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Blog / The Most Competitive Medical School Residencies The Ultimate Guide For 2023

The Most Competitive Medical School Residencies: The Ultimate Guide for 2023

Written by Seza on Aug 24, 2023

The Most Competitive Medical School Residencies: The Ultimate Guide for 2023

Getting into a medical school residency program has become more competitive in 2023. Medical students are competing for spots in prestigious specialties that offer excellent growth opportunities. To help these aspiring doctors, we’ve put together this guide to give you insights into what makes certain programs popular and how you can improve your chances. From understanding the importance of the school’s reputation to excelling in exams and choosing the right specialty, this guide equips you with the knowledge to succeed in the competitive world of medical residencies.

Overview of the Current Medical Residency Landscape in 2023:

As medical advancements and innovations continue to reshape the healthcare landscape, the medical residency scene undergoes transformations of its own. In 2023, medical residencies are witnessing an increasing number of applicants competing for a limited number of spots. The attraction of competitive residencies lies not only in the promise of top-notch training but also in their prestige and recognition.

Factors That Make a Medical Residency Program Competitive:

  • Prestige and reputation of the institution

Securing a position in a competitive medical residency program requires a keen understanding of the factors that influence the selection process. The first significant aspect is the prestige and reputation of the hospital or institution offering the residency. Renowned institutions tend to attract a larger pool of applicants, making their programs more competitive.

  • Residency program size and available positions

Another vital consideration is the size of the residency program and the number of available positions. Smaller programs may have fewer slots, leading to increased competition for admission. Additionally, larger programs may also be competitive due to the sheer number of applicants they receive.

  • Average Step 1 and Step 2 CK scores of accepted residents

Standardized test scores play a crucial role in the residency selection process. For many competitive residencies, the average Step 1 and Step 2 CK scores of accepted residents are relatively high. As a result, excelling in these exams becomes paramount for candidates aiming to stand out in the application pool.

  • Research opportunities and publications

Research opportunities and publications are highly valued in competitive residencies. Candidates who have actively engaged in research and have published their work in reputable journals are more likely to gain an advantage during the selection process.

  • Subspecialty vs. primary care programs

Lastly, aspiring residents must also decide between subspecialty and primary care programs. Some subspecialties, such as plastic surgery and otolaryngology, have become exceedingly competitive due to their unique challenges and high demand in the medical field.


List of the Most Competitive Medical Residencies in 2023 

Here we have gathered a list of the eight top competitive medical residencies in 2023 according to the data from the American Medical Association and  2023 NRMP (National Residency Matching Program).

Plastic Surgery (integrated)

Integrated plastic surgery residencies are highly sought-after due to their comprehensive training in both general surgery and plastic surgery. Aspiring plastic surgeons must excel in their USMLE Step 1 and Step 2 exams and demonstrate a commitment to research and academic achievements.

  • Fill rate: 92.3%
  • Positions offered: 207
  • Positions available per applicant: 0.8
  • Mean USMLE Step 1 score: 251
  • Mean USMLE Step 2 score: 257
  • Years of specialty training required: 6


Otolaryngology residencies, also known as ENT (ear, nose, and throat) programs, attract a competitive pool of applicants. Strong academic performance, research experience, and a genuine interest in head and neck surgery contribute to success in this field.

  • Fill rate: 83.1%
  • Positions offered: 373
  • Positions available per applicant: 0.98
  • Mean USMLE Step 1 score: 250
  • Mean USMLE Step 2 score: 257
  • Years of specialty training required: 5

Thoracic Surgery

Thoracic surgery residencies attract a considerable number of applicants due to the critical nature of the specialty. Aspiring thoracic surgeons must complete extensive surgical training and demonstrate exceptional clinical skills.

  • Fill rate: 83.7%
  • Positions offered: 1,736
  • Positions available per applicant: 0.6
  • Mean USMLE Step 1 and Step 2 scores: The NRMP hasn’t published this information, however mean step scores for successful applicants are usually similar to other integrated surgical residencies (240–250 for Step 1 and 250–255 for Step 2).
  • Years of specialty training required: 6–8

Vascular Surgery

Vascular surgery is a highly specialized field that deals with complex circulatory system disorders. Applicants with strong academic records and a demonstrated interest in vascular medicine stand a better chance in this competitive field.

  • Fill rate: 80.6%
  • Positions offered: 93
  • Positions available per applicant: 1.01
  • Mean USMLE Step 1 score: 241
  • Mean USMLE Step 2 score: 250
  • Years of specialty training required: 5–7

Neurological Surgery

Neurological surgery residencies are known for their rigor and complexity, attracting applicants with exceptional academic achievements, research experience, and a genuine passion for neurosurgery.

  • Fill rate: 86.8%
  • Positions offered: 243
  • Positions available per applicant: 0.9
  • Mean USMLE Step 1 score: 241
  • Mean USMLE Step 2 score: 252
  • Years of specialty training required: 7

Interventional Radiology (integrated)

Integrated interventional radiology programs combine diagnostic and interventional training, making them highly competitive. Applicants with a strong background in radiology and interventional procedures are favored.

  • Fill rate: 72.5% 
  • Positions offered: 51 
  • Positions available per applicant: 0.18 
  • Mean USMLE Step 1 score: 245
  • Mean USMLE Step 2 score: 253
  • Years of specialty training required: 6

Orthopedic Surgery

Orthopedic surgery residencies attract applicants with a passion for musculoskeletal health and excellent surgical skills. Strong academic performance and relevant research experience are essential for success in this field.

  • Fill rate: 76.8%
  • Positions offered: 899 
  • Positions available per applicant: 0.94
  • Mean USMLE Step 1 score: 248
  • Mean USMLE Step 2 score: 256
  • Years of specialty training required: 5 years minimum (with an addition of 2 years in clinical practice)

Medicine – Pediatrics

Medicine-Pediatrics programs attract candidates who are interested in combined training for both internal medicine and pediatrics. Successful applicants demonstrate a strong commitment to primary care and patient-centered approaches in healthcare.

  • Fill rate: 78.3%
  • Positions offered: 392
  • Positions available per applicant: 1.09
  • Mean USMLE Step 1 score: 236
  • Mean USMLE Step 2 score: 250
  • Years of specialty training required: 4

The Most Competitive Medical School Residencies

Strategies for Aspiring Residents to Improve Their Chances:

Building a strong academic foundation during medical school

One of the fundamental steps in securing a competitive medical residency is laying a solid academic groundwork during medical school. Focus on excelling in core subjects and specialty-related courses, while actively participating in clinical rotations to gain practical experience. Seek mentorship from experienced faculty members who can guide you in your academic and career pursuits. Engaging in extracurricular activities that demonstrate leadership, teamwork, and a commitment to community service can also enhance your candidacy.

Excelling in standardized exams (USMLE, COMLEX, etc.)

Standardized exams, such as the United States Medical Licensing Examination (USMLE) and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), play a crucial role in the residency selection process. These exams assess your medical knowledge and clinical skills, and strong performance can significantly enhance your competitiveness. Develop a comprehensive study plan and dedicate ample time to exam preparation. Utilize reputable review resources and practice exams to identify areas of improvement. If needed, consider enrolling in exam preparation courses or seeking help from tutors to achieve optimal scores.

Maximizing research opportunities and publications

Engaging in research during medical school can be a valuable asset in securing a competitive residency position. Seek research opportunities early in your medical education and collaborate with faculty members or researchers in your specialty of interest. Actively participating in research projects and presenting your findings at conferences can demonstrate your dedication to advancing medical knowledge. Publishing your work in respected medical journals can set you apart from other applicants and showcase your commitment to academic excellence.

Importance of networking and letters of recommendation:

Networking is an essential component of the residency application process. Attend medical conferences, seminars, and networking events to connect with professionals in your chosen specialty. Cultivate strong relationships with faculty, preceptors, and mentors who can provide meaningful letters of recommendation. These letters can offer valuable insights into your skills, work ethic, and character, influencing the selection committee’s perception of your candidacy. Seek out elective rotations or externships at institutions known for your desired specialty to further expand your network.


Balancing Passion and Practicality: How to Choose the Right Specialty

Understanding personal interests and goals

Choosing the right specialty involves understanding your personal interests, values, and long-term career goals. Reflect on which patient populations or medical challenges resonate most with you. Consider the types of medical cases that spark your passion and fuel your motivation to excel in your career. Seek advice from experienced physicians, faculty, and practicing professionals to gain insight into the day-to-day realities of different specialties.

Weighing lifestyle factors and work-life balance

While passion is vital, it’s also crucial to consider the lifestyle associated with different specialties. Evaluate the demands, work hours, and call schedules of your desired specialties. Understanding the work-life balance in each field will help you make an informed decision about which specialty aligns best with your personal life goals.

Considering future job prospects and salary

Another critical factor in choosing a specialty is understanding the future job market and salary prospects. Research the demand for your desired specialty in various regions and assess the potential for career advancement. While salary should not be the sole determinant, it is essential to consider your financial well-being when selecting a specialty.

To learn more about the challenges of the residency life, you can watch this episode of Jack Westin MCAT Podcast, where Phil Hawkins, lead Instructor and director of MCAT Prep and Alexis Bowder M.D. discuss Dr. Bowder’s experience in surgery and leading the charge in global health, how to have a family during residency, and how travel plays an important role in being a doctor.


Alternative Paths for Competitive Specialties

Preliminary year programs

For highly competitive specialties, some institutions offer preliminary year programs that allow residents to gain general clinical experience before specializing. These transitional programs can provide valuable foundational training and may lead to subsequent specialization in more competitive fields.

Fellowships and sub-specialization

After completing a residency, aspiring physicians can opt for fellowships to gain additional expertise and sub-specialization within a particular field. Completing a fellowship can make you more competitive for certain jobs and research opportunities.

International medical residency programs

Exploring international medical residency programs can provide unique experiences and exposure to different healthcare systems and cultures. These programs can broaden your perspective and add a global dimension to your medical training.


Final Word

Securing a competitive medical residency requires a combination of academic excellence, strategic planning, and self-awareness. Building a strong academic foundation, excelling in standardized exams, engaging in research, networking, and selecting the right specialty are essential components of a successful residency application. Balancing passion with practical considerations and exploring alternative paths can further enhance your opportunities in competitive specialties. 

Remember that each applicant’s journey is unique, and by staying true to your goals and aspirations, you can navigate the competitive landscape of medical school residencies with confidence. Also, don’t forget that Jack Westin experts are here for you every step of the way, you can contact us and we’ll be more than happy to guide you! 

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