Hardest Specialties to Match Into (2026 NRMP Fill Rate)

The 2026 NRMP data is out and we're ranking all 22 specialties by the percentage of positions filled by US MD seniors. Dojo ball medical insiders. com. We're going from lowest to highest fill rate for US MD seniors starting with the most accessible specialties up to the hardest. One specialty near the top lands somewhere you wouldn't expect and we'll get into why when we get there. Family medicine ranks last with the

lowest US MD senior fill rate of any specialty. Family medicine physicians provide comprehensive primary care for patients of all ages. In 2026, only 27. 2% of positions were filled by US MD seniors with the rest going to DOs, IMGs, and other applicants filling a very large pool. Internal medicine comes in at 21st with a 35. 7% fill rate. Internists provide primary and specialty care for adult patients across a wide range of conditions. In 2026, it offered 11,194 PGY1 positions, the largest pool in the entire match by a wide margin. Pathology sits at 20th with a 41. 5% fill rate. Pathologists examine tissues and fluids to diagnose disease, typically working behind the scenes without direct patient care. It has consistently struggled to attract US graduates, which makes it more accessible than its complexity might suggest. Emergency medicine comes in at 19th with a 44. 3% fill rate. EM physicians provide immediate care for acute illnesses and injuries. It has a large position pool and US MD seniors filled fewer than half of those slots in 2026. Pediatrics ranks 18th with a 45% fill rate. Pediatricians provide care for infants, children, and adolescents. Lower average compensation compared to adult medicine specialties makes it a less pursued path among US graduates and the large position pool means it draws heavily from other applicant groups to fill its ranks. Before we go further, it's important to understand that, generally speaking, less competitive specialties tend to have lower USMLE senior fill rates, and more competitive specialties tend to have higher ones. But, that relationship doesn't always hold, and fill rate alone doesn't tell you how hard a specialty is to get into. Pediatrics is a good example. It ranks 18th here, which might suggest moderate difficulty. In terms of overall competitiveness, though, pediatrics consistently ranks second to last. Keep that in mind as we move up the list. One specialty coming up has a fill rate that puts it ahead of several surgical specialties most people would consider far harder to match into. USMD fill rate and competitiveness are related, but they're measuring different things. To get the full picture across all 22 specialties, including board scores, research requirements, and more, head to specialtyrank. com. You can explore our default ranking system designed by Adcoms, or adjust the weightings by what matters most to you. We'll also be releasing updated competitiveness videos in the summer of 2026. Subscribe so you don't miss those. PM& R, or physical medicine and rehabilitation, ranks 17th with a 53% fill rate. These physicians focus on restoring function and quality of life in patients with physical impairments or disabilities. Diagnostic radiology comes in at 16th with a 53. 2% fill rate. Radiologists interpret imaging studies, including x-rays, CT scans, MRIs, and ultrasounds. PM& R and diagnostic radiology are essentially tied, separated by only 1/10 of a percent. Psychiatry ranks 15th with a 56. 2% fill rate. Psychiatrists diagnose and treat mental health conditions and psychological disorders. Neurology sits

at 14th with a 58. 1% fill rate. Neurologists diagnose and treat disorders of the brain, spinal cord, and nervous system. General surgery ranks 13th with a 61. 5% fill rate. General surgeons manage a broad range of conditions across the abdomen, breast, digestive tract, and beyond. It also serves as a gateway to several surgical subspecialties, which adds to its appeal. Child neurology comes in at 12th with a 64. 5% fill rate. Child neurologists diagnose and treat neurological conditions in infants, children, and adolescents. It's a niche specialty with a smaller applicant pool. OB/GYN comes in at 11th with a 68. 3% fill rate. These physicians specialize in women's reproductive health, pregnancy, and childbirth. Interventional radiology ranks 10th with a 70% fill rate. IR specialists use imaging guidance to perform minimally invasive procedures. Anesthesiology sits

at ninth with a 70. 5% fill rate. Anesthesiologists manage anesthesia and pain during surgical and other procedures. IR and anesthesiology are separated by half a percentage point, so they're effectively tied. Radiation oncology ranks eighth at 74. 9%. These specialists use radiation therapy to treat cancer and other disorders. One note to keep in mind here is that, as an advanced specialty, the bulk of radiation oncology positions are at the PGY-2 level. So, in this ranking, we used PGY-2 match data instead of PGY-1. Orthopedic surgery comes in at seventh with a 79. 4% fill rate. Ortho surgeons treat conditions of the musculoskeletal system, including bones, joints, ligaments, and tendons. Dermatology, by an extremely close 0. 1%, ranks sixth with a 79. 5% fill rate. Dermatologists diagnose and treat conditions affecting the skin, hair, and nails. Just as with radiation oncology, derm is an advanced specialty, so we used PGY-2 data for this ranking. Med-Peds, or internal medicine and pediatrics combined, ranks fifth with an 80. 4% fill rate. Physicians in this specialty train in both adult and pediatric medicine. This is the anomaly we flagged earlier. In overall competitiveness, Med-Peds ranks in the bottom half of specialties. Yet, if you focus on fill rate alone, you might say it's one of the most competitive specialties because it's in the top five. That would be vastly misleading, which is why multiple factors must be considered. For the full picture, visit specialtyrank. com. Vascular surgery ranks fourth with an 83. 6% fill rate. Vascular surgeons treat diseases of the arteries, veins, and lymphatic system. This data comes from the integrated track, meaning applicants enter a combined program directly from medical school. The integrated path tends to be far more competitive and more desirable because it's shorter, but the independent path is a vascular surgery fellowship after completing a general surgery residency. Some also choose to pursue it after taking on a cardiothoracic surgery fellowship, which also comes after a general surgery residency. Through this independent path, which gives you more time to decide if vascular surgery is right for you, training lasts anywhere from 7 to 10 years. Neurosurgery ranks third with

an 86. 8% fill rate. Neurosurgeons treat disorders of the brain, spine, and peripheral nerves through surgery. It's one of the longest training paths in medicine and also one of the most competitive. Otolaryngology, or ear, nose, and throat, ENT, ranks second with an 88. 1% fill rate. ENT surgeons manage conditions of the ears, nose, and throat, and related structures of the head and neck. Over the past decade, otolaryngology has been one of the top five most competitive specialties nearly every year. Plastic surgery sits at the top of this list with a 90. 4% fill rate, the highest US MD senior fill rate of any specialty in the 2026 match. Plastic surgeons perform reconstructive and aesthetic procedures, and by every competitiveness measure, it consistently ranks among the three most competitive specialties in medicine. US MD fill rate and match rate, these are just one piece of the puzzle. To really understand how hard a specialty is to get into, you need board scores, research output, AOA status, and more, all weighed together. We've done that work across all 22 specialties in our competitiveness video, linked right up here.