New Grad NP need your advice on employment

Specialties NP

Published

I want to get your feedback on choosing the right offer as a new grad so I will just get to the point. Both positions are in Southern California, won't disclose the specific locations but you'll get the idea.

1) Underserved primary clinic in urban city in Los Angeles County

8-4:30 pm outpatient setting; $50/hour with full benefits which include health insurance dental, vision, medical; CME reimbursement; PTO, sick/personal time off; paid holidays; PTO from Christmas to New Year

2) Academic Teaching Hospital Nephrology division in South of Orange County. Mostly seeing patients in multiple dialysis centers; MUST BE FLEXIBLE as dialysis schedule change DAILY depending on patient's compliances/emergencies etc.; may start early AM or off late evening ( early as 4 am or late as 10-11 pm ish), full comprehensive benefits with yearly bonuses range $8k-10k, don't know the exact amount for my salary as they haven't disclosed it yet but an NP who has been working here about 8 years is getting $108K with bonuses mentioned above. An NP took about 2 years to get used to the amount of driving required and schedule.

What will you choose?

Specializes in Psychiatric and Mental Health NP (PMHNP).
Seriously, lawyers? You aren't aware of the difficulties with the glut that significantly altered their profession?

Google "lawyer bubble" About 2,170,000 results

Respectfully, you don't know much about the legal profession. The graduates of the top schools like Harvard, Yale, Georgetown, Stanford, etc. look to get jobs with, and are heavily recruited by, the elite law firms (AmLaw 100). In those firms, 1st salary in a city like NYC, LA, SF is $160K to $180K, often with a $10K to $25K bonus on top. There is also a steady and substantial pay progression every year. I know a litigator who started his own firm and within a few years was making $700K per year and is now making $1 million+ per year. One of my best friends is a successful corporate attorney and was making $500K per year as General Counsel. She now works part time on contract and bills $500 per hour.

Yes, there is a lawyer glut, but the lawyers at the top still make plenty of money. A lawyer who becomes a partner in an AmLaw 100 firm will make $1 million +.

How do I know so much about law? In addition to my personal contacts, in my previous career some of these top law firms were my clients, so I am pretty well versed in law firm finances.

Here is a 2017 survey of top law firm compensation for 1st year lawyers:

2

Up Vote Up Vote ×
Specializes in Psychiatric and Mental Health NP (PMHNP).
Wow. I have friends who are lawyers who are suffering with sub par $100,000 wage who went to great law schools. It's simple economics about supply and demand. I don't have any printed evidence to show you that wages are coming down. My evidence consists of going to local CANP meetings and talking to other seasoned NPs who tell me whats happening at their clinics. It's happening at mine. It's happening at theirs. I can be the best NP in the whole world but it doesnt' make a darn bit of difference to the bean counters at corporate who writes that script for HTN. If they can find a new warm body NP who will work for half of what I will guess who they are going to hire. It's not rocket science If it is happening to me in a rural area with a population of 2,000 it will happen to you.

We are all replaceable for a lower cost.

I don't know your friends, but all my attorney friends are making huge bucks. I just explained legal pay and provided a 2017 pay link for 1st year lawyers in another response to this thread.

Just because someone goes to a great law school doesn't mean they are going to get the best job - that is a competitive process, as it should be. Legal pay also varies by location and type of law.

I am a new grad rural NP and am making $120 to $125K my first year in a very low cost of living area, depending on bonus amount. Since I only have to pay $750 rent for a cute 2 BR 2 BA house with a yard and nice view, my compensation would be the equivalent of making at least $150K to $160K in SF or LA. I'd say that's good pay for a new grad NP. Plus my site is eligible for loan repayment and loan forgiveness, a potentially huge benefit. At least in California, I am not aware of NP salaries being cut in half anywhere.

Assuming I do a good job, my employer will want to keep me, not replace me with a cheaper NP, if they could even find one at this location. This is why they offer retention bonuses.

I also don't follow your logic. Let's say a new grad NP makes $100K a year, which is reasonable in larger cities on the West and East coasts. If employers will get rid of experienced NPs so they can pay half to a new grad, that implies there are NPs out there making $200K plus in primary care. I seriously doubt that there are very many of those. My expectation is to top out at around $150K to $160K in today's dollars as a primary care NP. (My earnings estimates are based on being an employee - locums NPs make more and they can make $200K in primary care in California).

I don't know what kind of clinic you work at, either. I work for an FQHC, which has strict quality standards. Low quality and outcomes directly affect their bottom line. Until recently, they had a hard time recruiting perm providers, and the revolving door of locums did result in poorer health quality outcomes. They have been aggressively recruiting permanent providers and are paying very competitive salaries for NPs, PAs, and MDs and we've been getting some very experienced people from Texas and the Mid Atlantic states. We also had a locums NP agree to go perm and he seemed quite satisfied with his compensation. Our system also has very few administrators and is quite "lean," so maybe this makes a difference.

Up Vote Up Vote ×

Appreciate all of your comments/advices .

I have decided to take the Primary Care Clinic in LA. This organization is part of HPSA score of 14, so comes with loan forgiveness program which I'm sure I'll take advantage of as I can potentially receive up to $50k. Also, this organization is reputable, supportive and academically-focused, thus I have no doubt that I will learn a great deal from the Medical Director who just loves to teach. I never wanted any contract-based jobs that is not consistent or unstable but with much higher pay as a new job, it isn't always about the money. I want to work at an environment where I can professionally grow in a supportive, evidence-based focused practice. One of my colleagues took the job as a new NP making $50/hr, then quit and took the job that was giving him almost double the rate, but miserable because of work load, poor leadership & management and not very supportive.

Up Vote Up Vote ×
Appreciate all of your comments/advices .

I have decided to take the Primary Care Clinic in LA. This organization is part of HPSA score of 14, so comes with loan forgiveness program which I'm sure I'll take advantage of as I can potentially receive up to $50k. Also, this organization is reputable, supportive and academically-focused, thus I have no doubt that I will learn a great deal from the Medical Director who just loves to teach. I never wanted any contract-based jobs that is not consistent or unstable but with much higher pay as a new job, it isn't always about the money. I want to work at an environment where I can professionally grow in a supportive, evidence-based focused practice. One of my colleagues took the job as a new NP making $50/hr, then quit and took the job that was giving him almost double the rate, but miserable because of work load, poor leadership & management and not very supportive.

I mean best of luck, but I make 50 an hour as a RN in Seattle. I don't even know how you could live off that in LA.

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

Is it truly $50/hr or a salary based on a 40-hour week? If you are scheduled patients from 8am to 430pm you are realistically looking at a 10 hour day...

Up Vote Up Vote ×

A HPSA score of 14 is very low. You are unlikely to get loan repayment with that low of a score, sorry to say (assuming you are applying for the loan forgiveness program). 50/hr is ridiculously bad pay for an NP in CA. I mean, you're making what an RN makes but with a lot more responsibility and risk.

Is is just me or do new grad primary care NPs really get taken for a ride? I cannot believe the low wages people accept. And it just causes the wages to fall even further because employers know they can get someone for that cheap, plus it sets you up to accept paltry wages throughout your career since you started so low, blargh. I'll stop now.

Up Vote Up Vote ×

Yes, pay is low, I know and I get it. I'm not denying the pay isn't low but given the job market circumstances and inability to relocate elsewhere other than near OC equal to limited resources. I have negotiated with all of my interviewers and truly some physicians are just absolutely condescending with their low cheaply rate. Unfortunately, this employer couldn't match the rate but I took it anyway because I know I will learn a great deal from either the attesting and the environment of this facility. Now I'm not obligated to work here for 2 or 5 years, I can technically leave whenever, althogh that isn't my intention, but if I find a position that compensate accordingly based on experience with a reasonable rate within the current location job market, I will move on. Many of you strongly believe that first pay predicts the future pay, yes and no. I've heard cases of NPs making RN salary at first then a 1.5 to 2 x higher and by third year triple. I'm sure employers don't want their employee to quit after a year and have high turn over rate but yes, if they're not compensating right then there will be consequences. My plan is to re-negotiate in 6 months.

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.
I'm sure employers don't want their employee to quit after a year and have high turn over rate but yes, if they're not compensating right then there will be consequences. My plan is to re-negotiate in 6 months.

Is the position they are filling from someone that is leaving? How long were they at the practice?

Make sure you are truly being paid hourly and not a salary based on a 40 hour week.

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.
Is it truly $50/hr or a salary based on a 40-hour week? If you are scheduled patients from 8am to 430pm you are realistically looking at a 10 hour day...

This probably doesn't translate into psych but why wouldn't the NP dictate the number of patient appointments they are able to complete in a reasonable 8 hour day? Not that it never happens but I rarely run over and if that was a consistent issue I would make scheduling adjustments.

I have heard repeated complaints about inefficient NPs which on an hourly basis is lose:lose for employers.

Up Vote Up Vote ×

Yes, the position is based on hourly not salary. I've asked about the number of patients typically seen on a daily basis, he said about 24 a day but factoring into frequent no shows so about 16-18, which I know is high volume of work.

Up Vote Up Vote ×

Just an FYI but from what I understand no site with a HPSA score of

Up Vote Up Vote ×

Thanks Myelin for your info. my plan is to get 6 months experience in and find elsewhere closer to home and pays legit amount.

Up Vote Up Vote ×
+ Add a Comment