Critical Components in the Match

Steps 1 & 2, M3 Grades, and Your Residency Match

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Your M3 year is arguably the most challenging, exciting, and rewarding part of your medical school training. So much will happen during this year. You will see new life, death, healing, heartbreaking sadness, medical miracles, and much more. As the year progresses, you will also begin to consider the next direction you take within the fields of medicine that you wish to pursue. At some point everyone will ask some form of the question: I want to enter X specialty….what does it take (or do I have what it takes) to get into that field? This document is aimed at providing a least an initial foray into the answer to that question.

To start this conversation, the competitiveness of the major medical specialty fields are categorized into three tiers; Competitive, Moderately competitive, and Less competitive.

Competitive programs that are the most difficult to match into include: Dermatology, General Surgery, Neurosurgery, Orthopedic Surgery, Ophthalmology, Otolaryngology, Plastic Surgery, Urology, Radiology, and Radiation Oncology.

Moderately competitive programs include Anesthesiology, Emergency Medicine, Medicine/Pediatrics (combined), and Obstetrics and Gynecology.

Less competitive specialties include Family Medicine, Internal Medicine, Pathology, Pediatrics, Physical Medicine and Rehabilitation, and 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. Also, any one program can be considered more competitive depending on other variables such as program location, prestige, etc. For example, despite 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.

In order to be a strong candidate for competitive specialties, one must have at least a “very good” academic profile. What is a very good academic profile? The following paragraphs will shed light on this question.

As a general rule, there are 3 criteria that are often most critical to your residency application: Step 1, Step 2, and Clinical grades. We will classify these 3 most important criteria as “Class A” parts of your residency application. Although an oversimplification, it can be helpful to think about match prospects in the following manner. A student can “underperform” on one of the Class A parts, and recover by doing very well on the other two parts. Low performance on 2 parts however, quite likely limits match possibilities to less competitive specialties. And low performance on all 3 Class A criteria almost certainly narrows one’s match possibilities.

USMLE Step 1

M3 Clinical Grades

USMLE Step2 Clinical Knowledge (CK)