The Couples Match
Scott Thomas Hadden, M.D.
Tanie Hotan, M.D.
MATCHING SUCCESSFULLY IS A COMPLICATED AND OFTEN stressful endeavor for individual applicants. This is compounded for couples, when each partner of a medical student pair hopes to match in the same geographic area. The Couples Match, a variation of the National Resident Matching Program (NRMP), was established in 1984. It allows two residency candidates graduating in the same year to pair their Rank Order Lists. Prior to 1984, a graduating couple was allowed to negotiate residency positions outside of the match or attempt to match independently through the NRMP.1 This was an unwieldy solution, with the potential for misrepresentation on the part of both applicants and program directors. As the number of women students increased, so did the number of student couples and, likewise, the problems associated with matching. The Couples Match was introduced to address these issues.
In 1984, 812 students participated in the first Couples Match.2 This number has increased to 808 couples or 1,616 students currently.3 These numbers actually underestimate medical students who relocate together because some graduate in different years, and others do not use the NRMP. In 2011, 94.6 percent of couples matched successfully. This rate has remained relatively stable (Table 1).4,5 This percentage is comparable to the match rate of individual applicants and is higher than the chance of two students matching as individuals.
HOW THE COUPLES MATCH WORKS
The Couples Match is straightforward. The Electronic Residency Application System (ERAS) allows you to designate yourself as part of a pair. This alerts programs to your situation but is not binding. The actual link between two students in the match process occurs with the submission of a Rank Order List of Paired Programs to the NRMP. This costs $15 per person in addition to the $75 registration fee. Each student can rank up to 30 different programs. After this, a fee of $30 per program is incurred. However, couples can rank as many program pairs as desired, including ones in which one student is willing to indicate "no match." You may prefer to be "unmatched" to ensure that you both will live in the same city and then try for a position later. You can create pairs of programs in any combination of specialties or geographic locations. You must both rank the same number of programs, although the "unmatched" designation is also a valid entry. More detailed instructions regarding this process can be found at www.nrmp.org.
ADVICE FOR A SUCCESSFUL COUPLES MATCH
A successful Couples Match requires that you both know what you want from residency training, where compromises can be made, and what aspects are nonnegotiable. This includes details such as the size, setting (community versus university), and location of a program. It is crucial that you openly discuss your desires and expectations. Putting your thoughts on paper can be helpful. This reduces the likelihood of future disappointment and resentment. This is particularly important for couples entering different specialties.
When applying to programs, there are several ways to improve your chances of matching. For example, large population centers often support multiple training programs. By choosing an urban setting, you will have options to mix and match programs, giving you more combinations to put on your Rank Order List. It is also important to have a realistic understanding of your competitiveness as an applicant. You may seek advice from the Dean of Students or faculty in your specialty. In general, couples will rank more sites than their classmates. The more competitive the disciplines, the longer the rank order list is likely to be.
Another way to improve your chances of matching together is to apply early. Early in the process, programs have the most flexibility for scheduling interviews. Less competitive residencies will attempt to accommodate your timetable, whereas more competitive programs are not as flexible. Because there are more invitations than actual interview spots, you need to call and secure a time as soon as possible. We suggest that you travel together. This will allow you to compare ideas, get immediate feedback, and share expenses. Take advantage of interviewing together to show that you are a strong, stable, and well-adjusted couple.
If applying to the same residency program, you may be interviewed individually or as a pair. At the interview, inquire about the program's experience with couples. Make an effort to speak with current resident couples if there are any and even call ahead to make special arrangements. If there are no resident couples, contact recent graduates who matched as a couple. Ask about the call schedules. It would be difficult to have alternate call schedules because you would see each other mainly on post-call days. Inquire about taking vacations together. In general, the bigger the resident pool, the more accommodating the program is with vacations and call. What has worked well for some couples is to request vacation together during nonpeak times. Finally, it is enlightening to ask other residents how having a couple in their program has worked out for them.
PREGNANCY AND PARENTING
Another important couple's issue is pregnancy and parental leave. Under the NRMP guidelines, it is illegal for interviewers to initiate conversation regarding pregnancy. However, if the topic is brought up by the applicant, it can be discussed. Although there have been many programs with couples who successfully had children during their training, pregnancy is potentially disruptive for a program. The residency may be unprepared to have two residents on parental leave simultaneously, may have no formal policy for parental leave, or may have a small pool of residents to cover additional call nights. In an ideal world, every couple would be comfortable inquiring about parental leave, child care, and pregnancy issues. However, discretion should be taken because faculty and residents are not universally supportive of this issue.
SPECIAL MATCH SITUATIONS
The Couples Match was designed specifically for students entering the match at the same time and who are both applying to programs that rely on the NRMP match process. Life and love, however, are not always so conveniently arranged.
Different Medical Schools. Students graduating from different medical schools can use the NRMP. The Paired Rank Order List need not be entered at the same time or even from the same location. However, distance makes open communication more difficult.
Different Graduation Dates. Many medical student partners from the same medical school do not graduate at the same time. Unfortunately, the NRMP is unable to make provisions for these couples. However, there are several possible solutions. First, it is often feasible for the senior student to delay graduation a year in order for the couple to coordinate graduation dates. Research, fellowships, and international study are all examples of legitimate, fulfilling, and commonly employed options. If the senior cannot delay graduation, he or she can attempt to match in the same area as the medical school. If this is unsuccessful or undesirable, the junior student can take a number of rotations at or even attempt to transfer to a school close to where the partner has matched. These latter possibilities are more likely to succeed if the area is urban, with a higher density of available residency and medical school options.
Non-NRMP Programs. Several programs, for example, urology and child neurology, do not use the NRMP match but have their own independent selection process. These matches typically occur prior to the NRMP Rank Order List submission deadline. In this situation, one of you will match first. Subsequently, the other can focus rankings in the same geographic location.
PERSONAL THOUGHTS ON THE COUPLES MATCH
Matching into a residency spot is the glorious last hurdle of medical school. If you understand the logistics of the Couples Match, know what you want, apply early, and have a strong committed relationship, the Couples Match can be a successful and rewarding experience.
Things We Did Right
1. Applied early
2. Communicated openly
3. Traveled together
4. Scheduled two to three days per program
5. Spoke with resident couples
Things We Did Not Anticipate
1. Post-interview exhaustion
2. Joint interviews
3. Absence of interns during Boards Part 3 (early December)
4. Bad weather
ANOTHER COUPLE'S APPROACH
If you and your partner are applying to specialties in different matching programs, here is advice from a couple who did that. Rima Chamie, MD, applied to family medicine through the NRMP and Matt Wagner, MD, applied to urology through the American Urological Association Match.
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Have an open discussion about the importance of matching together versus going unmatched. One woman I know decided that she would rather be with her husband and reapply the next year than live in a different city. On the other hand, some relationships didn't survive the discussions. We decided to match no matter what, and we would work out the long distance relationship if need be.
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Start with a separate search for locations where you are willing to live. This can be because of family, weather, medical community or whatever is important to you.
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Cross reference these two lists to come up with locations for application.
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Separate and research programs in the agreed upon locations. Make sure you have an acceptable program at which to interview in each area. For example, we had a city where one of us liked the program but the other could not find a program at which to interview. Resources and time were used on an interview that could have been skipped all together.
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Interviews can always be canceled. If you are offered an interview, do not wait until your partner is offered one. Schedule the interview and cancel later if you have to (always give at least 2 weeks notice).
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If there is a program where you are more likely to match, have your partner apply to more than one program in that location to increase chances of matching together.
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With the more competitive specialties, interview when you can and don't stress about being there at the same time.
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Tell program directors that you are trying to couples match, give them the name of your partner, and remind them later in the season. See how they respond. If they don't respect this, you may want to reconsider the program.
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It is also possible to work out a match together if one person is doing an "early" match such as Urology or Ophthalmology. Couples in this situation typically apply to many more programs. The advice is the same but realize that the person doing the early match makes a list that represents what you both want. The person doing the NRMP match should finish interviewing before the early match person puts in their list so that the list can be made together. 10. Just like an exam, do not make last minute changes once you have agonized over the list. You will remember later why you didn't have it that way in the first place.
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Graettinger JS. Results of the NRMP for 1984. J Med Educ 1984;59:441-443.
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Kim G. An examination of the Couples' Match. JAMA 1997;277(9):765.
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Roth AE, Peranson E. The effects of the change in the NRMP Matching Algorithm. JAMA 1997;278(9):729-732.
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Roth AE, Peranson E. The effects of the change in the NRMP Matching Algorithm. JAMA 1997;278(9):729-732.
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Results and data 2011 main residency match. National Resident Matching Program, 2011 data.