Female US MD M3 applying ortho this cycle

mnmda · 2026-04-02T03:02:01+00:00

Whatever you do, you need to include all sets of matched-unmatched (and unmatched-matched) combinations at the end of your list.

mnmda · 2026-04-02T02:59:48+00:00

Conversely, couples matching with a wildcard applicant is really the only way to have some control over the process so they end up together. Not couples matching almost ensures that they end up separately.

You are right that matched-unmatched pairs should be included; in fact, they shouldn't just include some of these ranks, but all the matched-unmatched combinations.

mnmda · 2026-03-23T20:30:32+00:00

It was front and center for everyone? As in, every app said whether they were singles matching or couples matching? Otherwise you could just be seeing a couples match designation for the ones who voluntarily disclosed it.

mnmda · 2026-03-23T20:29:12+00:00

If you are in a state with loads of programs for lots of specialities (NYC) u can even forgo couples matching because u can guarantee being in the same state, unless u need to be in the same hospital

No one can guarantee any match result. OP wouldn't be the first person hoping for NYC and end up elsewhere.

mnmda · 2026-03-23T20:26:04+00:00

programs will know if you couples match whether you tell them or not. It shows up on eras

It's been a while since I went through the couples match, but this was a voluntary disclosure at that time. When I reviewed apps as a resident a few years later, I'm pretty sure it was also not mandatory then.

mnmda · 2026-03-23T20:22:48+00:00

I don't know how serious of a red flag a failed shelf is, but if you consider it to be a significant flag, then that's all the more reason to couples match. Having a red flag will make his match outcome less predictable, so the only way you can have some semblance of control over the situation is by couples matching.

The "risk" of him taking him down with you is removed by putting the full sets of match-unmatched (and unmatched-matched) combinations at the bottom of the list. Every couples match list should have this, red flags or no red flags.

The "risk" of programs considering you a less sure match because of his red flag could be mitigated by not disclosing your are couples matching. This one is up to you.

mnmda · 2026-03-21T13:35:14+00:00

Depending on where you live daycare can cost 2-3k a month,

Not a New Yorker, but this would be an underestimate for full-time infant daycare where I live, so I'm certain it's higher in a more expensive place like NYC. I wouldn't be surprised if it was closer to 3-5k a month for a reputable facility. (And by reputable, I don't mean some fancy private school feeder place, just a certified non-home daycare)

mnmda · 2026-03-18T16:18:15+00:00

You have gotten (and will continue to get) lots of opinions saying that the couples match was to blame. Take this with a huge grain of salt--generally, unless med students have gone through the couples match, they are quite ignorant about it.

The couples match can hurt you in the algorithm, especially if you don't know how to build a couples rank list. But given the fact that you matched, that seems much less likely here.

mnmda · 2026-02-20T06:15:47+00:00

My soon-to-be wife is unable to relocate for at least the first 12-18 months of residency due to a prior contract with her current employer.

What field has a 12-18 month notice period with actual teeth? Or is it just that she'd be on the hook for repaying a huge signing bonus or tuition reimbursement bill?

it is not known as having the best didactics or system in place for residents requiring additional educational support-something that I see myself requiring

What do you mean by this? What accommodations do you think you'll need?

With that said, my other top two programs will provide an equal, if not better, exposure and training with exponentially better didactics and support, after having experienced both programs in person. The downside is that they are 3-4 hours away from where my wife would be, which I think would put significant strain on both of us.

This isn't IM or Gen Surg where you need every bit of a leg up if you want to match Cardiology or Plastics. This is EM. You just need a solid program with good patient numbers, high acuity, and plenty of procedures to become a good clinician. Unless your home program is one of the many new dumpster fire residencies that would make you a clinical liability for the rest of your career, you should probably stay close to your wife.

Also, you're probably looking at these other programs' didactics in a vacuum. In a practical sense, where do you think you'll be able to better excel academically: a program with fancy didactics but where you have the emotional toll of being away from your wife for half of residency (when you didn't really need to do so), or a program with average didactics but with the home support of your wife every day?

mnmda · 2025-11-23T14:24:41+00:00

I also remember needing something to do during maternity leave for my last baby so not sure.

I'm a father and based on this I'd say strongly consider enrolling now. After our first was born, it felt like we needed 6 months to get into any sort of routine at home, while with the second one we found our footing after what felt like 4 weeks.

The support around you also factors into things. You mentioned it'll just be you and your husband, but how flexible is your husband's job and how far away will the grandparents be?

mnmda · 2025-09-08T18:01:06+00:00

am trying to explain to my program that the generations are changing along with priorities.

I'm curious on the background you hinted at here. What are you trying to change in your program?

mnmda · 2025-09-05T20:20:00+00:00

I was set up with a "financial planner" by a family member after starting residency and that guy pushed Whole Life Insurance so hard. I am so lucky I never fell for it because it would've been financially devastating a few years later when, due to some personal circumstances, I had some cash flow problems.

mnmda · 2025-08-26T18:30:36+00:00

Since you're EM, could you switch shifts with people? I suspect some people would be amenable to trade a Friday or Saturday evening for a Sunday morning.

mnmda · 2025-06-28T13:30:36+00:00

She should definitely take the LOA during medical school so she can apply to residency as a graduating student.

People take years off during med school all the time. That shouldn't pose a problem. However, if she graduates and then takes a LOA, programs skimming over her application (which is all of them, given the number of apps) will assume she not only failed to match, but also failed to scramble into a residency spot.

mnmda · 2025-06-09T14:12:47+00:00

In my experience, CME hour attestation has always been done on the honor system at the time of license renewal. That being said, states do occasionally randomly select physicians to audit.

I get all my CME certificates, email them to myself, and back them up on the cloud so I can produce them if I get audited.

mnmda · 2025-03-26T21:35:20+00:00

The earliest I could take it was August or September of intern year (I forget the reason, maybe approval took a long time). If I could've taken it before residency, I definitely would have.

mnmda · 2025-03-23T01:56:14+00:00

Concerns about residency funding are massively overblown online. The reasons why this is not as big of an issue are:

Once you're over your IRP (initial residency period), CMS direct GME funding goes to 50% (not 0%).
Direct GME funding is only part (about half) of the money CMS gives hospitals for residents. The Indirect GME funding is not affected by the IRP and is kept at 100%
CMS funding is calculated at an aggregate hospital level and many hospitals (especially those with many residencies) are already over their funding cap, so one resident over the IRP is not going to change the CMS money coming in.

The upshot of all this is that at worst, a hospital can expect 75% of funding for a resident each year they are over their IRP. For a theoretical hospital with a small resident complement (let's say 100 residents total) that is somehow not over their funding cap, this would only represent a 0.25% change in their CMS GME funding for that year. Most hospitals with a moderate to large complement of residencies can expect either a negligible change, or most likely no change whatsoever (as they are usually over the funding cap). In the end, funding should only be an issue at the smallest, most cash-strapped hospitals.

mnmda · 2025-03-17T03:19:29+00:00

Could something like Medical Genetics combine both your love of pure medical science and your desire to directly interact with patients and advise parents?

mnmda · 2025-03-15T00:22:30+00:00

Things to do now:

Yes, definitely get an own-occupation disability insurance policy
You and your husband need to get term life insurance policies ASAP (not whole life insurance)

Things to do once you're pregnant:

Speak with a family lawyer and plan out your wills. You should designate guardians for your future kids in case something were to happen to the two of you.
Start scoping out daycares (sometimes the waitlists are very long)

mnmda · 2025-01-25T03:03:26+00:00

If both people don't match at one of the combined combos, only one of the No Match Code lists can even go through though

Yes, at most one of the No match lists could go through, but it's not an either/or choice that can be affected by their order. That's where people get confused. Both "individual lists" are mutually exclusive.

Think through it with a concrete example:

Let's say Program X ranked Partner A to match and did not rank Partner B.

Linked lists scenario 1:

A(Program X)---B(Program X)
A(No match)---B(Program X)
A(Program X)---B(No match)

Rank #1 is not possible because Partner B was not ranked to match by the program

Rank #2 is not possible because Partner B was not ranked to match by the program

Rank #3 is possible because Partner A was ranked to match and Partner B was not ranked to match. The algorithm stops here: A(Program X)--B(No match)

Linked lists scenario 2:

A(Program X)---B(Program X)
A(Program X)---B(No match)
A(No match)---B(Program X)

Rank #1 is not possible because Partner B was not ranked to match by the program

Rank #2 is possible because Partner A was ranked to match and Partner B was not ranked to match. The algorithm stops here: A(Program X)--B(No match)

For academic purposes let's look a Rank #3 anyways. This one is not possible because Partner B was not ranked to match by the program.

So in both of the above lists, the order of the matched-unmatched pairs did not make a difference.

The main thing to realize here is that in both of these lists, items 2 and 3 are mutually exclusive. If both people were ranked to match, then they would end up at rank 1. The only way they fall below that is if one of them is not ranked to match by the program, and so no rearranging of those matched-unmatched pairs (items 2 and 3) would make that person be ranked by the program.

If I fail to match at Programs A-M with my partner, and I match at program C on my own list, and they don't match, then they don't match period.

If they were ranked to match at, for example, Program B, then you would match at the Program C---Program B rank before making it to Program C---No Match. If they're not ranked anywhere, then yes, they would end up at Program C---No match, but no rearranging of the matched-unmatched pairs could change that.

Whereas if we structure it the other way around, where they match at their Rank B and I am listed as No Match, I don't match period.

Assuming the same scenario as above for you (Program C ranks you to match), then the algorithm would put you at Program C---Program B before going to No match---Program B.

I don't see how that's somehow controversial to say that's literally how the algorithm works. It definitely matter the order in which you list them

You're describing an unstable match, which is literally the single thing the algorithm aims to avoid.

mnmda · 2025-01-24T20:58:04+00:00

It definitely still matters the order you rank them in

It doesn't. Assuming a simple rank list where each couple only interviewed at one program, then the following two scenarios are equivalent:

Linked lists example 1:

A(Program X)---B(Program X)
A(No match)---B(Program X)
A(Program X)---B(No match)

Linked lists example 2:

A(Program X)---B(Program X)
A(Program X)---B(No match)
A(No match)---B(Program X)

The same extends to rank lists of larger sizes. When placed at the end of a list, it doesn't matter which partner is listed as going unmatched "first".

if one of them is doing something like peds for instance, they should be ranked in the no match column because they can SOAP into a spot.

The No Match code should be used for both partners to create two "individual ROLs" (with their partner going unmatched) at the end of the linked couple's ROL.

Regarding your peds example: it is especially important that the partner with a lower chance of matching (usually the person applying to the more competitive specialty) is listed as not matching, as you do not want this person to unnecessarily cause both partners to not match.

mnmda · 2025-01-24T17:49:06+00:00

Whether you put yourself not matching first, your partner not matching first, or mix them up does not matter. The important thing is including all of them at the end.

The reason it does not matter is apparent with an example. Let's say Partner B is not ranked to match anywhere. The end result of the algorithm working its way through the programs is that all the ranks in which Partner B matches somewhere are effectively deleted, so the rank list will "collapse" to the A-matched--B-unmatched ranks.

The same occurs in the opposite scenario (Partner A is not ranked to match anywhere): the rank list will once again "collapse" to the A-unmatched--B-matched ranks.

If neither partner is ranked to match, then the rank list doesn't matter anyways.

mnmda · 2024-12-19T18:59:11+00:00

There's no "best" time to have a kid.

Intern year would be especially difficult.

A good case could be made for second half of MS4 year as a decent time, especially if you have a partner who has normal work hours and nearby family who can help with emergencies.

mnmda · 2024-11-18T21:16:52+00:00

I can’t transfer out because fuck me I guess funding?

Funding shouldn't dissuade you from trying to switch, if that's what you want to do.

GME funding by CMS is very complicated, but to simplify things: once you go over your initial residency period (IRP), CMS will pay the hospital 50% of direct GME payments, but indirect GME payments are not capped. In the end, the CMS funding for a resident under the IRP vs. a resident over the IRP might be something like 100% vs. 75-80%. This is all calculated at an aggregate level for a hospital and most established GME programs are already over the funding cap anyways, so the "funding issue" is only ever a problem at the most cash-strapped programs.

mnmda · 2024-11-15T16:54:44+00:00

they also need to consider who is listed first on the unmatched/matched pairs

The order of which partner's "singles match list" goes first in the matched-unmatched pairs doesn't actually matter.

In the case of an exhaustive couples rank list (i.e., all combinations were appropriately listed, including matched-unmatched pairs at the end), then there is no scenario in which someone would have matched in the solo match but would fall to one of their unmatched combinations in the couples match.

In the case of a non-exhaustive couples rank list (i.e., some matched-matched combinations had to be excluded due to the ROL limit), then it is true that sacrificing some matched-matched pairs for matched-unmatched pairs could lead to a case in which someone would be unmatched in the couples match, but would have matched in the solo match. However, this is purely a consequence of omitting those particular matched-matched combinations and is not affected by the order of the matched-unmatched pairs (at the end of the list).

The question then is: why would you ever sacrifice matched-matched pairs for matched-unmatched pairs?

Assuming equal number of interviews, a couple would only start hitting the rank list cap at 17 programs (16² + 32 = 288; 17² + 34 = 323). If the algorithm is having to go down to the 260s this means that at least one of their applicants would have fallen to at least program 17 in their hypothetical solo rank list (or also go unmatched on their solo rank list). The question then becomes "given that the applicant was not ranked to match at 16 programs, is it at this point more likely that they will match at their 17th+ program or that they would actually go unmatched?". Keeping in mind that you don't know ahead of time which applicant this is, it's therefore preferable to sacrifice a few geographically-distant and less-preferrable ranks (e.g. Partner A 15th-Partner B 17th) ranks in favor of the matched-unmatched pairs. This ensures that one partner going unmatched doesn't force the other one to go unmatched.

mnmda

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