Throughout medical school, your main goal has likely been working your way up to earning a top-tier residency, in the field and city in which you want to spend a lot of your career. Though your residency application as a whole plays an incredibly important role in this process, another part of your application can also make or break your chances of matching into that dream residency: your USMLE® Step 1 score.
What is a Good Step 1 Score?
Until the USMLE® Step 1 changes to pass/fail (earliest in January 2022) is officially in effect, your Step 1 score will carry its previous weight as a deciding factor on your residency application. Step 1 scores are currently used as an objective metric for cutoff into (or out of) certain specialties or programs. When Step 1 changes to pass/fail, this burden will likely shift to your Step 2 CK score, but Step 1 will continue to be important as the USMLE® is considering requiring a passing score on Step 1 to take Step 2. But until then… let’s stick to Step 1 scores.
What score should you aim for on Step 1? The short answer is: it depends. The current minimum passing score for Step 1 is a 194. The score you might want to get, however, could be somewhere between 238 or as high as 251, depending on the competitiveness of your desired specialty. In 2020, four of the top-matched specialty tracks for U.S. MD graduates were internal medicine, family medicine, anesthesiology, and radiology-diagnostic. The Step 1 score range for those top-matched specialities was between 220 and 249, and the percentage of first-year residents matched in these ranges in 2020 was between 60 percent and 66 percent.
| Specialty | Step 1 score range | Percentage of first-year residents matched in this range in 2020 |
| Internal medicine | 220–249 | 57.7% |
| Family medicine | 200–229 | 63.2% |
| Anesthesiology | 220–249 | 66.6% |
| Radiology-diagnostic | 230–259 | 66.7% |
There are so many specialty options, and thus so many score ranges you can aim for. Prior to starting your dedicated study time, make sure to do some research and figure out if your goal range matches the expectations of your chosen specialty. Generally speaking, however, a USMLE® Step 1 score between 230 and 245 is considered a good and a score between 245 and 255 is considered very good.
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What Are the Most and Least Competitive Residencies?
We’ve mentioned some of the most popular specialty choices, but the score you’ll need will also depend a lot on the competitiveness of your chosen specialty.
Some of the most competitive residencies, such as orthopedic surgery and plastic surgery, had a match rate between 72 percent and 80 percent for U.S. seniors matched by their preferred specialty.
Most competitive residencies
| Specialty | Average USMLE® Step 1 Score (U.S. Seniors Matched) | Average USMLE Step 1 Score (IMGs Matched) |
| Orthopaedic surgery | 248 | 241 |
| Neurological surgery | 248 | 239 |
| Plastic surgery | 249 | 246 |
| Otolaryngology | 248 | N/A |
1. Brendan Murphy, ama-assn.org
2. National Resident Matching Program, Charting Outcomes in the Match: Senior Students of U.S. MD Medical Schools
3. National Resident Matching Program, Charting Outcomes in the Match: International Medical Graduates
With the less competitive residencies, such as general surgery and pediatrics, there was a match rate between 83 percent and 98 percent for U.S. seniors matched by their preferred specialty.
Least competitive residencies
| Specialty | Average USMLE® Step 1 Score (U.S. Seniors Matched) | Average USMLE® Step 1 Score (IMGs Matched) |
| Internal medicine | 235 | 226 |
| Family medicine | 221 | 211 |
| Pediatrics | 228 | 222 |
| General surgery | 237 | 237 |
1. Brendan Murphy, ama-assn.org
2. National Resident Matching Program, Charting Outcomes in the Match: Senior Students of U.S. MD Medical Schools
3. National Resident Matching Program, Charting Outcomes in the Match: International Medical Graduates
There are numerous other factors that influence the competitiveness of your chosen residency program: some programs have more positions than others, some programs are newer, and though your score might get you through the door at first, the rest of your application and any interviews you have will influence the decision of residency directors during the Match process. Internal medicine, for example, has a larger number of positions available; otolaryngology is one of the oldest specialties; and orthopaedic surgery requires one of the highest Step 1 scores for applicants.
The mean USMLE® Step 1 score for U.S. seniors matched into competitive residencies was around 248. For less competitive residencies, the mean USMLE® Step 1 scores were between 221 and 237.
Match rates of US graduates: percent matched by preferred specialty
The mean USMLE® Step 1 score for IMGs for the most competitive residencies was between 239 and 246. For less competitive residencies, the mean USMLE® Step 1 score was between 211 and 237.
Match rates of international medical graduates: percent matched by preferred specialty and IMG applicant type
Upcoming USMLE® Scoring Changes and What They Mean for You
In February 2019, the USMLE® announced a handful of changes for Step 1, some of which will likely impact your residency plans. Historically, there has been a strong emphasis on USMLE® Step 1 scores on residency placements. This created extra stress for many medical students, which takes focus away from getting the experience you need to be prepared for practice in the medical field. Therefore, the Federation of State Medical Boards (FSMB®) and the National Board of Medical Examiners (NBME®) introduced this change.
But don’t worry – the changes will still fit states’ medical licensing board’s requirements for exam results that are used to determine medical licensure eligibility. The time leading up to this change will also provide you the chance to adjust your planning for your USMLE exams.
Key changes you should be prepared for:
- Step 1 exam scores will be reported only as pass/fail (no earlier than January 2022)
- Only four attempts will be allowed for each Step or Step Component (no earlier than January 2021)
- All examinees must successfully pass Step 1 as a prerequisite for taking Step 2 CS (no earlier than March 2021)*
* Since these changes were announced, the USMLE® has also suspended Step 2 CS until further notice due to COVID-19. Check the USMLE®’s website for the most up-to-date information regarding these and other changes/updates.
If you’re an IMG, these changes to the USMLE® Step 1 will affect how you might stand out in the residency process. Previously, high Step 1 scores were one way you could stand apart from US applicants because you may not have the same opportunity to receive US-based recommendations or experience. What’s another other way to stand out in the application process? Show research, volunteering, and leadership experience. Unfortunately, these experiences will be hard to be involved in given the COVID-19 pandemic. You will need to get creative since you don’t know what opportunities, or COVID-19, will look like in early 2022. Also, COVID-19 will still make it extremely difficult to do an away rotation.
Don’t deter, though. While these changes may impact your residency preparation, you can still set yourself up for success in the future.
What’s Next?
Once you have done your research and found the best fit for you, you will be one step closer to applying to, and hopefully getting accepted into, the best residency program for you. While there may be changes coming soon to the USMLE® Step 1, proper planning and patience will help you continue to thrive while you finish medical school. Above all, put your talents and your academic preparation first as you prepare for the next steps in your medical career.
