This year, I attended the American Society of Anesthesiologists (ASA) Advance conference in Las Vegas, which bills itself as the anesthesia business event. We heard lectures from thought leaders in the field, and saw innovative companies utilizing new technologies to improve quality, safety, and operating room (OR) efficiency. Leaders in the ASA, gave overarching lectures on where the field is now, the challenges we face, and where things are headed in the future.
In recent years, more and more med students have been applying for anesthesiology residency programs. Of course, this wasn’t always the case—there was a time when anesthesiology was viewed as a dying field, and interested students were dissuaded from pursuing it! Some of my own mentors remember being told to escape the “dead-end job” of an anesthesiologist, and get a secure position in a real medical field, like pulmonology or critical care. This guidance led to a lack of anesthesiology applicants in the late 90s.
More demand, but more competition.
But now, four years after the COVID-19 pandemic began, things are starting to change. An aging workforce and dwindling supply of anesthesia providers, in combination with a growing demand for anesthesia coverage both in the OR and for outside locations such as GI suites, cath labs, and interventional radiology, have led to an increased demand for anesthesiologists. And with that renewed demand have come increased salaries and lucrative locum contracts.
The increased demand for anesthesiologists has led the Accreditation Council for Graduate Medical Education (ACGME) to add residency positions in order to fill the ever-growing need.
However, despite the increase in residency positions, the ASA Monitor (the official news publication of the American Society of Anesthesiologists), just published an article entitled, “2023 Residency Match: Anesthesiology Is One of the Most Competitive Specialties.”
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How competitive is anesthesiology? Here are the numbers.
In the 2021-2023 match cycles, 100% of anesthesiology residency positions were filled. For some perspective, there was a 95.5% fill rate in 2024 for emergency medicine, and overall across all specialties, for 2024, a 93.8% fill rate.
This increased competitiveness in anesthesia comes with a growing number of residency applicants that one must compete against.
For the entirety of the match, the National Resident Matching Program (NRMP) reported that residency applicants hit an all-time high in 2024, with over 50,000 applicants, a nearly 5% increase over the previous year. Applicants desiring an anesthesia match are applying to a specialty that is growing more competitive, in an applicant pool that’s ever-growing.
The Average USMLE Step 2 CK Score for Anesthesiology
Part and parcel with declaring a specialty “competitive” is the USMLE score “necessary” to apply and match. While there’s no cut-off here, higher is always better, and the average Step 2 CK score for applicants that matched to anesthesia was 248.
This chart from the 2022 NRMP Charting Outcomes in the Match report speaks volumes:*
Naturally, higher scores led to a greater chance of matching. Just a few residency positions were filled by those scoring less than 220, but chances really increased when scores were greater than 230.
*Keep in mind, these are for US MD seniors, and this excludes IMGs and DOs.
Should you be concerned about how competitive anesthesiology is?
Data and numbers can only tell you so much. Let’s discuss the (perhaps more important) subjective side of things to get a sense of what the numbers really mean for you.
If you think about it, the important question isn’t “How competitive is anesthesiology?”, but rather, “Why are you concerned with how competitive this specialty is?”
This latter question always has me furrowing my brow. Naturally, if you want to enter a specialty, but don’t have the scores or grades to do so, you’ll need to have a backup plan to make sure you aren’t left high, dry, and unmatched.
But more important than that, regardless of competitiveness, if there’s a specialty that you want to pursue with all of your heart, then you should, you must, do what it takes to build a competitive application for that specialty. And while scores are important, and can get your foot in the door, there is so much more to your application than numbers.
Ask not “how competitive is anesthesiology?” but rather, “how do I become more competitive as an applicant?”
A great dean’s (MSPE) letter, excellent letters of recommendation (especially in said field), and a demonstration of dedication to the specialty can elevate your application to new heights. These things are a necessity, and you should be chomping at the bit to compile them throughout your medical school tenure.
Take electives in the field, make connections to attendings and mentors in the field, do research in the field, attend and lead your school’s interest group in the field, etc. The more the word “ANESTHESIOLOGY” is plastered all over your application, and the more meaningful these experiences are, the stronger your application will be.
Meaningful experiences mean that you were a material participant, or better yet, a leader in the group, not just an attendee who sat on the sidelines studying and taking advantage of the free pizza.
Certain situations do require a backup plan.
Part of the process comes down to truly wanting it, so that regardless of the specialty you’re gunning for, you’ll have the best application possible.
Along the way, it’s important to use your judgment. No matter how much you love dermatology, the cards will be stacked against you if you failed Step 1 and couldn’t really form a strong bond with any dermatology attendings.
If your Step 2 CK score was a 225, the rest of your application has to scream “heartfelt, selfless, pioneering anesthetic genius” if you want to have hope of a match. Scores and situations like these warrant the consideration of an alternate or backup specialty choice.
It comes down to the questions you ask.
In closing, make sure you’re asking the right questions. Don’t get hung up on “How competitive is anesthesiology?” (or any other competitive specialties for that matter). Instead, ask “How can I be as competitive as possible in my specialty?”
To be a contender in a competitive field like anesthesiology, you’ll have to go above and beyond what’s required. Muster the will, strength, and desire to devote yourself to the cause. Be wise about having a backup plan if your application necessitates it. But if there’s one career out there that’ll make your heart sing louder than all others, do what it takes, and go for it! We’ll be with you every step of the way.
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