FNP new grad and 1st job, red flags?

emtneel · Mar 16, 2008

The first job is always a mixed bag. I can't really speak for NPs but I know that for PAs in Colorado getting the first position is kind of hard. The RRCC grads usually have job offers right away but the CU students sometimes have a problem getting positions in Denver. Some take 5-6 months. /QUOTE]
I understand, I also expect my first job might not be my favorite. I really just want a job where I can get good experience, preferably Family practice and good mentoring, and more money than i'm making now (since i have loans to pay back!)
I think part of the problem in Colorado with oversaturation of PAs and NPs is we have several good schools kickin em out. Esp. the PA program at CU is CHAMPA or something like that, which means the PAs are specialized in Pediatrics. Then you have the PNP program at CU rate #1. So Pediatric jobs are VERY difficult if not impossible to come by. A collegue graduated 2 yrs ago with PNP and still working as a RN on our unit, not sure how hard she looked though.
I do think if you do a different speciality such as ARNP or NNP it is much easier to get a job.
I wonder if companies have problems with new grads not getting a job for 5-6 months.
New grad NPs in Colorado have a bigger disadvantage because of prescriptive authority. /QUOTE]
Not sure what you mean by this? NP's can get prescriptive authority after ~1 yr of work and writing prescriptions with MD's signature. Do PAs not have any restrictions as new grads?
In FP you also see a lot of "family run" practices where the wife or husband in the manager. Some of these need to be educated. /QUOTE]
Funny you should mention this, I was invited to a dinner interview in Po-tunk town Colorado and the HR/office manager turned out to be the solo MD's wife, she said used to be a 4 MD practice, some foul play happened and now this MD, "just can't trust anyone else."
They were actually really nice, I really liked what he told me about his practice and how he trained new grad's, didn't sound too scary. But the town is 1.5 hours from any "city" and too far to commute, and smelled really, really bad, like cow poop, so bad i thought i was going to throw up..
Actually the previous interview I was talking about was run by the NP was my understanding, and yes, was rural. It seemed to me they wanted a NP to increase pt. load and profit, and expected them to see 25+ pts. right off the bat.
I'm not saying I can't see 25 pts., I just don't know, I just really want to find a job that would work with me and not fire me right off the bat if I can't.
I received a few emails from some potential jobs in Texas, which I think may be better for me since I have family there, instead of new state, new job, new place, etc.. might be too much.
I do see about 24 patients a day, they gave me about 3 months to do it and it was something that I absolutely requested, at first they wouldn't and I simply said ok I'm not interested in applying for the position if you won't give me ramp up time./QUOTE]
That's good to know, that there are people out there that will work with you.
In the south the one interview i did have said they were desperate for NPs and had to hire some PAs although they wanted NPs but just couldn't find any.
(i think for the nursing background, not that PA/NP's better or worse)
Good input peoples!

core0 · Mar 16, 2008

The first job is always a mixed bag. I can't really speak for NPs but I know that for PAs in Colorado getting the first position is kind of hard. The RRCC grads usually have job offers right away but the CU students sometimes have a problem getting positions in Denver. Some take 5-6 months. /QUOTE]
I understand, I also expect my first job might not be my favorite. I really just want a job where I can get good experience, preferably Family practice and good mentoring, and more money than i'm making now (since i have loans to pay back!)
I think part of the problem in Colorado with oversaturation of PAs and NPs is we have several good schools kickin em out. Esp. the PA program at CU is CHAMPA or something like that, which means the PAs are specialized in Pediatrics. Then you have the PNP program at CU rate #1. So Pediatric jobs are VERY difficult if not impossible to come by. A collegue graduated 2 yrs ago with PNP and still working as a RN on our unit, not sure how hard she looked though.
I do think if you do a different speciality such as ARNP or NNP it is much easier to get a job.
I wonder if companies have problems with new grads not getting a job for 5-6 months.
The dynamics are actually more complicated than that. First there is an oversupply of FP docs. There are five or six residencies in Denver that probably produce about 80 FP docs per year. Then there are two PA programs that produce 64 PAs per year. There are two NP programs in Denver plus others outside Denver. I have no idea how many NPs they produce. Then from the PA perspective you have 30-40 PAs that are from Colorado but leave to go to school in other states. There are also a number of FP docs in the same area. So you have a lot of competition for a limited number of FP jobs. Most of the PAs will go into specialty or surgical practice. RRCC has a high specialty rate. About 25% of the recent CU (CHA/PA) grads have gone into peds with another 20% into FP. Both the Red Rocks and the CU program have rural medicine programs and this is where they have been placing their FP students in the last few years.
So you have a situation where a lot of people are chasing a few positions. The FP physician starting salary is around $100k in a few practices from what I hear. This is also why you see very few CRNAs in Denver itself. Basically they cover whatever the Anesthesiologists don't want. The starting (non-partner) anesthesia salary is only a little above what a CRNA would make so there is no real reason for these groups to hire outside of convenience. The NNP situation is also pretty tight. There is only one group that employs all the Neonatologists that are not at the academic centers or Kaiser. That means if you want to be an NNP you better know someone in the group. This is further tightened by the fact that two of the other NICUs are PA only.
The average FNP salary is probably well below what nurses are now making in Denver. The one ICU nurse that I know that did take an FNP job took a $10k pay cut. Most of the FNPs that I know are still working in the hospital as RNs.
The other big disadvantage that I see from the NP side in Colorado is that there does not seem to be much networking. The PA association is pretty active and runs a job site. In addition both the PA programs run mailing list for graduates and there is a lot of word of mouth solicitation for new jobs. Thats something I really didn't see with the NP community. I think thats also one of the differences between full time and part time programs. The PAs programs in Colorado have a vested interest in their graduates getting jobs. This produces more sites for rotations and preceptorships for their current students. The NPs that I worked in Denver anyway did not get the same level of service from their programs. It was more like OK we got your money, you got your degree, good luck.
Just my perspective on Colorado.
New grad NPs in Colorado have a bigger disadvantage because of prescriptive authority. /QUOTE]
Not sure what you mean by this? NP's can get prescriptive authority after ~1 yr of work and writing prescriptions with MD's signature. Do PAs not have any restrictions as new grads?
PAs don't have any prescriptive restrictions. You can scrip as soon as you get a license (schedule drugs when you get your DEA). There are different supervisory requirements for new grads and PAs that are new to the practice.
In FP you also see a lot of "family run" practices where the wife or husband in the manager. Some of these need to be educated. /QUOTE]
Funny you should mention this, I was invited to a dinner interview in Po-tunk town Colorado and the HR/office manager turned out to be the solo MD's wife, she said used to be a 4 MD practice, some foul play happened and now this MD, "just can't trust anyone else."
They were actually really nice, I really liked what he told me about his practice and how he trained new grad's, didn't sound too scary. But the town is 1.5 hours from any "city" and too far to commute, and smelled really, really bad, like cow poop, so bad i thought i was going to throw up..
Actually the previous interview I was talking about was run by the NP was my understanding, and yes, was rural. It seemed to me they wanted a NP to increase pt. load and profit, and expected them to see 25+ pts. right off the bat.
I'm not saying I can't see 25 pts., I just don't know, I just really want to find a job that would work with me and not fire me right off the bat if I can't.
I received a few emails from some potential jobs in Texas, which I think may be better for me since I have family there, instead of new state, new job, new place, etc.. might be too much.
There are some potential gems there but overall the bad outweighs the good. The good is that if the office manager is the spouse then they actually may be able to get the physician to do things. The bad is that they look at you as money out of "their" pocket. Also I have seen spouse managers dump everything on the NPP so that either the physician or the spouse (or both) can go home earlier. Overall its definitely a warning sign.
I do see about 24 patients a day, they gave me about 3 months to do it and it was something that I absolutely requested, at first they wouldn't and I simply said ok I'm not interested in applying for the position if you won't give me ramp up time./QUOTE]
That's good to know, that there are people out there that will work with you.
In the south the one interview i did have said they were desperate for NPs and had to hire some PAs although they wanted NPs but just couldn't find any.
(i think for the nursing background, not that PA/NP's better or worse)
Good input peoples!
I've only worked in specialty and the my first couple of jobs hired me specifically so someone could spend more time with the patients. I've never had less than a 30 minute slot. So I get kind of whiney if I have to see more than 16 patients per day:rolleyes:. The joys of specialty practice.
David Carpenter, PA-C