Representation of Medical Specialties in Dean’s Cabinets at the Top 40 NIH-Funded United States Medical Schools

Representation of Medical Specialties in Dean’s Cabinets at the Top 40 NIH-Funded United States Medical Schools | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Representation of Medical Specialties in Dean’s Cabinets at the Top 40 NIH-Funded United States Medical Schools Anagha Thiagarajan, Luke Horton, Ajay Sharma, Nathan Rojek This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7661591/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jan, 2026 Read the published version in BMC Medical Education → Version 1 posted 14 You are reading this latest preprint version Abstract Background Academic leadership within medical schools shapes institutional culture, policy, and educational priorities. While demographic diversity has been studied, specialty representation in leadership is less understood. This study evaluates the distribution of medical specialties in dean’s cabinets at the top 40 National Institutes of Health (NIH)-funded United States medical schools compared with national and hospital-based physician workforce data. Methods Publicly available institutional websites were reviewed to identify dean’s cabinet members across eight common leadership roles. Degree type and specialty (for MD/DO holders) were obtained from institutional profiles. Specialty representation was compared with 2023 national and hospital-based physician workforce data using paired t-tests. Results Of 320 leaders identified, 287 (89.7%) held an MD or DO. Internal Medicine (IM) accounted for 46.0%, followed by Pediatrics (13.2%) and Obstetrics/Gynecology (5.6%). Compared with the national workforce, IM (p < 0.0001), Pediatrics (p = 0.006), and Neurosurgery (p = 0.003) were overrepresented, while Family Medicine (FM; p < 0.0001), Emergency Medicine (p = 0.04), Anesthesiology (p = 0.008), Orthopedic Surgery (p = 0.016), and Ophthalmology (p = 0.037) were underrepresented. Similar trends were observed against hospital-based workforce data, with additional overrepresentation of Dermatology (p = 0.0008), ENT (p = 0.0005), and Plastic Surgery (p < 0.00001). Among IM leaders, 41.4% were generalists and 58.6% subspecialists, most commonly in Cardiology, Infectious Disease, and Pulmonary/Critical Care. Conclusions Dean’s cabinets at top NIH-funded medical schools are dominated by IM and Pediatrics, with primary care, acute care, and procedural specialties underrepresented. These disparities may influence curriculum design, mentorship, and institutional responsiveness. Leadership development initiatives targeting underrepresented specialties could diversify expertise in academic medical governance. Representation Medical Specialties Dean’s Cabinet Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Academic leadership within medical schools is pivotal in shaping institutional culture, policy, and priorities. The composition of leadership teams, such as the dean’s cabinet, not only reflects institutional values but can also influence strategic planning, access to mentorship, and educational opportunities for both faculty and students. Understanding which specialties dominate leadership roles in key functional areas can provide insight into how medical institutional priorities are shaped, and which specialties may be better positioned to influence curricular and policy development. Despite growing awareness of disparities (eg. gender, race, degree diversity) in medical education, little is known about how medical specialties are represented across high-level academic leadership roles. 1 – 3 Given the increasing unmet need for primary care physicians, it is essential to examine the representation of medical specialties in decision-making positions, particularly at the nation’s most research-intensive medical schools, which often shape the broader climate of medical education and influence national priorities. 4 , 5 This gap is particularly relevant as medical schools strive to increase transparency, promote inclusive leadership, and ensure that institutional priorities align with the diverse specialties that constitute modern medicine. By analyzing the medical specialties of dean’s cabinet members at the top 40 National Institutes of Health (NIH) funded United States (U.S.) medical schools and comparing them to the national physician workforce data, this study characterizes patterns of medical specialty representation across core leadership roles in top medical institutions to inform future leadership development and equity initiatives. Methods A review of publicly available institutional websites was conducted to identify dean’s cabinet members of the top 40 NIH-funded medical schools. Dean’s cabinet members were stratified by the top 8 most common leadership titles: Dean, Dean for Student Affairs, Dean for Faculty Affairs, Dean for Clinical Affairs, Dean for Education, Dean for Research, Dean for Admissions, and Dean for Diversity, Equity and Inclusion. Alternate titles were considered in data collection as leadership role naming varies by institution (Table 1 ). Members holding an MD, DO, combined degree (eg. MD/PhD, MD/MBA), PhD, MPH, MHA, or EdD were included in the analysis, and only members holding an MD or DO were included in the analysis of specialty representation. Each member’s specialty was determined using institutional profiles and professional biographies. The proportion of dean’s cabinet members in medical specialties identified was compared to the latest available (2023) national physician workforce data and hospital-based workforce data to assess medical specialty representation, utilizing pair t-test analysis in Microsoft Excel. 5 The Association of American Medical Colleges (AAMC) defines the hospital-based physician workforce as those whose primary professional activity occurs within a hospital setting involving direct patient care and working 20 or more hours per week. 5 Hospital-based workforce data was included in this analysis to provide a comparison to a setting most similar to academic medical institutions. Table 1 Alternate role titles for dean’s cabinet members Standard Role Common Alternate Titles Dean Dean, School of Medicine, Dean of the Medical School Dean for Student Affairs Associate Dean for Student/Academic Affairs, Assistant Dean for Student/Academic Affairs, Dean of Students Dean for Faculty Affairs Associate Dean for Faculty Development, Assistant Dean for Faculty Affairs Dean for Clinical Affairs Vice Dean for Clinical/Medical Affairs, Senior Associate Dean for Clinical/Medical Affairs Dean for Education Vice Dean for Education, Senior Associate Dean for Medical Education, Associate Dean for Curriculum Dean for Research Vice Dean for Research, Senior Associate Dean for Research/Clinical Research, Associate Dean for Biomedical Research Dean for Admissions Associate Dean for Admissions, Assistant Dean of Admissions Dean for Diversity, Equity and Inclusion Associate Dean for DEI, Assistant Dean for Diversity, Vice Dean for Inclusion, Dean for Multicultural Affairs Results Of the top 40 NIH-funded medical schools, 320 total dean’s cabinet members were identified. Dean’s Cabinet Members holding an MD or DO 287 (89.7%) members held either an MD or combined degree (eg. MD/PhD, MD/MBA), with only one member holding a DO degree. Internal Medicine (IM) (132, 46.0%) was the most represented specialty overall, followed by Pediatrics (38, 13.2%), Obstetrics and Gynaecology (OB/GYN) (16, 5.6%), Psychiatry (13, 4.5%), Radiology (13, 4.5%), Emergency Medicine (EM) (11, 3.8%), and Family Medicine (FM) (10, 3.5%). The most common specialty across all dean’s cabinet roles was IM (Table 2 ). The distribution of specialties by dean’s cabinet role is further characterized in Fig. 1 . Table 2 First and second most represented specialties by dean’s cabinet role Dean’s Cabinet Role Most Represented Specialty (#) 2nd Most Represented Specialty (#) Dean Internal Medicine (18) Pediatrics (6) Dean for Student Affairs Internal Medicine (19) Pediatrics (7) Dean for Faculty Affairs Internal Medicine (16) Pediatrics (5) Dean for Clinical Affairs Internal Medicine (14) Urology (4) Dean for Education Internal Medicine (21) Pediatrics (4) Dean for Research Internal Medicine (20) Pediatrics (5) Dean for Admissions Internal Medicine (9) Emergency Medicine (5) Dean for Diversity, Equity and Inclusion Internal Medicine (15) Pediatrics (4) Of the 128 IM Dean’s Cabinet members, 53 (41.4%) were general hospitalists while 75 (58.6%) belonged to various subspecialties. The most represented IM subspecialty throughout all dean cabinet roles was Cardiology (16, 21.3%), followed by Infectious Disease (15, 20.0%) and Pulmonary/Critical Care (11, 14.7%). Cardiology (4, 5.3%) and Pulmonary/Critical Care (4, 5.3%) were the most common subspecialties to fulfill the position of Dean, Infectious Disease (3, 4.0%) for Dean of Student Affairs, Pulmonary/Critical Care (2, 2.7%) and Rheumatology (2, 2.7%) for Dean of Faculty Affairs, Pulmonary/Critical Care (2, 2.7%) for Dean of Clinical Affairs, Infectious Disease (3, 4.0%) for Dean of Education, Cardiology (3, 4.0%) for Dean of Research, Cardiology (2, 2.7%) for Dean of Admissions, and Cardiology (4, 5.3%) for Dean of Diversity, Equity and Inclusion. The distribution of IM subspecialties by dean’s cabinet role is further characterized in Fig. 2 . Dean’s Cabinet Members holding other graduate degrees Of the 33 dean’s cabinet members holding a graduate degree other than an MD or DO (eg. PhD, MPH, MHA, EdD, MA), 25 (75.8%) held a PhD degree. 12 (36.4%) of these members were identified as a ‘Dean for Research.’ Comparison to National Workforce Representation Compared to the U.S. Physician Workforce Data, Anesthesiology (p = 0.008), EM (p = 0.04), Orthopedic Surgery (p = 0.016), Ophthalmology (p = 0.037), and FM (p < 0.0001) were underrepresented while IM (p < 0.0001), Neurosurgery (p = 0.003), and Pediatrics (p = 0.006) were overrepresented in the dean’s cabinets of top 40 NIH funded medical schools. These relationships are further characterized in Fig. 3 . Comparison to Hospital Based Workforce Representation Compared to the Hospital-Based Workforce Data, Anesthesiology (p < 0.0001), EM (p = 0.00003), and FM (p = 0.0084) were underrepresented while Dermatology (p = 0.0008), ENT (p = 0005), IM (p < 0.0001), Neurosurgery (p = 0.0001), OB/GYN (p = 0.0035), Pediatrics (p = 0.006), and Plastic Surgery (p < 0.00001) were overrepresented in the dean’s cabinets of top 40 NIH funded medical schools. These relationships are further characterized in Fig. 4 . Discussion This study reveals a striking concentration of medical school leadership in IM (132, 46.0%), Pediatrics (38, 13.2%), and OB/GYN (16, 5.6%). IM alone represents almost half (46%) of all dean’s cabinet members, an overrepresentation compared to the national physician workforce share (12.5%, p < 0.0001) as well physicians working in a full-time hospital-based setting (15.0%, p < 0.00001). 5 Notably, IM and pediatrics also consistently rank as the top two specialties across every cabinet role compared to national data. This pattern could be a reflection of physicians in primarily hospital-based specialties being more routinely involved in institutional operations, providing them with earlier and more frequent opportunities to engage in academic leadership. Moreover, IM and pediatrics are often regarded as the backbone of medicine, as both are generalist fields that emphasize holistic, longitudinal, and systems-based care. 6 This broad scope of practice may cultivate the adaptability, interdisciplinary collaboration, and institutional insight that are well-suited for leadership roles in academic medicine. 7 Interestingly, despite the critical roles that FM, EM, and Anesthesiology play in healthcare delivery, these specialties remain significantly underrepresented among leadership in the dean’s cabinets of the nation’s top medical schools. FM and EM are both central to primary care, population health, and community engagement, and their representation (FM: 3.5%, EM: 3.8%) is notably scarce in comparison to the proportion of practicing FM and EM physicians in the nation (FM: 12.2%, EM: 5.0%) (p < 0.0001 and p < 0.05 respectively) as well as those employed in hospital-based settings (FM: 7.6%, EM: 11.7%) (p < 0.00001 and p < 0.0001 respectively). Similarly, anesthesiology, which plays an integral role in perioperative medicine and patient safety, is likewise underrepresented in medical leadership (2.1%) when compared to the proportion of practicing anesthesiologists in the nation (4.3%, p = 0.008) or hospital-based settings (6.3%, p < 0.00001). These findings carry important implications for institutional equity and the shaping of medical education priorities. Underrepresentation of FM and EM is concerning given the national emphasis on addressing primary care shortages and health disparities especially in rural areas, and the rising amount of health misinformation available to the public. 8 , 9 FM is uniquely positioned as a first line point of contact for patients, and plays a pivotal role in healthcare delivery, patient safety, and coordination of care, equipping patients with the knowledge and support needed to navigate complex health systems effectively. It is an integral pillar of medicine that needs to be appropriately represented in medical school leadership. The limited representation of FM physicians in leadership roles may reduce opportunities to incorporate perspectives that emphasize community-based care, interprofessional education, and interdisciplinary collaboration. Additionally, EM physicians serve as critical first-line providers who not only triage diverse clinical presentations but also play an essential role in medical education by training students and residents in acute care, clinical decision-making, and interdisciplinary teamwork. This disparity may offer insights on a general trend in which medical graduates pursuing hospital-based specialties characterized by longitudinal care express desire to engage in institutional leadership, whereas medical graduates entering fields like FM, EM or Anesthesiology may prioritize different professional goals and resultingly encounter fewer academic leadership opportunities. 10 Still, the disproportionate representation of certain fields in comparison to the national workforce (eg. IM, Pediatrics, Neurosurgery) in this study raises questions of curricular rigidity, limiting the integration of emerging or cross-disciplinary specialties that are increasingly relevant to modern medicine, such as dermatology (1.0%) or ophthalmology (0.7%). For instance, underrepresented specialties including anesthesiology (2.1%) and EM (3.8%) benefit tremendously from educational modalities such as simulation-based learning and telehealth training. 11 , 12 Additionally, fields such as radiology (4.5%) and dermatology (1.0%) have vast applications in primary care settings, yet remain a small portion of the dean’s cabinet leadership. 13 , 14 This calls to attention the potentially negative impact of underrepresenting medical specialties that have broad applications touching all facets of modern medicine. Limited input from procedural or technology-driven fields such as these may delay the inclusion of simulation-based learning, telehealth training, or interdisciplinary team models in medical education. Given the increasing complexity of patient care and the prevalence of comorbidities, exposure to academic mentors comprising a diverse range of clinical specialties and perspectives is essential to cultivating advanced critical thinking skills in medical students. 15 Compensation may be one factor influencing the over- or underrepresentation of certain specialties in medical school leadership. Fields such as IM or pediatrics are overrepresented medical specialties in deans’ cabinets, which may in part be explained by these leadership roles offering a financial incentive compared to their traditional practice with lower-than-average clinical salaries in comparison to other medical specialties. 16 In contrast, highly compensated medical specialties such as anesthesiology, EM, or orthopedic surgery, which are underrepresented in leadership, may face a financial disincentive to pursue administrative roles that involve reduced clinical time and potentially lower overall compensation. 16 Interestingly, certain surgical fields such as neurosurgery and plastic surgery are overrepresented despite typically commanding some of the highest clinical salaries. 17 In these cases, the appeal of leadership may stem from other factors, such as influence over departmental priorities, academic advancement, or institutional prestige. This suggests that motivations for assuming administrative roles likely extend beyond compensation alone and may vary by specialty culture, career trajectory, and perceived impact within academic medicine. Limitations This study has several limitations. First, focusing on the top 40 NIH-funded medical schools may cause our findings to be subject to selection bias and as a result limit the ability to generalize these findings to all medical education institutions. This analysis also excludes osteopathic, community-based, or rural medical schools, which may prioritize different leadership models and clinical specialties. Additionally, this is a cross-sectional study that relies on publicly available websites to identify dean's cabinet members as of February 2025, allowing for the possibility of inaccuracies due to outdated or incomplete information or misrepresentations of longitudinal trends. Finally, this study limited inclusion to the eight most common leadership titles, which may exclude other, institutionally specific, influential leadership roles and in turn underrepresent certain specialties that may be more likely to fill these less common roles. Conclusions As medical education grapples with evolving population diversity, expanding scopes of practice, and increasing competition regarding the residency application process, equitable specialty representation at the leadership level is essential to ensure that the medical school curriculum is adaptable, inclusive, and forward-looking. Although this study highlights the disproportionate presence of certain specialties in academic leadership, further research is needed to assess how these imbalances may shape curricular development, mentorship opportunities, and institutional priorities. Future studies could explore whether greater specialty diversity among leaders influences student career interests or promotes more comprehensive institutional decision-making. In response, medical schools might consider implementing structured leadership development programs for faculty in underrepresented specialties to foster more representative and well-rounded leadership teams. Abbreviations NIH National Institutes of Health AAMC Association of American Medical Colleges IM Internal Medicine OB/GYN Obstetrics and Gynaecology EM Emergency Medicine FM Family Medicine Declarations Ethics Approval and Consent to Participate This study did not require ethical approval by the Institutional Review Board as it does not include human subjects. Consent for Publication Not applicable. Competing Interests Dr. Nathan Rojek has received consulting fees from Boehringer Ingelheim and royalty payments from McGraw Hill. Funding Not applicable. Author Contribution A.B.T. contributed to the conception, analysis and interpretation of data, writing and revising of the manuscript. L.H. contributed to the conception, interpretation, and revising of the manuscript. A.N.S. contributed to the conception, interpretation, and revising of the manuscript. N.W.R. contributed to the conception, interpretation, and revising of the manuscript. Acknowledgements Not applicable. Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Data was gathered from information on publicly available institutional websites. References Silver JK et al. (2018). Women physicians underrepresented in academic leadership. JAMA Intern Med https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2686149 Guevara JP et al. (2013). Minority faculty development programs and underrepresented minority faculty representation. 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Available from: https://www.ncbi.nlm.nih.gov/books/NBK557711/?utm_source=chatgpt.com Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Society for Academic Emergency Medicine 2020 Consensus Conference. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med. 2021;28(12):1452–1474. 10.1111/acem.14330 . Epub 2021 Jul 21. PMID: 34245649; PMCID: PMC11150898. Panagoulias DP et al. Dermacen analytica: A novel methodology integrating multi-modal large language models with machine learning in tele-dermatology. a rXiv preprint a rXiv:2403.14243 (2024). Cherryman G. Imaging in primary care. Br J Gen Pract. 2006;56(529):563–4. PMID: 16882370; PMCID: PMC1874516. Snedden SJ, Thein P, Chee WJ, Ong J, Junckerstorff R. Are our patients becoming more complex? Trends in comorbidity and functional dependence in General Medicine 2011–2019. Intern Med J. 2024;54(11):1849–55. 10.1111/imj.16505 . Epub 2024 Sep 10. PMID: 39257164. Leigh JP et al. Physician wages across specialties: informing the physician reimbursement debate. Arch Intern Med 170,19 (2010): 1728–34. 10.1001/archinternmed.2010.350 Leigh JP, et al. Lifetime earnings for physicians across specialties. Med care vol. 2012;50(12):1093–101. 10.1097/MLR.0b013e318268ac0c . Additional Declarations Competing interest reported. Dr. Nathan Rojek has received consulting fees from Boehringer Ingelheim and royalty payments from McGraw Hill. Cite Share Download PDF Status: Published Journal Publication published 05 Jan, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 02 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviews received at journal 24 Nov, 2025 Reviewers agreed at journal 24 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviews received at journal 02 Nov, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers invited by journal 13 Oct, 2025 Editor invited by journal 26 Sep, 2025 Editor assigned by journal 25 Sep, 2025 Submission checks completed at journal 25 Sep, 2025 First submitted to journal 19 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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16:13:17","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56567,"visible":true,"origin":"","legend":"","description":"","filename":"7fb412b82e154fc1bd6bbcdf5151f02c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/da05a7d29d7055113a35cc50.xml"},{"id":94481411,"identity":"e19b987c-f170-4a00-b4d7-b7c195eb3fd9","added_by":"auto","created_at":"2025-10-27 16:13:18","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":61014,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/ebbf58d627160c5254a82bef.html"},{"id":94481071,"identity":"8f145012-7ad3-4f2f-81e1-991c5cbfd9db","added_by":"auto","created_at":"2025-10-27 16:12:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2442262,"visible":true,"origin":"","legend":"\u003cp\u003eHeat map of represented specialties by dean’s cabinet role\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/0d594492a9d9827fb6f40b3c.jpg"},{"id":94481563,"identity":"5ee1e630-f4a3-4463-a661-af4f71044cba","added_by":"auto","created_at":"2025-10-27 16:13:46","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2140104,"visible":true,"origin":"","legend":"\u003cp\u003eHeat map of represented internal medicine sub-specialties by dean’s cabinet role\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/45ea0a1adb25511885f1be1f.jpg"},{"id":94480825,"identity":"90e40055-0c06-424b-b384-b78614f2d313","added_by":"auto","created_at":"2025-10-27 16:12:04","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1621801,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of represented specialties in dean’s cabinet to U.S. physician data\u003c/p\u003e","description":"","filename":"FIgure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/059cd218b849e6ba52efb4b0.jpg"},{"id":94481472,"identity":"0999be12-d883-45f1-8b0b-701796e30125","added_by":"auto","created_at":"2025-10-27 16:13:28","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1687453,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of represented specialties in dean’s cabinet to full-time hospital-based employees\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/c7c50d650ee9e84c0c878c03.jpg"},{"id":100069043,"identity":"a67fde80-97f4-46eb-8e4a-c95a60f6649f","added_by":"auto","created_at":"2026-01-12 16:07:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8464530,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7661591/v1/c1c5b38f-8873-47fd-b9eb-35de46b68aa5.pdf"}],"financialInterests":"Competing interest reported. Dr. Nathan Rojek has received consulting fees from Boehringer Ingelheim and royalty payments from McGraw Hill.","formattedTitle":"Representation of Medical Specialties in Dean’s Cabinets at the Top 40 NIH-Funded United States Medical Schools","fulltext":[{"header":"Background","content":"\u003cp\u003eAcademic leadership within medical schools is pivotal in shaping institutional culture, policy, and priorities. The composition of leadership teams, such as the dean\u0026rsquo;s cabinet, not only reflects institutional values but can also influence strategic planning, access to mentorship, and educational opportunities for both faculty and students. Understanding which specialties dominate leadership roles in key functional areas can provide insight into how medical institutional priorities are shaped, and which specialties may be better positioned to influence curricular and policy development. Despite growing awareness of disparities (eg. gender, race, degree diversity) in medical education, little is known about how medical specialties are represented across high-level academic leadership roles.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eGiven the increasing unmet need for primary care physicians, it is essential to examine the representation of medical specialties in decision-making positions, particularly at the nation\u0026rsquo;s most research-intensive medical schools, which often shape the broader climate of medical education and influence national priorities.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This gap is particularly relevant as medical schools strive to increase transparency, promote inclusive leadership, and ensure that institutional priorities align with the diverse specialties that constitute modern medicine. By analyzing the medical specialties of dean\u0026rsquo;s cabinet members at the top 40 National Institutes of Health (NIH) funded United States (U.S.) medical schools and comparing them to the national physician workforce data, this study characterizes patterns of medical specialty representation across core leadership roles in top medical institutions to inform future leadership development and equity initiatives.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA review of publicly available institutional websites was conducted to identify dean\u0026rsquo;s cabinet members of the top 40 NIH-funded medical schools. Dean\u0026rsquo;s cabinet members were stratified by the top 8 most common leadership titles: Dean, Dean for Student Affairs, Dean for Faculty Affairs, Dean for Clinical Affairs, Dean for Education, Dean for Research, Dean for Admissions, and Dean for Diversity, Equity and Inclusion. Alternate titles were considered in data collection as leadership role naming varies by institution (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Members holding an MD, DO, combined degree (eg. MD/PhD, MD/MBA), PhD, MPH, MHA, or EdD were included in the analysis, and only members holding an MD or DO were included in the analysis of specialty representation. Each member\u0026rsquo;s specialty was determined using institutional profiles and professional biographies. The proportion of dean\u0026rsquo;s cabinet members in medical specialties identified was compared to the latest available (2023) national physician workforce data and hospital-based workforce data to assess medical specialty representation, utilizing pair t-test analysis in Microsoft Excel.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The Association of American Medical Colleges (AAMC) defines the hospital-based physician workforce as those whose primary professional activity occurs within a hospital setting involving direct patient care and working 20 or more hours per week.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Hospital-based workforce data was included in this analysis to provide a comparison to a setting most similar to academic medical institutions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAlternate role titles for dean\u0026rsquo;s cabinet members\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard Role\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommon Alternate Titles\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDean, School of Medicine, Dean of the Medical School\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Student Affairs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssociate Dean for Student/Academic Affairs, Assistant Dean for Student/Academic Affairs, Dean of Students\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Faculty Affairs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssociate Dean for Faculty Development, Assistant Dean for Faculty Affairs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Clinical Affairs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVice Dean for Clinical/Medical Affairs, Senior Associate Dean for Clinical/Medical Affairs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVice Dean for Education, Senior Associate Dean for Medical Education, Associate Dean for Curriculum\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVice Dean for Research, Senior Associate Dean for Research/Clinical Research, Associate Dean for Biomedical Research\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Admissions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssociate Dean for Admissions, Assistant Dean of Admissions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Diversity, Equity and Inclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssociate Dean for DEI, Assistant Dean for Diversity, Vice Dean for Inclusion, Dean for Multicultural Affairs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the top 40 NIH-funded medical schools, 320 total dean\u0026rsquo;s cabinet members were identified.\u003c/p\u003e\n\u003ch3\u003eDean’s Cabinet Members holding an MD or DO\u003c/h3\u003e\n\u003cp\u003e287 (89.7%) members held either an MD or combined degree (eg. MD/PhD, MD/MBA), with only one member holding a DO degree. Internal Medicine (IM) (132, 46.0%) was the most represented specialty overall, followed by Pediatrics (38, 13.2%), Obstetrics and Gynaecology (OB/GYN) (16, 5.6%), Psychiatry (13, 4.5%), Radiology (13, 4.5%), Emergency Medicine (EM) (11, 3.8%), and Family Medicine (FM) (10, 3.5%). The most common specialty across all dean\u0026rsquo;s cabinet roles was IM (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The distribution of specialties by dean\u0026rsquo;s cabinet role is further characterized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFirst and second most represented specialties by dean\u0026rsquo;s cabinet role\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean\u0026rsquo;s Cabinet Role\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMost Represented Specialty (#)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2nd Most Represented Specialty (#)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePediatrics (6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Student Affairs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePediatrics (7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Faculty Affairs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePediatrics (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Clinical Affairs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUrology (4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePediatrics (4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePediatrics (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Admissions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmergency Medicine (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDean for Diversity, Equity and Inclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePediatrics (4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOf the 128 IM Dean\u0026rsquo;s Cabinet members, 53 (41.4%) were general hospitalists while 75 (58.6%) belonged to various subspecialties. The most represented IM subspecialty throughout all dean cabinet roles was Cardiology (16, 21.3%), followed by Infectious Disease (15, 20.0%) and Pulmonary/Critical Care (11, 14.7%). Cardiology (4, 5.3%) and Pulmonary/Critical Care (4, 5.3%) were the most common subspecialties to fulfill the position of Dean, Infectious Disease (3, 4.0%) for Dean of Student Affairs, Pulmonary/Critical Care (2, 2.7%) and Rheumatology (2, 2.7%) for Dean of Faculty Affairs, Pulmonary/Critical Care (2, 2.7%) for Dean of Clinical Affairs, Infectious Disease (3, 4.0%) for Dean of Education, Cardiology (3, 4.0%) for Dean of Research, Cardiology (2, 2.7%) for Dean of Admissions, and Cardiology (4, 5.3%) for Dean of Diversity, Equity and Inclusion. The distribution of IM subspecialties by dean\u0026rsquo;s cabinet role is further characterized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eDean’s Cabinet Members holding other graduate degrees\u003c/h3\u003e\n\u003cp\u003eOf the 33 dean\u0026rsquo;s cabinet members holding a graduate degree other than an MD or DO (eg. PhD, MPH, MHA, EdD, MA), 25 (75.8%) held a PhD degree. 12 (36.4%) of these members were identified as a \u0026lsquo;Dean for Research.\u0026rsquo;\u003c/p\u003e\n\u003ch3\u003eComparison to National Workforce Representation\u003c/h3\u003e\n\u003cp\u003eCompared to the U.S. Physician Workforce Data, Anesthesiology (p\u0026thinsp;=\u0026thinsp;0.008), EM (p\u0026thinsp;=\u0026thinsp;0.04), Orthopedic Surgery (p\u0026thinsp;=\u0026thinsp;0.016), Ophthalmology (p\u0026thinsp;=\u0026thinsp;0.037), and FM (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) were underrepresented while IM (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), Neurosurgery (p\u0026thinsp;=\u0026thinsp;0.003), and Pediatrics (p\u0026thinsp;=\u0026thinsp;0.006) were overrepresented in the dean\u0026rsquo;s cabinets of top 40 NIH funded medical schools. These relationships are further characterized in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eComparison to Hospital Based Workforce Representation\u003c/h3\u003e\n\u003cp\u003eCompared to the Hospital-Based Workforce Data, Anesthesiology (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), EM (p\u0026thinsp;=\u0026thinsp;0.00003), and FM (p\u0026thinsp;=\u0026thinsp;0.0084) were underrepresented while Dermatology (p\u0026thinsp;=\u0026thinsp;0.0008), ENT (p\u0026thinsp;=\u0026thinsp;0005), IM (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), Neurosurgery (p\u0026thinsp;=\u0026thinsp;0.0001), OB/GYN (p\u0026thinsp;=\u0026thinsp;0.0035), Pediatrics (p\u0026thinsp;=\u0026thinsp;0.006), and Plastic Surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001) were overrepresented in the dean\u0026rsquo;s cabinets of top 40 NIH funded medical schools. These relationships are further characterized in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study reveals a striking concentration of medical school leadership in IM (132, 46.0%), Pediatrics (38, 13.2%), and OB/GYN (16, 5.6%). IM alone represents almost half (46%) of all dean\u0026rsquo;s cabinet members, an overrepresentation compared to the national physician workforce share (12.5%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) as well physicians working in a full-time hospital-based setting (15.0%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001).\u003csup\u003e5\u003c/sup\u003e Notably, IM and pediatrics also consistently rank as the top two specialties across every cabinet role compared to national data. This pattern could be a reflection of physicians in primarily hospital-based specialties being more routinely involved in institutional operations, providing them with earlier and more frequent opportunities to engage in academic leadership. Moreover, IM and pediatrics are often regarded as the backbone of medicine, as both are generalist fields that emphasize holistic, longitudinal, and systems-based care.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e This broad scope of practice may cultivate the adaptability, interdisciplinary collaboration, and institutional insight that are well-suited for leadership roles in academic medicine.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eInterestingly, despite the critical roles that FM, EM, and Anesthesiology play in healthcare delivery, these specialties remain significantly underrepresented among leadership in the dean\u0026rsquo;s cabinets of the nation\u0026rsquo;s top medical schools. FM and EM are both central to primary care, population health, and community engagement, and their representation (FM: 3.5%, EM: 3.8%) is notably scarce in comparison to the proportion of practicing FM and EM physicians in the nation (FM: 12.2%, EM: 5.0%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 respectively) as well as those employed in hospital-based settings (FM: 7.6%, EM: 11.7%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 respectively). Similarly, anesthesiology, which plays an integral role in perioperative medicine and patient safety, is likewise underrepresented in medical leadership (2.1%) when compared to the proportion of practicing anesthesiologists in the nation (4.3%, p\u0026thinsp;=\u0026thinsp;0.008) or hospital-based settings (6.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). These findings carry important implications for institutional equity and the shaping of medical education priorities.\u003c/p\u003e\u003cp\u003eUnderrepresentation of FM and EM is concerning given the national emphasis on addressing primary care shortages and health disparities especially in rural areas, and the rising amount of health misinformation available to the public.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e FM is uniquely positioned as a first line point of contact for patients, and plays a pivotal role in healthcare delivery, patient safety, and coordination of care, equipping patients with the knowledge and support needed to navigate complex health systems effectively. It is an integral pillar of medicine that needs to be appropriately represented in medical school leadership. The limited representation of FM physicians in leadership roles may reduce opportunities to incorporate perspectives that emphasize community-based care, interprofessional education, and interdisciplinary collaboration. Additionally, EM physicians serve as critical first-line providers who not only triage diverse clinical presentations but also play an essential role in medical education by training students and residents in acute care, clinical decision-making, and interdisciplinary teamwork. This disparity may offer insights on a general trend in which medical graduates pursuing hospital-based specialties characterized by longitudinal care express desire to engage in institutional leadership, whereas medical graduates entering fields like FM, EM or Anesthesiology may prioritize different professional goals and resultingly encounter fewer academic leadership opportunities.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eStill, the disproportionate representation of certain fields in comparison to the national workforce (eg. IM, Pediatrics, Neurosurgery) in this study raises questions of curricular rigidity, limiting the integration of emerging or cross-disciplinary specialties that are increasingly relevant to modern medicine, such as dermatology (1.0%) or ophthalmology (0.7%). For instance, underrepresented specialties including anesthesiology (2.1%) and EM (3.8%) benefit tremendously from educational modalities such as simulation-based learning and telehealth training.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Additionally, fields such as radiology (4.5%) and dermatology (1.0%) have vast applications in primary care settings, yet remain a small portion of the dean\u0026rsquo;s cabinet leadership.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e This calls to attention the potentially negative impact of underrepresenting medical specialties that have broad applications touching all facets of modern medicine. Limited input from procedural or technology-driven fields such as these may delay the inclusion of simulation-based learning, telehealth training, or interdisciplinary team models in medical education. Given the increasing complexity of patient care and the prevalence of comorbidities, exposure to academic mentors comprising a diverse range of clinical specialties and perspectives is essential to cultivating advanced critical thinking skills in medical students.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eCompensation may be one factor influencing the over- or underrepresentation of certain specialties in medical school leadership. Fields such as IM or pediatrics are overrepresented medical specialties in deans\u0026rsquo; cabinets, which may in part be explained by these leadership roles offering a financial incentive compared to their traditional practice with lower-than-average clinical salaries in comparison to other medical specialties.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In contrast, highly compensated medical specialties such as anesthesiology, EM, or orthopedic surgery, which are underrepresented in leadership, may face a financial disincentive to pursue administrative roles that involve reduced clinical time and potentially lower overall compensation.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Interestingly, certain surgical fields such as neurosurgery and plastic surgery are overrepresented despite typically commanding some of the highest clinical salaries.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e In these cases, the appeal of leadership may stem from other factors, such as influence over departmental priorities, academic advancement, or institutional prestige. This suggests that motivations for assuming administrative roles likely extend beyond compensation alone and may vary by specialty culture, career trajectory, and perceived impact within academic medicine.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, focusing on the top 40 NIH-funded medical schools may cause our findings to be subject to selection bias and as a result limit the ability to generalize these findings to all medical education institutions. This analysis also excludes osteopathic, community-based, or rural medical schools, which may prioritize different leadership models and clinical specialties. Additionally, this is a cross-sectional study that relies on publicly available websites to identify dean's cabinet members as of February 2025, allowing for the possibility of inaccuracies due to outdated or incomplete information or misrepresentations of longitudinal trends. Finally, this study limited inclusion to the eight most common leadership titles, which may exclude other, institutionally specific, influential leadership roles and in turn underrepresent certain specialties that may be more likely to fill these less common roles.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAs medical education grapples with evolving population diversity, expanding scopes of practice, and increasing competition regarding the residency application process, equitable specialty representation at the leadership level is essential to ensure that the medical school curriculum is adaptable, inclusive, and forward-looking. Although this study highlights the disproportionate presence of certain specialties in academic leadership, further research is needed to assess how these imbalances may shape curricular development, mentorship opportunities, and institutional priorities. Future studies could explore whether greater specialty diversity among leaders influences student career interests or promotes more comprehensive institutional decision-making. In response, medical schools might consider implementing structured leadership development programs for faculty in underrepresented specialties to foster more representative and well-rounded leadership teams.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNIH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Institutes of Health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAAMC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAssociation of American Medical Colleges\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternal Medicine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOB/GYN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eObstetrics and Gynaecology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medicine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFamily Medicine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003eThis study did not require ethical approval by the Institutional Review Board as it does not include human subjects.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eDr. Nathan Rojek has received consulting fees from Boehringer Ingelheim and royalty payments from McGraw Hill.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.B.T. contributed to the conception, analysis and interpretation of data, writing and revising of the manuscript. L.H. contributed to the conception, interpretation, and revising of the manuscript. A.N.S. contributed to the conception, interpretation, and revising of the manuscript. N.W.R. contributed to the conception, interpretation, and revising of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Data was gathered from information on publicly available institutional websites.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSilver JK et al. (2018). Women physicians underrepresented in academic leadership. 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Med care vol. 2012;50(12):1093\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MLR.0b013e318268ac0c\u003c/span\u003e\u003cspan address=\"10.1097/MLR.0b013e318268ac0c\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Representation, Medical Specialties, Dean’s Cabinet","lastPublishedDoi":"10.21203/rs.3.rs-7661591/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7661591/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAcademic leadership within medical schools shapes institutional culture, policy, and educational priorities. While demographic diversity has been studied, specialty representation in leadership is less understood. This study evaluates the distribution of medical specialties in dean\u0026rsquo;s cabinets at the top 40 National Institutes of Health (NIH)-funded United States medical schools compared with national and hospital-based physician workforce data.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003ePublicly available institutional websites were reviewed to identify dean\u0026rsquo;s cabinet members across eight common leadership roles. Degree type and specialty (for MD/DO holders) were obtained from institutional profiles. Specialty representation was compared with 2023 national and hospital-based physician workforce data using paired t-tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 320 leaders identified, 287 (89.7%) held an MD or DO. Internal Medicine (IM) accounted for 46.0%, followed by Pediatrics (13.2%) and Obstetrics/Gynecology (5.6%). Compared with the national workforce, IM (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), Pediatrics (p\u0026thinsp;=\u0026thinsp;0.006), and Neurosurgery (p\u0026thinsp;=\u0026thinsp;0.003) were overrepresented, while Family Medicine (FM; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), Emergency Medicine (p\u0026thinsp;=\u0026thinsp;0.04), Anesthesiology (p\u0026thinsp;=\u0026thinsp;0.008), Orthopedic Surgery (p\u0026thinsp;=\u0026thinsp;0.016), and Ophthalmology (p\u0026thinsp;=\u0026thinsp;0.037) were underrepresented. Similar trends were observed against hospital-based workforce data, with additional overrepresentation of Dermatology (p\u0026thinsp;=\u0026thinsp;0.0008), ENT (p\u0026thinsp;=\u0026thinsp;0.0005), and Plastic Surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). Among IM leaders, 41.4% were generalists and 58.6% subspecialists, most commonly in Cardiology, Infectious Disease, and Pulmonary/Critical Care.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eDean\u0026rsquo;s cabinets at top NIH-funded medical schools are dominated by IM and Pediatrics, with primary care, acute care, and procedural specialties underrepresented. These disparities may influence curriculum design, mentorship, and institutional responsiveness. Leadership development initiatives targeting underrepresented specialties could diversify expertise in academic medical governance.\u003c/p\u003e","manuscriptTitle":"Representation of Medical Specialties in Dean’s Cabinets at the Top 40 NIH-Funded United States Medical Schools","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 15:23:55","doi":"10.21203/rs.3.rs-7661591/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-02T18:44:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-02T01:02:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337009459778258595769631367289428805507","date":"2025-12-02T00:31:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-25T02:33:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96315116844121611533237084278756608980","date":"2025-11-24T17:40:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334427804730825417942604382205647740791","date":"2025-11-14T20:19:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-03T03:28:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86814372980937861032157901951667840681","date":"2025-10-13T16:04:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56560027411966008713265156202613376994","date":"2025-10-13T15:51:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-13T15:17:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-26T12:00:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-26T03:49:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T03:48:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-09-20T00:37:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37439cb6-8752-4d38-8efb-2af8625e81bb","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:00:07+00:00","versionOfRecord":{"articleIdentity":"rs-7661591","link":"https://doi.org/10.1186/s12909-025-08548-y","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-01-05 15:57:06","publishedOnDateReadable":"January 5th, 2026"},"versionCreatedAt":"2025-10-27 15:23:55","video":"","vorDoi":"10.1186/s12909-025-08548-y","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08548-y","workflowStages":[]},"version":"v1","identity":"rs-7661591","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7661591","identity":"rs-7661591","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}