THE RESIDENCY MATCH IS

Every year in the middle of March, tens of thousands of graduating American medical students find out where they are going for their residency — and whether they will be whisked away from their families, friends, and romantic partners. For many relationships in which one or both people are in medical school, residency “Match Day” — which falls on March 17 this year — can be the end of another match. This mass breakup is happening to many of my own classmates, to students at medical schools all around the country, and to me.

For more than 70 years, the residency “Match” has been a unique but enduring aspect of medical training, pairing fourthyear medical students with a residency program at a hospital, where they complete three to seven years of grueling postgraduate training, supervised by attending physicians.

After applying to and interviewing at prospective residency programs, medical students submit a list, in order of preference, of where they hope to attend. Residency programs also rank the interviewees that they would most like to attend their program, and a Nobel Prize-winning algorithm — which is also used to match eighth-graders with their choices for New York City public high schools — generates the “most stable” pairings based on all the preferences entered into the system.

It’s hard enough to match at the place you want to train. For a couple to match together, whether at the same institution or even just the same city, is a major challenge.

On Monday of “Match Week,” tomorrow, applicants are notified of whether they have matched to a residency program at all. A few will go unmatched — the stuff of fourth-year medical students’ nightmares — and participate in a runoff process once known as the “Scramble” to try and find an unfilled residency spot.

At the end of the week, on Friday, is Match Day, when students open a physical letter or an email at noon notifying them of where they’ve matched and are contractually bound to attend. Unlike other career fields, there is no way to collect multiple acceptances and explore one’s options, no ability to negotiate contracts before accepting, and very little room for deferring and reapplying.

Most residency applicants are in their mid-20s to early 30s, and in the medical community, it’s no secret that the match process can complicate — and be complicated by — romances and future plans. Residents can expect to work up to an official limit of 80 hours a week (or more, off the books) and spend many weekends and holidays in the hospital. It is a trial for any relationship, but especially challenging when the match forces a relationship to become long-distance.

By late September, I had applied to dozens of residency programs in internal medicine. At the time, I was dating another med student who wanted to match into a very competitive surgical specialty, and he had applied to nearly 100. We had begun our relationship in August, when we were compiling our applications, and the possibility of our match being broken by the Match was always lingering in the background. Initially, he was more optimistic about our long-term prospects, while I was more cautious and internally questioned the wisdom of entering a relationship during such a tumultuous season.

The application cycle is a battle of priorities. There are ways to exert some limited control over the outcome of the match — for example, not applying to certain programs outside of a geographically preferred region. But limiting the region and the number of programs applied to can increase an applicant’s risk of going unmatched, especially in more competitive specialties that recruit small numbers of residents. It can also hold applicants back from matching into a more renowned or prestigious residency program in another part of the country.

Applicants’ rank lists are another way for them to express their preferences in the Match. However, the number of places each person applies to and interviews at has increased in recent years, since interviews largely went virtual due to COVID. This increases the unpredictability of the Match; it also forces applicants and programs to play more mind games to assess the other’s interest. How much did this