Don has taken up an associate professor position at Columbia University and Rosie has enrolled in a Doctor of Medicine degree while she concurrently completes the PhD.

Early in the story, Rosie becomes pregnant, and Don's philandering mentor, Gene, who has left his wife Claudia, comes to live with them.

Critical reception for The Rosie Effect has been mostly positive and the book was a bestseller in multiple countries.

NPR praised the book for not overly romanticizing Don, for achieving a tricky balance, and for its "classic Hitchcockian suspense".

[5] The Sydney Morning Herald, which had praised The Rosie Project, published two reviews, one of which criticized the novel as "formulaic"[6] while the second called it "a very funny book, possibly the funniest this year".