Residency tips: Making the couples match work for both partners
David Mitchell — The Match can be complicated, time consuming and stressful for an individual applicant. What happens when you add the hopes, dreams and rank list of your significant other to a life-altering equation?
- Do matching couples need to be engaged? Married?
- Do couples need to apply and interview with more programs than individual applicants?
- What if you're matching in different specialties?
- How should couples approach a rank list?
Just in time for the opening of ranking in the National Resident Matching Program (NRMP)—and Valentine’s Day—five family physicians who found training programs with their partners answer these questions and more in this couples match Q&A.
Top tips for couples matching in the NRMP
AAFP: What is your best piece of advice for applicants participating in the couples match?
Grace Kelly, MD, and Giselle Scarano, MD, celebrate matching into different specialties at the same institution in the couples match.
Ian Coker, DO, clinical faculty in the Department of Family and Community Medicine at the University of Arizona in Tucson, where his wife, Kelly Coker, DO, also is clinical faculty: The most important thing is being upfront with yourself and your partner about your goals and what type of program you’re looking for. You don’t want to end up compromising too much because that could lead to resentment down the road. If you know what you’re looking for and you know what your partner is looking for, there are so many programs out there. There are a lot of options.
Chandler Stisher, MD, family medicine faculty at the University of Alabama at Birmingham School of Medicine, where his wife, Amanda Stisher, MD, also is family medicine faculty: Investigate whether programs, in the same specialty or not, have had couples in the past because programs who have had couples will know how to deal with this. We had two programs that said, “No, we don’t participate in the couples match. We don’t even look at couples.” They were upfront with us, and we did not apply to those programs. It’s important to know if you are charting new waters.
Grace Kelly, MD, third-year resident at the University of Florida Family Medicine Residency in Gainesville, where her wife, Giselle Scarano, MD, is a third-year psychiatry resident: Figure out your priorities as a couple. Is it location? Is it that one of you wants to learn a specific thing that only certain programs offer? Is it cost of living? We had a grid with different categories, and we assigned value to each category: location, psych program, family medicine program, curriculum, cost of living. Then we gave the programs a score so we could figure out where each of us was coming from and make a joint decision.
Also, don’t underestimate how long it will take to make your rank list. It’s not just your thoughts about it. You have to talk about it. Split it into chunks. We would block off an hour and a half, and then two or three days later come back to it and block off an hour and a half again because it can be overwhelming.
Allison Zamora, DO, second-year family medicine resident at Riverside Health in Newport News, Virginia, where her husband, Carlo Zamora, DO, is a second-year emergency medicine resident: Sometimes you need a cooling off period after you’ve made it through ranking No. 1 through 5, and you need to take a break. Leaving that space and allowing the discussions to occur throughout the season allowed us to be open and honest about how we were feeling, which made it a more comfortable match in the end.
Ian Coker, DO, and Kelly Coker, DO, are now clinical faculty at the University of Arizona in Tucson.
Coker: I am a spreadsheet person. So, Grace, your system made perfect sense to me. My wife is not a spreadsheet person. So, clarifying how you’re going to have the conversation about the rank list before you get to that point is a good idea. I had iterations of scores and things, and she was like, “What is wrong with your brain? Can we just talk about whether or not we like it?”
Agreeing on what your process is going to be is a good thing. I stopped making spreadsheets when we were buying houses, and she met me halfway with spreadsheets for our budget, so it worked out.
Jiayu Kate Tian, MD, attending physician in Burlington, Vermont; her husband, James Graham, MD, is a third-year radiology resident at the University of Vermont Medical Center: Balancing your professional priority and your partner’s is the trickiest part of this process. I was advised to be cautious about what I shared with my partner because you don’t want the other person to compromise too much for you. But when it comes to program selection and rank list discussion, it is important to clearly communicate what is important to you and be realistic about what your options are for both of you.
Kelly: If you shared everything about the program before your partner interviews there, that might bias them unfairly. So, we did keep some of it quiet until we had done all our interviews and we were making our rank lists. It created some mismatches when we were making our lists, but I think it allowed us both to feel like we really saw programs from our own perspectives.
Coker: It’s OK to tell your partner, “I do not want to go to this place,” even when you’re researching programs before interviews.
My wife wanted a lot of OB training, and I wanted options for inpatient medicine, and that’s where we ended up. There were places I interviewed that had a lot of FMOB, and I thought, “This is not for me.” Looking back, because we had other options in that geographic region, it would’ve been fine to say, “I don’t need to interview at this one. This would not be a good fit for me, and this is probably not the training I want.”
Zamora: Every couple is different. For me and my husband, we didn’t shy away from sharing our thoughts during the process. When I had an interview that was a no, I just told him, “This is not a good fit for me. If you absolutely love this, I will do what I can to meet you where you’re at and we will figure something out.” We were upfront with each other about our feelings.
Don’t underestimate the power of leaning on each other. You’re both going through a stressful time. We were told to apply to 80 programs, and that was too many. My program told me that, statistically speaking, when you’re couples matching, you fall further down your rank list. So, if you were going to match like No. 2 or 3, you might match No. 6. We applied to 30 or 35 programs and then we did 18 interviews, which was way too many.
We would reach out to programs, very frankly, and say, “My partner got an interview here, and we’re really interested because of XYZ. What do you say?” And we got a couple of interviews that way. Actually, the program we’re at now was one of those. I was doing a rotation here, and Carlo messaged the program. It works out sometimes.
Carlo Zamora, DO, and Allison Zamora, DO, celebrate successful matches into different specialties in the couples match.
What to know about application and interview volume
AAFP: How many applications and interviews did you do?
Kelly: My school told me to apply to three times as many programs as I would if I was applying as an individual. There were certain cities we considered where there were more family medicine programs than psych programs, so I ended up applying to more programs than Giselle with the idea that if she had an interview, there would be three family medicine options for me in the same city. I did 30 interviews. She did 20, which was exhausting.
Chandler Stisher, MD, and Amanda Stisher, MD, share the news after matching into the same family medicine residency.
We also had a lot of success reaching out to programs.
The timeline for interviews vary among specialties, and they extend interview invites at different times. Family medicine offers came out earlier than psych, so a lot of times Giselle would send an email and say, “Hey, my partner got an interview with a program in your city,” and that approach was successful for us.
Stisher: Our medical school told us we should apply to 80 programs, and we thought, “We’re both doing family medicine. We don’t need to do that.”
Tian: The year we applied, radiology saw a 20% increase in applicants. We also did not have a geographic preference, so we applied broadly to secure a spot for my husband. We had to be realistic about how many programs to apply for in order to match. These days, with signaling, that may mean coordinating where to send signals if partner is in a competitive specialty.
The tip coming out of this experience is about communication during interview season with programs. Don’t be afraid to communicate to your program, or for your partner to reach out to programs where they will be interviewing.
I asked for family medicine programs that I was interviewing with to ask their institution’s radiology programs to give my husband interviews. He had reached out to radiology programs to express interests when I was interviewing in family medicine programs in the same institution as well. We had success securing a few interviews that way.
In the end, I interviewed at about 22 programs, and he interviewed at around 15.
Common pitfalls couples should avoid in the Match
AAFP: What are some things to avoid?
Zamora: Sometimes people can be tempted to jump into the couples match quickly, but it’s not something to take lightly. If it is the situation that you’re in, then 100% the couples match is an awesome option. We have a person in our program whose partner is in another program nearby. They did an informal couples match, and they didn’t match together. That is terrifying to me.
Stisher: You have to do your homework and understand the nuances of the couples match. I think some people don’t really understand how the couples ranking goes, and that could create issues. Amanda and I are sometimes the spokespeople for the couples match on our campus because not many people had gone through it before us. We tried to seek out people who had done it, and we actually were not able to find anyone at our institution when we were medical students.
Do not enter lightly into the couples match
AAFP: Should couples be engaged or married to match together?
Coker: I don’t want to tell anyone how to live their life, but it is a commitment.
Kelly: I am aware of couples who matched together, away from their families, and broke up once residency started. That’s a cautionary tale.
James Graham, MD, and Jiayu Kate Tian, MD, navigated the couples match to train in different specialties in the same state.
We got married right after we graduated. So, we matched in March, graduated in April and got married one week after graduation.
Coker: That’s efficient. I like that. We didn’t get engaged until after we matched, but we had made the decision that this is what we were going to do.
Tian: I think people need to understand that in many ways couples matching is more of a commitment than a marriage because the future of your career relies on this. I don’t want the message to be “you better be married or committed,” but it isn’t a decision to make lightly.
Matching in the same specialty—or not
AAFP: What differences should couples be aware of matching into different specialties versus both matching in family medicine?
Coker: It felt easier with both of us matching in family medicine than what I’ve heard from others matching in different specialties. A lot of family medicine programs, if they can fill two spots with both of you, that’s a pro for them.
Stisher: We only looked at larger family medicine programs because we thought, if we go to a program with only four or six residents per class, then the likelihood that we would be able to take vacations and things like that at the same time were probably not great. We have an internal medicine program and a psychiatry program at our campus, and so we’ve had several couples. The program directors have arranged schedules so that couples can have Christmas or New Year’s off together, and so they can have elective months together, too.
Kelly: In a larger academic center where there’s multiple specialties, there might be a higher chance of communication among the program directors. We do a psych rotation, so the program directors already talk to each other.
Zamora: As far as vacations go, Carlo and I being in different specialties has made some things a little bit easier. We rotate through all of the different specialties, so there’s a lot of interaction among programs that makes communication pretty easy.
Tian: The decision to couples match completely changed how my application list looked. Since my first year of medical school, I’ve been interested in small, community-based programs. Unfortunately, by the time that we decided to couple’s match, I realized that many of the community-based, unopposed programs do not have radiology residencies nearby. By expanding my list to include academic programs that provide broad scope of training with an emphasis on inpatient medicine and obstetrics is how I ended up finding my program. I would have never applied if we hadn’t needed to find accommodations for my husband. The process of selecting what programs to apply for is different when your partner is applying into a different specialty.
Match ranking closes March 4
AAFP: Any final thoughts on ranking?
Coker: One of the things that I was told to do was to have an option at the bottom of my rank list in case one of us matched and the other one didn’t, and vice versa. So, if you got that far down and you found out that one of you didn’t match on Match Day, the other person at least knew where you matched and could try to SOAP (participate in the Supplemental Offer and Acceptance Program) into the right geographic area. The 25th spot on our combinations was me not matching and my wife matching.
Kelly: We did not do that, but we made 135 combinations. Then we just were like, “If we go that far down, it’s over for us,” because we had 35 combinations in the same city. Beyond that we did combinations that were a one- or two-hour drive away from each other. We ended up matching on our top choices.
Zamora: I would really encourage couples and individuals to just make your rank list based on where you want to be. Eventually, all things will shake out. Obviously with the couples match, when you’re making your rank list, you have two thoughts instead of one. Make the rank list based on where you think that you’re going be the happiest.