Residency application season is almost in full swing, and medical students across the country are either scrambling to finish their applications, or anxiously awaiting invitations for interviews. This process is extremely stressful as applicants travel across the country for interviews, rank their favorite programs, and hopefully match at one of those locations. Adding to the anxiety ,these soon-to-be residents do not find out their assigned training locations until late in their last year of medical school, giving them and their families only a few months to secure housing, move and adjust to what is commonly an unknown and unfamiliar geographic location. The uncertainty involved in residency matching (including the last minute travel planning for interviews, program ranking strategy, not knowing where you will match etc.) can be a big strain on relationships where one person is in medical school. Often times, the applicant’s partner has to find new employment and move away from friends and family for the next 3-7 years. Not to mention they also have to deal with the neurosis of their significant other as he or she checks their phone every five minutes hoping for interviews and agonizes for weeks about possibly missing a small typo in their application (of which I am currently guilty). These months are rough. However, if both partners are applying, the results can be catastrophic. The way the match algorithm currently exists, even though both individuals submit identical rank lists they can still end up assigned to opposite sides of the country. For example during my third year, I found out that one of my favorite residents had matched at a program over two hours away from his wife and three month old daughter. He was only able to commute back and forth on the weekends that he was not on call. Luckily, the organization overseeing this process allows you to indicate that you want to train in a similar location as your partner, making the above scenario much less likely – as long as you are applying to a specialty that participates in their services. Couples were first allowed to match together in 1984, and since then the program has had a greater than 90% success rate. Data from the most recent residency application cycle shows that 1,046 couples registered for the “Couples Match” and that over 95% of them were successfully paired. This match rate is within a few percentage points of the overall success rate for all applicants, meaning that there does not seem to be a big disadvantage in applying together. This is great news for couples who are both entering the primary match program. But, what happens if one of you are applying to one of the very few specialties that do not participate in the main match program? Then your options are few, as there is no way to indicate that you plan to match together. Your only hope is to apply to a large number of programs and try to rank them in such a way that maximizes your odds of ending up together. This is the situation that my significant other and I find ourselves in. I was lucky enough to meet her during our first year of medical school, and we have been almost inseparable since. She is applying to a mid-competitive specialty in the main application service, while I have applied to a competitive specialty that has its own match program (I’m sure that narrows down the possibilities significantly if anyone is trying to guess). I like to think that we are approaching this process like a poker professional approaches a table: although you cannot completely control the outcome, do everything in your power to stack the odds in your favor. Here is our current plan: Apply very broadly – We are both applying to dozens more programs than any of our peers, and are significantly over double the national average for our specialty. “Audition”more – Most medical students only spend 1-2 months doing rotations outside of their home program. We are both doing more than 4 months in an attempt to woo program directors to our cause. Focus applications geographically – Large mostly urban areas (think Chicago, Los Angeles, New York) tend to have the most residencies per square mile. Thus, a larger percent of our applications are going to those areas. Contact programs when given an interview – When one of us receives an interview, we plan on both contacting nearby programs to inquire about their intent to interview. Hopefully this will net us an additional interview or two, and will save a little on travel costs Rank list management – One silver lining is that one of us will receive our training assignment before the other person has to submit their list. Hopefully this will let us format the second rank list to maximize our odds of success. Well, that is our plan and we’ll let you know how it goes. Have you or are you thinking about couples matching or know someone that has? Tell us about your experience!