To assess the long-term trends in tenure status, especially according to gender and underrepresented in medicine (URiM) status among academic neurology faculty in US medical schools.

Tenure-track positions in U.S. medical schools have sharply declined over time. The trends in tenure status and its correlation with gender and race/ethnicity in academic neurology is not well known.

We conducted a secondary analysis of the AAMC Faculty Roster with data from 2000 to 2023. Full-time academic neurology faculty were categorized by gender, race/ethnicity, and tenure status, and compared with 17 other clinical departments. Tenure status was dichotomized into tenure-line (tenured or on tenure-track) and non-tenure-line faculty. Trends were assessed using simple linear regression and chi-squared tests, with statistical analyses performed using Python 3.12.0

The number of full-time U.S. academic neurology faculty rose from 3,149 in 2000 to 7,129 in 2023, with an annual increase of 180 members (95% CI [174–187], P<.001). The annual increase was largest among non-URiM women (+93 annually), followed by non-URiM men (+65), URiM women (+12), and URiM men (+11) (P<.001). The proportion of non-URiM men fell from 69% to 51%, while non-URiM women rose from 26% to 40%. Non-tenure-line faculty tripled, and tenure-line faculty grew 1.5 times. Compared to other clinical departments, neurology had fewer women (44.6% vs. 45.2%) and URiM faculty (9.3% vs. 10.6%) but a higher tenure-line faculty proportion (26.7%, P<.001).

From 2000 to 2023, academic neurology in the U.S. experienced substantial growth in total faculty numbers, particularly among non-URiM women and men. However, the proportion of tenure-line faculty declined overall, with persistent underrepresentation of women and URiM compared to non-URiM men. These findings underscore the need for targeted policies to improve tenure-track opportunities to promote equity and diversity within academic neurology departments.