Residency & Beyond

The 10 Most Competitive Residency Programs in 2023

The Main Residency Match is meant to help medical school students join residency programs based on preference, experience, and USMLE scores. When applying for residency, it helps to know which programs are the most competitive and where you stack up.

The competitiveness of a specialty can fluctuate based on various factors. Some of the most significant include changes in healthcare needs and trends, the number of medical students applying each year, and shifts in the medical education landscape.

The top 10 most competitive residency programs in 2023 are:

  1. Plastic Surgery
  2. Dermatology
  3. Neurosurgery
  4. Orthopedic Surgery
  5. Otolaryngology
  6. Interventional Radiology
  7. Vascular Surgery
  8. Thoracic & Cardiac Surgery
  9. Radiation Oncology
  10. Internal MedicinePediatrics 

Keep in mind that a more competitive residency program doesn’t necessarily equate to a better fit for all med school students. 

Other factors, such as work-life balance, subspecialties available, rotations, and electives play big roles in determining the best residency programs for you as an individual medical student.

How We Determined the Most Competitive Residency Programs

Creating a list of the most competitive residencies within the medical field is no simple task. Our approach for this ultimate guide to the most competitive medical residencies is based on recent data from:

What is the hardest residency to match in? The hardest residency to match in depends on factors like your USMLE Step 2 CK score, positions available, and the number of applications in a given specialty. This data, in combination with the other factors, will help paint a more complete picture of each specialty’s competitiveness.

Let’s dive in and look at the stats.

A quick note: USMLE Step 1 scores are reported as pass/fail for exams taken after January 26, 2022.

1. Plastic Surgery

  • Match rate: 100%
  • Number of PGY-1 positions: 207
  • Number of PGY-2 positions: None
  • Number of applicants: 332
  • Average USMLE Step 2 CK score: 257
  • Average salary: $571,373 

Known for its high competitiveness as a subspecialty of general surgery, plastic surgery averages the highest step scores. You’ll need a strong personal statement to stand out among a large number of applicants.

2. Dermatology

  • Match rate: 100%
  • Number of PGY-1 positions: 29
  • Number of PGY-2 positions: 499
  • Number of applicants: 279
  • Average USMLE Step 2 CK score: 257
  • Average salary: $468,509

Dermatology is one of the most sought-after specialties because of the relatively high work-life balance. It helps that dermatologists tend to have lucrative salaries.

But this compelling specialty is for those passionate about medical and surgical treatment of skin conditions, not just the money.

3. Neurosurgery

  • Match rate: 98.8%
  • Number of PGY-1 positions: 243
  • Number of PGY-2 positions: None
  • Number of applicants: 373
  • Average USMLE Step 2 CK score: 252
  • Average salary: $788,313

Neurosurgery is a surgical specialty known for its intricate procedures and extended training period. To successfully match into neurological surgery, we recommend substantial clinical rotations and research experience in the field.

Even with the 6-year commitment, this specialty consistently ranks among the most competitive residencies.

Related: How Competitive is a Neurology Residency? 

4. Orthopedic Surgery

  • Match rate: 100%
  • Number of PGY-1 positions: 899
  • Number of PGY-2 positions: None
  • Number of applicants: 1425
  • Average USMLE Step 2 CK score: 256
  • Average salary: $624,043

The high earning potential and the hands-on nature of the work make this a top choice in the medical field. You can increase your chance of matching with orthopedic surgery rotation experience. There is 5-year residency training and a 1-2-year fellowship.

5. Otolaryngology

  • Match rate: 99.5%
  • Number of PGY-1 positions: 373
  • Number of PGY-2 positions: None
  • Number of applicants: 493
  • Average USMLE Step 2 CK score: 257
  • Average salary: $488,536

Often referred to as Ear, Nose, and Throat (ENT) surgery, otolaryngology has a diverse range of subspecialties. These include pediatric otolaryngology, head and neck surgery, laryngology, and rhinology. 

This diversity offers a wide range of practice options for specialists, adding to the specialty’s appeal.

6. Interventional Radiology

  • Match rate: 100%
  • Number of PGY-1 positions: 51
  • Number of PGY-2 positions: 125
  • Number of applicants: 266
  • Average USMLE Step 2 CK score: 253
  • Average salary: $503,564

Interventional Radiology (IR) involves an interplay of diagnostic and therapeutic procedures. Interventional radiologists utilize minimally invasive image-guided techniques to treat a variety of conditions, adding to the attractiveness of the field. 

As interventional radiology continues to expand, it remains one of the most competitive medical residencies.

7. Vascular Surgery

  • Match rate: 98.9%
  • Number of PGY-1 positions: 93
  • Number of PGY-2 positions: None
  • Number of applicants: 159
  • Average USMLE Step 2 CK score: 250
  • Average salary: $557,632

The vascular system includes the arteries, veins, and lymphatic circulation. Because of the complex nature of the system they want to treat, vascular surgery hopefuls should prepare by getting a substantial amount of experience through clinical rotations and research in the field.

8. Thoracic & Cardiac Surgery

  • Match rate: 100%
  • Number of PGY-1 positions: 49
  • Number of PGY-2 positions: None
  • Number of applicants: 138
  • Average USMLE Step 2 CK score: 254
  • Average salary: $706,775

This highly specialized field commands a high level of dedication and expertise. There are a relatively low number of positions compared to applicants and almost always a 100% fill rate. 

We recommend future thoracic surgery residents present exceptional credentials and a clear passion for the specialty in their residency applications.

Related: How Competitive is a General Surgery Residency? 

9. Radiation Oncology

  • Match rate: 70%
  • Number of PGY-1 positions: 10
  • Number of PGY-2 positions: 181
  • Number of applicants: 108
  • Average USMLE Step 2 CK score: 249
  • Average salary: $547,026

Radiation Oncology is a medical specialty focused on the use of radiation therapy as a treatment for cancer. This specialty demands a strong knowledge of physics, biology, and clinical skills, as residents work closely with patients to administer personalized treatment plans.

The substantial average salary is reflective of the high level of expertise and training required in this specialty.

Related: How Competitive is a Hematology-Oncology Fellowship? 

10. Internal Medicine — Pediatrics

  • Match rate: 99%
  • Number of PGY-1 positions: 392
  • Number of PGY-2 positions: None
  • Number of applicants: 571
  • Average USMLE Step 2 CK score: 250
  • Average salary: $293,894

Med-Peds is a dual specialty offering comprehensive care to patients of all ages, from newborns to seniors. The dual nature of this program means committing to both internal medicine and pediatrics. 

The balance of both adult and child patient care within the same practice appeals to many doctors, reflected in the volume of applicants for the limited number of residency positions.

Stand out from equally qualified applicants during your interview to match with the residency of your choice with help from our friends at MedSchoolCoach.

What are the least competitive residencies?

While a handful of specialties often grab the spotlight, other worthwhile residency programs are considerably less competitive. 

What’s the easiest residency to get into? The easiest residency to get into just by looking at raw numbers would be internal medicine, only because it has the highest number of first-year residency positions. 

It’s important to note that less competition and more positions really does not mean these specialties are easier. You still put many years of effort into become a doctor!

1. Family Medicine

  • Match rate: 88.7%
  • Number of PGY-1 positions: 5,088
  • Number of PGY-2 positions: None
  • Number of applicants: 6,927
  • Average USMLE Step 2 CK score: 241
  • Average salary: $273,040

Family Medicine, while a crucial field providing primary care for all ages, tends to be less competitive, often due to the misconception of lower remuneration and the broad scope of practice.

2. Psychiatry

  • Match rate: 99%
  • Number of PGY-1 positions: 2,164
  • Number of PGY-2 positions: None
  • Number of applicants: 3,039
  • Average USMLE Step 2 CK score: 242
  • Average salary: $220,380

Psychiatry, a field focused on mental health, faces less competition partly due to the societal stigma associated with mental health, despite the increasing demand for these services. The average salary range is also on the low end, adding to the hesitation some residents may demonstrate.

3. Pediatrics

  • Match rate: 97.1%
  • Number of PGY-1 positions: 2,986
  • Number of PGY-2 positions: None
  • Number of applicants: 3,724
  • Average USMLE Step 2 CK score: 245
  • Average salary: $232,500

Pediatrics, although vital to the health of children and adolescents, is typically less competitive. This may be due, in part, to the specialty’s relatively low average compensation. However, a match still requires a strong work ethic and a genuine interest in children’s health.

4. Pathology

  • Match rate: 99%
  • Number of PGY-1 positions: 613
  • Number of PGY-2 positions: None
  • Number of applicants: 1023
  • Average USMLE Step 2 CK score: 245
  • Average salary: $308,290

Pathology is a less competitive field. However, this career can be quite rewarding, as pathologists play a critical role in diagnosing diseases and managing patient care. Pathology tends to be one of the more popular specialties for IMG applicants.

5. Emergency Medicine

  • Match rate: 81.6%
  • Number of PGY-1 positions: 3,010
  • Number of PGY-2 positions: None
  • Number of applicants: 2,765
  • Average USMLE Step 2 CK score: 247
  • Average salary: $354,615

Emergency Medicine is not for the faint of heart. Dealing with conditions requiring immediate medical attention, while relatively less competitive as a medical specialty, creates a high-stress environment with unusual work hours. 

Nonetheless, this field is critical and highly rewarding, providing life-saving care for patients in emergency situations.

Specialties With the Highest Availability

According to the national residency match program (NRMP) 2023 report, these are the 10 residency specialties with the most positions offered to those in their first postgraduate year (PGY 1s), from highest number of offered positions to lowest:

  1. Internal Medicine — 9,725 positions offered
  2. Family Medicine — 5,088 positions offered
  3. Emergency Medicine — 3,010 positions offered
  4. Pediatrics — 2,986 positions offered
  5. Psychiatry — 2,164 positions offered
  6. Transitional — 1,736 positions offered
  7. Medicine-Preliminary — 1,715 positions offered
  8. Surgery — 1,670 positions offered
  9. Anesthesiology — 1,609 positions offered
  10. Obstetrics-Gynecology — 1,503 positions offered

Changes in the Number of Residency Positions

Amongst the larger specialties (more than 300 positions offered), those that observed the greatest increase in the number of positions offered in the Match in 2023 compared to 2022 include:

  • Neurology — up 10% (772 to 846)
  • Transitional — up 7% (1,616 to 1,736)
  • Anesthesiology — up 7% (1,509 to 1,609)
  • Psychiatry — up 6% (2,047 to 2,164) 
  • Medicine-Primary — up 6% (429 to 453)

In contrast, only 3 specialties with more than 300 positions offered observed declines from 2022 to 2023:

  • Medicine-Preliminary — down 3% (1,774 to 1,715)
  • Pathology — down 3% (631 to 613)
  • Surgery-Preliminary — down 1% (1,150 to 1,133)

Which specialty to choose and how to successfully obtain a residency position is complex, challenging, and requires extensive mentoring and planning. We’d love to help you figure it out!

Get Help With the Residency Match

Remember, choosing a medical specialty is a deeply personal decision that should align with your interests, skills, and long-term healthcare career goals. It’s about finding the right fit for you and where you can make the most meaningful contribution to patient care.

Our friends at MedSchoolCoach can provide mentoring and guidance from seasoned physician advisors on how to achieve your dream residency position. We happily assist with advising on elective rotations, letters of recommendation, the ERAS application process, and anything you may need to get an edge on in the most competitive specialties. 

Schedule a free consultation with our friends at MedSchoolCoach to see how to increase your chances of matching into the residency of your choice. 

David Flick MD

David graduated Magna Cum Laude from Loyola Marymount University in Los Angeles, California with a BS in biology where he was heavily involved in high school and university level tutoring. He then moved to Chiang Mai, Thailand where he worked as a high school mathematics teacher at an international baccalaureate school. In the two years prior to starting medical school, he volunteered in seven different countries throughout Asia with international medical aid programs. David attended medical school at UC Irvine after receiving the Army health professions scholarship. He served on the admissions committee for four years including working on the selection committee board. He completed a family medicine residency program in Oahu, HI and served on the residency admissions committee. He is board certified in family medicine and now works as a flight surgeon for the Army.

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