a flourishing career. However, all too often in practice, the “Joe Important” turns out to be suboptimally approachable, leaving the tasks of the daily mentor position to a junior staff member, often a female one. This phenomenon is called ghost mentoring and is detrimental for career development of the female junior staff member, who does the work but does not get the credit.14 The female mentee should be aware of this so that appropriate credit is obtained, for example, by a formal co-supervisor designation and appropriate senior authorships. Career hijacking is a phenomenon that seems to be a particular problem when the mentor is female. We have all experienced problems with some mentees, who seem to expect that the outcome of a mentor-mentee relation is to take over the field and position from the mentor, who is (conveniently?) expected to hand over. The mentee should remember that no mentor can and should guarantee a PhD, a career, or eventually a senior position. A career in academic medicine is a long, exacting, and demanding path to take, and one should always approach this daunting prospect with some humility. A caveat that we have encountered in our careers when working with groups of women professionals in research labs, in clinical research, on the wards and in various other situations, and would like to address is the so-called crab mentality. This is the phenomenon where people react negatively to those who are more successful and actively impede those to achieve their goals, without necessarily aiming to improve their own. The name comes from the observation that crabs fail to escape from a trap because they keep pulling back any crab who manages to get to the top. Most unfortunately, this seems to be a mechanism that is especially present in female working groups and is thought to result from various irrational and subconscious assumptions such as feelings of insecurity or inferiority, and group behavior of equality and blending in. At its worst, this results in bullying, betrayal and canceling from the group, just to prevent someone from advancing. While being so obviously detrimental, the phenomenon is widespread in the academic environment and a cause of impeding effective career advancement. In many instances, it may be preferable to just go one's own way, seek out collaborators (and mentors and mentees) who are genuinely supportive, rather than remain in the group of crabs. When discussing the subject of crab mentality, we came across the rarely addressed subject of the changing complex social interactions between medical doctors and nursing staff that we have experienced in the earlier years of our careers and still observe. A recent article in Forbes reported that women physicians may not be able to exert professional authority to gain cooperation from support staff. Women reported feeling pressure to erase status difference between them and their staff, so they helped with nursing tasks and made extra efforts to be warm and friendly, making their work harder. Culturally determined expectations as well as a crab mentality underlie these dynamics, that seem to be unique to the interactions between higher-status and lower-status women. Male doctors reportedly do not experience this problem from women nurses, and neither male nor female doctors get it from male nurses. Only by being aware and address the issue, this behavior can be overcome. And always remember this quote from the ever-inspirational Madeleine K. Albright: “There is a special place in hell for women who don't help other women!” From our Baby Boom generation to the present Millennials, the ideas on work/life integration have evolved, resulting in different personal expectations. Some socially and culturally determined aspects have remained disappointingly unchanged, however. It is still largely the norm that women serve as caregivers for the family, for aging parents and keeping the household going. Moreover, that it is women going through pregnancies has also not changed much. Many women in early academic careers are in “dual-career relationships,” but cultural expectations are still mostly that the career of the woman partner is the secondary one. Albeit that at the personal level, this is not necessarily or even generally the case. Whatever the norm implicitly set by culture, society, and generation may be, the challenges are major. Not all hopes and dreams one may have as a young woman doctor may be realistic and inevitably choices need to be made. Is your goal an academic specialized career, or to be a caring doctor with knowledge in many fields of medicine? Your family background may affect your choice and opportunities, as does your present social circumstances. For most academic positions both hard clinical work and great scientific research are required. The choice if and when to start a family is therefore not an easy one. In practice, lack of availability of daycare for children, paid help at home, and the time caring for your family can be an obstacle for a career. The differences between countries in governmental support and social conventions are large, as we even note for our three Northern European countries. From our personal experience, we feel that if you decide having children, it may not be the best idea postponing too long. It is never the perfect time, but there is a “biological clock.” In fact, having young children while in an early career phase that does not bear major end-responsibilities for a large group of collaborators, is not bad timing at all. It is worrying to realize that a disproportionally high rate of female physicians report infertility and pregnancy complications (25% for physicians in general, up to 42% for female surgeons). This is largely related to advanced maternal age and patient (the pregnant doctor) delay in case of health problems.15 Tensions in work/life balances complicated by professional challenges encountered when building a career in academic medicine contribute to a disturbingly high rate of burnout among medical professionals, both male and female. Far too often, the sad result being resigning from the academic career. Unfortunately, female physicians are most likely to be affected.16 As causes, many of the issues described in this review are identified, including unequal pay, lack of mentorship, limited career opportunities, home constraints, and health. Solutions are not easy but recognizing the problem and admitting that all aspects underlying inequality play a role is a first step. It is our personal opinion that academia should take a responsibility in this matter by offering awareness programs preferably starting early in medical training so that behavior preventing burnout becomes ingrained in the medical profession for both women and men. In this article we have tried to highlight some of the most important issues to be aware of and consider when embarking on a career in academic medicine as a young female doctor. We have summarized the key points in Table 1. The three of us have all had very rewarding careers in hematology/oncology. We have encountered, quite frequently, the issues mentioned above, and it has been a major challenge tackling these in the best possible manner at the time. However, gender inequality in academic oncology remains a significant issue. The scope of inequality issues has broadened in the past years with awareness rising on class, race, ethnicity, geographical location, immigration status, sexuality, and many others for which similar processes are encountered as we describe here.17 So, instead of being discouraged, use the obstacles as an incentive to fight back, to analyze, plan and execute your plans, and you will end up the stronger for it. Our field is full of opportunities. Surround yourself with people who inspire Recognize and take opportunities as they may come unexpectedly Understand the pitfalls of mentor—mentee relation to the benefit of both Avoid the “crab mentality” and pay it forward Do not wait to “start life” (i.e. family, other personal choices) Strive to reach your goals, but be aware of burn-out D. de Jong received grants (paid to her institution) from Roche and Lunenburg Lymphoma Biomarker Consortium. L. Specht received grants (paid to her institution) from Danish Cancer Society, Varian, and ViewRay. L. Specht received royalties from Springer Verlag and Munksgaard Publishing. D. de Jong and L. Specht received speaker honoraria from Takeda. D. de Jong received reviewer honoraria from Terry Fox Foundation and Swiss Cancer Society. E. Kimby received honoraria from AbbVie and Janssen. E. Kimby received payment for expert testimony from Pierre Fabre. D. de Jong received support for attending meetings from European Hematology Association and GLOW. L. Specht received support for attending meetings from Kyowa Kirin. D. de Jong is on advisory board for Nanostring. E. Kimby is on data safety monitoring board for Genmab, and on advisory board for Pierre Fabre and Beigene. L. Specht is on advisory board for Takeda and Kyowa Kirin. D. de Jong has a leadership role in European Association for Haematopathology, HOVON Pathology Facility and Lunenburg Lymphoma Biomarker Consortium. L. Specht has a leadership role in International Lymphoma radiation Oncology Group, Danish Lymphoma Radiation Oncology Group, and Danish Lymphoma Group. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1002/hon.3193. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.