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Tony1790 BSN, MSN, NP

Rheumatology/Emergency Medicine
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Tony1790 is a BSN, MSN, NP and specializes in Rheumatology/Emergency Medicine.

Retired Military

Tony1790's Latest Activity

  1. Tony1790

    Pay update for newish NP

    As an update to anyone that is interested, mainly new grads, I’ve battled and continue to battle the pay scale issue for nyewish NP. I graduated with my FNP 2016 and became licensed in March 2017, and started working three days after I got my license, I have worked in three states, In an urgent care, emergency department, and Rheumatology out patient office. The bad news: my RN that checks the vitals of the patients that I see In Clinic, makes approximately $7000 more per year base pay than I do, that is frustrating, but she does have more time as an RN than I do. The good news, The job situation that I was able to finagle, as I finally got my base pay up to $107,000 per year after two years, started at $97,000. However I only see patients for four days a week, on the fifth day I work overtime In the emergency department For $100 per hour, making approximately an extra $65,000 per year, for one day a week, so my total is approximately $172,000 per year for five days per week with 2 years experience. as an aside, my salary was $58,000 per year as an RN two years ago in TN, My education was paid for by the military, so it worked out very well for me even though I went back to school late in life, and I turn 53 years old next month Having said all that, I would not want to do the same thing if I had to take out a large student loan, especially going into an over saturated nurse practitioner market good luck to everyone As you go about your career and/or school Pursuits
  2. I work as an independent licensed Rheumatology/arthritis provider in Washington state, I am currently attending a Rheumatology conference in Atlanta, they are having a job fair and I swung by my old alma mater, ETSU, and like most places, they are hiring mainly for MD rheumatologist, what torqued my behind was when the recruiter said “we are hiring for a rheumatologist, and then maybe a fellow, and then maybe a third rheumatologist, and then we may consider an extender”. I really, really, really hate that term, “extender”, it just really reflects the backward thinking and the lack of value the NP’s are given in the southeast US, and even more demeaning from my alma mater where I got my BSN and MSN, to be referred as a tool, very insulting at least in my mind.and one of the reasons I moved from Tennessee to Seattle 2.5 years ago Part of me wants to move back home to the southeast, but I don’t think I can tolerate the backward status that NP are given in the SE, Maybe I am being overly sensitive, but definitely I think I need to keep the job I have, LOL
  3. Tony1790

    NP Salaries

    Arthritis/Rheumatology/Emergency Medicine 32-36 hours main job mon-fri with tuesday either off or a training day, 5 patients/day 14-28 hours OT on weekends, double time 26 days vacation time, 13 days sick time per year, 3 days CME time for annual conference and no money Started main job $95,000/yr, just got promotion at 1 year mark $103,000 base salary ER job, $60,000/yr with 1 day/week, or $120,000/yr with 2 days/week, Extra income So, I can make $165,000-$200,000/yr (before taxes) without too much trouble 1.5 years experience, no income to practice, (Govt job)
  4. Tony1790

    FNP Job Outlook

    I've worked TN, NC and WA state, I would NOT recommend NC, it is not very NP friendly, the MD's have a lock on that state, you may NOT even have a NC NP license without first getting a MD supervisor that will be your boss, so, yes you have to have a job lined up before you are allowed to have a license, and once the job ends, so does your license. And you have to pay NC income tax. WA state has no income tax, I believe more jobs, and is NP friendly, for the most part. Good luck either way.
  5. Tony1790

    FNP Oversaturation

    I moved to Seattle for a job as a new grad, the VA has several openings currently and the local market has several available jobs, I would have a job lined up before I moved to anywhere though, it won't be fun getting a new lease on a rental and then not finding a job nearby traffic stinks here and you need to live close to your work
  6. Tony1790

    Working in Rural Primary Care and Love It!

    I like your post, honest, realistic with pro/con's thrown in, love it, nice.....
  7. Tony1790

    New NP, take Integrated pain management job or keep looking?

    I can't believe that it's been a year in the "Seattle" area. I work as the only full-time Rheumatology provider at the Tacoma facility, four days a week, and I work as an emergency room provider one or two days per week, my main job is $97,400 per year plus an additional $50,000-$100,000 per year on the PRN job depending how many days I work one or two so I am making between $145,000 to $190,000 depending if I work five days per week or six, so pretty good money lots and lots of experience overall I like the jobs and experience. Still living in the small house with low overhead and a 9 minute commute but my stuff still in storage in TN, I have had zero interviews in TN too many people looking for too few jobs. I've only been an FNP for 1.5 years and still learning. Tony in WA
  8. Tony1790

    Hitting a wall, I hope it gets better fast

    I appreciate your view point and to be honest, maybe my whining in a public forum, isn't appropriate, which I will now stop. I am working to resolve the problem, and thankfully Rheum is a chronic problem and not usually life and death, essentially with the new consult I'm just getting an HPI, doing an examination and ordering baseline Rheum labs and xrays, and then I'm suggesting a multitude of differential diagnosis, where I'm reaching for the eject handle is, I'm then scheduling the patient to come back for the 2nd visit with the MD, so gathering an HPI & doing an exam is well within my NP role. The MD then see's the patient, reviews the labs, films that I ordered, agrees or disagrees with my diagnosis and either keeps the patient in their panel or puts them back into my panel on a co-managed basis, this is the model of many Rheum offices, the NP seeing the less involved cases and even then co-managing them, which is where I'm going. Thankfully, the pool of the departed MD's panel is drying up, I'm seeing and rescheduling them, updating her plan, re-assessing the patient and rescheduling for follow up with another provider, so really no worries. Thanks all for allowing me to whine, but I will now stop :-)
  9. Tony1790

    Hitting a wall, I hope it gets better fast

    Yes, it was supposed to be mainly injections, gout and Fibro, which is easy cheesy, but as my clinic has the most openings, it acts as the pressure relief valve for the clinic, in order to meet the CID, clinically indicated date, in order to meet the timelines for consults. Part of the problem, is that the schedulers are scheduling theses patients into my clinic, even though the MD clearly states in the consult triage, that the patient should be seen by a Rheum MD, but they schedule them into my clinic in any regards. To be fair, I am doing a good job on assessing and diagnosing the patients, it's just taking me hours and hours to do it and taking a toll on my psyche, but it's a great opportunity to learn, it's just stressing me out! Thanks again, I shouldn't whine, and as far as the Pay, it's a product of the VA system, there is no negotiation with the VA. I'm just keeping my head down until I get a couple of years of experience under my belt, hopefully I'll make it long term :-)
  10. I've been an NP for 1.5 years, but I've only been seeing patients at my new job for about 5 months, I work mon-fri seeing Rheumatology and Arthritis patients, and on the weekends I work ER/Fast track, I'm seeing a good number of patients and charting w/o worry in the ER, however, I'm struggling in my clinic during the week, and week before last, I hit a wall, angry, exhausted, tired, sleepy, nauseated. I was/am getting overwhelmed, I opened my own clinic (within our facility) seeing patients on my own in March of this year, after a few months training with some of the Rheumatologists for a few months prior to that, and initially I was doing ok, seeing mostly knee/shoulder pain w/lots of steroid injections, as our office had a contract Rheumatologist with over 40yr experience seeing all of the harder Rheumatology patients, she abruptly left the office and I have been seeing her patients now as well as seeing new Rheum consults all with very little Rheumatology training or back up and it's taking a toll on me, as I'm spending hours reading/charting and trying to figure out what the patients correct diagnosis is, and if you've worked Rheum, the difference between diagnosis is minute, I've been studying/charting until 10pm at night and I'm getting to be angry and grumpy, exhausted. Luckily, this past week, I've been back to mostly injections, gout treatment, fibromyalgia, etc, easy stuff, so I"m out on time, but I'm still quick to anger now, kinda punchy, I dunno, it's a mixture of fatigue and self doubt coupled with a little resentment, I suppose, I've received a tiny fraction of the training that the Rheumatologists receive and I make less than most of the RN's that I work with (VHA system). The Rheumatologist Fellows are MD's, graduated medical school, residency, etc, and they get 3 full years of Rheumatology Fellowship with an Attending that staffs with them on each patient and aren't out on their own until the 3 years are up, they train in the main hospital branch. I'm down at the satellite branch and I got 3 months of how to do injections, with a little on the fly Rheum training and I'm seeing patients on my own, with very little help when I have questions, and it's just a little overwhelming, a great opportunity to sink or swim, but I spend hours reviewing everything, with the hopes that I'm not missing too much, but week before last week, I just couldn't go any further and honestly if last week had been like the previous 4 weeks of nothing but new consults to the Rheumatology service, I don't think I would have made it to the end of the week, I'm trying to get them to remember, that I'm not a Rheumatologist! What do you do when you hit a wall? Literally I sleep a few hours, dream about diagnosis, dream about patient RVU's, and then I wake up and go back to work, now everyone looks like a joint, I don't see people, I see knee's, hands (dip, pip, mcp, cmc), ugh........If I had a life, a wife or girlfriend I wouldn't be able to keep up, as it is, it's just me, so I plug away. Some days I think that I should just take an RN job in the clinic, it'd be As I look at the clock, it's 1:30am, I have to stop rambling, I need to wake up in 5 hours and get ready for work! Sorry for the long rant and whining, I'm just so frustrated lately and I don't know how to make things better.
  11. Tony1790

    Favorite Urgent Care NP Pocket Guide?

    PACK OF OXFORD HANDBOOK OF EMERGENCY MEDICINE AND OXFORD HANDBOOK OF ACUTE MEDICINE (Oxford Medical Handbooks) 9th Edition Twin pack on Amazon for $38
  12. Tony1790


    Quote from Above: Sad, though, that pay will ultimately be determined by the market, and I fear we are flooding the market with poorly prepared NP's. Flooding the market, indeed.
  13. Tony1790


    Ummmmmm, hate to be a bummer here, but $40/hr = $83,400/yr and is pretty much the going rate in the SE from what I've seen, and it gets worse, I had a friend making $29/hr = $60,000 as an FNP at the health dept. Most of the office mon-fri FNP's that I knew in PC were only around $80k/yr, which is in the $38-$39/hr range. I moved to the NW and work with the VA, I make $97k/yr or under $47/hr...........the RN's in the Seattle area VA just got a huge pay raise, and most if not ALL are making more than I am currently, at my pay grade right now, I'd make $94,000/yr as an RN, floor nurse, base pay, with differentials for nights/weekends I'd be over $100k as an RN, but I work mon-fri as an FNP for $97k......I work weekends in the ER to make up for it, on the weekends, I make $82/hr with OT, weekend diff, etc..............So pay can totally stink for NP's, there's a trend that I have seen, bonuses, etc to get RN's, nothing for NP's for the most part. Thank God, that I didn't have to take on any student loan debt like a lot of people do, then it'd be way worse!
  14. Tony1790

    FNP Oversaturation

    From my limited experience, I had a friend that was working for the county health dept in TN as an FNP, she was making $60,000 yr full-time. I get emails from recruiters, wanting to hire NP's for positions, the job expectations listed was to see 40-45 patients per day, mid $80,000's. In my current work environment, I'm working 6 days per week, my main job, I only make a little more than many of the nurses and less than some other nurses. On the weekends, I work in our ER, the charge nurse (RN) is getting ready to graduate from NP school, but at his current RN position, he makes $13,000 more per year than I do as an FNP. For RN's the field is wide open across the nation, recruitment incentives galore, but not for NP's. I feel bad for the NP's that take on a load of debt to go to school, it often doesn't pencil out. My schooling didn't cost me anything, so I'm good to go as far as bang for the education buck :-) One last example, I have another NP that I had worked with in an urgent care, she was let go, w/o any notice, the reason, cost cutting, they are expecting the NP's in the urgent care to see at least 3 per hour, 36-40 per shift, and since census was low, they let one of the NP's go, and the remaining NP's are expected to work crazy schedules, where you may work days in a row and still not have 40 hours in a week. This is one of the reasons, I went back into the Federal system, stability, at least for now.
  15. Tony1790

    Nurse Practitioner Overtime Pay

    I'm lucky in that I get OT pay, I work with 4 MD's and I help out with their patient secure messaging and calling patients, putting out fires, etc at the end of the work day, but they pay me +70/hr during the week days and $82/hr on the weekends to do it, additionally I pick up 1 OT shift in our ER on sundays because I like the ER, in addition it's 1.50 OT + .25 for weekends = 1.75 of my regular rate. I will have close to 40 hours of OT on this next check, sweet bonus :-)
  16. Tony1790

    VA Nurse Practitioner

    NE TN? VA ER? Seeing as how I left a certain NE TN VA and I had previously worked in that ER, hmmmm, I wonder who you might be? :-) Not that it matters, I'm hoping that I get to get back there one day!! I'm working in the Seattle ER now on the weekends.