Nearly impossible to find NP jobs

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

Specializes in Psychiatric and Mental Health NP (PMHNP).
6 hours ago, Polly Peptide said:

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.

 

This job market is bad because of COVID.  It is starting to pick back up.  It is always hard to get that first job as a new grad NP or anything else.  I suggest you consider long distance commuting as I previously discussed for 1-2 years to get some experience.  Consider locations within a 5 hour drive of your permanent residence.

Many states and counties provide reports on healthcare provider needs and shortage areas.  Use Google to find these and this will help target your job search.  HRSA also has virtual job fairs for HRSA scholarship and loan repayment recipients, but the fairs are open to everyone.  These are organizations that have trouble finding candidates because they are not in the most desirable locations.  Sign up for the next job fair.  Apply to every organization in your target area, whether they are actively looking for an NP or not.

Do a search on all FQHCs within a 5 hour drive of your home and apply to every one, whether or not they have a job posted.

Join the local branch of your state NP organization and start going to meetings and networking.  Talk to working NPs to find out where the jobs are.

Contact your NP school and RN school to see if they provide assistance to alumni with networking and job search.

I just randomly googled "arkansas healthcare provider shortage" and got a bunch of hits.  Do this for where you are.

Good luck.

 

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Specializes in ICU, trauma, neuro.
1 hour ago, FullGlass said:

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.

 

While I acknowledge that it is "not for everyone" I believe it is the single most powerful dynamic available to NP's in many states for radically improving their level of compensation, while at the same time offering better access to healthcare providers for patients. Rather than "waiting on the world" to change NP's have the means to mold a better situation right now (at least many of them do). Many providers (including FNP's) especially in the worst paying, non IP states will find better pay and working conditions if they at least "look" for opportunities along these lines. Again, I have personally, known NP's in Florida and Alabama who have been able to find local opportunities that generate incomes well above 200K using this approach while W-2 jobs were in the 100 to 120K range (with expectations for production of around 4 patients per hour and little job security if you failed to achieve these numbers). 

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Specializes in ER, HH, CTICU, corrections, cardiology, hospice.

I am an adult NP in AZ and have been unemployed for close to two years now. Many jobs for urgent care setting and family practice seeing all ages, a tonne of PMHNP jobs.

I’m working with AZDES to help me find work. Today I shotgunned my resume and cover letter to 2-10 people group homes to do freelance physicals and non-emergent house calls. I also have my data 2000 waiver and would like to start and maintain people on suboxone.

Problem is, in the past, I’ve been hopeless in business, I don’t know what I don’t know, which is to say, near total ignorance when it comes to business.

I don’t have a clue why things dried up, even B.C. (before covid) the thought had crossed my mind that my age might have something to do with it, or I was blackballed by my last gig (they kept me around 12 months past the original contract and raises each time, so I kind of doubt it, but I don’t know for sure.)

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Specializes in ER, HH, CTICU, corrections, cardiology, hospice.
On 11/16/2020 at 3:02 PM, myoglobin said:

While I acknowledge that it is "not for everyone" I believe it is the single most powerful dynamic available to NP's in many states for radically improving their level of compensation, while at the same time offering better access to healthcare providers for patients. Rather than "waiting on the world" to change NP's have the means to mold a better situation right now (at least many of them do). Many providers (including FNP's) especially in the worst paying, non IP states will find better pay and working conditions if they at least "look" for opportunities along these lines. Again, I have personally, known NP's in Florida and Alabama who have been able to find local opportunities that generate incomes well above 200K using this approach while W-2 jobs were in the 100 to 120K range (with expectations for production of around 4 patients per hour and little job security if you failed to achieve these numbers). 

With 1099 income in the 200K range, that equates to 100K as a W2 employee, less if you tack on health insurance, etc. Doesn’t it?

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Specializes in ICU, trauma, neuro.
1 hour ago, nursetim said:

With 1099 income in the 200K range, that equates to 100K as a W2 employee, less if you tack on health insurance, etc. Doesn’t it?

I would say that 100K with great benefits is more like 150K 1099.  Most employers don't contribute more than about 10K towards the health insurance premium.  Most other benefits like vacation and matching on 401K (which is contingent upon you actually contributing) is worth perhaps another 15K and the extra "taxes" paid by your employer is probably worth another 7K at 100K in income. Thus, 150K is being generous.  200k is a much better salary. 

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Specializes in ICU, trauma, neuro.
12 hours ago, myoglobin said:

I would say that 100K with great benefits is more like 150K 1099.  Most employers don't contribute more than about 10K towards the health insurance premium.  Most other benefits like vacation and matching on 401K (which is contingent upon you actually contributing) is worth perhaps another 15K and the extra "taxes" paid by your employer is probably worth another 7K at 100K in income. Thus, 150K is being generous.  200k is a much better salary. 

Remember that the reason that employers offer benefits isn’t out of love or generosity, but rather because they can extract more perceived value from the employee for a given expenditure than they could if they simply offered money. Benefits save employers money relative to pay.

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Specializes in Psych/Mental Health.

After-tax income for 1099 making $150k should be closer to $110k (assuming you expense $20k). 1099 has to pay 15.3% self-employment tax on top of regular federal income tax.

After paying for benefits (medical insurance and vacation), 1099 will probably make closer to $100k or a bit less.

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Specializes in ICU, trauma, neuro.
8 minutes ago, umbdude said:

After-tax income for 1099 making $150k should be closer to $110k (assuming you expense $20k). 1099 has to pay 15.3% self-employment tax on top of regular federal income tax.

After paying for benefits (medical insurance and vacation), 1099 will probably make closer to $100k or a bit less.

Results will also differ. Even when I worked W-2 as an RN I didn't get health insurance or vacation paid (I elected for the $8.00/hr bonus pre Health care reform act and they grandfathered me in).  Also, there are health sharing organizations that can provide services comparable to health insurance (Zion is one of the better ones) for around $600.00 per month for a family much less than traditional health insurance.  Also, even though I'm 1099 I still don't itemize, I just take the standard deduction for a single individual (which costs me a bit, but not too much since my total business expenses probably are not much more than 15K per year).      

Also, many people form C corps and then pay themselves a "salary" of say 50K with the rest coming as distributed earnings. This way they only pay social security and Medicare on the portion of their "money" that is the "salary". The rest is taxed at the corporate rate.  Using this approach I know NP's that save over 30K per year on taxes, but I'm way to ADHD/autistic (set in my ways) to do something this complex.

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Specializes in Psych/Mental Health.
23 minutes ago, myoglobin said:

Also, many people form C corps and then pay themselves a "salary" of say 50K with the rest coming as distributed earnings. This way they only pay social security and Medicare on the portion of their "money" that is the "salary". The rest is taxed at the corporate rate. 

If you are hired by a employer as a 1099, you can't file your taxes using S-corp (s-corp is most often used by NPs with their solo practices, never seen anyone use c-corp). But yes you can save money on taxes if you use s-corp but have to set up an independent practice.

 

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Specializes in ICU, trauma, neuro.
2 hours ago, umbdude said:

If you are hired by a employer as a 1099, you can't file your taxes using S-corp (s-corp is most often used by NPs with their solo practices, never seen anyone use c-corp). But yes you can save money on taxes if you use s-corp but have to set up an independent practice.

 

I use the term 1099. Not sure why you say I could not use S-corp or C corp. Technically, the company I work with requires that you be a PLLC or a C corp but they made an exception and let me be a "sole proprietor" (I have a business license and pay Washington State business tax currently about 2.5% of receivables).   My SO who just started at the same company as a PLLC (Washington state does not allow LLC's any longer for some reason).  She filed with IRS to not treat her PLLC as a non

"taxable" entity thus all of the income flows through to her as taxable income.  Still with any luck we should each be in the 300 to 400K range and thus it seems like a decent gig for working from home even if it is without benefits.

If we ever start are own company I will probably offer people the option of either being 1099 at a higher percentage (say 70%) or W-2 with benefits in which case they would probably be at around 50% with benefits. Either way they would end up earning much more than what is typically paid at similar institutions run by MD's.  I would probably offer the same option for therapists.  I see many (perhaps the majority) of practices in Washington (I noted this in Colorado as well) owned by therapists, but few owned by NP's. I wonder why this is?

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Specializes in Psych/Mental Health.

I believe if you're receiving pay as 1099 (or even sole proprietor), all your earnings are subject to self-employment tax. If you set up an LLC and file s-corp tax, you can pay yourself a salary and the rest will be regular income tax, meaning that a chunk of your earnings can bypass the high self-employment tax. It's a way to save money on taxes.

Most if not all 1099 jobs I see pay hourly and most pay crap these days ($75-85/hr). Those 1099 jobs aren't worth it compared to a w-2. The way yours is set up is much better, but I rarely see them at least not on places like Indeed.

37 minutes ago, myoglobin said:

I see many (perhaps the majority) of practices in Washington (I noted this in Colorado as well) owned by therapists, but few owned by NP's. I wonder why this is?

My guess is that most NPs simply don't know or don't want to bother with the business side of running a private practice.

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Specializes in ICU, trauma, neuro.
3 minutes ago, umbdude said:

I believe if you're receiving pay as 1099 (or even sole proprietor), all your earnings are subject to self-employment tax. If you set up an LLC and file s-corp tax, you can pay yourself a salary and the rest will be regular income tax, meaning that a chunk of your earnings can bypass the high self-employment tax. It's a way to save money on taxes.

Most if not all 1099 jobs I see pay hourly and most pay crap these days ($75-85/hr). Those 1099 jobs aren't worth it compared to a w-2. The way yours is set up is much better, but I rarely see them at least not on places like Indeed.

My guess is that most NPs simply don't know or don't want to bother with the business side of running a private practice.

That's the thing "the company" books all of my appointments, schedules followups, bills insurance, collects payments, provides office space. The only thing I do is see patient's, order medicines (write letters), and yes pay taxes.  They charge me 30% for the services they provide plus I pay an additional $700.00 per month for the office space and support.  

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