Residency Report Shows New Specialty Data, USMLE Score Changes

Marcia Frellick

January 07, 2021

The annual residency report from the Association of American Medical Colleges (AAMC) reveals characteristics of medical school graduates and residents, including specialty insights, test scores, demographics, and professional activities post-residency. This year's report shows that almost half (48.7%) of medical students graduating in 2019-2020 said they had a different specialty than planned at the beginning of medical school.

Those graduating with a specialty in child neurology were the most likely to have changed their minds from the beginning of med school (88.5%), followed by those in vascular surgery (74.4%), and plastic surgery (63.1%).

Students in orthopedic surgery were the most likely to stick with their original choice (48.7%, up from 44.8% in 2019), followed by those in pediatrics (39.1%), neurologic surgery (37.6%), and emergency medicine (36.8%).

Test scores on the US Medical Licensing Examination (USMLE) vary widely among specialties. Below are the highest average scores among first-year residents in 2019-20 for Step 1 and Step 2 Content Knowledge (CK).

Table. Highest Average Scores on Step 1, Step 2 CK by Specialty

Specialty Step 1 Score Step 2CK Score
Thoracic Surgery (Integrated) 247.3 254.2
Otolaryngology 246.8 254.0
Orthopedic Surgery 246.3 253.3
Neurologic Surgery 246.0 251.6
Plastic Surgery 245.4 251.5


Racial breakdowns also widely varied by specialty. Overall, several groups remain significantly underrepresented among the 139,848 residents in 2020.

Table 2. Racial Breakdown of Residents in 2020*

Race Selected % of Residents
White 50.8
Asian 21.8
Hispanic  7.5
Black/African-American  5.5
American Indian/Alaska Native  0.6
Native Hawaiian/Other Pacific Islander  0.2

*Residents could choose more than one race, and figures do not include the 16.5% of residents who are neither US citizens nor permanent US residents.

In terms of gender-based data, in some specialties women outnumbered men 2-to-1; in others, that ratio flipped. Women dominated in obstetrics and gynecology (83.8%) and pediatrics (72.4%) for instance; men were more prevalent in diagnostic radiology (73%), anesthesiology (66.9%), and emergency medicine (64.1%).

Overall, the number of residents increased by 4897 from 2019. However, the percentage who are international medical school graduates has decreased, from 25.9% in the 2015 report to 23.1% in the 2020 report.

The report also included a look at full-time faculty appointments at US MD-granting schools for those who completed residencies from 2010 through 2019. According to the report, 77.4% hold appointments at the assistant professor level (15.3% of the entire group who completed residency training). This percentage dropped slightly from the 77.6% of people who completed residency training from 2009 through 2018.

Medically Underserved Areas

Among those who completed residencies from 2010 through 2019, 25.4% said they are providing direct patient care in medically underserved areas (MUAs) across the United States.

Some specialties had high percentages of early-career residents practicing in MUAs, including child neurology (31%), internal medicine (27.3%), neurology (27.2%), family medicine (26.5%), and general surgery (26.3%). 

By state, more than half of early-career physicians report having practiced in MUAs in Alabama, Mississippi, and Montana, whereas fewer than 10% in Maine, North Dakota, Wisconsin, and Wyoming said they had.

Overall, more than half (55.5%) who completed training from 2010-2019 continue to practice in the state in which they completed their residency. California had the highest retention of residents (77.6%), followed by Alaska (68.6%) and Texas (66.6%). Delaware had the lowest retention (38.3%) followed by New Hampshire (40.6%) and Rhode Island (42.8%).

More women than men (59.1% vs 52.5%) who completed residency training from 2010 through 2019 are practicing in the state where they trained.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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