Residency Couples Match – Shedding Light and Debunking Myths


Guest post authored by Nikhil Agrawal, MD and Kirsty Hillier, MD.

The Couples Match

You worked hard to get into medical school. Then you worked hard again doing research, studying, and trying to prove yourself constantly to attendings and residents who you hope will fight for you to get into residency. Through it all you found time to develop a relationship with another medical student.

Maybe you spent late nights at the coffee shop slaving through every page of First Aid. Maybe Friday night after the worst test of your life you enjoyed adult beverages at the bars together. Maybe you couldn’t focus on rounds because you spent the whole time catching each other’s gaze. All you know is that you would be a happier person if this person could come with you to residency.

Well shame on you, now getting into residency is in jeopardy, right? 100% wrong. The conversations surrounding couples matching are filled with misconceptions and lack of understanding. In this article, we are going to help you figure out if couples matching is right for you. We are going to talk about how it works, debunk misconceptions about the process, and discuss how to navigate interviews as a couple.


Whether or Not to Couples Match

This is not the first time you will have to decide between doing something for your career versus doing something for your personal life. This is actually a decision you will make every day and have made a million times in the past.

The difference is this decision will change the next 3-6 years of your life. There is a lot that goes into it and at the core of it all is your relationship. It is not fair that you might have to make the decision while your relationship is just beginning. As we all know the length of time that you have been dating is not relevant to how close you feel. If you have already made the commitment of being engaged or married, there is no question that you should couples match. For the rest of us, the decision is a little more difficult. There is a lot of fear and anxiety when it comes to the process and you two will need to talk about a few things.

First of all, you must understand that your chance of matching is in no way hampered by couples matching. This is vital to understand and is commonly misunderstood. As is discussed more in the mechanics section, at the end of your list you have the option that one partner could match, while the other goes unmatched. If you end up not matching after applying as a couple, you were not going to match if you were applying alone. The downside is that your chance of matching at your desired program is lower when couples matching.

Your specialty choice will also play some role in the decision process. It is important to understand though, that the top 5 pediatrics programs will end up being just as competitive as any program in the cardiovascular surgery integrated match. Just because one person is applying to a specialty that is less competitive, both people are making a bit of a sacrifice.  For us, we tried to make the most of our chances by putting extra focus on big cities where there was more than one program.

Furthermore, your relationship cannot be fragile enough that this discussion causes a division in your partnership. You will argue and go back and forth but at the end of the day you should want to continue on with the relationship. In the near future, there will be talks about the rank list which will ask both people to make sacrifices. Then in the future you will make sacrifices not only for each other but also for children, your hobbies, and so much more.  This is only the beginning and if this discussion creates a problem that divides you then it is better that you find out now. At the end of the day, if you know that residency would be better with this person by your side, then I would encourage you to couples match.


The Mechanics

The way the match works is that your rank lists are paired.  Your match is successful when both lists find a match on the same line. It really is that simple. 

There is an option where a line has “No Match” for one person in the couple. There is no stipulation that each line has to be geographically near to each other or in the same program. In fact, if you hated someone so much that you wanted to make that you were not in the same city, the couples match would be the perfect way to do it. You could have each line be in opposite ends of the country to ensure that you will be far away from that person.

Each person must logon to the NRMP website and agree to have the rank lists coupled. Then you make the list together and make sure that the lines match up. We recommend making your list on an excel file then transferring it over at a later time. Also, it is good to get on the website early and get familiar with how it works before it is the day before the lists are due.

An example list would look something like:
1. UC-SF Surgery – UC-SF Pediatrics

2. Ohio State Surgery – Ohio State Pediatrics

3. Stanford Surgery – Stanford Pediatrics

11. Stanford Surgery – UC-SF Pediatrics

12. UC-SF Pediatrics – Stanford Surgery

13. Ohio Stage Surgery – Cincinnati Pediatrics

31. Ohio State Surgery – UC-SF Pediatrics

32. Stanford Surgery – UC-SF Pediatrics

33. Harvard Surgery – UC-SF Pediatrics

61. No Match – UC-SF Pediatrics

62. No Match – Ohio State Pediatrics

63. No Match – Stanford Pediatrics

71. UC-SF Surgery – No Match


Be open to the advice of your deans and medical school advisors but also cross reference their information with sources. The number of people that couples match is small enough that your advisor may not be keeping up to date on the latest NRMP data. The best resource you can find is someone who recently went through the process.


The Interview Process

Getting interview invites is a stressful experience. It is a big waiting game, and they will email you while you are in the middle of your work day and expect a quick response or else your spot may be taken by someone else. Now add to all of this that you want to get interviews at the same institution (and possibly even go to your interviews at the same time!) and it can be extremely tricky. Thankfully, getting invites is where couples matching can actually help you.

If person A gets an interview invite at a program, it can prompt person B to email the program director of their respective program in the same city and tell them that they are both interested in coming to that city. There are some programs who will bite and some that will not but adding one or two extra common cities to the rank list can be a huge boost to your chances. Sending the email cannot really hurt you if they were not going to invite you anyway. It can also be a way to get off of a wait list. While going through the process we were able to get at least 2 additional interviews this way.

Of course, do your best to schedule interviews together so that you can explore cities together and decide where would be a good match for both of you. Getting on and talking amongst people in your class can be ways to trade interview dates if needed though it is hard to do. Just know this will not always be possible so make sure to take notes on the programs you visit. Even just one or two sentences can help you later on. An important point to remember is that even if a program is not high on your individual list, it may end up being high on your joint list.


The Match List

There is no best and obvious way to do this. We found it best to each make our own individual “dream” lists first.  You can start this process throughout the interview trial and adjust the list as you go to new places. At the end of interviews we took our final “individual” lists together and tried to match these lists up. This is also where you need to decide how much to compromise. Start this process soon after interviews are over and re-evaluate it often. The list takes time to iron out and however it starts is not likely how it will end up. We found that it helped that each of us had a few important factors that were most important to us (examples included being at a large academic program and weather of the city) and in the end although our final top choices were not what either of us would have guessed at the beginning, our choices were consistent with our top program factors.

When making the list, the easiest thing to do is to put all your geographically nearby choices first. Next, the combinations where you are further away from each other. Then finally the choices where one person does not match. The caveat is if there is a program low enough on your individual list that you would rather not be at the program even if your couple will be there with you. As always if you would rather not match than be at a program, do not put it on your rank list.



  1. At the core of deciding to couples match is your relationship
  2. Your chance of matching is in no way hampered by couples matching
  3. You are less likely to match at your desired program
  4. The mechanics are very simple with very few stipulations
  5. Focus on large cities with multiple programs to maximize chances of being close to each other
  6. Email program directors if one of you has gotten an invite in a city but the other has not. You may get an extra interview invite this way
  7. Start the rank list early and re-evaluate often

About the Authors

Nikhil Agrawal and Kirsty Hillier started dating while medical students at Ohio State University in 2010. They couples matched into Plastic Surgery and Pediatrics, respectively, at Baylor in Houston, Texas. After seven years of dating they married and now support each other through their toughest residency years.


NRMP Website About Couples Matching:


This Post Has 2 Comments

  1. Tanner

    Very helpful article, thank you!

  2. chaudhry saab

    a quick question on pairs, lets say after 10 combinations we decide to go with partner 2 not matching and put no match code with partner one’s last 5 programs. after that same thing partner 2 ranks his programs with no match code on partner 1 list. the question is what if at # 11 one partner match with the no match code of other partner, would computer stop matching him because he chose no match code and would not process the list further more?

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