Applying to residency in a pair, often referred to simply as “ couples matching ,” is when 2 people link their residency applications together in the National Residency Matching Program (NRMP). For me, the idea of being able to not only pursue diagnostic radiology, but to do so with my partner by my side, was incredibly exciting. I sought out the help of the internet to see what was out there about diagnostic radiology applicants successfully matching with their partners or best friends, and was met with a lot of contradictory opinions and left with anxiety about the process.

After going through the 2023 to 2024 Electronic Residency Application Service (ERAS) cycle with my now husband (who applied and matched to combined internal medicine and dermatology), I have some of my own tales to tell! Here is everything I learned on my journey, and the advice of some program directors (PDs) I met along the way.

Note: If you’re looking for general tips on applying for radiology residency, the AMSER Guide to Applying to Radiology Residency is a must read, for couples matchers and non-couples matchers alike.

Tip #1: Plan Ahead for Signaling

Program signals are a newer addition to the residency application process that allow applicants to indicate their interest in a program with a limited resource. For the 2026 application season, diagnostic radiology provides 15 signals. As program signals are now a permanent fixture in ERAS, applicants should be using them to their advantage. During the months leading up to application submission, both sides of the couple should do their due diligence in figuring out what programs they are competitive for, what cities and regions have high concentrations of programs, and which programs may be a good personality or goal match. After applicants have a program wish list, they can come together and see where the intersections are; as much as possible, your respective signals should overlap, either by city or program . If both applicants love “program A,” they should both signal “program A.” If one applicant loves “community program in city B” and their partner loves “academic program in city B,” you each should signal those programs.

Applicants can also compare geographic program concentration across each of your specialties easily with Medmap.io ( https://medmap.io/specialty ), which allows you to map programs across the US and mark them with colored pins. Try to cluster signals around major cities to maximize signaled combinations, but always consider program competitiveness and individual preferences.

In the event of signal mismatch, in which one applicant has more signals than the other, the partner with more signals can either: cluster their signals around the partner who has fewer signals; or use their signals for additional programs that both partners would want to attend, understanding that the other partner may not be interviewed without a signal. This is very specialty dependent, and meeting with specialty mentors can help in selecting an individualized strategy for signaling.

Once both applicants figure out where the majority of program signals will be, cross-reference them with the ERAS geographic preferences list. The Association of Program Directors in Radiology showed data in 2023 demonstrating that alignment of geographic preferences and program signals works to the applicant’s benefit. That said, only signal programs that you truly have a preference for and identify geographic preferences in places where you want to live for 4 to 5 years.

Tip #2: Don’t Leave Preliminary Programs for the Last Minute

Couples matching into an advanced specialty is especially challenging since applicants also need to think about preliminary positions. The radiology applicant should select at least 2 to 3 preliminary programs for each of the signaled programs, especially if their partner is applying into a categorical specialty, where all residency training is completed in one program. Another strategy is to focus on preliminary programs near the applicant’s current location, to prevent 2 moves. While it’s not mandatory that you do that first year together, the intern year is hard and having a support system nearby is helpful.

After you start to hear back from advanced programs, email the preliminary programs in the area, letting them know that you are interviewing nearby and very interested in their program in the same city. Adding that you are couples matching also helps, and we will get into that in Tip #4.

Tip #3: Get on the Same Page

This one is short and sweet. When it comes time to push “submit” on your applications, sit down and run through the list together. I cannot tell you how important this is, as it is very easy to accidentally leave off a program code by mistake when you’re trying to line everything up with your partner.

Tip #4: Get an Interview, Send an Email

This is probably the most important tip I could give: don’t be shy about sending the couples match email! When you get an interview, reach out immediately to the PD and program coordinator (PC) of your program expressing your gratitude and excitement, and ask them to notify your partner’s program of your interview status. I never asked for my partner to be interviewed, as each specialty will be looking at applicants for their specific qualities, but rather, I asked my program to notify the other of my upcoming interview, to put my partner on their radar for review. Be sure to include the contact info for the other specialty’s PD and PC in this email to make communication easier.

In the case that my partner got an interview and I did not, I sent a variation of this email again expressing my interest in the program, stating that my partner was interviewing and asking to be considered for a position in the radiology residency. This process may feel like a lot at first, but we found that being direct helped to ensure that our couples match status didn’t fall through the cracks.

Tip #5: Bring Each Other Up

This one is slightly more controversial, but my partner and I found that programs were very receptive to hearing that we had an important person that we were going to prioritize in the match decision. If you and your partner have family in a specific city where you’re interviewing, include that in your response when interviewers ask: “Why this program?” The person interviewing you wants a resident who wants to be both at that program and in that city.

Additionally, when programs see you are couples matching on your application, they may ask about your partner’s specialty. I’d recommend having your answer ready and give a little background about why your partner is excited about their specialty. If your partner is applying into a particularly competitive specialty, you may sometimes encounter hesitation from the interviewer, but just remember that you are a team—you should be your partner’s biggest cheerleader. Your confidence in your partner is key in these interactions.

Tip #6: Rank Separately First, Then Come Together

Keep a separate, rank-order list (ROL) that’s hidden from your partner and have them do the same. Update it after every interview. To remember how you felt after interacting with each program, consider recording a short clip of yourself after each interview, or taking notes and creating a pros and cons list. Either way, you will have factors that are important to you when choosing a program, and you should weigh them as if you’re matching alone, at first.

You can use software like Couples Match Tool ( https://couplesmatchtool.com , created by a couple in medicine) to enter your lists in and combine them using factors such as average rank and distance. We elected to use all our possible combinations in order to maximize our chances of matching, since we felt some distance between us would be better than not having a job at the end of the process. We also opted to include match/no match combinations, in which one partner matches but the other does not, but that is something you need to decide as a pair.

We found the best method for us was to generate a list sorted by distance, then average rank. Combinations with zero distance were priority, and from there the average programs rating controlled the order. We also found it helpful to do some post-analysis in which we grouped combinations by distance of 25 to 50 miles, 50 to 100 miles, 100 to 200 miles, 200 to 400 miles, and so on, and then ranked combinations by average rank within those distance groupings. Our priority was to be physically in the same city; however, once we started to hit an hour and up of driving distance and flying distances, we took liberties with arranging the list not just by mileage, but program preference. For instance, if we dropped down our list and had to be 6 hours apart by car, we wanted to both be at our favorite programs to make that distance a little more bearable.

Tip #7: Rank-Order Lists

Creating keyboard shortcuts for each program code helped us to enter all the combinations once we finalized our ROL. In iOS, we created text replacements (Settings > Keyboard > Text Replacements) so I could type in “program” and auto-populate the NRMP code without having to worry about typos. You will need to enter a program code for each of the up to 300 combinations and make preliminary lists for each advanced program. This trick really saved my sanity. You also have the option to import in an Excel file of your list, which may be even faster. Duplicate combinations are not allowed by the NRMP software, but it is possible to accidentally transpose combinations, so we spent lots of time performing multiple checks of our ROL combinations prior to submission.

Match Day Reflections

Couples match is a difficult process, and my partner and I had plenty of misgivings about the possibility that we could end up across the country from each other. In March of 2024, the wait was over: my partner and I opened our match day letters and found out that we would be spending the next 5 years together in Philadelphia, Pennsylvania, in our specialties of choice. We continue to be so grateful to our mentors who advocated for us and supported us in our dream to train together in the same city, and we couldn’t be happier with where we ended up!

Important Links Mentioned in the Article

1. National Residency Matching Program

2. https://www.nrmp.org/residency-applicants/get-ready-for-the-match/couples-in-the-match/

3. AUR Resources for Applying to Residency

4. https://www.aur.org/applying-diagnostic-radiology-residency

5. Residency Explorer™ Tool

6. https://www.residencyexplorer.org/

7. APDR Quarterly Roundtable: Post Mortem on ERAS Program Signaling (2023)

8. https://youtu.be/swUY_-DGmWc?si=4c1wr9cHwKATdtzo&t=390

9. AAMC Geographical preferences

10. https://students-residents.aamc.org/applying-residencies-eras/publication-chapters/biographical-information#geographic

11. Residency Couples Match Rank List Tool

12. https://couplesmatchtool.com/