10 Hardest specialites to gain a residency?

[BONDFAN]

Since I am an entering 1st year I was curious as to what the ten hardest specialties to gain a residency are. If you could list them in order I would appreciate it. I figure derm, ortho, neuro, would top the list but what do I know.

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[MD2b06]

I know you asked for order, just remember that it's very subjective. This would be my best guess. Please, no pissing contests, as this is only my view.

DERM
Rad Onc
Integrated Plastics (3+3)
ENT
Ortho
Urology
Rads
Ophtho
Neurosurgery
ER

Some of the medicine fellowships, (e.g, GI, Cardiology, etc) are probably just as difficult to obtain as some of the above residencies, but I didn't include them as you don't apply for them directly out of med school.

 

[ocean11]

I would take ER off and put cardiac-thoracic surgery instead!!

I know you asked for order, just remember that it's very subjective. This would be my best guess. Please, no pissing contests, as this is only my view.

DERM
Rad Onc
Integrated Plastics (3+3)
ENT
Ortho
Urology
Rads
Ophtho
Neurosurgery
ER

Some of the medicine fellowships, (e.g, GI, Cardiology, etc) are probably just as difficult to obtain as some of the above residencies, but I didn't include them as you don't apply for them directly out of med school.

 

[Chris's patient]

I would take ER off and put cardiac-thoracic surgery instead!!

Neither ER nor cardiothoracic is competitive. The rest of the list is accurate. Surgery is increasing in competitiveness - maybe you could add that.
If your talking about fellowships, peds surg is highly competitive.

 

[Obedeli]

I would take ER off and put cardiac-thoracic surgery instead!!

You don't match into CT surgery out of medical school. It is a fellowship out of general surgery. There may be some combined programs but I don't know.

 

[jonb12997]

everyone knows Family Pracitce is the hardest specialty to get into!!!

 

[MD2b06]

Yeah, I'll admit I was stretching trying to come up with #10. GSurg is only getting more competitive b/c of the 80hr workweek. 4 or 5 years ago, General Surgery had a ridiculous amount of unfilled spots. I hope whoever said CT Surgery is competitve was joking. Given the current job market for CT surgeons, it's popularity has plummeted. No one trains that hard for that long only to be unemployed in the end. Besides, I don't think there are too many intergrated CT programs out there where one could apply directly out of med school.

 

[Obedeli]

Yeah, I was thinking "10 hardest specialites" seems like, well, almost of all them. I mean seriously, how many are left? Yes, there are those weird combo ones(med/psych, etc) you see on eras but 10 is a large number. I think the most difficult 4 would make more sense. I have no idea why I am posting on this thread, I must be real bored waiting to move and start residency.

 

[Mumpu]

Isn't anesthesiology fairly competitive too? It's all the lifestyle (or so they think!) specialties.

 

[doc05]

I know you asked for order, just remember that it's very subjective. This would be my best guess. Please, no pissing contests, as this is only my view.

DERM
Rad Onc
Integrated Plastics (3+3)
ENT
Ortho
Urology
Rads
Ophtho
Neurosurgery
ER

Fairly good approximation. I'd say that Plastics tops the list, followed by derm and radonc. Rads and ophtho are fairly equivalent in terms of competitiveness.

I'd replace ER with general surgery: ER isn't particularly competitive, at least not compared to the others. Neither is anesthesiology.

 

[Mumpu]

General surgery is no more competitive than family or IM. A specialty cannot be called competitive if it doesn't fill all slots at the end of the match.

 

[tigress]

Okay, how about IM fellowships, since the topic was brought up? This is certainly an important issue for students interested in one of the IM subspecialties but unsure as to whether they have a chance to actually get into them.

 

[UCLAstudent]

Isn't anesthesiology fairly competitive too? It's all the lifestyle (or so they think!) specialties.

It isn't terribly competitive anymore.

 

[Leukocyte]

General surgery is no more competitive than family or IM. A specialty cannot be called competitive if it doesn't fill all slots at the end of the match.

Only 6 categorical programs went unfilled after the match. All were gone within the first few hours of the scramble.

 

[SocialistMD]

Only 6 categorical programs went unfilled after the match. All were gone within the first few hours of the scramble.

Add to that the fact that ~200 people who wanted to match into general surgery didn't and I think the previously mentioned rule of "if all spots didn't fill, it isn't competitive" goes out the window.

 

[md2000]

Yeah, I'll admit I was stretching trying to come up with #10. GSurg is only getting more competitive b/c of the 80hr workweek.

How funny is it that we are now clamoring for "only" an 80-hour work week! Trust me, I'm grateful for it, but I don't know how these older docs had been working 120 hour weeks for 5 years. Damn.

 

[Haybrant]

General Surgery had a ridiculous amount of unfilled spots. I hope whoever said CT Surgery is competitve was joking. Given the current job market for CT surgeons, it's popularity has plummeted. No one trains that hard for that long only to be unemployed in the end. Besides, I don't think there are too many intergrated CT programs out there where one could apply directly out of med school.

Yah I dont think there are many ct direct programs but that is changing. I didnt know however that the popularity of CT has plummeted; Is this due to the perception that Cancer will be controlled (maybe not cured, but controlled) in x number of years?

 

[AJM]

Yah I dont think there are many ct direct programs but that is changing. I didnt know however that the popularity of CT has plummeted; Is this due to the perception that Cancer will be controlled (maybe not cured, but controlled) in x number of years?

What does cancer have to do with the popularity of CT surgery? Sure, CT surgeons might do some lung cancer resections, but the vast majority of the work in CT surgery is cardiac. (besides, with all the smokers around, lung cancer is not going to be going away any time soon).

 

[doc05]

Yah I dont think there are many ct direct programs but that is changing. I didnt know however that the popularity of CT has plummeted; Is this due to the perception that Cancer will be controlled (maybe not cured, but controlled) in x number of years?

It is due to the fact that the supply of newly-graduated CT surgeons far outnumbers demand. The current # of approved CT residency positions was established when everyone was getting a CABG and huge numbers of CT surgeons were needed. With the increasing use of stents over the last 10 years, demand for additional CT surgeons has waned; nonetheless, training programs have continued to turn out CT surgeons.

What has happened is that newly-minted CT surgeons are having difficulty finding jobs. Some end up becoming super-fellows instead of directly joining the workforce. Others end up doing general or trauma for 1-2 years while they search for a CT job. Others still end up going on dozens of job interviews and are lucky to get 1 offer; and the offer may very well be in an undesirable part of the country, at a salary far below what they deserve.

After 7-10 years of postgraduate medical education, you'd think these folks -- arguably the hardest working people in medicine -- would be able to get jobs. They can, but with significant difficulty, and these are often undesirable positions.

 

[worriedwell]

couple of good friends of mine going into ophto cite that optho has a reputation of being much more competitive than it actually is. They say that it really isn't that difficult to match into optho, but you should do decent on step 1. they said it was a slightly numbers oriented field (boards, aoa, etc) but you don't need to be a superstar. Granted, they were coming from a top 25 caliber school, but they were definitely not superstars. take it for what it is worth, but to them its laughable to lump optho with plastics, derm, rad-onc, neurosurgery, and urology. Those fields would be our top 5, followed closely by ent, radiology, orthopedics. And then in the next tier, optho and maybe ER. Anasthesia would probably be next, but all of my classmates who did it were definitely not the superstars of the class, and the ones who were in the top half of my class matched in programs like UCSF and the Brigham.

Anybody in the know would probably say that plastics is the hardest one to get. And by the way, the reason plastics as well as the others in the top five are slightly more competitive than the next tier is simply due to the small amount of total spots in plastics, rad onc, neursurgery, and urology. Derm has more spots but is ridiculously competitive due to lifestyle. Ortho and Rads are very competitive, but they have a ton of spots comparably. ER is the same way and thats why its not more competitive. However, trying to match into any of the top programs in the above mentioned fields is incredibly competitive.

Its funny because I went into psychiatry, easily one of the least competitive fields, but knowing my numbers, grades, letters, class standing, etc vs my friends who I know these things about or can roughly generalize...I would say that I am confident I would have matched into any specialty except plastics, derm, rad onc and neurosurgery. I honestly would have been very doubtful that I would have matched into those fields. Thats one factor that contributed to me thinking which ones are the most competitive.

 

[doc05]

couple of good friends of mine going into ophto cite that optho has a reputation of being much more competitive than it actually is. They say that it really isn't that difficult to match into optho, but you should do decent on step 1. they said it was a slightly numbers oriented field (boards, aoa, etc) but you don't need to be a superstar. Granted, they were coming from a top 25 caliber school, but they were definitely not superstars. take it for what it is worth, but to them its laughable to lump optho with plastics, derm, rad-onc, neurosurgery, and urology. Those fields would be our top 5, followed closely by ent, radiology, orthopedics. And then in the next tier, optho and maybe ER. Anasthesia would probably be next, but all of my classmates who did it were definitely not the superstars of the class, and the ones who were in the top half of my class matched in programs like UCSF and the Brigham.

Anybody in the know would probably say that plastics is the hardest one to get. And by the way, the reason plastics as well as the others in the top five are slightly more competitive than the next tier is simply due to the small amount of total spots in plastics, rad onc, neursurgery, and urology. Derm has more spots but is ridiculously competitive due to lifestyle. Ortho and Rads are very competitive, but they have a ton of spots comparably. ER is the same way and thats why its not more competitive. However, trying to match into any of the top programs in the above mentioned fields is incredibly competitive.

Its funny because I went into psychiatry, easily one of the least competitive fields, but knowing my numbers, grades, letters, class standing, etc vs my friends who I know these things about or can roughly generalize...I would say that I am confident I would have matched into any specialty except plastics, derm, rad onc and neurosurgery. I honestly would have been very doubtful that I would have matched into those fields. Thats one factor that contributed to me thinking which ones are the most competitive.

ortho and ent are both much more competitive than neurosurgery.

 

[worriedwell]

ortho and ent are both much more competitive than neurosurgery.

would you mind elaborating a bit? or should we just take your word as the person who knows more than every other recent med school graduate?

by the way, i'm not using some magic formula myself, just taking into account basic knowledge of match rates while factor in number of spots as well as subjective info like...of the people who did neurosurg this year, all of them would have matched into ortho or ent, while of all the ortho meatheads in my class (many of which are my friends), probably one would have matched into neurosurgery. Nobody did ENT in my class this year, so its hard to say. In general, ortho matching seemed much more easy to match into with the right personality, while neurosurgery matching seemed much more about research, numbers, and proven academic work ethic. This is subjective, but not totally.

to echo the sentiments of some previous poster, don't want to get into a pissing match...so i'm comfortable saying they are roughly equally competive, but i won't accept the notion that neurosurgery is significantly less competitive to match into than ortho. Not when there are no more than 3 spots at any given powerhouse hospital like hopkins, and a city like new york has like 10 spots total in the city.

 

[Stanford_Playah]

would you mind elaborating a bit? or should we just take your word as the person who knows more than every other recent med school graduate?

by the way, i'm not using some magic formula myself, just taking into account basic knowledge of match rates while factor in number of spots as well as subjective info like...of the people who did neurosurg this year, all of them would have matched into ortho or ent, while of all the ortho meatheads in my class (many of which are my friends), probably one would have matched into neurosurgery. Nobody did ENT in my class this year, so its hard to say. In general, ortho matching seemed much more easy to match into with the right personality, while neurosurgery matching seemed much more about research, numbers, and proven academic work ethic. This is subjective, but not totally.

Yeah, ortho seems to be more about personality than neurosurgery. If you have decent numbers and some research work in the field, it comes down to your personality, which usually means that it pays to be like "the Todd" in Scrubs to land a residency position in ortho. Or that's what I tell myself because he's my idol.

 

[JAMMAN]

How funny is it that we are now clamoring for "only" an 80-hour work week! Trust me, I'm grateful for it, but I don't know how these older docs had been working 120 hour weeks for 5 years. Damn.

Don't even get me started on the 80 hour work week. In order to comply, residency programs seem to be undertraining residents. Some residents are doing 30-40% fewere cases and the cases they are doing are not necessarily commesurate with their level of training.

 

[Shah_Patel_PT]

I know you asked for order, just remember that it's very subjective. This would be my best guess. Please, no pissing contests, as this is only my view.

DERM
Rad Onc
Integrated Plastics (3+3)
ENT
Ortho
Urology
Rads
Ophtho
Neurosurgery
ER

Some of the medicine fellowships, (e.g, GI, Cardiology, etc) are probably just as difficult to obtain as some of the above residencies, but I didn't include them as you don't apply for them directly out of med school.

How hard is Rad Onc for a foreign grad?

 

[Whisker Barrel Cortex]

I'd probably put the list like this (your results may vary)

Toughest:
1. Derm
2. ENT
3. Rad Onc
4. Integrated Plastics
5. Neurosurg

Tough
6. Urology
7. Ortho
8. Radiology
9. Optho
10. Gen Surg / ER

Programs such as Rads, Gen Surg, and ER are somewhat competitive, but don't reach the level of some of the others due to an abundance of spots (rads as around 1000 compared to 100 for rad onc for example).

 

[velo]

ortho and ent are both much more competitive than neurosurgery.

I hearby declare this pissing contest top notch!

 

[doc05]

would you mind elaborating a bit? or should we just take your word as the person who knows more than every other recent med school graduate?

look at the match rates: over 90% for neurosurg; less than 80% for ent.
#'s of fmgs in ortho and ent: far smaller %age than other specialties.

 

[SanDiegoSOD]

Why are Rad Onc and ENT so competitive? Derm is obviously competitive due to low hours and good pay, but Rad Onc and ENT don't appear to be low hour specialties and also have full five year residencies. Are those specilties all about the $$$?

 

[doc05]

Why are Rad Onc and ENT so competitive? Derm is obviously competitive due to low hours and good pay, but Rad Onc and ENT don't appear to be low hour specialties and also have full five year residencies. Are those specilties all about the $$$?

ent is a tough residency; but in private practice, the hours and pay are very sweet.

getting into radonc is like getting a license to print money. plus it offers intellectual challenges that few specialties can match.

 

[sven]

look at the match rates: over 90% for neurosurg; less than 80% for ent.
#'s of fmgs in ortho and ent: far smaller %age than other specialties.

Those who try to match into neurosurg and plastics are a pretty self-selecting group, so match rates can be a misleading indicator of competitiveness. If you don't have the numbers and research, you usually don't bother trying to match in the first place. Remember, medical schools used to brag about x % of their grads getting one of their top three choices -- but the AAMC no longer bothers to track this because it's a pretty meaningless statistic.

 

[pikachu]

Rad onc had 136 spots in 79 programs this year (I think), about 2.5-3 applicants for every spot. This has been a big change for the field over the past five or six years. it used to be very easy to match into rad onc, so the self-selection that you see in Plastics or Neurosurgery probably plays less of a role and increases the number of applicants.

It's true that the residency is 5 years but once you are finished with your intern year there is no in house call, and there are very few emergencies that will actually bring you into the hospital at night or on weekends. Most of rad onc is done on an outpatient basis. That said, it's not necessarily an easy residency given the intellectual demands as doc05 mentioned. At most programs you may get close to the 80 hour week with all the reading you will have to do (physics, radiobiology, plus text reading and journals) - the rad onc boards are reportedly one of the hardest with an oral as well as a written exam covering all of the above.

 

[YouDontKnowJack]

hey. what's the big deal about 5 year residencies?
most residencies that are worth a damn are at least 4 years.
3 year residencies are for lowly primary care....

besides, the years fly by really quickly.

 

[pikachu]

Yeah I would take 5 years of rad onc over 3 years of FP any day - one of the other posters seemed to think it was an issue -

 

[donnap86]

everyone knows Family Pracitce is the hardest specialty to get into!!!

Haaaaaaaaaa, HHHHHHAAAA!!! That is very funny.

 

[humuhumu]

getting into radonc is like getting a license to print money.

 

[salsadoc44]

ortho and ent are both much more competitive than neurosurgery.

here here

 

[salsadoc44]

ent is a tough residency; but in private practice, the hours and pay are very sweet.

getting into radonc is like getting a license to print money. plus it offers intellectual challenges that few specialties can match.

ENT all the way!

 

[NIQ]

hey. what's the big deal about 5 year residencies?
most residencies that are worth a damn are at least 4 years.
3 year residencies are for lowly primary care....

besides, the years fly by really quickly.

Years fly by really quickly? Hahaha

Nearly every trainee in any speciality is underpaid and overworked. Sorry but that doesn't make time fly

 

[JudoKing01]

Yeah, ortho seems to be more about personality than neurosurgery. If you have decent numbers and some research work in the field, it comes down to your personality, which usually means that it pays to be like "the Todd" in Scrubs to land a residency position in ortho. Or that's what I tell myself because he's my idol.

Dude, The Todd is the greatest surgeon ever. I hope someday I can be like him, regardless of what specialty I enter.

 

[synapse]

so derm really is THE HARDEST?

i always thought ortho was.

 

[Leukocyte]

hey. what's the big deal about 5 year residencies?
.....
besides, the years fly by really quickly.

True. But it also means that a guy can go from his mid 40s to his early 50s really quickly too. Also take into account the some 5 year residencies like General Surgery do not guarantee graduation in 5 years, but rather are "5 year MINIMUM residencies" (especially if you need to do reasearch during your residency).

 

[Long Dong]

so derm really is THE HARDEST?

i always thought ortho was.

I always thought plastics was or is?

 

[Ross434]

I always thought plastics was or is?

I think ortho has a rep for being one of the hardest residencies to actually *do*.. Because you're learning so much that you never learned in med school, *and* having to do surgery.

 

[doc05]

Because you're learning so much that you never learned in med school, *and* having to do surgery.

That's true of many fields including plastics.


it's hard because of the long hours and physical demands of the work.

 

[cammy1313]

Can we get a list of top 5 most competitive IM fellowships?

 

[automaton]

Can we get a list of top 5 most competitive IM fellowships?

cards & GI are the two hardest. rest are so-so i guess.

check this out for more info
http://forums.studentdoctor.net/showthread.php?p=2611951

 

[03Doc]

Top 3:

1. Derm (50-60% senior match rate)
2. Rad Onc (50-55% generally, but 80% in 04)
3. Plastics (50-55% senior match rate)

The reason I rank them as such is this: most plastics folks who don't get in do GSurg and try again on the back end, they have 2 chances. Rad Onc for some reason was easier as of late, but Derm is getting worse. There is a HUGE reapplicant contingent in Derm such that there are about 280-300 spots each year, and ~600-650 US senior applicants, but almost 900 total applicants, who are not all FMGs or DOs, but reapplicants who are interns, derm research fellows, IM, FP, or Peds residents, etc. Even once people have their residency they want in.

The others mentioned (Ortho, Optho, ENT, Rads, NSurg) all hover in the 75-85% match rate area, which I consider difficult, but one tier down in competitiveness from the three above.

 

[alhkim]

automaton is right...the top two are cards and GI, simply because many people apply to them. allergy/immunology is very competitive, but for the opposite reason--there are very few spots. the other perceived difficult fellowship to get is heme/onc.

Can we get a list of top 5 most competitive IM fellowships?

 

[Pir8DeacDoc]

Plastics is the toughest.

The numbers I have seen for the other fields mentioned are tough but not as low as integrated plastics. Also, you can't say it's easier simply because someone has two chances to get it. We are talking about matching right out of med school. Plus, the fellowship match rate for plastics is ridiculiously low. I seem to recall it has eclipsed peds as the hardest fellowship to get after GS.