Low stress job vs more challenging job vs higher income??

[Tony1790]

Hi,

I work in a federal facility, and I'm a newer (1 yr) FNP but an Older NP (51yr), so I'm weighing my options and trying to figure out the best work/life/income/career balance.

Do I focus on a low stress job or do I focus on a job that will make more annual income as I'm getting nearer to retirement or do I fine tune it as much as possible??

1. Low stress decent/not great salary: Currently working in Seattle WA state doing arthritis/rheumatology in a slow paced, relatively low stress job, mostly 4 days/week for $97,000 year. Everyone is great to work with, low stress boss, I work with 4 MD's as the only NP. Great job, but pay could be better and I'm located far from family.

2. I have a pending job offer in TX in orthopedics with the same federal agency, doing pre/post surgery care/follow ups/consults. 5 days per week, outpatient office for $108,900, which should be low stress, better pay, etc. I'd be the only orthopedics provider in the facility, the main hospital is 110 miles away (hence the need for outpatient clinic).

However, I've not been able to speak to any provider in the surgery service line, my phone interview was done by 3 RN's, so I've not been able to get any specifics answers to my questions that I have as a provider, so I feel as though that the service line folks (surgeons) don't appreciate me as a potential provider to even bother to be a part of the interview process or to return my phone calls (I located the department head and talked to his secretary multiple times on the phone). Meanwhile HR keeps calling to verify if I will accept the position............I'm thinking that this might not be where I need to go.

3. Emergency department: I have a pending offer in SC, but the pay is horrendous, at $83,000 annually and I'd have to pay state income tax, which I don't in WA or TX.

4. Emergency department: I turned down a job in NV with the same agency as the pay was the same as in WA, however Jan 1st brought a pay boost to this facility and now I'd be at $114,000 base pay. And the position that I turned down has recently been re-opened, however, I'm doubtful if they will give me the time of day now :-(

My main goals career wise:

1. Stability, guarenteed employability, and with the ability to retire at 65 yo or sooner

2. Income of $100k annually

3. Settle down in/near the area that I want to retire to, which is TN, but there are few openings there as the market is overflowing with hungry NP's driving the wages down, $62,000 for the local health dept as an NP :-0

What do you all think? What makes the most sense for an newer but older provider, (I'm the oldest in my service line, older than the MD's)

I've done mostly orthopedics: with 5mo as chronic pain management of mostly orthopedics patients with injections, braces and of course Narcotics, 5mo of Arthritis/rhem with joint injections/aspirations, braces, PT, and eventually consults to Ortho for surgery. Which makes sense why I was offered the position to do the Ortho consults now.

Thanks,

Tony

p.s. I thought I had finally decided to start where I am currently (I had asked for advice before) however, it's not helping that I live alone in a 1 bedroom apartment on an inflatable mattress with all of my stuff still in storage in TN, so I don't feel grounded at all.

And I had applied to so many jobs before, that the offers are still trickling in, which puts me back into indecision :-(

[Tony1790, BSN, MSN, NP]

I'm actually relocating to a rural area in WA that is 1.5 hours from Seattle and will be making more that you which is surprising.

And I"m in Seattle, these gloomy winter days are so blah! My pay here is fairly low, but I get 5 weeks paid vacation, plus another 13 days sick leave and 5% match 401k (tsp) plus pension, but the pay is low no matter what, I could easily make more as an RN in the same hospital as where I work now.

The job is in Beaumont, TX, which I understand isn't the best place to live.

[Tony1790, BSN, MSN, NP]

After that, being an ortho NP, you won't send an absolutely unprepared, severely anemic and malnourished patient with preterminal organ failure for hip replacement only to see him getting worse with every passing day and wonderign why the great job you and your boss M.D. did doesn't turn out the way you intended.

I will agree with you that you want to be well rounded as a provider, that's why I'm trying to expand my realm, I've done urgent care, pain management, arthritis, rheumatology, currently credentialing is done and I'll be picking up shifts in our E.D., in addition to work on continuing education.

However, I cannot agree with your premise that unless an NP has had some particular job, they are unable to assess their patient, order and review labs and somehow become completely ignorant of the basic concepts of patient care, diagnosis and just plain old liability concerns, sounds a little condescending to me, but maybe I'm just reading it wrong.

[Tony1790, BSN, MSN, NP]

I think you are wise to be wary of the job that made you interview with RNs without any physician contact. At best dismissive and worst you will be relegated to doing their grunt work. I don't accept positions that fall under nursing, I work as medical staff. In my experience when you are aligned with the physicians everything is better.

Jules, you've been an VA employee before and you know how buttbackwards it can operate at times......I finally found out the email address for the MD that should have been in the interview, it turns out that he didn't know about it, otherwise he would have been there to answer specific questions.

Update on the job, so it's a new position, I'd have to go to Houston for 5 months in training with various MD's and then be on my lonesome in the clinic, providing specialty coverage for Orthopedics, ENT & Urology! I've not heard of a clinic that you run all three specialities, but the clinic is 90 miles each way from the main hospital, so they are trying to do as much with as little as they can in an outpatient setting. Still he said it'd be 85% conservative management of Ortho, which is what I do now in an Arthritis/Rheumatology clinic.

Good opportunity to work and learn, but man o man, I don't like the idea of either commuting 180 miles a day, nor of having to move twice, live in Houston for 5 months and then move east. Sound like a good job though.

[smz9510]

Don't go to Beaumont. Not good. Check the other CBOC's connected to Houston. Lufkin, Katy, Richmond, Conroe, and I think Lake Jackson. NOT BEAUMONT

[Tony1790, BSN, MSN, NP]

Don't go to Beaumont. Not good. Check the other CBOC's connected to Houston. Lufkin, Katy, Richmond, Conroe, and I think Lake Jackson. NOT BEAUMONT

What's wrong with Beaumont specifically?? I've just about talked my way out of moving to Beaumont anyway, I start orientation in the Emergency Room next week.........nervous would be an understatement :-)

[Goldenfox]

There is a thing about NP trade:

...But, as I can see it, NPs who start in specialty and continue in specialty for a few years, became WAY more severely limited than physicians specialists. They never get this "see the patient as a whole picture" idea, or they continue to hang onto classic nursing concerns of having daily BMs and such instead of instantly grabbing clinical picture and critically accessing it. When they encounter a problem which doesn't fit into their "routine", even if it is something ordinary, they overlook it much easier than physicians.

... After that, being an ortho NP, you won't send an absolutely unprepared, severely anemic and malnourished patient with preterminal organ failure for hip replacement only to see him getting worse with every passing day and wonderign why the great job you and your boss M.D. did doesn't turn out the way you intended....

Careful! You are making some HUGE assumptions here.