Updated 2022: Top 10 Most Competitive Specialties in Medicine


Have you ever been confused when people talk about certain medical specialties being competitive? We meticulously calculated the most competitive specialties in medicine based on a wide selection of average data across Step scores, match rate, publications, school funding, and more.

There’s a tremendous amount of misinformation out there regarding which medical specialties are competitive. Everyone wants to say their specialty is competitive—and they’re not wrong. Getting into any residency is a challenging ordeal. That being said, some specialties are more competitive and harder to get into than others.

There’s often a lot of pride involved, but whether or not your specialty is considered competitive does not make you a good or bad doctor. It simply says which specialties are hardest to get into. And knowing which specialties are hardest to get into can be very useful information for premeds and medical students. All specialties are competitive, and if your specialty is ranked lower than you’d like, that’s not a judgment at all—it’s simply what the data says.

This post will examine recent data from the National Residency Matching Program (NRMP) to explore which are the most competitive and desired specialties. We’ll share the top 10 most competitive specialties, but you can view our complete spreadsheet to see where the other specialties ranked.

Take a look at our article (and video) on the Least Competitive Medical Specialties.

If you’d like to learn more about our methods and the data we used to reach our results, continue further into this article for a complete overview.


The Top Most Competitive Specialties in Medicine

Based on our comprehensive analysis, the top most competitive specialties are as follows:

  1. Plastic Surgery
  2. ENT
  3. Dermatology
  4. Orthopedic Surgery
  5. Neurosurgery
  6. Thoracic Surgery
  7. Urology
  8. Vascular Surgery
  9. Interventional Radiology
  10. Diagnostic Radiology

This ranking was determined by combining six categories of data that determine a specialty’s competitiveness. We utilized the latest US data from 2022, and we will update the list again as soon as new data becomes available in future years.

  • Match rank
  • Step 1 score
  • Step 2 CK score
  • Publications
  • AOA percentage
  • Top 40 NIH

Doctor specialty analysis data categories


What the Data Says

In total, we examined 24 different specialties using data gathered from the National Residency Matching Program (NRMP). We examined six categories for each specialty: 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.

The top 40 NIH-funded medical schools are usually more competitive, meaning students who got into these schools were, on average, stronger students. AOA, or the Alpha Omega Alpha Honor Medical Society, is often a good indicator of being a high-performing student, but it’s not perfect, as not all schools have it.

Every analysis has its weaknesses, and this is no exception. The main limitation is that it weighs each of the six components equally. In reality, some components are more indicative of a specialty’s competitiveness than others. To help address this shortcoming, we created the new 2022 MSI Competitiveness Index, which weights each of the six components based on their relative importance. Match rate is weighted 25%, Step 1 score 25%, Step 2 CK score 15%, publications 20%, AOA 10%, and Top 40 NIH School 5% to better reflect the relative importance of each component.

Using this data, we ranked each specialty from 1 to 24 in each category, with 1 being the specialty with the lowest score in that category and 24 being the specialty with the highest score. We then added up all of the points to determine the specialty’s competitiveness.

The specialty with the highest total points is plastic surgery, followed by ENT, and dermatology.

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. Keep in mind that due to a lack of complete data, ophthalmology was not included in this analysis.

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


1 | Plastic Surgery

Plastic surgery ranks number one with a total of 94 points. This specialty ranks high across nearly all six of our data categories, with the exception of Top 40 NIH.

Plastic surgeons focus on soft tissue, such as skin, muscle, and fat, as opposed to bones, which are in the territory of orthopedic surgeons. The word plastic comes from the Greek word “plastikos,“ meaning “to mold,” which is a reference to how plastic surgery reshapes and manipulates tissues.

If you are precise, meticulous, and have an obsession with details, plastic surgery may be a good fit for you. Plastic surgery is an innovative field where you’ll experience a ton of variety. Pay is more variable than other specialties, but you’ll still have quite a good lifestyle, as compensation is above average.

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


2 | ENT

In the second spot is the ENT specialty (Otorhinolaryngology), with a high AOA percentage and Step scores.

ENT is a surgical subspecialty focused on diseases of the head and neck region. This includes the vocal cords and larynx, the nose and sinuses, ears, and endocrinology, including the thyroid and parathyroid, as well as head and neck cancers.

The lifestyle of an ENT is great, and you can make good money with a good balance in your life. This makes it an ideal specialty for those who want to be able to prioritize a family along with their career. It’s also one of the top paying specialties, averaging $450,000+ per year. The downside is that you deal with a very limited region of the body—one that is incredibly complex and difficult to navigate.

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


3 | Dermatology

The dermatology specialty dropped down to the third spot based on recent data, but this specialty is strong in all six of our data categories.

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

The dermatology specialty attracts a large number of medical students due to the excellent lifestyle and work-life balance that isn’t afforded by most other disciplines within medicine. Dermatologists are also highly compensated, usually ranking in the top 5 highest paid specialties in medicine, with an average salary of over $400,000 per year.

Learn more about the Dermatology Specialty and if it’s the right fit for you.


4 | Orthopedic Surgery

Orthopedic surgery ranks in the number four spot, with fairly high rankings in all six categories, except for Top 40 NIH, in which orthopedic surgery ranks mid-range of 24 specialties.

Orthopedic surgery focuses on the musculoskeletal system, which includes fractures and broken bones. Surgeries also involve tendons, ligaments, and nerve or vascular injuries.

There’s notable satisfaction in being an orthopedic surgeon, as orthopedics usually have good outcomes. Most patients experience substantial improvement in their condition after surgery. Like many surgical specialties, orthopedic surgery can have challenging hours, but the trade off is that orthopedic surgeons are consistently the number 1 or number 2 highest compensated physicians.

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


5 | Neurosurgery

The neurosurgery specialty is next, ranking fairly high across all six categories, with a slightly lower ranking for match rate and Step 2 CK score.

Neurological surgery focuses on the nervous system, which consists of two main components—the central nervous system (CNS) and the peripheral nervous system (PNS). CNS includes the brain and spinal cord, and PNS includes all other nerves within the body. Neurosurgery deals with surgical interventions of both CNS and PNS.

Neurosurgeons get to touch, change, and augment the central nervous system in real-time. Neurosurgery is one of the few specialties that can truly save people’s lives. Though it can be an exhilarating career, at a moment’s notice, you may be called into the hospital to save someone’s life. It’s a fascinating specialty that satisfies the intellectually curious, but it has one of the most challenging lifestyles of any specialty.

Learn more about the Neurosurgery Specialty and if it’s the right fit for you.


Final Thoughts

There’s always complaints about imperfect methodologies. Every analysis has its limitations. I urge you to take a close look at the spreadsheet and play with the data to see for yourself.

Now, you might be confused. If a specialty has a low match rate, then it must be more competitive, right? Not exactly. Specialties are self-selecting. I recently saw an analysis by someone who went only by match rates alone, and in doing so, they suggested that general surgery and psychiatry were the third most competitive specialties. Anyone who is in medical school or residency will tell you that’s certainly not the case.

For example, in plastic surgery, applicants use general surgery as their backup in case they don’t get into plastics. Look at it this way: if you’re not a competitive applicant, you’re not going to apply to something like plastic surgery or neurosurgery. Lots of people want to do surgery, and general surgery is the most commonly applied to. General surgery is tremendously broad and diverse, leaving options open to subspecialize after, and it’s the least competitive of the surgical specialties. Hence the high number of applicants and the low match rate.

This is not a judgment against general surgery. This is simply an explanation for its low match rate. Again, please view the data in the spreadsheet to see how it compares once multiple data categories are examined.

In order to overcome the shortcomings of looking at match rate alone, we examined 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.

Want to learn more? Here’s Why Some Specialties are More Competitive than others.

An interesting pattern I noticed was that the top 5 were all very well-paid specialties. Neurosurgery and orthopedic surgery are almost always the top 2 best-paid specialties, regardless of the survey. Plastic surgery is also up there, but it’s important to note that cosmetic practices make much more than reconstructive practices. Dermatologists don’t make as much as the other top 4 specialties, all of which are surgical, and that makes sense. Surgeons put in more work and do more challenging procedures, but dermatologists have a lifestyle that’s hard to beat.

What do you think of the results? Are you surprised, or is this what you were expecting? Leave a comment down below—We’d love to hear your thoughts.

So, what’s the conclusion to all of this? It’s quite clear that the most competitive specialties are highly correlated with either excellent pay or excellent lifestyle. Correlation is not causation, but I think it’s safe to say that there’s more than a simple correlation going on here.

Every analysis has its limitations. That being said, we took careful care to craft a comprehensive analysis of multiple factors that contribute to a specialty’s competitiveness. We’ll continue to update the overall analysis spreadsheet to reflect the most recent data available.


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.

Some recent specialties we’ve covered include:


Do You Want to Pursue a Competitive Specialty?

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.


This Post Has 5 Comments

  1. DS

    Very well put. Doctors are people, people, in the end, are simple. Want high reward (high salary) and little effort (dermatology). If meteorology would be a medical speciality with the highest pay and work hours 9-3, it would surely be in the top 1 list.

  2. YT

    You did not even include ophthalmology into your analysis probably because a lot of people don’t realize that ophthalmology is through the sfmatch. Ophtho is no cakewalk to match into with step scores among the highest and even less regarded positions in community programs being difficult to match to.

  3. Dick Burns


  4. Zane

    You numbers on ophthalmology are incorrect. Ophthalmology has a totally separate match system. The most recent data for 2019 show that the match rate was 75%. That is more competitive than the specialty that you listed as number one, dermatology.

  5. Parker

    Just a quick note, Ophthalmology and Urology do not use the NRMP. Curious to know if their numbers were considered.

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