What are the hardest (most competitive) residencies to match in?

[Deuce 007 MD]

I've been a slacker threwout college, who wasn't sure or confident enough to think he could make it in medicine. I've been lucky enough to be accepted to a US allopathic school. Now that I'm going to med. school in Aug. I wanted to go into it with an idea of what I want to do for my career. I don't want to repeat my misguided undergrad years, I'm planing to take this alot more seriously. Im also originally from Calif., but the school I'll most likely be going to is in the mid. west. I would like to go back to Calif. for my residency. So I wanted to get an idea from you guys as to what are the hardest (most competitive) residencies to match in? And could you rank them in order of difficulty, from hardest to easiest. So I don't have any delusions of grandeur of matching things that would be out of my league.

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[smackdaddy]

i think the worst thing you can do is pick your residency based on difficulty getting in. location, sure. but residency is only 3-10 years, and afterwards you can move. if you can do a top tier residency (in any field) your chances of getting a job in the location you want improve. depending on what field you go into, your chances of landing a california job may not be much better because you did a california residency. but it might help too, especially if you see a lot of private practitioners who know best who locally might be hiring. job markets change too, although you can make some general predictions about them.

you are starting over, sort of. at least grade wise, so do your best, find what you like and then pick. if you want to know what in the first two years will keep the most doors open, i think it is step 1 score. if you ace step 1, no one will care what your undergraduate grades were.

good luck

 

[Ctrhu]

Hardest:
Surgical Subspecialties (ENT, Urology, Ortho)
Opthalmology
Derm

Harder:
Rad
ER
Neuro Surg

Hard:
OB
Anesth

Fair:
PM&R
Neuro
Gen Surg

Easy:
IM
Ped
FP
Psych
Path

The caveat is that the best programs in any subspecialty would require excellent stats and the subspecialties in each specialty would be more difficult. The above is only my estimation of how hard it is for a individual to get into any program in a particular specialty. My info may also be dated. Welcome anyone with more current opinion.

 

[droliver]

I think one objective way to analyze trends in this is the % of filled programs by US senior medical students, a reasonable proxy for competition:
(http://www.nrmp.org/res_match/tables/table10_2002.pdf)

Plastic Surgery 94%
Ortho 93%
Derm 91%
ENT 89%

Radiology 82%
Urology 81%
Rad-Onc 79%
Anesthesia 78%
ER 80%
Surgery 75%
Neurosurgery 75%
OBGYN 75%
Peds 70%

PMR 65%
Neurology 40%

You can see the 4 usual suspects stick out @ the top of the list in 2002 before you get to a bunch of specialties in the 70-80% range (opthomology was not included, but I suspect it goes with the second group of programs). More data to better interpret this would be the non-match rate for the applicants (which was not easily available). It runs as high as 50%+ for the integrated Plastic surgery spots, while say for ER it was only 7% recently. I'm not sure PMR or neuro really belong on your list of competative positions (yet). Some degree of caution is also required when comparing field ranging from ~1000 (surgery/EM)to fields with 34 spots (Derm)

I suspect that General Surgery creeps back over the 80% mark this year as the applicant pool is up over 10%

 

[Alias]

When you analyze the data you must look at a couple of things. First of all those residency programs that do not use the traditional match do not supply their match data to NRMP and you would have to go to their site for that info (Urology, Neuro, Neurosurg, plastics, ENT). For example Neuro on the NRMP list says 38% but that is for the very very few spots that are offered through NRMP for rather poor programs. If you look at SFMatch the fill rate is in the upper 90's. If you were to tell an ENT person that only 89% filled they would be jumping for joy because in that field some people do not match as there are more applicants than spots.

Second for those specialties that require a separate PGY1 year such as Rad, Rad Onc, Derm, etc you have to look at the PGY2 spots that are listed at the bottom right of the post that you listed. If you look there where most spots are listed derm is at 100% PM&R at 90% Rad 99%, etc. Again if you were to tell a derm applicant there were left over spots after match they would laugh as again a large number go unmatched and must look to another field. And plastics probably the hardest to get is definitely at 100%.

What it comes down to though is while some of the specialties do fill at 100% and one must be a strong candidate to match others even less competitive fields are still unbeleivably competitive at the top programs like Hopkins and MGH.

Hope all this clears things up.

 

[droliver]

Yup, see what you mean about the pgy-2 spots in the other table. However, for the US graduates section (the better benchmark for competativeness) derm only filled 73% , PMR 40%, Anesthesia 61% & Rad 77% if you believe the #'s. I'm a little puzzled over the derm % myself(?).

I had forgotten the SFmatch didn't pool into the NRMP #'s so the ENT,Neurosurg, & Neurology information needs some rounding out. The integrated plastics programs are NRMP (not SFmatch) so those are correct.


Thanks

 

[Alias]

I see what you mean but you still have to be careful in the interpretation. Quite often those matching into Derm have either done a medicine residency or have taken a year or more off after medical school to do research to make themselves more competetive. Some of the other figures though are puzzling.

 

[The White Coat Investor]

The numbers you really want to look at are percentage of US seniors who want to do a certain specialty, but do not match. For instance, Emergency medicine was 93%. On the other hand Derm was about 40%, Ortho and Optho were in the low 80%s, and the primary care specialties were closer to 98-99%. The numbers are really hard to find though. I wish I had the rest of them, or a source to refer you to.

 

[Iron Horse]

Originally posted by Desperado
The numbers you really want to look at are percentage of US seniors who want to do a certain specialty, but do not match. For instance, Emergency medicine was 93%. On the other hand Derm was about 40%, Ortho and Optho were in the low 80%s, and the primary care specialties were closer to 98-99%. The numbers are really hard to find though. I wish I had the rest of them, or a source to refer you to.

I don't follow. Are you saying that 93% of US seniors who tried to match in EM failed to do so? Where are these stats coming from?

Thanks.

 

[Deuce 007 MD]

Originally posted by Iron Horse
I don't follow. Are you saying that 93% of US seniors who tried to match in EM failed to do so? Where are these stats coming from?

Thanks.

Ya, I don't follow either. So only 7% of the people who applied to EM matched, huh? Or is that 93% the people who did match in EM? And only 40% of those who applied to derm matched, making derm harder to match?

 

[Histrionic]

Now tell me if this is correct. There were 777 pgy-2 positions offered in anesthesiology in 2002 and 476 of these spots were filled by US seniors (MD and DO presume), leaving 261 spots that were filled by IMG/FMG's leaving about 40 unfilled spots? Hmmm, not too shabby!

 

[Tenesma]

histrionic - those numbers are overlapped by non-us seniors and non-FMG/IMG... most of the unfilled spots and the spots not filled by non-us seniors went to transferring residents... there is a huge exodus (in particular from surgery) into anesthesia as people go through residency... at my program we routinely have surgical residents fill our anesthesia spots and they don't count as seniors nor as IMGs.... in fact in my year we have a board certified general surgeon, and several former surgical residents as part of the team.... have they seen the light ?

 

[edinOH]

For statistical purposes do they define a US grad as having graduated from a US allopathic school only or do they include the DO grads as well? Nothing against the DO grads but these numbers are traditionally compiled by allopathic organizations I believe.

 

[TraumaLlamaMD]

I guess that's helpful if OP still hasn't decided after 11 years in med school, haha.

 

[Winged Scapula]

I'am not a medical doctor or student.

Then why is your status listed as "MD/PhD student"?

 

[j4pac]

I guess that's helpful if OP still hasn't decided after 11 years in med school, haha.

Even PGY-7s need help every now and then.

 

[drbludevil]

I've been a slacker threwout college, who wasn't sure or confident enough to think he could make it in medicine. I've been lucky enough to be accepted to a US allopathic school. Now that I'm going to med. school in Aug. I wanted to go into it with an idea of what I want to do for my career. I don't want to repeat my misguided undergrad years, I'm planing to take this alot more seriously. Im also originally from Calif., but the school I'll most likely be going to is in the mid. west. I would like to go back to Calif. for my residency. So I wanted to get an idea from you guys as to what are the hardest (most competitive) residencies to match in? And could you rank them in order of difficulty, from hardest to easiest. So I don't have any delusions of grandeur of matching things that would be out of my league.

The hardest residencies according to relatives friends and classmates who are now doctors and starting their residencies:
Not a scientific poll, but I find many people agree but not in any particular order

1. Neurosurgery
2. Radiology
3. Anesthesiology
4. Dermatology
5. Opthamology

 

[SierraMist14]

The hardest residencies according to relatives friends and classmates who are now doctors and starting their residencies:
Not a scientific poll, but I find many people agree but not in any particular order

1. Neurosurgery
2. Radiology
3. Anesthesiology
4. Dermatology
5. Opthamology

Switch out Radiology for Rad-onc, and anesthesia for EM.

And Plastics should be somewhere on this list right?

 

[rokshana]

The hardest residencies according to relatives friends and classmates who are now doctors and starting their residencies:
Not a scientific poll, but I find many people agree but not in any particular order

1. Neurosurgery
2. Radiology
3. Anesthesiology
4. Dermatology
5. Opthamology

radiology and anesthesiology not so much anymore...Rad-Onc probably tops them all and integrated surgery residency...plastics, vascular, etc...
oh and urology...

 

[spartan564]

there is a lot of "self selection" in that many people do not even bother applying to certain fields like plastics and derm as they are not competitive enough to match. Thus gives rise to falsely "elevated" match rates where you may not see as high percentage of US seniors who do not match into those fields. I think a better means of comparison of competitiveness is average step 1 and percentage AOA. Derm is arguably the most competitive field given the percent matched who are AOA (50.8%) vs the next highest which I believe is plastics at 39%.

 

[rokshana]

there is a lot of "self selection" in that many people do not even bother applying to certain fields like plastics and derm as they are not competitive enough to match. Thus gives rise to falsely "elevated" match rates where you may not see as high percentage of US seniors who do not match into those fields. I think a better means of comparison of competitiveness is average step 1 and percentage AOA. Derm is arguably the most competitive field given the percent matched who are AOA (50.8%) vs the next highest which I believe is plastics at 39%.

why? that doesn't say anything about the competitiveness of a specialty...simply how many apply and the number that remains unmatched says more about the competitiveness of being able to get a spot...you self selection theory works in this scenario as well...since all of those that apply have been either advised or they felt that they are competitive.

 

[spartan564]

why? that doesn't say anything about the competitiveness of a specialty...simply how many apply and the number that remains unmatched says more about the competitiveness of being able to get a spot...you self selection theory works in this scenario as well...since all of those that apply have been either advised or they felt that they are competitive.

Step 1 and percent AOA are absolute quantitative indicators of an applicant's competitivity. We don't really know how good or not the advisors are in advising people to apply or not. If they were perfect, then the match rate would be 100% which would imply that its not a competitive specialty (but we know thats not true, regardless of whether or not you think it is the most competitive). Maybe advisors are better in some fields than others. Or maybe people in ENT are less easily discouraged and thus they have lower match rates (may not be true, just making an example). There are no similar considerations in comparing Step 1 and AOA. Another good quantitative indicator would be average number of papers published which I think is highest for plastics then derm.