Just like there's promotion and relegation in English football, I think the conventional definition for the "ROAD to Success" (Radiology, Ophthalmology, Anesthesiology, Dermatology) has run its course and needs to be revamped. Here are my changes: 1) Replace Radiology with Radiation Oncology What used to be the best kept secret in medicine is now out of the bag. With Derm lifestyle and pay + uber lay and professional prestige (no one will ever demean you with taunts of "pimple popper" or "botox injector") it's no surprise that Radonc applications have gone way up in quantity and quality in recent years. It has already become a specialty of choice by top students who aren't surgically inclined and by the time the class of 2016 matches, I predict Radonc to be as competitive as Derm if not moreso. Meanwhile, Radiology has become the new Pathology with a tight job market and fellowships pretty much being a prerequisite to landing a job. With over 80 unmatched spots this year and the shady impact that HCR will have on imaging plus potential outsourcing, Radiology has gone down in competitiveness and I expect this trend to continue - http://residency.wustl.edu/medadmin...b1a2b4ee4af135b386256f8f0072972a?OpenDocument 2) Keep Ophthalmology but understand there are substitutes - Optho is in the ROAD because it's "surgery-lite." That is, surgery salary and sexiness but with a better lifestyle. While Ophto is facing competition from Optomotrists who have recently gained the right to perform surgery in some states, it still has a bright future. Understand, however, that there are other surgical subspecialties that can yield similar lifestyles and $$$ like ENT and Urology. 3) Replace Anesthesiology with Allergy/Immunology - The downside to Allergy/Immunology is that you have to do an IM residency and that Allergy is the most competitive of IM fellowships. Otherwise, it's basically Derm lifestyle and low stress level with a little lower salary. Gas, on the other hand, is quite stressful despite misconceptions of it being otherwise. Not to mention the CNRA scare. No surprise it's competitiveness has gone way down in recent years - http://residency.wustl.edu/medadmin...a6e8c6b1ba8c35cb86256f8f0071c74f?OpenDocument 4) Keep Derm as is - The perfect specialty for people (especially women) who want it all - lifestyle, money, low stress, and great job satisfaction (one of the highest of all specialties). The whole nine yards. Very versatile as well - you can focus on cosmetics, cancer, Mohs surgery, dermatopathology, etc. It's the only part of the original "ROAD" that needs no alterations.