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

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.