Most Competitive & Least Competitive Residencies in

How Is Residency Competitiveness Measured?

There is no single NRMP statistic that defines how competitive a residency specialty is. For this comparison, we use several current measures together, with preferred-specialty match outcomes as the primary indicator of how difficult a specialty was for applicants who wanted to enter that field.

We consider:

• Preferred-specialty match outcomes: How many applicants who preferred a specialty successfully matched to it.
• Applicants per available position: Greater applicant pressure relative to the number of positions can indicate more competition.
• Position fill rate: The percentage of available residency positions that were filled.
• Applicant characteristics: NRMP Charting Outcomes data also examines factors such as USMLE Step 2 CK performance, research experience and rank-list behavior, which help show the profile of applicants who successfully match.

Match rate and fill rate are not the same thing. A specialty with a 100% position fill rate filled all of its available positions; this does not mean that 100% of applicants who wanted that specialty matched. Likewise, the percentage of positions filled by U.S. MD, DO or IMG applicants describes who filled the positions, not the probability that an individual applicant from that group matched.

For the US lists below, we therefore do not classify specialties solely according to whether they filled every available position. We use 2026 NRMP applicant and position data together to identify specialties that were relatively more or less competitive.

Most Competitive Residency Specialties in the US

Based on 2026 NRMP preferred-specialty match outcomes together with applicant pressure, dermatology, integrated thoracic surgery, integrated plastic surgery, orthopedic surgery, neurological surgery and otolaryngology stand out as some of the most competitive residency specialties in the US.

The table below uses the number of U.S. MD seniors who matched to their preferred specialty divided by all U.S. MD seniors who preferred that specialty. The applicants-per-position figure includes all applicant types and provides a second measure of demand relative to available positions.

Source: NRMP 2026 Charting Outcomes for U.S. MD Seniors. Preferred-specialty match rate is calculated as U.S. MD seniors matched ÷ total U.S. MD seniors who preferred the specialty.

These numbers show why overall fill rate alone can be misleading. A specialty can be extremely difficult for applicants who prefer it even if its position fill rate is not exactly 100%, and specialties with similar position fill rates can have substantially different applicant outcomes.

What about ophthalmology? Ophthalmology is also commonly considered a highly competitive specialty, but it uses the SF Match rather than the NRMP Main Residency Match. Because its matching system and reporting are separate, we do not mix ophthalmology statistics directly into the NRMP comparison table above.

These are specialty-level trends, not predictions for individual programs or applicants. Your competitiveness will also depend on applicant type, academic profile, experiences, program selection and how effectively application materials such as your residency personal statement and residency CV present your candidacy.

Least Competitive Residency Specialties in the US

Among larger US residency specialties, pediatrics, family medicine, internal medicine, child neurology, emergency medicine and psychiatry were comparatively less competitive for U.S. MD seniors in the 2026 Match. These specialties generally combined high preferred-specialty match rates with substantially more position capacity than the most competitive surgical and procedural fields.

Source: NRMP 2026 Charting Outcomes for U.S. MD Seniors. Preferred-specialty match rate is calculated as U.S. MD seniors matched ÷ total U.S. MD seniors who preferred the specialty.

Neurology and pathology also had relatively high preferred-specialty match rates for U.S. MD seniors in 2026, but applicant composition differs considerably across these fields. This is one reason a single national ranking cannot describe competitiveness equally well for U.S. MD, DO and IMG applicants.

“Least competitive” does not mean “easy.” These are national specialty-level comparisons. An individual internal medicine, family medicine or pediatrics program can still be highly selective because of its location, reputation, training opportunities or applicant pool. Your own match probability also depends on how well your profile and application fit the programs you choose.

Does Residency Competitiveness Differ for MD, DO, and IMG Applicants?

Yes. A specialty’s overall competitiveness does not translate into the same match probability for every applicant type.

The NRMP publishes separate 2026 Charting Outcomes reports for U.S. MD seniors, U.S. DO seniors, U.S. IMGs and non-U.S. IMGs because match patterns and applicant characteristics differ across these groups. For this reason, you should use the US specialty lists above as a description of the overall competitive landscape—not as a personal match-chance calculator.

For example, the percentage of positions filled by U.S. MD seniors, DO seniors or IMGs is useful for understanding who ultimately entered a specialty, but it is not the same thing as the match rate for applicants from those groups. To evaluate your own competitiveness, compare yourself with data for your applicant type and preferred specialty.

This distinction matters especially for highly selective specialties. A specialty may have enough positions to fill almost completely while still having a large proportion of applicants who prefer that field go unmatched. Conversely, a field with a lower percentage of positions filled by U.S. MD seniors is not automatically easier; those positions may simply be distributed more broadly among DO and IMG applicants.

If you are an IMG, use the applicant-specific information in our international medical graduate residency guide alongside the specialty-level data on this page.

Check out this video on the most and least competitive residencies:

Most and Least Competitive Residency Specialties in Canada

Canadian residency competitiveness should be analyzed separately from the US because CaRMS uses different applicant categories, streams and reporting methods.

For the 2026 R-1 Match, CaRMS compared the number of available CMG positions with the number of Canadian medical graduates who listed each discipline as their first choice. This provides a useful supply-and-demand measure:

• A ratio below 1.00 means there were fewer available CMG positions than first-choice applicants.
• A ratio of 1.00 means supply and first-choice demand were approximately equal.
• A ratio above 1.00 means there were more available positions than first-choice applicants.

Source: CaRMS 2026 R-1 Match Data Overview. Ratios compare available CMG positions with the number of CMGs who listed the discipline as their first choice.

These disciplines had substantially more first-choice CMG demand than available CMG positions.

Less Competitive Canadian Residency Specialties

Among the larger mainstream disciplines, the 2026 supply-demand picture was substantially different:

Source: CaRMS 2026 R-1 Match Data Overview. Ratios compare available CMG positions with the number of CMGs who listed the discipline as their first choice.

Family medicine had almost two CMG positions for every applicant who listed it as a first-choice discipline, making it substantially less constrained by first-choice demand than the highly competitive surgical and procedural specialties above.

Overall applicant outcomes still depend heavily on applicant type. In the 2026 first iteration, CaRMS reported a 92.8% match rate for current-year CMGs. Among IMGs, the corresponding first-iteration match rate was 80.6% for current-year graduates and 47.8% for previous-year graduates. These overall statistics are not specialty-specific, but they demonstrate why applicant background must be considered separately from discipline-level competitiveness.

If you are applying in Canada, use our CaRMS guide for the full application and matching process. If you receive an interview invitation, our CaRMS interview prep guide explains how to prepare for the Canadian residency interview process.

What Makes a Residency Specialty Competitive?

Residency competitiveness is primarily a question of supply, demand and applicant outcomes, but several factors can shape those numbers.

1. Number of Positions Compared with Applicant Demand

The clearest source of competition is a mismatch between the number of applicants strongly interested in a field and the number of residency positions available. When many applicants compete for relatively few positions, a larger proportion of applicants can go unmatched even when nearly every available position is filled.

This is one reason specialties such as dermatology, plastic surgery, neurological surgery and orthopedic surgery remain highly competitive: available positions are limited relative to applicant demand.

2. Strength of the Applicant Pool

Competitiveness also reflects who is applying. NRMP Charting Outcomes examines applicant characteristics such as USMLE Step 2 CK performance, research experiences and rank-list behavior. In highly competitive specialties, successful applicants may have particularly strong academic or scholarly profiles.

These characteristics should not be confused with the definition of competitiveness itself. A high Step 2 CK score does not make a specialty competitive; rather, the academic profile of successful applicants can show how selective the field has become.

3. Specialty and Program Demand

Career interests, compensation, lifestyle, training opportunities, reputation and other characteristics can affect how many applicants pursue a specialty or individual program. However, none of these factors alone tells you whether a residency is competitive. The actual Match data remains more useful than assumptions about prestige or lifestyle.

4. Specialty Competitiveness Is Not the Same as Program Competitiveness

The tables above compare specialties nationally. Individual residency programs within the same specialty can have very different levels of competition.

A program may attract more applicants because of its location, institutional reputation, faculty, research opportunities, training environment or other program-specific features. Therefore, a residency in a comparatively less competitive specialty can still be very difficult to match if you apply only to especially selective programs.

5. Competitiveness Depends on Applicant Type

A specialty may also look different depending on whether you are a U.S. MD senior, U.S. DO senior or IMG. This is why applicant-specific NRMP data should be considered alongside the overall specialty landscape rather than relying on one universal ranking.

How to Use Residency Competitiveness Data When Planning Your Application

Residency competitiveness should help you plan your application, but it should not determine your specialty choice by itself. Start by considering whether the specialty fits your interests and career goals, then use current Match data to understand how selective the field is and how your applicant profile compares with successful applicants.

If you are targeting a highly competitive specialty, evaluate more than your USMLE scores. Consider your specialty-specific clinical experiences, research, letters of recommendation, program selection and the overall coherence of your application. Applying broadly within a specialty can also be important because program-level competitiveness varies substantially.

If you apply to more than one specialty, each application should still demonstrate a credible interest in that field. A comparatively less competitive specialty should not be treated as an automatic backup.

You can use our Residency Match Calculator as an additional planning tool when evaluating your residency options. Once you begin receiving interview invitations, review our residency interview questions, how to prepare for a residency interview, and residency mock interview guides. Later in the cycle, our residency letter of intent guide explains how to communicate continued interest after an interview when appropriate.

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