Nearly impossible to find NP jobs

[mrsannRN]

Anyone else having difficulty finding a job as an NP? I thought psych wasn't oversaturated but apparently it is.

[verene, MSN]

On 11/13/2020 at 11:14 AM, Polly Peptide said:

So, is it the overall consensus that there are "jobs" but one must be willing to move?

One doesn't have to move, but may need to make other concessions - lower pay, less ideal job, longer commute - to find a job that gets that initial experience.  Typically job search is MUCH easier once that initial 1-2 years of experience is complete. 

Also- NETWORK, network, network. Who do you know in the field? (or even related fields); let them know you are looking and interested. Even if they aren't hiring sometimes asking for an informal/informational interview with someone who works in the job or organization you want can 1) give you valuable information on how to sell yourself when they do have a job, and 2) broadens your network and can have people keep you in mind as a "potential" when they do have a job available.  

I knew someone at my current employer - bud didn't think I had enough experience for the organizations current openings - but asked some questions about their work and what they would like to see in an applicant and just generally tried to learn more - It was a good (e-mail) conversation. They asked for my resume and put it on the hiring managers desk. An hour later HR called and wanted to set up an interview. I got a job. 

[Polly Peptide, BSN, MSN, RN, APRN]

18 hours ago, FullGlass said:

My honest advice is reconsider your career plans.  You have to be realistic about getting a job.  Why do you want to be an NP?  It is because you are passionate about doing the work an NP does?  Or are you just looking for the next step in your career?

I don't know why it is so hard for people to be realistic in career planning.  If I wanted to be an actor or actress, but refused to move to places like NYC or LA, how good would my prospects be?

 

Please stop advising everyone to start their own practice.  Not everyone is cut out for this - it is basically running a small business.  And there is no way that a new grad NP is safe to practice independently.

I respect much of your advice on this site but telling someone who has already invested much time, money, and energy into this career path to "reconsider their career path" is a tough thing to say.  And perhaps not much more helpful than telling a new grad to start their own practice.

I'm not sure how comparing a nurse practitioner to an actor is correct or helpful, either.  One is almost totally driven by geography and the other isn't.  The geography problem we have right now for NPs is related to supply, not the fact that an entire sector's work is only conducted in certain cities.

I have paid attention to your story, FullGlass, because its not unlike mine.  I am a midlife career changer and I left a very well-paying job in another industry solely to become a nurse practitioner.  It is something I've wanted to do for many years.  I had the opportunity to go straight through but chose to become a nurse first.  I do not judge either path.  Sometimes I wish I had gone straight through.  But here I am - I'm a working nurse,(whether it will help me, who knows), and now I'm getting my MSN at the same school I could have gone to in the first place.

Having taken this road - now that I AM a nurse first - it causes me to pause and wonder if it's worth it to become an NP.  Had I just gone the route of "straight through to NP" like I originally wanted to, this would have never come up.  I would have still come out the other side with the same potential issues (looking for a job in saturated market...except with no RN experience).  But now that I am a nurse, I am looking at it with a new perspective and just wondering if I should continue.  The money is better...once you finally get a job.  But not by a ton.  It IS the work I would rather be doing.  It is what I've wanted to do all this time.

But with the market the way it's looking - I have concerns.  I am giving myself all the best chances - good school, they find my preceptors, working as a nurse, making contacts.  But I don't know if will be okay in the end.

[myoglobin, ASN, BSN, MSN]

19 hours ago, FullGlass said:

My honest advice is reconsider your career plans.  You have to be realistic about getting a job.  Why do you want to be an NP?  It is because you are passionate about doing the work an NP does?  Or are you just looking for the next step in your career?

I don't know why it is so hard for people to be realistic in career planning.  If I wanted to be an actor or actress, but refused to move to places like NYC or LA, how good would my prospects be?

 

Please stop advising everyone to start their own practice.  Not everyone is cut out for this - it is basically running a small business.  And there is no way that a new grad NP is safe to practice independently.

Well, I feel that I practice "safe" and am a "new grad".  Also, even if I had accepted one of the 100K "new grad" Florida jobs the only difference (other than much lower pay) would have been an expectation to see four patients per hour and rarely an opportunity to have my "cases" looked at or consulted by the "supervising" physician. At least working more independently I can take up to two hours on intakes (or longer) and 30 minutes to an hour on follow ups. Also, I have the time to communicate with experienced psychiatrists who often give me input on my cases (for free) something I would never have had time to do with one of the "new grad" jobs.  

[Polly Peptide, BSN, MSN, RN, APRN]

I'm not sure the reasoning, but it seems I see more psych practitioners having their own practices than others.  Perhaps due to overhead being lower (not as much need for equipment, etc).  I'm theorizing.  But I see a lot more talk on here about PMHNPs opening their own practices than I do others.   I do not have personal experience in the matter but don't see myself being able to do that with my specialty (AG-ACNP).@myoglobin

[myoglobin, ASN, BSN, MSN]

It is much harder for FNP's for a plethora of reasons including:

1. Relatively more "vast" number of procedures and knowledge base that you can encounter.

2. A greater need to see the person "in person".  

However, it is still feasible before I decided on Psych I had two or three MD's offer me an "80% deal" (no benefits, and about $400.00 for the office space). Still, I would have had a supervising MD, a place to work, front office support, and billing/insurance support as an FNP and my income potential would have still been much better than the 100K offers I see left and right for new grad FNP's in Florida.

[FullGlass, BSN, MSN, NP]

6 hours ago, myoglobin said:

Well, I feel that I practice "safe" and am a "new grad".  Also, even if I had accepted one of the 100K "new grad" Florida jobs the only difference (other than much lower pay) would have been an expectation to see four patients per hour and rarely an opportunity to have my "cases" looked at or consulted by the "supervising" physician. At least working more independently I can take up to two hours on intakes (or longer) and 30 minutes to an hour on follow ups. Also, I have the time to communicate with experienced psychiatrists who often give me input on my cases (for free) something I would never have had time to do with one of the "new grad" jobs.  

You yourself say you consult with experienced psychiatrists.

NPs DO NOT have internships or residencies like MDs or DOs.  They are NOT safe to practice unsupervised as a new grad.  PERIOD.  You don't know what you don't know.

When I started my first NP job I was constantly asking the MDs questions.  Constantly.  Any new grad NP that thinks they know it all and are ready to open their own practice is naive at best.  

Mental health is very low overhead.  It can be done via telehealth.  One can establish a cash-only practice.  An office just needs basic furniture.  That is simply not true of other specialties.

A psychiatrist told me that even in an area with a shortage of mental health professionals, it took him 2 years to build a solid practice of his own.

Now for other, physically oriented specialties, it is almost impossible to start a cash-only practice.  An office must be rented, with expensive equipment.  All that equipment in a typical primary care office is not cheap.  Staff must be hired - at the very least, someone to do scheduling and a medical assistant.  All the insurance and billing has to be handled in house or out-sourced.  Someone has to clean the office, pay utilities, buy an EHR, etc.  Anyone who thinks a new grad NP can just easily do all of the above is not being realistic.

 

[FullGlass, BSN, MSN, NP]

7 hours ago, Polly Peptide said:

I respect much of your advice on this site but telling someone who has already invested much time, money, and energy into this career path to "reconsider their career path" is a tough thing to say.  And perhaps not much more helpful than telling a new grad to start their own practice.

I'm not sure how comparing a nurse practitioner to an actor is correct or helpful, either.  One is almost totally driven by geography and the other isn't.  The geography problem we have right now for NPs is related to supply, not the fact that an entire sector's work is only conducted in certain cities.

I have paid attention to your story, FullGlass, because its not unlike mine.  I am a midlife career changer and I left a very well-paying job in another industry solely to become a nurse practitioner.  It is something I've wanted to do for many years.  I had the opportunity to go straight through but chose to become a nurse first.  I do not judge either path.  Sometimes I wish I had gone straight through.  But here I am - I'm a working nurse,(whether it will help me, who knows), and now I'm getting my MSN at the same school I could have gone to in the first place.

Having taken this road - now that I AM a nurse first - it causes me to pause and wonder if it's worth it to become an NP.  Had I just gone the route of "straight through to NP" like I originally wanted to, this would have never come up.  I would have still come out the other side with the same potential issues (looking for a job in saturated market...except with no RN experience).  But now that I am a nurse, I am looking at it with a new perspective and just wondering if I should continue.  The money is better...once you finally get a job.  But not by a ton.  It IS the work I would rather be doing.  It is what I've wanted to do all this time.

But with the market the way it's looking - I have concerns.  I am giving myself all the best chances - good school, they find my preceptors, working as a nurse, making contacts.  But I don't know if will be okay in the end.

You posted here to get advice and opinions.  Sorry the answer is not what you wanted to hear.  To start off my NP career, I took a job in the middle of nowhere, literally, a very small rural town with no high speed internet, where even cell phone and GPS service is spotty.  I didn't plan on staying there forever, but was willing to make that sacrifice for a couple of years.  One of our doctors did the same thing - he literally commuted home every weekend to the SF Bay Area, 5 hours each way.  

A lot of people do these long distance commutes.  It is very common in Silicon Valley for tech workers to couch-surf during the week and go home on the weekends.  I used to drive from Los Angeles to San Francisco every week as my commute, renting a room in the Bay Area.

If you want it bad enough, you will make the sacrifices to make it happen.  

As for locations, if I wanted to be a professional dog-sled racer, I would not choose to live in Florida!

Sorry you have put a lot into becoming an NP, but that was your choice and you evidently did not do the research before doing so, and you don't have the flexibility needed to pursue this career.  I don't know how to sugar coat that.

NP is not the only way for an RN to advance or make more money.  RNs have a lot of other options, like specializing, management, executive management, etc.  Some specialties, like RN First Assist, can make a ton of money.  The rural health clinic I worked for had expanded a lot, grew to 7 clinics, and appointed a former RN to be their COO, then their CEO.

 

[myoglobin, ASN, BSN, MSN]

I ask questions via email of several psychiatrists and do so only because I have the time. I have the time because I am 1099 and set my appointment times. My practice isn’t “full” and I am not certain if it is successful but my share after expenses was about 22k for Oct. Had I taken a “supervised” position I would have no time to speak to MD’s or anyone else (I in know this because when I was a student I was required to see about 30 patients per day and the supervision was essentially “on paper”. Also when I was doing my 6 month “medical” rotation I had two MD’s offer me 80 percent 1099 if I would work as an FNP rather than PMHNP and that was Florida not a “good” area for new grads. Too many NP’s limit themselves to posted jobs rather than approaching MD’s directly or via letter/ email and proposing a more favorable offer. Ultimately, all jobs are “non benefitted” in the sense they pay you less for the “benefits” the fees for the benefits are hidden in a usually much smaller pay check. You can usually purchase the “benefits” you need for less and be left with more for your family.

[FullGlass, BSN, MSN, NP]

1 hour ago, myoglobin said:

I ask questions via email of several psychiatrists and do so only because I have the time. I have the time because I am 1099 and set my appointment times. My practice isn’t “full” and I am not certain if it is successful but my share after expenses was about 22k for Oct. Had I taken a “supervised” position I would have no time to speak to MD’s or anyone else (I in know this because when I was a student I was required to see about 30 patients per day and the supervision was essentially “on paper”. Also when I was doing my 6 month “medical” rotation I had two MD’s offer me 80 percent 1099 if I would work as an FNP rather than PMHNP and that was Florida not a “good” area for new grads. Too many NP’s limit themselves to posted jobs rather than approaching MD’s directly or via letter/ email and proposing a more favorable offer. Ultimately, all jobs are “non benefitted” in the sense they pay you less for the “benefits” the fees for the benefits are hidden in a usually much smaller pay check. You can usually purchase the “benefits” you need for less and be left with more for your family.

I am glad you found a good situation for yourself.  However, it is not the norm.  Also, you are quick to pooh-pooh benefits.  Benefits can be worth a lot and are important to some people.  Some people just prefer being an actual employee and employees typically have more job security than a contractor.

 

[Polly Peptide, BSN, MSN, RN, APRN]

9 hours ago, FullGlass said:

You posted here to get advice and opinions.  Sorry the answer is not what you wanted to hear.  To start off my NP career, I took a job in the middle of nowhere, literally, a very small rural town with no high speed internet, where even cell phone and GPS service is spotty.  I didn't plan on staying there forever, but was willing to make that sacrifice for a couple of years.  One of our doctors did the same thing - he literally commuted home every weekend to the SF Bay Area, 5 hours each way.  

A lot of people do these long distance commutes.  It is very common in Silicon Valley for tech workers to couch-surf during the week and go home on the weekends.  I used to drive from Los Angeles to San Francisco every week as my commute, renting a room in the Bay Area.

If you want it bad enough, you will make the sacrifices to make it happen.  

As for locations, if I wanted to be a professional dog-sled racer, I would not choose to live in Florida!

Sorry you have put a lot into becoming an NP, but that was your choice and you evidently did not do the research before doing so, and you don't have the flexibility needed to pursue this career.  I don't know how to sugar coat that.

NP is not the only way for an RN to advance or make more money.  RNs have a lot of other options, like specializing, management, executive management, etc.  Some specialties, like RN First Assist, can make a ton of money.  The rural health clinic I worked for had expanded a lot, grew to 7 clinics, and appointed a former RN to be their COO, then their CEO.

 

I actually did do my research - years of it, in fact.  It’s one of the primary reasons I became a nurse first instead of going directly through to NP.  But discovering just how many NP jobs there are to applicants seems to be a little less concrete.

 

[myoglobin, ASN, BSN, MSN]

I've only got about five minutes and I must start prepping for clients. However, I believe several points are in order:

a.  Obviously, 1099 or self employment isn't for everyone. However, I have personally known at least four NP's who have nearly in some cases or more than doubled their income by going this route. My goal is to offer actionable solutions to help people achieve their dreams.  Even in cases where "self" employment isn't the ultimate outcome many times NP's will get better offers by "approaching businesses" rather than waiting on jobs to be listed and posted. For example I had several jobs through agencies tell me in essence "we could have offered you more, and or a nice bonus, but we will have to pay an agency fee ranging from 10K to in one case 40K.".  

b. I had multiple job offers in many states despite poor interviewing skills (indeed worse than poor, in many cases I'm outright confrontational in interviews, my attitude is that I would rather lose a job "up front"}, virtually no psych experience and the burden of severe (untreated at least with medication) ADHD as well as autism spectrum disorder (I did at least bath, brush my teeth and wear my ten year old suit to most of my interviews).  I came of about like I do here as "a half crazed lunatic" and yet I still had offers at around 30% of interviews. Granted this was pre covid but I had at least 20 offers. The key is that I used multiple agencies and applied directly to probably 200 positions (maybe more).  If I can achieve that as a 51 year old with all my issues it stands to reason that someone with less 'issues" should at least be able to get a  few acceptable offers (granted I was willing to move to the outback of Wyoming or literally Alaska if that is what it had taken leaving my family behind for several years (but would have sent money home). 

[FullGlass, BSN, MSN, NP]

4 hours ago, myoglobin said:

I've only got about five minutes and I must start prepping for clients. However, I believe several points are in order:

a.  Obviously, 1099 or self employment isn't for everyone. However, I have personally known at least four NP's who have nearly in some cases or more than doubled their income by going this route. My goal is to offer actionable solutions to help people achieve their dreams.  Even in cases where "self" employment isn't the ultimate outcome many times NP's will get better offers by "approaching businesses" rather than waiting on jobs to be listed and posted. For example I had several jobs through agencies tell me in essence "we could have offered you more, and or a nice bonus, but we will have to pay an agency fee ranging from 10K to in one case 40K.".  

b. I had multiple job offers in many states despite poor interviewing skills (indeed worse than poor, in many cases I'm outright confrontational in interviews, my attitude is that I would rather lose a job "up front"}, virtually no psych experience and the burden of severe (untreated at least with medication) ADHD as well as autism spectrum disorder (I did at least bath, brush my teeth and wear my ten year old suit to most of my interviews).  I came of about like I do here as "a half crazed lunatic" and yet I still had offers at around 30% of interviews. Granted this was pre covid but I had at least 20 offers. The key is that I used multiple agencies and applied directly to probably 200 positions (maybe more).  If I can achieve that as a 51 year old with all my issues it stands to reason that someone with less 'issues" should at least be able to get a  few acceptable offers (granted I was willing to move to the outback of Wyoming or literally Alaska if that is what it had taken leaving my family behind for several years (but would have sent money home). 

Thank you for acknowledging that a 1099 or one's own practice is not for everyone.  The key to your ability to find a job is that you are flexible on location and you were willing to temporarily relocate to get that first job.