The Residency Match Matrix
A Strategic Framework
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Enter your credentials to calculate your Applicant Investment Score (AIS) and see where you stand on the matrix.
The Specialty Competitiveness Index (SCI)
The SCI doesn't measure how difficult a specialty is right now, but rather how much more competitive it has become over the last decade (2014-2024). A high score indicates a specialty where the barriers to entry, like board scores and research output, have risen the fastest.
| Rank | Specialty | SCI Score (0-100) | Key Drivers & Narrative |
|---|---|---|---|
| 1 | Orthopaedic Surgery | 98.5 | Extreme acceleration in research output (over 250% increase) combined with consistently rising scores. |
| 2 | Neurosurgery | 97.2 | Possesses the highest absolute research demands and has seen a 220% increase. |
| 3 | Otolaryngology | 95.8 | A steep and continuous climb in both research and Step 2 scores. |
| 4 | Plastic Surgery | 94.1 | Continues to accelerate, particularly in research, where the average has nearly tripled. |
| 5 | Dermatology | 89.5 | With scores already near maximum, competition has shifted almost entirely to research, which has exploded. |
| 6 | Anesthesiology | 85.4 | Shows one of the highest velocities in Step 2 score increase, combined with a 172% rise in research. |
| 7 | Obstetrics & Gynecology | 82.0 | Strong, balanced growth in the competitiveness of both its academic and research metrics. |
| 8 | General Surgery | 76.6 | The research bar has risen substantially (148% increase). |
| 9 | Ophthalmology | 75.1 | A rapidly accelerating field with a steep climb in Step 2 scores and a significant increase in research demands. |
| 10 | Thoracic Surgery (I) | 72.5 | Applicant demand has skyrocketed, making it one of the most competitive fields to enter. |
| 11 | Physical Med & Rehab | 71.3 | Exhibits one of the highest velocities in Step 2 score increase among all specialties. |
| 12 | Psychiatry | 69.9 | A surge in applicant interest combined with a very high rate of Step 2 score increase. |
| 13 | Internal Medicine | 65.7 | The steady climb in both scores and research reflects the overall rising tide across all of medicine. |
| 14 | Diagnostic Radiology | 61.8 | While score inflation has been minimal, the research expectation has grown by 150%. |
| 15 | Pediatrics | 55.2 | Shows consistent but more measured increases in metrics compared to surgical or procedural fields. |
| 16 | Emergency Medicine | 51.5 | Rate of increase in academic and research metrics has been slower than in many other fields. |
| 17 | Family Medicine | 48.3 | The barriers to entry have risen the least among major specialties. |
| 18 | Neurology | 45.1 | While academic and research metrics have increased, the rate has been slower than many other fields. |
| 19 | Pathology | 38.2 | Has seen a comparatively modest increase in its competitive metrics over the past decade. |
| 20 | Radiation Oncology | 25.5 | Competitive metrics have stagnated or declined, reflecting a significant shift in the job market. |
SCI Calculation Methodology
The SCI is a weighted average of three normalized components that measure the change in competitiveness from 2014 to 2024:
- Step 2 CK Score Velocity (40% weight): Measures the rate of score inflation by analyzing the slope of the mean Step 2 CK scores over the decade. A steeper slope indicates the academic bar is rising quickly.
- Research Output Acceleration (50% weight): Quantifies the acceleration of the research arms race by analyzing the slope of the mean number of research output. This is weighted heavily due to the dramatic increases observed.
- Applicant Demand Index (10% weight): Captures the change in applicant interest relative to available positions, indicating whether demand is outstripping supply.
Interesting Findings/Undervalued Fields
While the matrix shows the landscape of effort vs. reward, the Effort-to-Reward (ETR) ratio itself reveals specialties with the highest return on investment. These fields offer excellent professional outcomes relative to the application effort required.
Family Medicine (ETR: 1.90)
Offers the highest ROI with the lowest application barriers, providing an efficient path to a rewarding career, especially with gateways to innovative models like Direct Primary Care (DPC).
Psychiatry (ETR: 1.75)
A standout choice combining a low application investment with solid compensation and excellent work-life balance. Offers high-income potential through flexible private practice and telepsychiatry.
Pathology (ETR: 1.42)
Often overlooked, it presents a compelling ROI with low application effort, a favorable lifestyle, and solid compensation for those inclined towards diagnostic medicine.
Emergency Medicine (ETR: 1.40)
Provides a strong return with a combination of good income and a lifestyle defined by shift work, offering predictability and freedom from calls on days off.
PM & Rehab (ETR: 1.19)
An attractive option known for a positive work-life balance. It's on a strong upward trajectory in terms of recognition and compensation, suggesting its ETR may continue to improve.