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Nii sits down with Trevor Cabrera, who completed his residency training in General Pediatrics at the University of Texas Health Science Center in Houston and then transitioned to working as an exclusive Locum Tenens provider. Listen in as Dr. Cabrera, also known as The Nomadic Pediatrician, talks about his first locum job, paying off student loans, the lifestyle locum work affords him, and his blog that documents his travels and experiences.
Things to expect in this episode:
- Trevor discusses why he pivoted to locum work
- The early, lean locum days
- Consistent locum work and paying off student loans
- The lifestyle of a locum, especially the benefits
- Growing through locum work
Check out The Nomadic Pediatrician Blog: www.thenomadicpediatrician.com
Additional Dr. Cabrera writings:
- 5 ways to make locums housing feel like home
- From medical school to residency to…locums?
- Paying off medical school debt
- The social life of a locum physician
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Did you know Locum's Docs make, on average, 33% more
than employed docs?
Got your attention now.
So if you're considering Locumtenants, either full-time or on
the side, you probably have aquestion or two, or maybe even
20.
Locumstorycom is packed withunbiased information and tools
(00:22):
to see what the trends are inyour specialty and even make a
decision if locums is right foryou.
My advice make locumstorycomthe go-to place to learn more
about locum tenants.
That's locumstorycom.
All right, dr Trevor Cabrera,the nomadic physician.
(00:43):
What's up?
What's good?
Welcome to Docs Outside the Box.
How you doing.
Speaker 2 (00:46):
Good, how are you?
Speaker 1 (00:47):
Good good.
Where are you located at man?
Speaker 2 (00:49):
Currently I'm in Augusta Maine, central Maine.
Speaker 1 (00:52):
Central Maine.
So when I think of Augusta, Ithink about Georgia.
Okay, so there is an Augusta inMaine.
It looks like for's in anextended stay.
It has that typical appearanceof you got the hotel door with
the exit right behind you, theexit mat behind you, and then
you got microwave, refrigeratorand all the things that you need
to do, a mini kitchenette.
Speaker 2 (01:12):
Stove top there, yeah .
Speaker 1 (01:17):
Stove top so you can cook if you're going to be there
for an extended period of time.
So you are a locums pediatricphysician and let's jump right
into this.
How long have you been doinglocums now?
Speaker 2 (01:26):
Um, I, I'm actually a relative new grad, so I've been
doing it since I finishedresidency 2020.
And I mean like immediatelystarted straight into locums,
did nothing else, right out oftraining.
Speaker 1 (01:36):
Okay, so all you know is locums coming out of a
fellow or coming out ofresidency.
Speaker 2 (01:40):
So, uh, kind of not not entirely actually.
So I so I meant to, I meant todo purely locums but because of
COVID, pediatrics took a hugehit.
So, unlike the rest of theworld seeing tons of people
getting sick and medicine, kidsstayed home.
They didn't get sick as often,so the census for us went down.
So actually when I startedworking I couldn't find work,
(02:01):
consistent work.
For several months I livedpaycheck to paycheck.
I lived like month to monthwaiting for locum work.
I thought about quitting Waitquitting what.
Quitting locums, I thought aboutgoing to a permanent job
because I couldn't find work.
So that was 2020 for me.
I literally it would be the endof October and I didn't know if
(02:22):
I was working November.
But I would be sitting therejust waiting for my recruiter
call and we'd be like, hey,there's a new job.
And then fast forward to lastsummer June 2021, I had an
opportunity for kind of therewas a locum to perm kind of job.
But instead of us working alocum and then converting to
permanent, they actually decidedbefore I even started they
wanted to sign a permanentcontract.
(02:42):
Before I even started theywanted to sign a permanent
contract.
So I did work as a permanentprovider at this hospital in
middle of nowhere, new Mexico,where I was there for 15 days a
month.
But the contract waseffectively set up like a locum
contract but I was actually anemployee as a permanent provider
of the hospital.
So it was kind of like a quasikind of mix of both.
So it's been kind ofinteresting because I've gotten
(03:03):
to see both sides of it.
I mean, that was a W-2 job,that was a job with some
benefits.
I had to be forced with some ofthe administration stuff, but
it wasn't true permanent job,because they still paid for my
hotel, they paid for my rental,some CME stuff.
I kind of just worked that intothe contract, I guess, but it
was effectively basically in mymind just a locum.
Speaker 1 (03:27):
Got you.
So how about this?
Let's take a step back.
Let's take a step back.
Two years ago you werefinishing up your residency.
I'm sure the majority of therest of your current residents
were thinking about graduatingand going into their respective
jobs I'm assuming most of themhospital employed.
Talk to us about why youdecided to do locums.
Speaker 2 (03:49):
So most people that I actually know in pediatrics do
a lot of them.
Yeah, they went to clinic orsomeone to hospital, someone to
fellowship, you know someprivate, some academic, all
those different parts of it.
For me, actually, it was kindof a hard situation because I
actually went back and forth ondoing fellowship myself and I
actually was forced to make atough decision because of the
(04:11):
AAP.
As of 2020, there is a newcertification that the American
Academy of Pediatrics is pushing, which is for PHM pediatric
hospital medicine.
So, as of 2020, anybody thatgraduates is being forced or
required to do PEDS HospitalMedicine fellowships.
Speaker 1 (04:30):
So what that kind of put me in a situation was- so
basically what you're saying is,if you graduate from a
pediatrics residency, if youwant to do pediatric hospitalist
, you have to be board certifiedin a fellowship.
Speaker 2 (04:44):
That is what they're trying to create.
Speaker 1 (04:47):
And that's what you you want to be a pediatric
hospitalist.
Speaker 2 (04:52):
No, not necessarily.
I wasn't sure because I likethe, I like intensive care, so I
didn't know.
I didn't know which fellowshipI wanted to do, but I knew that
as a 2020, unlike my colleaguesbefore me I couldn't jump
straight into hospital medicinebecause right now the
fellowship's not required acrossthe country, but in 15 years it
might be.
And so my thought was well,I'll go take a year to do locums
(05:15):
and then I'll figure out do Iwant to go back for pediatric
ICU neonatology?
Do I want to go back forpediatric emergency medicine or
pediatric hospital medicine?
Speaker 1 (05:23):
So was this a conversation that you're having
in your mind or is this aconversation that you're having
with your attendings?
Your fellow residents Talk tous about that whole
deliberations.
Speaker 2 (05:32):
Mainly myself.
Mainly myself trying to figureout what, like specialty within
pediatrics I wanted to do.
Speaker 1 (05:38):
Because this is third year now, like third year, like
so how did even locums get intoyour mind?
Like, who told you about locums?
Because that's the other thing,cause I think a lot of times
people struggle with thesedecisions but they're just like
well, I didn't ever even heardabout locums until this point,
did that?
Speaker 2 (05:53):
happen to you?
It did, and so you know, for usas a pediatric resident we
train in huge academic centersis we're not in the rural places
, and that's an importantdistinction, because where I
trained there was no such thingas a locum.
I'd never heard of it, and myresidency program was big.
We had about 30 residents perclass.
So out of I would say out of200, 150, 200 pediatricians I've
(06:15):
met, zero or two of them havedone locums at all, and one of
them did it as a bridge to hispermanent job, um, and then the
other one did it just for ashort time in the past.
So, um, for me it was secondyear of a residency, a locum
agency came to talk to us it'sactually, interestingly, an
agency that I don't, I don'twork with, but they came to talk
(06:37):
to us and I heard about theidea.
And when I heard about it, atfirst I wasn't sure, um, and
then, when I got towards thirdyear, I kind of started talking
to agencies a little bit moreand was like huh, this is a
short term idea and so I canfigure out applying to
fellowship.
I'm only going to do it for ayear, we'll see what happens.
Um, but then I didn't find work, very I didn't find enough work
(06:59):
, and so I decided well, I'mgoing to extend this, and it
wasn't just for the fact.
Speaker 1 (07:03):
But when you say work , what do you mean?
Speaker 2 (07:05):
Like I literally did not have work.
Speaker 1 (07:07):
This is your third year or is this when you
graduated?
When I graduated, when Igraduated, so the plan was
graduating we're just trying tokeep the timeline right for the
for the listeners, so they canclarify.
So now you have graduated andnow you are, you are working
locums and you're thinkingshould I try to find a permanent
gig versus continue locums?
Speaker 2 (07:26):
No, I'm graduated July and I can't find consistent
locum work for eight months.
Speaker 1 (07:33):
Oh wow, so you're not working at all.
Speaker 2 (07:41):
No, I am so, like I was saying, I'm living like
month to month.
So the one job that I had inHuntsville, texas, in July 2020,
they didn't have their scheduleuntil the end of each month.
Speaker 1 (07:47):
So I didn't know if I was getting any shifts, that's
what I'm saying, Dr Trevor man,you got to be clear with this,
All right.
So you were working at a spot.
They would do their schedule ona month to month basis, but you
don't know if you're going tobe a part of that schedule until
that that month schedule comesout like maybe a week before the
next month, correct, Right?
So that's what I'm saying.
Speaker 2 (08:04):
So that's what happened in 2020.
And so that's why I said 2020,that happened.
And I did that, and I livedmonth to month and thought about
well, shit, I can't findconsistent work, they're running
out of days.
Do I need to consider stoppinglocums and taking a permanent
job?
I didn't want to take apermanent job, but then in 2021,
the next year I kept working atthat same site and then it
(08:25):
still was so unstable that Idecided to take that
semi-permanent job in New Mexicoto make sure I had some
consistency while the locummarket was starting to come back
.
Speaker 1 (08:37):
This episode is brought to you by locumstorycom.
Backdrop 2012, finishing myfellowship in Miami and no
decision bigger than where andhow I was going to start working
on my own, and there it was thefork in the road being employed
versus something I had neverheard of before locum tenants.
So I decided to go the locumsroute and I had a ton of
(09:00):
questions.
Then I stumbled a bit, buteventually I was able to stand
on my own and I have beenworking locums over the past 10
years.
Now what about you?
If you're considering locums,you probably have hella
questions, just like I did, likewho covers my malpractice?
Do I really have control overhow often I work, and what are
the tax implications?
(09:21):
Now, lucky for you,locumstorycom has the answers
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It's packed with unbiasedinformation and advice from docs
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There's even a quiz to see iflocums is right for you.
So listen, take my advice.
(09:43):
Locumstorycom is the perfectplace to start if you want to
learn more about locums.
That's locumstorycom.
So what was it like when youwere telling your fellow
residents that hey, I knowyou're going to be going to this
clinic spot.
I know you're going to be goingto this academic spot.
I'm good, I'm just going to belooking at locums.
(10:05):
What was that conversation like?
Speaker 2 (10:06):
Everybody in the world thought I was crazy.
My mentor, directly my mentor,who was one of the two
pediatricians I told you that Ihad met that did locums.
He did it for a short timebefore he became a full staff,
attending right out of trainingalso, but only for a very short
time.
He literally told me I wouldn'tdo that.
I would recommend you.
(10:26):
Or he said, be careful, don'tjump around from place to place,
because it's going to look bad.
They're going to say why areyou jumping from place to place?
Why can't you hold a steady job?
And that was one of the bigthings I was told and a lot of
people were just confused.
They didn't quite know what itwas and they still don't
entirely understand it because Ido it to an extreme.
(10:49):
I mean, I do it a little bitmore extreme than you know some
people if they're doing locumsone week a month, I do more than
that.
Speaker 1 (10:56):
So when you, when it was time to graduate, I'm sure,
when it was time to graduate andyou are looking at the
presentations and your fellowresident is going here, your
resident is going there and itprobably says for you Dr Trevor
Cabrera, locums, full-timelocums or whatever.
What was that like?
Speaker 2 (11:15):
I mean it was hilarious.
Everyone was confused and wehad a Zoom graduation because it
was COVID, right?
So you see everyone's name goesup and it was like a
presentation and the second part.
Just to throw this in there togive you a background of who I
am.
I kind of forgot I hadgraduation.
So I was in my kitchen, drunk,cooking some mushroom risotto
and I'm sitting there on thezoom just cooking risotto.
Speaker 1 (11:36):
Well, I hear this girl, y'all hear this he forgot
about his graduation.
Speaker 2 (11:39):
Yeah.
And so I'm saying they're drunk, just cooking some fancy ass
mushroom risotto.
And so I'm standing there drunk, just cooking some fancy ass
mushroom risotto.
And so they're like all talkingright, and in the chat box on
the side everyone like literally200 people watching.
They're like Trevor, what areyou cooking?
And I'm standing there cuttingmushrooms.
Everyone else's head is justsitting there right Watching I'm
cutting mushrooms, I'm cooking.
I'm like, oh, I'm makingmushroom risotto, and everything
goes up on the board.
(12:00):
And then it says locum tenensfor me.
And you know I definitely gotflooded with a bunch of messages
not, you know, not just from mypeers.
I'd talked to you, but everyoneelse is like what is that?
Like people didn't know because, like I said, it wasn't talked
about.
I mean, I heard about a secondyear residency, but I'd never
met a locum.
Speaker 1 (12:19):
So why didn't that scare you Like, why didn't that?
Even to that point You're likeman, am I really making the
right decision?
I mean, I could, I could bewrong.
You may have already had thosethoughts Like, well, were you at
that point, it's not going towork, yeah.
Speaker 2 (12:30):
I was freaked out.
I made the decision a couplemonths before graduating and
then I was freaked out when Imade the decision in third year.
I was freaked out at graduationand I became more freaked out
every day when I couldn't findconsistent work.
So when I graduated, I don'tthink I even had a locum job set
up.
I was just hopeful andoptimistic that it'd come back,
(12:52):
and so I grinded every singleday to try to find work.
Speaker 1 (12:59):
So the next day after graduation you have no job.
You don't have any perspectivesat this moment Financially.
Were there any preparationsthat you made right before
graduating, like?
Did you save up any amount ofmoney?
Did you have an emergency fund?
Talk to me about that.
Speaker 2 (13:12):
Yeah, that's a really good question.
So I did.
I saved up for a couple ofmonths, but the main thing that
I tried to save up on was tomake sure that I had enough to
pay my loans back when thefederal loan, when I since you
finished residency, when theystart requiring payments to come
back.
The big thing that saved me wasCOVID.
In some ways, I mean, it hurtbecause I didn't have work but
(13:35):
on the flip side, the federalgovernment froze my loans.
So I was lucky to escape by.
Speaker 1 (13:40):
I also did things like extreme couponing, like man
, I would that's what I want toknow about your lifestyle.
So yeah, so let's talk abouthow you were able to pay for
food, like, did you save forfood, couponing, rent, all that
stuff, like, so you had to savefor all that, right?
Speaker 2 (13:53):
Yeah, and you know I think you know no offense to
most and where did you live?
Where were you living?
So I, I lived in my apartmentin Houston the same apartment
third year through graduationand what I did was the way I
thought about it was I savedenough money to pay rent and I
(14:14):
set aside money for food for acouple of months before I
graduated and then each month Ikept kind of reassessing that to
make sure that I had enough.
And the nice thing is, locumspay well enough compared to a
resident salary.
That me working.
If I got a good week, sevendays of work in a month, I
wasn't going to make money but Icould survive till the next
(14:34):
month.
So, um, and that's so, so sorry.
So go to back up.
So I'm not in order here.
The pre the plan before Igraduated, I did save up a
safety fund and this was reallybecause I couldn't find work.
And then when I graduated Ikept every month I had to
reassess am I at the right pointfor the safety fund?
Do I need to do I need toconsider stopping locums because
(14:55):
my safety fund is going down?
And that's where that mentalitycame in.
Speaker 1 (14:59):
So went from graduation to when you first
started your first locums gig.
How long?
Because I'm assuming yougraduated sometime in June, july
1st.
You ain't got no job.
When did you start workinglocums?
Speaker 2 (15:11):
I got offered one shift July 27th 2020.
Speaker 1 (15:16):
One shift.
Speaker 2 (15:17):
The locum job was for one day of coverage, to go up
for 24 hours to cover deliveries.
I went up.
I covered 24 hours.
I did orientation went up.
I covered 24 hour orientation.
Speaker 1 (15:27):
Where's this at?
Where's the first gig at?
Speaker 2 (15:28):
Huntsville, Texas.
Speaker 1 (15:29):
Huntsville, texas, gotcha.
Speaker 2 (15:30):
Yeah, so the nice thing was it was within driving,
so about an hour north of.
Speaker 1 (15:36):
Houston, so you had a job within three weeks of
graduating.
Or at least an opportunity.
I had one day of work.
That's good, I'm glad youclarified that I had one day of
work.
Got you Okay.
Speaker 2 (15:48):
And so I had one day of work.
I went up there, sat in thehotel, didn't get called in.
I was so confused.
I was like a new attending,thought I was going to be seeing
patients, but, unsaid, I wassitting there at the hotel on
call.
I went up there for one shift.
I went back home, I called mymom.
I'm like, oh my God, they paidme to do this.
Speaker 1 (16:04):
Well, hold on hold on Cause you didn't get your money
yet when you worked there,right?
So so when they gave you thatJuly shift, you didn't know if
anything was going to turnaround for August, right, you
didn't know anything aboutAugust.
You didn't know nothing aboutSeptember, okay, perfect.
So when you got there, so yourrecruiter tells you hey, I found
something for you, it's for oneshift, it's in July.
I'm interested.
(16:26):
What was that first day like?
Take us through what it waslike.
Take us through thoseconversations you were having
with your mama, all that stuff.
Speaker 2 (17:00):
And when they called me about this job, I thought a
little differently.
I thought a little bit moreaggressively as a new grad, the
first way I thought about it washey, I've got all this
different competition frompeople that are experienced
providers.
And I straight up told myrecruiter I'm like look low ball
, I'll go in lower than mycompetition because I need work.
And so I did.
I went in low, I got one shift,I drove up there.
I was really nervous becauseI'm a new attending, I just
started a new job and I get allready for orientation.
I go in the next day, I walkinto the unit and real quick.
Speaker 1 (17:16):
Before you did that, how do you remember?
You don't have to tell me howmuch you got paid, but do you
remember how you got paid?
Was it you got paid like everyhour for 24 hours, or did you
get paid for?
You know you work for severalhours and then you get to go
home Like how did that pay thingwork?
So people can get anunderstanding of how you got
paid.
Speaker 2 (17:34):
Sure, so there's different schedules and
different ways that we get paid,because our jobs are always
different, whether we're clinicor inpatient or just on call.
This job was something we wereconsidered to be just on call,
so I had a set amount to be oncall for, 24 hours and then
every hour that I so you gotpaid a certain amount.
Speaker 1 (17:51):
There's a certain dollar amount to be available
for 24 hours.
Speaker 2 (17:54):
Certain base amount to be available for 24 hours,
but then within that, at thisparticular job, it included
within it four hours of work.
So if I worked one zero hoursor if I worked four hours of
work.
So if I worked one zero hoursor if I worked four hours, I got
a.
I got the same rate, but thenevery hour after that.
If I had to work five hours,then I get one hour of overtime
like what's an hourly rate ontop of that.
Speaker 1 (18:16):
Got you.
So if you, let's say, you weregetting paid a hundred dollars
for 24 hours Now, everyonelistening, that's really low.
I'm just using that forillustrative purposes.
Everyone listening, that'sreally low.
I'm just using that forillustrative purposes.
If you got $100 for 24 hours,that means that for hour zero to
the end of the four hours,you're going to get $100, right.
And then if you were in yourhospital or, excuse me, if you
(18:37):
were in your hotel and youstayed there for the rest of the
whatever 18 hours, you're stillgoing to get a total of $100.
But if after 18 hours, you'restill going to get a total of
$100.
But if after four hours youwere in the hospital, for hour
five, hour six, hour seven, houreight, you would get additional
pay, overtime pay past that$100, correct.
Speaker 2 (18:56):
Yeah, that's correct.
So that's basically, but mostlysmall jobs, the way they're set
up, like that it sounds good inyour head.
You're like all right if I'mthere for eight hours.
Well, shoot, I'm going to bemaking this hourly.
But this hospital is so slowthat I never hit four hours,
almost ever.
So I took a low salary.
(19:18):
And then I go up there for thefirst shift and I did it so that
they I wanted to do that, sothat they would confirm me.
I wanted them to take me, uh,and I wanted to get my foot in
the door.
And that's where I thought verybusiness strategy.
I'm like I could ask for allthis money that all the other
doctors are asking for.
I'm aware of my worth, eventhough I'm a new grad, but like,
let's, let's try to get anactual job.
(19:38):
I need food on the table, whichis crazy to say as a doctor,
right?
So I get up there, I walk in, Imeet everyone and I'm like all
right.
Well, I'm real confused becauseI don't even know, in residency
there's no on-call jobs.
You're seeing people the wholetime.
So I go introduce myself andthey're like all right, we'll
call you if we need you.
And I leave the hospital andI'm like well, really confused.
(20:03):
So, you know, I'm like all right, so I drive around the town, I
go sit in my hotel room, I'mjust hanging out.
I'm like this is weird, what amI doing?
And I remember that night, whenit got towards nighttime, I
actually called the night shiftcrew to be like hey, just want
to let you know I'm here if youneed anything.
And they're like we know,wanted to let you know I'm here
(20:23):
if you need anything.
And they're like we know, allright.
Yeah, they're like why are youcalling?
And they're you know this is anold town where they're used to
the old school pediatriciansthat you know they don't call
them unless someone's like dying.
And you hear me like being soeager to be like hey, I'm free,
but I'm a new grad, I don't knowwhat the hell I'm doing.
Speaker 1 (20:39):
They know you're a new grad.
Speaker 2 (20:40):
Yep, they got it I don't know how much they knew I
was a new grad right away, CauseI didn't tell everyone the
first day, right?
So I think they might have.
But, um, you know, they didn'tknow right away, and so I go
home the next day and that's it.
That's July 28th.
Speaker 1 (20:53):
I go home and this is something that does differ with
locum agencies is the way theypay you.
Speaker 2 (21:07):
With working with Comp Health.
The one thing I and I don't putany particular favoritism out
to be fair, no bias.
But with Comp Health the thingI really really like about the
company and CHG Healthcare ingeneral is they pay me the next
week.
Speaker 1 (21:22):
Okay.
So you got paid the next week.
So I'm going to be honest withyou.
So the first time I startedworking as a locums it took me
about a month and a half tostart working.
So I started working lateAugust after I finished my
fellowship in June 30th or 31.
I can't remember if June has 30or 31 days.
But I worked for two weeks andthen I got a paycheck.
(21:44):
And I'm not going to lie to you, when I got that paycheck, that
paycheck was multiple fractionsof what my parents got paid in
a year.
Right, which is something thatI've never seen before.
Right, like I was so used to aresident salary which was
reasonable.
And then, all of a sudden, Iworked two weeks and it's like
whoa, I've made this significantamount of money.
(22:07):
I've never seen this amount ofmoney before.
I was extremely happy, I wasextremely humble, but also, at
the same time, I was kind offreaked out.
I was like yo, I don't knowwhat to do with this money.
And so, when you saw yourpaycheck, how did you feel when
you first got your paycheck?
Speaker 2 (22:24):
Now, granted, it's one day.
But how did you feel when yousaw that paycheck?
I kind of felt like I didn'treally deserve it for the work I
did.
But at the same time I felt thesame way of like, oh shit, I
just made one.
I just made a quarter 25percent of my monthly salary as
a resident in one day.
But, realistically just, not totalk too much about the numbers
but to be totally honest.
Speaker 1 (22:42):
but realistically just, and I'm not to talk too
much about the numbers, but tobe totally honest, we should
talk about the numbers.
Speaker 2 (22:47):
It's okay.
I mean, it's kind of hardbecause with that first job it's
difficult because, like I said,I settled and it was COVID.
But realistically, when I lookback at those numbers, the
amount that I got paid for thatparticular job wasn't really
more than if I'd taken apermanent job.
Sure, like I said, the only ifI had taken a permanent job, I
actually might've gotten paidmore for that kind of work.
But uh, it came with all theother pros of locums, which is a
(23:10):
whole other you know, a longerconversation, of course.
Um, so I I did, I did havethose feelings, I did have those
feelings, as you did, of like,oh my God, I can't believe that.
Um, and it was, it was actuallyreally interesting, but at the
same time I couldn't enjoy it orthink about it as much, because
I was very, very aware of howinconsistent my work was.
(23:33):
So, even if I got a bigpaycheck- you didn't really
consider your money.
It was like yo, this is survivalmoney, right here Exactly, I
didn't consider any money my mymoney, and I didn't for very
long time.
It took months until I got tothat point, because even when I
got to a point where I was outof the hole and I was let's put
it this way I had an emergencyfund at graduation, maybe for
(23:54):
two months, and as I went on in,that emergency fund grew like
very, very slowly, I was able toproject out okay, four months,
five months, whatever.
It wasn't enough, though,because my goal, my plan, was to
entirely move out of myapartment, so I needed an
emergency fund that wouldaccount for the fact that I
didn't have a place to live, andso I needed to think much
(24:18):
bigger.
So for me, the money was neverin the first, like I would say.
The first year I did locums, Ididn't, I wasn't in the block
the first year.
Speaker 1 (24:26):
You were playing catch up in your head.
Speaker 2 (24:28):
you thought and I, yeah, and I don't even mean for
loans, I mean I was playingcatch up to survive.
Speaker 1 (24:34):
Got you.
So how long did it take youbefore you felt like you were
even keel, like you were, youknow, floating in water.
Um, with finances I'm nottalking about loans, I'm just
talking about just with moneythat's coming in as a locums how
long did it make you to?
You felt like I'm good.
Speaker 2 (24:49):
So for me it probably took about eight months.
Okay, but just because of theinconsistency of work.
Speaker 1 (24:56):
Right, you know, I think.
How long did it take you tofind consistent locums work?
Speaker 2 (25:01):
A year.
Speaker 1 (25:02):
It took you a year.
Speaker 2 (25:03):
Yeah, and that's, and that's why the timeline was
July.
Graduated inconsistent locumsFebruary 2021.
Saved up enough to get aroundmy apartment, but still
inconsistent locums March 2021.
Signed a like locum slashpermanent per diem contract in
New Mexico so that I could fallback on that.
Speaker 1 (25:23):
When you were doing that per diem work, were you
getting paid 1099 or W-2?
Speaker 2 (25:27):
No, so that's where I was introduced by a locum
agency to the hospital, but thenimmediately they signed me as a
permanent person.
So I was W-2.
Speaker 1 (25:35):
Got you.
So now, when you are working,right, because I looked at all
the states that you've been,you've been in several hospitals
since right Right now, you arelisted as full-time locum, so
that means that you are not W2,you are 1099, correct, correct?
I?
Speaker 2 (25:52):
um, last year about uh, 75% of my work was W2 and
this year I am well, I guess.
To be honest, this year I'mabout 90%, 1099.
I did recently take up a newper diem job, but that per diem
job, I think, has to pay me W-2.
Speaker 1 (26:10):
So how do you feel about work in general, like, how
do you feel about, like, theskills that you've learned in
this locums type of experience,type of experience?
Do you feel like you know,comparing yourself to how you
are now compared to, maybe howyour partner or, excuse me, how
your fellow graduates, maybe intheir clinic position, their
employee position?
How do you think you are incomparison to them?
(26:32):
Like, do you think you, do youthink that you are behind them?
Do you think you're above them?
Talk to me about that.
Speaker 2 (26:37):
So there's two things I will.
I will, I will, I guess, gogravitate to.
There's one, the physicalskills of my job in medicine,
and there's two, the businessside.
One of the one of the reasons Ichose to do locums was I felt
that I had a lot of oversightand I had my handheld in
residency.
And frankly, it's different than10 years ago.
(26:58):
It's not resident run traininganymore.
There's a attending doctor inhouse, overnight in the hospital
I could ask for help.
So I wanted to leave.
I wanted to get trial by fire.
I wanted to put myself insituations where I was out in
the middle of nowhere to see ifI could broaden those skills,
because when there's not help,or just see how good your skills
(27:18):
are in general.
Well, I doubted them and I waslike and I still doubt them, but
I was like you know, if I'm outthere and no one else can help
me, I'm going to have to do thisshit, like I don't have choice,
right, and I'll give like justa brief examples of that.
I mean, uh, last summer, uh, Ihelped in part of a to stabilize
and resuscitate a 28 week uh,1200 gram baby in the middle of
(27:39):
uh, in middle of central Mainewith a small critical access
hospital and we kept that babyalive for 53 minutes until we
could get a neonatal intensivecare transport team to pick the
baby up and fast forward.
This past couple of months agoI was in Santa Fe, new Mexico,
responded to my first neonatalcode and it was only my second,
(28:02):
I think second successfulintubation as a attending.
But I got it right away becausethere's no one else that could
do it and I needed to intubatethis baby so that we could
resuscitate them.
And I went in and I rememberfull code was blown.
They called a full code, blueoverhead.
I go in, there's like 25 peoplein and like I'm like shit.
Go in, there's like 25 peoplein and like I'm like shit, I'm
(28:24):
the pediatrician.
I just worked a 72 hour in a rowin house shift.
It was a 72 hour call a job.
I did get to leave the hospitalfor three days.
I run an hour 70 and I'm likeI'm just, I got woken up and I'm
like, shit, I got to do this.
And so I go up and I intubatethe baby and I mean I'm just
when there's no one else there.
It was that fire and so it gaveme that kind of encouragement
(28:46):
and at the same time, I meananother experience I had was I
had a baby that blew apneumothorax, which is where
there's for anyone listening.
The lung is collapsed and thebaby needed a chest tube.
I'd never done one, and so Iwas lucky that the transport
team showed up on time to helpme, but I got to learn with them
on the job.
The neonatal nurse practitionerwas like, hey, yeah, I'll show
(29:07):
you how to do a chest tube.
And so she, we did it, and itwas a cool experience and you
know, part of me doing thesethings was my, my original goal
over time, going, like we saidearlier, wanting to go back to
fellowship.
I wanted some more learning outof residency and doing locums
has put me in a situation whereI have obtained that partially
(29:28):
by choice and sometimes by force, and it's sometimes what I
needed to push myself out of thehole.
In that regard, I don't knowthat I would say.
I would say I'm definitelystill inferior to a lot of my
colleagues that went straight tofellowship.
But I've been forced to becomemore of a leader.
I've had to run codes and runor not full codes, but I've had
to run resuscitations and runthings.
(29:50):
That and fellowship.
If I were still in training Icould always have someone else
behind me.
So it's forced me to grow andmature in that way.
But it's also made me morehumble because I realized shit
the more I meet people, the lessI know, and the more I see
variability, the more there is.
I need to learn.
Speaker 1 (30:10):
Yeah, and I think that's a really good point,
because I think that there's theacademic, large tertiary care
experience and then there's theexperience that you have, and
one of the points that I tellresidents, and I think one of
the things that I learned, isit's always good to have a good
mix of those type of experiences, because if you spend a
(30:31):
significant period of your timeat academic hospitals, tertiary
care hospitals, you're going toget called from a pediatrician
or you're going to get calledfrom somebody who's at another
hospital and they're going to berequesting to either transfer
or they're going to berequesting for a consultation,
and it's very important for youto understand what kind of
capabilities they have at thoserural, suburban or just, let's
(30:52):
just say, not as capablefacilities as a tertiary care
center.
And it's very important tounderstand what they're doing at
these facilities, the greatthings that they're doing at
these facilities, so that whenyou get a consultation, it's not
a what's the word I want to use, not an adversarial type of
conversation, but really like acollegial type of experience
where you're saying, okay, great, thanks, tag, I got it, you
(31:13):
know, I'll take over.
And then also, like you said,like the amount of growth that
you have to undertake when youare at these facilities by
yourself and you don't have allof the resources, you don't have
all of these different thingsthat you have at tertiary care
centers.
It does make you rely on yourclinical acumen that much better
.
Everything that they taught youfrom a textbook standpoint,
everything that they taught youfrom a physical exam standpoint
(31:35):
you really got to rely on thatand I can definitely speak to
that as someone who immediatelyfinished fellowship and then I
was working in a rural area andthen I did some to that as
someone who immediately finishedfellowship and then I was
working in a rural area and thenI did, like some work in Ghana.
It's just like whoa, like I wasprepared for this, but I really
wasn't prepared for this, andyou just feel like you can grow
from that.
So I appreciate you sharingthat.
Now I want to ask you aboutloans.
Let's talk about loans realquick.
(31:56):
Let's pivot a little bit,because I read one of your posts
where you talked about 10 yearswith the PSLF program.
Right, yeah, versus.
So that's a loan forgivenessprogram, y'all federal loan
forgiveness program versus doingthree years with locums.
Now, for everybody listening,my man, dr Trevor, had what
$315,000 of student loan debtwhen you finished residency?
Speaker 2 (32:19):
Yes, that's including all the interest that built up
over time.
Speaker 1 (32:22):
So how did you?
What are you handling?
What is your decision?
Did you decide to do PSLF ordid you decide?
Did you pay it all off or areyou paying a significant period
off?
How are you handling yourstudent loans?
Speaker 2 (32:33):
That's a good question.
I'm happy to talk about thenumbers on this one because I
think this is something that'simportant.
So I do the same thing.
I talk to all my residents, allmy med students.
I'm like, think that'simportant.
So I do the same thing.
I talk to all my residents, allmy med students.
I'm like you need to thinkabout these things.
The public service loanforgiveness is designed for your
loans to be forgiven after 10years, with the caveat that
you're working in certainpractice settings.
You're working in ruralhealthcare, you're working in a
(32:54):
nonprofit, you're working at theVA, but the differential in how
much they're going to pay youfor that job versus working in a
private job is pretty decent.
And then the differentialbetween those private and those
academic jobs and locums is verysignificant.
So let's say that as a generalpediatrician, you're making X
(33:18):
amount of money.
To work as an academic center,it's probably 20% more to work
in private practice.
And at this point, to give youa ballpark, I work a lot, but
this year, if I keep up my samework, I'm on track to possibly
make around three times my peers.
Speaker 1 (33:38):
I think you said at one point you're making like
what an orthopedic surgeon wouldmake.
Speaker 2 (33:41):
Yeah, if I continue working at the same level that I
have this year, then I will.
I made more than most of thealmost all the pediatricians I
know in the last six months inone year.
Sorry, so, in the last likefive months is mid-June, so in
the last five months I'vealready surpassed a one-year
salary for everyone I know.
Five months I've alreadysurpassed a one-year salary for
(34:05):
everyone I know.
So that's where, if I continueat this velocity, what I'm
looking at and this goes back tothe instability of locums but
if I keep the current work I'mdoing, there's a potential in
the remainder of 2022, there's apotential that one of those
months I'm going to make more inone month that I did an entire
(34:27):
year of residency.
Okay, that makes sense andthat's what.
And it's hard to say that as apediatrician, because you know,
for you as a surgeon and apediatrician, just so everyone
knows, we get the same.
We get the same residencysalary.
You know, when we are firstyear residents, generally for
most programs, the post-gradyear, the resident salary tends
to be the same across the board.
(34:48):
Maybe a little bit of variation, but not astronomical, but then
you know.
So for me to be able to do thatas a pediatrician is is,
frankly, unheard of.
And so that's where I'm at withmy loans now is like you know.
Like I said, they kind of harpback again.
Those eight months aftertraining I was in the hole and
then, about one year aftertraining, when I started to feel
(35:09):
more comfortable, I started toput a little bit less.
I had a good emergency fund andthen I started channeling
everything towards my studentloans.
So there's two parts of thatthat's made it really nice.
I put a majority towards myloans just because of my
lifestyle.
I don't spend a whole lotpersonally, but the hidden bonus
(35:31):
that people don't think aboutall the time because I work
exclusively locum tenens, Idon't pay rent, I don't pay for
a car, so I'm saving anadditional probably what?
20 to 30 grand a year, probably50 grand now with gas prices,
just based on the fact that thelocum agency is reimbursed for
airfare, hotel and lodging.
Speaker 1 (35:49):
Okay, so quick question so you don't pay for
rent, so people want to know, soyou're completely nomadic then.
So where does your mail go toIf you are applying for
something major, let's say yougot to get a credit card, or
someone wants to write to you DrCabrera, you know I miss you,
like you're my pen pal, blah,blah, blah.
Where, where's your address?
Like how, where are you gettingyour mail?
Speaker 2 (36:07):
Yeah, that's a good question.
So I have a PO box in Texas andalso I live at, or I file my
taxes essentially at, myfriend's house in Texas.
Um and uh, I have everythingbesides that still in the name
of Texas my license, mydisability insurance, and part
(36:34):
of the big reason is Texas hasno state income tax.
So I'm from California but Idon't claim that as home because
I'm always worried that theywould want an income tax on top
of my work, even if it's inother states.
Speaker 1 (36:44):
Got you, so you completely live nomadic.
You live in hotel to hotel orextended stay to extended stay,
but your actual like mailingaddress for licensing purposes,
healthcare purposes, all ofthese different things are in
one place, which is in Texas,and that's where everything goes
.
Speaker 2 (37:02):
Right and I just have people I really trust down
there.
Speaker 1 (37:04):
So, just as a heads up for people listening, there's
an app, there's multiple apps.
They call virtual mailboxes.
One thing to consider is youapply for the service.
It's really cheap, it's like 99bucks or like 100 bucks a year
and you have your mail sent tothis virtual place.
They open up the mail.
First of all, they'll scan yourenvelope, they'll send you a
(37:25):
note and say, hey, you know,this is what you got.
Do you want us to open it, ordo you want us to trash it?
Or do you want us to mail it toyou?
And it's all.
Through your phone, you cansend it to them and if you say,
yeah, I want you to scan it,they'll scan it in and send it
to you and you can read it right.
Or if they trash it, they'lltrash it for you, or they can
literally not open it, putanother stamp on it and send it
(37:46):
to whatever address that youhave or that you're at.
So they call that virtualmailboxes.
A lot of people do that withreal estate If they have like a
real estate rental property.
A lot of people do that withbusinesses.
So just something as a heads up, dr Trevor, and all the people
listening, like you can kind ofnow.
(38:08):
Technology's kind of caught upto this nomadic lifestyle where
you can keep up with these typeof things.
So I'm interested so right now,with your loans.
I saw that you were able tomake a significant dent in your
private loans.
Is that correct?
Speaker 2 (38:16):
Yeah, so I had like 115 in private loans, paid those
off last year.
Speaker 1 (38:22):
Okay, so you paid it off in a year, basically.
Speaker 2 (38:24):
I paid it off in half a year, cause I you know, like
I said, I don't consider realmoney coming in until June of
2021, probably.
So I paid that off last yearand, um, as of right now, I'm
down to under six figures, alittle under six figures.
Speaker 1 (38:42):
Congratulations, man.
Congratulations.
So you've decided not to doPSLF, you decided to just pay
off your loans at your own pace.
Speaker 2 (38:49):
So that's why, going back to that, to give total,
arbitrary numbers if you'redoing an academic center and
they are paying you $100,000 ayear but you have to work there
for 10 years to pay off yourloans at the minimum payments,
that's one option.
But if you're going to bemaking 300,000 to do locums and
(39:10):
you're able to pay moreaggressively, then there's.
I think, the question thatcomes down that people have to
think about individually is howmuch money are you truly going
to save if you have loanforgiveness in 10 years?
That's the thing For somepeople.
If they have a million dollarsin loans, then doing the minimum
payments for 10 years, they'regoing to save hundreds of
(39:30):
thousands of dollars.
But if you only have $20,000 inloans doing the minimum
payments for 10 years, it's likeyou're not going to.
You're going to save like athousand bucks, like what's the?
Speaker 1 (39:39):
Yeah, and I also think it's lifestyles also
related, and where you want tobe, like, do you want to be at a
certain type of hospital?
Do you want to be in a certaintype of location?
Do you want like what, do youwant to kind of be freely mobile
?
And that was what me and mywife kind of thought about too
was like, well, we don't knowwhat kind of, we don't know
what's going to happen in thenext 10 years, but I damn sure
(40:01):
know that those 10 years I don'twant it to.
I don't want loans to be amajor part of it.
That's how we thought about itand with that thought process,
that's why we decided to go hamon our loans early, so that we
can get it out of the way.
So, whether we've decided tohave kids, whether we decided to
travel or what have you, we atthat point realized that you
(40:21):
know what.
I just don't want loans,whatever thought process that
may be, to be in mathematics.
That's not for everybody.
Everybody looks at itdifferently.
You can skin a cat multipleways.
We just let people know how wego and how it worked for us, but
appreciate your honesty on that.
Speaker 2 (40:35):
So it's true, you know I mean.
So I was sitting at a bar thereand I was listening to the
people next to me and they'relike they're, they're definitely
in these women that wereprobably in their later thirties
, early forties still talkingabout their loans and how it's a
problem.
I'm just like that's not andI'm just laughing at myself
because I'm like huh, I'm notgoing to have that issue.
Speaker 1 (40:53):
Right, right Now, let's let's ask you about this.
So you, you think that probablyprojected, maybe realistically,
the next five years you'll getyour federal loans all taken
care of.
Speaker 2 (41:01):
No Projected in the next five months, I'll be out of
debt.
Speaker 1 (41:04):
Damn.
Okay, that's what I'm talkingabout, good.
Speaker 2 (41:07):
Good, and so that's the thing right.
So I'm saving by the fact thatyou know I only spend about 10%
of my adjusted gross income onlife.
I mean, we're talking food,we're talking vacation, we're
(41:29):
talking my disability insurance,my health insurance 10%.
All of that goes into only 10%of the actual money that is
coming in.
So I have to think about taxes,of course.
But outside of that, I meanthat's a good majority versus a
good, sorry, a very small amountversus if I had a rent in
apartments, in places to liveand all of that I'd probably be
(41:51):
spending more closer to 20, 30%of my income to take care of my
life.
So I think that's where I'mable to shift so much of
everything.
Of every dollar I make, I canshift closer to 70% of that
straight to loans, or, you know,50%, I guess, um, straight to
loans All right, let's, let'stalk about lifestyle.
Speaker 1 (42:11):
Okay, so you work, um , you're you're working pretty
hard.
You're saying um, who's makingyour schedule?
You, or is it the hospital ismaking your schedule?
Who makes your schedule?
Speaker 2 (42:22):
Come on.
That's why we do locums.
I do whatever the hell I want.
Speaker 1 (42:26):
Okay.
Speaker 2 (42:26):
And that's what I tell all everybody I talk to you
.
So there's pros and cons forhow I tell people this, but the
way I set it up is I try to setup it has changed over a couple
years of doing this.
I set it up so that I work likeblocks of time in certain
places and we're notflip-flopping super frequently.
Currently my job, for example,in Maine.
(42:49):
I'm here for roughly aboutthree weeks at this particular
job.
I've talked to the director andshe's super nice and super cool
with giving me days off inbetween these like stints of
work.
So today I'm off, for example,some jobs.
I will intentionally work thateight or nine days in a row and
(43:09):
then I'll just schedule off acouple of days afterwards and
I'll make that schedule and I'llaccount for traveling myself,
like my travel days, and I'llmake sure to tailgate every job
with the day off and a travelday.
Speaker 1 (43:21):
So, okay, go ahead, please go ahead.
Speaker 2 (43:23):
Oh, I was going to say so at the most extreme, um,
and I don't.
I try to be more over time,since I've become less reliant
on the need for money to survive.
But over time I've I've gottena little bit more relaxed.
But last year it was a pointwhere man I finished work at 7
am in central Maine on Mondayand then started 7 am on Tuesday
(43:43):
in New Mexico and I was workingreal hard.
But now it's like I'll scheduleone day's off.
Speaker 1 (43:49):
Okay, so what's the longest break you ever took
working out of residency, onceyou started working locums now
consistently, what's the longestbreak you've ever taken?
Speaker 2 (43:57):
Yeah, longest intentional break after I
started having consistent work.
I mean, I think it was thispast month.
I took like five days off, broAll right.
Speaker 1 (44:09):
So that leads to my next question Do you think that
you're working too much?
Right, let's talk aboutresident life versus attending
life, cause as a resident, youknow there's duty hours, right.
There's a certain amount ofhours that you're going to work
and then that's it when you'rein attending I'm sure you've
realized that you had mentionedbefore.
It is 72 hours straight and youpossibly may be working, but
that's your schedule.
You said that you set it upthat way.
(44:29):
Um, you don't necessarily have.
Well, excuse me, you don't haveto work that way at all.
You chose to work that way.
But I'm concerned, like, let'stalk to the people about do you
think you work in too much rightnow versus how it could be?
For?
Speaker 2 (44:40):
me personally, oh, hell yeah.
But part of why I set myself upfor it was that in my head, um,
since my, my, my, my, my viewis pointed towards fellowship, I
didn't want to lose too much ofthe mojo.
So you know, I've realized whenI have too many days off, I'm I
(45:02):
see it like I'm off.
Today, I'm going to go eatlobsters, sit at the beach in
Maine.
That's what I'm going to do andit's nice and I'm enjoying
those days off that I didn'thave residency.
But I try not to get too muchtowards that, only because I
want to keep up the momentum togo back to trading.
So that's my personal thoughton it, right?
Speaker 1 (45:19):
now Do you feel like?
Because in many respects Ithink you're probably putting in
more.
You don't think it is, butyou're probably putting in more
hours as an attending than youare as a resident.
Speaker 2 (45:28):
I am putting in more hours sometimes, so it depends
on what the job is.
For example, last year I worked26 consecutive days on call in
Huntsville, texas.
I went into the hospital for atotal of maybe five or six hours
.
So I was on call that time and,yeah, being on call mentally was
(45:50):
different, it counts but at thesame time, if you're able to,
if you're able to separate itand to be able to do things
outside the hospital, being oncall.
It was a little bit differentthan being as a resident, I
guess.
You know, like I didn't have tophysically be in the hospital,
so it felt different, Um, but Idefinitely am working more, Um,
but the difference, of courseand I I've talked to people
about this is I get paid for it.
(46:11):
So that's, that's where it's.
It's not, it's something whereI excuse it, Um, and I actually
that part of that 72 hour job Itold you about it's a bigger,
it's, it's part of a biggerpicture.
I worked six days in New Mexico, which 120 hours were in the
hospital, so it's a lot, but, um, you know, I do it partially
(46:35):
for the challenge too.
Maybe I'm just, you know,psychotic or something, but uh,
it's kind of fun, Okay.
Speaker 1 (46:42):
Well, for the, for the, for the folks you know that
are listening.
You know, one of the best thingsof what Dr Trevor said is he
makes his own schedule and youcan decide how many days in a
row you want to work or how manydays a month you want to work.
If you want to do like 10 in arow, 14 in a row or however long
in a row.
You decide that.
You make that choice up to youand it's unlike residency where
(47:04):
someone is keeping track of thatand per hour, how many hours
you're going to work as anattending and I don't know what
(47:25):
the answer is.
But I definitely think that ifwe do resident work hours, which
work, but then we are puttingthem in a situation or in the
outside world where there aren'tany work hour limitations,
there's a bit of a disconnectand I don't know what the answer
is.
Right, like it's, you'repreparing them for safety in one
area, but then you'regraduating them into a place
(47:46):
where nobody's keeping track oftheir hours and I can say, as an
attending, I put in more hoursas an attending than I did as a
resident.
Go ahead please.
I was going to say especiallyas a surgeon.
Yeah.
Especially as a surgeon, youknow, you know.
So I don't, to this day, Idon't know what the answer is
right.
I do think that the way howwe're training residents is
(48:07):
correct, but also, at the sametime, I don't know, just because
we're training them correctdoesn't mean that we're
preparing them correct, if youknow what I'm saying, right.
Like, if you're putting them ina world where there's no
resident work hours, then whyare we training them with
resident work hours?
But you actually do needresident work hours because you
don't want them tired.
So it's just, it's, it's weird.
I don't know the answer to that, but that's just something to
to think about and somethingthat, now that I'm 10 years out,
is Overall, overall, overall.
(48:31):
Dr Cabrera, what kind oflifestyle do you want?
Let's talk about it.
Speaker 2 (48:34):
Yeah.
So you know, I want to befinancially like, not tied to
loans.
I think that's because that'sobviously my big priority here.
Now I'll say like one thing Iforgot to mention on why I work
so much is this by doing, byworking this many days, this is
how I get the local agencies tocover all of my housing, because
normally they're only going tocover the day before.
Speaker 1 (48:55):
I love it.
Give me more.
Give me more.
Speaker 2 (49:01):
Yeah, so the strategy , right?
The strategy is they're goingto cover the day before, the day
after the job assignment dates,and so I think historically
they used to cover more thanthat.
I don't know, you could correctme if I'm wrong, but now I
think people are a little bitmore stingy on that.
So if I'm working Mondaythrough Sunday, they're going to
cover the Sunday before untilthe Monday after, perfect.
The day before day after thatgoes for the rental, that goes
(49:21):
for the hotel and then theflights.
I'm able to kind of schedulethat differently.
So to give you a real exampleright now June 14th, last week,
I took four days off.
What I did was I used the locumagency to fly from California
to Maine and then, on my owndime, I spent three days on
vacation.
But then I picked up anotherrental under the agency to come
(49:43):
back into the hotel to work formy couple of weeks and then when
I leave I'm going to fly out onthe agency and go back to
wherever I'm going.
So there's that part of it andthat's why I schedule so close
to close back-to-back piggybackjobs.
And the big point to point outto that- it's like you're travel
hacking.
Speaker 1 (49:59):
That's what it is.
Speaker 2 (49:59):
It is travel hacking To talk about a little bit, to
give people a little bit more ofa number, and then we talked
about it before.
But I traveled 320 days lastyear and this year it is June
14th and I have traveled, Ibelieve, something like 180,
like 283.
(50:19):
So you're ahead of schedule yeah, but that's how many days I've
been traveling.
Now the question is what kindof and I go back to your what
kind of lifestyle?
So the unseen other benefitsright, my plan, if everything
worked out, I would apply tofellowship right now, I would
match into fellowship next year,I mean, and I go back and forth
(50:40):
.
So you know, don't hold me tothat, because I do like I do
love this lifestyle.
But the plan is next year I'mI'm planning to take off a whole
month and I'm going to travel,probably Europe or somewhere
else, purely on all of the twomillion points that I've
accumulated by living in hotels.
So at this point you know a lotof Make it longer, Dr Trevor.
Speaker 1 (51:01):
Yeah, that's the thing, make it two months.
Speaker 2 (51:03):
Huh.
Speaker 1 (51:04):
Make it two months.
Nobody's checking on you, bro,you deserve it.
Speaker 2 (51:08):
I might do some things, but I'm saying that,
like you know, just the pointbeing that with this lifestyle,
what people don't remember theythink about all the time and
sometimes people ask me as thepoints.
I mean what I'll usually do isI have an America, I have a card
there's a Hilton honors card,credit card.
I'll pay for the hotel on theHilton card, I'll get points for
that and then I'll getreimbursed from the agency.
(51:28):
So so I ended up getting liketriple, quadruple points on a
hotel stay, and it puts me in apoint now that I could literally
go to Europe for probablyyou're right two months, just
purely on the points.
So it'd be like a paid vacation, other than the food.
Speaker 1 (51:43):
Dr Trevor, I think you should extend it out to two
months.
Don't just do it.
It's okay Like nobody ischecking for you.
There's nobody who's going tocheck a box.
Give yourself the time, thegrace to take however time that
you want off.
So well, listen, this was areally dope conversation and you
know, I think that you know Iwanted to harken back to what
(52:06):
the attending said that if yougo from job to job to job to job
, that possibly could be, youknow, maybe a poor reflection on
who you are as a pediatrician,and I can say that as, 10 years
out, I had that sameconversation with attendings and
I'll leave it to you like this.
Those same attendings havecalled me several times over the
(52:27):
last, I'd say, three yearsasking hey, what company did you
go with?
Hey, how did you set yourselfup with locums?
Hey, I'm sick and tired of X, yand Z.
Can you teach me how you'redoing locums?
Hey, blah, blah, blah, blah,blah, blah blah.
I think that a lot of peoplemake comments and I know you're
attending did locums?
But I think it really comesdown to individually who you are
(52:49):
.
Are you going to be able tolike?
What kind of panache are yougoing to be able to like, what
kind of you know what kind ofpanache are you going to bring
when you come to a job?
Right, because I think, justsaying that, if you go to locums
, you're going to have this darkshade on you, you know, I think
that that's the wrongperspective to give residents.
Right, I think there aremultiple ways to skin a cat and
there's multiple ways topractice and, um, I'm really
glad that you heard all thatinformation and you decided
(53:09):
still to try this out, right,and now you're, you're still,
you're thriving in it now.
Speaker 2 (53:14):
Yeah, and I want to just one more thing to say add
onto that.
So so I've loved it for a bunchof reasons.
It's not for everyone.
Like you said, we do.
I do it to the extreme, you cando it, but the best part is you
can do it how you want to.
I've been.
I've been learning so much.
I've learned these contractnegotiations I've seen.
I've worked in a dozen hospitalsin the time that all my friends
have worked in maybe one job,you know there's just parts that
(53:36):
go to it, but at the same partsame point something I've
noticed with being dropped intoplaces man in my head and I
maybe it's a grandiose idea, butin my head we're like freaking
special ops and it's awesome andI can do stuff.
And I can do things in someways that, like other people,
like how did you do that?
I got an orientation at ahospital, at a quaternary care
(53:58):
children's hospital, from 9am to12pm and I got thrown in just
like helicopter, dropped in 8pm,starting that night as the
nocturnist.
Like I can do that right, I canlearn an EMR in two hours.
I can be flexible and adaptable.
They call us in for jobs wherethey can't find people.
They call us in for jobs.
(54:19):
That need someone that can bequick, that can learn fast and,
if anything, I think it sets usup as more attractive candidates
for the future, because that'sthe thing People ask me now for
jobs.
They're like can you do this?
I said yes, or I can figure itout immediately.
I don't need to go through yourtwo weeks of orientation.
You give me 30 minutes and wecan.
I can hit the ground runninganywhere, absolutely Just like
(54:41):
falling out of a helicopter, sothat's that's kind of like in my
head, that, the way I thinkabout it, so that's that's kind
of where, where I've been, andthat's why I love being the uh,
it's the nomadic pediatrician.
You know, that's like that.
Speaker 1 (54:50):
Tell them where it's at.
Tell them where it's at.
How did they find?
Speaker 2 (54:53):
it, yeah, you know.
So, if anyone's listening forthat, the uh, my blog, where
I've got a lot of uh, a lot ofthings on locums, my travels,
and also a uh, I've got abrewery map and pictures of all
the food I cook in these hotels,which is awesome, but it's the
uh, the nomadic.
Live it.
Yeah, I get it and I thinkwe're going to leave it at that.
It's the life that you want ifyou decide to live it.
Speaker 1 (55:26):
And I think that that's a huge change from
residency, where you feel likeyou're just trying to survive
and you feel like you are underthe thumb of somebody else and
as a resident excuse me, onceyou finish and you are in an
attending level, whether youdecide to do private practice or
you're working on your own oryou're doing locums, it's really
you know you make the decisionas to what you're going to do.
So, hey, I appreciate this, um,this talk.
This was really dope, dr Trevor.
And listen, I hope to hear fromyou next year when you're doing
(55:49):
your two months off somewhereon a train in Spain or wherever
you are in the channel, orsomething dope and let us know
how you're doing.
All right.
Speaker 2 (55:57):
Yeah, no, I appreciate it.
Thank you so much, man.
Speaker 1 (56:00):
All right, man take care All right, have a good one.
Hey guys, thanks again forlistening as well as supporting
Docs Outside the Box.
Listen this show is produced byDarko Media Group and the dope
audio experience is edited bythe one.
The only christian parry, alsoknown as your podcast pal, links
(56:21):
to them in the show notes.
Listen this is dr neem, the docoutside the box.
I'll catch you on the next one,peace.
Did you know Locum's Docs make, on average, 33% more
than employed docs?
Got your attention now.
So if you're considering Locumtenants, either full-time or on
the side, you probably have aquestion or two, or maybe even
20.
Locumstorycom is packed withunbiased information and tools
(00:22):
to see what the trends are inyour specialty and even make a
decision if locums is right foryou.
My advice make locumstorycomthe go-to place to learn more
about locum tenants.
That's locumstorycom.
All right, dr Trevor Cabrera,the nomadic physician.
(00:43):
What's up?
What's good?
Welcome to Docs Outside the Box.
How you doing.
Speaker 2 (00:46):
Good, how are you?
Speaker 1 (00:47):
Good good.
Where are you located at man?
Speaker 2 (00:49):
Currently I'm in Augusta Maine, central Maine.
Speaker 1 (00:52):
Central Maine.
So when I think of Augusta, Ithink about Georgia.
Okay, so there is an Augusta inMaine.
It looks like for's in anextended stay.
It has that typical appearanceof you got the hotel door with
the exit right behind you, theexit mat behind you, and then
you got microwave, refrigeratorand all the things that you need
to do, a mini kitchenette.
Speaker 2 (01:12):
Stove top there, yeah .
Speaker 1 (01:17):
Stove top so you can cook if you're going to be there
for an extended period of time.
So you are a locums pediatricphysician and let's jump right
into this.
How long have you been doinglocums now?
Speaker 2 (01:26):
Um, I, I'm actually a relative new grad, so I've been
doing it since I finishedresidency 2020.
And I mean like immediatelystarted straight into locums,
did nothing else, right out oftraining.
Speaker 1 (01:36):
Okay, so all you know is locums coming out of a
fellow or coming out ofresidency.
Speaker 2 (01:40):
So, uh, kind of not not entirely actually.
So I so I meant to, I meant todo purely locums but because of
COVID, pediatrics took a hugehit.
So, unlike the rest of theworld seeing tons of people
getting sick and medicine, kidsstayed home.
They didn't get sick as often,so the census for us went down.
So actually when I startedworking I couldn't find work,
(02:01):
consistent work.
For several months I livedpaycheck to paycheck.
I lived like month to monthwaiting for locum work.
I thought about quitting Waitquitting what.
Quitting locums, I thought aboutgoing to a permanent job
because I couldn't find work.
So that was 2020 for me.
I literally it would be the endof October and I didn't know if
(02:22):
I was working November.
But I would be sitting therejust waiting for my recruiter
call and we'd be like, hey,there's a new job.
And then fast forward to lastsummer June 2021, I had an
opportunity for kind of therewas a locum to perm kind of job.
But instead of us working alocum and then converting to
permanent, they actually decidedbefore I even started they
wanted to sign a permanentcontract.
(02:42):
Before I even started theywanted to sign a permanent
contract.
So I did work as a permanentprovider at this hospital in
middle of nowhere, new Mexico,where I was there for 15 days a
month.
But the contract waseffectively set up like a locum
contract but I was actually anemployee as a permanent provider
of the hospital.
So it was kind of like a quasikind of mix of both.
So it's been kind ofinteresting because I've gotten
(03:03):
to see both sides of it.
I mean, that was a W-2 job,that was a job with some
benefits.
I had to be forced with some ofthe administration stuff, but
it wasn't true permanent job,because they still paid for my
hotel, they paid for my rental,some CME stuff.
I kind of just worked that intothe contract, I guess, but it
was effectively basically in mymind just a locum.
Speaker 1 (03:27):
Got you.
So how about this?
Let's take a step back.
Let's take a step back.
Two years ago you werefinishing up your residency.
I'm sure the majority of therest of your current residents
were thinking about graduatingand going into their respective
jobs I'm assuming most of themhospital employed.
Talk to us about why youdecided to do locums.
Speaker 2 (03:49):
So most people that I actually know in pediatrics do
a lot of them.
Yeah, they went to clinic orsomeone to hospital, someone to
fellowship, you know someprivate, some academic, all
those different parts of it.
For me, actually, it was kindof a hard situation because I
actually went back and forth ondoing fellowship myself and I
actually was forced to make atough decision because of the
(04:11):
AAP.
As of 2020, there is a newcertification that the American
Academy of Pediatrics is pushing, which is for PHM pediatric
hospital medicine.
So, as of 2020, anybody thatgraduates is being forced or
required to do PEDS HospitalMedicine fellowships.
Speaker 1 (04:30):
So what that kind of put me in a situation was- so
basically what you're saying is,if you graduate from a
pediatrics residency, if youwant to do pediatric hospitalist
, you have to be board certifiedin a fellowship.
Speaker 2 (04:44):
That is what they're trying to create.
Speaker 1 (04:47):
And that's what you you want to be a pediatric
hospitalist.
Speaker 2 (04:52):
No, not necessarily.
I wasn't sure because I likethe, I like intensive care, so I
didn't know.
I didn't know which fellowshipI wanted to do, but I knew that
as a 2020, unlike my colleaguesbefore me I couldn't jump
straight into hospital medicinebecause right now the
fellowship's not required acrossthe country, but in 15 years it
might be.
And so my thought was well,I'll go take a year to do locums
(05:15):
and then I'll figure out do Iwant to go back for pediatric
ICU neonatology?
Do I want to go back forpediatric emergency medicine or
pediatric hospital medicine?
Speaker 1 (05:23):
So was this a conversation that you're having
in your mind or is this aconversation that you're having
with your attendings?
Your fellow residents Talk tous about that whole
deliberations.
Speaker 2 (05:32):
Mainly myself.
Mainly myself trying to figureout what, like specialty within
pediatrics I wanted to do.
Speaker 1 (05:38):
Because this is third year now, like third year, like
so how did even locums get intoyour mind?
Like, who told you about locums?
Because that's the other thing,cause I think a lot of times
people struggle with thesedecisions but they're just like
well, I didn't ever even heardabout locums until this point,
did that?
Speaker 2 (05:53):
happen to you?
It did, and so you know, for usas a pediatric resident we
train in huge academic centersis we're not in the rural places
, and that's an importantdistinction, because where I
trained there was no such thingas a locum.
I'd never heard of it, and myresidency program was big.
We had about 30 residents perclass.
So out of I would say out of200, 150, 200 pediatricians I've
(06:15):
met, zero or two of them havedone locums at all, and one of
them did it as a bridge to hispermanent job, um, and then the
other one did it just for ashort time in the past.
So, um, for me it was secondyear of a residency, a locum
agency came to talk to us it'sactually, interestingly, an
agency that I don't, I don'twork with, but they came to talk
(06:37):
to us and I heard about theidea.
And when I heard about it, atfirst I wasn't sure, um, and
then, when I got towards thirdyear, I kind of started talking
to agencies a little bit moreand was like huh, this is a
short term idea and so I canfigure out applying to
fellowship.
I'm only going to do it for ayear, we'll see what happens.
Um, but then I didn't find work, very I didn't find enough work
(06:59):
, and so I decided well, I'mgoing to extend this, and it
wasn't just for the fact.
Speaker 1 (07:03):
But when you say work , what do you mean?
Speaker 2 (07:05):
Like I literally did not have work.
Speaker 1 (07:07):
This is your third year or is this when you
graduated?
When I graduated, when Igraduated, so the plan was
graduating we're just trying tokeep the timeline right for the
for the listeners, so they canclarify.
So now you have graduated andnow you are, you are working
locums and you're thinkingshould I try to find a permanent
gig versus continue locums?
Speaker 2 (07:26):
No, I'm graduated July and I can't find consistent
locum work for eight months.
Speaker 1 (07:33):
Oh wow, so you're not working at all.
Speaker 2 (07:41):
No, I am so, like I was saying, I'm living like
month to month.
So the one job that I had inHuntsville, texas, in July 2020,
they didn't have their scheduleuntil the end of each month.
Speaker 1 (07:47):
So I didn't know if I was getting any shifts, that's
what I'm saying, Dr Trevor man,you got to be clear with this,
All right.
So you were working at a spot.
They would do their schedule ona month to month basis, but you
don't know if you're going tobe a part of that schedule until
that that month schedule comesout like maybe a week before the
next month, correct, Right?
So that's what I'm saying.
Speaker 2 (08:04):
So that's what happened in 2020.
And so that's why I said 2020,that happened.
And I did that, and I livedmonth to month and thought about
well, shit, I can't findconsistent work, they're running
out of days.
Do I need to consider stoppinglocums and taking a permanent
job?
I didn't want to take apermanent job, but then in 2021,
the next year I kept working atthat same site and then it
(08:25):
still was so unstable that Idecided to take that
semi-permanent job in New Mexicoto make sure I had some
consistency while the locummarket was starting to come back
.
Speaker 1 (08:37):
This episode is brought to you by locumstorycom.
Backdrop 2012, finishing myfellowship in Miami and no
decision bigger than where andhow I was going to start working
on my own, and there it was thefork in the road being employed
versus something I had neverheard of before locum tenants.
So I decided to go the locumsroute and I had a ton of
(09:00):
questions.
Then I stumbled a bit, buteventually I was able to stand
on my own and I have beenworking locums over the past 10
years.
Now what about you?
If you're considering locums,you probably have hella
questions, just like I did, likewho covers my malpractice?
Do I really have control overhow often I work, and what are
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Now, lucky for you,locumstorycom has the answers
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So listen, take my advice.
(09:43):
Locumstorycom is the perfectplace to start if you want to
learn more about locums.
That's locumstorycom.
So what was it like when youwere telling your fellow
residents that hey, I knowyou're going to be going to this
clinic spot.
I know you're going to be goingto this academic spot.
I'm good, I'm just going to belooking at locums.
(10:05):
What was that conversation like?
Speaker 2 (10:06):
Everybody in the world thought I was crazy.
My mentor, directly my mentor,who was one of the two
pediatricians I told you that Ihad met that did locums.
He did it for a short timebefore he became a full staff,
attending right out of trainingalso, but only for a very short
time.
He literally told me I wouldn'tdo that.
I would recommend you.
(10:26):
Or he said, be careful, don'tjump around from place to place,
because it's going to look bad.
They're going to say why areyou jumping from place to place?
Why can't you hold a steady job?
And that was one of the bigthings I was told and a lot of
people were just confused.
They didn't quite know what itwas and they still don't
entirely understand it because Ido it to an extreme.
(10:49):
I mean, I do it a little bitmore extreme than you know some
people if they're doing locumsone week a month, I do more than
that.
Speaker 1 (10:56):
So when you, when it was time to graduate, I'm sure,
when it was time to graduate andyou are looking at the
presentations and your fellowresident is going here, your
resident is going there and itprobably says for you Dr Trevor
Cabrera, locums, full-timelocums or whatever.
What was that like?
Speaker 2 (11:15):
I mean it was hilarious.
Everyone was confused and wehad a Zoom graduation because it
was COVID, right?
So you see everyone's name goesup and it was like a
presentation and the second part.
Just to throw this in there togive you a background of who I
am.
I kind of forgot I hadgraduation.
So I was in my kitchen, drunk,cooking some mushroom risotto
and I'm sitting there on thezoom just cooking risotto.
Speaker 1 (11:36):
Well, I hear this girl, y'all hear this he forgot
about his graduation.
Speaker 2 (11:39):
Yeah.
And so I'm saying they're drunk, just cooking some fancy ass
mushroom risotto.
And so I'm standing there drunk, just cooking some fancy ass
mushroom risotto.
And so they're like all talkingright, and in the chat box on
the side everyone like literally200 people watching.
They're like Trevor, what areyou cooking?
And I'm standing there cuttingmushrooms.
Everyone else's head is justsitting there right Watching I'm
cutting mushrooms, I'm cooking.
I'm like, oh, I'm makingmushroom risotto, and everything
goes up on the board.
(12:00):
And then it says locum tenensfor me.
And you know I definitely gotflooded with a bunch of messages
not, you know, not just from mypeers.
I'd talked to you, but everyoneelse is like what is that?
Like people didn't know because, like I said, it wasn't talked
about.
I mean, I heard about a secondyear residency, but I'd never
met a locum.
Speaker 1 (12:19):
So why didn't that scare you Like, why didn't that?
Even to that point You're likeman, am I really making the
right decision?
I mean, I could, I could bewrong.
You may have already had thosethoughts Like, well, were you at
that point, it's not going towork, yeah.
Speaker 2 (12:30):
I was freaked out.
I made the decision a couplemonths before graduating and
then I was freaked out when Imade the decision in third year.
I was freaked out at graduationand I became more freaked out
every day when I couldn't findconsistent work.
So when I graduated, I don'tthink I even had a locum job set
up.
I was just hopeful andoptimistic that it'd come back,
(12:52):
and so I grinded every singleday to try to find work.
Speaker 1 (12:59):
So the next day after graduation you have no job.
You don't have any perspectivesat this moment Financially.
Were there any preparationsthat you made right before
graduating, like?
Did you save up any amount ofmoney?
Did you have an emergency fund?
Talk to me about that.
Speaker 2 (13:12):
Yeah, that's a really good question.
So I did.
I saved up for a couple ofmonths, but the main thing that
I tried to save up on was tomake sure that I had enough to
pay my loans back when thefederal loan, when I since you
finished residency, when theystart requiring payments to come
back.
The big thing that saved me wasCOVID.
In some ways, I mean, it hurtbecause I didn't have work but
(13:35):
on the flip side, the federalgovernment froze my loans.
So I was lucky to escape by.
Speaker 1 (13:40):
I also did things like extreme couponing, like man
, I would that's what I want toknow about your lifestyle.
So yeah, so let's talk abouthow you were able to pay for
food, like, did you save forfood, couponing, rent, all that
stuff, like, so you had to savefor all that, right?
Speaker 2 (13:53):
Yeah, and you know I think you know no offense to
most and where did you live?
Where were you living?
So I, I lived in my apartmentin Houston the same apartment
third year through graduationand what I did was the way I
thought about it was I savedenough money to pay rent and I
(14:14):
set aside money for food for acouple of months before I
graduated and then each month Ikept kind of reassessing that to
make sure that I had enough.
And the nice thing is, locumspay well enough compared to a
resident salary.
That me working.
If I got a good week, sevendays of work in a month, I
wasn't going to make money but Icould survive till the next
(14:34):
month.
So, um, and that's so, so sorry.
So go to back up.
So I'm not in order here.
The pre the plan before Igraduated, I did save up a
safety fund and this was reallybecause I couldn't find work.
And then when I graduated Ikept every month I had to
reassess am I at the right pointfor the safety fund?
Do I need to do I need toconsider stopping locums because
(14:55):
my safety fund is going down?
And that's where that mentalitycame in.
Speaker 1 (14:59):
So went from graduation to when you first
started your first locums gig.
How long?
Because I'm assuming yougraduated sometime in June, july
1st.
You ain't got no job.
When did you start workinglocums?
Speaker 2 (15:11):
I got offered one shift July 27th 2020.
Speaker 1 (15:16):
One shift.
Speaker 2 (15:17):
The locum job was for one day of coverage, to go up
for 24 hours to cover deliveries.
I went up.
I covered 24 hours.
I did orientation went up.
I covered 24 hour orientation.
Speaker 1 (15:27):
Where's this at?
Where's the first gig at?
Speaker 2 (15:28):
Huntsville, Texas.
Speaker 1 (15:29):
Huntsville, texas, gotcha.
Speaker 2 (15:30):
Yeah, so the nice thing was it was within driving,
so about an hour north of.
Speaker 1 (15:36):
Houston, so you had a job within three weeks of
graduating.
Or at least an opportunity.
I had one day of work.
That's good, I'm glad youclarified that I had one day of
work.
Got you Okay.
Speaker 2 (15:48):
And so I had one day of work.
I went up there, sat in thehotel, didn't get called in.
I was so confused.
I was like a new attending,thought I was going to be seeing
patients, but, unsaid, I wassitting there at the hotel on
call.
I went up there for one shift.
I went back home, I called mymom.
I'm like, oh my God, they paidme to do this.
Speaker 1 (16:04):
Well, hold on hold on Cause you didn't get your money
yet when you worked there,right?
So so when they gave you thatJuly shift, you didn't know if
anything was going to turnaround for August, right, you
didn't know anything aboutAugust.
You didn't know nothing aboutSeptember, okay, perfect.
So when you got there, so yourrecruiter tells you hey, I found
something for you, it's for oneshift, it's in July.
I'm interested.
(16:26):
What was that first day like?
Take us through what it waslike.
Take us through thoseconversations you were having
with your mama, all that stuff.
Speaker 2 (17:00):
And when they called me about this job, I thought a
little differently.
I thought a little bit moreaggressively as a new grad, the
first way I thought about it washey, I've got all this
different competition frompeople that are experienced
providers.
And I straight up told myrecruiter I'm like look low ball
, I'll go in lower than mycompetition because I need work.
And so I did.
I went in low, I got one shift,I drove up there.
I was really nervous becauseI'm a new attending, I just
started a new job and I get allready for orientation.
I go in the next day, I walkinto the unit and real quick.
Speaker 1 (17:16):
Before you did that, how do you remember?
You don't have to tell me howmuch you got paid, but do you
remember how you got paid?
Was it you got paid like everyhour for 24 hours, or did you
get paid for?
You know you work for severalhours and then you get to go
home Like how did that pay thingwork?
So people can get anunderstanding of how you got
paid.
Speaker 2 (17:34):
Sure, so there's different schedules and
different ways that we get paid,because our jobs are always
different, whether we're clinicor inpatient or just on call.
This job was something we wereconsidered to be just on call,
so I had a set amount to be oncall for, 24 hours and then
every hour that I so you gotpaid a certain amount.
Speaker 1 (17:51):
There's a certain dollar amount to be available
for 24 hours.
Speaker 2 (17:54):
Certain base amount to be available for 24 hours,
but then within that, at thisparticular job, it included
within it four hours of work.
So if I worked one zero hoursor if I worked four hours of
work.
So if I worked one zero hoursor if I worked four hours, I got
a.
I got the same rate, but thenevery hour after that.
If I had to work five hours,then I get one hour of overtime
like what's an hourly rate ontop of that.
Speaker 1 (18:16):
Got you.
So if you, let's say, you weregetting paid a hundred dollars
for 24 hours Now, everyonelistening, that's really low.
I'm just using that forillustrative purposes.
Everyone listening, that'sreally low.
I'm just using that forillustrative purposes.
If you got $100 for 24 hours,that means that for hour zero to
the end of the four hours,you're going to get $100, right.
And then if you were in yourhospital or, excuse me, if you
(18:37):
were in your hotel and youstayed there for the rest of the
whatever 18 hours, you're stillgoing to get a total of $100.
But if after 18 hours, you'restill going to get a total of
$100.
But if after four hours youwere in the hospital, for hour
five, hour six, hour seven, houreight, you would get additional
pay, overtime pay past that$100, correct.
Speaker 2 (18:56):
Yeah, that's correct.
So that's basically, but mostlysmall jobs, the way they're set
up, like that it sounds good inyour head.
You're like all right if I'mthere for eight hours.
Well, shoot, I'm going to bemaking this hourly.
But this hospital is so slowthat I never hit four hours,
almost ever.
So I took a low salary.
(19:18):
And then I go up there for thefirst shift and I did it so that
they I wanted to do that, sothat they would confirm me.
I wanted them to take me, uh,and I wanted to get my foot in
the door.
And that's where I thought verybusiness strategy.
I'm like I could ask for allthis money that all the other
doctors are asking for.
I'm aware of my worth, eventhough I'm a new grad, but like,
let's, let's try to get anactual job.
(19:38):
I need food on the table, whichis crazy to say as a doctor,
right?
So I get up there, I walk in, Imeet everyone and I'm like all
right.
Well, I'm real confused becauseI don't even know, in residency
there's no on-call jobs.
You're seeing people the wholetime.
So I go introduce myself andthey're like all right, we'll
call you if we need you.
And I leave the hospital andI'm like well, really confused.
(20:03):
So, you know, I'm like all right, so I drive around the town, I
go sit in my hotel room, I'mjust hanging out.
I'm like this is weird, what amI doing?
And I remember that night, whenit got towards nighttime, I
actually called the night shiftcrew to be like hey, just want
to let you know I'm here if youneed anything.
And they're like we know,wanted to let you know I'm here
(20:23):
if you need anything.
And they're like we know, allright.
Yeah, they're like why are youcalling?
And they're you know this is anold town where they're used to
the old school pediatriciansthat you know they don't call
them unless someone's like dying.
And you hear me like being soeager to be like hey, I'm free,
but I'm a new grad, I don't knowwhat the hell I'm doing.
Speaker 1 (20:39):
They know you're a new grad.
Speaker 2 (20:40):
Yep, they got it I don't know how much they knew I
was a new grad right away, CauseI didn't tell everyone the
first day, right?
So I think they might have.
But, um, you know, they didn'tknow right away, and so I go
home the next day and that's it.
That's July 28th.
Speaker 1 (20:53):
I go home and this is something that does differ with
locum agencies is the way theypay you.
Speaker 2 (21:07):
With working with Comp Health.
The one thing I and I don't putany particular favoritism out
to be fair, no bias.
But with Comp Health the thingI really really like about the
company and CHG Healthcare ingeneral is they pay me the next
week.
Speaker 1 (21:22):
Okay.
So you got paid the next week.
So I'm going to be honest withyou.
So the first time I startedworking as a locums it took me
about a month and a half tostart working.
So I started working lateAugust after I finished my
fellowship in June 30th or 31.
I can't remember if June has 30or 31 days.
But I worked for two weeks andthen I got a paycheck.
(21:44):
And I'm not going to lie to you, when I got that paycheck, that
paycheck was multiple fractionsof what my parents got paid in
a year.
Right, which is something thatI've never seen before.
Right, like I was so used to aresident salary which was
reasonable.
And then, all of a sudden, Iworked two weeks and it's like
whoa, I've made this significantamount of money.
(22:07):
I've never seen this amount ofmoney before.
I was extremely happy, I wasextremely humble, but also, at
the same time, I was kind offreaked out.
I was like yo, I don't knowwhat to do with this money.
And so, when you saw yourpaycheck, how did you feel when
you first got your paycheck?
Speaker 2 (22:24):
Now, granted, it's one day.
But how did you feel when yousaw that paycheck?
I kind of felt like I didn'treally deserve it for the work I
did.
But at the same time I felt thesame way of like, oh shit, I
just made one.
I just made a quarter 25percent of my monthly salary as
a resident in one day.
But, realistically just, not totalk too much about the numbers
but to be totally honest.
Speaker 1 (22:42):
but realistically just, and I'm not to talk too
much about the numbers, but tobe totally honest, we should
talk about the numbers.
Speaker 2 (22:47):
It's okay.
I mean, it's kind of hardbecause with that first job it's
difficult because, like I said,I settled and it was COVID.
But realistically, when I lookback at those numbers, the
amount that I got paid for thatparticular job wasn't really
more than if I'd taken apermanent job.
Sure, like I said, the only ifI had taken a permanent job, I
actually might've gotten paidmore for that kind of work.
But uh, it came with all theother pros of locums, which is a
(23:10):
whole other you know, a longerconversation, of course.
Um, so I I did, I did havethose feelings, I did have those
feelings, as you did, of like,oh my God, I can't believe that.
Um, and it was, it was actuallyreally interesting, but at the
same time I couldn't enjoy it orthink about it as much, because
I was very, very aware of howinconsistent my work was.
(23:33):
So, even if I got a bigpaycheck- you didn't really
consider your money.
It was like yo, this is survivalmoney, right here Exactly, I
didn't consider any money my mymoney, and I didn't for very
long time.
It took months until I got tothat point, because even when I
got to a point where I was outof the hole and I was let's put
it this way I had an emergencyfund at graduation, maybe for
(23:54):
two months, and as I went on in,that emergency fund grew like
very, very slowly, I was able toproject out okay, four months,
five months, whatever.
It wasn't enough, though,because my goal, my plan, was to
entirely move out of myapartment, so I needed an
emergency fund that wouldaccount for the fact that I
didn't have a place to live, andso I needed to think much
(24:18):
bigger.
So for me, the money was neverin the first, like I would say.
The first year I did locums, Ididn't, I wasn't in the block
the first year.
Speaker 1 (24:26):
You were playing catch up in your head.
Speaker 2 (24:28):
you thought and I, yeah, and I don't even mean for
loans, I mean I was playingcatch up to survive.
Speaker 1 (24:34):
Got you.
So how long did it take youbefore you felt like you were
even keel, like you were, youknow, floating in water.
Um, with finances I'm nottalking about loans, I'm just
talking about just with moneythat's coming in as a locums how
long did it make you to?
You felt like I'm good.
Speaker 2 (24:49):
So for me it probably took about eight months.
Okay, but just because of theinconsistency of work.
Speaker 1 (24:56):
Right, you know, I think.
How long did it take you tofind consistent locums work?
Speaker 2 (25:01):
A year.
Speaker 1 (25:02):
It took you a year.
Speaker 2 (25:03):
Yeah, and that's, and that's why the timeline was
July.
Graduated inconsistent locumsFebruary 2021.
Saved up enough to get aroundmy apartment, but still
inconsistent locums March 2021.
Signed a like locum slashpermanent per diem contract in
New Mexico so that I could fallback on that.
Speaker 1 (25:23):
When you were doing that per diem work, were you
getting paid 1099 or W-2?
Speaker 2 (25:27):
No, so that's where I was introduced by a locum
agency to the hospital, but thenimmediately they signed me as a
permanent person.
So I was W-2.
Speaker 1 (25:35):
Got you.
So now, when you are working,right, because I looked at all
the states that you've been,you've been in several hospitals
since right Right now, you arelisted as full-time locum, so
that means that you are not W2,you are 1099, correct, correct?
I?
Speaker 2 (25:52):
um, last year about uh, 75% of my work was W2 and
this year I am well, I guess.
To be honest, this year I'mabout 90%, 1099.
I did recently take up a newper diem job, but that per diem
job, I think, has to pay me W-2.
Speaker 1 (26:10):
So how do you feel about work in general, like, how
do you feel about, like, theskills that you've learned in
this locums type of experience,type of experience?
Do you feel like you know,comparing yourself to how you
are now compared to, maybe howyour partner or, excuse me, how
your fellow graduates, maybe intheir clinic position, their
employee position?
How do you think you are incomparison to them?
(26:32):
Like, do you think you, do youthink that you are behind them?
Do you think you're above them?
Talk to me about that.
Speaker 2 (26:37):
So there's two things I will.
I will, I will, I guess, gogravitate to.
There's one, the physicalskills of my job in medicine,
and there's two, the businessside.
One of the one of the reasons Ichose to do locums was I felt
that I had a lot of oversightand I had my handheld in
residency.
And frankly, it's different than10 years ago.
(26:58):
It's not resident run traininganymore.
There's a attending doctor inhouse, overnight in the hospital
I could ask for help.
So I wanted to leave.
I wanted to get trial by fire.
I wanted to put myself insituations where I was out in
the middle of nowhere to see ifI could broaden those skills,
because when there's not help,or just see how good your skills
(27:18):
are in general.
Well, I doubted them and I waslike and I still doubt them, but
I was like you know, if I'm outthere and no one else can help
me, I'm going to have to do thisshit, like I don't have choice,
right, and I'll give like justa brief examples of that.
I mean, uh, last summer, uh, Ihelped in part of a to stabilize
and resuscitate a 28 week uh,1200 gram baby in the middle of
(27:39):
uh, in middle of central Mainewith a small critical access
hospital and we kept that babyalive for 53 minutes until we
could get a neonatal intensivecare transport team to pick the
baby up and fast forward.
This past couple of months agoI was in Santa Fe, new Mexico,
responded to my first neonatalcode and it was only my second,
(28:02):
I think second successfulintubation as a attending.
But I got it right away becausethere's no one else that could
do it and I needed to intubatethis baby so that we could
resuscitate them.
And I went in and I rememberfull code was blown.
They called a full code, blueoverhead.
I go in, there's like 25 peoplein and like I'm like shit.
Go in, there's like 25 peoplein and like I'm like shit, I'm
(28:24):
the pediatrician.
I just worked a 72 hour in a rowin house shift.
It was a 72 hour call a job.
I did get to leave the hospitalfor three days.
I run an hour 70 and I'm likeI'm just, I got woken up and I'm
like, shit, I got to do this.
And so I go up and I intubatethe baby and I mean I'm just
when there's no one else there.
It was that fire and so it gaveme that kind of encouragement
(28:46):
and at the same time, I meananother experience I had was I
had a baby that blew apneumothorax, which is where
there's for anyone listening.
The lung is collapsed and thebaby needed a chest tube.
I'd never done one, and so Iwas lucky that the transport
team showed up on time to helpme, but I got to learn with them
on the job.
The neonatal nurse practitionerwas like, hey, yeah, I'll show
(29:07):
you how to do a chest tube.
And so she, we did it, and itwas a cool experience and you
know, part of me doing thesethings was my, my original goal
over time, going, like we saidearlier, wanting to go back to
fellowship.
I wanted some more learning outof residency and doing locums
has put me in a situation whereI have obtained that partially
(29:28):
by choice and sometimes by force, and it's sometimes what I
needed to push myself out of thehole.
In that regard, I don't knowthat I would say.
I would say I'm definitelystill inferior to a lot of my
colleagues that went straight tofellowship.
But I've been forced to becomemore of a leader.
I've had to run codes and runor not full codes, but I've had
to run resuscitations and runthings.
(29:50):
That and fellowship.
If I were still in training Icould always have someone else
behind me.
So it's forced me to grow andmature in that way.
But it's also made me morehumble because I realized shit
the more I meet people, the lessI know, and the more I see
variability, the more there is.
I need to learn.
Speaker 1 (30:10):
Yeah, and I think that's a really good point,
because I think that there's theacademic, large tertiary care
experience and then there's theexperience that you have, and
one of the points that I tellresidents, and I think one of
the things that I learned, isit's always good to have a good
mix of those type of experiences, because if you spend a
(30:31):
significant period of your timeat academic hospitals, tertiary
care hospitals, you're going toget called from a pediatrician
or you're going to get calledfrom somebody who's at another
hospital and they're going to berequesting to either transfer
or they're going to berequesting for a consultation,
and it's very important for youto understand what kind of
capabilities they have at thoserural, suburban or just, let's
(30:52):
just say, not as capablefacilities as a tertiary care
center.
And it's very important tounderstand what they're doing at
these facilities, the greatthings that they're doing at
these facilities, so that whenyou get a consultation, it's not
a what's the word I want to use, not an adversarial type of
conversation, but really like acollegial type of experience
where you're saying, okay, great, thanks, tag, I got it, you
(31:13):
know, I'll take over.
And then also, like you said,like the amount of growth that
you have to undertake when youare at these facilities by
yourself and you don't have allof the resources, you don't have
all of these different thingsthat you have at tertiary care
centers.
It does make you rely on yourclinical acumen that much better
.
Everything that they taught youfrom a textbook standpoint,
everything that they taught youfrom a physical exam standpoint
(31:35):
you really got to rely on thatand I can definitely speak to
that as someone who immediatelyfinished fellowship and then I
was working in a rural area andthen I did some to that as
someone who immediately finishedfellowship and then I was
working in a rural area and thenI did, like some work in Ghana.
It's just like whoa, like I wasprepared for this, but I really
wasn't prepared for this, andyou just feel like you can grow
from that.
So I appreciate you sharingthat.
Now I want to ask you aboutloans.
Let's talk about loans realquick.
(31:56):
Let's pivot a little bit,because I read one of your posts
where you talked about 10 yearswith the PSLF program.
Right, yeah, versus.
So that's a loan forgivenessprogram, y'all federal loan
forgiveness program versus doingthree years with locums.
Now, for everybody listening,my man, dr Trevor, had what
$315,000 of student loan debtwhen you finished residency?
Speaker 2 (32:19):
Yes, that's including all the interest that built up
over time.
Speaker 1 (32:22):
So how did you?
What are you handling?
What is your decision?
Did you decide to do PSLF ordid you decide?
Did you pay it all off or areyou paying a significant period
off?
How are you handling yourstudent loans?
Speaker 2 (32:33):
That's a good question.
I'm happy to talk about thenumbers on this one because I
think this is something that'simportant.
So I do the same thing.
I talk to all my residents, allmy med students.
I'm like, think that'simportant.
So I do the same thing.
I talk to all my residents, allmy med students.
I'm like you need to thinkabout these things.
The public service loanforgiveness is designed for your
loans to be forgiven after 10years, with the caveat that
you're working in certainpractice settings.
You're working in ruralhealthcare, you're working in a
(32:54):
nonprofit, you're working at theVA, but the differential in how
much they're going to pay youfor that job versus working in a
private job is pretty decent.
And then the differentialbetween those private and those
academic jobs and locums is verysignificant.
So let's say that as a generalpediatrician, you're making X
(33:18):
amount of money.
To work as an academic center,it's probably 20% more to work
in private practice.
And at this point, to give youa ballpark, I work a lot, but
this year, if I keep up my samework, I'm on track to possibly
make around three times my peers.
Speaker 1 (33:38):
I think you said at one point you're making like
what an orthopedic surgeon wouldmake.
Speaker 2 (33:41):
Yeah, if I continue working at the same level that I
have this year, then I will.
I made more than most of thealmost all the pediatricians I
know in the last six months inone year.
Sorry, so, in the last likefive months is mid-June, so in
the last five months I'vealready surpassed a one-year
salary for everyone I know.
Five months I've alreadysurpassed a one-year salary for
(34:05):
everyone I know.
So that's where, if I continueat this velocity, what I'm
looking at and this goes back tothe instability of locums but
if I keep the current work I'mdoing, there's a potential in
the remainder of 2022, there's apotential that one of those
months I'm going to make more inone month that I did an entire
(34:27):
year of residency.
Okay, that makes sense andthat's what.
And it's hard to say that as apediatrician, because you know,
for you as a surgeon and apediatrician, just so everyone
knows, we get the same.
We get the same residencysalary.
You know, when we are firstyear residents, generally for
most programs, the post-gradyear, the resident salary tends
to be the same across the board.
(34:48):
Maybe a little bit of variation, but not astronomical, but then
you know.
So for me to be able to do thatas a pediatrician is is,
frankly, unheard of.
And so that's where I'm at withmy loans now is like you know.
Like I said, they kind of harpback again.
Those eight months aftertraining I was in the hole and
then, about one year aftertraining, when I started to feel
(35:09):
more comfortable, I started toput a little bit less.
I had a good emergency fund andthen I started channeling
everything towards my studentloans.
So there's two parts of thatthat's made it really nice.
I put a majority towards myloans just because of my
lifestyle.
I don't spend a whole lotpersonally, but the hidden bonus
(35:31):
that people don't think aboutall the time because I work
exclusively locum tenens, Idon't pay rent, I don't pay for
a car, so I'm saving anadditional probably what?
20 to 30 grand a year, probably50 grand now with gas prices,
just based on the fact that thelocum agency is reimbursed for
airfare, hotel and lodging.
Speaker 1 (35:49):
Okay, so quick question so you don't pay for
rent, so people want to know, soyou're completely nomadic then.
So where does your mail go toIf you are applying for
something major, let's say yougot to get a credit card, or
someone wants to write to you DrCabrera, you know I miss you,
like you're my pen pal, blah,blah, blah.
Where, where's your address?
Like how, where are you gettingyour mail?
Speaker 2 (36:07):
Yeah, that's a good question.
So I have a PO box in Texas andalso I live at, or I file my
taxes essentially at, myfriend's house in Texas.
Um and uh, I have everythingbesides that still in the name
of Texas my license, mydisability insurance, and part
(36:34):
of the big reason is Texas hasno state income tax.
So I'm from California but Idon't claim that as home because
I'm always worried that theywould want an income tax on top
of my work, even if it's inother states.
Speaker 1 (36:44):
Got you, so you completely live nomadic.
You live in hotel to hotel orextended stay to extended stay,
but your actual like mailingaddress for licensing purposes,
healthcare purposes, all ofthese different things are in
one place, which is in Texas,and that's where everything goes
.
Speaker 2 (37:02):
Right and I just have people I really trust down
there.
Speaker 1 (37:04):
So, just as a heads up for people listening, there's
an app, there's multiple apps.
They call virtual mailboxes.
One thing to consider is youapply for the service.
It's really cheap, it's like 99bucks or like 100 bucks a year
and you have your mail sent tothis virtual place.
They open up the mail.
First of all, they'll scan yourenvelope, they'll send you a
(37:25):
note and say, hey, you know,this is what you got.
Do you want us to open it, ordo you want us to trash it?
Or do you want us to mail it toyou?
And it's all.
Through your phone, you cansend it to them and if you say,
yeah, I want you to scan it,they'll scan it in and send it
to you and you can read it right.
Or if they trash it, they'lltrash it for you, or they can
literally not open it, putanother stamp on it and send it
(37:46):
to whatever address that youhave or that you're at.
So they call that virtualmailboxes.
A lot of people do that withreal estate If they have like a
real estate rental property.
A lot of people do that withbusinesses.
So just something as a heads up, dr Trevor, and all the people
listening, like you can kind ofnow.
(38:08):
Technology's kind of caught upto this nomadic lifestyle where
you can keep up with these typeof things.
So I'm interested so right now,with your loans.
I saw that you were able tomake a significant dent in your
private loans.
Is that correct?
Speaker 2 (38:16):
Yeah, so I had like 115 in private loans, paid those
off last year.
Speaker 1 (38:22):
Okay, so you paid it off in a year, basically.
Speaker 2 (38:24):
I paid it off in half a year, cause I you know, like
I said, I don't consider realmoney coming in until June of
2021, probably.
So I paid that off last yearand, um, as of right now, I'm
down to under six figures, alittle under six figures.
Speaker 1 (38:42):
Congratulations, man.
Congratulations.
So you've decided not to doPSLF, you decided to just pay
off your loans at your own pace.
Speaker 2 (38:49):
So that's why, going back to that, to give total,
arbitrary numbers if you'redoing an academic center and
they are paying you $100,000 ayear but you have to work there
for 10 years to pay off yourloans at the minimum payments,
that's one option.
But if you're going to bemaking 300,000 to do locums and
(39:10):
you're able to pay moreaggressively, then there's.
I think, the question thatcomes down that people have to
think about individually is howmuch money are you truly going
to save if you have loanforgiveness in 10 years?
That's the thing For somepeople.
If they have a million dollarsin loans, then doing the minimum
payments for 10 years, they'regoing to save hundreds of
(39:30):
thousands of dollars.
But if you only have $20,000 inloans doing the minimum
payments for 10 years, it's likeyou're not going to.
You're going to save like athousand bucks, like what's the?
Speaker 1 (39:39):
Yeah, and I also think it's lifestyles also
related, and where you want tobe, like, do you want to be at a
certain type of hospital?
Do you want to be in a certaintype of location?
Do you want like what, do youwant to kind of be freely mobile
?
And that was what me and mywife kind of thought about too
was like, well, we don't knowwhat kind of, we don't know
what's going to happen in thenext 10 years, but I damn sure
(40:01):
know that those 10 years I don'twant it to.
I don't want loans to be amajor part of it.
That's how we thought about itand with that thought process,
that's why we decided to go hamon our loans early, so that we
can get it out of the way.
So, whether we've decided tohave kids, whether we decided to
travel or what have you, we atthat point realized that you
(40:21):
know what.
I just don't want loans,whatever thought process that
may be, to be in mathematics.
That's not for everybody.
Everybody looks at itdifferently.
You can skin a cat multipleways.
We just let people know how wego and how it worked for us, but
appreciate your honesty on that.
Speaker 2 (40:35):
So it's true, you know I mean.
So I was sitting at a bar thereand I was listening to the
people next to me and they'relike they're, they're definitely
in these women that wereprobably in their later thirties
, early forties still talkingabout their loans and how it's a
problem.
I'm just like that's not andI'm just laughing at myself
because I'm like huh, I'm notgoing to have that issue.
Speaker 1 (40:53):
Right, right Now, let's let's ask you about this.
So you, you think that probablyprojected, maybe realistically,
the next five years you'll getyour federal loans all taken
care of.
Speaker 2 (41:01):
No Projected in the next five months, I'll be out of
debt.
Speaker 1 (41:04):
Damn.
Okay, that's what I'm talkingabout, good.
Speaker 2 (41:07):
Good, and so that's the thing right.
So I'm saving by the fact thatyou know I only spend about 10%
of my adjusted gross income onlife.
I mean, we're talking food,we're talking vacation, we're
(41:29):
talking my disability insurance,my health insurance 10%.
All of that goes into only 10%of the actual money that is
coming in.
So I have to think about taxes,of course.
But outside of that, I meanthat's a good majority versus a
good, sorry, a very small amountversus if I had a rent in
apartments, in places to liveand all of that I'd probably be
(41:51):
spending more closer to 20, 30%of my income to take care of my
life.
So I think that's where I'mable to shift so much of
everything.
Of every dollar I make, I canshift closer to 70% of that
straight to loans, or, you know,50%, I guess, um, straight to
loans All right, let's, let'stalk about lifestyle.
Speaker 1 (42:11):
Okay, so you work, um , you're you're working pretty
hard.
You're saying um, who's makingyour schedule?
You, or is it the hospital ismaking your schedule?
Who makes your schedule?
Speaker 2 (42:22):
Come on.
That's why we do locums.
I do whatever the hell I want.
Speaker 1 (42:26):
Okay.
Speaker 2 (42:26):
And that's what I tell all everybody I talk to you
.
So there's pros and cons forhow I tell people this, but the
way I set it up is I try to setup it has changed over a couple
years of doing this.
I set it up so that I work likeblocks of time in certain
places and we're notflip-flopping super frequently.
Currently my job, for example,in Maine.
(42:49):
I'm here for roughly aboutthree weeks at this particular
job.
I've talked to the director andshe's super nice and super cool
with giving me days off inbetween these like stints of
work.
So today I'm off, for example,some jobs.
I will intentionally work thateight or nine days in a row and
(43:09):
then I'll just schedule off acouple of days afterwards and
I'll make that schedule and I'llaccount for traveling myself,
like my travel days, and I'llmake sure to tailgate every job
with the day off and a travelday.
Speaker 1 (43:21):
So, okay, go ahead, please go ahead.
Speaker 2 (43:23):
Oh, I was going to say so at the most extreme, um,
and I don't.
I try to be more over time,since I've become less reliant
on the need for money to survive.
But over time I've I've gottena little bit more relaxed.
But last year it was a pointwhere man I finished work at 7
am in central Maine on Mondayand then started 7 am on Tuesday
(43:43):
in New Mexico and I was workingreal hard.
But now it's like I'll scheduleone day's off.
Speaker 1 (43:49):
Okay, so what's the longest break you ever took
working out of residency, onceyou started working locums now
consistently, what's the longestbreak you've ever taken?
Speaker 2 (43:57):
Yeah, longest intentional break after I
started having consistent work.
I mean, I think it was thispast month.
I took like five days off, broAll right.
Speaker 1 (44:09):
So that leads to my next question Do you think that
you're working too much?
Right, let's talk aboutresident life versus attending
life, cause as a resident, youknow there's duty hours, right.
There's a certain amount ofhours that you're going to work
and then that's it when you'rein attending I'm sure you've
realized that you had mentionedbefore.
It is 72 hours straight and youpossibly may be working, but
that's your schedule.
You said that you set it upthat way.
(44:29):
Um, you don't necessarily have.
Well, excuse me, you don't haveto work that way at all.
You chose to work that way.
But I'm concerned, like, let'stalk to the people about do you
think you work in too much rightnow versus how it could be?
For?
Speaker 2 (44:40):
me personally, oh, hell yeah.
But part of why I set myself upfor it was that in my head, um,
since my, my, my, my, my viewis pointed towards fellowship, I
didn't want to lose too much ofthe mojo.
So you know, I've realized whenI have too many days off, I'm I
(45:02):
see it like I'm off.
Today, I'm going to go eatlobsters, sit at the beach in
Maine.
That's what I'm going to do andit's nice and I'm enjoying
those days off that I didn'thave residency.
But I try not to get too muchtowards that, only because I
want to keep up the momentum togo back to trading.
So that's my personal thoughton it, right?
Speaker 1 (45:19):
now Do you feel like?
Because in many respects Ithink you're probably putting in
more.
You don't think it is, butyou're probably putting in more
hours as an attending than youare as a resident.
Speaker 2 (45:28):
I am putting in more hours sometimes, so it depends
on what the job is.
For example, last year I worked26 consecutive days on call in
Huntsville, texas.
I went into the hospital for atotal of maybe five or six hours
.
So I was on call that time and,yeah, being on call mentally was
(45:50):
different, it counts but at thesame time, if you're able to,
if you're able to separate itand to be able to do things
outside the hospital, being oncall.
It was a little bit differentthan being as a resident, I
guess.
You know, like I didn't have tophysically be in the hospital,
so it felt different, Um, but Idefinitely am working more, Um,
but the difference, of courseand I I've talked to people
about this is I get paid for it.
(46:11):
So that's, that's where it's.
It's not, it's something whereI excuse it, Um, and I actually
that part of that 72 hour job Itold you about it's a bigger,
it's, it's part of a biggerpicture.
I worked six days in New Mexico, which 120 hours were in the
hospital, so it's a lot, but, um, you know, I do it partially
(46:35):
for the challenge too.
Maybe I'm just, you know,psychotic or something, but uh,
it's kind of fun, Okay.
Speaker 1 (46:42):
Well, for the, for the, for the folks you know that
are listening.
You know, one of the best thingsof what Dr Trevor said is he
makes his own schedule and youcan decide how many days in a
row you want to work or how manydays a month you want to work.
If you want to do like 10 in arow, 14 in a row or however long
in a row.
You decide that.
You make that choice up to youand it's unlike residency where
(47:04):
someone is keeping track of thatand per hour, how many hours
you're going to work as anattending and I don't know what
(47:25):
the answer is.
But I definitely think that ifwe do resident work hours, which
work, but then we are puttingthem in a situation or in the
outside world where there aren'tany work hour limitations,
there's a bit of a disconnectand I don't know what the answer
is.
Right, like it's, you'repreparing them for safety in one
area, but then you'regraduating them into a place
(47:46):
where nobody's keeping track oftheir hours and I can say, as an
attending, I put in more hoursas an attending than I did as a
resident.
Go ahead please.
I was going to say especiallyas a surgeon.
Yeah.
Especially as a surgeon, youknow, you know.
So I don't, to this day, Idon't know what the answer is
right.
I do think that the way howwe're training residents is
(48:07):
correct, but also, at the sametime, I don't know, just because
we're training them correctdoesn't mean that we're
preparing them correct, if youknow what I'm saying, right.
Like, if you're putting them ina world where there's no
resident work hours, then whyare we training them with
resident work hours?
But you actually do needresident work hours because you
don't want them tired.
So it's just, it's, it's weird.
I don't know the answer to that, but that's just something to
to think about and somethingthat, now that I'm 10 years out,
is Overall, overall, overall.
(48:31):
Dr Cabrera, what kind oflifestyle do you want?
Let's talk about it.
Speaker 2 (48:34):
Yeah.
So you know, I want to befinancially like, not tied to
loans.
I think that's because that'sobviously my big priority here.
Now I'll say like one thing Iforgot to mention on why I work
so much is this by doing, byworking this many days, this is
how I get the local agencies tocover all of my housing, because
normally they're only going tocover the day before.
Speaker 1 (48:55):
I love it.
Give me more.
Give me more.
Speaker 2 (49:01):
Yeah, so the strategy , right?
The strategy is they're goingto cover the day before, the day
after the job assignment dates,and so I think historically
they used to cover more thanthat.
I don't know, you could correctme if I'm wrong, but now I
think people are a little bitmore stingy on that.
So if I'm working Mondaythrough Sunday, they're going to
cover the Sunday before untilthe Monday after, perfect.
The day before day after thatgoes for the rental, that goes
(49:21):
for the hotel and then theflights.
I'm able to kind of schedulethat differently.
So to give you a real exampleright now June 14th, last week,
I took four days off.
What I did was I used the locumagency to fly from California
to Maine and then, on my owndime, I spent three days on
vacation.
But then I picked up anotherrental under the agency to come
(49:43):
back into the hotel to work formy couple of weeks and then when
I leave I'm going to fly out onthe agency and go back to
wherever I'm going.
So there's that part of it andthat's why I schedule so close
to close back-to-back piggybackjobs.
And the big point to point outto that- it's like you're travel
hacking.
Speaker 1 (49:59):
That's what it is.
Speaker 2 (49:59):
It is travel hacking To talk about a little bit, to
give people a little bit more ofa number, and then we talked
about it before.
But I traveled 320 days lastyear and this year it is June
14th and I have traveled, Ibelieve, something like 180,
like 283.
(50:19):
So you're ahead of schedule yeah, but that's how many days I've
been traveling.
Now the question is what kindof and I go back to your what
kind of lifestyle?
So the unseen other benefitsright, my plan, if everything
worked out, I would apply tofellowship right now, I would
match into fellowship next year,I mean, and I go back and forth
(50:40):
.
So you know, don't hold me tothat, because I do like I do
love this lifestyle.
But the plan is next year I'mI'm planning to take off a whole
month and I'm going to travel,probably Europe or somewhere
else, purely on all of the twomillion points that I've
accumulated by living in hotels.
So at this point you know a lotof Make it longer, Dr Trevor.
Speaker 1 (51:01):
Yeah, that's the thing, make it two months.
Speaker 2 (51:03):
Huh.
Speaker 1 (51:04):
Make it two months.
Nobody's checking on you, bro,you deserve it.
Speaker 2 (51:08):
I might do some things, but I'm saying that,
like you know, just the pointbeing that with this lifestyle,
what people don't remember theythink about all the time and
sometimes people ask me as thepoints.
I mean what I'll usually do isI have an America, I have a card
there's a Hilton honors card,credit card.
I'll pay for the hotel on theHilton card, I'll get points for
that and then I'll getreimbursed from the agency.
(51:28):
So so I ended up getting liketriple, quadruple points on a
hotel stay, and it puts me in apoint now that I could literally
go to Europe for probablyyou're right two months, just
purely on the points.
So it'd be like a paid vacation, other than the food.
Speaker 1 (51:43):
Dr Trevor, I think you should extend it out to two
months.
Don't just do it.
It's okay Like nobody ischecking for you.
There's nobody who's going tocheck a box.
Give yourself the time, thegrace to take however time that
you want off.
So well, listen, this was areally dope conversation and you
know, I think that you know Iwanted to harken back to what
(52:06):
the attending said that if yougo from job to job to job to job
, that possibly could be, youknow, maybe a poor reflection on
who you are as a pediatrician,and I can say that as, 10 years
out, I had that sameconversation with attendings and
I'll leave it to you like this.
Those same attendings havecalled me several times over the
(52:27):
last, I'd say, three yearsasking hey, what company did you
go with?
Hey, how did you set yourselfup with locums?
Hey, I'm sick and tired of X, yand Z.
Can you teach me how you'redoing locums?
Hey, blah, blah, blah, blah,blah, blah blah.
I think that a lot of peoplemake comments and I know you're
attending did locums?
But I think it really comesdown to individually who you are
(52:49):
.
Are you going to be able tolike?
What kind of panache are yougoing to be able to like, what
kind of you know what kind ofpanache are you going to bring
when you come to a job?
Right, because I think, justsaying that, if you go to locums
, you're going to have this darkshade on you, you know, I think
that that's the wrongperspective to give residents.
Right, I think there aremultiple ways to skin a cat and
there's multiple ways topractice and, um, I'm really
glad that you heard all thatinformation and you decided
(53:09):
still to try this out, right,and now you're, you're still,
you're thriving in it now.
Speaker 2 (53:14):
Yeah, and I want to just one more thing to say add
onto that.
So so I've loved it for a bunchof reasons.
It's not for everyone.
Like you said, we do.
I do it to the extreme, you cando it, but the best part is you
can do it how you want to.
I've been.
I've been learning so much.
I've learned these contractnegotiations I've seen.
I've worked in a dozen hospitalsin the time that all my friends
have worked in maybe one job,you know there's just parts that
(53:36):
go to it, but at the same partsame point something I've
noticed with being dropped intoplaces man in my head and I
maybe it's a grandiose idea, butin my head we're like freaking
special ops and it's awesome andI can do stuff.
And I can do things in someways that, like other people,
like how did you do that?
I got an orientation at ahospital, at a quaternary care
(53:58):
children's hospital, from 9am to12pm and I got thrown in just
like helicopter, dropped in 8pm,starting that night as the
nocturnist.
Like I can do that right, I canlearn an EMR in two hours.
I can be flexible and adaptable.
They call us in for jobs wherethey can't find people.
They call us in for jobs.
(54:19):
That need someone that can bequick, that can learn fast and,
if anything, I think it sets usup as more attractive candidates
for the future, because that'sthe thing People ask me now for
jobs.
They're like can you do this?
I said yes, or I can figure itout immediately.
I don't need to go through yourtwo weeks of orientation.
You give me 30 minutes and wecan.
I can hit the ground runninganywhere, absolutely Just like
(54:41):
falling out of a helicopter, sothat's that's kind of like in my
head, that, the way I thinkabout it, so that's that's kind
of where, where I've been, andthat's why I love being the uh,
it's the nomadic pediatrician.
You know, that's like that.
Speaker 1 (54:50):
Tell them where it's at.
Tell them where it's at.
How did they find?
Speaker 2 (54:53):
it, yeah, you know.
So, if anyone's listening forthat, the uh, my blog, where
I've got a lot of uh, a lot ofthings on locums, my travels,
and also a uh, I've got abrewery map and pictures of all
the food I cook in these hotels,which is awesome, but it's the
uh, the nomadic.
Live it.
Yeah, I get it and I thinkwe're going to leave it at that.
It's the life that you want ifyou decide to live it.
Speaker 1 (55:26):
And I think that that's a huge change from
residency, where you feel likeyou're just trying to survive
and you feel like you are underthe thumb of somebody else and
as a resident excuse me, onceyou finish and you are in an
attending level, whether youdecide to do private practice or
you're working on your own oryou're doing locums, it's really
you know you make the decisionas to what you're going to do.
So, hey, I appreciate this, um,this talk.
This was really dope, dr Trevor.
And listen, I hope to hear fromyou next year when you're doing
(55:49):
your two months off somewhereon a train in Spain or wherever
you are in the channel, orsomething dope and let us know
how you're doing.
All right.
Speaker 2 (55:57):
Yeah, no, I appreciate it.
Thank you so much, man.
Speaker 1 (56:00):
All right, man take care All right, have a good one.
Hey guys, thanks again forlistening as well as supporting
Docs Outside the Box.
Listen this show is produced byDarko Media Group and the dope
audio experience is edited bythe one.
The only christian parry, alsoknown as your podcast pal, links
(56:21):
to them in the show notes.
Listen this is dr neem, the docoutside the box.
I'll catch you on the next one,peace.
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