The new era of neurosurgery department chairs in the United States: a national analysis of leadership trends.

Objective

Neurosurgery department chairs play a critical role in shaping clinical practice, research priorities, and workforce development within academic medicine. Prior studies have largely provided cross-sectional snapshots of chair characteristics, limiting understanding of how chair profiles have evolved over time. This study aimed to characterize temporal trends among neurosurgery department chairs in the US.

Methods

All neurosurgeons who served as department chair at ACGME (Accreditation Council for Graduate Medical Education)-accredited US neurosurgery residency programs between 2000 and 2025 were identified. Demographic characteristics, educational history, scholarly productivity, and institutional familiarity prior to chair appointment were collected from publicly available sources, Scopus, National Institutes of Health (NIH) RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results), and Google Patents. Chairs were stratified into quartiles based on appointment year, and temporal trends were assessed using chi-square and Kruskal-Wallis tests. Univariable and multivariable logistic regression identified predictors of long-standing chair tenure (> 75th percentile).

Results

Between 2000 and 2025, 322 chair tenures were identified (median age at appointment, 48 [IQR 45-54] years), including 112 current chairs (median age 49 [IQR 45-54] years). The median age at appointment increased from 46 to 51 years from the earliest to the most recent quartile (p < 0.001), while female representation rose from 0% to 10.4% (p = 0.001). Additional graduate degrees and fellowship training became more common over time (p < 0.001). Scholarly productivity increased markedly, with median publications rising from 34 to 155, citations from 221 to 3139, and h-indices from 18 to 37 (all p < 0.001). In contrast, the median completed chair tenure declined from 19 to 3 years across cohorts (p < 0.001). On multivariable analysis, earlier appointment year and prior NIH funding were independently associated with longer tenure, whereas age at appointment, fellowship training, and h-index were not.

Conclusions

Contemporary neurosurgery department chairs are appointed later in their careers, with substantially greater academic productivity and shorter tenures than prior generations, reflecting a fundamental shift in leadership expectations within academic neurosurgery.