There’s a tremendous amount of misinformation out there regarding which medical specialties are the most competitive. Everyone wants to say that their specialty is competitive—and they’re not wrong. Getting into any residency program is challenging; however, it is undeniable that some specialties are substantially more competitive and harder to get into than others.
With the release of new 2022 data, we decide to reexamine the top most competitive specialties, and update our algorithm to better reflect competitiveness.
Here are the top 5 most competitive specialties in 2022.
- Plastic Surgery
- Orthopedic Surgery
MSI Competitiveness Index Breakdown
We gathered data from the official source—the National Residency Matching Program, or NRMP—and 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.
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. Once we had rankings for each specialty in each of the six different categories, we added up all of the points to determine which specialties are most competitive.
In 2018, the top 5 most competitive specialties were dermatology, plastic surgery, neurosurgery, orthopedic surgery, and ENT.
When the NRMP released their updated data for 2020, the top 5 specialties remained the same; however, the order shifted with plastic surgery moving up to first, followed by dermatology, neurosurgery, ENT, and orthopedic surgery.
In 2022, however, things have changed yet again. We have added data for two new specialties to the list, thoracic surgery and urology, as well as new data from the NRMP. It should be noted that the NRMP does not publish data for thoracic surgery and urology, so the data used in this analysis for these two specialties are from 2021.
Plastic surgery retains its number 1 ranking as the most competitive specialty which it has held for the past few years. Dermatology, which has consistently duked it out with plastic surgery for the number one spot, has moved down to number three with ENT moving into the number two position. Thoracic surgery takes the number four spot followed by neurosurgery at number five.
It should be noted that ophthalmology was not included in this analysis given the lack of complete data; however, based on the data that we do have such as Step 1 scores and match rate, it is a middle-tier specialty and would not be in the top 5 most competitive specialties. Historically, it has hovered high on tier 3 and that likely hasn’t changed for 2022.
Every analysis has its weaknesses, however, and this analysis is no exception. The main limitation is that it weights each of the six components equally – again being match rate, Step 1 score, Step 2 CK score, the number of publications, AOA status, and coming from a top 40 NIH school. In reality, some components are more indicative of a specialty’s competitiveness than others.
To help address this shortcoming, we have 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.
When we add these weightings, plastic surgery, ENT, and dermatology remain as the top 3; however, thoracic surgery moves out of the top 5 and neurosurgery and orthopedic surgery move back into the fourth and fifth positions.
Trends in the Top 5 Specialties
One noticeable trend among the most competitive specialties is that nearly all of them are surgical specialties. Dermatology is the only exception to this. There are a few possible explanations.
To start, surgical specialties tend to have high compensation relative to other medical specialties. According to Medscape’s 2022 Physician Compensation report, plastic surgeons make an average of $576,000, orthopedic surgeons make $557,000 and ENT surgeons earn $469,000.
Neurosurgeons and thoracic surgeons are also known for having very high compensation but were not included in Medscape’s report. According to data from the AAMC, the median salary for neurosurgeons is $753,000 per year and the median salary for thoracic surgeons is $712,000 per year.
In addition, surgical specialties tend to be fairly resistant to mid-level encroachment which is a growing concern for many physicians in the United States.
Another trend, specifically within the top 3, is the ability to open cash-based practices. This is particularly relevant as Medicare reimbursement rates have not kept up with the rising costs of healthcare in the U.S. As such, specialties that have the option to open cash-based practices are more resistant to changes in insurance reimbursement.
Within plastics and dermatology, there is potential to open aesthetic practices which are generally cash-based due to the cosmetic and elective nature of procedures. In addition, ENT surgeons are able to complete a fellowship in facial plastics which provides them with training in aesthetic procedures including rhinoplasties, facelifts, blepharoplasties, and more. This may be another factor contributing to the continued competitiveness of plastics and dermatology and the increase in competitiveness that we are seeing with ENT in 2022.
Although the top 5 has remained constant for several years, the most notable change is ENT moving from the number five spot to the number two spot and passing dermatology in terms of competitiveness. There are a few potential reasons for this.
The lifestyle of ENT surgeons is great, and you can make good money with a good work/life balance. Compared to some other surgical subspecialties, there is often more clinic time allowing you to split your time more evenly between the clinic and the operating room.
In addition, as a surgical specialty, ENT is fairly resistant to midlevel encroachment whereas dermatology is at an elevated risk. Although this is speculative and it is impossible to know for sure, these factors likely play a role in ENT moving up to the number two most competitive specialty in 2022 and pushing dermatology into the number three spot.
That being said, it’s not just about how much money you make but also how hard you have to work to make it. Dermatology is still known for being one of the best lifestyle specialties. Given the outpatient nature, low acuity of medical conditions, limited call, and flexible workdays, dermatologists generally have more control over how they work.
Dermatologists are also at the higher end of the spectrum in terms of physician compensation with an average salary of $438,000 in 2022. Although this is less than most surgical specialties, dermatologists also work fewer hours on average.
The average dermatologist works 45 hours per week whereas most surgical specialties vary from 52 hours at the low end to upwards of 60 hours at the high end. When we take this into account, dermatologists enjoy the third highest average hourly rate out of any specialty with only plastic surgeons and orthopedic surgeons earning more per hour.
For these reasons, it is not surprising that dermatology still ranks as the number three most competitive specialty.
Other Noteworthy Changes
Outside of the top 5, there were also changes in the rankings of some of the middle-tier specialties in 2022 – the most notable of which was radiation oncology. In 2020, radiation oncology ranked as the seventh most competitive specialty. In 2022, however, it now ranks fourteenth.
It should be noted that urology and thoracic surgery were added for 2022; however, even if we omit these specialties, it would still be in the number twelve spot. This significant decline in competitiveness may reflect decreasing interest in radiation oncology from medical students.
In recent years, many have been concerned about oversaturation within the field of radiation oncology. Between 2001 and 2019, the number of radiation oncology positions offered annually in the match increased by 227%. Additionally, advancements in technology and our understanding of cancer biology have allowed radiation oncologists to offer more effective therapies in fewer treatments than before.
As a result, the American Society for Radiation Oncology, or ASTRO, predicts that fewer radiation oncologists may be needed in the coming years. In a 2021 Statement regarding the future of radiation oncology, ASTRO stated that “residency positions should be reserved for those who are enthusiastic about the field and should reflect the anticipated societal need for radiation therapy services.”
Another notable change is that anesthesiology has moved up in the rankings from the seventeenth most competitive specialty in 2020 to the fourteenth most competitive in 2022. This increase in competitiveness may reflect increased interest in the field of anesthesiology.
Anesthesiology has always been known for having a great lifestyle; however, there seems to be an ever greater emphasis placed on lifestyle among medical students today.
The COVID-19 pandemic shed light on the long-standing issues of overwork and burnout among physicians. As such, many students may be attracted to the great work-life balance that anesthesia can offer.
Many anesthesiologists work regular 9 to 5 hours and when they’re off, they’re completely off. There’s no need to carry a pager home or be called during the middle of the night.
Overall, it’s quite clear that the most competitive specialties are highly correlated with excellent pay, excellent lifestyle, or resistance to issues like oversaturation, encroachment, and changes in insurance reimbursement. Correlation is not causation, but I think it’s safe to say that there’s more than a simple correlation going on here.
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