I think this year 93% of US senoirs matched and 50% of IMGs matched. It has gotten more competitive over the last few years but it still isn't nearly as competitive as derm that you mentioned. I think it is a little harder than medicine but I don't have those numbers.
The USMLE step 1 matched score was 219 and the average score of those who didn't was 205.
Personally, I think it will get more intense over the next several years as things like vascular neuro and neuro-ICU specialties start to take off. There are also cool things going on in the cognitive/behavioral relm. People are starting to recognize that it is exciting!
My 2cents.