HELP CHOOSING JOB OFFERS! Cardiology vs Endocrine

[Dumplins, MSN, RN, APN]

Hello everyone! I'm stuck choosing between two job offers that seem fairly even to me. I was curious as to which one you guys would choose/recommend.

Endocrine NP - This job would be at an outpatient facility that is affiliated with the nearby hospital. The job consists of seeing patients for the morning (approximately 8 patients - 30min/patient), then the afternoon would be mostly phone calls and paper work (calling patients on lab results, correcting insulin from blood sugar logs, etc. Goals for the practice are also eventually to get the NP's to be Endo/Diabetes certified and run classes to teach patients about insulin pumps, medication, diet, etc.

Salary: Around $90,000 with no wiggle room. After about 1.5 - 2years of working and obtaining 2 certifications, salary bumped up to approx $100,000 (5k per certification)

Vacation: 4 weeks to be used however I want (this includes vacation, sick days, CME, etc)

Health/Vision/Dental: Not paid by employer, but offers various company tier plans to choose from. Individual health insurance through them would be approx $167/month.

403b: No matching, but contributes 10% of whatever your salary is every year (approx an additional $9,000)

Pros - No call or weekends, good staff support, education-based nursing (something I'm interested in), slightly closer commute of 45minutes (compared to 1hr+ from the cardiology position), 403b contribution of $9k/year

Cons - Would have to relocate to Rhode Island (which isn't too bad of a con for me), not much negotiation, fear of difficulty finding another job if this one doesn't work out (endocrine jobs are far and few between in the north east)

Cardiology NP - I would be working with a single physician who runs two offices. One office would eventually become my own where I would be the primary person running it. He would train me in everything I need to know and seems like a very open and flexible person, as well as very open to contract negotiation. Days would roughly be me rounding at an LTAC to see 5-6 patients, then heading to the office to see patients. The goal is to reach up to 25 patients/day at the office (approx 15 minutes/patient).

Salary: Around $95,000 with opportunity for bonuses and productivity incentive

Vacation: Negotiable. Doctor mentioned it would be close to the typical 2wk vacation, 1 week sick, 1 week CME.

Health/Vision/Dental: Not offered

401k: Offered after 1 year of employment, with matching (unsure how much matching)

Pros - Located in the state I'm currently residing in, opportunity for higher salary, more common specialty if I'm ever looking for another job

Cons - Longer commute (probably around 1hr including traffic), taking call every other weekend. Staff support at the office doesn't seem adequate. It would just be me and probably 1 medical assistant who will take the patient in and answer phones as well (though I'm not sure if this is how smaller offices usually work).

My interest level is about the same regarding the specialty. I can envision myself in both positions.

[CrunchRN, ADN, RN]

Number 1. No call means a much better lifestyle.

[OrganizedChaos, LVN]

Job 1. On call is for the birds.

[PG2018]

Before I even read your post, I knew the cards would require call without the endo doing so. I think endo is the better option. HOWEVER, you're really doing some crappy work in the afternoons there. Interestingly, the guy is willing to pay you that salary for making calls and shuffling papers. I'm guessing the certs you have to get include CDE. Take it. You may can market that later.

I am of the OPINION, CME should be nothing but a paid work day, i.e. no one week allotted for CME, but merely "Hey, I'm going to CME. See you when I get back. I'll expect my check as usual." It definitely shouldn't come out of your allowed days off. I also don't see any funding for CME mentioned. Surely, they're not expecting you to go off and self fund the CDE? Next, 30 minutes is too much. I don't have a clue what it is with NPs wanting or being expected to see patients for 30 minutes. I'm in psychiatry and have nothing to say after about 12 minutes of visit. What is there to talk about for 30? I suppose if you're having to look at feet, do neuropathy evals, etc then you might suck some time particularly if you're trying to change a lifestyle, but the latter sounds more like something you'd want to do in the afternoon. Maybe finish all the patients within 20 minutes, kick them out of the exam room, prove you can see more patients than currently forecast and thus get paid more. I'm all about making money. Doctors are all about automating their clinics and making them more efficient to get patients in the room and out of the room quickly so they can see more people which leads to a larger patient base, more revenue, and more money in your pocket. This is something "midlevels" haven't caught on to yet. It really irritates me.

Also, you have RETIREMENT at the endo clinic. Take it. Anytime you're getting free money, you're doing great. Plus you get to move to Rhode Island. Maybe you'll see Jim Carey patroling the highways on his motorcycle (Me, Myself, and Irene and that's all I know about RI).

NEXT, at BOTH jobs and particularly cards, you're underpaid, LOL. How much is a cardiologist making especially if interventional? 300K+ ? And he's wanting to pay you peanuts and take all of his call (which I bet would turn into more). The endo guy is making some good dough too. You really need to get paid in excess of 100k now. But if you can't negotiate, which being told that is always UNPROFESSIONAL, and you feel like taking it then I think the endo is the lesser of two evils. NPs accept salary offers from doctors as RNs accept med orders. Unquestioning.

[littlepeopleRNICU]

If your interest is really the same for both specialities, I feel like the first option offers the better lifestyle and benefits.

[aurora1212]

I have to echo everyone's comments about being on call. It doesn't seem like a big deal until someone calls you at midnight or in the middle of a family dinner. I like to leave work at work. Also, I think the certifications you get with the endo job will be value added anywhere you go. Good luck with your decision. Pray about it and go with your instinct. Nurses are known to have well honed instincts.

[twozer0, NP]

I do call now as a nurse and its terrible. Nothing like getting called in to work at 2am to deal with a patient after surgery or in your case whatever they need you for. They are usually pretty easy to care for at this time due to it being normal sleep hours but still. No call = awesome. Plus you have to work the next day! I hope they give you an extra large coffee mug that says "in it to win it" if you were to work there!

[nbnjNP]

Which one did you end up selecting?

[tobyrn]

Hi,

I think i would go for endocrinology. No On call, No weekend. If you have children, it matters a lot.

[Dumplins, MSN, RN, APN]

Thanks for all of your suggestions! Sorry I didn't get to reply to this sooner. I ended up going with the Cardiology offer because of my gut. It was more because the field of Cardiology is a lot less specific than Endocrinology and I figured it would be better for my future with Cardiology experience under my belt. So far I'm 3 weeks in and it has been great! The doctor has been very supportive in my training and very flexible as far as my wants and concerns.

Currently I'm not taking call, but he said that may change in the future. I am just started to do every other weekend rounding. Which really just come out to an addition 3 hours of work per week (which adds up...I know..)

We are already in discussion with a pay increase as long as I can meet my patient quota. Which I am fairly close already and will probably meet it within another 1-2 months.

Overall I'm satisfied. Especially with it being my first NP job. No complaints...yet =)

Thanks again for your help guys!