Looking for input on first PMHNP job.

Published

Specializes in ICU, trauma, neuro.

So it is looking like my options may come down to three basic "first job" offers as a PMHNP. Currently, I live in Florida and my wife would stay here at least two weeks out of the month (she is a telehealth provider and can work from anywhere). So here are the basic option(s) offer:

a. A local outpatient position with about a 60 minute commute each way paying around 115K and with very modest benefits (50% contribution for health insurance for me very little if any for my family) two weeks paid off. 15 minute medical management appointments/ 40 minute initial evaluations. Hours would be around 0730 until 1830 four days per week.I have several offers in this category.

b. I can take a local job in a center that focuses on "neurological rehab" inpatient for diagnoses like traumatic brain injury, autism, and other long term neurological scenarios. Pay would be around the same with somewhat better benefits, plenty of time with patients, but lots of ancillary duties to help nursing administration. My concern here is that the lack of outpatient experience might compromise my career down the road (of course two years from now anything besides being new grad is exponentially better than my current scenario). The commute would be about 90 minutes each way 0900-5PM. Monday-Friday.

c. I have a probable "out of state" offer in Washington State where I would be part of an NP practice. I would get paid fees minus a charge for "services" that include office space, front office, billing, insurance accreditation, and so forth. The office(s) are seeing 500 plus patients between them and promise a full case load within about three months with the average first year earnings between 150-200K. TMS and counseling is also available onsite. Of course the first three months I would be earning absolutely nothing. So this plan would involve probably working a prn/RN job (probably in a local ICU or psych facility) on Friday and Saturday evenings (and working 4 days in the clinic). I would be able to determine my appointment windows with the usual being 30minute med management and 60 minute evaluation. The commute would be around 20-30 minute(s) depending upon which low cost apartment/Airbnb I went with (but I would only see my wife two weeks at best out of the month).

I owe about 150K in student loans and 40K in credit card debt and am 50 years old (plan on working until 80 or dead or in a Medicaid nursing home should I suffer a stroke/dementia or some other unfortunate fate) so money is a significant issue (no 401 K). None of these options compare to the $85.00 per hour telehealth position my significant other was offered with a year to go in school in 2016 ( a job which she still has and we do not intermix incomes), but I'm uncertain which direction to go in. All are infinitely better than nothing so I am very grateful for the blessings that I have. Any guidance?

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