Top 10 Least Competitive Specialties in Medicine

Choosing a specialty is one of the most important decisions that any future doctor makes, and even then, there’s no guarantee of matching into the one you want. So, what specialties have the least competition? We meticulously calculated the least competitive specialties in medicine using a wide range of data on Step scores, match rates, publications, school funding, and more.

In a previous article, we covered the Top 10 Most Competitive Specialties to match into, so be sure to check out that post too.

Using data from the official NRMP Charting Outcomes released this year, we meticulously reassessed the most and least competitive specialties.

Though the NRMP included USMLE Step 1 scores in their data, this was only for the 13.3% of applicants who had taken Step 1 prior to January 26, 2022. For the vast majority of residency applicants, their Step 1 score was already pass/fail, and, therefore, no numeric score was available to programs.

For this reason, we removed Step 1 entirely and increased the weight of Step 2 scores, which residency programs now place much more importance on. To offset the removal of Step 1, other factors, such as match rate and publication items, were also adjusted to better reflect the current landscape.

The 10 Least Competitive Specialties in Medicine

The following medical specialties ranked lowest, meaning they’re relatively easier to match into.

These are the 10 least competitive specialties to match into:

1. Family Medicine
2. Pediatrics
3. Emergency Medicine
4. Psychiatry
5. Pathology
6. Neurology
7. Child Neurology
8. Internal Medicine
9. Physical Medicine & Rehabilitation
10. Radiation Oncology

Our competitiveness index considers a wide selection of data points, including USMLE Step 2 CK scores, match rate, publications, NIH funding, and more, to determine a specialty’s competitiveness.

The weighted breakdowns are now as follows.

• Step 2 CK Score – 30%,
• Match Rate – 30%
• Research Items – 25%
• AOA – 5%
• Top 40 NIH – 10%

Want to see how your stats stack up? Head to specialtyrank.com for detailed specialty rankings and competitiveness metrics.

5 | Pathology

In the fifth spot is pathology at 28.0 points. Pathology is the field of medicine concerned with the study of body tissues and body fluids. They provide tissue diagnoses after examining specimens and manage all clinical labs ordered by other physicians.

Previously, in 2022 and 2020, pathology did not place in the top 5. In 2022, it ranked 8th in our top 10 least competitive specialties.

This shift is in part due to a lower average Step 2 score, which is now weighted more heavily. Pathology is tied for the 3rd lowest average Step 2 score. Additionally, pathology shifted lower in the ranks due to the average number of research items, which went slightly down from 8.5 in 2022 to 8.4 in 2024.

While this is a fairly insignificant difference, what’s more significant is that most other specialties saw a notable increase in the average number of research items. For example, PM&R went from 6.2 to 8.6, and child neurology went from 7.4 to 8.9 average research items.

Pathologists are known for having a great lifestyle. They work about 47 hours a week and make $373,384 a year.

While not always the case, money and lifestyle are often tied to the competitiveness of a medical specialty.

4 | Psychiatry

Next is psychiatry, which moves up from 3rd to 4th with 25.2 total points.

Psychiatry is focused on understanding and treating mental health disorders and psychological distress.

The higher weight of Step 2 scores did not push psychiatry up the list, as it still sits at the 2nd-lowest score among specialties. Research items improved for psychiatry, going from 6.2 in 2022 to 7.5 in 2024. Additionally, top 40 NIH funding continues to be higher than the top 3 least competitive specialties.

Psychiatrists also often enjoy a healthy work-life balance. The average psychiatrist earns $341,977 and works 47 hours per week.

If you’re having trouble deciding what specialty you want to pursue, you’re not alone. Our So You Want to Be playlist takes a deep dive into the pros, cons, and training steps for every medical specialty to help you determine what’s right for you.

3 | Emergency Medicine

The third-least competitive specialty is emergency medicine, with 15.0 points.

Emergency medicine focuses on treating patients who are acutely ill and have critical healthcare needs. This includes treating acute conditions like heart attacks, also known as myocardial infarctions, stabilizing patients involved in trauma, exacerbations of chronic health conditions, and more.

Emergency medicine switches places with psychiatry due to a smaller increase in research items, going from 5.1 to 5.7, and a decreased rank for Step 2 scores, which, keep in mind, is more notable in this assessment due to its higher weight compared to prior years.

Emergency medicine physicians earn $411,133 per year and typically work 46 hours per week. EM doctors do shift work and typically work 3-4 days a week, getting the rest of the week off.

While that may seem like a solid work-life balance, shift work isn’t always at the same time each day you’re on, and emergency medicine physicians experience some of the highest rates of burnout due to the fact that they spend their day-to-day on the front line of healthcare, consistently dealing with high-intensity, unpredictable situations.

2 | Pediatrics

In the second spot is pediatrics with 13.4 points.

Pediatrics is the field of medicine that provides care for babies, children, and adolescents from birth to age 25. The average pediatrician earns $265,230, though the salary and job responsibilities vary widely by subspecialty.

The position of pediatrics remains the same despite research items going from 5.6 to 6.9. What we’re noticing across the board is that the research item average continues to increase for nearly every specialty; the question is just by how much.

For example, dermatology, this year’s most competitive specialty, saw average publications increasing from 20.9 to 27.7. As any medical student will tell you, achieving another 7 research items is no small feat, and this average increase occurred in only 2 years.

Research items, consisting of publications, abstracts, and presentations, consistently play a huge role in a specialty’s competitiveness, as well as a candidate’s ability to match into their desired program, no matter how competitive it is.

The Med School Insiders Ultimate Research Course distills the tactics the fellow course creators and I used to gain over 60 research items each. Not surprisingly, adcoms loved how prolific we were, and it opened doors. You’ll learn to publish more in less time, build a research team around you, confidently present your work, and so much more, including advanced tactics you won’t find anywhere else because we innovated them.

The course includes over 75 video modules, templates, and resources, as well as an exclusive private community to help you elevate your research to the highest level. We’re so confident you’ll find tremendous value that it comes with a 10-day money-back guarantee.

1 | Family Medicine

And in the number 1 spot is family medicine with 7.3 points.

Family medicine is the center of primary care, and these physicians are the generalists of generalists. Unlike most specialties that focus on a single organ system, disease, or age range, they see the full spectrum of patients, from young to old, healthy to unhealthy, and everything in between.

The increased weight of Step 2 scores further solidifies family medicine as the least competitive medical specialty, as it has the lowest average Step 2 score at 244, 2 full points below the 2nd-lowest, psychiatry, with a score of 246.

Family medicine physicians usually work regular 9-to-5 business hours with minimal call, if any. They earn an average annual salary of $318,959 and work an average of 53 hours per week.

Understanding the Data

So, what’s the conclusion to all of the 2024 changes?

Overall, things didn’t move as much in our least competitive specialties as in our most competitive ones.

Family medicine and pediatrics remained in the 1st and 2nd spots, respectively. Emergency medicine and psychiatry swapped spots for 3rd and 4th, and the main change was the addition of pathology in the bottom 5, replacing PM&R.

PM&R moved up 4 spots to the 9th least competitive or the 14th most competitive of 22 specialties. This notable jump is in large part due to an increase in research items and a relatively more competitive match rate.

Unlike with the most competitive specialties, there is far less correlation between pay and competitiveness rank on this list.

While it is true that family medicine doctors and pediatricians are among the lowest-paid physicians, this is not the case for emergency medicine, pathology, or psychiatry, none of which are even among the 10 lowest-paid specialties.

It will be interesting to see how these rankings evolve in our 2026 assessment.

One trend we don’t see slowing down anytime soon is the increased emphasis on research items to distinguish top candidates, no matter the specialty.

Were you surprised by any of the specialties on this list? Let us know with a comment below.

Every analysis has its limitations. That said, we carefully crafted a comprehensive analysis of multiple, differently weighted factors that contribute to a specialty’s competitiveness. I urge you to take a close look at the spreadsheet and play with the data to see for yourself.

Don’t let the data fool you, though. Just because these are the ten least competitive specialties doesn’t mean they aren’t hard to get into. Every specialty in medicine is competitive; it’s just that some are more competitive than others. If you want to get the best training at a top program, you’ll have to be a stellar candidate.

This is Why Some Specialties are More Competitive than others.

Results From 2022

How to Choose a Specialty

Are you having trouble deciding what specialty to pursue? We have a series called “So You Want to Be…” that dissects different specialties and subspecialties. The series takes a comprehensive look at pursuing each specialty, its pros and cons, and whether it will be a good fit for you.

Some specialties we’ve covered in the past include:

• So You Want to Be a Radiologist
• So You Want To Be a General Surgeon
• So You Want to Be a Cardiologist
• So You Want to Be an Endocrinologist
• So You Want to Be a Global Health Doctor

We continually add to this series, so be sure to follow along on the Med School Insiders blog. If you don’t see a specialty you’re interested in, leave a comment below or contact our team to request an analysis.

Find Your Best-Fit Specialty

Competitiveness matters, but it’s only one piece of the puzzle. The right specialty for you balances your interests, lifestyle goals, and realistic match probability based on your actual credentials.

Before you commit to a specialty based solely on competitiveness rankings, get a personalized assessment. SpecialtyPredictor.com uses your Step scores, research experience, and other application factors to show you realistic match probabilities across all specialties.

You’ll see where you’re genuinely competitive, where you might be reaching, and where you have safety options, all based on real NRMP data. It’s the strategic insight you need to build a smart rank list and maximize your chances of matching into a program you’ll actually love.