Successfully did the couples match thing with pediatrics this year. I think that whole process can be somewhat of a double edged sword. Some places it may help you, while others it may hurt you. Alot depends on what your significant other is planning on pursuing. Some of the less competitive fields should not hinder you too much if you are a strong candidate. Whereas, trying to couple with derm, etc... makes things inherently more difficult. I know this was a major concern of mine when beginning this whole process, so I'll tell you what I've learned.
A few words of advice....
Apply to alot of places, even if you think you will have little trouble securing interviews. I applied to 66, she approx. 80. While its expensive, consider it an investment in your future. This allows for significant overlap between you and your couple so that the likelihood of a successful couples match is increased. I interviewed at 17 programs, while she interviewed at 19. Definitely more interviews than I would recommend if one was applying solo. This provided us with enough programs that were either in the same city or if not the same institution. This also allows for some flexibility if one of the couple doesn't like the particular program, then there are other combinations that will work. We ranked 16 pairs total.
Second word of advice, be upfront with programs (both you and your s.o.) about your intentions to couples match. This will not only fuel communication between departments, but may also score you interviews. I actually recieved at least one interview that I was initially shut out of due to space limitations because my girlfriend brought up this very issue. I never came across a program that seemed to frown upon this, not to say they don't exist.
Thirdly, talk to medical school advisors as the time comes closer to ROL etc... as they can show you some tricks to ranking as a couple. Plus, these people usually have a pretty good grasp on how feasible this is given your particular situation. I would recommend you and your s.o. meeting with such an advisor together to get a little feedback with open communication. Have them put you in contact with people from your school who have done this before (especially ortho) to see if they have any inside info or things they wished they had done differently.
All in all, it's a painful way to interview if you ask me (my girlfriend agrees) but it paid off in the long run. It's expensive and time-consuming so be sure that you are serious about it if that's the route you choose. And be ready for some heated debates when the ROL is close to being due! (just kidding). Hope this helps. Good luck.
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