Pediatric meeting a family
HealthJune 15, 2020

The least competitive medical specialties - and why to choose them

By: Brian Wu, MD, PhD

You may have an easier time breaking into the least competitive medical specialties, but that doesn’t mean they aren’t among the most rewarding fields.

If you're a medical student thinking about choosing a specialty, you've probably read about the most competitive specialties to get into - fields like plastic surgery or orthopedics known for benefits like high salaries. But there's a lot to be said for choosing one of the least competitive medical specialties, for reasons ranging from societal benefit to your personal satisfaction and happiness.

Med School Insiders ranked the least competitive specialties with a broad range of criteria, including required USMLE Step 1 and Step 2 CK scores, match rate, number of publications, the rate of matriculants who are AOA and the percentage of residents who come from a top-40, NIH-funded school.

With that in mind, the five least competitive medical specialties are:

  • Family medicine
  • Physical medicine and rehabilitation
  • Anesthesiology
  • Pediatrics
  • Psychiatry

For a closer look at each of these specialties and the benefits that come with choosing them, read on.

Family medicine

Though family medicine tops the list of the least competitive specialties, it still forms the bulk of preventive and routine care across the life spectrum. This specialty requires a three- to four-year residency, and you can choose subspecialties such as sports medicine, hospital medicine or geriatrics. While family medicine lends itself to fairly regular, predictable hours, compensation is low compared to other specialties — around $234,000 a year, according to the Medscape Physician Compensation Report 2020.

So why choose family medicine? One reason is its incredible importance: According to the American Academy of Family Physicians, family medicine specialists treat the majority of rural and/or underserved patients in America; without them, many of these patient populations would lack vital access to primary care. Physicians also enjoy working in this area: The Medscape Physician Lifestyle and Happiness Report 2019 found that 52% of family physicians report being happy.

Physical medicine and rehabilitation

Physical medicine and rehabilitation (PM&R) - also known as physiatry - improves the quality of life for individuals with debilitation or disabilities resulting from conditions like stroke, cerebral palsy or traumatic brain injury. This specialty requires a four-year residency, and it's possible to specialize in areas like neuro-rehabilitation or musculoskeletal and spine rehab. It brings with it a midrange salary of around $308,000, according to the Medscape compensation report, and predictable working hours.

The American Academy of Physical Medicine and Rehabilitation notes that this specialty has become increasingly important as patients survive conditions that once would have been fatal and must learn to live with ongoing issues such as muscle weakness, pain or other loss of function. Helping this population restore function increases their ability to work and to contribute to the community. According to the Medscape happiness report, PM&R practitioners fall in the middle of the list of happiness by specialty, clocking in at 51%. Read why one resident chose PM&R.

Anesthesiology

Of the five least competitive medical specialties, anesthesiology offers the highest compensation ($398,000 annually) and the prospect of a great lifestyle. This specialty largely deals with general, regional and sedation anesthesia for patients undergoing procedures. A four-year residency is required, and you can choose from a variety of subspecialties, including cardiothoracic or pediatric anesthesiology.

Benefits to specializing in this field range from a good income and job prospects - with Anesthesiology News predicting a shortage - to regular hours that help with work-life balance. Anesthesiologists also rank about halfway down the list for physician happiness, at a rate of 51%.

Pediatrics

Pediatrics deals exclusively with the care of infant, child and adolescent patients. The specialty requires a three-year residency, and it's possible to subspecialize in areas like pediatric oncology, nephrology or cardiology. Pediatricians' lifestyles vary widely depending on subspecialty, but it's considered to be one of the lowest-compensated areas of medicine, with an annual salary of around $232,000.

Yet pediatrics ranks in the top five in regard to physician happiness by specialty. The American Academy of Pediatrics found that around 94% of pediatric residents report they would still choose this field if they had to make the choice again. It's also a good specialty for work-life balance, and a significant percentage of pediatricians (around 25%) work part time to make this balance work.

Psychiatry

Finally, psychiatry - which deals with the treatment of mental illness - is also among the least competitive specialties. Subspecialization is possible and can include child and adolescent psychiatry or forensic psychiatry. Hours are generally regular and the pace of work is slower, but compensation is comparatively low at around $268,000 a year.

In regard to personal happiness, psychiatry ranked slightly lower than some of the other least competitive specialties, closing in at 49%, but many are still attracted to it. The American Psychiatric Association notes that psychiatry provides flexibility, with clinicians generally setting their own hours. Psychiatry's social worth is also significant since mental wellness is so vital to the health of the community.

I myself chose psychiatry, not because I felt like I couldn't get into more competitive areas but because I love the work itself. Not only do I feel that my work benefits my community, but I also appreciate the lifestyle it gives me. I can spend time with my family and be a husband and father as well as a physician. I don't think I could have found this balance with some of the more competitive specialties, and I don't for a moment regret my choice.

Brian Wu, MD, PhD