Disappointment trying not to be discouraged (very long post)

[jaznia15]

After two years of hard work, I passed the AANP boards May 27th and am only waiting on the board of nursing to approve my license. Living in the Southeastern region of the U.S. I was prepared for a long wait before attaining interviews or job offers. So far the "interviews" have been really disappointing.

Interview #1- "screening interview" with large clinic in northern part of the state (more expensive) Asked the typical interviewing questions and afterward sent information about salary/benefits. I stopped really reading after I saw 70k for the position, its a M-F position

Interview #2- interview with MD, not really an interview. MD acted as though I already had the job although I never accepted or led her to believe this. She's going to Atlanta but would like to keep current practice open. I told her 80K and she said she would speak to her practice partner about it. I would be the only practitioner in office with minimum training and would have only a receptionist and medical assistant in the building. Let's not mention medical assistant will soon be made "office manager" and she hasn't even told her staff she is leaving yet. She leaves in July. After speaking to one of my classmates I found out that the MD had offered her the position as well. In the words of my classmate the MD "stalked" her even after her refusal of the position trying to get her to take the job. I could tell the MD was desperate, but she really had no knowledge of what the benefits package would be. The ONLY good thing about this job was that it was Mon-Thurs.

Interview#3- I drove 1.5 hours to this interview. It is in rural GA but an easy commute from a bigger town with an excellent school system. Again this was not like any interview I was used to as far as asking the standard interview questions. I was told about the office, the typical patient population, and what was expected of me. MD basically wanted a second provider in the office so that she could see less patient load and be able to go to the hospital to see patients. I would be alone in the office at times, but would be built up to this. She asked me what I was looking for in a salary. I told her that 80k was the average but I was open to negotiation. She basically said she paid her last NP 67K as a base salary but there were incentives for completing charts. Benefits included the usual (vacation, health insurance, etc.) EXCEPT malpractice and DEA would be paid for by NP. If practice paid for such it would be taken from base salary and it would only be for the first year. According to the MD, NP left after 3 years and was making around 85k at that point with incentives. Again this practice is Mon-Thurs with Fridays being used to catch up charting. Rarely there might be patients seen Friday but its only a half-day either way.

Today I have my fourth interview in my actual hometown. After speaking to my former preceptor yesterday, he assured me that the job was mine. The only problem is they have big dreams and visions of opening up a lot of outpatient clinics and possibly an urgent care center but no big dreams of paying better. The FNP currently working there has been employed a little less than a year. She was employed solely for the family practice making 70k per year. Well she is now running a wound care clinic two times a week and has increased business to the point that they would like to open it 5 days a week. She does not receive a differential for the days in the wound care clinic although she performs about 12-15 minor procedures a day. They recently started a breast clinic which allows women to get a clinical breast exam performed by a midlevel and if any problems are noted an U/S is performed which could lead to a biopsy performed by the surgeon the same day!!! If CBE is normal, regular mammogram is performed with results handed to patient before leaving. I LOVE IT!!! They've increased from just 3 patients a day to 13-15 just with word of mouth alone. My preceptor has been the vehicle for all these changes and I love his vision. He states all the mid-levels should be paid more but of course he is not the CEO of the hospital. I would love to stay here for another 2-3 years gaining experience, but the current mid-level is locked into her contract at 70k for 3 years despite the extra responsibilities she has taken on. Today is my day to bargain and I feel 75K is reasonable. I will be cross-trained for wound care and breast clinic. He also wants me to be the lead NP for a weight loss clinic in the community (still an idea, non-existent). I think differentials should be paid for different areas. And if an urgent care is opened with the extended hours (Mon-Fri 8a-8p, Sat 8-4), there should be some kind of increase in pay. I feel as though the CEO is not going to budge and neither am I. I want 75k with the benefits and some kind of room for an increase in pay or differentials for different areas. I'm not signing a 3 year contract unless I know there is a guaranteed increase in pay over 3 years. The current office hours are 9-530 Mon-Fri. My preceptor states that the CEO should offer some way for us to bring in extra income by picking up extra shifts in different areas (such as ER). He feels like since we were floor nurses and able to do this that this would be a great for retention. What he fails to realize is that floor nurses work 3 days a week and pick up shifts NOT 5 days a week. If I take any position for 5 days a week, I don't want to necessarily work a 6th day for extra income, I feel my base salary should be enough or else why take the position? At this point, I am so disappointed with the greed in the rural area, I'm ready to leave the southeast completely. Its quite clear to me that these MDs or hospitals are trying to use mid-levels to stuff their pockets.

[futureeastcoastNP]

Oh my, they are REALLY taking advantage of NPs there. Those salaries are very low for even a new graduate NP, especially the 67K!! I think when NPs accept salaries that low, they lower the average salary for the whole profession. I would honestly try to get at least to 80K, and make sure you aren't locked into that salary for 3 years.

Think about it: they are going to be making a ton off of you once you're up to speed. It's robbery to pay you so little.

My main concern is that these salaries will become the norm as more and more diploma mill type NP programs pump out endless NP graduates and flood the market...

[jaznia15]

Update: Interview #4: arrive at interview on time, CEO is 15 minutes later than scheduled. I am placed into the conference room with the recruiter, the HR director, and my preceptor. Its a very laid back atmosphere. Basically once the CEO comes its quite clear that he has not even looked at my resume (which I provided two weeks prior). He does not even know that I am a town local which has been my preceptor's selling point for months. He tells me nothing of his plans for me, instead I am asked to tell what I am looking for. This threw me off, but I think I did myself justice at this point. After hearing from my preceptor and myself, he reviews my work history. I am a float pool PRN nurse at a hospital the next town over therefore I have experience in various departments within the hospital. He tells me he wants me to "float" over to his hospital, meaning become a PRN RN at the hospital. I tell him that would be fine but my FNP license should be approved by July. So I end up filling out paperwork for a PRN RN position with the promise that he will have a NP contract drawn up in 2-3 days. No discussion of anything dealing with NP besides my preceptor telling his CEO his vision for the mid-levels to be running the outpatient clinics. My preceptor actually had to tell the CEO that I have other offers (of course he doesn't know those offers suck) to put wind beneath his wings to draw up a contract. I just don't even know what to think....(depressed)

[reddgirl]

67K?!!!! No way! Even 70K is way too low and not to mention student loan repayments! I make 80k and that's not even enough and I'm in Miami but drive an hour away to get to work! This is very frustrating I must admit but please do not take anything less than 80K!

[traumaRUs, MSN, APRN]

1. No way to tell if salary is too low as $70k in a rural southern town usually goes further than 90k in an urban area. Salary is definitely low for my area (central IL rural area) but you can research local salaries via your states APN organization.

2. APN interviews (at least in my experience) vary tremendously. I have had interviews at an expensive steakhouse with just the MD present, panel interviews with other APNs and office staff, a series of interviews with different people and just the usual 1 on 1 interviews). So, this may be just a local variant.

3. Regardless of what you decide, malpractice, all licensure and credentialing expenses should be borne by the practice. Some of the more usual benefits nowadays include: 5 days CME, $1500-2000 per year for CME, PTO (varies drastically - I got 8 hrs per pay period the first 5 years, then 12 hours per payperiod for 5-10 years and then 15 hrs per pay period after 10 years and this is very generous in my opinion). There is also some type of profit sharing, pension, retirement. Our practice gives us 17% of our base salary to invest as we see fit.

4. You can listen to all the naysayers that talk about professionalism, etc.. In the end, choosing a job is your job. Its not about "oh if I accept 67k I'm not professional" but rather all about your negotiation skills.

Best wishes!

[jaznia15]

After speaking with another person, I have decided to set my low at 80k. I have two classmates who were gracious enough to share their salary with me. One is getting 90k at private peds office and the other is getting $52/hour at 80 hours every two weeks (adds up to 108k). Both with full benefits and both not even in city area. I will not be low-balled.

[redlion777]

Um, you have an 80k offer- what you are complaining about? Do you think the NP education doesn't really give you the confidence to be the sole practicioner in a clinic?

[futureeastcoastNP]

Um, you have an 80k offer- what you are complaining about? Do you think the NP education doesn't really give you the confidence to be the sole practicioner in a clinic?

NPs, as they do not have residencies nor the number of clinical hours of PAs or MDs, do need some supervision the first year or so to come into their own. I don't blame her for not wanting her first job to be solo. Second, the 80K offer clearly came with a bit of a psychotic MD who she said "stalked" her friend. Third, 80K is low of a solo practitioner.

[jaznia15]

Um, you have an 80k offer- what you are complaining about? Do you think the NP education doesn't really give you the confidence to be the sole practicioner in a clinic?

I actually never got confirmation on the 80K, I was just told that she would try her best to convince her business partner to pay me that much. After speaking with my friend who was offered the same position but turned it down, I learned a lot more. The physician who offered me the position was ill-prepared with an offer. She didn't know what to tell my friend about paying for the DEA # and practice insurance. After my friend turned her down, she called my friend continously stating she would pay for this and that. After meeting me and shaking my hand, I was basically offered the position, this is why I'm weary.

As far as NP education is concerned, no I do not feel confident to be sole provider at a clinic where the medical assistant will become the office manager. There is much to do and know when running a clinic solo including the medical aspect as well as the business side. I have nursing experience not business experience. As far as the clinical aspect is concerned, I agree with the response that I do need some sort of physician guidance for at least the first year. Even a medical doctor fresh out of medical school has to complete a residency to perfect the clinical component.

[zmansc, ASN, RN]

It sounds like you have several offers and different practices to work with. I would suggest you research the issues that are major with each, write notes, identify potential solutions to these major issues and have discussions with each that are taken from the perspective of "I appreciate your offer, but I want to make sure that I and the practice will be successful, so I have some issues/concerns and potential solutions to resolve those issues". This will show them that you are serious, and have taken the time to work through their business plan as well as your compensation package.

As for salary, I don't know your region, so I can't say what is reasonable or not in each of these offers. I would be hesitant to make a blanket statement that you shouldn't accept a certain salary to start out at a practice that is going to be supportive and teach you, and is local to your family (I don't know that all of these are, just an example). I know that many practitioners of all degrees come to our local community health clinic, making substantially sub-par wages because it offers loan repayment. They stay long enough to get their loans paid off and get a few years of experience under their belt and then they move on. Each situation is truly unique.

[MommaFNP2012]

I always based any offer I got as an NP on what I was making as an RN. I had no problem telling a prospective employer when salary was addressed, what I expected in compensation. After 3 job offers, I realized none offered what I wanted in salary nor what I wanted out of my first position. It took me moving to a different state, and the job, is a perfect fit for me and I make way more than I did as an RN. It took almost a year and a half to find the job I wanted, and I'm so glad that I never lowered my expectations. Good luck to you!

[jaznia15]

The conclusion to my very stressful job search, but I must say at least this stress was brief. After talking with family, friends, and God I decided to take the offer of taking over the practice. After speaking to the physician who has bought the practice, I feel more comfortable doing so. My supervising physician is actually taking over one of his practices toward Atlanta. Both were very kind and supportive especially with me being a new graduate. They needed an answer fairly quickly so I have foregone even waiting on the offer from the local hospital where the CEO wasn't prepared for the interview. I know that the current FNP working with that hospital owned practice makes 70k and can only re-negoiate her contract after 3 years. These are the terms I have agreed to after negotiations with the private practice.

Pay: $39/hr at 40 hours a week (roughly 81k/year), evaluation after 6 months for increase, if practice increases volume pay will go up ( I was told average full day schedule of patients was 15 currently). I am expected to market to increase volume which to me is to be expected whether I was alone at the practice or there with another provider.

Benefits: Practice will pay for DEA#, NPI, and malpractice insurance. 2 weeks paid vacation. $1000 towards CME with 5 days alloted (these will be used as sick days as well). Only paid holidays are Christmas/New Years Day (probably will ask for Thanksgiving tomorrow, forgot about that major holiday).

Extras: Office does not offer health insurance, instead of health insurance I will receive $7k ($3500 paid every 6 months). This amount will increase by $1k every year. On top of that, will receive 5% of any profits from office to be paid annually as bonus. And he offered sign on bonus of $1250 to be paid this upcoming week once contract is signed.

Perks: After working a full week with my supervising physician at the end of June, I will begin job by myself the following week. I am my own boss. The owning physician wants me to see myself as a provider and that this is my practice. He operates a pain clinic here every other friday so I will have some interaction with a physician every other week. I can reach my supervising physician anytime via cell phone. I agreed to the 40 hrs a week to be split with hours being Mon-Thurs (9a-6p) and Fri 8a-12p. The practice is roughly 25-30mins from my house in the next town over. I will have ample enough to get my child to school and get ready for work. I'll also have enough time to get my child, check his homework, and spend some time with him each night Mon-Thurs. I have family in my hometown therefore I have help especially if my son, I'll have many options of babysitters before having to close the practice. I already possess a health discount plan because I have been PRN at my current RN position. If I'm inclined I can keep working PRN there with just 2 shifts a month. Just for my own security in case this does not work out, I definitely will probably do that the first 6 months to a year. I think I have made the best decision professionally and personally for my son and I's benefit. I get more time with him with normal hours and I also get the autonomy and patient/provider relationship I have wanted in my professional life. We'll see how this turns out, I'll give update in a few months.