Prior research suggests disparities in gender, racial, and ethnic representation in the US academic neurology workforce, but this has not been longitudinally evaluated over decades.

To examine gender, racial, and ethnic representation trends among US academic neurology faculty between 1972-2021.

Gender, racial, and ethnic data were extracted from Association of American Medical Colleges (AAMC) US Medical School Faculty annual reports (1972-2021) of active full-time neurology department faculty. Gender, racial, and ethnic trends among US neurologists were examined by academic rank (1972-2021) and department chair status (1977-2021) using multivariable linear regression. Subgroup differences were evaluated by analysis of variance and pairwise t-test. Multiple comparisons were conducted by Tukey’s honestly significant difference.

From 1972 to 2021, there was an increase in the proportion of women (32.9%), American Indian or Alaska Natives (0.1%), Asian (16.3%), Black (1.4%), Native Hawaiian or Other Pacific Islanders (0.1%), and Hispanic (0.4%) US academic neurologists. Annually, the prevalence of women neurologists increased by 0.71% [95%CI: 0.66-0.76%; P<0.0001], Asian by 0.35% [95%CI: 0.23-0.47%; P=0.0001], Black by 0.030% [95%CI: 0.016-0.044%; P=0.001], and Hispanic by 0.023% [95%CI: 0.006-0.039%; P=0.01]. At each academic rank, there was a greater proportion of men than women (all P<0.0001) and of white than Asian and Black (both P<0.0001). Higher ranks had greater proportional disparity. Of neurology chairpersons (1977-2021), there was a greater proportion of men than women and of white than Asian and Black neurologists (all P<0.0001).

Over the past five decades, there has been an increase in diversity among US neurology faculty, though less pronounced in leadership positions. Women and racial-ethnic minorities remain underrepresented, especially in senior academic ranks and leadership positions. This representational gap may negatively impact healthcare productivity and patient outcomes. Future work should identify and address barriers to promote diverse, equitable representation within US academic neurology.