Erin Elbel and Dr. Mike Ren contributed to this post.

Ah, medical love: the phenomenon where, from across the lecture hall, your eye is drawn more to someone cute than it is to the acid-base lecture. This is not an uncommon occurrence; according to a recent AMA survey, 40% of doctors are married to other doctors, probably due to the vast number of hours we spend around one another during training coinciding with the prime life stage for finding a partner. With ERAS open and residency interviews fast approaching, many students are leaping into the couples match.

How Does Couples Match Work?

Stage 1: Early Courtship in Med School

Dating a fellow med student can be a huge source of support. For me, having a built-in study buddy during pre-clinical years and someone to relax with after a long day on the wards was one of the biggest joys of medical school. Most couples who match together start dating before third year, but not all. We have friends who started dating in October of their fourth year and happily couples matched!

Stage 2: Having the Couples Match Conversation

Couples matching is a huge decision and the conversation about whether to do it starts early. If one of you is a year ahead, it may entail taking a research year, completing an MPH, or finding some other way to get synced up.

Note: you do not have to be married, or even in a relationship. You could theoretically couples match with a best friend.

Stage 3: ERAS Locked & Loaded

At most schools, the first step of couples match involves meeting with the dean of students, both separately and together with your partner. These meetings display the seriousness of choosing to tie your fate together.

Because of the way the match algorithm works, couples matching is more likely to “hurt” you than to help you (in terms of matching at your highest choice). You also have to decide whether to list the fact that you are couples matching on ERAS—in general, it is recommended that you do (so that residency directors don’t feel you are trying to hide anything), but some specialties are more hesitant about couples match applicants. Overall, though, we have heard that many program directors prefer couples as they have built-in stability.

The next step involves making lists of programs to apply to. We made our lists separately at first, and then together. For our specialties (pediatrics and OBGYN), this means adding about 20 more programs each than we would if we were applying solo. We are both of similar competitiveness, but this number may need to be tweaked if one applicant is applying into a very competitive specialty or if one applicant is substantially stronger than the other.

We then sorted our potential programs by city. We had a low threshold to add a program in a city if our partner was very attached to a program there, but also had some honest conversations about which cities we absolutely did not want to live in. You pay per program on a sliding scale that increases the more programs you add, so this step can get pricey. This is about the time we signed up for credit cards with good miles rewards programs.

The stress sets in once couples have to coordinate their rank lists. The National Resident Matching Program (NRMP) combines both partner’s lists and will match couples to the top preferred program on their rank order lists where each partner has been offered a position, meaning if they do not match as a couple, they will not match unless one of the applicants chooses to go “unmatched” on their rank lists.

Finally, we swapped personal statements and ERAS applications and went through each others’ applications with a fine-toothed comb. Your partner’s success is your success!

It is important to have a mentor who can oversee your couples match in general, rather than looking solely at your individual lists. Fortunately, we were able to find multiple mentors who had couples matched themselves, so we had lots of great support.

Don’t be discouraged by the difficulty of this process though, because the statistics for couples matching are great! In 2021, 2,448 individual applicants (1,224 couples) participated in the Match, which was a similar number to 2020. Couples enjoy success, with match rates above 90 percent every year since 1984. In 2021, the match rate for couples was 93.4 percent.

Stage 4: On the Road Again: The Residency Interview Trail

Applying to lots of programs means lots of interviews. It’s not unheard of to interview at 20+ places. It may be possible to coordinate some of your interviews to be at the same time (especially if one of you is applying into a program with a lot of interview dates, such as internal medicine or pediatrics), but more often than not you’ll be riding solo.

During this stage, it’s important to keep your mutual spreadsheet updated with who is getting which interviews, the dates, and their impressions. If your partner gets an interview and you don’t, you can often reach out to your dean or mentors and have them help get you an interview there. Many students have gone so far as to reach out to program directors, with mixed success. They may call directly on your behalf, or recommend that you each send emails to your respective departments and ask them to consider interviewing the partner who doesn’t have an offer yet.

In the era of virtual interviews, applying to more programs is only seen as advantageous. There are no additional travel costs, and you increase your chances of couples matching!

Stage 5:  Ranking for Days

While your non-couples matching friends get to agonize over which of their 10 or so programs to rank first, you and your partner will be tackling the Herculean task of sorting a joint match list that can easily extend hundreds of permutations deep. Your combined list will rank each possible combination of programs for both of you. For example, if you each interviewed at only three hospitals, A, B, and C, your list might look like:

The number of possible ranks = (number of Partner A interviews +1) * (number of Partner B interviews +1) -1.  E.g., if Partner A has 15 interviews and Partner B has 20 interviews, they can rank (16*21)-1 = 336 possible combinations.  You can see why you need Excel here.

Don’t forget that there is always the option to withdraw. If individuals who have coupled in a Match subsequently choose to participate in that Match as individuals or if one partner wants to withdraw from the Match, both partners first must uncouple. Once uncoupled, each individual must adjust their rank order before the Rank Order List Certification Deadline.

Stage 6: Matchmaker, Matchmaker, Make Me a Match (Day)

Finally, March rolls around and the big day arrives. Different couples have different approaches to handling this momentous day. Some open one another’s envelopes, others livestream the opening on social media, yet others find a quiet room in which to learn their fate. Regardless, most couples end up in the same city or at least the same region, and get to head off to residency with their favorite person in tow.

Best of luck with your couples match journey!