Every doctor says their specialty is one of the most competitive, but obviously, that can’t be the case. Most of these doctors are lying to you, but here’s the truth.
People are quick to say that their own specialty is competitive, and even ostensibly reputable sources will make claims about competitiveness based solely on one variable because it’s easier. It takes far more effort to create a comprehensive and objective assessment of specialty competitiveness.
That’s why we painstakingly designed the Med School Insiders Competitiveness Index—with no opinions and no bias; it’s just the facts.
Today, we’re breaking down all 22 medical specialties by competitiveness using our proprietary competitiveness index built from the latest 2024 NRMP match data.
The index uses five key factors with weightings based on how important each factor is to competitiveness:
- Step 2 CK scores, weighted at 30%
- Match rate, weighted at 30%
- Research items, weighted at 25%
- Top 40 NIH-funded medical school attendance, weighted at 10%
- AOA status, weighted at 5%
For longtime viewers, you’ll remember our detailed breakdowns of the top 5 most competitive and bottom 5 least competitive specialties in previous guides.
Today, we’re going comprehensive and covering ALL 22 specialties in one definitive ranking.
Let’s dive straight into the countdown, from least competitive to most competitive.
22 | Family Medicine (7.3 Points)
First, family medicine consistently ranks as the least competitive specialty. This year it has only 7.3 points. FM physicians provide broad, comprehensive care for patients of all ages, genders, and conditions.
With a near-perfect match rate of 98.8%, the lowest average Step 2 score at 244, and minimal research requirements of only 4.2 items, family medicine primarily focuses on addressing the primary care physician shortage.
21 | Pediatrics (13.4 Points)
The next least competitive specialty is pediatrics at 13.4 points. Pediatricians provide comprehensive care for infants, children, and adolescents.
With the second-highest match rate of 99.7%, an average Step 2 score of 247, and an average of 6.9 research items.
20 | Emergency Medicine (15.0 Points)
Next, emergency medicine scores 15.0 points. These physicians provide immediate care for acute illnesses and injuries in emergency settings.
With a high match rate of 98%, an average Step 2 score of 248, and only 5.7 research items on average, EM remains accessible despite its high-intensity environment.
Emergency medicine has moved down the competitiveness ladder from 18th in 2020 to 19th in 2022 to now 20th in 2024. This is due to two main factors, something I discuss in my 2025 Match Data analysis.
19 | Psychiatry (25.2 Points)
The fourth least competitive specialty is psychiatry, which scores 25.2 points. Psychiatrists focus on understanding and treating psychological disorders and distress.
It has a match rate of 89.1%, the second-lowest Step 2 score at 246, and an average of 7.5 research items, making it a more accessible option for applicants.
18 | Pathology (28.0 Points)
Next up is pathology with 28.0 points. Pathologists examine tissues and fluids to diagnose disease, most often behind the scenes without much patient interaction.
Pathology has a match rate of 93.5%, an average Step 2 score of 247, and an average of 8.4 research items.
Now, let’s continue with the remaining specialties, which often aren’t covered since they don’t fall into the top or bottom lists.
17 | Neurology (33.6 Points)
Neurology comes next with a score of 33.6 points. Neurologists diagnose and treat disorders of the brain, spinal cord, and nervous system.
With a match rate of 93.8%, an average Step 2 score of 250, and an average of 8.8 research items, neurology offers lower barriers to entry than many specialties. A Step 2 score of 250 puts applicants right at the 50th percentile among test-takers, marking the dividing line between the less competitive and more competitive specialties.
16 | Child Neurology (34.3 Points)
Next is child neurology with 34.3 points. Child neurologists diagnose and treat neurological conditions in infants, children, and adolescents.
With a match rate of 97.1%, Step 2 score of 248, and 9.8 research items, child neurology represents a specialized niche with low to moderate competitiveness. Interestingly, child neurology requires more research items than adult neurology, despite having a lower Step 2 score requirement.
15 | Internal Medicine (35.0 Points)
Next comes internal medicine with a score of 35.0 points. Internists provide primary and specialty care for adults.
IM has one of the highest match rates at 97.8%, a Step 2 score of 251, and an average of 8.7 research items. In 2025, internal medicine filled an impressive 11,379 positions, more than double the next most popular specialty, making it by far the largest specialty in the match.
14 | Physical Medicine & Rehabilitation (37.3 Points)
PM&R, or physical medicine and rehabilitation, scores 37.3 points. These physicians focus on restoring function and quality of life to patients with physical impairments or disabilities.
With a match rate of 84.8%, an average Step 2 score of 248, and an average of 8.6 research items, PM&R has moved up significantly in competitiveness over the last four years, climbing a whopping seven spots.
13 | Internal Medicine/Pediatrics (49.1 Points)
Next, with a score of 49.1 points, is Med-Peds. This combined specialty trains physicians in both adult and pediatric medicine.
Med-Peds has a match rate of 86%, an average Step 2 score of 253, and fewer research items than most specialties above it, at only 6.9.
Notably, Med-Peds matched applicants have a higher average Step 2 score than either pediatrics, which has 247, or internal medicine, which has 251, despite having the same research requirements as regular pediatrics.
12 | OB/GYN (49.1 Points)
OB/GYN also comes in at 49.1 points. OB/GYNs focus on women’s reproductive health, pregnancy, and childbirth.
With an 85.7% match rate, a Step 2 score of 252, and 9 research items, OB/GYN sits in the middle in terms of competitiveness. OB/GYN also ties with anesthesiology and radiation oncology for its Step 2 score requirement.
11 | Radiation Oncology (49.5 Points)
Next up is radiation oncology with a score of 49.5 points. These specialists use radiation therapy to treat cancer and other disorders.
Despite having one of the highest match rates at 97.5%, radiation oncology still requires substantial research credentials—15.9 items on average—and maintains a Step 2 score of 252. This specialty shows that a high match rate doesn’t always indicate low competitiveness, since the research requirement for radiation oncology is the 6th highest among all specialties.
10 | Anesthesiology (53.2 Points)
Next is anesthesiology, which scores 53.2 points. Anesthesiologists administer anesthetics during surgery and to manage pain.
It has a Step 2 score of 252, a match rate of 85.2%, and an average of 9 research items. Its Step 2 score ties with OB/GYN and radiation oncology, placing it squarely in the middle tier when it comes to academic metrics.
9 | Vascular Surgery (59.1 Points)
Next, at 59.1 points, is vascular surgery. Vascular surgeons treat diseases of the vascular system, including arteries, veins, and lymphatic circulation.
With a match rate of 88.5%, a Step 2 score of 253, and an average of 12.8 research items, vascular surgery represents the beginning of the higher tier of competitiveness. It shares its Step 2 score requirement with general surgery, interventional radiology, and Med-Peds, but demands more research than many specialties with similar Step 2 scores.
8 | Diagnostic Radiology (62.3 Points)
Diagnostic radiology comes in at 62.3 points. Diagnostic radiologists interpret imaging studies like X-rays, CT scans, MRIs, and ultrasounds to diagnose diseases.
Diagnostic radiology has an average of 12 research items and one of the highest average Step 2 scores at 256. But despite having a Step 2 score that ties with plastic surgery and otolaryngology, which is the second-highest of all specialties, diagnostic radiology ranks as only the 8th most competitive specialty, thanks to a moderate match rate of 86.4%Â and lower research demands.
7 | General Surgery (62.7 Points)
Next up is general surgery, which ranks at 62.7 points. These surgeons manage a broad spectrum of surgical conditions affecting the abdomen, breast, head and neck, blood vessels, and digestive tract.
With a match rate of 81.8%, an average Step 2 score of 253, and an average of 10.9 research items, general surgery can serve as a pathway to several surgical subspecialties, much like internal medicine does for medical subspecialties. Notably, general surgery was ranked 11th on the competitive index just 2 years ago, squarely in the middle of the pack, and now just makes the top third of the list.
6 | Interventional Radiology (65.7 Points)
The sixth-most competitive specialty is interventional radiology, which sits at 65.7 points. These specialists use imaging guidance to perform minimally invasive procedures.
The average IR applicant has 15.8 research items—a number that’s dramatically increased from 10.3 in 2020. That’s a 53% increase in only four years.
Rising research requirements are a trend that’s not slowing down—it’s also something that most premeds and medical students struggle with.
I was no different. I worked tirelessly for only a handful of research items before medical school, and I saw firsthand how inefficient this was for myself and so many peers. That’s why I developed a system that focused on results without eating up so much valuable time, ultimately accumulating over 60 research items by the time I applied to residency.
Together with Dr. Shaun Andersen and Dr. Deepal Patel, who also have over 60 publications, abstracts, and presentations each, we created The Ultimate Research Course for premed and medical students to help you skip the years of frustration and immediately implement strategies that actually work.
The students who’ve taken the course have dramatically increased their research output and matched into specialties they previously thought were out of reach.
5 | Otolaryngology/ENT (80.7 Points)
Next, we’re on to the top five most competitive specialties, which shuffle around with each assessment. Currently, otolaryngology, or ENT, is in fifth place with 80.7 points. In 2022, ENT placed second, and in 2020, it claimed the fourth place spot.
ENTs manage conditions of the ears, nose, throat, and related structures of the head and neck.
With an average Step 2 score of 256, 81.9% match rate, and 20 research items per applicant, ENT remains highly competitive as we enter the top 5. It requires the fifth-highest number of research items and ties for the second-highest Step 2 score at 256, making it quite a challenging specialty to match into.
4 | Orthopedic Surgery (88.4 Points)
At 88.4 points, orthopedic surgery focuses on the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles.
Ortho demands a stellar Step 2 score of 257, with a 73.1% match rate and an average of 23.8 research items. Over a third of successful applicants are AOA members, which shows just how fierce the competition is. It ties with dermatology for the highest Step 2 score of any specialty at 257, placing successful applicants above the 63rd percentile of test-takers.
3 | Plastic Surgery (88.6 Points)
Next, plastic surgery ranks third with 88.6 points. In 2020 and 2022, plastics claimed the top spot but was recently dethroned.
Plastic surgeons restore, reconstruct, and alter human body tissues with both reconstructive and aesthetic operations.
Applicants need an average of 34.7 research items, a Step 2 score of 256, and they face a 74.3% match rate. The bar is set exceptionally high, with nearly 36% of successful applicants being AOA.
Plastic surgery has also seen the most dramatic increase in research requirements, jumping from 19.1 items in 2020 to 34.7 in 2024, which is an increase of over 15 items in just four years.
2 | Neurosurgery (92.3 Points)
Just missing the top spot is neurosurgery at 92.3 points. In 2022, neurosurgery was the fifth-most competitive but it’s leapt forward to second based on 2024 data. Neurosurgeons surgically treat disorders of the brain, spine, and peripheral nerves.
Neurosurgery boasts the highest research requirement with an average of 37.4 items per applicant, which is more than nine items per year during medical school, assuming you don’t do gap years or go the PhD route, which is common in neurosurgery.
With the lowest match rate at 68.7% and one of the highest Step 2 scores at 255, neurosurgery demands nothing short of excellence. Neurosurgeons also command the highest average salary in medicine at over $760,000 annually, though they have little time to enjoy their earnings due to their extremely demanding schedules.
1 | Dermatology (94.1 Points)
At the top of our list, with 94.1 points, stands dermatology, the current most competitive specialty in medicine. Dermatologists diagnose and treat conditions affecting the skin, hair, and nails. Dermatology was second in 2020, third in 2022, and now holds the top spot for the most competitive medical specialty.
With the highest average Step 2 CK score of 257, which is tied with orthopedic surgery, a challenging match rate of just 70.5%, and an average of 27.7 research items per applicant, dermatology’s position is no surprise. Plus, over 41% of matched applicants are AOA, which is the highest of any specialty.
Dermatology offers the rare combination of high compensation, which is nearly $500,000 annually, and an exceptional work-life balance, making it perennially competitive.
Want to explore this data yourself? Download our interactive Specialty Competitiveness Index to customize rankings based on what matters most to you.
