Most Competitive & Least Competitive Residencies in 2020

Updated: July 20, 2020

What are the most competitive and least competitive residencies? First, you'll need to understand how The Match works. Medical students are matched into residency programs using a computer algorithm that considers the preferences of both students and the programs. Matching to a residency program, no matter what the specialty, is no easy feat. The competitiveness for residency positions varies greatly between specialties, as some are more competitive and harder to get into than others. You may be asking yourself, is the specialty I want to pursue competitive? Whether you are looking for the easiest residency specialty to match, or the most competitive, you’ve come to the right place!

This blog includes an overview of the most competitive residencies and the least competitive residencies. How is competitiveness among specialties determined? Competitiveness is not related to specialty difficulty; it is simply based on numbers. Specialty competitiveness is measured by the percentage of positions filled by senior students in medical schools. The higher the fill-rate, the more competitive the residency.

Here's what you'll learn in this blog:

Most Competitive Residency Programs Based on Fill-Rate

Least Competitive Residency Programs Based on Fill-Rate

Trends in Specialties and Residency Matching

Factors That Affect Matching Success

Frequently Asked Questions

Conclusion

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 percent by the end of Match Week:

Dermatology

Behind the numbers: There were 239 total applicants, 195 of which were senior MD students and 28 of which were senior DO students, applying for the 31 positions offered in Dermatology. All of the positions were filled, 25 of them by MD seniors and 6 by DO seniors.

Medicine - Emergency Medicine

Behind the numbers: There were 111 total applicants, 59 of which were senior MD students and 27 of which were senior DO students, applying for the 30 positions offered in this specialty. All of the positions were filled, 19 of them by MD seniors and 9 by DO seniors.

Neurological Surgery

Behind the numbers: There were 397 total applicants, 273 of which were senior MD students and 18 of which were senior DO students, applying for the 232 positions offered in Neurological Surgery. All of the positions were filled, 203 of them by MD seniors and 3 by DO seniors.

Physical Medicine & Rehabilitation

Behind the numbers: There were 550 total applicants, 275 of which were senior MD students and 206 of which were senior DO students, applying for the 151 positions offered in this specialty. All of the positions were filled, 81 of them by MD seniors and 60 by DO students.

Integrated Plastic Surgery

Behind the numbers: There were 291 total applicants, 236 of which were senior MD students and 13 of which were senior DO students, applying for the 180 positions offered in this specialty. All of the positions were filled, 165 of them by MD seniors and none by DO seniors.

Thoracic Surgery

Behind the numbers: There were 120 total applicants, 78 of which were senior MD students and 8 of which were senior DO students, applying for the 38 positions offered in Thoracic Surgery. All of the positions were filled, 32 of them by MD seniors and 1 by a DO senior.

These specialties had more than 30 positions available and fill-rates by senior MD students greater than 80 percent. The fill-rates for DO students is also provided:

Integrated Plastic Surgery (MD: 91.7%, DO: 0%)

Behind the numbers: Out of 291 total applicants, 91.7% of the 180 positions offered in this specialty were filled by MD students and 0% were filled by DO students.

Otolaryngology (MD: 88.6%, DO: 4.9%)

Behind the numbers: Out of 505 total applicants, 88.6% of the 350 positions offered in Otolaryngology were filled by graduating MD students and 4.9% were filled by DO students.

Neurological Surgery (MD: 87.5%, DO: 1.3%)

Behind the numbers: Out of 397 total applicants, MD students secured 87.5% of the 232 positions offered in this specialty and 1.3% were filled by DO students.

Ophthalmology (MD: 86.3%, DO: 3.2%)

Behind the numbers: Out of 635 total participants, 86.3% of the 496 positions offered in this specialty were filled by MD students and 3.2% were filled by DO students.

Medicine-Pediatrics (MD:81.0%, DO: 9.2%)

Behind the numbers: Out of 606 total applicants, 81.0% of the 390 positions offered in this specialty were filled by MD students and 9.2% were filled by DO students.

Thoracic Surgery (MD: 84.2%, DO: 2.6%)

Behind the numbers: Out of 120 total applicants, 84.2% of the 38 positions offered in this specialty were filled by MD students and 2.6% were filled by DO students.

Vascular Surgery (MD: 81.3%, DO: 6.7%)

Behind the numbers: Out of 153 total applicants, MD students obtained 81.3% of the 75 positions offered in Vascular Surgery and 6.7% were filled by DO students.

Orthopedic Surgery (MD: 80.8%, DO: 13.2%)

Behind the numbers: Out of 1,192 total applicants, 80.8% of the 849 positions offered in this specialty were filled by MD students and 13.2% were filled by DO students.

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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:

Internal Medicine (MD: 40.2%, DO: 16.0%)

Behind the numbers: Out of 13,118 total applicants, 40.2% of the 8,697 positions offered in this specialty were filled by MD students and 16.0% were filled by DO students.

Pediatrics – Primary (MD: 39.1 %, DO: 12.0%)

Behind the numbers: Out of 871 total applicants, 39.1% of the 92 positions offered in this specialty were filled by MD students and 12.0% were filled by DO students.

Pathology (MD: 33.8 %, DO: 11.1%)

Behind the numbers: Out of 917 total applicants, MD students secured 33.8% of the 603 positions offered in Pathology and 11.1% were filled by DO students.

Family Medicine (MD: 33.1%, DO: 29.9%)

Behind the numbers: Out of 7,175 total applicants, 33.1% of the 4,662 positions offered in Family Medicine were filled by MD students and 29.9% were filled by DO students.

Surgery – Preliminary (MD: 24.7%, DO: 2.6%)

Behind the numbers: Out of 1,962 total applicants, 24.7% of the 1,174 positions offered in this specialty were filled by MD students and 2.6% were filled by DO students.

Trends in Specialties and Residency Matching

All allopathic (MD) and osteopathic (DO) applicants now participate in one match program through the National Resident Matching Program (NRMP). As osteopathic program positions were incorporated into the Main Residency Match, there was an increase in the number of residency positions available to students. The increase in participation of DO medical school seniors has resulted in more applicants seeking positions each cycle. The number of International Medical Graduates (IMGs) seeking residency positions in the United States and Canada has also increased in recent years. 

Check out this video to learn about matching as an IMG:

In specialty trends, Obstetrics-Gynecology programs offered more positions than in recent years and filled all but a few spots. Orthopedic Surgery programs and Radiology-Diagnostic post-graduate year two (PGY-2) programs also offered more positions and saw a high overall fill-rate. With all applicants now participating in one match program, more DO medical student seniors are securing spots in these residency programs than ever before.

Match results can be an indicator of future physician workforce supply. Recent matches have seen an increase in the number of primary care specialty positions offered as well as high position fill-rates, particularly for internal medicine, family medicine, and pediatrics. The number of psychiatry residency positions also continues to grow each cycle.

Factors That Affect Matching Success

What candidate attributes do residency programs consider when ranking applicants? Candidates that successfully match into competitive programs or specialties exhibit the following:

  • Strong academic performance through their clinal grades. Residencies place high value on clinical performance as it is a much better reflector of dedication, knowledge, communication and work ethic than a score on a test. Honors grades are difficult to earn, but they will greatly increase your chances of matching at more desirable programs in competitive specialties.
  • Passing licensing exams on the first attempt, as well as achieving noteworthy exam scores, impacts matching success. While many programs look at USMLE Step 2 CK scores, these are typically lower on the list compared to USMLE step 1 scores. However, if a student scores below the average on USMLE step 1 (<220), then a score above 245 on the USMLE step 2 CK will help to give programs a new outlook on their application. Licensing exams are an important factor in selecting applicants for interviews and can play a role in post-interview ranking.
  • Comments from your attending physicians and preceptors on your Medical Student Performance Evaluation (MSPE). The MSPE is a collection of all comments that are given by individual evaluators who have worked with you during your 3rd year (clerkship year) in core rotations such as pediatrics, family medicine, surgery, internal medicine, psychiatry, and OB/GYN.
  • You should aim to get positive comments on each rotation, including in the specialties that you are not applying to, to make your MSPE as strong as possible.

At this point, you may be asking yourself how you can stand out when preparing for residency match beyond academic performance. Consider the following tips:

  • Apply early and meet all deadlines. Have a look at our ERAS timeline blog to review important dates and deadlines.
  • If you have a CASPer test, be sure to practice with CASPer sample questions in advance.
  • Beyond academics, the interview can make or break your chances of matching. The interview shows who you are beyond what can be represented in your application.
  • Before your interview, review our residency interview tips and prepare for common residency interview questions and MMI questions.
  • When deciding between applicants that are all potential matches, a program will consider additional criteria such as research experience and publications, extracurriculars, leadership roles, your residency personal statement, letters of recommendation, and a residency letter of intent. If a specialty is research-oriented, research involvement will be more highly valued.
  • Show interest in the specialty! Successful applicants for competitive residencies demonstrate their interest in pursuing a residency in that specialty by the middle of their 3rd year of medical school. Typically for competitive residency programs, having great scores and grades alone will not distinguish you from the other applicants. Key attributes for successful applicants include: outstanding research in the specialty, supportive letters of recommendation from faculty who are known in their field (who can describe your fit for the specialty), and extracurricular commitments that show dedication to that particular specialty (conferences, international trips, leadership, etc.)

Watch our video below for a quick summary of the most competitive and least competitive residencies:

Frequently Asked Questions 

1. 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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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!

9. 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.

10. 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.

Conclusion

In helping thousands of students each year match at their top-choice residency programs, students often ask what the most competitive or least competitive programs are. The lists within this blog are based purely on numbers: the higher the fill-rate, or percentage of positions filled by senior students in medical schools, the more competitive the residency. Competitiveness is only one factor to consider when applying to residency programs; be sure to take into account your passion for the specialty, potential for burnout, and the type of work-life balance you see for yourself in the future. That being said, matching at any residency program is a long and challenging process and we will be here to support you every step of the way!

Lastly, in addition to the information within this blog, be sure to do your own research to ensure you are applying to residency programs that are a good fit for you and that will ultimately allow you to have a successful and fulfilling career.

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