One's not half of two; two are halves of one.
Applying for residency training as a medical student is a tough enough proposition when you only have to worry about one person. As a couple, this process is terrifying. Every decision you make throughout the application season can impact the residency chances of both you and your partner. Luckily there are a few things you can do to maximize your chances of ending up together for residency.
This list was compiled based on our experience with the couple’s match, combined with the information we gathered from the other couples in our class. It is obviously not exhaustive, but should give you some pointers on what to think about and how to plan.
1. Create a Couple’s Match Strategy
Relationships require a lot of compromise, and couple’s matching is no exception to this rule. My partner desperately wanted to head back home to the West Coast, while I was looking for programs that I felt were the best “fit” for me. While working out our rank lists, we had several intense discussions about how and where we wanted to spend the next 3-5 years.
Before you even begin working on your ERAS application, we recommend sitting down and figuring out what factors are most important to you for residency. Make sure that you and your partner decide on a region you want to train, and start talking about what types of programs are important to you. Do one of you want to train at an academic center with fellowships? City versus a rural program? Have these conversations early. If you know what your partner wants, it can be easier to evaluate programs as you visit and interview.
2. Plan realistic “auditions”
Away rotations (also called auditions) can give you insight into different types of programs, and even occasionally get you an interview that you wouldn’t normally get. The average number of away rotations varies based on intended specialty and other factors. For example, the average medical student does 2.1 away rotations (at a cost of almost $1000/rotation). Students applying for something very competitive (I.E. Orthopedics, ENT, Urology) may do up to 4. Osteopathic students can do up 5-6 auditions depending on the specialty.
When planning away rotations, it is important to set your sights on realistic programs in realistic areas. For one of my aways, I went to a Top-10 program in one of the most desirable areas on the west coast. While it was an amazing experience, this program was most definitely beyond being “reach-program” for me. Not only did I not receive an interview there (and neither did any of the other students who rotated with me), but I ultimately had very little success in the region.
Looking back, both my partner and I wished we had planned our away rotations differently. We both targeted places that we hoped to go, without considering how that could impact the other person. For example, despite the fact that my specialty choice made it unrealistic that I could match on west coast, both of us planned rotations there. In fact, my partner has done over 4 rotations there, and received over 6 interview rotations west of the Rocky Mountains (while I received zero west of the Mississippi).
It would have been much better if we had looked at where we had the best chances, and done more rotations in that area. Don’t go for as many reach programs. Target realistic and reasonable residency options.
3. Apply to more programs
I feel like this is a bit of a no brainer, but the residency couples match is a numbers game. It would be better to spend an extra $400 on applications than to not match together. Our strategy was to apply VERY broadly and then filter residency options based on the interviews we received.
Although there is no data on how many programs a typical couple applies for, I would assume it would be significantly higher than the average for single applicants. The preliminary data from ERAS for the 2017 cycle shows that the average number of applications per person varied from ~20 to over 70 based on the competitiveness of the specialty. We would recommend at least doubling those numbers if you plan to apply as a couple.
Together, we applied to over 200 programs. Yes, I know that this seems like a case of extreme overkill, but we do not regret the decision to apply this broadly. Because of the competitiveness of the specialty I was applying for, I was forced to apply to programs a very large geographical distribution. Only due to the large number of applications was my partner able to secure one or more interviews in every city that I also interviewed at. This is the key to success: having many options.
4. Tailor your applications to the most competitive specialty
Again, the NRMP collects and publishes very little data about couples, but it is safe to say that competitive specialties make the couples match significantly more difficult. I met many residents that spent 3-4 years apart from their partner because one or both of them pursued something competitive. Although this is just an anecdote, I only met one successful couples match among the seven I met while rotating through surgical subspecialty programs. The other six spent 3-4 years apart, with one couple being over 2,000 miles away from each other for five years.
What did the successful couple do that the others did not? They tailored their interview applications to fit the needs of the competitive applicant. For example, if Partner A (the more competitive candidate) received an interview in Chicago, Partner B accepted 2 interviews there. Partner B also interviewed at more community programs, and less university residencies.
Unfortunately, in this scenario Partner B had to make some sacrifices. Both partners ultimately received great training and are happy with their placement. But, the individual applying to the more forgiving specialty had to be very flexible with their hopes and expectations. For us, that meant my partner going on more interviews than she had to. There were more flights, car rentals, stress, and expense throughout the whole process. I’m sure that at times she felt like she was being punished for trying to match with me, but in the end she stuck it out.
If neither of you are applying to one of the ROAD specialties, then this may not apply to you. However, for the couples out there going for these specialties, be prepared to make significant sacrifices throughout the application process.
5. Mention your partner early and often (without overdoing it)
Many people feel like there’s a stigma associated with couples matching. I was told that Program Directors are wary of ranking these applicants highly because they were less likely to match. I decided early that even if this was true, hiding my intention to rank with my partner would do more harm than good if word got around.
Thus, at every away rotation and interview, the residents and faculty knew that I was applying with my significant other. Contrary to what I had expected, I never once noticed any sign that my couple’s status was viewed negatively. In fact, it gave me something to talk about during several of my interviews and was generally well received.
The hard part, I found, was how to mention my partner without being too blunt or mentioning her too often. You don’t want to be that guy (or girl) who can only talk about about their significant other. It’s weird. Don’t do that.
Instead, try to sneak in questions about the program that you partner was applying to. For example, when we were consulted for a patient on the hospital floor I took the chance to ask about the internal medicine residents. My simple question turned into an opportunity to bring up that my partner was applying to the program. I was able to Additionally, during the interview I used the “Why our program” question to bring her up.
What are your couple's matching tips? Let us know in the comments!