This article provides an overview and update on the current status of academic neurology based on structured insights from departmental leaders across the United States. Academic neurology, at a time when and leaders in academic medicine in general, are facing protean administrative, structural, and financial challenges that threaten all academic missions.1,2 In 2002, the Association of University Professors of Neurology (AUPN) and American Neurologic Association (ANA) jointly surveyed US neurology department chairs on the health of US academic neurology.1 The results showed troublesome findings related to adverse financial pressures on education, research, faculty development, and growth of new programs. In 2016, the AUPN surveyed neurology department chairs to better understand the organization and operations of neurology departments under contemporary health care reform. Results highlight that most neurology departments had fewer than 60 faculty members, a minority of whom were tenured or on a tenure track. Over a third had faculty members on a purely clinical track, with no education or research responsibilities.2 In early 2019, the AUPN partnered with the American Academy of Neurology (AAN) to resurvey academic neurology chairs using most of the 2002 AAN/AUPN survey questions. Survey responses from 2019 were compared with the earlier findings.