While some people pursue medicine knowing exactly what specialty they want to practice, most enter the medical field with only a vague idea of what their Match® letter might reveal in four years. Between the endless tests of your first and second years and the grueling schedule of third-year clinical rotations, your specialty interests may evolve over time. Still, the most competitive specialties tend to attract applicants consistently, whether those students thought they’d be pursuing those fields when they entered medical school or not.
Here’s a deeper dive into why some specialties are more competitive than others — and what it means for your choice of field.
What Are the Most Competitive Specialties?
For clarity, it’s probably best to define what is meant by “most competitive specialties.” The American Medical Association (AMA) defines this category as specialties with a greater than 90% Match fill rate of U.S. allopathic senior medical students. In other words, over 90% of the students who fill the residency positions in those fields are MS4s who will graduate with a Doctor of Medicine (vs. a Doctor of Osteopathic Medicine) degree from a U.S. medical school. Generally, only specialties that have at least 10 positions to be filled (throughout the entire U.S.) qualify for consideration as a top-ranked specialty.
Match data is released through the National Resident Matching Program® and is available to the public. Despite a few shifts in top positions, current trends for the past several years have been fairly consistent. Specifically, the 2010 Main Residency Match report lists neurological surgery, orthopedic surgery, otolaryngology and radiation oncology as specialties that all had a greater than 90% match fill rate with U.S. allopathic seniors for available PGY-1 positions. The 2019 data was filled with similar names: otolaryngology, integrated plastic surgery, thoracic surgery, neurological surgery and orthopedic surgery. Notably absent from the 2019 list is radiation oncology; this specialty recently increased its available positions, which may have been a factor in decreasing its competitiveness.
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Unpacking Recent Trends
Several studies have focused on explaining why the trend for specialty competitiveness has remained fairly consistent throughout the 2000s. Specifically, although some positions have become less competitive, the overall trend for the fields boasting a competitive match has remained clear. Primary care positions have been (and continue to be) significantly less competitive than their specialty counterparts.
A 2016 JAMA research letter raises concerns about the likely correlation between lower salaries and lower competitiveness in primary care positions compared to specialists. The letter also highlights the increase in burnout rates in primary care versus specialty fields. With these factors in mind, the authors note that policymakers should increase incentives for practitioners to choose primary care, as the demand for primary care physicians will likely only increase as the U.S. baby boomer population ages.
A 2010 study in the Journal of Graduate Medical Education also examined specialty trends, noting that students from highly ranked, research-based medical schools are more likely to match into specialties offering both high salaries and a “controllable lifestyle.” Of the 2019 competitive specialties listed earlier, only otolaryngology offers both benefits. Internal medicine, family medicine and pediatrics all had low average salaries with low controllable lifestyles — factors that still hadn’t changed by the time the 2016 JAMA letter was released.
A Look at Contributing Factors
It does bear mentioning that the competitiveness of a field like thoracic surgery or neurological surgery is unlikely to stem from an interest in pursuing a controllable lifestyle. Such positions are more likely to appeal to students interested in “high risk, high reward” practices, with “high salary” also factoring into the equation. In fact, a quick glance of the most competitive specialties reveals that procedure-based fields consistently fill the top spots. Not coincidentally, these specialties also offer the highest salaries.
Beyond compensation, the perceived job security offered by procedural practices is likely a driving factor behind these specialties’ continued competitiveness. Specifically, although advanced practice providers may hold supportive clinical positions in those fields, they can’t replace surgeons as primary practitioners for those patients. Plastic surgery’s rise in the competitive specialty list is likely related to its appeal in all these categories — salary, lifestyle and procedure-based security — as well as to its impressively low burnout rate, as the AMA notes.
Choosing a Medical Specialty
Choosing a medical specialty is not a decision to take lightly. The finances and time you’ve invested in your medical degree should warrant careful consideration of the options available to you. In addition to looking for a field that appeals to your personal interests, factors such as lifestyle, salary and job security can also play into the equation.
With this in mind, know that the controllable lifestyle of a specialty is unlikely to change in the coming years, but the compensation in that field may change. Competitiveness tends to correlate strongly with salary for the current U.S. medical reimbursement system, but the high demand for excellent primary care physicians may push for legislature to shift the pay (at least somewhat) to more strongly compensate PCPs. Until that happens, however, the residency Match fill rates likely won’t change significantly.