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New NP looking for Help Choosing Between Offers! (Pain Management vs Asthma/Allergy)

NP   (437 Views | 3 Replies)

NewNPinReno1982 specializes in Family Nurse Practitioner.

32 Profile Views; 2 Posts

Hello all new and experienced NPs,

I graduated in August, and passed my boards in November. I have been on a tedious journey to find the right job, and not just take the first offer; ever since. I feel I have done my due diligence. Hopefully, I have made the right choices so far. However, now I am at a stalemate. That’s where all of your opinions, knowledge, and experiences come to play.

In all I received 4 offers. Two of which I have respectively declined. Shall I dare mention those now that they are no longer an option?! Hopefully, I did the right thing by passing on those two. Obviously, the right thing can be subjective in this particular topic.

My ultimate goal is to find a first job that positively sets me up for the future. Meaning, I want to gain knowledge, and experience that will make my background desirable to prospective employers. With that being said...I have been in school soooo long, raised a child, gone through a divorce, and survived cancer. A top priority for me is work, life, and balance. I’m sure that is a top priority for most of us right! But if I am being completely honest with myself; balance is probably higher of the three priorities. Benefits/insurance is the 3rd of my top priorities.

So, the jobs I’ve turned down so far:

4) Ideal Image. Only offered Part-time Position. Originally, when I applied it was posted as a Full-time position; then turned to a part-time. Which would have been fine if they had offered health insurance. Pay would have been $55/hourly + incentives. I was worried about narrowing my skill set, and knowledge so much.

3) Pain Management “Alternative therapies.” I almost took this one. New business in town. Only open 2 years. They offer pain management therapies besides pain medication. Including, stem cells, PRP, light therapy, joint injections, PT, chiropractic. They also plan on expanding to things like the “vampire facial.” And this other approach where they use PRP to help women with bladder leakage. I really liked the progressiveness of this company, and the owners. I liked the idea of not just handing out scripts of narcotics. It would have started off as part-time with the high likelihood of going full-time in 3-4 months. They did offer health insurance. The kicker is I even started negotiating with them because I was very close to accepting their offer. After negotiations, It would have been $75/hour part-time (three 10 hour shifts). Then once full time it would have been $140,000 + incentives (four 8 hour shifts). So, I’m sure some of you are thinking that I am crazy for declining this offer. And even as I type out what they wanted to offer me; I’m thinking to myself did I make the right choice! So, this is what put the nail in the coffin. The vacation only included 1 week after the first year. That includes, personal time off, sick time, and vacation. 1 week! After 2 years all the sick time and personal time off was only 2 weeks. Why make all that money, and never have time to really enjoy it. I just got out of a situation where I could not take much time off because I was both working, and in school. Plus, I didn’t want to have to push for sales.


Now we are down to my final 2 choices, and I need to decide soon:

1 or 2) Pain Management: This company is very reputable, and has been in business for a long time. I did some of my clinic hours in school there, and really enjoyed the staff, leadership, and the owners (which are doctors). They have a small outpatient surgery onsite, and a med spa. If I take this job, the manager wants me to get my ACLS, and preform Moderate sedation on patients receiving kyphoplasty surgery. My background is the Operating Room which I loved. But I have never done moderate sedation. The company currently has 4 NPs, and 1 PA. The manager would also want to me to travel to another office; 1 day a week to manage pain pumps, and work in the med spa. The travel does add about 40 mins each way. She will also have me do trigger points, and just the usually pain management stuff which includes scripts for narcotics. The med spa duties would include Botox injections, fillers...things like that. The offer works out to $55/hourly + quarterly incentives. The shift is four 8 hour days, but high likelihood of working longer on about half the days (this is a salaried position). Okay, now for the BONUS...the company is very generous with the vacation/personal time off. As, long as there are not more than 2 providers off at once, and we do not excessively take time off; it is usually approved and paid for. What does that look like...comfortably taking 3-4 weeks off a year. This is a very fast paced company. I think that I will have about 25-27 patient load on the days I won’t be doing sedation. I will definitely learn a lot of new skills. The company has about 40 employees.

1 or 2) Allergy & Asthma: This is a full time offer. In a clinic that has been very successful since 1990. The staff only consists of about 10 people. Which I have spent a half a day with, and I liked. The core staff has worked there for decades. One person 29 years, and another 20...and so on (I believe that says something about a company). The owners consist of 2 doctors. One that is trying to slow down (which is where I come in). However, they have never had a NP work there before. And the one doctor seems apprehensive about having an NP seeing the patients in a “specialty field” over a doctor. However, the other doctor could not be more supportive, and eager for me to come on board. I would see patients of all ages. I would also need to travel to their other site one day, probably every other week. That drive does also add about 40 min commute each way. The primary location is closure to my house. So the daily commute would be shorter. They are offering $60/hr + a possible bonus at the end of the year. Their vacation offer is nice. 2 weeks after the first year + 10 sick days that can be used however I see fit. So, that brings me to the 3 weeks I would want. I will have about a 16 patient per day load. Plus, the doctor is going to mentor me; and ease me into seeing patients (the nice doctor).


So, which one?!!!!

Both places seem like a great place to work, with awesome people, and genuinely caring leadership.

I have the chance to make a lot more money at Pain, and still get the vacations I want. The down sides is the hectic/rushed office environment. I loved surgery but absolutely do not miss that component. The staff there are a lot younger than the other office. I’m not old yet (37, hehe). But I don’t want drama. And it sounds like I will have a variety of things to learn.

Asthma will be an easier transition, and the office is not as hectic. The pay hourly is more, and the vacation opportunity after the first year is right where I want it. Plus there are annual bonuses. The current staff is more even in age. The major down sides is the doctor/owner that is apprehensive of having an NP, being the only NP (none of their current patients have ever had to see an NP). And even though my hourly pay is more the “potential” is less.

So what would you do or have you done?

I don’t want to go with a job merely because of the money. I think I would be just as happy with a field that I can stay in for a very long time. I know many nurses/NPs eventually change areas of speciality. But I would be happy staying in the right place for at least 5-10+years.


Thank you for reading my long tedious journey! I am so looking for some guidance, and direction.



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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

6 Followers; 2 Articles; 957 Posts; 8,518 Profile Views

I'm not sure how we can help, as we don't know you.  These both look like good offers.  Reading your post, it seems you are leaning towards the asthma clinic.  Go with your gut.  It's not the end of the world if you don't like the job, as you can get another job.  Good luck

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BCgradnurse has 11 years experience as a MSN, RN, NP and specializes in allergy and asthma, urgent care.

1 Follower; 1 Article; 1,660 Posts; 49,396 Profile Views

I've been working in Asthma and Allergy for most of my NP career, and really enjoy it.  I like having the depth of knowledge in a few select areas.  I have my own panel of patients, and work independently.  It's a relatively low stress environment.

I personally would not work in pain management. It's not my thing.  

Please PM me if you have any questions about working in Allergy.


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601 Posts; 10,845 Profile Views

Congrats on getting four job offers. It's good you narrowed it down to two; makes life easier.

To you I would ask: What do you want to be doing the most? There will be positives and negatives to all jobs so really, think about what excites you most or what you could learn the most from.  

You ask what would I do? I would choose the pain mgmt because that is more interesting to me but ask 20 other people and they're going to say either the same thing or something different (case in point: BCgradnurse said she likes allergy/asthma). The asthma/allergy office may be less hectic but it also sounds boring to me.  

So again, at the end of the day, it is really about what excites you the most, in my opinion. I hope this helps. 


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