New Grad NP need your advice on employment

  1. 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?
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  2. Visit BruinAGNP profile page

    About BruinAGNP, MSN, APRN, NP

    Joined: Jan '10; Posts: 62; Likes: 5

    23 Comments

  3. by   FNP2B1
    Neither, keep looking Both jobs are paying way undermarket for your skill set. You would starve trying to live in Aliso Viejo or San Clemente in south Orange County at 108k per year. At $100k in LA you are doing even worse with the high cost of living. DaVita will run you ragged. Keep looking. There are better jobs out there even for new NPs
  4. by   BruinAGNP
    Thanks for your input. However, I've been having 'bad luck' in the past months with the couple of offers I've received and had to turn them down during the negotiation process. For example, the private specialty providers in either infectious disease & Cardio. Both located in OC. They were offering similar rate of $45/hr 'in the beginning' then raise based upon performance with very, very minimal benefits. I tried SO HARD not to show my emotions during negotiation process! After multiple unsuccessful attempts, I feel as if I need to be less picky about terms as it is my 1st position and start somewhere to build experience.
  5. by   Jules A
    Quote from BruinAGNP
    After multiple unsuccessful attempts, I feel as if I need to be less picky about terms as it is my 1st position and start somewhere to build experience.
    That is what employers are counting on and with NPs it often seems a fruitful strategy, sigh. I would have continued working as a RN until I found a position that would pay me according to my education and the level of responsibility being a NP entails.

    Something few seem to realize is your entry salary largely dictates your pay trajectory. If you start now at $50 an hour your next opportunity will expect you to be grateful for $55 or $60 an hour and so on. Business acumen really should be taught in advanced degree programs. Med schools are reported to be lacking in this area also although it seems MDs are more likely to know their value and be willing to push their weight around when needed.
  6. by   FNP2B1
    You can make great money with Medicare Advantage housecalls as a new NP. I would look up MedXM which is now part of Quest. They pay you around $100 per housecall and can usually get you 5 to 6 clients a day on average. If you are persistent you can get more. I did this when I was first out of NP school and demanded they get me 9 to 10 which they did initially but later they ran out of patients for me to see. United Health Care also does house calls as does a few other companies. It's not the best job but its going to pay you more than what these other outfits in OC are looking to pay you. You deserve more $
  7. by   FullGlass
    Right now you need a job. Take the primary care clinic and get some experience. Once you have 1 or 2 years of experience, you will be in a much better negotiating position and will have more options. Check the HPSA score for the primary care clinic (google "HPSA finder"). A high score > 14 for either primary care or mental health means this site is likely eligible for loan repayment from the feds or the state, which is a huge benefit. 10 years of service in an underserved area may also qualify for loan forgiveness. Look into this.

    You will have a lot more options if you are willing to look outside of LA metro and you would make more money in a lower cost of living area. Look at the Inland Empire and the Central Valley and NoCal. You can also consider NV (outside of Las Vegas), AZ, NM, Oregon, etc. Cities like Bakersfield, Fresno, Sacramento, Chico, Redding, etc., all have lots of opportunities for new grads, pay well, and have a low cost of living. You may be pleasantly surprised at how nice some of these places are. I had multiple job offers just a few months ago as a new grad, including cities near Lake Tahoe, Fresno, Chico, and a 30 minute drive from Sacramento (which is booming, with lots of young professionals). Focus on getting a first job that is a good learning experience that has experience training new grads. There are also NP residency programs in SF and LA - the LA VA has one - try applying.

    I have written extensively about my job search at the beginning of this year - you can look up my posts.

    Good luck.
  8. by   Dranger
    Lol I make more than that as a RN and I don't even live in SoCal. These wages are a joke at this point. This is the direct result of over supply and bad negotiation...
  9. by   FNP2B1
    Its going to get worse. Those who don't believe this have their heads in the sand. It's simple economics. This is a prime example of a new grad trying to take any job she can get and any pay grade. I get it that we all need positions but the glut of new grads just brings wages down for all NPs.
  10. by   FullGlass
    Quote from FNP2B1
    Its going to get worse. Those who don't believe this have their heads in the sand. It's simple economics. This is a prime example of a new grad trying to take any job she can get and any pay grade. I get it that we all need positions but the glut of new grads just brings wages down for all NPs.
    What evidence do you have to support your position? We have a largely free-market capitalist economy and competition is its driving force. When labor markets are distorted, as the AMA did by severely restricting the number of MDs, needlessly high costs result. That is why PAs and NPs became increasingly popular. Now the medical profession is working to increase the number of med school grads.

    Let's do a thought experiment: we magically restrict the number of new grad NPs and PAs to increase their compensation. This works in the short-term, but in the long run it will backfire. Organizations will now have an incentive to train lower-level healthcare workers, automate, and outsource. Here's how that could work:
    1. An "RN Plus Specialist" with limited diagnosis and ordering capabilities.
    2. Increasing the move to develop healthcare AI that can be used by trained healthcare technicians to diagnose and treat simple conditions - this is already in development.
    3. Using cheap foreign healthcare workers, including MDs, via telemedicine. This is already happening in radiology.

    Right now, we have a distribution problem, not a supply problem. There are plenty of places with a shortage of primary care providers of all flavors, and these areas pay quite well. It is incumbent on job seekers to go where the jobs are.

    Professionals at the top of their game are not afraid of competition. I don't hear lawyers, accountants, business executives, and top technology talent complaining about too many new grads.

    Personally, I think our society should be striving for universal access to affordable basic healthcare. We have a long way to go and a lot of unmet demand.
  11. by   Jules A
    Quote from FullGlass
    Professionals at the top of their game are not afraid of competition. I don't hear lawyers, accountants, business executives, and top technology talent complaining about too many new grads.
    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
  12. by   FNP2B1
    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.
  13. by   Dranger
    Quote from FullGlass
    What evidence do you have to support your position? We have a largely free-market capitalist economy and competition is its driving force. When labor markets are distorted, as the AMA did by severely restricting the number of MDs, needlessly high costs result. That is why PAs and NPs became increasingly popular. Now the medical profession is working to increase the number of med school grads.

    Let's do a thought experiment: we magically restrict the number of new grad NPs and PAs to increase their compensation. This works in the short-term, but in the long run it will backfire. Organizations will now have an incentive to train lower-level healthcare workers, automate, and outsource. Here's how that could work:
    1. An "RN Plus Specialist" with limited diagnosis and ordering capabilities.
    2. Increasing the move to develop healthcare AI that can be used by trained healthcare technicians to diagnose and treat simple conditions - this is already in development.
    3. Using cheap foreign healthcare workers, including MDs, via telemedicine. This is already happening in radiology.

    Right now, we have a distribution problem, not a supply problem. There are plenty of places with a shortage of primary care providers of all flavors, and these areas pay quite well. It is incumbent on job seekers to go where the jobs are.

    Professionals at the top of their game are not afraid of competition. I don't hear lawyers, accountants, business executives, and top technology talent complaining about too many new grads.

    Personally, I think our society should be striving for universal access to affordable basic healthcare. We have a long way to go and a lot of unmet demand.
    You lost me at lawyers....cmon now.
  14. by   FullGlass
    Quote from Jules A
    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:
    217 1st Year Salaries and Bonuses of the Top Law Firms | LawCrossing.com

    Personally, I always plan to be at the top of my profession, and work hard to get the education and training required to achieve this.

    Finally, you did not respond to my point that business executives, management consultants, accountants, high technology professionals, etc., do not complain about too many new grads driving down wages. I will say from my experience as a high tech management consultant and executive that the high wages commanded by American workers has driven foreign outsourcing and abuse of the H1B visa system to import cheap foreign workers. I doubt you want to see this happen for healthcare providers.

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