2024 Top 10 Most Competitive Specialties in Medicine

What the Data Says

In total, we examined 22 different specialties using data gathered from the National Residency Matching Program (NRMP).

To overcome the shortcomings of looking at a single factor, we examine six categories of data: average match rate, Step 1 score, Step 2 CK score, number of publications, percentage of matriculants that were AOA, and percentage of applicants from a top 40 NIH-funded medical school.

Each specialty is ranked by those six categories on a point-based ranking system, and certain categories are weighted higher than others. Step 1 is weighted at 25%, Step 2 CK at 15%, match rate at 25%, publications at 20%, AOA at 10%, and NIH at 5%.

Even though Step 1 changed to pass/fail in 2022, the students included in the 2024 data took Step 1 when it was still scored. When we analyze the 2026 Charting Outcomes data, we’ll remove Step 1 and increase the weighting of Step 2 scores.

Data was analyzed for US applicants only, as incorporating international medical graduates (IMGs) would muddy the analysis. The analysis goes far beyond match rate, as that would be an inaccurate marker of competitiveness. Note that Urology, Thoracic Surgery, and Ophthalmology are not included in NRMP Charting Outcomes. We do our best to fill in data for those specialties from other sources, but it’s less accurate and not as up-to-date. Based on preliminary data and patterns from prior years, we’re confident none of these would be in the top 5.

If you want to evaluate the data yourself, we have an entire spreadsheet with all of our calculations.

So, what are the most competitive medical specialties in 2024?

5 | Otorhinolaryngology (ENT)

In the fifth spot is otorhinolaryngology, or ENT, standing for ears nose and throat, coming in at 73.3 points. ENT is a surgical subspecialty focused on diseases of the head and neck region.

Previously, based on 2022 data, ENT was in second place for most competitive. The drop in position is in large part due to a notable match rate increase from 69.2% in 2022 to 81.9% in 2024. Additionally, average Step 1 scores decreased from 250 to 243. The total points for ENT went down from 89.6 in 2022 to 73.3 in 2024, and this is one of the reasons so many of the rankings have shifted.

ENTs are known for having a great lifestyle. You can make over $500K a year while having a reasonable work-life balance. While not always the case, money and lifestyle can be tied to how competitive a medical specialty is.

Learn more about becoming an Otorhinolaryngologist (ENT) and if it’s the right fit for you.

4 | Orthopedic Surgery

Orthopedic surgery ranks in the fourth spot with 79.6 total points.

Orthopedic surgery focuses on the musculoskeletal system, which includes broken bones, tendons, and ligaments.

Orthopedic surgery was also in the fourth spot in 2022, so not much has changed here. While orthopedic surgeons don’t have the best lifestyle due to irregular and unpredictable hours while on call, they have the third-highest pay of any medical specialty at over $650,000 a year as of 2024 data.

It’s natural not to be totally certain of the specialty you want to pursue. If you’re having trouble deciding, or just want to learn more about your favorite specialties, check out our So You Want to Be playlist, which takes a deep dive into the pros, cons, and training steps for every medical specialty.

Learn more about Orthopedic Surgery and if it’s the right fit for you.

3 | Plastic Surgery

The third most competitive specialty is plastic surgery with 83.5 points.

Plastic surgery focuses on a patient’s soft tissue, such as fat, skin, muscle, and occasionally bone, to reshape or reconstruct a patient’s function or appearance.

Plastic surgery jumps down from the number 1 spot in both 2022 and 2020 data to third in 2024.

The big drop for plastic surgery comes from a lower average Step 1 score, dropping from 251 in 2022 to 247 in 2024. Additionally, the match rate changed from 62.7% in 2022 to 74.3% in this year’s data. Plastic surgery is another specialty that saw a huge decrease in total points, going from 94.4 in 2022 to 83.5 in 2024.

Plastic surgery is another specialty with a huge paycheck. It’s the fourth highest paid specialty at $620K a year. And the lifestyle of a plastic surgeon isn’t bad either since most surgeries are not urgent.

Learn more about Plastic Surgery and if it’s the right fit for you.

Before we get to our top 2, let’s talk about research because average publications across all of the top most competitive specialties saw a huge leap. And this is a trend we’ve seen year after year.

The data show just how important research is to matching into residency. Publications consistently play an outsized role in a specialty’s competitiveness, as well as a candidate’s ability to match into their desired program.

Plastic surgery research items increased from 28.4 to 34.7 from 2022 to 2024 alone. This is massive. Back when I applied to plastic surgery residency in 2016, the average was just under 12.

Luckily, even back then, I earned over 60 publications, abstracts, and presentations which helped me land a residency seat in Southern California. It’s the tactics and methodologies I used to gain these publications that myself and my colleagues, who also have over 60 research items each, distilled in The Med School Insiders Ultimate Research Course.

Through the course, 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.

We’ll show you how it’s done step by step and make the traditionally painful process feel nearly pain-free. The course is packed with over 75 video modules, templates and resources, and exclusive private community access to elevate your research game to the highest level.

We’re so confident you’ll find tremendous value that it comes with a money-back guarantee. Try the course today at no risk.

2 | Neurosurgery

Back to our list. In the second spot is neurosurgery with 83.8 points, just barely beating out plastic surgery.

Neurosurgery focuses on the nervous system, which consists of two main components—the central nervous system and the peripheral nervous system.

You may be familiar with neurosurgery from the viral video made by @GoobieAndDoobie after he quit being a neurosurgeon. Check out my thoughts and what I agree and disagree with about his video over on my personal channel.

This year, neurosurgery took a huge leap from the fifth spot to second place. However, the only notable difference to neurosurgery numbers was match rate, which moved from 74.3 in 2022 to 68.7 in 2024. The change in competitiveness has less to do with neurosurgery and more to do with other specialties, like plastic surgery and ENT moving down the rank list. Neurosurgery’s total points only changed from 81.3 in 2022 to 83.8 in 2024.

While it may not be all that relaxing being a neurosurgeon—they are known for having a terrible work-life balance—they make the most out of any medical specialty at over $760K.

Learn more about Neurosurgery and if it’s an ideal fit for you.

1 | Dermatology

And in the number 1 spot is dermatology with 84.8 points.

Dermatologists manage diseases of the skin, hair, and nails in both medical and procedural aspects and can identify and treat more than 3,000 conditions, including eczema, psoriasis, and skin cancer.

In 2018 dermatology claimed the number 1 spot but was beat out by plastics in 2020 and 2022. It now holds the most competitive title once again.

Dermatology may not make the top 10 list of highest paid specialties, but it’s still up there, just missing the half a million mark at $494,000 a year.

In addition to great pay, dermatology is known for having an excellent lifestyle and work-life balance that isn’t afforded by most other disciplines within medicine. They have limited call, low acuity of medical conditions, flexible workdays, and control over when and how they work.

Considering the number of hours worked per week, and the predictability of those hours, dermatologists make quite a lot. A dermatologist’s hourly rate is among the highest of any medical specialty. Check out our video on the Doctor Specialties with the Highest Hourly Rate.

Find out if Dermatology is the right fit for you.

What’s Misleading About the Numbers

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

It’s quite clear that the most competitive specialties are still highly correlated with either excellent pay, excellent lifestyle, or both. Correlation is not causation, but it seems fairly clear year after year that there’s more than a simple correlation going on here.

This year, we also started to see close clustering of the top 3 specialties. Even though plastic surgery moved from the number 1 spot to number 3, this is the closest top 3 race we’ve seen since the NRMP started releasing Charting Outcomes. This is largely due to plastic surgery’s drop from the number 1 spot at 94.4 by a significant margin of 5 points in 2022 to 83.5 total points this year.

The top 3 most competitive specialties, plastic surgery, neurosurgery, and dermatology, are all within 1.3 points of each other. In 2022, 8.4 points separated the top 3 most competitive specialties.

But keep in mind that the total scores are only relative to the specific year. This means you can say how competitive a specialty is compared to another specialty from that same year and how the rankings changed year to year, but not how more or less competitive it is compared to itself from the previous year.

It’s normal for the rankings to move up and down from year to year, and there are many factors that go into these changes. One of those key factors is supply and demand. The demand part is how many students are interested in the specialty. Supply is how many seats are available.

The match rate going up and down is a function of supply and demand, but there’s a confounding factor since self-selection bias is occurring. That’s why it’s dangerous to look at match rate alone, a common trap you’ll see many YouTubers and blog writers fall into.

For example, in 2018, general surgery had a lower match rate of 84% compared to neurosurgery at 86.4%, leading some YouTubers to claim that general surgery was more competitive than neurosurgery.

However, if you look at the average Step 1 score, Step 2 CK score, and other factors demonstrating how competitive a student is, it’s clear that the students applying to neurosurgery were far more competitive; their Step 1 scores were 9 points higher on average, they had 18.3 research items compared to 6.2 for general surgery, and so on.

It’s the same line of thinking that makes some believe PA school is more competitive than medical school given the lower matriculation rate, despite PA students having significantly lower GPAs and standardized test scores than medical students. Match rate alone is not sufficient. The self-selection bias needs to be accounted for by looking at variables quantifying the strength of a candidate.

Some sources can be incredibly misleading about match rate data. This year, the NRMP even went as far as saying, “The results of the Match can indicate the competitiveness of specialties as measured by the percentage of positions filled overall and the percentage of positions filled by U.S. MD and DO seniors.”

You should never solely use fill rate as the determining factor for how competitive a specialty is. If we did that, internal medicine and emergency medicine would top the charts over fields like neurosurgery and dermatology, which is laughable to anyone who has ever attended medical school.

And finally, average publications are showing no sign of slowing down, with increases in nearly all medical specialties in 2024. This is particularly true of the most competitive specialties. Like the leap we saw for plastic surgery, neurosurgery increased from 25.5 to 37.4 research items, and dermatology increased from 20.9 to 27.7.

The good news for premeds is that any publications and abstracts from college will count even when you apply to residency. If this trend worries you as a premed or med student, make sure to check out The Med School Insiders Ultimate Research Course.

How to Choose a Specialty

If you’re not sure what specialty you want to pursue, we have a whole series dedicated to dissecting different specialties and subspecialties. Our “So You Want to Be…” series takes a deep dive into how to pursue each specialty, pros and cons, and how to determine if the specialty will be a good fit for you.

If you’re aiming for a highly-competitive specialty, we can get you there. Med School Insiders offers a range of multimedia courses designed to help you reach your potential.

Each course was created by our team of top performing doctors. The Premed Roadmap will help you get accepted to a Top 40 NIH medical school, and the interview courses for medical school or residency are hands down the most comprehensive and high-yield guides on the interview process that you’ll find anywhere. Even better, both are constantly being updated and improved with new exclusive videos, written content, and private group mentorship access.

If you’re about to apply to residency, check out our Comprehensive Residency Match Packages, which include essay editing, application editing, interview preparation, research advice, and more.

Next read: Here’s Why Some Specialties are More Competitive than others.

2022 Most Competitive Specialties