Ask any aspiring doctor and they will agree that some specialties are more competitive
to get into than others. Ask them why, and you will get a variety of answers. What are
the underlying factors that actually determine a specialty’s competitiveness? Let’s find
out. Dr. Jubbal, MedSchoolInsiders.com.
On this channel, we’ve discussed the Top 5 Most Competitive Specialties as well as
the Top 6 Least Competitive Specialties, but in this video, we are going to do a deep dive
into the basis for those lists and discuss the factors that dictate what makes a specialty
competitive. Let’s start by defining what we mean by
a specialty's competitiveness. The first thing that typically comes to mind is its match
rate. Every couple years, the National Residency Matching Program, or NRMP, posts data on the
most recent residency application cycle. They record a variety of different statistics,
including the number of medical students that match into each specialty versus the total
number of applicants to that specialty. This is referred to as that specialty’s match
rate. For most people, this is the holy grail of determining how competitive a specialty
is. But it’s all it’s chalked up to be. Match rate alone is a very poor metric in
determining a specialty’s competitiveness. Is it helpful? Yes. Should we pay attention
to it? Of course. But does it tell the full story? Absolutely not, and here's why.
First, specialties are self-selecting. Each specialty attracts a certain type of applicant.
The match, which I've explained in a previous video, covers the process in depth. In short,
it's in the applicant’s best interest to only apply to specialties that they have a
realistic chance at getting into. If you’re not a competitive applicant, you’re not
going to apply to something like dermatology or plastic surgery because you won’t get
in. Plain and simple. Now, why does this matter when talking about
match rates? Match rates don’t account for this fact, that applicants are already pre-screened
before even applying. For example, general surgery has a match rate around 84%. In 2018,
this was lower than plastic surgery's 85%. But when you look at the average Step scores
and other factors, in addition to the fact that many plastic surgery applicants use general
surgery as a backup in case they can't get into plastics, it becomes clear match rate
alone isn't a reliable indicator. Another shortcoming of match rate that is
often overlooked involves international medical graduates, or IMGs. Graduating medical students
come from all over the world to finish their medical training in the U.S., and there are
certain specialties that attract more IMGs than others. This is important because IMGs
match into U.S. residencies at a far lower rate than U.S. graduates. So, if a specialty
attracts a large number of IMG applicants, it can make it difficult to compare to a specialty
that doesn’t. To overcome these shortcomings, I gathered
data from the NRMP and organized it into a spreadsheet. I examined six categories of
data: 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 school.
For the full results and link to the spreadsheet, check out my videos covering the top 5 most
and top 6 least competitive specialties. Link in the description.
Now that we’ve looked at the competitiveness of a specialty as it relates to applicant
metrics, let’s look at it from a more macroeconomic perspective and explore the concepts of supply
and demand. Supply when referring to a specialty’s competitiveness
refers to the number of open residency positions available. Specialties with few residency
positions are generally more competitive than specialties with more residency positions.
In essence, more residency positions means more chances to get in.
The supply of residency positions for a given specialty is largely dictated by the societal
demand for that specialty. Specialties like internal medicine have high societal demand.
Internal medicine physicians are the backbone of our hospital systems. They are often referred
to as the quarterbacks of inpatient care. They manage the patient's overall plan of
care while in the hospital and often serve as the bridge between the patient and other
consulting specialties. Internal medicine is also a gateway into multiple fellowships
including cardiology, gastroenterology, pulmonology, infectious diseases, hematology, oncology,
nephrology, and more. Any physician wishing to pursue these specialties will have to go
through internal medicine residency first. For these reasons, our society needs a lot
of physicians to go into internal medicine, making the societal demand for internal medicine
high. According to the AAMC, there is approximately one internal medicine physician for every
2,800 people. If we contrast this with something like plastic surgery that has less societal
demand, there is approximately one plastic surgeon for every 45,000 people. I’m not
saying plastic surgeons are not important, it's just that objectively, there are fewer
people that require the services of a plastic surgeon compared to an internist. This is
one of the contributing factors to plastic surgery being more competitive than internal
medicine. Additionally, the majority of funding for
residency programs comes from the federal government through Medicare and Medicaid.
Graduate medical education payments are made to teaching hospitals and health systems which
then have control over how those funds are allocated. The financial impact of residency
training programs on these teaching hospitals and health systems is complex and not well
understood; however, research has suggested that there are substantial differences in
the financial impact of different specialties. This means that hospitals may have incentives
to fund residency positions for specialties that generate their facilities more revenue.
Internal medicine and its related services drive a large portion of a hospital's revenue.
For this reason, there is a financial incentive on the part of the hospital to fund IM residency
positions. This may be another contributing factor to why IM has the largest number of
residency positions by far. This works in the reverse direction as well in that if a
particular specialty does not generate the facility a lot of revenue, then there is a
disincentive to adding residency positions for that specialty.
In addition to societal demand, demand can also refer to the number of medical students
that want to go into a particular specialty. In essence, how desirable is that specialty
to a medical student? The primary factors that influence the desirability
of a specialty are compensation and lifestyle. How much money do you make and how hard do
you work to make it? Many people will tell you that that money shouldn’t be a factor
when becoming a doctor. Although this is true for most students when they enter medical
school, by the time that they graduate, they often place a greater emphasis on the importance
of lifestyle. For this reason, specialties that have a good lifestyle and high compensation
like dermatology are typically seen as more desirable. If we refer back to our competitiveness
index, this may explain why dermatology is ranked as the #1 most competitive specialty.
Additionally, plastic surgery, neurosurgery, and orthopedic surgery also ranked in the
top 4 and just so happen to be the three highest compensated specialties.
Prestige is another factor that influences the desirability of a specialty – albeit
to a lesser degree than compensation and lifestyle. Some students are attracted to a particular
specialty because of the respect and admiration they believe they will receive from others
if they go into it. Surgical specialties in particular are often seen as more prestigious
and coincidentally tend to be more competitive compared to non-surgical specialties. Although
this is an important factor for some, I would strongly recommend against letting it dictate
your choice of specialty. Prestige is very externally focused. It takes the emphasis
away from what you want and what you enjoy and places it on what other people think.
Going into a specialty that you actually enjoy will be far more important in your long-term
happiness than the mental exercise of thinking which specialty has the best lifestyle, best
compensation, or most prestige. If you find yourself getting discouraged because
your dream specialty ranks high on the competitiveness index, or has low supply relative to its demand,
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 orthopedics or
dermatology or plastic surgery, but ultimately decided they weren’t competitive enough
for the specialty that they truly desired. If you think you’re not the smartest and
that you’re doomed, stop right there. Your ability to crush your MCAT, USMLE, and have
dozens of research articles is less a function of your intelligence and more a function of
proper preparation, constantly improving, and putting in the work. Having a stellar
medical school or residency application and crushing the interviews is no different, even
if you don’t consider yourself a “people person.” At Med School Insiders, our mission
is to empower a generation of happier, healthier, and more effective future doctors. From medical
school or residency application help to crushing your MCAT or USMLE, we’ve got your back.
And our results speak for themselves. We’ve become the fastest-growing company in the
space with the highest satisfaction ratings. See for yourself and learn more at MedSchoolInsiders.com.
Thank you all so much for watching! If you enjoyed this video, check out the Top 5 Most
Competitive Specialties or the Top 6 Least Competitive Specialties. Much love and I’ll
see you guys there.