Medicine or Surgery? Factors for Medical Students to Consider When Choosing a Specialty

Joshua T Bram



One of the first branches in the medical specialty decision tree is the choice between a surgical and non-surgical career. However, no work has previously compared the applicant factors that determine a student’s competitiveness for surgical versus non-surgical residencies. This study aimed to compare applicant characteristics between students who matched into surgical and non-surgical specialties.



This was a cross-sectional study comparing surgical and non-surgical residency applicant characteristics obtained from annual reports published by the National Resident Matching Program (NRMP) for 2017-2018. Career data obtained from the 2019 Medscape Physician Compensation Report were then compared between surgical and non-surgical physicians to examine factors influencing specialty choice.



Surgical residencies had higher US applicant to available residency spot ratios (1.05 vs 0.66, p<0.001) and more frequently utilized minimum Step 1 score cut-offs for interview consideration (83.1% vs 59.8%, p=0.001). Surgical applicants demonstrated higher Step 1 (242.3 vs 233.1, p=0.015) and Step 2 CK (250.8 vs 245.2, p=0.023) scores, had more research publications (10.3 vs 6.4, p=0.044), and were more frequently members of AOA (30.0% vs 16.7%, p=0.020) than non-surgical applicants. Surgical attendings had significantly higher average salaries ($415,800 vs $311,182, p=0.022) and worked more hours annually when standardized to family medicine physicians (+281.7 hrs vs -146.9 hrs, p=0.002).



Surgical specialties are, on average, more competitive than non-surgical specialties, with applicants demonstrating higher examination scores and publications than applicants to non-surgical specialties. These findings are important for administrators and students to help better prepare for match day success.

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