An In-Depth Guide to the Couples Match for Residency

Matching into residency is stressful enough on your own. For two applicants hoping to train in the same area, there’s the added challenge of coordinating two career paths while navigating one of the most competitive processes in medicine.

The National Resident Matching Program (NRMP) allows applicants to participate in a Couples Match, linking their rank order lists (ROLs) so the algorithm evaluates their preferences together. While some applicants hope to train at the same hospital, others simply want to match in the same city or within commuting distance to complete medical residency near one another.

Because this process works differently from the standard Match, it requires additional planning when creating and ranking programs. In this guide, I’ll explain how the process works, how to build a strong paired ROL, common mistakes to avoid, and what happens if one or both applicants don’t match.

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What Is the Couples Match?

The NRMP Couples Match allows two residency applicants to link their ROLs so the Match algorithm considers their preferences together. Instead of evaluating each applicant’s choices separately, the algorithm looks at paired program combinations to determine the best possible outcome for both applicants.

The goal is not necessarily for both partners to train at the same hospital. Couples can decide what matters most for their situation, whether that means:

• Match at the same residency program.
• Match at different residency programs within the same hospital system.
• Match at different institutions in the same city.
• Match within commuting distance of one another.
• Prioritize one partner's preferred program while keeping the other nearby.

As every couple has different priorities, your linked ROLs should reflect what works best for both of your careers.

Applicants can also participate in a Couples Match even if they are applying to different specialties. There is no requirement for both applicants to pursue the same field, even if they’re both targeting competitive specialties.

For example, one applicant may be applying to neurology while the other is applying to pediatrics. Other applicants may pair specialties such as neurosurgery and ophthalmology or urology and internal medicine. The Couples Match allows both applicants’ residency preferences to be evaluated together, even when they are pursuing different specialties.

Who Can Participate

Any two applicants participating in the NRMP Main Residency Match may participate in the Couples Match. Applicants do not have to be married, engaged, or in a romantic relationship. Friends, siblings, or any two applicants who want to coordinate where they complete residency training may also participate.

To participate, both applicants must register through the NRMP’s Registration, Ranking, and Results (R3) system and link their applications. Once linked, they can submit paired ROLs that allow the Match algorithm to evaluate their residency preferences together. This process is covered in more detail below.

How the Couples Match Works

Although the Couples Match follows the same overall Match timeline as individual applicants, there are a few additional steps you'll need to complete before certifying your ROLs:

1. Register for the NRMP Match. Both applicants must register for the same NRMP Main Residency Match through the R3 system before participating in the Couples Match.
2. Link your accounts. Once you've both registered, one applicant initiates a Couples Match request through the R3 system, and the other applicant accepts it. Your Couple Status will display as Accepted once the request has been completed and both applicants have paid the required Couples Match fee.
3. Build linked ROLs. The biggest difference between the Couples Match and the standard Match is how your ROLs are created. Instead of submitting two separate lists, every residency on your list is paired with a residency on your partner's list. The NRMP algorithm evaluates these program pairs and attempts to place both applicants into the highest-ranked pair.

As you make your lists, pair programs strategically. You're allowed to pair the same residency program with multiple programs on your partner's ROL. This is a common strategy for applicants who strongly prefer one residency while giving their partner several nearby options on Match Day.

What Is No Match?

When creating an ROL, couples can decide whether they are willing to accept an outcome where one applicant matches and the other doesn’t. The NRMP allows couples to include a “No Match” code as a ranking option for this situation.

The No Match code for residencies is 999999999. The No Match code for fellowships is 888888888.

If a No Match code is paired with a program choice and ranked high enough for the algorithm to consider it, one applicant may match while the other remains unmatched. Because most couples prioritize matching together, these options should typically be placed at the bottom of their rank lists after all preferred paired choices.

Without a No Match option, the couples matching process focuses on finding a combination where both applicants can match. If no acceptable combination is available, one or both applicants may not match.

Creating Your Rank Order Lists (With Examples)

Applicants participating in a couples match need to approach their ROLs a little differently than individual applicants. Each applicant creates their own list of programs, but those lists are evaluated together as paired choices.

Here’s an example:

Each ranked program is paired with the program at the same position on the other applicant’s list. In this example, the University of Miami and Broward Health create one paired rank. The University of Colorado programs create another.

The matching algorithm evaluates each possible pairing in order of the applicants’ preferences to find the highest-ranked combination where both applicants can match.

When building your ROLs, the goal is to include every realistic program combination that you would genuinely accept. Don’t rank programs you wouldn’t want, but avoid limiting your options unnecessarily.

For example, if both applicants receive 10 invitations during interview season, there could be up to 100 possible program pairings. The NRMP allows up to 300 ranks, so many applicants choose to include every feasible combination that could work for both of them.

You’ll likely need to compromise when building your lists. Consider both applicants’ career goals, competitiveness, and geographic priorities. For example, if one applicant is a strong candidate for their dream residency in New York City but the other applicant doesn’t have realistic options nearby, the pair may need to decide whether that outcome is worth prioritizing.

I recommend listing the same preferred program multiple times to boost your chances of matching. Then your partner can rank different program choices alongside your preferred residency.

Here’s a second example:

If your ROL looks like this, you have a better chance of matching at Mount Sinai while your partner has multiple opportunities to match with a nearby NYU residency. However, this strategy only works if the other applicant still has viable nearby programs remaining on their list.

If all geographically reasonable programs are exhausted, Mount Sinai may not be a possible match unless the other applicant ranks a No Match code alongside that choice. In that situation, the other applicant would remain unmatched if the first applicant matched at Mount Sinai.

Again, the No Match code allows one applicant to match while the other remains unmatched. Because most applicants using the Couples Match prioritize matching together, No Match options should be placed near the bottom of the list after all preferred paired combinations.

Advanced and Supplemental ROLs

If you’re applying to an advanced program, each advanced residency listed on your Couples Match ROL must have an attached supplemental ROL for preliminary year or transitional PGY-1 programs. (You can also choose not to submit a supplemental list.)

Understanding how programs are structured by PGY level is important because advanced programs typically begin at the PGY-2 level. The supplemental rank order list is used to rank PGY-1 positions that provide the required first year of training.

The algorithm only considers a supplemental list after an applicant has matched into the linked advanced residency. The advanced residency and PGY-1 position are not evaluated as a single combined choice by the NRMP algorithm.

No matter how many advanced residencies you’re ranking, the supplemental list will need to be the same.

Applicants can rank up to 20 supplemental programs before additional fees apply. However, the NRMP counts each supplemental ranking across all attached advanced program lists.

For example, if you rank 10 preliminary programs on your supplemental ROL and attach that same list to three advanced residencies, the NRMP counts those as 30 supplemental rankings. Additional fees may apply once you exceed the allowed number of supplemental ranks.

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Common Mistakes to Avoid

Creating a Couples Match ROL takes extra planning, so avoiding common mistakes can help both applicants maximize their chances of matching in a location that works for them.

• Don’t rank No Match codes too high. A No Match code allows one applicant to match while the other remains unmatched. Because most applicants using the Couples Match want to train in the same area, No Match options should be placed near the bottom of the ROL after all preferred paired combinations. The exception is if both applicants agree that one person’s preferred outcome is worth prioritizing over matching together.
• Don’t rank too few programs, or be too picky. You both want to match. If you got an interview at a program where you’d be willing to complete a residency, include it on your ROL. You can rank it lower, but avoid leaving programs off your list unless you would not accept an offer there.
• Don’t limit your geographic options too narrowly. The Couples Match is designed to help two applicants coordinate their training locations, whether that means matching at the same institution, in the same city, or within commuting distance. Consider what geographic locations would realistically work for both of you, and think through your options if one applicant matches farther away than expected.
• Don’t forget to use all available ranks strategically. The NRMP allows up to 300 ranks. If one applicant strongly prefers a specific residency program, consider listing that program multiple times alongside every feasible option for the other applicant. Remember that the algorithm evaluates paired program choices rather than individual programs when considering a Couples Match.

Expert Tip: As you navigate interview invitations, remember that residency program directors evaluate applicants across multiple areas. That includes clinical skills, communication, professionalism, and other ACGME core competencies.

Average Success Rates

Participating in a Couples Match doesn’t guarantee that both applicants will match, but overall outcomes are similar to the broader residency Match. In the 2026 Main Residency Match, 93.0% of couples had at least one applicant match; 88.5% of couples had both applicants match.

Below is a breakdown of recent PGY-1 match rates:

• 93.5% of U.S. MD seniors matched
• 93.2% of U.S. DO seniors matched
• 93.0% of applicant pairs had at least one applicant match
• 88.5% of applicant pairs had both applicants match
• 67.8% of U.S. citizen international medical graduates (IMGs) matched
• 58.0% of non-U.S. citizen IMGs matched

In 2026, 1,258 couples submitted certified ROLs. Of those, 1,113 couples had both applicants match, 114 couples had only one applicant match, and 31 couples had neither applicant match.

While the Couples Match can make coordinating residency locations more complicated, these outcomes show that many applicants successfully match together. Creating a broad, realistic ROL and considering a range of geographic options can help improve the chances for both applicants.

A quick note: Both MD and DO graduates apply for residency programs through the NRMP.

What if One or Both Don’t Match?

If no acceptable paired rank is available, both applicants may go unmatched. Applicants who don’t match can participate in the Supplemental Offer and Acceptance Program (SOAP) during Match Week to apply for available residency positions.

A different outcome is possible if a No Match program code was included on the ROL. In that case, one applicant may match while the other remains unmatched if the No Match option is part of the highest available rank combination.

If one applicant matches and the other doesn’t, the applicants need to decide how to move forward. Some may choose to participate in SOAP. Others may consider reapplying in a future ERAS application cycle.

Applicants who reapply may also focus on strengthening areas of their application, such as clinical experiences, personal statements, and scholarly work.

Both applicants should discuss their priorities before submitting their ROLs. Decide in advance whether matching separately is acceptable, whether one applicant would consider taking a different path, and how you would handle every outcome.

Read Next: The ERAS Scholarly Work Section

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Get Expert Support for the Match

The Couples Match allows two applicants to coordinate their residency locations, but creating a strong paired ROL requires additional strategy and planning. From choosing programs to rank to understanding how different outcomes may affect both applicants, expert guidance can help you approach the process with confidence.

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