Want to know the most competitive residencies and the least competitive residencies? How is competitiveness among medical specialties determined? based on this? Residency 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. In this blog, we’ll explore the most and least competitive residencies, including tips on how to match to your top program!
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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. In our list, we will provide you with a list of programs that fill all of their available positions – meaning that the competition for each spot is fierce.
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.
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: 42.3%, DO: 24.3%)
Behind the numbers: Out of 2,765 total applicants, 42.3% of the 3,010 positions offered in this specialty were filled by MD students in the United States and 24.3% were filled by DO students.
Behind the numbers: Out of 6,927 total applicants, 29.2% of the 5,088 positions offered in this specialty were filled by United States MD students and 29.7% were filled by DO students.
Internal Medicine (MD: 36.9%, DO: 17.4%)
Behind the numbers: Out of 14,231 total applicants, 36.9% of the 9,725 positions offered in Internal Medicine were filled by MD students in the United States and 17.4% were filled by DO students.
Pathology (MD: 39.5%, DO: 14.2%)
Behind the numbers: Out of 1,023 total applicants, 39.5% of the 613 positions offered in this specialty were filled by MD students in the United States and 14.2% were filled by DO students.
Surgery-Preliminary (PGY-1 Only) (MD: 21.7%, DO: 4.1%)
Behind the numbers: Out of 2,032 total applicants, MD students in the United States secured 21.7% of the 1,133 positions offered in Surgery-Preliminary and 4.1% were filled by DO students.
Want to match to an internal medicine residency? Here's some tips:
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:
Behind the numbers: Out of 1,425 total applicants, 76.8% of the 899 positions offered in this specialty were filled by MD students in the United States and 13.2% were filled by DO students. The rest of the positions were filled by MD and DO grads, as well as US and non-US IMGs. (MD Grad: 7.6%, DO Grad: 0.8%, IMG: 1.3%, Other: 0.2%)
Physical Medicine & Rehabilitation
Behind the numbers: There were 745 total applicants, 355 of which were senior MD students in the United States and 266 of which were senior DO students, applying for the 206 positions offered in this specialty. All of the positions were filled, 118 of them by MD seniors, 74 by DO students, 3 by MD grads, 1 by DO grad, and 10 by US and non-US IMGs.
Interventional Radiology (Integrated)
Behind the numbers: There were 266 total applicants, 173 of which were senior MD students in the United States and 38 of which were senior DO students, applying for the 51 positions offered in Dermatology. All of the positions were filled, 37 of them by MD seniors, 4 by DO seniors, and 10 by US and non-US IMGs.
Plastic Surgery (Integrated)
Behind the numbers: There were 332 total applicants, 255 of which were senior MD students in the United States and 5 of which were senior DO students, applying for the 207 positions offered in Plastic Surgery. All of the positions were filled, 191 of them by MD seniors, 0 by DO seniors, 7 by MD grad, 1 by DO grad, and 8 by US and non-US IMGs.
Behind the numbers: There were 1,235 total applicants, 765 of which were United States senior MD students and 199 of which were senior DO students, applying for the 143 positions offered in this specialty. All of the positions were filled, 90 of them by MD seniors, 4 by MD Grads, 28 by DO seniors, and 21 by US and non-US IMGs.
Behind the numbers: There were 138 total applicants, 95 of which were United States senior MD students and 6 of which were senior DO students, applying for the 49 positions offered in Thoracic Surgery. All of the positions were filled, 41 of them by MD seniors, 2 by MD Grads, 1 by a DO senior, and 5 by non-US IMGs.
Specialties with High MD Match Rates
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 are also provided:
Neurological Surgery (MD: 86.8%, DO: 1.2%)
Behind the numbers: Out of 373 total applicants, MD students in the United States secured 86.8% of the 243 positions offered in this specialty and 1.2% were filled by DO students. 2.6% were obtained by MD Grads, 0.2% by DO Grads, and 4% by US and non-US IMGs.
Otolaryngology (MD: 83.1%, DO: 6.2%)
Behind the numbers: Out of 493 total applicants, 83.1% of the 373 positions offered in Otolaryngology were filled by graduating United States MD students and 6.2% were filled by DO students. 6% were taken by MD Grads, 0.2% by DO Grads, and 1.4% by US and non-US IMGs.
Vascular Surgery (MD: 80.6%, DO: 4.3%)
Behind the numbers: Out of 159 total applicants, MD students in the United States obtained 80.6% of the 93 positions offered in Vascular Surgery and 4.3% were filled by DO students. 1.8% were obtained by MD Grads, 0.6% by DO Grads, and 5.6% by US and non-US IMGs.
Here's some tips on matching to a family medicine residency:
CaRMS data indicates that Family Medicine is by far the least competitive residency specialty in Canada. After the first iteration there were 268 positions left unfilled, while after the second iteration 100 positions were left unfilled. But do not be misled by the numbers - the Match in Canada is extremely competitive. Canadian graduates have a Match rate of 93.5%, while US IMGs have a match rates of 86.7% in Canada, and non-US IMGs have a rate of 72.3%.
Internal medicine and Psychiatry are also relatively non-competitive, with 21 and 23 unfilled spots respectively.
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:
- Diagnostic Radiology
- Emergency Medicine
- Obstetrics and Gynecology
- Orthopedic Surgery
What candidate attributes do residency programs consider when ranking applicants? Consider the following tips:
Get Your USMLE/COMLEX/MCCQE Scores Up:
These scores, especially and , are often used as screening tools by residency programs. Higher scores can enhance your application and increase your chances of getting a residency interview. According to , Step 1 scores have the highest influence on program directors when it comes to whom they invite to interview. While scores are not everything, aim to get the passing score or higher. These scores can really help you get that coveted interview invite.
Get Stellar Letters of Recommendation (LORs) from Experts in Your Specialization:
Strong or from respected physicians in your specialty can significantly bolster your application. As you might know, you need to show strong passion for your specialization and nothing will convince the program directors more of your commitment to surgery, family medicine, or pediatrics, etc., than an objective review of your suitability. Build relationships during clinical rotations, showcase dedication and enthusiasm, and ask for LORs from those who've observed your clinical performance closely. Your LORs are the second most influential application component that affects programs’ interview choices.
Ace Your Clinical Rotations:
Outstanding performance during clinical rotations, especially in the specialty of interest, is crucial. Engage actively in rotations, seek feedback regularly, and continuously work on areas of improvement. 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.
Research showcases a candidate's dedication, analytical skills, and potential contributions to the field. It is especially important to gain quality research experience if your chosen residency program is research-focused. However, even if your program of choice is not research-focused, your experience with research will make you stand out. Seek out research opportunities early, collaborate with mentors, and aim for publications or presentations.
When deciding between applicants that are all potential matches, a program will consider yourand other essays, such as the. It provides insight into your motivation, aspirations, and personality. It is one of the top 5 factors that affect programs’ interview lists. Write genuinely, get feedback from peers/mentors, and tailor the statement for the specific specialty. Remember, they want to see your interest in the specialty – use your personal statement to demonstrate your dedication.
or MSPR is actually the 3rd most important factor that affects the directors’ choice of interviewees. This evaluation offers a comprehensive review of your performance during medical school. Here’s the key: consistent performance throughout medical school years. Yes, consistency is really important.
Comments from your attending physicians and preceptors on your Medical Student Performance Evaluation (MSPE) can often really help or damage your chances with a program. The MSPE is a collection of all comments that are given by individual evaluators who have worked with you during your 3rd year clerkships 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.
Your residency interview is the bottom line. It’s pretty much the only thing that will affect how you are ranked by the program. We are not exaggerating. Your interactions with faculty during the interview and visit, interpersonal skills, interactions with house staff during the interview and visit, as well as feedback from current residents are the 4 most important factors that affect directors’ rankings. So., your interview is pretty much the only thing that matters.
Our best advice is to use residency mock interviews to prepare to go over sample . These interviews simulate the real-life interview setting and you can really get a feeling of what it’s like to speak with program directors and staff. Use this opportunity to really prepare!
Genuine Interest in the Specialty:
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 showcase your fit for the specialty), and extracurricular commitments that show dedication to that particular specialty (conferences, international trips, leadership, etc.)
CV and Extracurriculars
Actually, extracurricular activities and leadership roles demonstrated in your is a great way to demonstrate your interest in a specialty “outside of official hours”. In other words, outside of required medical school rotations and clerkships.
So, get involved in non-profit organizations, community service, or global health initiatives. Seek leadership roles when possible. But do not be afraid of engaging in non-medical activities as well – program directors look for well-rounded applicants. Your music, sports, arts, dance, cooking, make-up, or other interests can also contribute to your image as a great candidate!
As you can see from NRMP data, some programs have a preference for recent graduates. MD and DO Seniors tend to have higher match rates that graduates. If you take gap years after medical school graduation, it's essential to use that time productively, like engaging in research, further training, or relevant work.
This might be surprising to some, but your geographical connections to where the programs are located can have a great positive affect on your ranking. Being open to diverse locations can improve chances, but this also means that you should research the locations of the programs to see how you can truly connect to that area. For example, even if you have never been to a state or city, but your partner comes from that area, you can express this during the interview and explain that you are very happy to see yourself in this area long-term. This is just an example, but you see how you can build connections if you genuinely want to stay in the area.
In helping thousands of students each year match to 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.
Check out this video for more info on most and least competitive residencies:
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 , each individual must register with NRMP separately, then request to match as a couple and notify 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 , 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 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.