Help choosing between two jobs!

[gigiaprn]

Hello! I recently got two job offers and am looking for any kind of guidance. I'm a new grad (FNP) with 8 years of critical experience as an RN. I graduated in May and accepted a job in August however; due to credentialing issues my start date got pushed back until January, in the mean time I started to look for something else.

Option #1- APRN as a hospitlaist at the hospital I currently work. Salary $98K 40 hours a week working (4) 10 hour days 8-6, one weekend a month. plus all the other usual benefits. cmes, 401k blah blah....I know that almost everyone works over 40 hours a week and get paid overtime so salary will probably be more like 110-115K but Id be working my little butt off. Expectation is to see 10-15 patients a day. daily notes, H&Ps, dictations, discharges.

Option #2- APRN with a multispecialty group that places you in a nursing home. Base salary $88K with increasing to $92K after the first year. plus monthly bonuses. $1K a month if you see 11.6 patients a day (they say that is extremely doable). PLUS 50% of whatever you see after the 11.6 patients. Its "fee for service" they claim I can make an extra $5K a month on top of my base. M-F no weekends. Hours are 8-6 however; they say most people are physically at the facility more like 10-4 and reachable by phone the other hours. Most practitioners are only working 30-35 hours a week. This company is also offering all usual benefits. 30 day PTO, CME, cell phone reimbursement ect.

Any suggestions????? They never really taught us "fee for service" in school but I understand it is how most physicians make their money. Option 2 has 4 weeks orientation where they will teach how to bill. Option 2 seems a lot more laid back and flexible I'm just nervous because I have never worked in a skilled nursing facility. any thoughts?!?!

[2015]

gigiaprn,

I have worked in nursing homes and I think 11.6 patients a day is doable. You will also have time to spend with family. Most doctors I knew back then had their own practice, on top of visiting nursing homes and doing patient rounds weekly. They could see up to 20 patients in one visit if they wanted to within 2-3hrs max. However these were seasoned doctors.

The advantage of working with nursing home patients is that over time, you get to know them really well hence making seeing more patients an achievable task. It's like when you work three 12s in a row in the hospital and you have the same patients all the three days.

Option one is an amazing opportunity to color your CV. I think being a hospitalist is a big deal especially for a new grad FNP. You should be humbled by the job offer. You can go back to the negotiating table and tell them you have a job offer that's better than what they are offering and see if they can increase your pay on option 1. I also think option 1 will open more doors for you in the future. However if you have a mountain of student loans and family obligations, option 2 sounds like the way to go.

[BostonFNP, APRN]

A few thoughts from personal experience.

I think that a competitive base plus a productivity bonus is an ideal situation provided the base is reasonable and you could live with it for a year or two. Seeing 11.6 a day might be about your max right out of school but should be reasonable in future years.

Hospitalists get worked. It's a fun job and you learn a ton but expect to earn the salary. If you are at a major academic hospital ask about how NPs are treated. At my hospital we are treated like attendings, at others NPs are treated like interns. It makes a quality of life difference.

Honestly I would take the job with the best track record of training novice NPs and where you will have the most support.