Couples match question

[Aesculapius]

Hello all,
My wife has graduated from an IM program 2 years ago and she has her heart set on Pulmonary/CC fellowship (it just didn't work out with respect to our life for her to apply straight out of residency). I am a practicing EM doctor, but getting a bit weary of the field in some ways, and also tired of seeing it become increasingly dominated by corporations. I have considered in the past doing a Palliative Care fellowship as a career change, so this might be a decent opportunity. However, I don't want to hurt my wife's chances of matching in any way. Is there a way for us to couples match that would allow that? Or perhaps would looking for a spot outside the match, or the following year be a better idea?

Thank you in advance.

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[Raryn]

Hello all,
My wife has graduated from an IM program 2 years ago and she has her heart set on Pulmonary/CC fellowship (it just didn't work out with respect to our life for her to apply straight out of residency). I am a practicing EM doctor, but getting a bit weary of the field in some ways, and also tired of seeing it become increasingly dominated by corporations. I have considered in the past doing a Palliative Care fellowship as a career change, so this might be a decent opportunity. However, I don't want to hurt my wife's chances of matching in any way. Is there a way for us to couples match that would allow that? Or perhaps would looking for a spot outside the match, or the following year be a better idea?

Thank you in advance.

Yes.

So we've gone over this any number of times on the forum, but a quick overview of how the couples match works. If you and her apply for two fields that share a match (which palliative and P/CC do), you apply independently. You have the option of telling programs you're applying as a couple, but you are not required to. Telling programs is a bit of a double edged sword - it may get programs that really like one party to try and get the other party and interview, but it may get them to avoid the whole kit and kaboodle.

Separately to the decision of whether to inform programs you're couples matching, you mark yourselves as a couple in the NRMP matching system. Again, no one has to know about this. Then you can put together a rank list, which consist of matched pairs of programs including the possibility of one of you going unmatched. That is, lets say you each have three interviews - A-C and 1-3. That means you could rank any of the below combinations, where X is one partner unmatched:

A1
A2
A3
B1
B2
B3
C1
C2
C3
X1
X2
X3
AX
BX
CX

There end up being (X+1)(Y+1) -1 combinations - where X and Y are the number of ranks for the two individuals. If you rank all of the above combinations, your individual chances of matching are identical to your chances had you not couples matched at all. Of course, the above combinations include combos where one/both/neither of you like your program and you're together/apart. Some of those combinations may not be preferred to one or the other of you going unmatched - for example, you may decide that a combination where neither of you like the program very much AND you're far apart is far enough from ideal that you'd rather go unmatched than take that. Well, you can just decide not to rank that program combination. And as long as you put the combos with you unmatched below the combos with her unmatched, her chances of matching don't change - they're mathematically identical to if she applied alone. Your chances would go down in that scenario though.