New Grad NP - Job Offer I Accepted

  1. The purpose of this post is to give new grad NPs an idea of the job market in the Western US. I'm a new grad Adult and Geri Primary Care NP w/o RN experience. I completed an ABSN and then went immediately into an MSN NP program. This is my second career; I'm in my mid 50s and previously was a business executive.

    As a Nurse Corps Scholarship winner, I have to serve for 2 years in a medically underserved area with a Health Professional Shortage Area (HPSA) score of 14 or higher. These areas are typically inner cities, smaller cities and towns, or rural areas. However, there are also cities with 100,000 to over 1,000,000 population that have high HPSA scores.

    I began seriously looking for work at the beginning of November. My search area was: California, Nevada, New Mexico, Oregon, Montana, Arizona, Alaska, and Hawaii. After getting my resume out and updating my LinkedIn profile, I spent an average of 4 hours per day on the phone answering calls and emails from recruiters and employers, and on phone interviews. I spent another 4 hours per day on finding open positions and submitting applications. For the past 7 weeks, including the holidays, I was driving over 1,000 miles per week all over the Western US for face to face interviews, with a couple of flights on top of that. After 2 months of intensive job search, I received 9 job offers, all of them excellent:
    • AGPC NP Native American tribe
    • Neurology NP
    • Sleep Science NP
    • Pain Management NP for a hospital system outpatient clinic
    • Occupational Health + Urgent Care for agricultural workers
    • NP Director of Student Health Services for a community college
    • Urgent Care NP for hospital system clinic
    • 2 offers for AGPC NP in FQHCs

    Below is the offer I am going to accept. It is not the one with the highest cash compensation, but I feel it has the best overall cash + benefits package, along with the best path for future career advancement. In addition, to put this into perspective, the cost of living at this location is extremely low (yes, we do have low cost of living areas in California). One can rent a single family house (3 BR, 2 BA) for $800 to $900 per month or buy a nice little house for less than $200K at this location. By comparison, in the San Diego area, where I currently live, new grad NP pay is $100K to $110K, without any recruitment incentives, and the cost of housing is literally 3x as high (average rent for a 1 BR apartment is $2,000 and median purchase price > $600K).

    Accepted Offer - AGPC NP at a FQHC


    $110K base salary

    Up to $4K performance bonus

    $10K sign on bonus

    $5K relocation

    Opportunity to earn additional $ by volunteering to work ½ day on Saturdays at the walk-in clinic – pay is double time for this

    Clinic has solid experience precepting, as well as ramping up new grad NPs with an established orientation and training program

    Eligible for loan repayment – 100% applicant success from this site

    PTO – 25 days per year

    Continuing Ed - $2,000 + 5 days per year

    1 hour per day for admin time + 2 extra hours 1 day per week

    Option to work five 8 hour days or four 10 hour days, flexibility on start time in morning

    Malpractice and license fees paid

    Good benefits for medical, dental, vision, and 403b

    Retention bonuses for continuing service

    Big, beautiful, new state-of-the art clinic facility

    Physically beautiful area that is a tourist attraction

    In terms of my future career goals, they are thrilled I want to earn a post master's PMH NP and have said they will find money to pay for that and give me all necessary support in terms of help finding preceptors, flexible schedule, etc.

    In conclusion, two thoughts:
    1. A paraphrase: "Go west, new NP!"
    2. Don't pay attention to the negativity on this forum
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  2. Visit FullGlass profile page

    About FullGlass, MSN, NP

    Joined: Dec '17; Posts: 432; Likes: 564

    34 Comments

  3. by   umbdude
    Congrats, FullGlass!

    It sounds like you are super organized and have well thought out plans. I'm not surprised that you landed so many offers. I'm sure your business background helped with the negotiations. Seems like a pretty sweet opportunity.

    When do you start this new job? Do keep us in the loop on how the job goes.

    How was your job search in Hawaii? PMHNP student here and will graduate in 2020 (I do work as a RN). I don't plan on relocating right away post graduation, but I do hope to move West or Hawaii after a couple years of practice.
  4. by   Oldmahubbard
    I am glad for you. There will be a steep learning curve ahead, but that would be true even if you had worked as an RN.

    The offer sounds fair, overall, given the cost of living.

    So good luck.
  5. by   FullGlass
    Quote from umbdude
    Congrats, FullGlass!

    It sounds like you are super organized and have well thought out plans. I'm not surprised that you landed so many offers. I'm sure your business background helped with the negotiations. Seems like a pretty sweet opportunity.

    When do you start this new job? Do keep us in the loop on how the job goes.

    How was your job search in Hawaii? PMHNP student here and will graduate in 2020 (I do work as a RN). I don't plan on relocating right away post graduation, but I do hope to move West or Hawaii after a couple years of practice.
    Thank you for your kind wishes. I'll start in mid February.

    As for Hawaii - I had 3 super long phone and video interviews for a position on a very small island. However, the problem is that I am Adult and Geri, not an FNP, and that is what they really needed.

    Since you are a PMHNP student, you will have NO trouble finding a great job in the Western US, including Hawaii. PMHNPs are in very short supply and in super high demand. The clinics literally say, "Finding a PMHNP out here is like finding a needle in a haystack." I'm sure you will also have multiple great job offers when you finish school.

    Best wishes!
  6. by   BostonFNP
    Quote from FullGlass
    Clinic has solid experience precepting, as well as ramping up new grad NPs with an established orientation and training program
    How long is the orientation program?

    How many patients per day starting out and what is the expected patient load by the end of orientation?

    Hours/day they total clinic time or the total time scheduled?
  7. by   FullGlass
    Quote from BostonFNP
    How long is the orientation program?

    How many patients per day starting out and what is the expected patient load by the end of orientation?

    Hours/day they total clinic time or the total time scheduled?
    We are negotiating the ramp up process and establishing metrics to measure performance.

    Once fully up to speed the expected patient load is an average of 20 min per patient, with a 18 patient per day minimum.

    For a five 8 hour day a week schedule, the NP works 8 am to 5 pm and sees patients from 8:30am-11:30am and 1:00pm-4:30pm.
  8. by   BostonFNP
    Quote from FullGlass
    We are negotiating the ramp up process and establishing metrics to measure performance.

    Once fully up to speed the expected patient load is an average of 20 min per patient, with a 18 patient per day minimum.

    For a five 8 hour day a week schedule, the NP works 8 am to 5 pm and sees patients from 8:30am-11:30am and 1:00pm-4:30pm.
    Hopefully they will give you a nice long run in before 18+ per day; if they have a good track record of training novice NPs I am sure they know this.

    Where does the admin time come in to play? If you are scheduled patients starting at 8:30 and ending at 4:30 that means you will effectively be in the room with patients from 8:30 through at least 5 (more realistically 6) with a half hour lunch. That leaves you only a half-hour each day, not 1-2 hours, and doesn't include a real-world end time. Just things to ask about.

    What is the performance structure? RVU-based?
  9. by   traumaRUs
    Wow - I can't get over the cost of living in SanDiego!!!

    Congrats - sounds great.

    Agree with Boston - don't skimp on admin time
  10. by   Rocknurse
    This is very encouraging. Thanks for sharing. I have a goal of landing $110,000 to start. I'm a AGACNP student in my final year in the NorthEast and the pay here is quite high.
  11. by   Oldmahubbard
    I did an Adult NP program, ended up becoming a Psych NP (and never worked as an Adult NP). But as preparation, I worked on learning strategies to handle the top 10 primary care presenting problems, and made sure I knew those thoroughly. This was in 2003, so the details are fuzzy.

    Now for the psych component you will surely encounter in any primary care office, I would suggest getting comfortable and familiar with a couple of antidepressants.
  12. by   FullGlass
    Quote from BostonFNP
    Hopefully they will give you a nice long run in before 18+ per day; if they have a good track record of training novice NPs I am sure they know this.

    Where does the admin time come in to play? If you are scheduled patients starting at 8:30 and ending at 4:30 that means you will effectively be in the room with patients from 8:30 through at least 5 (more realistically 6) with a half hour lunch. That leaves you only a half-hour each day, not 1-2 hours, and doesn't include a real-world end time. Just things to ask about.

    What is the performance structure? RVU-based?
    Good points - I will clarify the schedule. They did say they get one hour for lunch. I think it is Tues or Wed mornings that they give all the providers 2 hours for admin time as well. This would also be when they have any staff meetings.

    Bonus - this was interesting. They recently implemented an EHR, so the bonus is for completing charts within 72 hours!

    They are working on giving me a ramp up schedule in writing. I will say that as an NP student, I was able to see 2 routine patients per hour in an inner city Urgent Care, with the preceptor doing a quick confirmation of my H&P and orders, maybe a couple corrections, by the end of my rotation.

    This clinic said most of their patients are routine and they do a lot of preventative care - immunizations, annual physicals, physicals for work and school, and follow up/monitoring for conditions like HTN and diabetes. My plan is to study up on ahead of time on their population's most common conditions.

    This clinic also has dental care, which is a great benefit for the community, as the fees are sliding scale based on income. In Baltimore, the poor people just get their teeth yanked as it is very difficult to find low cost dental care - many middle aged and older people have very few teeth left as a result. At least in California, the FQHCs all seem to have primary care, mental health, and dental care.
  13. by   FullGlass
    Quote from Oldmahubbard
    I did an Adult NP program, ended up becoming a Psych NP (and never worked as an Adult NP). But as preparation, I worked on learning strategies to handle the top 10 primary care presenting problems, and made sure I knew those thoroughly. This was in 2003, so the details are fuzzy.

    Now for the psych component you will surely encounter in any primary care office, I would suggest getting comfortable and familiar with a couple of antidepressants.
    Thank you for the guidance - will definitely be doing prep work until I start work. This clinic has psychologists and social workers on site. For medication management, they use telepsychiatry, or some people make a one hour drive to a good size city.
  14. by   Oldmahubbard
    When you get a chance, you might ask more experienced providers at the clinic what are their top 3 (or 5) clinical conundrums?

    Also, any unexpected bad outcomes and what the provider learned?

    Final thought- have you decided when and how you will prescribe controlled substances?

    Haha, I applied for a job several years ago as an instructor in a BSN program. I didn't get it, and it would be hard living on the 60k they were offering.

    Still, I have this teaching fantasy in the back of my mind.

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