Education Research: Trends in Faculty Tenure Status and Diversity in Academic Neurology Departments in the United States.

Background and Objectives: Tenure has long been fundamental to academic medicine, supporting faculty advancement and academic freedom. However, tenure-track positions in US medical schools have declined sharply, raising concerns for academic departments including neurology, a field reliant on a stable workforce to drive research, education, and patient care. This study examines trends in tenure status among academic neurology faculty from 2000 to 2023, focusing on gender and racial and ethnic diversity. Methods: Using the AAMC Faculty Roster through the FAMOUS portal, full-time academic neurology faculty tenure status was classified by gender and race and ethnicity. Underrepresented in medicine (URiM) faculty were defined as American Indian or Alaska Native, Black or African American, Hispanic, or Native Hawaiian, whereas non-underrepresented in medicine (non-URiM) faculty included all other racial and ethnic groups such as Asian, Other Race, Multiple Race, Non-Hispanic, White, and Unknown. Statistical analyses included linear regression for trends and multiple logistic regression to analyze the effects of gender and race and ethnicity on odds of tenure-line status over time. Results: From 2000 to 2023, the number of full-time academic neurology faculty more than doubled (3,149-7,129), and the proportion of non-URiM men declined (69%-51%), whereas the proportion of non-URiM women increased (26%-40%) and URiM faculty increased (5%-9%) (p < 0.001). Adjusting for gender and race and ethnicity, the odds of tenure-line status decreased over time (odds ratio 0.96 per year, p < 0.001). The odds of tenure-line status for all subgroups were lower than for White men throughout the study period. At the current trajectory, this gap will close with time for URiM women (until 2040), Asian women (until 2049), and White women (until 2053), but not for Asian men and URiM men. In 2023, compared with Internal Medicine and Surgery departments, Neurology had greater representation of women, lower URiM representation, and a higher proportion of tenure-line faculty. Discussion: Despite faculty expansion, the proportion of tenure-line positions in academic neurology declined, with persistent underrepresentation of women and URiM faculty, possibly reflecting persistent structural barriers in academic advancement that need to be addressed.