Need a sanity check

aprnKate · Jan 24, 2018

Its great that you are putting out feelers out there. I guess it depends what you are looking for 85k plus RVUs/incentive 12 ppd..do they offer benefits? also is the 85k considered W2 or will you be a contractor 1099? if its 1099 i think this is low especially if they don't offer benefits. Also I would ask exactly what is the average number of patient the clinic sees per day because I used to work at a rural clinic that told me that if I saw x amount of patients beyond x number of patients I would get a bonus, I never got that bonus because the average amount of patients per day never did exceed the amount to get the bonus. Therefore, I was stuck with the base salary.

95k starting with AF is not bad for a new grad especially if this had benefits and your years for the govt will count. I currently work for the govt not at AF but IHS. I really like having benefits and retirement benefits which I did not have with my first perm job.

Pain management clinic - i'm glad you like this because many people don't including myself. I try very hard to not put my patients on opioid therapy and also i'm trying to wean off patients on opioid therapy that i have inherited from another provider's panel and this is not fun because you face a lot of resistance from patients. One thing with taking a pain management job is that it is specialized so in the end if you don't like it anymore and want to switch to Family Medicine/Internal Medicine then you don't have that experience since you started with a field that is specialized. So think also about the skills that you should learn that will set a good foundation for your NP experience for future marketability.

Good luck!

yogagal · Jan 24, 2018

How far would you have to move for the Air Force job? I dunno, I feel like it's good to be an actual family practitioner first then specialize later if you hate it. I've also heard federal benefits are great but perhaps that doesn't matter for you since you already have benefits as a vet? I worked in family practice for my first 8 years and because I can "do it all" in an outpatient setting, see all ages etc that I feel like I have so many options now. Right now I'm doing Medicare in-home assessments because I need to be home more for family reasons (super flexible and GREAT pay), still working family practice pre diem, and am in talks with a telemedicine position. I was considering a position in clinical research but didn't like the hours. I've gotten calls from recruiters for oncology positions (I had onc experience as an RN, it's on my Linkedin). I'm sure if I wanted I could go work in any number of specialties because generally speaking specialist MDs want to train you to practice they way they do so what they are most concerned about is that you are able to function as an independent provider and relieve some of their patient load. I've seen FNPs come from years of specialty practice and try to come back to primary care quit in tears because it was so overwhelming for them. You also learn SO MUCH in primary care because as the PCP you get reports from every sort of specialist on your patients, as tedious as it was to sign off on all of them I also found it fascinating and learned so so much!

I feel like family practice/primary care is where we as NPs can be the most autonomous, you are the PCP, you are responsible for the patient. This is not so much the case working as an NP in most specialties so you may not reach your full potential as a provider if you start in pain management. And if you are interested in preventive medicine I would lean more toward primary care as well.

In short it is MUCH easier to go from primary care to specialty and much harder to do the reverse.

Good luck!

djmatte, ADN, MSN, RN, NP · Jan 24, 2018

Its great that you are putting out feelers out there. I guess it depends what you are looking for 85k plus RVUs/incentive 12 ppd..do they offer benefits? also is the 85k considered W2 or will you be a contractor 1099? if its 1099 i think this is low especially if they don't offer benefits. Also I would ask exactly what is the average number of patient the clinic sees per day because I used to work at a rural clinic that told me that if I saw x amount of patients beyond x number of patients I would get a bonus, I never got that bonus because the average amount of patients per day never did exceed the amount to get the bonus. Therefore, I was stuck with the base salary.
95k starting with AF is not bad for a new grad especially if this had benefits and your years for the govt will count. I currently work for the govt not at AF but IHS. I really like having benefits and retirement benefits which I did not have with my first perm job.
Pain management clinic - i'm glad you like this because many people don't including myself. I try very hard to not put my patients on opioid therapy and also i'm trying to wean off patients on opioid therapy that i have inherited from another provider's panel and this is not fun because you face a lot of resistance from patients. One thing with taking a pain management job is that it is specialized so in the end if you don't like it anymore and want to switch to Family Medicine/Internal Medicine then you don't have that experience since you started with a field that is specialized. So think also about the skills that you should learn that will set a good foundation for your NP experience for future marketability.
Good luck!

The 85k is a base rate for all their NPs with rvus being the differentiator. They said something along the lines of 750/quarter which translates to 12 ppd. Now these are rural clinics and the one md who called indicated they had 75 ppd with their current 5 providers. So still might be tight. This is a medium size Midwest health system that's very inexpensive to live, so I'm not shocked.

My last preceptor did suggest since the specialty is I a health system to negotiate some primary care time. So that might be an option. But I am leaning toward the air force position.

djmatte, ADN, MSN, RN, NP · Jan 24, 2018

How far would you have to move for the Air Force job? I dunno, I feel like it's good to be an actual family practitioner first then specialize later if you hate it. I've also heard federal benefits are great but perhaps that doesn't matter for you since you already have benefits as a vet? I worked in family practice for my first 8 years and because I can "do it all" in an outpatient setting, see all ages etc that I feel like I have so many options now. Right now I'm doing Medicare in-home assessments because I need to be home more for family reasons (super flexible and GREAT pay), still working family practice pre diem, and am in talks with a telemedicine position. I was considering a position in clinical research but didn't like the hours. I've gotten calls from recruiters for oncology positions (I had onc experience as an RN, it's on my Linkedin). I'm sure if I wanted I could go work in any number of specialties because generally speaking specialist MDs want to train you to practice they way they do so what they are most concerned about is that you are able to function as an independent provider and relieve some of their patient load. I've seen FNPs come from years of specialty practice and try to come back to primary care quit in tears because it was so overwhelming for them. You also learn SO MUCH in primary care because as the PCP you get reports from every sort of specialist on your patients, as tedious as it was to sign off on all of them I also found it fascinating and learned so so much!
I feel like family practice/primary care is where we as NPs can be the most autonomous, you are the PCP, you are responsible for the patient. This is not so much the case working as an NP in most specialties so you may not reach your full potential as a provider if you start in pain management. And if you are interested in preventive medicine I would lean more toward primary care as well.
In short it is MUCH easier to go from primary care to specialty and much harder to do the reverse.
Good luck!

Air Force job would be a move from Michigan to Louisiana. Benefit is no need to get a new license as it's a federal position. Downside is no move reimbursement or bonus incentive. Neither of those are huge with us because we have no problem selling everything and going. But bonuses would be useful to move the house a little faster to sell and get out.