Navigating the Residency Match Process as a Couple

Though there's loads of information on creating rank lists as an applicant, I found that I had a lot of questions specifically about going through the process as a couple.  Now that we're (almost) done, I decided to share some of the information we learned along the way and hope that it will help clear up some confusion surrounding couple's matching.



What is couple's matching? 
Couple's matching allows applicants participating in the AOA or ACGME match to link their rank list with another individual's.  Anyone is allowed to couple's match (significant others, spouses, best friends, siblings...you get the point) but doing so has its own set of advantages/disadvantages. Participating in the couple's match allows you to rank different combinations (ie: same program, hospitals within close proximity, hospitals across the country, etc) in conjunction with your partner.

Prioritize
Communicating with your partner and discussing your priorities is crucial.  Is it more important that you both get your desired specialties/programs or are you willing to compromise (either choice of program or, in some cases, specialty) to maximize your shot of ending up near each other?  This is even more important if one or both of you are considering applying into a more competitive specialty with limited available residency programs.  Many people apply for a less competitive specialty in addition to their primary specialty of choice to increase the likely rank combinations and alleviate some of the worry of not matching at all.

Research
Once you've decided what/where you want to focus your efforts, begin researching programs early your third year. Depending on the specialty you and your partner are interested in, doing an audition or sub-internship may be something that you consider. The advantage of auditioning at programs that you're interested in is the ability to relay your interest in the program and/or location and establish relationships with residents and attendings. This is particularly true if you and/or your partner are vying for more competitive specialties or those that place a heavy emphasis on auditions.

Half the battle (on the AOA side, at least) is making sure you can get auditions scheduled at your desired programs for the months when you want them so staying on top of things is vital.  I had an extensive excel sheet with all possible programs listed by state, what their application requirements were, minimum board scores (if any), contact information, and possible audition dates.  My husband and I tried to coordinate being at the same hospital during the same month to cut down on housing costs but it didn't always work out.  For the most part, we were able to stay in the same general area so we were able to split rent for a 1 bedroom place for those months which helped save some money.

Focus on certain regions
When researching possible residencies, consider regions with multiple programs within driving distance to each other.  Focusing on areas with multiple residency programs increases the number of combinations that can be ranked (for example, if each partner has three programs in the same vicinity, a total of nine combinations are possible as opposed to only three if the programs are different geographical areas). Like I stated above, it's important as a couple to discuss priorities --for us, living together was of the utmost importance. There were plenty of programs that both my husband and I were interested in but for various reasons they weren't viable options for the other person (they didn't have both specialties we were looking for, minimum score cut-offs were too high, etc) so we opted to skip over those for auditions.  Instead, we focused our attention on the midwest because of the flexibility and number of options we would have. This was invaluable when it came to ranking programs since we were able to list various combinations of programs in close proximity to each other (more on that later...). The locations we focused on were: Detroit, Cleveland, and New York. ACGME programs may have additional geographic regions with multiple programs in close proximity.

Making your rank list
As if creating your rank list wasn't challenging enough, the couple's match adds another element into the mix. I highly recommend the NRMP tutorial on couple's matching (link here) for anyone considering the couple's match.  NatMatch.com also provides a useful tool via excel sheet (on this page) which will generate all possible combinations, along with examples of how ranking combinations works.  The list will also automatically create the combination of one individual matching while the other goes unmatched. It's up to you and your partner to go through and eliminate any combinations that are undesirable and rank remaining combos based on order of preference.  Understand that every combination you delete theoretically worsens your chance of matching.

To disclose or not?
Whether or not to disclose you're couple's matching is controversial. I've heard mixed things from attendings, students, residents, program directors and all I've gathered is that there is no right answer. If you do disclose, be prepared to explain how couples matching works (we were asked countless times if that meant that we could only match at the same hospitals) as there is a lot of misinformation about the process.

Of note, if you disclose you are couple's matching on your ERAS application, programs will be able to see it and ask you about it.  You will be required either way to register as a couple on the actual matching program, but programs will not be able to see that. For some people, disclosure is advantageous, as it allows you to really convey interest and stress your desire for the particular program, especially if your partner has received strong feedback there/program nearby.  On the other hand, some program directors may be hesitant to invest in a candidate that may not rank their program as highly due to their partner.  In the end, the decision to disclose couple's match status or not is ultimately yours.

Once all of this is done, you submit...and wait (and try not to stress...yeah, right)!

Good luck!

Did you participate in the match as a couple? How'd it go? Any advice? Let me know!