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HealthMarch 10, 2020

What are the most competitive specialties?

By: Brian Wu, MD, PhD

Last year’s Match Day was the largest ever, according to the National Residency Match Program® (NRMP), with a record 44,600 registered applicants competing for more than 35,000 positions. That’s an impressive milestone, but it also demonstrates the growing competition fourth-year medical students and other applicants face.

It’s even more difficult for those who are hoping to get into residency in a specialty where there are many others vying for the same spots. The American Medical Association (AMA) reported that the five most competitive specialties were:

  • Otolaryngology
  • Integrated plastic surgery
  • Thoracic surgery
  • Neurosurgery
  • Orthopedic surgery

If you’re at the point in your career where you’re considering any of these five areas, it’s important to know what can help you be a successful match.


According to the NRMP, 93.9% of available residency positions in otolaryngology were filled in 2019. The Successful Match notes that because this is one of the most competitive residencies, matching requires a strong showing on your USMLE Step 1. The mean score for matched residents last year was 248.

But the USMLE isn’t the only thing you should focus on. Residency programs in this area report that awards demonstrating leadership, solid evaluations on required clerkships and a compelling personal statement can all contribute to a strong application. However, matching in this area is more difficult for international graduates and for osteopathic students.

Integrated plastic surgery

91.9% of residencies in integrated plastic surgery were matched in 2019. If you want to get into residency in this area, you should know going in that high USMLE scores (250+) will be expected, and that membership in the Alpha Omega Alpha Honor Medical Society also carries a lot of weight, according to the American Society of Plastic Surgeons.

Yet what many programs rank as being one of the most important factors when evaluating a candidate in integrated plastic surgery is research experience, and it’s not uncommon for candidates to take time off for a research fellowship in order to strengthen their chances of a successful match.

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Thoracic surgery

NRMP statistics show that 91.9% of thoracic surgery residencies were matched in 2019. Elite Medical Prep notes that while a high USMLE Step 1 score (240+) is important, the three factors that residency programs in thoracic surgery want you to focus on include (in order of importance):

  • Letters of recommendation from physicians in the thoracic surgery field
  • Demonstrated commitment to the specialty
  • A strong personal statement

Elite Medical Prep also notes that there are a few things you may not need to emphasize as much, including the USMLE Step 2, clerkships and Dean’s letters. While international students may have difficulty in matching in a residency, around 22% of programs will routinely interview osteopathic students.


91.8% of available neurosurgery residency positions were filled in 2019, and Match A Resident considers the competition for the specialty to be “extreme.” So, needless to say, if your heart is set on neurosurgery, some extra planning and hard work are in your future.

Match A Resident recommends that if you want to put together a strong application for a neurosurgery residency, you’ll need a USMLE Step 1 score of 240 or better, a subinternship or away residency in that area of study and a strong research background in neurosurgery. It also notes that since the neurosurgery field is a relatively small one, letters of recommendation from neurosurgeons can potentially carry a lot of weight.

Orthopedic surgery

The NRMP reports that 91.8% of orthopedic surgery residencies were matched in 2019. If you’re interested in matching in this highly competitive specialty, Elite Medical Prep suggests, unsurprisingly, that you pay special attention to your Step 1 scores. A score of 250 or better is considered solid, with the median suggested score being 245 and 220-235 the absolute minimum to receive an interview. Of course, failing Step 1 is a big deal no matter what specialty you pursue, but that’s especially true here: 65% of orthopedic surgery programs will not consider a candidate who has failed this important exam.

Students coming from an osteopathic background and international graduates may find it more difficult to match. Elite Medical Prep also suggests that letters of recommendation within the specialty are crucial.

Matching is difficult for any applicant, but in the most competitive specialties, the field is even tighter. If you want to pursue one of these five, take a look at our strategies for getting into competitive specialties.

Brian Wu, MD, PhD

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