Pathology chairpersons continue their preeminence in US medical schools. The Hirsch (h) index of citation was analyzed for the chairpersons of 8 specialty departments in 41 US medical schools. The current h indices of department chairs (302 of 328 positions filled) were tabulated by specialty and medical school. The proportion of women was noted, as was whether the chairs had completed the first decade of this millennium continuously in post in the same medical school. Of the 8 specialties, pathology chairs at the 41 schools are the most likely to have been in the same post in 1999 and 2009, and the pathologists who remained are exclusively male. In the 41 medical schools studied, women chairs constituted only 3.7% of all heads of departments in 1999 and 7% in 2009. The paucity of female chairs 3 decades after women became at least one third of the medical student body is unfortunate.