I don't know. But it helps to hear people's experiences.
Hey bear, here's my experience. I'm applying to radiology and my spouse is applying to a small ultra-competitive specialty. Radiology is the least competitive specialty these days in terms of match rate of applicants (close to 100% of US MD seniors). My spouse's specialty, in comparison, is one of the most competitive specialties, with an average US MD applicant applying to over 50 or 60 programs and still have an unmatched rate in excess of 20%.
Initially, one of my advisors told me that I was a strong candidate and I could stay at the program if I wanted to so I should just apply to a handful of programs that I would conceivably be willing to go to other than my home institution. So simple. But that would be the story if I were applying alone. My spouse is also a strong candidate, but that field is so dramatically different in competition. We heard anecdotes of strong applicants with bad luck in that specialty. A 250/AOA/5 pubs US MD couples applicant who ended up matching to their 15th rank. A 268/AOA/5 pubs applicant applying alone to only 15 programs who went unmatched. A dean at school cautioned that when faced with a situation where interview dates conflict (which is common in such a small specialty where each program has only a few dates), don't always choose the more prestigious institution; a student did that some years ago went unmatched even though she had great credentials. When each program gets in excess of 400 applications, I have heard of program directors going through applications with extreme prejudice, taking less than 5 minutes to look at each application, filtering by AOA only, delaying review of the application of anyone who is not a US citizen, etc. Similarly, in one surgical field this year, I heard program directors colluded to require program-specific paragraphs in each personal statement, solely in order to reduce the volume of applications each program has to review.
So we looked at the numbers for that specialty from the NRMP: median applications, median interviews, and chance of matching for a given number of contiguous ranks. We looked at stats that SDN users posted in previous years. We looked at the reputation rankings for that specialty and for radiology. We added those together to make a super-rank list.
I applied to nearly 40 radiology programs. As rads is an advanced specialty, I also shelled out for 25 prelim or transitional year programs across 7 of our top cities. At this point, I have scheduled 15 rads interviews out of our top 20, and 8 interviews out of the rest, plus 8 prelim/TYs. I'm grateful that I won't be the limiting factor in this situation, but it's going to cost a pretty fortune. I applied for more federal loans. I would love to cancel some but cannot do so in good conscience yet because my spouse's specialty has yet to release interview invites.
I just canceled one low on my list because I just went to an interview at another much better program in the geographic vicinity that gave me lots of positive vibes, and a few days later my spouse received a rejection from the lower tier institution. Coincidence or causation, I'm not sure. I did read on the ask-a-program-coordinator thread of an instance where a program ended up not ranking an applicant altogether after they found out the applicant's spouse canceled an interview at their institution.
Meanwhile the older people I talk to in rads don't entirely grasp what it's like in the other specialty and the complications it brings to my application strategy. I'm getting pressure from my research advisor who tells me I'll get in everywhere and it's a waste of my time to go to so-and-so mid-tier institution. He means well but I surmise a vested interest of his is also to see that I have more time to work on research.
I don't want to complain too much about my first-world problems. I am grateful that the Couples Match exists. I am grateful that my spouse chose a specialty that participates in the NRMP (ie not ophtho or urology). I am grateful my specialty is at a historic nadir in competitiveness. I am grateful that my spouse is a strong applicant. I am grateful that I have advisors and letter writers who I can count on to make calls if we need it. I am grateful that the few programs I've interviewed with have already said they would contact my spouse's specialty's program at that institution in order to advocate for us. I am grateful for the vacation and research elective time built into our fourth year curriculum. I am grateful for fixed interest government loans. I am grateful for TSA pre-check. I am grateful for mileage rewards credit cards and frequent flier miles programs. I am grateful for Uber and Lyft driving down prices and waiting times for transportion. I am grateful for acquaintances who let me couch surf. I am grateful for the opportunity to visit many different cities, institutions, restaurants, and old friends.
