Canada's Top 5 Most (and Least) Competitive Residencies

December 13, 2021 | Maxine Betteridge-Moes


As medical graduates prepare for the CaRMS, here's a look at 2021 most and least competitive specialties to match.

Choosing the right medical specialty is a big decision. There are many possibilities based on your goals, interests, abilities and the specialties' competitiveness. Here's a quick look at the most and least competitive specialties to match, based on 2021 CaRMS Forum findings.

In addition to matching students into postgraduate medical training programs throughout Canada, Canadian Resident Matching Service (CaRMS) also collects data and publishes research reports related to their matches on an annual basis.

The following lists are based on the 2021 Canadian medical graduates' first choice discipline compared to availability according to the 2021 CaRMS Forum findings. Disciplines with a lower position over applicant's first choice discipline ratio would mean there is less supply than demand (aka these disciplines are more competitive to match), and vice versa.

For easy reference, the following lists also include the various specialty profiles and their average gross payments in 2019. (Source: Canadian Medical Association & Canadian Institute for Health Information)

The 5 Most Competitive Disciplines to match in 2021

1. Otolaryngology (Head and Neck Surgery)

Otolaryngology is concerned with the screening, diagnosis and management of diseases and lesions above the shoulders. This includes disorders of the ear, nose, throat, neck and head, apart from eye-related disorders (ophthalmology) and lesions of the brain (neurology and neurosurgery).

Average gross payment (2019-20): $483,616

Required training: 5 years (2 years of core training in surgery plus 3 years of Royal College-approved resident training in otolaryngology)

Average hours per week: 59.3

Professional satisfaction: 65%

Work-life balance satisfaction: 42%

Additional resources: Canadian Society of Otolaryngology.

2. Dermatology

Dermatology is a diverse specialty that deals with benign and malignant disorders of the skin. Dermatologists perform a variety of procedural work and they also have expertise in the prevention of skin disease and skin cancers.

Average gross payment (2019-20): $426,874

Required training: 5 years (2 years of basic clinical training plus 3 years of Royal College-approved residency training in dermatology).

Average hours per week: 49.8

Professional satisfaction: 68%

Work-life balance satisfaction: 37%

Additional resources: Canadian Dermatology Association.

3. Ophthalmology

Ophthalmology specializes in the screening, diagnosis and management of optical, medical and surgical disorders and diseases of the eye. Ophthalmologists are the leaders of the eye care team, which often includes orthoptists, ophthalmic technicians, nurses and optometrists.

Average gross payment (2019-20): $842,913

Required training: 5 years (1-year basic clinical training, plus 4 years of Royal College-approved residency in ophthalmology)

Average hours per week: 48.4

Professional satisfaction: 87%

Work-life balance satisfaction: 68%

Additional resources: Canadian Ophthalmological Society.

4. Emergency medicine

Emergency medicine is a high-pressure, fast-paced specialty that focuses on the care of patients who are acutely ill or injured. Emergency physicians (emergentologists) require a broad base of medical knowledge and a variety of clinical and technical skills to treat patients of all ages suffering from all conditions and degrees of illness.

Average gross payment (2017/18): $390,195

Required training: There are two tracks to become an emergency physician. The first is a one-year certificate programme in emergency medicine which follows the basic two-year residency training in family medicine. The second is a five-year residency program with the Royal College of Physicians and Surgeons of Canada.

Average hours per week: 46.4

Professional satisfaction: 79%

Work-life balance satisfaction: 56%

Additional resources: Canadian Association of Emergency Physicians.

5. Plastic surgery

Plastic surgery includes the management of major burns, reconstruction of congenital malformations, cosmetic surgery and other minor surgical procedures. Many plastic surgeons concentrate on cosmetic procedures; however, their goal is often not only to improve appearances but also to restore function. Plastic surgeons treat a wide variety of clinical disorders including congenital and developmental problems, trauma, cancer and degenerative diseases.

Average gross payment (2019-20): $455,174

Required training: 5 years (2 years of foundational training, 3 years of progressive senior residency training)

Average hours per week: 59.8

Professional satisfaction: 79%

Work-life balance satisfaction: 47%

Additional resources: Canadian Society of Plastic Surgeons.

The 5 Least Competitive Specialties to match in 2021

1. General/Clinical pathology

General pathology specializes in laboratory investigation that focuses on the causes, manifestations and diagnosis of disease. A pathologist may act as a consultant for clinical physicians and their advice is often sought in the treatment of patients. General/clinical pathology encompasses autopsy, surgical pathology, anatomical pathology, cytology and medical biochemistry, hematological pathology, medical microbiology and transfusion medicine.

Average gross payment: Data not available

Required training: 5 (1-year basic clinical training, 2 years Royal College-approved training in anatomical pathology, 6 months specialty training, 6 months laboratory experience)

Average hours per week: 48.3

Professional satisfaction: 76%

Work-life balance satisfaction: 53%

Additional resources: Canadian Association of Pathologists.

2. Nuclear medicine

Nuclear medicine is the use of unsealed radioactive sources in the study, diagnosis and treatment of disease. The discipline combines medicine and basic biomedical science and it has grown out of the fields of radiology, internal medicine and pathology.

Average gross payment (2017/18): $390,195

Required training: 5 years (1 year of basic clinical training, 3 years residency in nuclear medicine, 6 months cross-sectional imaging, 6 months residency)

Hours worked per week: 48.6

Professional satisfaction: 76%

Work-life balance satisfaction: 48%

Additional resources: Canadian Association of Nuclear Medicine.

3. Neuropathology

Neuropathology is the study of diseases in the central and peripheral nervous systems and skeletal muscle. It is a subspecialty of anatomical pathology, which is the branch of medicine concerned with the study of the morphologic aspects of diseases. Neuropathologists diagnose tumours, inflammatory disorders and infectors, and they are increasingly becoming part of research teams studying neurological diseases including Alzheimer's, Huntington's and Parkinson's.

Average gross payment: Data not available

Years of residency training: 5 years (1 year of basic clinical training, 3 years of residency training, 3 months' training in cytopathology, training in forensic pathology and pediatric pathology, 1 year of approved residency)

Average hours per week: 52.5

Professional satisfaction: 68%

Work-life balance satisfaction: 52%

Additional resources: Canadian Association of NeuropathologistsCanadian Association of Pathologists.

4. Psychiatry (research track)

Psychiatry is the medical specialty that deals with diseases of the mind. Psychiatrists provide a comprehensive assessment, leading to a diagnosis and a treatment plan for the care and rehabilitation of patients with mental illness, and emotional and behavioural disorders.

Average gross payment (2019-20): $311,495

Required training: 5 years (1-year basic clinical training, 2 years junior residency, 2 years senior residency)

Average hours per week: 46.6

Professional satisfaction: 72%

Work-life balance satisfaction: 54%

Additional resources: Canadian Psychiatric Association.

5. Medical microbiology

The Medical Microbiology and Infectious Disease specialty focuses on the diagnosis and treatment of infectious diseases and human illnesses caused by microorganisms in any region of the body. The specialty consists of four major spheres that include: clinical consultations; infection control programs; public health and laboratory administration.

Average gross payment (2017/18): $437,000

Required training: 5 years (1-year basic clinical training, 2 years diagnostic laboratory residency, 2 years approved residency)

Average hours per week: 55

Professional satisfaction: 73%

Work-life balance satisfaction: 48%

Additional resources: Association of Medical Microbiology and Infectious Disease Canada.

Watch the 2021 CaRMS Forum presentation or download their presentation deck for additional data, including Top 10 discipline choices for the past 3 years; Supply & demand ratio for key disciplines.

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This article originally appeared on the RBC Healthcare - Advice & Learning