As you may know, getting into medical school is a tedious process. All throughout undergrad you studied for hours in the library with other pre-meds while others had a more traditional college experience of parties and two-hour-long dinners. You probably spent your weekends shadowing doctors and your summers doing research so you could build your resume for medical school applications. You spent hours studying for the MCAT and hundreds or even thousands of dollars in prep courses, tutors, medical school admissions consulting, and exam fees.
All of that is just the beginning, as you will discover that medical school is multiple times more demanding. If you are reading this, you are probably near the end of your medical school journey and are applying for residency, the next chapter in your medical career. After passing the USMLE Step 1, Step 2, and Step 2CK, and having completed most of your third-year clinical rotations, you probably have an idea of the specialty you want to spend the next three to seven years training in. Although medical students are a highly motivated, intelligent, and hardworking group, the reality is that not everyone can match into a competitive specialty such as orthopedic surgery, ophthalmology, dermatology, radiology, or neurosurgery. If you have less than stellar credentials, here is a list of the least competitive medical specialties based on average USMLE scores, publications, percentage of applicants matched, AOA status, and medical school ranking, which are all factors that residency programs consider when ranking applicants.
1. Family Medicine
Family medicine remains one of the least competitive medical specialties. The average USMLE Step 1 score of medical students who match into a family medicine residency program is among the lowest at 221. Over 96 percent of applicants match into a family medicine residency program. Family medicine is also feasible for graduates of foreign medical schools. If you have some red flags in your application such as a failed class or needed two attempts to pass a board exam, many family medicine programs will not automatically filter out your application. Family medicine involves the care of patients from newborns to geriatrics, and programs tend to consider aspects other than board scores. Excellent letters of recommendation, for example, can show that you can be a well-rounded and humanistic physician.
Family medicine residency is 3 to 4 years and encompasses training in newborn care, OBGYN care including attending deliveries and providing prenatal care, and both inpatient and outpatient adult and pediatric medicine. In the past, family physicians also staff emergency rooms, although that is now largely defunct due to the advent of emergency medicine as a separate training program. In rural areas, family physicians can do surgeries. There are fellowships to help you further specialize in sports medicine, hospice and palliative care, geriatric medicine, and sleep medicine.
As a practicing family physician after residency, your job conditions can vary widely depending on where you choose to work. In rural settings, you may be one of few family physicians for miles, staffing a busy outpatient clinic, performing procedures because of the lack of surgical specialists in the area, and round on your patients in the wards and emergency room. If you choose to practice in an urban setting, your focus may be narrowed towards either outpatient or inpatient, and emergency room positions may be less available to family medicine trained physicians. In big cities saturated with pediatricians, your patient population may lean towards adults and the elderly as many parents may wish to bring their child to a pediatrician. Your hours will vary depending on your job, and your salary will average $230,000 per year.
2. Physical Medicine & Rehabilitation
PM&R is not a very well-known specialty to medical students because it is not usually offered as a core clinical rotation. It is one of the least competitive medical specialties to match into, with average USMLE 1 scores of accepted applicants in the mid 220s. Applicants can match into a decent program without stellar grades or multiple publications. As with any specialty, it is important to have positive letters of recommendation and a well-written personal statement to get you in the door for an interview.
PM&R doctors help patients recover from debilitating conditions such as stroke, amputation, spinal cord injury, chronic pain, sports injuries, traumatic brain injuries, and other musculoskeletal disorders. You will work with both children and adults who have either congenital or acquired conditions. It requires a lot of patience as these patients are to likely to recover with a few sessions. Often, prolonged physical therapy and multiple treatment modalities are used to restore a patient’s daily function. PM&R makes use of artificial limbs, joint injections, ultrasound or electrical stimulation of muscles, heat and cold therapy, and muscle manipulation by physical therapists. PM&R is known as a lifestyle specialty, with minimal call hours and a decent physician salary averaging over $300,000 per year after a 4-year residency.
Although anesthesiology is traditionally a ROAD specialty, which are the four specialties known for high salary with good work hours. ROAD stands for radiology, ophthalmology, anesthesiology, and dermatology. While only medical students with the best credentials can match into radiology, ophthalmology and dermatology, anesthesiology is surprisingly one of the least competitive medical specialties. A medical student with average grades will have no trouble matching into an anesthesiology residency program. Although the pay is high, over $390,000 annual salary, and a flexible work schedule that is shift-based, there are more residency spots than applicants.
Anesthesiology residency training is 4 years long. Anesthesiology hours match that of surgeons, as both specialties are working together, albeit on opposite sides of the curtain. Anesthesiology is one of the few specialties along with pathology and radiology that have minimal patient interaction. As a anesthesiologist, you will speak with your patients briefly pre-op, but for the most part your patients will be sedated. Anesthesiologists mostly work in hospitals alongside surgeons, however there are also opportunities to work in clinics doing sedation for outpatient procedures such as colonoscopies and endoscopies.
After 4 years of residency, some choose to further specialize with fellowships in sleep medicine, pain management, pediatric anesthesiology, obstetric anesthesiology, or critical care medicine. Anesthesiologists are experts at managing difficult airways and intubations. In addition, to know different types of sedation, anesthesiologists also become experts at placing peripheral and central lines and patient resuscitation. CRNAs are becoming more common in anesthesiology and anesthesiology attending physicians may find themselves supervising CRNAs depending on the requirements of their employed hospital.
Pediatrics is not only one of the least competitive medical specialties, but it is also the lowest paying medical specialty. General pediatricians in urban settings can have salaries as low as $160,000 for a full-time position. It is also the only specialty where fellowship-trained specialists have even lower pay because they can only work in academic hospitals, which tend to be lower-paying than private practice. This includes pediatric infectious disease and oncologists that may earn even less than general pediatricians.
Pediatrics requires a 3 year residency program. It is easy to match into pediatrics whether you are a below average student from an American medical school or a foreign medical graduate. The average USMLE score of matched applicants is in the low 220s and over 98% of applicants match. The 3 year residency training includes rotations in outpatient clinics, pediatric emergency rooms, pediatric inpatient wards, and different subspecialty clinics. Residents spend time in the newborn nursery, attend deliveries, and take care of premature babies in the NICU. They care for patients from birth to early adulthood, usually age 21. Patients can range from cute babies to shy toddlers to angsty teenagers. Not only are pediatricians great at interacting with children, they are also skilled at dealing with parents who can range from teenage mothers to experienced older mothers.
It takes a special personality to want to become a pediatrician. Although it is one of the least competitive medical specialties, it does not mean that pediatricians are not as competent or intelligent as their adult medical counterparts. Pediatricians choose to work with children because they truly enjoy working with children and their families and seeing them grow over time. The pathophysiology of a newborn or infant is also very different from that of an adult and the breadth of congenital and genetic disorders is quite interesting to some people. Work hours can be predictable if you choose to work in an outpatient clinic, or you can choose to work the hours of a hospitalist and take call. If you do not mind the relatively lower salaries, pediatrics is one of the least competitive medical specialties and at the same time one of the most rewarding medical specialties.
Psychiatry is also one of the least competitive medical specialties. The field deals with disorders of personality and the mind. Some people feel that this is not medical enough and that psychiatrists are not “real doctors.” But that is an outdated thought because now it is widely recognized that mental health is an important aspect of patient care. Psychiatry pays well and is one of the easiest specialties to open your own private practice. Overhead is low and you do not need much equipment to operate a psychiatry practice. Psychiatrists are in demand in many parts of the country due to supply and demand. Hours can be very predictable, with very few emergent cases.
If you do not like the idea of rushed 15 minute visits, psychiatry is an excellent choice because patient visits can last for hours. You truly delve into the mental state of a patient and try to talk them through their issues. Further specialization in pediatrics and adolescent psychiatry, forensics, geriatrics allows you to better serve specific populations. New treatment modalities include electroconvulsive therapy for severe depression. Psychotherapy, cognitive behavioral therapy, dialectical behavior therapy, and exposure therapy are different techniques used by psychiatrists. As research brings more light into the relationship between chemical imbalances, hormones and mental health, new medications are being developed, in addition to the traditional SSRIs and antipsychotics. In psychiatry, you get to use a combination of medication and therapy to treat patients.
6. Emergency Medicine
Emergency medicine is surprisingly one of the least competitive medical specialties, even though it pays well and the lifestyle is good. Emergency medicine physicians train in residency for 3 to 4 years. Further sub-specialization is available with fellowships in critical care, ultrasound, medical toxicology, sports medicine, and hyperbaric medicine. You will be trained to hand any type of emergency. Emergency rooms are often the first line of care for many patients who are uninsured and do not have a primary doctor. It is fast-paced and you never know who is going to roll into the ER next. A shift may include multiple codes, such as gunshot wounds, burns, cardiac arrests, strokes, and acute injuries. Or it may consist mostly of conditions that can be handled in an outpatient clinic. Emergency medicine physicians have to decide who can go home and who needs to be admitted for further work-up and care.
Although the work is intense and fast-paced, the good thing is once your shift is over, you do not have to take any work home with you. You do not have to follow the patient because the person in the next shift will take over, or if discharged the primary care physician will follow up. The pay is high, expecting at least $300,000 per year and even higher in rural areas with greater demand. However, many older emergency medicine physicians feel burned out because of the constant night shifts, long shifts, and disruption in circadian sleep. The patient population can also be difficult, consisting of people who do not have routine care, such as the homeless. Nonetheless, people who appreciate the adrenaline filled work flow will want to apply to an emergency medicine residency.