Neurology residency is moderately competitive. It sits below the most selective specialties like dermatology, plastic surgery, and orthopedic surgery, but interest has grown sharply in recent years, pushing applicant numbers to record highs. In 2024, a record 2,344 applicants competed for 1,103 neurology training spots, more than doubling the ratio of applicants to positions. That said, nearly every available position fills each year, which signals strong demand from both sides.
How Neurology Compares to Other Specialties
Neurology falls in the middle tier of residency competitiveness. The most selective fields routinely see match rates below 70% for applicants, while neurology programs fill at or near 100% of their offered positions. In 2024, 99% of PGY-1 neurology spots filled, as did 98.7% of PGY-2 positions. That near-perfect fill rate reflects a specialty where programs are eager for qualified applicants, but where a growing applicant pool means you can no longer treat it as an easy match.
The number of ranked applicants programs need to review before filling each seat has held steady at about 6.1 to 6.2 over recent cycles. For context, the most competitive specialties require far fewer ranked applicants per seat because programs can be highly selective early in their rank lists. Neurology’s ratio suggests programs cast a wider net, which works in applicants’ favor.
Applicant Growth and Rising Interest
The field has seen significant growth on both sides. PGY-1 positions rose from 772 in 2020 to 846 in 2023 and hit a record 1,103 in 2024. But applicants have grown even faster. The 2,344 applicants in 2024 represent a major jump, and child neurology saw a similar trend, with 366 applicants competing for a record 190 positions in 2024, up from 309 applicants in 2019.
This growth means neurology is becoming more competitive year over year, even as new training positions open. If trends continue, applicants should expect stiffer competition than what students from five or ten years ago experienced.
What Programs Look for in Applicants
A national survey of program directors across specialties found that the residency interview is the single most important factor, with 99.5% of directors rating it extremely or very important. After that, the priorities are passing your licensing exams (88.2%), core clerkship grades (79.1%), demonstrated leadership (70%), letters of recommendation (69.4%), and your personal statement (64.2%).
Specialty-specific research ranked much lower, with only about 19% of program directors calling it very important. Research publications and presentations were even less influential. This means a strong clinical record and compelling interview will carry you further than a long CV of neuroscience papers, though research can still distinguish you at top academic programs.
For exam scores, the average USMLE Step 2 CK score among first-year neurology residents has been around 239. You don’t need a 260 to match, but scoring well below the average will limit your options, particularly at competitive academic centers.
Opportunities for International Medical Graduates
Neurology is one of the more IMG-friendly specialties, though the match rate is still challenging. In the 2025 cycle, U.S. citizen IMGs matched into neurology PGY-1 positions at a rate of about 34%, while non-U.S. citizen IMGs matched at roughly 36%. Those rates are significantly lower than what U.S. MD graduates experience, but they’re higher than what IMGs face in many other specialties.
In raw numbers, 223 non-U.S. IMGs matched into neurology PGY-1 spots in 2025 out of 627 applicants, making neurology one of the larger landing spots for international graduates. Programs in neurology have historically relied on IMG applicants to fill their classes, and while that reliance is decreasing as more U.S. graduates apply, the door remains meaningfully open.
Does Location Matter?
Geography plays a surprisingly small role in whether positions fill. In 2025, nearly every state filled 100% of its neurology PGY-1 spots. California (73 positions), Texas (82), Florida (68), New York (100), Ohio (55), and Pennsylvania (61) all filled completely. Only a handful of states had any unfilled spots: Michigan and New York each filled 98% of positions, and West Virginia filled about 71%.
This means you won’t find geographic “backdoors” into neurology the way you might in some other specialties. Programs across the country are filling their classes. That said, the applicant pool at a top-ten academic program in Boston or New York will look very different from the pool at a newer community-based program in a rural state. If you’re a competitive applicant, you have the luxury of aiming for marquee programs. If your application has weaknesses, casting a wide geographic net and including less well-known programs is a smart strategy.
Child Neurology vs. Adult Neurology
Child neurology is slightly less competitive than adult neurology by the numbers, though the gap is narrowing. In 2024, 96.2% of child neurology PGY-1 positions filled compared to 99% for adult neurology. The applicant pool is smaller (366 vs. 2,344), and the number of available spots is far fewer (190 vs. 1,103). Child neurology matched 177 trainees to PGY-1 programs in 2024, up from 151 in 2020.
The smaller scale of child neurology means individual programs may be less selective, but it also means fewer options if your application isn’t strong. Both tracks are trending toward greater competition as interest in neurological disorders continues to grow.