The importance of couples matching for medical residents (it's missed where it's missing)

 One of the successes of the design of the NRMP Match for medical residents is that it accommodates couples, using the Roth-Peranson algorithm*.  Here's an article reflecting on the fact that the Ophthalmology and Urology matches are done outside of the NRMP, and don't have a couples match.

Massenzio, Samantha S., Tara A. Uhler, Erik M. Massenzio, Emily Sun, Divya Srikumaran, Marisa M. Clifton, Laura K. Green, Grace Sun, Jiangxia Wang, and Fasika A. Woreta. "Navigating the Ophthalmology & Urology Match with a Significant Other." Journal of Surgical Education (2022).

"• There is an increasing number of couples applying for residency

• Ophthalmology and urology applicants cannot utilize the NRMP Couples Match system

• A Couples Match is highly desired by applicants to these two specialties

• The lack of a Couples Match is a deterrent to these specialties for some applicants

• Systems to aid applicants to these specialties with significant others are needed"

...

"The Couples Match is currently not offered to applicants to ophthalmology or urology as these specialties utilize separate match systems outside of NRMP - the San Francisco (SF) Match1 and Urology Residency Matching Program,2 respectively. Historically, the NRMP implemented the match starting in 1952 for internship programs (postgraduate year 1) only. Individual specialties later established their own systems for matching to advanced training beyond internship; for ophthalmology this occurred in 1979, and urology in 1985. While other specialties have since merged their match processes with the NRMP, ophthalmology and urology continue to facilitate their own match.3, 4, 5

"Ophthalmology and urology also have an “early match,” with match results released in January or February versus in mid-March for applicants using the NRMP. This was historically advantageous because of the preliminary internship year required for both ophthalmology and urology, allowing applicants to rank their preference for internship year in the NRMP based on the outcome of their specialty match. However, as of 2021 and 2019, ophthalmology6 and urology7 respectively transitioned to an integrated or joint internship model, meaning that an internship position is secured at the same time as the specialty match. Given these changes, it is currently timely to evaluate applicant viewpoints on the Couples Match.

...

"Survey Findings

"107 respondents reported having a significant other in medicine (72 ophthalmology, 35 urology), making up 31% of all respondents. 68 (64%) significant others applied in the same cycle as the survey respondent, 11 (10%) applied before, and 28 (26%) will apply after. If the Couples Match had been available, 78% of respondents with a significant other who applied in the same cycle reported that they would have participated.

...

"The lack of a Couples Match is a deterrent to ophthalmology and urology for over one-fifth of applicants with a significant other. Of applicants’ partners who considered ophthalmology or urology, over one-third reported to have been deterred. These findings suggest that for many students who want to be in the same location as their partner in medicine, ophthalmology and urology are specialty choices that may be less desirable toward this end. It is unclear how this impacts efforts to foster more diversity (in terms of gender, race, and other factors) in these specialties.

"The inability for ophthalmology and urology applicants to use the Couples Match adds significant stress to an already difficult application season with survey respondents commenting on the negative mental health effects. In addition, there is currently no official avenue for ophthalmology and urology applicants to communicate a desire to match in proximity to a significant other. Although applicants found methods to overcome this barrier, such as by mentioning their significant other during interviews, a majority indicated that there were times that they were hesitant to discuss their significant other out of concern that it would negatively affect their chances of matching, with female applicants disproportionately affected.

"Regarding the early match, most applicants liked receiving match designations sooner; however, there are mixed responses as to whether or not this timeline is helpful for individuals with a significant other in medicine. The authors are aware that a benefit of the early match for ophthalmology/urology applicants is that a significant other applying through the regular NRMP match has the opportunity to selectively contact programs in the vicinity of the applicant's matched program to express heightened interest. Disadvantages to the early match include that once the ophthalmology/urology applicant matches, their significant other has a limited number of programs in the vicinity to choose from - this is in contrast to a Couples Match where any pair of programs in any location may be ranked. This may also be exacerbated by recent efforts to limit the number of applications submitted or interviews accepted by each student.16, 17, 18 Further, the early match does not help individuals whose significant other is also applying to ophthalmology or urology as they would not be able to take advantage of the difference in timeline between partners. It is presently very challenging for a couple who both want to apply in the same year to ophthalmology or urology to be able to coordinate their match outcome to the same location."

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*Roth, A. E. and Elliott Peranson, "The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design," American Economic Review, 89, 4, September, 1999, 748-780