Recently my boyfriend accepted a job 4 hours away from where I'm going to medical school so it looks like we will be doing some long distancing. We plan on getting married- we've been together since college and have known each other since elementary school, but his career choice (an engineer) has put some constraints on where we will be able to live, especially early in his career. While I would love to stay in the city I am currently going to school in for residency and we both have deep personal ties to the area in the Midwest where I am currently going to school, it is not an optimal place for my significant other to get a job. There are a few cities in the Midwest where he might be able to get a job, but his prospects would be better in places like the West Coast, Texas, and Boston. I have no connections (personal or academic) to any of the major cities he would be able to get a job in, even in the Midwest. I do not know how I can explain to a program in a place I have no connections to why I want to leave the place I have called home for basically my entire life when my only significantly compelling reason will be I need to be in an area my significant other, likely spouse by then, can get a job. I definitely want to do IM- not sure about whether I want to do a fellowship yet because I do love primary care. Are IM residencies geographically biased- ie do they generally only look at people with ties to the area? Is there a way to stand out without significant connections to residencies outside the midwest area? I am fine with moving away from where I currently am to be with my significant other. I have been a midwesterner all my life and would welcome a change of scenery as well so moving somewhere unfamiliar would not feel like a sacrifice on my part.