Curious about the most and least competitive residencies? The competitiveness of a residency specialty might be a significant factor influencing your choice. In this blog post I’ll delve into the most and least competitive residency specialties, explore the reasons behind their competitiveness, and offer my advice for aspiring physicians on how to navigate applying to residency.
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Most Competitive Residency Programs Based on Fill-Rate
In the most recent Match, these specialties had more than 30 positions available and every open position was filled at the conclusion of all rounds of matching. Meaning that these specialties had a total fill-rate (MD seniors, DO seniors, as well as other applicants) of 100% by the end of Match Week:
Orthopedic Surgery
- MD Fill Rate: 77.9%
- DO Fill Rate:14.1%
- # of Positions: 929
- # of Applicants: 1,590
- IMG Fill Rate: 2.4%
Plastic Surgery
- MD Fill Rate: 89.1%
- DO Fill Rate: 0.9%
- # of Positions: 221
- # of Applicants: 396
- IMG Fill Rate: 2.7%
Thoracic Surgery
- MD Fill Rate: 92.6%
- DO Fill Rate: 3.7%
- # of Positions: 54
- # of Applicants: 130
- IMG Fill Rate: 3.7%
Dermatology
- MD Fill Rate: 80%
- DO Fill Rate: 16.7%
- # of Positions: 30
- # of Applicants: 299
- IMG Fill Rate: 3.3%
Vascular Surgery
- MD Fill Rate: 82.4%
- DO Fill Rate: 2.0%
- # of Positions: 102
- # of Applicants: 172
- IMG Fill Rate: 10.8%
Physical Medicine & Rehabilitation
- MD Fill Rate: 52.5%
- DO Fill Rate: 37.5%
- # of Positions: 240
- # of Applicants: 782
- IMG Fill Rate: 8.0%
Interventional Radiology
- MD Fill Rate: 75%
- DO Fill Rate: 7.7%
- # of Positions: 252
- # of Applicants: 299
- IMG Fill Rate: 13.5%
The following specialties had a 99.9% fill rate:
Anesthesiology
- MD Fill Rate: 72.1%
- DO Fill Rate: 17.1%
- # of Positions: 1,805
- # of Applicants: 3,017
- IMG Fill Rate: 7.3%
Obstetrics-Gynecology
- MD Fill Rate: 69.9%
- DO Fill Rate: 19.8%
- # of Positions: 1,587
- # of Applicants: 2,151
- IMG Fill Rate: 6.0%
Why Are these Specialties Highly Competitive?
These specialties are known for their low match rates and high applicant-to-position ratios. For instance, in the NRMP match, Dermatology had one of the lowest match rates, with many highly qualified applicants going unmatched. Orthopedic Surgery and Plastic Surgery similarly attract top-tier candidates due to the demanding nature of the training and the high rewards in terms of career prospects and compensation.
The competitiveness of residency specialties, whether is influenced by various factors. Specialties like Dermatology, Orthopedic Surgery, and Neurosurgery attract a large number of applicants due to their prestige, high earning potential, and perceived lifestyle advantages. However, the limited number of residency positions available relative to the high applicant pool intensifies the competition, requiring applicants to meet stringent selection criteria and demonstrate exceptional academic performance and research experience.
Least Competitive Residency Programs Based on Fill-Rate
In the most recent Match, these specialties had more than 30 positions available and fill-rates by senior MD students of less than 45% percent. The fill-rates for DO students is also shown:
Emergency Medicine
- MD Fill Rate: 44.9%
- DO Fill Rate: 35.1%
- # of Positions: 3,068
- # of Applicants: 3,753
- IMG Fill Rate: 14.6%
Family Medicine
- MD Fill Rate: 28%
- DO Fill Rate: 27.7%
- # of Positions: 5,357
- # of Applicants: 7,337
- IMG Fill Rate: 26.7%
Internal Medicine
- MD Fill Rate: 34.6%
- DO Fill Rate: 17.2%
- # of Positions: 10,941
- # of Applicants: 17,131
- IMG Fill Rate: 43.2%
Pathology
- MD Fill Rate: 42.3%
- DO Fill Rate: 16.7%
- # of Positions: 622
- # of Applicants: 1,018
- IMG Fill Rate: 36.2%
Surgery-Preliminary (PGY-1 Only)
- MD Fill Rate: 22.4%
- DO Fill Rate: 45.4%
- # of Positions: 1,194
- # of Applicants: 2,229
- IMG Fill Rate: 12.0%
Why Are These Specialties Less Competitive?
These specialties tend to have higher match rates and lower applicant-to-position ratios. Family Medicine, for example, consistently fills its positions with a lower level of competition compared to surgical specialties. These fields are vital to healthcare but generally attract a broader range of applicants, thus reducing the intensity of competition.
Specialties like Family Medicine, Internal Medicine, and Pediatrics appeal to a broader range of medical students due to their diverse patient populations and opportunities for primary care practice. This broader appeal results in a larger applicant pool, but also more residency positions available relative to the number of applicants, making them less competitive overall.
Additionally, residency programs in these specialties often have a wide range of training sites, including community hospitals, academic medical centers, and outpatient clinics. This diversity of training opportunities allows for more flexibility in matching applicants with available positions, contributing to lower competition.
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Specialties with High MD Match Rates
What are the most competitive and least competitive residencies? NRMP considers the most competitive residencies to be those with the highest fill rates. In other words, the programs which fill the majority of their open positions in the match. The least competitive programs are determined by looking at programs that had over 30 available positions but did not fill all of them. This means that there was little competition per spot available.
To understand the landscape of residency competitiveness, let me share some data from the National Resident Matching Program (NRMP). The NRMP publishes annual reports that provide detailed statistics on match rates, applicant numbers, and fill rates for various specialties.
Check out this video on the most and least competitive residencies:
These specialties had more than 30 positions available and fill-rates by senior MD students greater than 75%. The fill-rates for DO students are also provided:
Neurological Surgery
Out of 476 applicants, 85.1% of the 268 positions were filled by US MD seniors, while 1.9% were filled by DO seniors. US and non-US IMGs made up 6.7% of matches.
Otolaryngology
Out of 552 total applicants, 89.1% of the 394 positions offered in Otolaryngology were filled by graduating United States MD students, 6.1% were filled by DO students and 1.9% by US and non-US IMGs.
Vascular Surgery
Out of 172 total applicants, MD students in the United States obtained 82.4% of the 102 positions offered in Vascular Surgery, 2.0% were filled by DO students, and 10.8% by US and non-US IMGs.
Want to match to an internal medicine residency? Here's some tips:
Least and Most Competitive Residency Programs Based on Fill-Rate in Canada
CaRMS data indicates that Family Medicine is by far the least competitive residency specialty in Canada. Internal medicine and Psychiatry are also relatively non-competitive.
But do not be misled by the numbers - the Match in Canada is extremely competitive. Canadian graduates have a match rate of 93%, while US IMGs have a match rate of 45.5% in Canada, and non-US IMGs have a match rate of 77.2%.
Unfortunately, CaRMS does not provide detailed reports on the number of applicants to each specialty. However, the list below includes specialties that had over 30 available positions and were all filled, both in first and second iteration:
- Anesthesiology
- Dermatology
- Emergency Medicine
- Neurosurgery
- Ophthalmology
- Plastic Surgery
- Urology
Factors Influencing Residency Specialty Competitiveness
The competitiveness of a residency specialty is influenced by several factors:
Reputation and Prestige
Residency programs with a strong reputation and prestigious affiliations often attract a larger pool of highly qualified applicants. Institutions known for their cutting-edge research, innovative clinical practices, and distinguished faculty members are perceived as desirable destinations for residency training.
Location
The geographical location of a residency program can also impact its competitiveness. Urban areas with access to diverse patient populations, renowned medical centers, and cultural amenities may be more appealing to applicants. However, rural programs may offer unique experiences and opportunities for hands-on training that appeal to certain candidates.
Size and Available Positions
The size of a residency program and the number of available positions can influence its competitiveness. Larger programs may offer more resources, subspecialty exposure, and networking opportunities but may also attract a higher volume of applicants. Smaller programs may provide a more personalized learning environment and greater individual attention from faculty but may have fewer spots available.
Here's some tips on matching to a family medicine residency:
Selection Factors
Residency programs often consider various factors when selecting applicants, including academic performance, USMLE scores, letters of recommendation, research experience, and extracurricular activities. Programs may also prioritize candidates who demonstrate a strong fit with their institutional culture and mission.
Training Environment and Culture
The overall training environment, including the culture, camaraderie among residents, support from faculty, and work-life balance, can significantly impact a program's competitiveness. Positive testimonials from current residents and alumni can enhance a program's appeal to prospective applicants.
Length and Rigor of Training
Specialties with longer and more rigorous training programs, such as Neurosurgery (7 years) and Plastic Surgery (6 years), tend to attract applicants who are highly dedicated and academically inclined. These programs require a significant commitment, and residency selection committees seek candidates who are unlikely to quit and who demonstrate the resilience necessary to complete the training, making them more competitive residencies.
Lifestyle and Compensation
Specialties like Dermatology and Radiology are highly competitive partly because they offer attractive lifestyles and high compensation. Dermatologists, for instance, often have regular hours and fewer on-call responsibilities compared to other specialties. This lifestyle appeal makes these specialties highly sought after, despite the intense competition.
Research Opportunities
Specialties that emphasize research, such as Radiation Oncology and Ophthalmology, often attract applicants with strong academic and research backgrounds. These fields offer significant opportunities for academic careers and research funding, making them appealing if you’re interested in scholarly pursuits. The emphasis on research attracts a subset of medical students who excel academically and have a strong interest in research. As a result, these specialties may have a higher concentration of highly qualified applicants, increasing competition for residency positions. The limited number of residency positions available relative to the high demand for research-focused training further intensifies competition in these fields.
1. What are the most competitive residencies?
The data changes every year, but most competitive residencies tend to be specialties with the most training. For example, plastic surgery, thoracic surgery, and radiology.
2. What are the least competitive residencies?
Primary care specialties tend to be less competitive. For example, family medicine, internal medicine, and pathology.
3. How does the National Resident Matching Program (NRMP) classify programs for the Main Residency Match?
The NRMP classifies residency programs in five types:
Categorical (C) – programs that begin in post-graduate year one (PGY-1) and provide full training required for specialty board certification
Primary (M) – categorical programs in primary care medicine and primary care pediatrics that begin in PGY-1 and provide full training required for specialty board certification
Preliminary (P) – one-year programs that begin in PGY-1 and provide prerequisite training for more advanced programs
Advanced (A) – programs that begin in post-graduate year two (PGY-2) after a year of prerequisite training in a preliminary program
Physician (R) – programs reserved for physicians with prior graduate medical education, reserved programs offer PGY-2 positions that begin during Match year and are therefore not available to senior medical students
4. Which residency specialty is the right specialty for me?
Many students will use their clinical rotations in medical school to find a specialty they are interested in by process of elimination, but what if you are interested in a specialty that is not typically represented in required medical school clinical rotations?
Our biggest tip: explore medical specialties early! Remember, for competitive residencies it will be important to demonstrate early interest in pursuing a certain specialty. You will want to demonstrate this early on, so be sure to use your time efficiently. Some medical schools provide elective time to explore additional specialties during the 3rd year, and early in your 4th year, while others do not. Take advantage of the summer to test the waters in other specialties. In the end, be true to yourself, and to your interests, when choosing a specialty and choose a specialty that will allow you to be successful and content.
5. What is an away rotation and how does it affect my chances of matching with a competitive program?
Away rotations can give you experience in a new city and with new faculty and patient populations, but they can also strengthen your residency applications, especially if you are trying to match to a competitive specialty or a specific residency program. Beyond providing exposure to a new setting, an away rotation is essentially a month-long interview.
During this opportunity, you will be evaluated by potential future colleagues on a daily basis and this can open doors for you if you make a good impression. Away rotations can be key in securing an interview down the road: it makes a big difference to the selection committee if they have actually met you and have observed how you interact with patients and people in their program. To show interest in a specific specialty, be sure to complete your away rotation within the first few months (July-September) of your 4th year of medical school so they can be included in your application.
Away applications are done through VSAS and typically start in the spring of 3rd year of medical school. You'll have the chance to rotate at a particular program to see if it fits you well, demonstrate other qualities/work ethics that may not necessarily be reflected in your grades/scores, and obtain letters of recommendation from faculty at these institutions.
Begin looking in your 3rd year of medical school to understand which programs allow away students and when then research how much lead time you will need to apply and secure a spot. In some cases, you may need to do this six months in advance of the elective. Some schools have windows in which they allow away students and limited spots, so be sure to start early if you wish to secure a spot.
6. Is it more competitive to match as a couple?
Your chance of matching is not hindered by choosing to match as a couple. In recent years, more couples have participated in The Match than ever before. Couples continue to see great success and high match rates. When applying for the Couples Match, each individual must register with NRMP separately, then request to match as a couple and notify ERAS as well. You will apply and interview separately, but when creating your rank order list (ROL), you will create pairs from that list. Be honest with your priorities when making your list with your partner. After your ROLs are linked, NRMP only matches couples to preferred pairs of programs if each partner has been offered a position. Look for programs that present themselves as couples friendly and focus on applying to programs in larger cities, with multiple programs, to maximize your chances of completing a residency close to your partner.
7. What is the “ROAD to success” in reference to competitive residency specialties?
ROAD stands for Radiology, Ophthalmology, Anesthesiology, and Dermatology. These specialties rank highly with respect to lifestyle: they come with a great salary, while often being less demanding than many other fields. ROAD specialties were designated because of their generally acceptable work-life balance after training. The intensity of the residency programs can vary within each of these specialties, but for the most part, upon graduation and entry into practice, each of these specialties has more manageable schedules than other specialties with similar reimbursements.
Radiology is typically broken up into shifts, with the ability to work from home if working for a reading center. Ophthalmology and Dermatology have relatively few emergencies and generally work a typical 9-5 workday with some elective surgeries. Anesthesia is known for having a difficult residency, but upon graduation, many can proceed to fellowships in interventional pain management, or recruit the assistance of C-RNAs in the OR, which makes life more manageable. All of this makes ROAD specialties some of the most desirable and competitive fields in medicine.
Keep in mind that less demanding does not mean that these specialties are not challenging. It can mean, however, that you have fewer on-call, overnight, weekend, or holiday shifts and a more set schedule with regular hours of work. Lifestyle is only one consideration when deciding which specialty to enter, as most physicians are happiest in a field where they love the work and are able to achieve a work-life balance.
8. What if I am an International Medical Graduate (IMG) applying for residency in the United States or Canada?
Check out our blog for International Medical Graduates, which outlines the eligibility criteria for IMGs in Canada and the United States, how to prepare your residency application, tips for writing your personal statement, and recommendations for how to prepare for a coveted residency interview.
9. So, is a more competitive residency more prestigious?
A more competitive residency is not more prestigious. All physicians are highly trained and respected professionals. Competitive residencies have fewer spots available, mostly because fewer specialists in those areas are required to meet the population’s needs. This is why more primary-care spots are available (as these are required at least occasionally by almost everyone) and there are fewer spots in specialties like surgery or dermatology (not everyone sees a dermatologist in their lives).
Keep in mind that competitiveness and prestige do not necessarily equate with a good fit. It is important to pursue the specialty that most interests you and is what you will be most happy doing, rather than perceived prestige, as most people outside of medicine will not really understand the differences. The competitive residencies generally have fewer spots and require stronger connections to “match” into. Even a community dermatology program will be highly desired, and there may be many applicants trying for one position, while another specialty may have open spots even long after the match.
10. What can I do as a DO student to match to a competitive specialty?
It looks like fewer DO students match to competitive specialties, but do not get discouraged if you are a DO vs MD student! What matters is what you accomplished during medical school, not which medical school you attended or whether it is an MD or DO school. So, ensure you do well on your USMLE (especially the Step 2 CK) and excel on your clinical rotations. Receive mentorship from physicians in your desired field, seek away rotations, and ensure you have great experiences like research, volunteering, and leadership to highlight on your personal statement and CV. These steps will show your initiative and interest and you will be well on your way to matching to whichever specialty you wish!
11. Do I need to know what field I want to go into before starting medical school?
Absolutely not! In fact, unless you have already had a lot of clinical experience, you can count on changing your mind about which specialty to pursue. Typically, most students do not shadow during the first or second year of medical school, as preclinical coursework can be very heavy.
However, if you're interested in competitive programs, it's a good idea to look for research during this time so you can have your work published by the time you apply to a residency program. Core rotations in your 3rd year of medical school will also help in deciding which specialty you wish to pursue. It is normal to have narrowed this down to two or three areas by your 3rd year and to keep refining your thoughts during your 3rd year. By the time you get to 4th year, you will know for sure which specialty is your passion.
12. Can I apply to more than one specialty?
Yes, you can apply to multiple specialties. On average, students apply to 1.2-1.6 specialties, so at least some students are applying to more than one specialty. What you must ensure, though, is that your application is equally strong for each specialty. Do not treat a “less competitive” specialty as a backup and think that you will match because more spots are available. For example, some students think that they will just apply to internal medicine because there are more spots, but their genuine desire is to be a dermatologist. If you apply to a specialty for which your application is not strong, it does not matter if there are more spots available; you will not receive an interview and you will not get in. You must show that you have experiences, mentors, and genuine interest in the specialty if you are applying.
To your success,
Your friends at BeMo
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2 Comments
john Ezeli • 11/06/2021 16:13
i presently live in puerto rico, as my wife is from there..do i have a chance to match in a hospital here with basic spanish
ReplyKay • 03/18/2022 19:59
Where is anesthesiology on this list?
Reply