If most people enter medicine for the right reasons (doing good, improving the community, developing strong connections with patients and being able to improve the lives of those you care about) then why is the competitiveness of specialties so heavily correlated with lifestyle/salary. To boot, the two most competitive specialties, derm and plastics, are the two specialties that can be geared most towards cosmetics (not that every derm/plastics does only cosmetics and not that cosmetics in its own right is evil). My question is, if most people come into med school with the right intentions, why is the competitiveness of specialties more dependent on money and lifestyle than on the content of that specialty? few things: I realize people still do choose specialties that they will genuinely enjoy and I'm sure people with good apps turn down more competitive specialties for less competitive specialties, but regardless, the correlation between $/lifestyle and step score seems so strong that it appears these are the main contributors to specialty choice. The only thing I can think of is that maybe most people still do pursue specialties that they will genuinely enjoy, and if that specialty happens to be plastics/derm/ortho/ENT they know they will just have to work harder to score well and match (as opposed to scoring really well and then simply choosing a specialty from the score).