Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Pediatrician Trevor Cabrera discusses his article “Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine.” Trevor explains how choosing the path of an independent contractor allowed him to pay off massive student debt while exploring the country on his own terms. He challenges the misconception that temporary staffing is only for unstable providers and highlights how it serves underserved communities in health care deserts. The conversation details the five essential traits for success in this field and how financial sovereignty can shift a career from living to work to working to live. Discover how stepping outside the traditional system can restore the joy of patient care and provide a renewed sense of purpose.

Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let’s work together to tell your story.

PARTNER WITH KEVINMD → https://kevinmd.com/influencer

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Trevor Cabrera, pediatrician and soon-to-be neonatologist. Today’s KevinMD article is “Locum tenens: reclaiming purpose, autonomy, and financial freedom in medicine.” Trevor, welcome to the show.

Trevor Cabrera: Thank you so much, Kevin. It is an honor to finally have a chance to talk to you.

Kevin Pho: All right, so let’s start by briefly sharing your story and then jump right into the article and why you decided to write it.

Trevor Cabrera: My story originally is that I am from California. I did a lot of my training in the South. I did medical school in New Orleans. I did my pediatric residency training at Houston at UT Houston. During my second year of residency or so, I had been introduced to the idea of locum tenens. I think that had become more and more popular. With COVID, people started to hear a lot more about these things.

I finished my residency in 2020. I had thought about for a while going back to fellowship to subspecialize, but I wanted a little bit more experience. I wanted to really throw myself into the fire in some of the scenarios that I would face as a pediatrician and hopefully a neonatologist. So I ended up starting with locum tenens. During that time, the plan had been to do locums for a year. I ended up doing it for three years full-time.

I did it to the extent that I actually renamed myself “The Nomadic Pediatrician.” I have a blog for that too that has some of those journeys. When I say that, I mean that I lived entirely out of a suitcase for two and a half years. There was one year that I traveled and did locums for 359 days. I have known a lot of people that have done locums, but I do not know how many have really taken it on that significantly. During that time period from 2020 to 2023, I worked in 15 hospitals in 10 different states.

Then as we hit 2023, I realized I was getting a little bit older and getting a little more tired. This was the time to reconsider fellowship. So in 2023, I started my fellowship in neonatal-perinatal medicine, or neonatology, at Children’s Mercy in Kansas City, Missouri. That is currently where I am at. I will be graduating this upcoming July 2026 with plans to go back into locum tenens.

That was some of the things that sparked me contributing this article to KevinMD. I really loved my experience. I have written about it on your site, but I think that there has been a really growing trend towards a generational change in who is deciding to do it. Part of why I have taken such an interest in discussing it, bringing it to the surface, and bringing it to the mainstream is that there are a lot of trainees that have started to ask me about locum tenens. It is no longer just the mid-career or retiring physician. So that is kind of what led to this article.

Kevin Pho: So you mentioned that the concept of locum tenens was introduced to you while you were in training. What specifically about locum tenens appealed to you that early in your career?

Trevor Cabrera: You know, I think when I had first heard about it, and granted I had heard about it by an agency so there was a little bit of bias, one thing that was stressed was the ability to have the flexibility in a schedule. It offered the autonomy of choice on what you are doing. That kind of freedom appealed to me. Of course, a big part for me was also the income.

Now when I started doing locums, for me my thought had been that these are short-term contracts. I am a substitute going to some hospital in the middle of nowhere. It was a personal journey where I realized if I went from somewhere with all of the resources in Houston to somewhere with fewer resources, it would force me to grow in ways I hadn’t thought about before. The other thing is that the compensation sounded great. As I dove into it more, I learned it could be very lucrative. Really it made sense because I was going places nobody wanted to go. Those were the things that really stood out to me regarding why I thought about doing it. The other thing was I wasn’t 100 percent sure on which fellowship I wanted to go back for. So this gave me some time to work without very stringent commitments, and I could make the choice to go back to training or change my life at any other point.

Kevin Pho: So at that time, what other options were available to you? I could imagine you had locums and then you just had other traditional pediatric jobs, whether in a clinic or a hospital, some type of W-2 job. Is that correct?

Trevor Cabrera: Correct. The biggest thing that changed, and this may not apply to everyone, but in 2019 the American Academy of Pediatrics and the American Board of Pediatrics changed our training. They started to really want to mandate that anyone wanting to be a hospitalist had to do a pediatric hospital medicine fellowship. So when I graduated residency in 2020, I was the first year that was not able to grandfather into that without the fellowship. So for me, the options were really actually clinic outpatient work or fellowship. Within the realm of fellowship, I had thought about pediatric intensive care, neonatal intensive care, or doing the pediatric hospital fellowship. So that is kind of where I was stuck frankly.

Kevin Pho: So tell us the main messages that you want readers to come away with from your article on KevinMD.

Trevor Cabrera: The main messages that I want people to come away from are significant. You know, I think a lot of people are starting to learn about what locum tenens are, so that is no longer really the main question. When I peruse KevinMD, I have also seen that there are a lot of articles on locum tenens. There are a lot of people discussing the pros and benefits and a lot of things having to do with the costs or the savings or a lot of things financially.

The purpose of my article is really to reinforce that outside of some of the connotations that locum tenens has for these substitute workers and the fact that there is a lot of money in it, there is a lot of good that can come from it. There is a large effect that can happen in communities that make ripples way farther than we believe. It doesn’t matter what specialty you are. I have met surgeons, I have met internal medicine adult physicians, and I have met people that do pediatrics who have done locum tenens. What you see is a lot of them enjoy the freedom of choice for their schedule. They enjoy that autonomy of being able to really choose what they want to do and how much they are going to do it for, or if they don’t want to do it.

But on top of that, there is a large effect that brings you back to the sense and the focus of medicine on how you can affect large communities. For me, I think at the time too there was a big part that obviously finances were a big deal. I was able to pay off all of my medical school loans in three years. I think that is a harder thing to be said of some of the lower-paying specialties. So the overall takeaway for me is that anybody can do locum tenens. For every reason that people hesitate on it, I can give you a reason that I would actually advocate for it. Whether you are at the beginning of the career, whether you are mid-career, or later in life in a career, or you want to do it on the side of what you are currently doing, I think that it has brought more fulfillment to my life and has also lessened a lot of the burnout that we face.

Kevin Pho: So you mentioned that you were able to pay off your medical student loans in three years. So the income that you get from pretty much full-time locum tenens, you mentioned that you did it pretty much every day for a year, is substantially more compensation than a typical pediatrician W-2 job. Is that correct?

Trevor Cabrera: That is correct. I would say that most people doing locum tenens, and I still advise this anytime I have a trainee or actually a co-attending that comes up to me asking, should expect at least about 20 to 30 percent of a salary that is higher than the average market for your specialty. It can vary drastically, but that is the bare minimum of an increase to expect.

Another thing you bring up is the point on the W-2 versus 1099. I think that this is something that is extremely lucrative to really understand that being an independent contractor has incredibly vast savings differences. There were some of those things I didn’t really quite know about. I think I had referenced one of the resources I had used in looking these things up. There was a CompHealth or CHG Healthcare guide called Physicians Guide to Working as an Independent Contractor, which kind of gave me some advice in this regard.

But there are times where when you are looking at retirement, if you have a standard W-2 job, let’s say you can put 20,000 dollars into your 401(k). Well, with my solo independent retirement, my SEP IRA, my maximum contribution was something like 60,000 dollars or up to 25 percent of my overall salary. So when you think about that in the very, very long term, not only are you making more per hour, you also are able to invest more per year. On top of that, the tax deductions that you are able to figure out are actually very savvy.

Kevin Pho: And then what about things like benefits like malpractice and health insurance now that you are kind of a more contracted employee during those locum tenens years?

Trevor Cabrera: About the benefits? Yeah. Well, that is one thing that I would say that on the positive side, what I enjoyed about working with an agency is there is really no concern for me from a malpractice coverage standpoint. They always carry the liability for you. I am sure that direct contracts with hospitals, which I have done one or two of, also can work in to have liability as part of what they cover for you.

As far as the other benefits, yeah, it is true that you are going to pay for those own benefits. I pay for my own health insurance and I pay for my own disability. But realistically, when you think about the increase in the salary for the job, it really kind of levels out. That is what I think is the really important thing I stress to people. Overall people are trained to follow the same mantra that everyone before us has done. We are trained just to go through these steps and to not question things that sound uncomfortable and different. The reality is everyone says to me: “Wait a second. Well, they are not going to cover your health insurance.” I said: “Yes, that is true, but I am making so much more money that me paying for private health insurance out of pocket is actually really a good deal.”

Kevin Pho: Now, you mentioned that you were in some pretty remote places for your locum tenens placements. Give us an example of, say, something that you would find out was a good fit for you and somewhere that perhaps was a less good fit for you. Just give us an idea of the spectrum of places that you have worked at.

Trevor Cabrera: Sure, and this is something that will vary depending on specialty and the need. But as a pediatrician that was open to doing different types of care within that clinical scope, I was able to go a lot of places. I would say some of my biggest impacts were in Deming, New Mexico, which was a small town about 45 minutes north of the border. We would have a lot of patients that would actually come to the border in Mexico. They would come to the border in labor and they would be transported to our hospital to deliver. I know a lot of people have different thoughts on that, but for them in Mexico, we were actually the closest hospital being about 45 minutes to an hour from their border town versus another hospital in Mexico that might have been two hours away. So I had patients that would come up from there. It was in the middle of the desert.

I worked in a small town called Bridgton in Maine. There were only about 5,000 people that lived in that town. I also got to work in Bismarck, North Dakota, where I got to work with a lot of the tribes that had come into that area as well. Those were some places that were a little bit more rural. I actually liked them because the way that I actually went into these jobs and went into these situations was with an open mind to experience and really just immerse myself in those kinds of situations.

But on top of that, outside of those jobs, I also worked at a major medical center, which was Tufts Medical Center in Boston, Massachusetts. I worked with a Mayo Clinic out in the Midwest. These were some places that were pretty significant as far as their popularity and people know about these names. They were in some more rural and urban areas. So I worked in urban and rural. I worked mostly inpatient. Within inpatient, I worked with newborns or I worked with older kids doing full actual pediatrics. Then there were some times where I did work and have a little bit of clinic as well.

So for me, finding what was a good place involved a multitude of factors. What I ultimately found was I didn’t like some of the places that were a little bit smaller. Then there were some that were in the medium size that really fit me. There were some that were in colder areas that I liked more than hot areas. Then I also found that a lot of the people that I tended to really fit in with were in New England. I never would have experienced and I never would have thought about that had I not done locum tenens just because all of my experience and all of my training prior to that had been in the South.

Kevin Pho: And I just want to emphasize that point. Locum tenens doesn’t necessarily only mean remote places. Like you said, you worked at Tufts and Mayo Clinic as well as urban settings as well. So again, there is a spectrum of settings that locum tenens can be placed in.

Trevor Cabrera: I think that is another large takeaway. Everybody sees my life, especially when I call myself “The Nomadic Pediatrician,” and they think: “OK, you need to travel.” That is not true. I can tell you where I am currently based out of, for different specialties there is more than one job within less than an hour or two from where I am at. That kind of helps out. Also in big cities, people that want to be a little bit more urban or can’t travel because of family or responsibilities have options to do that.

Kevin Pho: Let’s talk about locum tenens companies. As you know, there is some variability, and I have read a lot of variability in terms of how good they are and how reliable they are. Tell us some things that physicians should look for when working with a locum tenens company and some red flags.

Trevor Cabrera: Absolutely. I love this question. So just like there is going to be a good physician and a bad physician no matter where you are at or a good or bad hospital, it is the same with locum agencies. In my experience, I have worked with agencies that I didn’t like, but I liked the recruiter. I have worked with some others where I didn’t like the recruiter, but I really liked the agency. Or vice versa.

A couple of things I looked for include a group called NALTO, which is the National Association of Locum Tenens Organizations. It serves as a little bit of their moral and ethical standard among their different agencies. Of course, when we all go to Google a locum tenens agency, there are the big ones that come up. Whether that is because of SEO searching or because they just really are that large in the market and they have such a large footprint, we are going to come across them. Those are things like CHG Healthcare for example. You will see a lot of big things like that. They are big for good reason. They have departments that help with your credentialing and your travel. These are things that I kind of look for to see if they are going to be someone reliable.

But the biggest thing I would say that I have seen, which you may not see formally written out there, is regarding recruiters. When I look at a locum agency, if I am getting called by a different recruiter every week, that tells me there is something not working well in that agency. Or if I am getting called by a different recruiter about the same jobs, it makes me wonder if they communicate with other people in your group.

For me, when I have had a good agent, there are still some that I still keep in touch with. It is 2026 and there are some that I worked with in 2020 and 2021 that I reach out to every now and then. Not even just to send my references, but just to say: “Hey, how is it going?” Those relationships and the recruiters that put you in the focus are the great people to work with.

Also, it is the ones that understand what our training is. You know, if someone comes to you, Kevin, and they are like: “Hey, do you want to go work in this pediatric clinic?” or “Can you go do surgery?” then you would really question if they actually looked up who you were at all. That is just the reality of how the cold calls and the recruiting goes. I can empathize with that for the agencies. But the reality is, if you are coming to me, a pediatrician, a board-certified pediatrician, and all that information is out there and you ask me if I am going to cover at the adult jail, it is going to push me away.

I have talked to over a couple dozen physicians that do locum tenens or that are interested in it. What they do not like is getting berated by incessant phone calls. They do not like getting these new recruiters that do not understand what their specialty is or do not know who they are. A lot of times there is a lack of transparency. So when I see the opposite, when I see transparency, I see it is only the same recruiter coming at me. I have had a couple of times where I have had a recruiter say: “Listen. There is a great job here or there is a job here, but for X, Y, Z reason I do not think it is the right one for you. So I am not going to send you there because I am looking out for you.” Those are the people I am going to work with more. I think it is important that everybody understands the agency’s prerogative. We all do know that they are trying to also run a business. But the ones that actually keep in mind the doctor or the APP as their really important person and their priority are the people I work with.

Kevin Pho: We are talking to Trevor Cabrera, pediatrician and soon-to-be neonatologist. Today’s KevinMD article is “Locum tenens: reclaiming purpose, autonomy, and financial freedom in medicine.” Trevor, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Trevor Cabrera: The take-home messages that I would leave about locum tenens are significant. I really put in my headline for this article that it will give you purpose back. It will give you that autonomy and the financial freedom, which are all things that we seek. The important part is to realize that there is no single linear path for medicine. At any time we can make a change. We can do something different. There is nothing wrong with that.

I have a lot of people that have doubted me. A lot of people have not liked the idea of doing this substitute kind of work or independent contracting. But it has really been fulfilling. I think that for any reason that you are questioning right now going into locum tenens, there are a thousand reasons they would argue on the opposite side that you should. So whether you are at the beginning of your career, in the middle of the career, or the end of the career, as I said earlier, those are all things that are made for locum tenens. So give it a try. I think that by doing that you will really find ways to fight burnout, to find purpose, and to get back to the heart of why you went into medicine in the first place.

Kevin Pho: Trevor, thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Trevor Cabrera: Thank you so much, Kevin. Appreciate it.