Primary care residencies aren't nearly as competetive as Ortho, so your wife shouldn't have too much trouble. Most people I know that went into primary care matched at their top choice. For ortho, you will still want to apply to as many programs as possible, but your wife shouldn't have a problem matching anywhere you go, unless you have you heart set on programs like Harvard, Hopkins, Mayo, etc...where even primary care is super competetive.

A few things to consider:

1. You are not guaranteed interviews at most places you apply to...so your wife may need to apply to at least 1 program in every city that you apply to. This can be costly for someone who would otherwise apply to 5-10 programs for family practice...she may need to apply to 30-40.

2. Lots of sacrifice on the part of both of you. You may have to give up your dream residency for the sake of ending up in the same city as your spouse (same for her).

3. If she's not a strong candidate, it could possibly hurt you if she's trying to get into a program that is a stretch for her. Example...peds is a very noncompetitive specialty, but matching at Boston Children or CHOP may be harder than getting an ortho spot.

well...not really...but you understand what i'm saying.

4. In general, i think the couples match is a headache. My girlfriend and I thought about doing it, but opted against it due to personal reasons (and the fact that we found it impossible to match up programs).

4. we ended up in different cities (but not too far apart)

5. All in all, I don't think it hurts you as long as you're both willing to sacrifice and both of you are flexible with where you train (it doesn't work if you're only willing to train at HSS or HJD in NY...apply and be willing to go to every program in the cities you're considering and it will work).