Top 10 Most Competitive Specialties in Medicine

What the Data Says

In total, we examined 24 different specialties using data gathered from the National Residency Matching Program (NRMP).

To overcome the limitations of considering a single factor, we examined five categories of data: average match rate, Step 2 CK score, number of research items, 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 as follows.

• Step 2 Score: 30%
• Match Rate: 30%
• Research Items: 30%
• AOA: 5%
• Top 40 NIH: 5%

Research figures reflect mean combined items (publications, abstracts, and presentations), consistent with how we’ve reported this data in prior years. Starting with the 2026 cycle, the NRMP’s Charting Outcomes report now emphasizes median figures. We continue to use the mean for consistency with our historical data.

Step 1 has been pass/fail since 2022, which means numeric scores are no longer available for the vast majority of residency applicants. 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 research 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.

It should be noted that Urology is not included in NRMP Charting Outcomes, so its data comes from alternative sources and is less comprehensive. Thoracic Surgery and Ophthalmology, while also outside standard NRMP Charting Outcomes, are included in this analysis via SpecialtyRank.com, which draws from additional data sources to fill those gaps.

If you want to evaluate the data yourself, we have a spreadsheet containing all our calculations.

5 | Neurosurgery

Neurosurgery ranks fifth with 82.4 points in 2026, down from 92.3 in 2024 and 84.5 in 2022.

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 Dr. Jubbal’s thoughts on his video, including what he agrees and disagrees with, over on his personal channel.

The drop in points reflects shifts across the broader ranking landscape rather than neurosurgery becoming less demanding. The match rate moved from 68.7% in 2024 to 70.6% in 2026, a slight loosening that nudged the total score down. Neurosurgeons remain the highest-compensated physicians in medicine, averaging $829,161 a year, and the research bar continues to climb, with matched applicants averaging 45.5 research items in 2026.

4 | Orthopedic Surgery

Orthopedic surgery ranks fourth with 83.7 points in 2026, consistent with its fourth-place finishes in both 2024 (88.4 points) and 2022 (84.8 points). It’s one of the most stable rankings on the list.

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

While orthopedic surgeons deal with irregular, unpredictable hours on call, the compensation reflects that demand. Orthopedic surgeons average $696,852 a year, among the highest of any specialty in medicine.

If you’re not totally certain orthopedic surgery is the right fit, or just want to learn more before committing, check out our So You Want to Be playlist, which takes a deep dive into the pros, cons, and training path for every medical specialty.

3 | Dermatology

Dermatology drops to third with 88.7 points in 2026, down from first place in 2024 (94.1 points) and third in 2022 (87.7 points). It held the top spot for just one cycle before plastic surgery and thoracic surgery pushed it down the rankings.

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.

The lifestyle case for derm remains as strong as ever. Limited call, low acuity, flexible workdays, and control over when and how you work. Dermatologists average $497,509 a year, and when you factor in hours worked per week and the predictability of those hours, the hourly rate is among the highest of any specialty in medicine. Check out our video on Doctor Specialties with the Highest Hourly Rate for the full breakdown.

2 | Plastic Surgery

Plastic surgery climbs back to second with 91.5 points in 2026, rebounding from third in 2024 (88.6 points) after holding the top spot in 2022 (95.5 points). It’s had the most volatile ranking of any specialty in the top five over the past three cycles.

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.

The match rate tells part of the story. It jumped from 62.7% in 2022 to 74.3% in 2024, which pulled the total score down considerably. In 2026, it tightened back to 65.4%, helping plastic surgery recover ground in the rankings. At $625,757 a year, it remains one of the highest-paid specialties in medicine, and the lifestyle is more predictable than most surgical fields since the majority of procedures aren’t urgent.

Before we get to number one, let’s talk about research. Average research items across the most competitive specialties continue to climb, and plastic surgery is the most dramatic example of that trend.

Plastic surgery research items increased from 28.4 in 2022 to 34.7 in 2024 to 50.8 in 2026. That last jump alone is staggering. Back when I applied to plastic surgery residency in 2016, the average was just under 12.

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1 | Thoracic Surgery

Thoracic surgery claims the top spot for the first time, debuting on this list with 95.9 points in 2026. It’s also new to SpecialtyRank.com, where it now ranks first overall across all specialties we track.

Thoracic surgery, also known as cardiothoracic surgery, covers the surgical treatment of organs inside the chest cavity, including the heart, lungs, aorta, esophagus, and diaphragm. These surgeons perform lung and heart transplants, valve replacements, coronary artery bypass grafts, and lung resections for cancer.

The data makes clear why this specialty sits at the top. With only 56 positions offered in the 2026 match and 1,937 total applicants competing for them, roughly 35 applicants per seat, it’s one of the smallest and most fiercely contested fields in medicine. Matched applicants averaged 34.8 research items, a Step 2 CK score of 259, and a 35% AOA rate.

The lifestyle reflects the stakes of the work. A coronary artery bypass graft alone can run anywhere from 4 to 8 hours, and complications can push that to 12. Thoracic surgeons average $749,707 per year, the second-highest of any specialty on this list, but the work-life balance is among the most demanding in medicine.

What’s Misleading About the Numbers

The most competitive specialties continue to correlate strongly with excellent pay, an excellent lifestyle, or both. Correlation isn’t causation, but the pattern is consistent enough year after year that it’s worth taking seriously.

The 2026 rankings show a wider spread at the top than we’ve seen in recent cycles. Thoracic surgery debuts at 95.9 points, with plastic surgery at 91.5 and dermatology at 88.7. That’s a 7.2-point gap from first to third, compared to the much tighter 5.5-point spread across the top three in 2024.

Keep in mind that total scores are only meaningful relative to the specific year. You can compare specialties within the same cycle and track how rankings shift year to year, but a specialty’s score from one year can’t be directly compared to its score from another.

Rankings move for many reasons, and one of the biggest is supply and demand. Demand is the number of students pursuing a specialty. Supply is the number of available seats. Match rate fluctuates as a function of both, but there’s a confounding factor: self-selection bias. That’s why it’s dangerous to rely on match rate alone, a trap many fall into.

For example, in 2018, general surgery had a lower match rate of 84% compared to neurosurgery at 86.4%, leading some to claim that general surgery was more competitive. But when you look at Step 2 CK scores and other factors that actually reflect applicant strength, the picture is clear. Neurosurgery applicants averaged 18.3 research items compared to 6.2 for general surgery, and their Step 2 CK scores were significantly higher as well. Match rate alone doesn’t tell you that.

It’s the same reasoning that leads some to believe PA school is more competitive than medical school based on lower acceptance rates, despite PA applicants having significantly lower GPAs and standardized test scores than medical school matriculants. The self-selection bias has to be accounted for.

Some sources remain misleading about match rate data. The NRMP has said that “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. If we did, internal medicine and emergency medicine would top the charts over neurosurgery and dermatology, which anyone who has attended medical school would find absurd.

Research items continue to rise with no sign of slowing. Plastic surgery jumped from 34.7 in 2024 to 50.8 in 2026. Neurosurgery climbed from 37.4 to 45.5. Dermatology moved from 27.7 to 31.7. The good news for premeds is that any research from college counts when you apply to residency. If this trend concerns you, 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, our “So You Want to Be…” series breaks down how to pursue each specialty, the pros and cons, and how to determine if it’s the right fit for you.

Once you have a target specialty in mind, 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.

2024 Most Competitive Specialties