Lazers thinks that any endeavor where >80% of self-selected people attain success is not competitive. A better definition of competitive would be 1) relative to other options, and 2) student-centered.
First, the major surgical subspecialties (neurosurg, ortho, ENT, plastics) are more competitive relative to the average of other specialties based not only on match rate, but also metrics of achievement such as board scores, research abstracts/publications, grades/AOA. Vascular surgery and general surgery are less competitive.
Second, imagine you have a student who is the average ENT applicant who has a Step 1 score of 245 and 4 research experiences resulting in 6 abstracts/presentations/publications. She has mostly Honors grades but just missed out on AOA. She has had dreams of becoming an ENT since day 1 of medical school. She will be applying to ENT and has no plans to apply to a backup specialty. She has >20% chance of going unmatched. You are her advisor, and she has come to you for advice about what programs to apply to, how many programs to apply to, whether to do away rotations, etc. Are you going to start off by telling her, don't worry, the process will be uncompetitive?
When we say a specialty is competitive, we make this classification as a warning, and we adopt the view that going unmatched is a Really Bad outcome that should be avoided or anticipated. Saying a 20% unmatched rate is no big deal reveals a severe disconnect with the experiences of students who find themselves in that position.
