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  • Youll often hear medical students and residents talk about which specialties are most competitive;

  • however, most of them don’t have the data to back up their claims.

  • Let’s explore the most up-to-date statistics and answer the question once and for all.

  • Here are the top 5 most competitive specialties in 2022.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • There's a tremendous amount of misinformation out there regarding which medical specialties

  • are the most competitive.

  • Everyone wants to say that their specialty is competitive - and theyre not wrong.

  • Getting into any residency program is challenging; however, it is undeniable that some specialties

  • are substantially more competitive and harder to get into than others.

  • Although specialty competitiveness always results in some bruised egos, whether or not

  • your specialty is considered competitive does not make you a good or a bad doctor.

  • This is Med School Insiders, and were committed to cutting through the noise and giving it

  • to you straight.

  • With that out of the way, let’s start with how we came up with our list.

  • We gathered data from the official sourcethe National Residency Matching Program,

  • or NRMPand examined six categories for each specialty: average match rate, Step 1

  • score, Step 2 CK score, number of publications, percentage of matriculants that were AOA,

  • and percentage of applicants from a top 40 NIH funded medical school.

  • You can access the data in our spreadsheet linked below.

  • AOA, or the Alpha Omega Alpha Honor Medical Society, is an honor society in medicinewhat

  • you need to know for this analysis is that being AOA is often a good indicator of being

  • a high-performing student.

  • That being said, it’s not perfect, as many schools don’t have it.

  • The top 40 NIH-funded medical schools are usually more competitive, meaning students

  • that got into these schools were, on average, stronger students.

  • Next, we ranked each specialty from 1 to 24 in each category, with 1 being the specialty

  • with the lowest score in that category and 24 being the specialty with the highest score.

  • Once we had rankings for each specialty in each of the six different categories, we added

  • up all of the points to determine which specialties are most competitive.

  • If you want to learn more about the methodology used in this analysis, be sure to check out

  • our previous video covering the Top 5 Most Competitive Doctor Specialties - link in the

  • description.

  • In 2018, when that video was released, the top 5 most competitive specialties were dermatology,

  • plastic surgery, neurosurgery, orthopedic surgery, and ENT.

  • When the NRMP released their updated data for 2020, the top 5 specialties remained the

  • same; however, the order shifted with plastic surgery moving up to first, followed by dermatology,

  • neurosurgery, ENT, and orthopedic surgery.

  • In 2022, however, things have changed yet again.

  • We have added data for two new specialties to the list, thoracic surgery and urology,

  • as well as new data from the NRMP.

  • It should be noted that the NRMP does not publish data for thoracic surgery and urology,

  • so the data used in this analysis for these two specialties are from 2021.

  • Plastic surgery retains its number 1 ranking as the most competitive specialty which it

  • has held for the past few years.

  • Dermatology, which has consistently duked it out with plastic surgery for the number

  • one spot, has moved down to number three with ENT moving into the number two position.

  • Thoracic surgery takes the number four spot followed by neurosurgery at number five.

  • It should be noted that ophthalmology was not included in this analysis given the lack

  • of complete data; however, based on the data that we do have such as Step 1 scores and

  • match rate, it is a middle-tier specialty and would not be in the top 5 most competitive

  • specialties.

  • Historically, it has hovered high on tier 3 and that likely hasn’t changed for 2022.

  • To learn more about the different tiers of specialty competitiveness, check out Why Every

  • Specialty Seems Competitive over on the Kevin Jubbal, M.D.

  • channel - link in the description.

  • Every analysis has its weaknesses, however, and this analysis is no exception.

  • The main limitation is that it weights each of the six components equallyagain being

  • match rate, Step 1 score, Step 2 CK score, number of publications, AOA status, and coming

  • from a top 40 NIH school.

  • In reality, some components are more indicative of a specialty’s competitiveness than others.

  • To help address this shortcoming, we have created the new 2022 MSI Competitiveness Index

  • which weights each of the six components based on their relative importance.

  • Match rate is weighted 25%, Step 1 score 25%, Step 2 CK score 15%, publications 20%, AOA

  • 10%, and Top 40 NIH School 5% to better reflect the relative importance of each component.

  • When we add these weightings, plastic surgery, ENT, and dermatology remain as the top 3;

  • however, thoracic surgery moves out of the top 5 and neurosurgery and orthopedic surgery

  • move back into the fourth and fifth positions.

  • One noticeable trend among the most competitive specialties is that nearly all of them are

  • surgical specialties.

  • Dermatology is the only exception to this.

  • There are a few possible explanations.

  • To start, surgical specialties tend to have high compensation relative to other medical

  • specialties.

  • According to Medscape’s 2022 Physician Compensation report, plastic surgeons make an average of

  • $576,000, orthopedic surgeons make $557,000 and ENT surgeons earn $469,000.

  • Neurosurgeons and thoracic surgeons are also known for having very high compensation but

  • were not included in Medscape’s report.

  • According to data from the AAMC, the median salary for neurosurgeons is $753,000 per year

  • and the median salary for thoracic surgeons is $712,000 per year.

  • In addition, surgical specialties tend to be fairly resistant to mid-level encroachment

  • which is a growing concern for many physicians in the United States.

  • To learn more about scope of practice for nurse practitioners and physician assistants,

  • be sure to check out our Research Explained video covering the Scope Creep Controversy

  • - link in the description.

  • Another trend, specifically within the top 3, is the ability to open cash-based practices.

  • This is particularly relevant as Medicare reimbursement rates have not kept up with

  • the rising costs of healthcare in the U.S. As such, specialties that have the option

  • to open cash-based practices are more resistant to changes in insurance reimbursement.

  • Within plastics and dermatology, there is potential to open aesthetic practices which

  • are generally cash-based due to the cosmetic and elective nature of procedures.

  • In addition, ENT surgeons are able to complete a fellowship in facial plastics which provides

  • them with training in aesthetic procedures including rhinoplasties, facelifts, blepharoplasties,

  • and more.

  • This may be another factor contributing to the continued competitiveness of plastics

  • and dermatology and the increase in competitiveness that we are seeing with ENT in 2022.

  • Although the top 5 has remained constant for several years, the most notable change is

  • ENT moving from the number five spot to the number two spot and passing dermatology in

  • terms of competitiveness.

  • There are a few potential reasons for this.

  • The lifestyle of ENT surgeons is great, and you can make good money with a good work/life

  • balance.

  • Compared to some other surgical subspecialties, there is often more clinic time allowing you

  • to split your time more evenly between the clinic and the operating room.

  • In addition, as a surgical specialty, ENT is fairly resistant to midlevel encroachment

  • whereas dermatology is at an elevated risk.

  • Although this is speculative and it is impossible to know for sure, these factors likely play

  • a role in ENT moving up to the number two most competitive specialty in 2022 and pushing

  • dermatology into the number three spot.

  • That being said, it’s not just about how much money you make but also how hard you

  • have to work to make it.

  • Dermatology is still known for being one of the best lifestyle specialties.

  • Given the outpatient nature, low acuity of medical conditions, limited call, and flexible

  • workdays, dermatologists generally have more control over how they work.

  • Dermatologists are also at the higher end of the spectrum in terms of physician compensation

  • with an average salary of $438,000 in 2022.

  • Although this is less than most surgical specialties, dermatologists also work fewer hours on average.

  • The average dermatologist works 45 hours per week whereas most surgical specialties vary

  • from 52 hours at the low end to upwards of 60 hours at the high end.

  • When we take this into account, dermatologists enjoy the third highest average hourly rate

  • out of any specialty with only plastic surgeons and orthopedic surgeons earning more per hour.

  • For these reasons, it is not surprising that dermatology still ranks as the number three

  • most competitive specialty.

  • Outside of the top 5, there were also changes in the rankings of some of the middle-tier

  • specialties in 2022 – the most notable of which was radiation oncology.

  • In 2020, radiation oncology ranked as the seventh most competitive specialty.

  • In 2022, however, it now ranks fourteenth.

  • It should be noted that urology and thoracic surgery were added for 2022; however, even

  • if we omit these specialties, it would still be in the number twelve spot.

  • This significant decline in competitiveness may reflect decreasing interest in radiation

  • oncology from medical students.

  • In recent years, many have been concerned about oversaturation within the field of radiation

  • oncology.

  • Between 2001 and 2019, the number of radiation oncology positions offered annually in the

  • match increased by 227%.

  • Additionally, advancements in technology and our understanding of cancer biology have allowed

  • radiation oncologists to offer more effective therapies in fewer treatments than before.

  • As a result, the American Society for Radiation Oncology, or ASTRO, predicts that fewer radiation

  • oncologists may be needed in the coming years.

  • In a 2021 Statement regarding the future of radiation oncology, ASTRO stated that  “residency

  • positions should be reserved for those who are enthusiastic about the field and should

  • reflect the anticipated societal need for radiation therapy services.”

  • Another notable change is that anesthesia has moved up in the rankings from the seventeenth

  • most competitive specialty in 2020 to the fourteenth most competitive in 2022.

  • This increase in competitiveness may reflect increased interest in the field of anesthesiology.

  • Anesthesiology has always been known for having a great lifestyle; however, there seems to

  • be an ever greater emphasis placed on lifestyle among medical students today.

  • The COVID-19 pandemic shed light on the long-standing issues of overwork and burnout among physicians.

  • As such, many students may be attracted to the great work-life balance that anesthesia

  • can offer.

  • Many anesthesiologists work regular 9 to 5 hours and when theyre off, theyre completely

  • off.

  • There’s no need to carry a pager home or be called during the middle of the night.

  • Overall, it’s quite clear that the most competitive specialties are highly correlated

  • with excellent pay, excellent lifestyle, or resistance to issues like oversaturation,

  • encroachment, and changes in insurance reimbursement.

  • Correlation is not causation, but I think it’s safe to say that there’s more than

  • a simple correlation going on here.

  • What do you think of the results?

  • Are you surprised, or is this what you were expecting?

  • Leave a comment down below – I’d love to hear your thoughts.

  • If you find yourself getting discouraged because your dream specialty ranks high on the competitiveness

  • index, don’t fall into the trap I’ve seen many succumb to.

  • I’ve come across dozens of residents and attending physicians who wanted to do a different

  • specialty, like plastic surgery, ENT, or dermatology, but ultimately decided they weren’t competitive

  • enough for the specialty that they truly desired.