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To investigate the large gender gap in decanal leadership at U.S medical colleges, female Deans were interviewed about the barriers facing women advancing towards deanships. Four main themes emerged during the interviews: (1) the role of relationships in personal and career development, (2) leadership skills and training, (3) barriers between women and leadership advancement, and (4) recommendations to help alleviate these hindrances. The Deans identified lack of mentorship, family responsibilities, the culture of medical colleges and the varied goals of women faculty as contributing factors to the current gender gap. Recommendations from this study include allocating resources and mentorship to career flexibility and faculty development, updating the criteria for deanships, and restructuring search committees.