Couples Match for Residency: The Ultimate Guide
/Everything you need to know about matching as a couple for residency programs
Learn how to develop your NRMP rank order list as a couple
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Part 1: Introduction
If you’re in your final year of medical school, you know how stressful applying and interviewing for residency programs can be. It’s hard enough to navigate the application process and coordinate travel plans for residency interviews, let alone make the hard decisions about preference and ranking that will determine where you train and spend the next few years of your life.
But what if you have a spouse or partner who is also applying to residency programs? How are you two going to manage your careers and your relationship over the next four years? If you’re in this situation, you’ve likely heard of “couples matching,” a system in which two M4s can seek to be placed in teaching hospitals within the same geographic area.
How does this complicate or alter the application process? Consider this your guide to how couples matching works, and to the National Resident Matching Program (NRMP).
What is the residency couples match?
Couples match is a means by which two coupled applicants may link their Rank Order Lists (ROLs) through the NRMP. This means that the couple’s ranked programs will be considered as pairs. The paired program choices will be run through the matching algorithm, and applicants will then be matched with the highest ranked pair for which they’ve both been offered positions.
Note that a couple can be any two people—spouses, domestic partners, friends. Documentation of a marriage or partnership is not required. But given the fact that NMRP requires two people to, in a way, tie their fates together, it’s not something most people undertake lightly. Coupled applicants need only have a shared commitment to obtaining positions within the same geographic area.
How does couples match work?
As per the NRMP’s website, both applicants must sign up with the Registration, Ranking, and Results (R3) System. Registration opens September 15, and the deadline is January 31st. A couple request must be sent through this system by one partner and accepted by the other. A fee ($45) is required, whether or not the request is accepted by the other partner.
You don’t need to make a final decision about couples matching until it’s time to put together your Rank Order List (ROL) in February, but it can only help to make the decision earlier, so that you and your partner can coordinate interviews.
It's important to keep a few things in mind:
The algorithm treats both applicants only as a couple. This means that if all the paired ranks are exhausted, the algorithm will not then find a match for you as an individual (or your partner). A match is obtained if and only if both partners match at a pair of programs.
Each partner’s Rank Order List must contain the same number of ranks. 300 is the upper limit.
It’s possible to enter a “No Match” code. Let’s say your partner is interested in matching at a program in rural Wisconsin, but you’re happy to go anywhere but rural Wisconsin. Next to their rural Wisconsin ranking, you’d enter your No Match code. It’s crucial to understand, however, that if this pairing appears high in the rankings on your shared list, there’s a good chance you and your partner will be separated geographically. The NRMP recommends that No Match codes be reserved for rankings near the bottom of your shared list, so that all other possibilities are exhausted first and you have a better shot at matching as a couple.
Let’s say you change your mind or your circumstances change at some point during the process and now you need to match as an individual. You must both “uncouple” before the Rank Order List Certification Deadline (March 1st).
If you decide to rank advanced specialty programs, and consequently include a Supplemental Rank Order List for preliminary or first-year transitional programs, your supplemental ROLs will be treated individually by the algorithm, and only after a match is obtained for a paired ranking on the primary ROL.
(Suggested reading: How to Develop Your NRMP Rank Order List)
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Part 2: Developing your rank order list as a couple
The most difficult aspect of matching will probably come while making compromises as you assemble your shared list. Because you’ll be pairing your Rank Order List with another person, you’ll also, in a sense, be wedding your credentials. This means that if your partner is a less competitive applicant than you, you might not be matched with your most desired programs.
For example, you might rank Internal Medicine at the University of Chicago and your partner might rank Family Medicine at the University of Illinois College of Medicine as a pairing high on your list. With your credentials alone, you might match with the University of Chicago, but if the University of Illinois College of Medicine declines a match with your partner, then you won’t match there, either. The algorithm will move further down the list, to the next paired ranking.
The possibility of listing duplicate programs, each with a different pairing, means that the University of Chicago could still be an option. You could, for example, list the University of Chicago multiple times. Let’s say your rankings look like this:
You
Internal Medicine, University of Chicago
Internal Medicine, University of Chicago
Internal Medicine, University of Chicago
Your Partner
Family, University of Illinois
Family, McGaw Medical Center
Family, Mount Sinai
With these rankings, you’d have three opportunities to match at the University of Chicago as the algorithm works its way down the list. Maybe your partner fails to match with the University of Illinois College of Medicine, but they do match with McGaw Medical Center. If this occurs, and you’ve been offered a position by the University of Chicago, then you and your partner will have successfully matched as a couple. But it’s important to consider that your prospects will be limited also by geographic proximity. There are only so many programs in the Chicago area, and once they’ve been exhausted, the algorithm will move on, excluding the University of Chicago as a possibility.
The one exception to this rule is if one partner uses a “No Match” code. If, for instance, you rank the University of Chicago and your partner enters a No Match code on the same line, the ranking will not be considered as a pair by the algorithm, meaning you might land at the University of Chicago, your top choice, while your partner lands up at Emory University, their second choice. If the paired rankings above have been exhausted, and the University of Chicago likes you as a candidate, you’ll match with them and your partner will go unmatched. That’s why it's so important to reserve the No Match code for the bottom your shared list.
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Part 3: Common concerns about couples matching
Naturally, the couples matching process raises all sorts of questions for applicants. While it’s hard to give generic answers or advice (each couple’s circumstances will be unique), let’s go through some of the common concerns one by one.
What are the chances of a successful couples match?
The chances are very good! While it varies year to year, the success rate for couples match—referring to whether or not people who enter the process as couples match anywhere at all—is around 95%.
When should we decide?
The earlier the better. Though you wouldn’t technically need to reach a decision until February, when you put together your Rank Order List, it makes sense to coordinate travel plans for interviews. This is all the more important when couples matching, since couples often apply to more programs than individuals to spread their bets.
The AAMC’s website lists the optimal number of programs for each specialty, after which applicants see diminishing returns. There’s no “magic number” for those applying as a couple, and the number will depend on financial feasibility and your ability to travel for interviews. It will also depend on which specialties you apply for.
Should we let our interviewers know we’re matching as a couple?
Though it is not required, there are no real disadvantages to letting your program know. In fact, it could be advantageous to discuss this with your evaluators. Programs are often happy to work with couples. They know that you’ll be happier and have a greater chance of success if you’re with your partner and can rely on them for support. They also understand that you’re far enough along in your professional career that you want to establish both your career and your home life.
Programs can also assist you in coordinating interviews. Let’s say you and your partner are applying for different specialties within the same hospital. If your program has already offered you an interview, and you let them know you’re part of a couple, they could contact the other department and help get your partner an interview as well.
How do we arrive at our Rank Order List?
This is a complicated and personal question, for which there’s no one right answer. One place to start might be for each person to make their own individual lists after their interviews have been completed, and then compare their preferences with their partner’s. This way, you’ll each know what the other prefers, independent of your own preferences. With this in mind, you can begin to pair and rank the programs. Obviously, this will involve some measure of compromise.
It’s worth remembering, however, that you’re much more likely to match with a pair of programs in a large metropolitan area, as opposed to a smaller town or rural area, simply because there are far more available programs in cities. Remember also that you set the upper limit in terms of distance, not the algorithm.
What if my partner is a year behind (or ahead of) me?
Again, the answer depends on individual circumstances, but matching as a couple is often the best way to ensure that both partners end up in the same place, so it might make sense for the partner who’s ahead to take a year off.
What if I’m applying to an early match specialty, and my partner isn’t?
If you’re applying to one of the four early match specialties (urology, ophthalmology, neurosurgery, neurology), it’s not possible to couples match through the NRMP. However, most of these specialties require a transitional or preliminary year, for which it is possible to couples match.
How many programs should we apply to?
Because there are more prerequisites to satisfy for a successful couples match as opposed to an individual match, couples often apply to a greater number of programs.
What happens if I don’t match, but my partner does?
The “No Match” code allows for this possibility, and if it happens, the unmatched partner will be eligible for the Supplemental Offer and Acceptance Program (SOAP). If one partner is matched by Monday of Match Week, the unmatched partner can contact the NRMP and find out the location of the matched partner’s program.
Final thoughts
The Match can be a stressful experience and matching as a couple can complicate the process. But by applying early and coordinating effectively with your partner, you can make it as painless as possible. Though it may seem like a headache, the benefits of being close to your partner throughout your residencies and having each other to rely on for emotional support can make it all well worth the trouble.