West coast highly competitive I think. Several reasons like not many programs and too few spots, so they probably try to accommodate their own first (if you look through the forum, one of the year someone published Stanford internal IM residents fellowship match data and their hem/Onc had 5 of their own IM residents match there!).
Similar with UCSF, UCLA, UCSD, etc UW is of course another top program so highly competitive. Utah also similar to other top programs and they have only 4 spots (their IM program has something like 30+ residents in each year!! And are bound to have some internal candidates too). Some states have no programs at all like NV, IA or have only one like WA, PO. CA is the most populous state but does not have many spots, strange.