6 Least Competitive Specialties

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As if finishing medical school wasn’t already difficult enough, certain specialties are much harder to match into for residency compared to others. In a previous video, we went over the top 5 most competitive and difficult specialties to match into. Today, let’s cover the 6 least competitive specialties. (Originally published Jan 25, 2020. Updated with recent data June 14, 2021.)

The 6 least competitive medical specialties are:

  1. Family Medicine
  2. Pediatrics
  3. Physical Medicine and Rehabilitation
  4. Psychiatry
  5. Anesthesiology
  6. Emergency Medicine

Getting into any residency program, regardless of the specialty, is no easy task. It requires completing 4 years of medical school, taking USMLE Step 1, writing a personal statement, doing interviews, and several other steps that are not to be taken lightly. That being said, your life becomes much easier if you apply to a less competitive specialty.

If your specialty is not considered as competitive, this doesn’t make you a good or bad doctor. It’s just the facts, without any judgment, so please no butt-hurt comments.

We’ll be using the same methods from our previous video on the top 5 most competitive specialties. We’re taking into account the match rate, average Step 1 score, Step 2CK score, number of publications, percentage of matriculants who are AOA, and the percentage from a top 40 NIH funded medical school.

The following 6 medical specialties are those that ranked lowest, and are therefore the easiest to match into, relatively speaking. Check out the data for yourself in the spreadsheet with all the calculations.


1 | Family Medicine (15 points)

Family medicine is by far the least competitive specialty to match into, scoring only 15 points in our dataset, with the runner up at 27 points.

Family medicine is the specialty devoted to the comprehensive medical treatment of patients across all ages. Think of them as the first-line defense when it comes to maintaining health. Family med doctors are central to routine checkups, preventive care, health-risk assessments, immunization, screening tests, and acting as the coordination hub to manage the patient’s big picture treatment across several specialties. While less common, some family medicine doctors also deliver babies and provide prenatal care to pregnant women, which is now more commonly performed by OB-GYN doctors.

Family medicine is a foundational specialty to medicine, with nearly one out of every four office visits being made to family med physicians — that’s 208 million office visits each year, with the next closest specialty at 83 million visits. They’re also the ones doing most of the heavy lifting in treating America’s underserved and rural populations.

After completing medical school, you must complete either a 3 or 4-year family medicine residency. If you’d like to specialize, there are multiple fellowship options to choose from, including geriatric medicine, sports medicine, sleep medicine, hospital medicine, and hospice and palliative care.

In terms of lifestyle, family physicians have predictable hours without unexpected calls in the middle of the night. In terms of compensation, however, they’re toward the bottom, making on average $231,000 per year.

Learn more about what it’s like to specialize in family medicine in our video series: So You Want to Be an OB/GYN.


2 | Pediatrics (27 points)

Placing second is pediatrics, the branch of medicine involving the medical care of infants, children, and adolescents. Think of it as the equivalent of internal medicine, but for patients who aren’t adults. Just like internal medicine, peds is a 3-year residency. And just like internal medicine, there are dozens of subspecialties to choose from through fellowship training, like pediatric cardiology, emergency medicine, nephrology, oncology, infectious disease, and many more.

Working with kids is a mixed bag. On one hand, it’s incredibly gratifying to help children in need. On the other hand, it can be tremendously disheartening to care for a child with cancer or another terminal illness. As a pediatrician, you’ll essentially have two patients — the child and their parents, and you’ll quickly become well versed in handling upset or crying babies as well as highly neurotic parents. As a college student and first-year medical student, I was aiming for pediatric gastroenterology, but after working in the department for a few months, I realized working with kids and their parents every day wasn’t a challenge I was excited to take for the rest of my life.

In terms of lifestyle, pediatrics is so broad and varied that you can be anywhere on the spectrum. On average, however, pediatricians are one of the lowest compensated physicians, making on average $225,000 per year.

We dug deeper into what it’s like to be a pediatrician in our video series: So You Want to Be a Pediatrician.


3 | Physical Medicine & Rehabilitation (28 points)

Physical medicine and rehabilitation, or PM&R for short, and also called physiatry, is the specialty focused on restoring functional ability, reducing pain, and enhancing the quality of life for individuals with physical impairments or disabilities.

PM&R doctors use non-surgical methods to treat conditions such as spinal cord injury, traumatic brain injury, stroke, limb amputation, chronic pain, and a variety of sports injuries and musculoskeletal disorders. When I visited the PM&R clinic as a medical student, we saw several cerebral palsy patients as well. While it may be easier to get into PM&R residency, I would consider the specialty anything but easy. Dealing with this sort of patient population day after day can be highly taxing and discouraging without high degrees of patience, compassion, and optimism.

Treatment modalities, of course, include medication, but also physical modalities such as heat, cold, ultrasound, or electrical stimulation. PM&R doctors also make use of adaptive equipment and devices such as braces, artificial limbs, and wheelchairs, and also perform spine and joint injections, often under fluoroscopic or ultrasonic guidance.

Including intern year, PM&R residency is a total of 4 years. If you’d like to subspecialize further, you can complete a fellowship in musculoskeletal & spine, stroke, multiple sclerosis, neurorehabilitation, electrodiagnostic medicine, cancer rehabilitation, or occupational and environmental medicine.

As for lifestyle, PM&R doctors have predictable hours, no crazy calls, and make mid-range physician salaries at an average of $306,000 per year.

More on physical medicine and rehabilitation in our video So You Want to Be a Physiatrist (PM&R).


4 | Psychiatry (35 points)

Psychiatry, not to be confused with psychology, is the practice of medicine devoted to the treatment and management of mental disorders. It wasn’t until I started doing YouTube that I learned of the negative stigma some people have against psychiatrists, which puzzled me. It turns out this misplaced distaste of the profession arises from questionable and unethical practices regarding the use of lobotomy and electroconvulsive therapy in the mid 20th century. Since the 1970’s, however, psychiatry as a profession has tightened up ethical codes and addressed the misconducts of the past.

Psychiatry is a favorite rotation amongst medical students because it’s… well, chill. You won’t be working before 9 or after 5, and in fact, you’ll probably have many days shorter than that. On the other hand, while the subject material of mental illness is endlessly fascinating, the practice of psychiatry leaves many medical students feeling lethargic. You’ll be speaking to one patient sometimes for close to an hour, you’ll need to be incredibly patient, and sometimes it may feel like you’re just talking to them and not doing enough.

Psychiatry residency is 4 years, after which you can subspecialize in addiction, child and adolescent, forensic, geriatric, psychosomatic, and more.

In terms of lifestyle, you’ll be working at a slower pace and usually won’t have to deal with calls at odd hours in the night. In terms of salary, the average psychiatrist is in the bottom quartile in terms of physician compensation at $260,000 per year.

We dug deeper into what it’s like to specialize in psychiatry in our video series: So You Want to Be a Psychiatrist.


5 | Anesthesiology (36 points)

Next up is anesthesiology with 36 points. You may have heard of the ROAD to success, standing for radiology, ophthalmology, anesthesiology, and dermatology. These are four specialties with good pay and fantastic lifestyles. Despite its high pay of $392,000 and a flexible lifestyle, anesthesiology is less competitive, likely a function of supply and demand, with many residency spots going unfilled each year.

Most typically, anesthesiologists handle anesthesia for patients undergoing surgery or other procedures. This can be general anesthesia, where the patient is unconscious, sedation anesthesia, where the patient is somewhat conscious but not feeling pain, or regional anesthesia, such as a spinal, epidural, or regional nerve blocks.

While the surgeon is responsible for doing the surgical procedure, the anesthesiologist is the patient’s guardian angel, monitoring their vitals, ensuring they are comfortable, and keeping them stable on the operating table.

Anesthesia residency lasts four years, after which you can sub-specialize further with a fellowship in pain management, sleep medicine, cardiothoracic anesthesiology, pediatric anesthesiology, neuro anesthesiology, regional/ambulatory anesthesiology, obstetric anesthesiology, or critical care medicine.

There are two types of doctors working in the operating room – surgeons and anesthesiologists. I think anesthesia is an excellent field if you have the right personality for it. That means you’ll need to be comfortable being second in command and watching the surgery rather than actually doing it yourself.

Learn more about this specialty in our video series: So You Want to Be an Anesthesiologist.


6 | Emergency Medicine (41 points)

Last, we have emergency medicine, which received 41 points. If you like shift work and fast-paced exciting medicine, then emergency medicine might be a good fit. Emergency medicine physicians work in the emergency department, or ED, although most laypeople say ER for emergency room.

EM residency lasts 3 or 4 years in duration, after which you can subspecialize with a fellowship in palliative care, critical-care medicine, medical toxicology, wilderness medicine, sports medicine, disaster medicine, hyperbaric medicine, and more.

Emergency medicine physicians are essentially the first-line defense, dealing with acute conditions requiring immediate treatment. Or at least they’re supposed to. Given the high rates of uninsured patients in the U.S., the ED is often crowded with uninsured patients that can’t get care elsewhere. That problem, and the prospect of universal healthcare, is a topic for a future video.

TV shows portray the emergency department as exciting, fast-paced, and adrenaline-fueled. Truth is, during my multiple rotations on emergency, I was dealing with abdominal pain and chest pain more than anything else. Don’t get me wrong, when a patient comes in with cardiopulmonary arrest or tension pneumothorax, it is exciting. Just know that most of your time in the ED won’t be like that.

In terms of lifestyle, emergency medicine physicians are unique in that they have shift work, meaning they clock in and clock out at a predefined time, and you have flexibility in choosing your shifts such that you could have several days off in a row. Emergency physicians are well paid, at an average of $353,000 per year, but they do unfortunately experience very high rates of burnout.

Learn more about the pros and cons of emergency medicine in our video So You Want to Be an Emergency Medicine Doctor.


Bottom Line

Don’t let the data fool you. Just because these are the six least competitive specialties doesn’t mean they aren’t hard to get into! Every specialty in medicine is competitive, just some more so than others. Particularly if you want to get the best training at a top program, you’ll have to be a stellar candidate.

We covered specialties in a bunch of other guides including, How to Choose a Medical Specialty, Highest Paid Specialties, Sexiest Doctor Specialties, and Overlooked Considerations in Choosing a Specialty

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