Navigating the Fellowship Application Experience With Jorge Avila, MD

Fellows Forum: Good morning, and welcome to this episode of the Fellows Forum podcast. Today, I’m joined by Fellows Forum member Dr. Jorge Avila, who’s a first-year fellow at Montefiore Medical Center. Dr. Avila is here today to tell us about his experience of applying for hematology/oncology (heme/onc) fellowship and tips he has for residents who are currently starting or going through the process.

Dr. Avila, first of all, we’re so excited to have you as a member of the Fellows Forum and also to have you on the podcast today.

Jorge Avila, MD: Thank you for having me.

Fellows Forum: To start off, would you like to introduce yourself and share what you do?

Dr. Avila: I’m Jorge Avila. I’m currently a first-year fellow in heme/onc here at Montefiore in New York, and I did my residency in Boston at St. Elizabeth’s Hospital, but I’m originally from Ecuador. I finished medical school back in 2017. I worked for a few years and then I applied to come here for residency, and now I’m doing my fellowship here in New York. I’m very excited about what the future might bring.

Fellows Forum: Awesome. I’m looking forward to hearing more about your experience. First of all, for a little bit of comparison for the residents out there, how is applying for fellowship different than applying for residency?

Dr. Avila: I think it’s quite different for multiple reasons. Number one, when you apply for residency, you’re much younger, and sometimes when you apply for fellowship, you have kids, you got married, or you have other life changes that you need to take into consideration. I think for us international medical graduates (IMGs), we graduated from other hospitals and programs from all over the world. The most important part for us is to be able to come to the US, so we tend not to be very picky about where we want to go.

I think for fellowship, you kind of know what you want a little bit more. You kind of have decided maybe you want to do this specialty, or maybe you want to be more of a researcher or more of a clinician, and you choose exactly what you want to do and where you want to go geographically for personal preferences. So, I think that’s very different. You grow as a person, you change as a person, and you realize that maybe you also need to have more of a work and life balance. All of these things are different from when you apply for residency.

Fellows Forum: Definitely. Along these lines, as candidates start the application process, what are some of the things that they could be looking for in a program when they’re applying?

Dr. Avila: I think it’s very important to be honest with yourself and realize what type of candidate you are and what you want to do in the future. Those plans may change once you start fellowship and you realize that maybe you want something different. But for example, if you want to be more of a clinician and you have a lot of experience with patients, and you really want interaction but you’re not very into research, you should apply broadly to all those programs. We have about 140 programs for heme/onc fellowship, so you can show them that’s what you want to do.

But if you, on the other hand, are more of a researcher and have multiple publications and multiple abstracts at conferences, and you have done a postdoctoral fellowship and things like that for research, I think your curriculum vitae (CV) aligns more with one of our researchers. You may want to apply to fewer programs and only those programs that are very research-heavy, have a lot of mentorships for research, and have specific areas, maybe basic translational or research outcomes and things like that.

At the end of the day, if you get interviews from programs that you realize your goals don’t align with, you are not going to rank them, and that interview could have been sent to somebody else. I think it’s very important to know what you want and apply based on that. And of course, as I mentioned before, life happens. If you have any geographical preference, you should apply to those areas and put them higher on your list.

Fellows Forum: Absolutely. You mentioned building up your CV. For example, how can candidates improve their CV if they’re doing residency in a community program?

Dr. Avila: Right, so for those of us who did residency in a community program, sometimes doing research activities can be a little more challenging. I loved my residency program. I trained very well, and I think I learned a lot as a clinician, but I think as a researcher, I had to look for opportunities somewhere else. For example, I did my residency in Boston, so in terms of research opportunities, there are tons. You can email people from all the institutions, and you can present yourself and show them your CV and say, “Hey, this is me. I moved here from Ecuador a few years ago. I want to do some research, and I’d like to participate with you because of these specific reasons.” I think it’s important to find different mentors in other institutions, send emails, and maybe reach out at conferences or things like that.

Many times, if you show interest, people are going to say, “This person really wants to work and do some research, and I’m going to help them.” I was lucky enough to get two mentors. One of them was just by sending an email. Then there are different awards by institutions like the American Society of Clinical Oncology (ASCO), the American Society of Hematology (ASH), the American Association for Cancer Research (ACCR), and all these institutions. Sometimes they provide mentorship, and I know ASCO has their virtual mentorship program. For ASH, I applied for a minority award, and they actually matched me with a mentor. I think it’s important for you to look for all these opportunities that are out there and just be able to send emails. Of course you’re going to get rejections, and of course you’re going to get people not replying back to you, but it’s important that you try. That’s the most important part.

Fellows Forum: Awesome, definitely a lot of great opportunities out there. So, after somebody has applied and they’ve submitted everything, what can they expect after they apply?

Dr. Avila: After you apply, I think it’s important to know that you did your part. You worked hard for two and a half years, maybe even more. I think it’s important that you have to stay calm first of all, because compared to some other subspecialties, hem/onc is more competitive, so you need to wait a little longer. Sometimes it’s a month, a month and a half. I got my first interview a month and a few days into the application process. So, first of all, be patient.

Number two, I would say if there’s a specific program that you want to go to for whatever reason, some people send emails and reach out to those programs or the program directors of that institution. I didn’t do that, but what I did was I asked some of my mentors and some of the attendings I had worked with, the ones who wrote me the letters of recommendation, to contact these institutions. You’re not going to ask them to contact every hospital you apply to, but if for some reason you really want to go to a specific hospital, I think it’s worth it to ask them if they can maybe send an email or reach out to somebody. It worked for me. I asked for them to reach out to three institutions. I got the interview invite from two of them. You’re not going to get all the invites that you expected, but if you have somebody advocating for you, maybe that’s going to make it easier.

Then when you get the interview, just be prepared and read about the program. During the month or few weeks that you are waiting for invitations to come, make sure that when you get to the interview, you are able to answer the question, “Why this program?” Because they ask that question in every interview.

Fellows Forum: Do you have any other tips for candidates about interviews? Was there anything you found that helped you?

Dr. Avila: Definitely. I think that, as I mentioned before, you need to do your research on the program and be able to answer exactly why that hospital or why that institution. I would say to try and see what attendings they have and what type of projects and activities they’re doing. When they ask, “Why this institution,” you can say, “Oh, I want to work with this person specifically. I want to be part of this project that I saw your hospital is doing. I’ve seen the people who have graduated from the program. They’re doing community practice in this area, or they have all stayed in your hospital, and that speaks volumes of your program because people want to stay.” When you say, “I want to work with this attending,” and “I want to do this project,” it’s important to be specific with your answers.

Then it’s also a bonus if you have family in the area or maybe your significant other found a job nearby. All of those things are important to say during your interview. I do believe that they take that into consideration when doing the ranking and when getting to know you.

Fellows Forum: That’s great. After interviewing, what comes next?

Dr. Avila: I’ve heard different approaches on this. Some people just wait—I just waited, to be honest; I waited and let the process be. Some other people, for example, instead of asking their mentors or their attendings to reach out before the interview, some people actually ask them to send that email after you get the interview. Let’s say you already got the interview, so they like you already, but maybe they need that extra push from somebody else to say, “Hey, this person is great. You should take them into the program.” Maybe you can ask your mentors and the people who wrote you the letters to reach out after you get the interview. But that’s a personal preference. I decided to do it before.

Some people send emails to say, “Hey, you are my number one program, you’re at the top of my list.” Again, that’s a personal preference. I didn’t do that. I did it for residency. But as I said before, you change a lot, and I think that I learned that you have to trust the process. For me, it was more about knowing that I did my part, and I’d interviewed already. I asked my mentors to reach out. I decided to just wait and let it be and see what program takes me. I did my ranking based on what I wanted and my preferences, and then I just hoped I’d be able to go to a program that aligns with them. And it worked out for me. Some people send handwritten letters and things like that, but it’s up to you. You can either just lay back and do nothing, or you can be more active and reach out to people through social media—some people do that a lot—or you can just let the process be.

Fellows Forum: As we wrap up, do you have any words of advice for people who are applying to heme/onc fellowship, especially for international medical graduates or IMGs?

Dr. Avila: Yes. As I mentioned before, when I came to the US, I knew I wanted to do research. I had very little research experience back home. When I got here, I was like, “Okay, now I’m here and I know there are all these opportunities I’ve seen all these conferences from afar. I want to be part of them. I want to be part of this kind of world.” It wasn’t only about the clinical work, because I love patients and I love taking care of them, but I’m also very curious about what can be done and how can we learn. I think it’s important that you start early if you want to do so, because again, if you want to start a project and you reach out to somebody—let’s say you reach out to somebody in July, when you start residency, you may not get a reply, so you need to find somebody else, like a different mentor from another institution. So, you have to send another email and then maybe they don’t get back to you, so you have to send more emails. The process of finding somebody that can work with you takes a few months.

Then you find someone and the process of getting a project takes a few more months. Even though you started in July, you realize that your first project is starting to crystallize around April of the following year. Then when you submit your project or your abstract, it’s already July of the following year. It took you one year to get a project. So, if you start to do so during the second year of residency, I think that by the time you have one project, it’s going to be application season already. That’s why I think you should start very early. Again, projects will not just come to you; you have to look for them and you have to start working on them. So, number one, start early.

Number two, be honest with yourself about what type of candidate you are and apply based on that. Number three, I would say don’t apply to those programs that for whatever reason don’t align with what you want. If you don’t want to go to a small program or you don’t want to go to a big program for any specific reason, or you don’t want to go to a specific city, don’t apply to those programs, because at the end of the day you’re not going to rank them. Be honest with yourself and know if you want to go to a specific area, or if you want to go to the East Coast or you want to go to the West Coast, you’re not going to rank those other places. That interview could have been given to somebody else. I think it’s important to be honest with yourself. That’s number three. I would say number four, like I did, just trust the process and go from there.

Fellows Forum: Awesome. This is some fantastic advice you’ve shared today, so thank you so much for walking us through the whole process. And congratulations to you for navigating this journey and starting your fellowship this year. I’m looking forward to hearing more about your experiences throughout your fellowship.

Dr. Avila: Thank you so much. It was lovely interviewing with you.

Fellows Forum: Absolutely and looking forward to the next one.

Dr. Avila: Thank you so much.

About Dr. Avila

Jorge Avila, MD, is a first-year Hematology/Oncology Fellow at Montefiore Medical Center in New York. He previously graduated from medical school in Ecuador and did his residency at St. Elizabeth’s Hospital in Boston. He is passionate about becoming a researcher in the field of hematology/oncology.

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily represent those of the Fellows Forum.