Performance on Step 2 of the United States Medical Licensing Examination (USMLE) isn’t a gauge of how effective a physician a medical student will become. A medical student’s Step 2 score is, however, one key indicator of how many residency program interview invitations they are likely to receive.
In a 2024 survey of residency program directors conducted by the National Resident Matching Program, a medical student’s Step 2 score—which has taken on increased importance since the Step 1 exam went pass-fail in 2022—was the fourth most frequently considered factor in determining which applicants to interview.
“Given the numbers of applications that program directors receive, they're still using objective criteria like Step 2 scores to screen the application so that they have a smaller pool from which to invite people for interviews,” said John Andrews, MD, the AMA’s vice president for graduate medical education.
The importance of Step 2 performance varies widely by specialty. A look at data from the National Resident Matching Program offers insight into which specialties place the most importance on the metric across applicant types.
Breaking down MD Step 2 scores
Across all physician specialties, the average Step 2 score for matched applicants from U.S. MD-granting medical schools was 250, according to a 2024 report on characteristics of matched applicants.
These figures, drawn from data compiled by the National Resident Matching Program, are limited to specialties in which at least 50 matched applicants from each group were reported. The five physician specialties that featured the top average Step 2 scores for matched applicants who trained at U.S. MD-granting medical schools were:
- Dermatology—257.
- Orthopaedic surgery—257.
- Diagnostic radiology—256.
- Plastic surgery—256
- Otolaryngology—256.
These top five specialties were drawn from a list of 22 specialties that included anesthesiology, child neurology, emergency medicine, family medicine, general surgery, internal medicine, internal medicine-pediatrics, interventional radiology, neurological surgery, neurology, obstetrics and gynecology, pathology, pediatrics, physical medicine and rehabilitation, psychiatry, radiation oncology, and vascular surgery.
Four of the top five specialties had a procedural bent, and neurological surgery (255), vascular surgery (253) and general surgery (253) were not far behind. Internal medicine-pediatrics (253) and internal medicine (251) were the primary care specialties with the highest average Step 2 score among matched applicants.
Performance was high across the board with 14 specialties registering average Step 2 scores higher than 250. Across all 22 specialties there was a 13-point spread between the highest and lowest average Step 2 scores.
The AMA helps medical students master the residency-application process so you can make the right decisions about your career, prepare for a knockout interview, explore residency opportunities—all so you can successfully match.
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DO scoring trends mirror MDs
Looking at Step 2 score trends for DO applicants, the average for all who matched—regardless of specialty—was 248.
There were 17 physician specialties with at least 50 matched applicants in the NRMP dataset. The specialties with the highest average Step 2 CK scores among matched applicants who trained at U.S. osteopathic, or DO-granting, medical schools were:
- Diagnostic radiology—252.
- Anesthesiology—251.
- Orthopaedic surgery—251.
- General surgery—248.
- Obstetrics and gynecology—245 (tie).
- Pathology—245 (tie).
- Neurology—245 (tie).
That group of specialties was drawn from a list that included child neurology, emergency medicine, family medicine, internal medicine, internal medicine-pediatrics, pediatrics, physical medicine and rehabilitation, and psychiatry.
Like MDs, the spread across all included specialties was tight—just 12 points separated the highest and lowest average Step 2 CK scores among specialties with 50 or more DO matches.
Most DO applicants take two series of licensure exams. The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) is necessary for graduation, while USMLE scores—AMA policy advocates for the exams to be viewed equally—are more commonly used as a metric in the residency selection process. Like the USMLE series, COMLEX Level 1 is pass-fail and Level 2 is scored.
Among DO applicants who matched into specialties with at least 50 positions, the top average COMLEX Level 2 scores were reported in orthopaedic surgery, diagnostic radiology, anesthesiology, general surgery and obstetrics and gynecology. These specialties align closely with those that topped Step 2 CK averages among DO applicants.
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More specialty concentration for IMGs
Among international medical graduates (IMGs) the average Step 2 score for matched U.S. citizen IMGs was 236. For non-U.S. citizen IMGs the figure was 245.
IMGs experienced far greater specialty concentration than their MD and DO counterparts, meaning the field of specialties in which 50 or more applicants matched and reported Step 2 scores was far more limited.
Among U.S. citizen IMGs, eight specialties had at least 50 matched applicants. The highest average Step 2 CK score reported among these was 248, in both general surgery and anesthesiology. The range of highest average step scores for matched applicants across the group of eight specialties was 231–248.
Among non-U.S. citizen IMGs, five specialties had at least 50 matched applicants with reported scores. The highest average Step 2 CK score among those specialties was 246, in both general surgery and anesthesiology. Across the five qualifying specialties, the range of average Step 2 scores for applicants who matched was 231–246.
Roughly 40% of U.S. citizen IMGs and about half of non-U.S. citizens who matched in any specialty placed in internal medicine. Average Step 2 CK scores in the specialty were 238 for U.S. IMGs and 244 for non-U.S. IMGs.
The AMA offers essential tools and resources to support medical students in their preparation for the USMLE series of exams. To help you with your studies, AMA members receive a discount on test prep materials for the USMLE and the COMLEX-USA.
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High scores aren’t everything
The scores above are average and provide some clues about how specialties compare. On the other side of the coin, a high Step 2 score isn’t going to be the sole reason an applicant matches.
“A low Step 2 score isn’t necessarily a disqualification,” Dr. Andrews said. “But it does make it less likely that a program director will notice your application in a sea of similar applications.”
To stand out, other key factors such as strong clinical grades, trusted faculty endorsements, and any meaningful research or leadership experience can go a long way.
Dr. Andrews encouraged applicants to look at the available data and compare their Step 2 scores with national averages by physician specialty. If your score is well below the average for matched applicants in a given specialty, it may be wise to broaden your application strategy.
“There are a number of specialties where the difference in the actual practice of medicine is narrower than students sometimes think,” he said.
For students who are drawn to procedural specialties or who want strong continuity with patients, many fields offer overlapping experiences—even if the title or training pathway looks different. Flexibility, paired with realistic self-assessment, is key.
“I had a colleague who always wanted to go into orthopaedic surgery. That was their plan from day one of medical school,” he said. “And in the end, they weren’t successful in matching into orthopaedic surgery but found themselves in a family medicine residency and then did a sports medicine fellowship. They’re now doing 100% sports medicine and spent years as the team physician for the University of Wisconsin football program.”
As applicants embark on the residency-selection process, no online resource contains as much information as FREIDA™, the AMA Residency and Fellowship Database®, which includes more than 13,000 Accreditation Council for Graduate Medical Education-accredited residency programs, and offers a streamlined user experience.
