Doctor Specialties Ranked by Step 2 CK Score

One test score can decide whether you match into your dream specialty or spend another year wondering what went wrong. It’s USMLE Step 2 CK, the nine-hour exam that carries more weight than almost anything else in your residency application. With Step 1 pass/fail, it’s the only standardized score left for programs to assess you by, and the bar keeps rising every year.

We’re ranking all 24 specialties by their average Step 2 CK score, from lowest to highest, using brand new 2026 data.

24 | Family Medicine: 244

Family medicine has the lowest average Step 2 CK score of any specialty, and that gap isn’t closing. The average has climbed from 238 in 2020 to 241 in 2022, then to 244 in 2024 and 2026, but it still sits notably 2 points below the next-highest.

23 | Psychiatry: 246

Psychiatry sits above family medicine at 246. It’s consistently one of the lowest Step 2 CK averages in medicine and also among the least competitive specialties by every other measure we track.

Having a higher or lower average Step 2 score doesn’t make a certain specialty better or worse or those doctors more or less capable at their job. If you’re aiming for a less competitive specialty, you don’t need to achieve as high of a Step 2 score. And this is an important distinction because every med student is spread thin. Where you spend your time matters, and knowing you don’t need to achieve a 270 Step 2 means you can apply your time and energy elsewhere.

22 | Emergency Medicine: 248

Emergency medicine opens a two-way tie at 248. Overall competitiveness has fluctuated over the years, but EM often ranks among the five least competitive medical specialties.

You may be noticing that lower Step 2 CK averages tend to cluster with specialties that rank lower in overall competitiveness. That’s not a coincidence. Step 2 is now a heavily weighted factor, since Step 1 is pass/fail.

21 | Pathology: 248

Pathology ties emergency medicine at 248. It’s historically been one of the less-pursued specialties among US MD seniors, which may help explain why its average score is lower than its diagnostic complexity might suggest.

20 | Pediatrics: 249

Pediatrics comes in at 249. Like family medicine, it’s a primary care specialty that consistently ranks near the bottom of the Step 2 CK list and on every other measure of competitiveness.

19 | Child Neurology: 250

Child neurology opens a two-way tie at 250, which sits at the 47th percentile. That means 47% of Step 2 CK takers scored at or below 250, with the rest of the pack still ahead. It’s also a niche specialty with a much smaller applicant pool than most others on this list, which makes a direct comparison tricky.

18 | PM&R: 250

PM&R ties child neurology at 250. 

SpecialtyRank.com places it in the “Moderately” competitive tier, the middle of the pack amongst the 6 tiers of competitiveness. You can see where every specialty falls in terms of competitiveness and how each factor affects the rankings at SpecialtyRank.com.

17 | Neurology: 251

Neurology opens the next tie at 251. It’s a cognitively demanding specialty, but that hasn’t historically translated into a higher Step 2 CK average.

16 | Radiation Oncology: 251

Radiation oncology ties neurology at 251. Note that most of these positions are filled at the PGY-2 level rather than PGY-1, since it’s an advanced specialty that typically follows a preliminary year.

15 | Internal Medicine: 252

Internal medicine opens the next tie at 252. It’s the most pursued specialty in the entire match, filling 11,078 PGY-1 positions in 2026, by far the largest pool of any specialty. This is because IM is the gateway to many non-surgical subspecialties only accessible through a fellowship, like cardiology and gastroenterology.

14 | OB/GYN: 252

OB/GYN ties internal medicine at 252. Of the two, it ranks higher in overall competitiveness once all other factors are weighed.

13 | Med-Peds: 253

Med-Peds opens the next tie at 253. It has a higher average Step 2 CK score than adult internal medicine alone and ranks higher in overall competitiveness, despite being a less-pursued path.

12 | General Surgery: 253

General surgery ties Med-Peds at 253. It’s the gateway specialty for many surgical subspecialties, including vascular surgery’s traditional path, colorectal surgery, surgical oncology, and many more.

11 | Anesthesiology: 254

Anesthesiology opens the next tie at 254. Despite its high Step 2 average, it sits in the “Moderately” competitive tier on SpecialtyRank.com, ranking 11th overall.

10 | Interventional Radiology: 254

Interventional radiology ties anesthesiology at 254, and it’s the more competitive of the two once you factor in everything else that goes into a specialty’s overall competitiveness. 

Students aiming for more competitive specialties tend to cluster at the top across every measure, and if you’re dedicated to killing your Step 2 CK score, there’s a good chance you’re crushing the rest of them too. 

9 | Neurosurgery: 255

Neurosurgery climbs to 255, putting it at the 60th percentile. It’s a specialty that attracts a particular kind of personality, one willing to endure brutal hours and put in the work, and that shows up clearly in the research numbers, with an average of 45.5 research items as of 2026, the second highest of any specialty.

8 | Vascular Surgery: 256

Vascular surgery sits at 256. This data reflects the integrated track, where applicants enter a combined program straight out of medical school, rather than the traditional track that begins with a general surgery residency.

7 | Diagnostic Radiology: 257

Diagnostic radiology ranks 257, which falls between the 60th and 74th percentiles per official NRMP data.

6 | Otolaryngology: 258

Otolaryngology, or ENT, opens a four-way tie at 258. It’s consistently one of the most competitive specialties in medicine, sitting in SpecialtyRank.com’s “Very” competitive tier alongside dermatology, orthopedic surgery, and neurosurgery.

5 | Dermatology: 258

Dermatology ties ENT at 258. If you want to earn half a million dollars a year while having one of the best lifestyles in medicine, derm is the specialty for you. The only downside is that everyone else wants that too. 

4 | Orthopedic Surgery: 258

Orthopedic surgery also ranks at 258 and is the fourth most competitive specialty overall, according to SpecialtyRank.com.

3 | Plastic Surgery: 258

Plastic surgery rounds out the four-way tie at 258. Once you weigh in research and match rate alongside the score, plastic surgery pulls well ahead of the other three despite the identical Step 2 CK average.

2 | Ophthalmology: 259

Ophthalmology ties the top spot at 259. 

Note that ophtho matches are processed through SF Match rather than the NRMP main match, which is why you won’t find them in standard residency match data. Lower numbers in other key areas make the specialty far from in the running for most competitive, despite having the highest Step 2 of any field.

1 | Thoracic Surgery: 259

Thoracic surgery ties ophthalmology at the top with a 259. It’s one of the smallest and most fiercely contested fields in the entire match, with only 56 positions offered in 2026. In terms of overall competitiveness, thoracic surgery ranks first among all specialties.

If you want to see the numbers for yourself for how all 24 specialties stack up in overall competitiveness, visit SpecialtyRank.com.

2024 Data