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 limitations of considering a single factor, we examine five categories of data: average match rate, Step 2 CK score, number of publications, percentage of matriculants who were AOA, and percentage of applicants from a top-40 NIH-funded medical school.

Each specialty is ranked across five categories using a point-based system, with certain categories weighted higher than others.

The weighted breakdowns are now as follows.

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

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 scores were 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.

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 the data for those specialties from other sources, but it’s less accurate and less 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?

5 | Otorhinolaryngology (ENT)

In the fifth spot is otorhinolaryngology, or ENT (ears, nose, and throat), with 80.7 points. ENT is a surgical subspecialty focused on diseases of the head and neck region.

Previously, based on 2022 data, ENT ranked second for competitiveness. The drop in position is largely due to a notable increase in match rate from 69.2% in 2022 to 81.9% in 2024. The total points for ENT decreased from 89.6 in 2022 to 80.7 in 2024, which is one reason so many rankings have shifted.

ENTs are known for their high-quality lifestyle. You can make over $520K a year while having a reasonable work-life balance. While not always the case, money and lifestyle can be tied to the competitiveness of a medical specialty.

4 | Orthopedic Surgery

Orthopedic surgery ranks fourth with 88.4 total points.

Orthopedic surgery focuses on the musculoskeletal system, including bones, tendons, and ligaments.

Orthopedic surgery also ranked fourth in 2022, so not much has changed here. While orthopedic surgeons don’t have the best lifestyle due to irregular, unpredictable hours on call, they have the third-highest pay of any medical specialty at nearly $680,000 a year, according to 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

3 | Plastic Surgery

The third most competitive specialty is plastic surgery with 88.6 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 drops from the number 1 spot in both 2022 and 2020 to third in 2024.

The big drop in plastic surgery is due to a change in the match rate, from 62.7% in 2022 to 74.3% in this year’s data. Plastic surgery is another specialty that saw a considerable decrease in total points, going from 94.4 in 2022 to 88.6 in 2024.

Plastic surgery is another specialty with a high pay scale. 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.

Before we get to our top 2, let’s talk about research: average publications across the most competitive specialties saw a significant increase. 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 and in 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 more than 60 publications, abstracts, and presentations, which helped me secure a residency seat in Southern California. It’s the tactics and methodologies I used to gain these publications that my colleagues and I, 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, resources, and exclusive access to a private community to elevate your research game to the highest level.

We’re so confident that 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 92.3 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 on his video, including what I agree with and disagree with, over on my personal channel.

This year, neurosurgery made a huge leap from fifth to second place. However, the only notable difference in neurosurgery numbers was the 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 with other specialties, like plastic surgery and ENT, moving down the ranking list. Neurosurgery’s total points changed from 81.3 in 2022 to 92.3 in 2024.

While it may not be all that relaxing being a neurosurgeon, as they are known for having a terrible work-life balance, they make the most of any medical specialty, earning nearly $750K.

1 | Dermatology

And in the number 1 spot is dermatology with 94.1 points.

Dermatologists manage diseases of the skin, hair, and nails, both medically and procedurally, 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 beaten 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, surpassing the half-million mark at $508,000 a year.

In addition to great pay, dermatology is known for an excellent lifestyle and work-life balance that isn’t afforded by most other medical disciplines. 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.

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 excellent pay, an 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 began releasing Charting Outcomes. This is largely due to plastic surgery’s drop from the number 1 spot, from 94.4 in 2022 to 88.6 this year, a significant 6-point drop.

The top 3 most competitive specialties, plastic surgery, neurosurgery, and dermatology, are all within 5.5 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 in the same year and how the rankings changed year to year, but not how much 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 many factors go into these changes. One of those key factors is supply and demand. The demand part is the number of students interested in the specialty. Supply is the number of available seats.

The match rate fluctuating up and down is a function of supply and demand, but there’s a confounding factor: self-selection bias is at play. 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 examining variables that quantify a candidate’s strength.

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 rely solely on fill rate as the determining factor in 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, with increases across 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 which specialty you want to pursue, we have a whole series that dissects 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.

Before you commit to a specialty, get a realistic assessment of your match chances. SpecialtyPredictor.com analyzes your Step scores, research experience, and other application factors to show you where you’re competitive, where you’re reaching, and where you have safety options. It’s data-driven insight that helps you build a smarter residency application strategy.

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