I came into medical school engaged to my high school sweetheart, Josh, who also was entering medical school. We knew we would be participating in the Match as a couple (hereafter called "couples matching"). We were very surprised when friends of ours chose not to couples match, citing fears it would negatively impact their match success. They tried to “sync” their lists and unfortunately were separated. Once we experienced the couples match for ourselves, I saw these fears had merit. On Match Day, we matched together, Josh in orthopaedic surgery and me in neurology. I soon learned that some couples were living the nightmare that had plagued us leading up to the Match. They did not match at all, or they had matched but were separated — some by a few hours, others by cross-country flights. My experiences in the couples match made it clear to me that we could do better.

An Enigma to Applicants and Programs

The guidance medical students receive about all things Match, including couples matching, varies greatly by medical school and it often is left to the couple to figure it out as they go. Throughout our interview process, we encountered many program directors who lacked understanding of the couples match. I was asked if I got to “set the distance” for the algorithm or if I could even rank a program if my husband did not get an interview in the same city. Many freely admitted they did not know much about the process, and this negatively impacts couples. I propose that accrediting bodies and medical schools should provide universal education to applicants and to residency programs about how couples matching works.

Interview Bias?

The NRMP website states, “applying as a couple should not influence the selection decisions made by program directors.” How programs interpret and enforce this is all over the map. Several programs told me that they had policies for couples. They would not interview me unless my husband also interviewed at their institution. Putting it another way: My opportunity to interview was dependent on a single program’s interest in my husband, or vice versa. They had no knowledge of where else my husband could interview or how that would impact our rank list. Our list consisted of pairs of programs at the same institution, in the same city, within driving distance, and near major airports with direct flights to other cities. Although we considered location in our final rank list, it was not the only consideration. We ranked all three hundred allowed combinations. In the 2024 match, 90% of couples had success in that both partners matched at a program. There is no data on how close these couples ended up to one another, or in their preferred specialty. Programs with these policies assume that a couple would not want to match with them if their partner is not in the same hospital or city. It is not that simple. Wouldn’t you prefer to be a two hour drive away from your partner over a cross-country flight? We spent hours upon hours staring at a computer, ranking 300 options of how our lives together would look like for the next four years. All options mattered.

Residency programs should seek to eliminate bias from the couples match and offer interviews to their top candidates, regardless of their status. Programs could additionally blind themselves to an applicant’s couples match status during the initial selection process. Couples concerned about bias can choose not to click the couples match box on ERAS but register for couples match through NRMP. Candidates can send letters of interest emphasizing multiple partner programs, access to airports or family support and can choose to reveal their status as a couple to a program via email, for example, after their partner gets a nearby interview. 

Mixed Signals

The use, meaning, and number of signals vary widely across specialties. I had three to use, the importance of which varied by program. Josh had 30 for orthopaedic surgery, which acted as a soft application cap. As couples need to apply to more programs, this made things much more complex. It felt like playing 4D chess. It was not as simple as what programs we liked the most. Who would interview us both? Is there a program that might interview him without a signal? Is a program too much of a “reach” to waste a signal? It was a logistical nightmare, and we felt it did nothing to benefit us as applicants. From the program side, it seems unclear how they are supposed to be utilized, if at all. If signaling is here to stay, the use needs to be transparent. If signals are used as a means of limiting the number of applications, it may be worth increasing the number for candidates who declare their intent to match as a couple.

Not-So-Universal Interview Release

In recent years, some specialties have adopted universal release dates, many later in the recruitment season. Partners applying to early interview specialties are forced to interview at programs with no knowledge of the options their partner will have. Partner status may or may not impact someone’s decision to interview at certain programs. Several Neurology programs where I applied were unaware that orthopaedics had a mid-November universal release date. This confusion exacerbates the issues caused by interview bias. By the time orthopaedic programs decided who to interview, many neurology programs had filled their interview slots. The delay between interview offers for neurology and orthopaedics created some missed opportunities for both of us. Residency programs should be aware of the universal interview release dates for all specialties as they may impact couples in their applicant pool, and these release dates should be moved up if possible. 

These challenges only scratch the surface of what couples face while applying together but I hope this article can shed light on these issues, open the system to needed change, and lead to more couples having their partners by their side during residency.

How would you fix the Match for couples? Share in the comments.

Samantha J. Stallkamp Tidd is a first-year neurology resident at the University of Rochester in Rochester NY and a recent graduate of the Cleveland Clinic Lerner College of Medicine. She can be found on X @SamanthaJSTidd.

Illustration by Jennifer Bogartz