Internal Medicine vs specialty (pain management)

[islandsyndrome]

Hello,

I am in need of some advice. I am a newly board certified FNP. I was just interviewed by a pain management clinic with urgent care (on the side) and was "unofficially hired" by them. I will also be getting an interview for an internal medicine outpatient clinic on thursday. If both would like to hire me, which one should I choose? Both are willing to train a new grad like me. And I do not have any idea yet of the starting salary they would offer me. Is starting in a specialty a good idea for a new NP?

Thanks!!!

[islandsyndrome]

First, islandsyndrome thank you for the excellent question, because I am (and I expect many others) are in a similar boat! I very much agree with djmatte's above response. I would like to add to it as well. I have noticed that many new NPs are not in their first job for very long. I expect there are a number of reasons for this, but one major one would be unrealistic expectations. What is the expected number of patients you will see in the IM and pain management positions? Obviously, I would expect more in the pain management, because it would typically be less comprehensive. For this position, or any position you take in your career, you should ask questions at the end of the interview to determine if the doctor or direct report is someone you can work well with. Finally, I think many NPs leave their first job because organizations say they are willing to hire a new NP, but then they realize how little hands-on experience we get in clinicals (~550 hours total), but expect us to work at a 4th year resident level (15,000 + hours hands-on experience as a resident). Then everyone gets frustrated and upset. The NP leaves and goes somewhere else, where they build on the knowledge they gained in that frustrating environment or go to a "lesser job". At least this is my perspective about what is happening...viewing from a far, because I am applying for my 1st jobs too. There seem to be A LOT of hospitalist jobs, but I realize that is one of the toughest jobs in medicine. That is why it is being offered to us NPs. I am strongly leaning toward a comprehensive pain management clinic. I was concerned, at first, that I would be limiting myself. However, pain is universal, but there has been very little training devoted to it...even for doctors. Not only can I use this to springboard to a more generalized position, but I will not be overwhelmed. I will be able to pick and choose where I want to go. From what I can see these positions mostly just want SOME NP experience. I will have that, when I want to "move up". Or I can open up my own pain clinic, should I choose.

Hi DavidRNNV, thank you for giving me an idea about this dilemma. I was also about to take an interview for hospitalist job but I figured I was not trained for acute care even though they would train me. I thought that would be dangerous and something I should not risk it over. So are you working for a pain management right now?

[islandsyndrome]

Have you called the IM office to see if you're still being considered? I'd do that first before making any decisions.

Yes I have reached out and told me they're still interviewing other candidates too and setting up interviews for next week! It's frustrating

[islandsyndrome]

When I stated take the IM position over pain, I state that with the presumption all things are relatively equal. With the right group and appropriate focus on improving pain with minimizing use of opiate therapy, you can absolutely use a broader scope of your skill set and perhaps become more versed in an area many pcps are lacking. Obviously I would follow up with internal medicine, but if the offer was right and the practice had a serious multimodal focus to pain management, it would be one of the most important fields of our time just given the pure numbers of patients who need the therapy. Seek out the I'M position, but don't let them take you away from a potentially lucrative alternative. But again, REALLY seek out and understand the position on how the pain clinic practices.

Hi djmatte, I have reached out to them but told me they are still in the process of interviewing other candidates. And I am not sure how many positions they are trying to fill up. And I negotiated with the PM about the salary which they gladly complied to my request. So the $$$ offer is about right and I am happy about it. Thank you for your advice!

[ICU2NP]

Hi there, you said there was urgent care hours on the side - do you know how much would be in urgent care? That would have a good range of experience, so I'm thinking you wouldn't be too specialized with pain if you are doing some urgent. Something to think about! I would like to do urgent care when done, I did a clinical experience there and loved the variety.