What is the hardest residency to get into?

To start this conversation, the competitiveness of the major medical specialty fields are categorized into three tiers:

  • Competitive
  • Moderately competitive
  • Less competitive

Competitive programs that are the most difficult to match into include:

  • Cardiac and Thoracic Surgery
  • Dermatology
  • General Surgery
  • Neurosurgery
  • Orthopedic Surgery
  • Ophthalmology
  • Otolaryngology
  • Plastic Surgery
  • Urology
  • Radiation Oncology

Moderately competitive programs include:

  • Anesthesiology
  • Emergency Medicine
  • Medicine/Pediatrics (combined)
  • Radiology (Diagnostic)
  • Obstetrics and Gynecology

Less competitive specialties include:

  • Family Medicine
  • Internal Medicine
  • Pathology
  • Pediatrics
  • Physical Medicine and Rehabilitation
  • Psychiatry

These categories are meant to provide a general guideline, but know that there is fluidity, and nuance to these categories, and that the boundaries between them are not fixed. Regardless of the category of competitiveness, any one program can be considered more competitive depending on other variables such as program location, prestige, etc.

For example, despite the fact that Internal Medicine is categorized as a “less competitive” specialty, the most highly respected and renowned Internal Medicine residency programs are highly competitive and therefore difficult to get into. Exceptions in the opposite direction generally do not hold up as well. That is, the least prestigious Dermatology program in the least desirable location is still likely a highly competitive program, as there are consistently many more applicants in Dermatology than there are available slots across the country.

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