Changes in Racial, Ethnic, and Gender Differences in Promotion and Retention Among US Medical School Clinical Faculty

Importance Understanding how racial-, ethnic-, and gender-based differences in academic promotion have changed over time is important for advancing equity in academic medicine. Objective To examine changes over time in racial-, ethnic-, and gender-based differences in promotion and attrition among academic clinical faculty. Design, Setting, and Participants This cohort study used deidentified data from the AAMC faculty roster for full-time faculty appointments between 1960 and 2024, based on an August 31, 2025, data snapshot. Exposure Race and ethnicity (categorized as American Indian, Alaska Native, Native Hawaiian, or Pacific Islander; Asian; Black; Hispanic; White; and other [any race or ethnicity not otherwise specified]), gender, and medical school graduation cohort (2000 or earlier vs after 2000). Main Outcomes and Measures Cox proportional hazards models were used to examine differences in promotion to associate professor, professor, and attrition by race, ethnicity, and gender across medical school graduation cohorts and were presented as adjusted hazard ratios (aHRs). Results Included were 289 129 physicians at 152 institutions (179 081 men [61.9%]; 1093 American Indian, Alaska Native, Native Hawaiian, or Pacific Islander [0.4%]; 62 403 Asian [21.6%]; 13 330 Black [4.6%]; 16 865 Hispanic [5.8%]; 3034 other [1.1%]; 192 404 White [66.6%]). Compared with White faculty, Black faculty were less likely to be promoted to associate professor overall; this difference narrowed over time (before 2000: aHR, 0.67; 95% CI, 0.60-0.74; after 2000: aHR, 0.77; 95% CI, 0.71-0.83; P for interaction = .01). The difference in promotion to professor between Black and White faculty also narrowed over time (before 2000: aHR, 0.85; 95% CI, 0.77-0.94; after 2000: aHR, 1.09, 95% CI, 0.92-1.29; P for interaction = .02). Women were less likely than men to be promoted to associate professor, although this difference narrowed over time (before 2000: aHR, 0.79; 95% CI, 0.77-0.82; after 2000: aHR, 0.91; 95% CI, 0.85-0.98; P for interaction <.001). Women were less likely than men to be promoted to professor in both graduation cohorts, with no evidence of change over time (before 2000: aHR, 0.93; 95% CI, 0.90-0.97; after 2000: aHR 0.91; 95% CI, 0.83-0.99; P for interaction = .48). Attrition was more likely among American Indian, Alaska Native, Native Hawaiian, or Pacific Islander (aHR, 1.25; 95% CI, 1.12-1.40), Asian (aHR, 1.07; 95% CI, 1.04-1.10), Black (aHR, 1.19; 95% CI, 1.14-1.25), Hispanic (aHR, 1.10; 95% CI, 1.05-1.15), and women (aHR, 1.11; 95% CI: 1.08-1.13) faculty than among White and men faculty. Conclusions And Relevance In this retrospective cohort study of 289 129 physicians, Black faculty experienced less disparity in promotion over time, and disparities in promotion to associate professor also narrowed for women; however, women remained less likely to be promoted to professor, and attrition remained higher for all minoritized racial and ethnic groups and for women. These findings suggest incremental progress while underscoring the need for continued efforts to achieve greater diversity and equity within academic medicine.