Out-Ranking Couples Matching

Anna Piazza - Feb 14, 2019

Matching into a residency program that meets your every criterion, from its location to the growth opportunities it offers, requires hard work, lots of research and perhaps a touch of luck. Matching into that same program together with your significant other, however, raises the already high bar significantly. But it can—and has—been done. With meticulous planning and plenty of patience, Jocelyn Bowker and her husband were able to successfully couples match just last year; now, she tells us just how they pulled it off.

Regardless of whether or not you’re couples matching, you likely have been busy reviewing the programs you’ve interviewed for, skimming each one’s pros and cons and stewing over how to rank your top choices. With Rank Order List certification right around the corner, the pressure is on to finalize that list. But if you’re (crazy enough to be) couples matching, you’re really feeling it right about now!

My husband and I (fiancé at the time) successfully couples matched into Internal Medicine and Family Medicine, respectively, just last year. We thought we’d share our story with you as well as a few tips that, we feel, allowed us to be individually “successful” in The Match while still couples matching. We also wanted to remind you that while The Match is stressful no matter who you are, it WILL work out in the end!

So much has changed in the year since we’ve matched, though it feels like only yesterday we were meticulously making our rank list. We remember all too well how nerve-wracking it is, not only to make the list, but then to actually certify it. Below are a few things to consider while creating your own.

Decide what’s important for you AND your partner

There’s no doubt you have both worked hard to get to this position. Four years of undergrad and three years of medical school, all the studying, exams, hours in the lab, frustrations, tears, stress, sweat and blood (!) are about to pay off. So remember: the couples match is just that, a couples match. You should be going into this with the understanding that there will need to be compromise (and trust) in order for you both to be successful.

Communicate honestly and clearly

Communication is key to ensuring you both end up matching into programs that are a good fit. For example, for me, fit was important—that feeling that it was the right program. Not only did my programs have to be well-rounded and provide true, full-spectrum Family Medicine, I felt I needed to connect with both the residents and the faculty, too. While some of my requirements changed throughout the interviewing process, that desire to find my program was always most important to me.

On the other hand, my husband was looking for larger, university-based (or solid community-based) programs that set up their residents to be successful when it comes to fellowship matching. Obviously, well-being and happiness, as well as training quality, were important to him. However, he was more indifferent when it came to the warm and fuzzy feelings.

Devise a strategy

Our strategy took the form of a three-tiered list. First, his university-based programs, then, community-based programs with success of matching residents into fellowships and finally, smaller community-based programs.

[Disclaimer: In no way are we saying that community-based programs are inferior to others. This was our preference and what was important to us. Your list might be completely different. There are a lot of advantages and disadvantages to both, and one type is definitely not superior to the other. This is a personal preference and one that should be heavily considered when applying and interviewing.]

Create match combinations by listing all the permutations

Once you have the priorities hashed out and an idea of your individual rank lists, start to make your couples match list. I would recommend using a spreadsheet while forming this initial list. This way, you’ll be able to clearly see everything and move things around. I also recommend starting to form your list based on how you decided what was important for each. For us, there could be one to three FM programs for every one IM program. Our list reflected just that:


His program #1 – Her program #1 city A

His program #1 – Her program #2 city A

His program #2 – Her program #3 city B


His program #5 – Her program #7 city F

His program #6 – Her program #8 city G


His program #1 – Her program #4

His program #5 – Her program #1

No match – Her program #1

His program #1 – No match

We first listed all of our programs in the order in which both of us match. Then, we started permutations with him at bigger programs and me within driving distance, then flying distance with large airports and so on. Finally, we needed to decide whether or not we wanted to make permutations with one of you not matching—ex: me at my top program and him not matching or vice versa. Again, depending on what you established as your priorities for this match, you and your partner may opt to include these permutations further up on your rank list or not at all. This is a personal decision. In the end, we did include “no match” for both of us, though these were far enough down our rank list that—based on the number of permutations and programs—we felt safe. With that said, we knew that if it were to happen, we would have accepted. Ultimately, we had about 80 combinations or “ranks.”

Check your match combinations

Here’s the catch to this strategy: you cannot have two permutations that are the same. For example, having your #5 rank as: His program #5 city C + Her program #6 city C, and then further down in your #18 rank spot: His program #5 city C + Her program #6 city C (the same thing).

Why is it important to catch this potential error? Because if don’t catch it, the algorithm will discover it and deem your list erroneous and won’t include you. AKA, you will not match. Yikes. So, make your list, check it. Recheck it. Have someone else check it. Then check it again.

Fill your list

Once you have finalized your rank list, transfer it into the official NRMP site. You and your partner must each do this separately, so sit down together and be meticulous. My husband and I made our list early, then certified. Then a few days later, we triple checked everything to make sure it was perfect. Once you certify, you can make changes and re-certify up until the deadline.


There is nothing more for you to do once that list is certified, so relax! Celebrate, even! You’ve killed all the interviews (or maybe feel like you survived them), paid for all the travel and ate all the food. You’ve worked your butt off for three and a half years to get to this moment. There’s nothing else to do besides enjoy the rest of your time in medical school.

Match Day 2019 is Friday, March 15th and it will be here before you know it—but all that hard work and stress will surely have paid off. My husband and I were fortunate to have matched into our #1 rank and we could not be happier at our respective programs. I truly believe we all end up where we are supposed to, even if it’s not where you thought you would be. We wish you all the best of luck in The Match 2019. Can’t wait to see where you end up!

Head over to Jocelyn’s Instagram page, @dr.j_bowker, to message her with any questions and to follow along during her intern year.



Jocelyn is currently an Intern at the University of Arizona College of Medicine Phoenix Family Medicine Residency program. She is passionate about Primary Care and Women’s Health. In her spare time, she enjoys exploring new hiking trails with her husband and fur baby, Jordy.