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The Most Competitive Medical Specialties

What are the most competitive medical specialties? Results from the 2024 National Resident Matching Program (NRMP) have the answer.

The 2024 Match had the largest number of available positions in history, at 41,503. Of them 38,941 were filled from among 50,413 applicants. This resulted in an overall fill rate of 93.8%, up half a percentage point from last year. 

From an applicant point of view, 93.5% of MD and 92.3% of DO applicants from U.S. medical schools matched to a postgraduate year one position (PGY-1). 

Two male physicians review brain scans on screen

Here is a look at the most competitive medical specialties based on the 2024 NRMP.

How does the NRMP define competitiveness?

The NRMP defines competitiveness by the fill rate for U.S. MD seniors: The residencies with the highest fill rates are the most competitive. This is true for the various specialties, but also within specialties. There can be highly selective individual residency programs within less competitive specialties.

To rank the most competitive specialties, it is important to look at those with the highest fill rates for all spots. Within these specialties, it will be very challenging to match with any available program. 

Obviously, the fewer available spots and the more applicants there are, the harder it will be to match. This concept is reported in a number — positions available per applicant. For example, 100 applicants applying for 75 positions is 0.75 positions per applicant. The lower the number, the higher the competitiveness.

Most competitive specialties from the 2024 Match

Here were the 2024 Match specialties with the lowest number of PGY-1 positions available per applicant, of programs that offered at least 25 positions.

1. Dermatology

  • Fill rate (U.S. MD seniors): 80%
  • Number of PGY-1 positions: 30
  • Number of applicants (U.S. MD seniors): 229
  • Positions available per applicant: 0.13
  • Number of unfilled positions: 0

2. Radiology-Diagnostic

  • Fill rate (U.S. MD seniors):  54.5%
  • Number of PGY-1 positions: 145
  • Number of applicants (U.S. MD seniors): 743
  • Positions available per applicant: 0.20
  • Number of unfilled positions: 1

3. Interventional Radiology

  • Fill rate (U.S. MD seniors): 78.4%
  • Number of PGY-1 positions: 51
  • Number of applicants (U.S. MD seniors): 187
  • Positions available per applicant: 0.27
  • Number of unfilled positions: 1

4. Pediatrics-Primary

  • Fill rate (U.S. MD seniors): 23%
  • Number of PGY-1 positions: 61
  • Number of applicants (U.S. MD seniors): 181
  • Positions available per applicant: 0.34
  • Number of unfilled positions: 1

5. Medicine-Psychiatry

  • Fill rate (U.S. MD seniors): 92.3%
  • Number of PGY-1 positions: 26
  • Number of applicants (U.S. MD seniors): 58
  • Positions available per applicant: 0.45
  • Number of unfilled positions: 0

6. Medicine-Primary

  • Fill rate (U.S. MD seniors): 57.1%
  • Number of PGY-1 positions: 420
  • Number of applicants (U.S. MD seniors): 744
  • Positions available per applicant: 0.56
  • Number of unfilled positions: 3

7. Thoracic Surgery

  • Fill rate (U.S. MD seniors): 93.8%
  • Number of PGY-1 positions: 48
  • Number of applicants (U.S. MD seniors): 80
  • Positions available per applicant: 0.60
  • Number of unfilled positions: 0

8. Physical Medicine and Rehab 

  • Fill rate (U.S. MD seniors): 52.1%
  • Number of PGY-1 positions: 219
  • Number of applicants (U.S. MD seniors): 349
  • Positions available per applicant: 0.63
  • Number of unfilled positions: 0

9. Neurological Surgery

  • Fill rate (U.S. MD seniors): 84.6%
  • Number of PGY-1 positions: 241
  • Number of applicants (U.S. MD seniors): 299
  • Positions available per applicant: 0.81
  • Number of unfilled positions: 0

10. Plastic Surgery (Integrated)

  • Fill rate (U.S. MD seniors): 88.3%
  • Number of PGY-1 positions: 213
  • Number of applicants (U.S. MD seniors): 258
  • Positions available per applicant: 0.83
  • Number of unfilled positions: 0

What makes these specialties so attractive to applicants? Two main reasons include future pay and positive work-life balance. 

In 2023, the average primary care physician salary was $265,000. Specialists earned an average of $382,000. However, the average salary for these competitive medical specialties are well in excess of this, with neurological surgery topping the list at an average of $788,313 in 2023.

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