Ranking Doctor Specialties by USMLE Step 1 & Step 2CK Scores

The USMLE Step exams are a series of standardized tests that every aspiring doctor must take during medical school and residency. Step 1 is generally taken at the end of the second year of medical school, Step 2 CK is taken during the fourth year of medical school, and Step 3 is usually taken during the first year of residency.

Because test scores are an easy, objective metric to sort applicants, Step scores have become incredibly important in residency admissions. As such, it’s critical for any aspiring doctor to know which specialties have the highest and lowest scores so you can anticipate how well you’ll need to score to be competitive.

Here are the doctor specialties with the highest (and lowest) Step scores.

Specialties with the Highest & Lowest Step 1 Scores

Let’s start with Step 1 scores.

According to the 2022 NRMP Charting Outcomes in the Match report, the top 5 specialties with the highest Step 1 score were plastic surgery in first with an average score of 251, followed by ENT in second at 250, and dermatology, neurosurgery, and orthopedic surgery tied for third at a score of 248. At the other end of the spectrum, the bottom 5 specialties were neurology in twentieth place with a score of 233, PM&R and pediatrics tied for twenty-first at 230, psychiatry in twenty-third at 228, and family medicine in last place at 225.

If we look at the 2022 MSI Competitiveness Index, which takes additional residency application factors into account including Step 2 CK, number of publications, AOA status, and match rates, we can see that the top 5 specialties with the highest and the lowest Step 1 scores closely mirror the top 5 most and least competitive specialties. This emphasizes just how important Step 1 has been historically in terms of matching into residency.

That being said, as of January 2022, Step 1 has officially become pass/fail meaning that it will no longer be the primary determinant of one’s competitiveness as an applicant. You shouldn’t be fooled by this change, however. This doesn’t mean that residency admissions are getting any easier.

Competitiveness is not a function of Step scores. Instead, it is a function of supply and demand.

There are more medical students applying for residency each year than there are available residency positions. During the most recent 2022 NRMP Match, there were approximately 43,000 applicants competing for roughly 36,000 residency spots, meaning that over 6,000 medical students went unmatched.

Residency programs still receive hundreds, if not thousands, more applications than they have available slots. As such, they need a way to quickly filter through applicants. Now that Step 1 has become pass/fail, much of the weight will be passed on to other objective metrics – the most notable of which is Step 2 CK.

Specialties with the Highest & Lowest Step 2 Scores

Now let’s look at the specialties with the highest and lowest Step 2 CK scores.

In 2022, the top five specialties with the highest average Step 2 CK scores were plastic surgery, dermatology, and ENT all tied for first at 257, orthopedic surgery in fourth at 256, and diagnostic and interventional radiology tied for fifth at 253 just edging out neurosurgery with a score of 252. At the other end of the spectrum, the bottom five specialties were neurology in twentieth place with a score of 246, pediatrics in twenty-first with a score of 245, psychiatry and PM&R tied for twenty-third with a score of 242, and family medicine in last place with an average score of 241.

If we compare this to the average Step 1 scores from 2022, we can see that the top five and bottom five specialties are very similar. With the exception of diagnostic radiology and interventional radiology edging out neurosurgery, the specialties with the highest and lowest Step 1 and Step 2 scores are identical. This is perhaps to be expected as students who do well on Step 1 should naturally do well on Step 2 as well, barring any major external factors.

Given the fact that the first class of medical students with pass/fail Step 1 scores has not applied to residency yet, we can’t say for certain how exactly residency admissions will change.

Although much of the weight will be passed on to Step 2 CK, it’s yet to be seen if it will hold the same weight that Step 1 did, or if that weight will be passed on to other components such as medical school grades, dean’s lists, number of publications, letters of recommendation, and AOA status.

Regardless, it wouldn’t be surprising if we see an increase in Step 2 scores in the coming years as students put more time and attention into doing well on this test.

Should Step 2 CK Become Pass/Fail?

Another question that has come up over the last year or so, is whether or not Step scores hold so much weight in the first place.

According to the NBME Scoring Interpretation Guide, the standard error measurement, which represents how precise a test’s scoring system is, is about 6 points for both Step 1 and Step 2 CK.

To calculate a 68% confidence interval using the standard error of measurement, or SEM, we can add one SEM and subtract one SEM from an individual’s score. For example, if you scored a 250 on Step 2 CK, there is about a 68% chance that your “true” score lies somewhere between 244 and 256.

Statistics aside, the key takeaway is that an individual’s score can vary significantly based on the specific version of the exam they take.

Furthermore, the standard error of difference, which is used to determine if the difference between two scores is statistically significant, is approximately 9 points for Step 1 and 8 points for Step 2 CK. The NBME reports that if two examinees’ scores differ by two or more standard errors of difference, then the two examinees are likely different in their proficiency.

This means that residency applicants should be considered statistically equivalent if their scores are within 16 to 18 points of each other. For instance, a 235 should be considered statistically equivalent to a 250. But ask any medical student, and they’ll tell you that the two scores are certainly not viewed in this way by residency programs.

In addition to the high degree of variability in an individual’s test scores, Step scores are also not good indicators of one’s clinical performance. Although Step 2 CK is more clinically relevant than Step 1, it is still far from a perfect predictor of how a doctor will perform in the clinical setting. There are many other factors including communication, empathy, and leadership skills that determine one’s ability to succeed as a physician.

One of the main reasons that Step 1 became pass/fail was because people felt it held too much weight for residency admissions and it put unnecessary pressure on students to perform. If a student wasn’t feeling well or if unforeseen circumstances occurred on test day, it could affect that student’s entire career. But making Step 1 pass/fail doesn’t change that.

According to new research, many residency program directors feel that the change simply redirects stress onto Step 2 CK.

In fact, it may even make things more stressful for students as they often take the exam towards the start of the residency application cycle.

The logical conclusion then is that Step 2 CK should also become pass/fail; however, this comes with its own set of problems. As we discussed previously, residency competitiveness isn’t a function of test scores, but of supply and demand. There are only a certain number of residency positions each year, so program directors need a way to efficiently sort through applicants.

It’s nothing more than wishful thinking to believe that residency programs will complete a comprehensive and holistic view of each applicant. The reality is that they need a way to narrow down the thousands of applications they receive into more manageable numbers before they can take a closer look at each individual application. Making Step 2 CK pass/fail would just pass the weight onto something else – whether that be research, standardized evaluation forms, who you know, or something else.

Taking a sledgehammer approach and making Step 2 CK pass/fail would just be pushing the can down the road and opening the door for more subjective metrics to play a greater role in residency admissions. It wouldn’t affect the root cause – which is the limited number of residency positions.

No matter what changes to residency admissions occur, it’s important to focus on the things you can control. The last thing you want to do is fall into the trap of having a victim mentality and blaming your inability to get into your desired residency on external factors.

Some residency programs will always be more competitive than others, so there will always be certain metrics to pare down the pile of applicants. What separates those who are successful from those who are not, is the willingness to adapt and push forward. While the cards were heavily stacked against me in more than one way, I was still able to match into plastic surgery using the methods discussed at Med School Insiders.

If you find yourself getting discouraged because your dream specialty is highly competitive, stop right there. Your ability to crush Step 2 CK and have dozens of research articles is less a function of your intelligence and more a function of proper preparation, constantly improving, and putting in the work. Having a stellar residency application and crushing the interviews are no different.

At Med School Insiders, our mission is to empower a generation of happier, healthier, and more effective future doctors. From medical school or residency application help to crushing your MCAT or USMLE, we’ve got your back. We know what you’re going through and can help present you in the best light possible with your medical school and residency applications. And our results speak for themselves. We’ve become the fastest-growing company in the space with industry-leading results.

If you enjoyed this article, be sure to check out the Top 10 Most Competitive Specialties or How I Scored a 265+ on Step 2 CK.