emtneel

I am an independent contractor and have been for ~5 years now Sounds like they are trying to rip you off! you should make like $20/hr more as independent contractor... Just think of the vacation alone you won't get paid. As an independent contractor You pay your own CMEs most get 1500-2000/annual allowance You pay your own health insurance which you can deduct 100% and all meds, etc.. you pay your own malpractice ~ $1500/year Own licenses A BIGGIE, you are NOT covered under workman's comp!!! And it is VERY difficult to find a health insurance company that will give you something in writing stating they will cover work related injuries. I have personally dealt with this and had to switch to a worse health insurance plan but one that covers work injuries. you pay your own vacation you pay your own life insurance, disability, etc.. you pay your own retirement without employer contribution you pay quarterly taxes-- if you are at one job, one state, this would not be a big deal, you just talk with your tax person and send a check every 3 months. i've worked multiple states, in one year with multiple companies.. that makes it complicated at the end of the year. i pay ~10% taxes (as nurse ~30%) but i only work half the year so if my income was higher i probably would have to pay more, but you can deduct a lot more as independent contractor. your are also responsible for your 7% of SS tax and what the employer would normally pay 7% so you are responsible for the whole portion. Most ERs which I have dealt with who have independent contractor status for the ER staff pay midlevels $65-90/hr. I think some offer malpractice but that's it. Right now for me, it works well because I can take lots of time off and schedule when and where I want to work and not limited to 2-3 weeks vacation/year. Plus I get paid housing, travel, rental car, gas.. so I don't have many expenses and lots of deductions.

And another thing.. we in the healthcare industry are one of the few who have people knocking on our door for our services, while other people are struggling every day and would LOVE to have any job, even if they are over qualified. Man it just annoys me with so many out of work, no/under insured, etc.. that someone complains about something so trivial. I for one consider myself blessed and grateful to be in such a position and do not take it for granted. We could be the one's struggling to find work and could care less what someone called us...

I don't understand what you are complaining about? Sounds like you are on a high horse and consider yourself better then the recruiter.... I've talked to Delta lots of times and would not discount this company, and if you have never worked for them, then you are jumping to judgement conclusions! Do you call the smelly drunk guy who is cursing at you Mr.Smith? Do you show all your patients the exact respect that you think you deserve?? Even if I go to med school and become a Doctor, I would still tell people to call me by my first name. Yes its an earned title, but I don't think i'm better then someone just because I may have had more opportunity or maybe because I worked harder. I have a friendly first name basis with multiple recruiters from multiple companies. They know i'm a professional, they know I work hard. Its a small world out there... and if you burn your bridges at Delta... who knows he could become the next chief such and such at another company that you do like.. i've seen it happen....

Since we are discussing. There is one drug I refuse to prescribe and thankfully have been able to mostly get around it. And that is the morning after pill. This is based on my own personal beliefs and I can't in good conscious prescribe it. I'm glad people can just get the medication at the pharmacy now. I only had an issue once, in which I had a telephone interview, and the Doc asked me if I had a problem prescribing it and referring for abortions and I said yes, and we both agreed that I was not a good fit for the position. Otherwise most other medications are on a case by case situation if they are what I consider "high risk". I definitely think you cannot go around and say i'm not going to prescribe this and this.. you won't be working! Although, at least in the ER/UC where I work, everybody is on the same page about narcotics and benzo's and they don't want anyone prescribing large amounts. There is a lot of abuse but you can't always figure it out. So if i suspect someone is abusing or selling.. or drug seeking.. I try to treat there pain with Toradol/ibuprofen/tylenol (but of course they are often "allergic") so sometimes i give a script for #2 tabs of norco. Or just #1 in the ED. That way they can't say I didn't treat their pain, since its "subjective" its kinda funny though, I worked quite a bit of Occupational medicine, where we had a lot of injuries including LOTS of back pain etc.. I RARELY ever wrote for narcotics.. really only if a bone was broken. And its AMAZING!! How biofreeze, ibuprofen/aleve, ICE, RICE, and PT actually heals and improves patients back to 100%. I always am a little irritated when people go to the ED and get treated for such with narcotics when that is not the standard of care, and you ask these people and none of them were told to take an NSAID and most of them don't have contraindications for taking one!

Why not HRT? (its not something I normally prescribe due to ER/UC work) but currently in Family practice. I recently prescribed it for a woman who had been on it before, and tapered off, and was complaining of multiple symptoms, hot flashes, insomnia, etc... that were according to her severe enough that she wanted to go back on it. According to UTD it is okay as long as the patient knows the risks, which I in detail explained to her and documented. She had done a 6 month taper before and UTD said some people need a 1 year taper. I think she was 55. So we made a plan for 1 year taper. She had been off like 3-4 mo I believe. I also told her she had to have f/u q8 weeks until she was off and only gave her 30 days script.

Yeah, true, every other person is bipolar or has anxiety! i wonder if insurances would cover "yoga" and relaxation seminars! I tend to be more conservative and holistic in my approach.. What a lot of people need probably is a vacation!:)

thanks, its good to hear other providers also use "I don't prescribe such and such" Like I said I work primarily UC/ED, so I don't prescribe a lot of chronic meds except for occ refills for people that can't get into their PCP. I also work in high abuse narcotic ERs (which is known that the patient's either sell or abuse the narcotics, you can look up their pharmacy history of narcotics and they lie straight to your face that they have never used narcotics and records show they got 300# pills in the past month from various providers/pharmacies) This is why i just say, I don't prescribe hydrocodone 10s (i usually only have to tell this to people who come in specifically asking for that which is a red flag anyways) i believe they have a higher street value. Also i don't prescribe Oxycodone except on very rare occasion for someone who doesn't have a long narcotic record and allergy to hydrocodone. I believe in some states NPs aren't allowed to write for Oxycodone anyways, so i usually just say i'm not allowed since i work in multiple states. this just makes my life easier. ITs funny though, for example in an UC once, had an elderly lady coming in from out of town, was leaving the next day and was requesting a refill of her Ambien. We actually had a rule which was posted in the waiting room and patient rooms that we did not refill Ambien, xanax, pain meds etc.. So she did not seem like an abuser so i had thought about giving her 1-2 tabs until she got back home.. upon further questioning she actually had not been taking ambien for several years etc.. so i ended up telling her to take benadryl and f/u with her PCP, because one night until she got home was not a crisis. I guess there is just this idea in patients mind that if you go to a provider, you ask for what you want and they are supposed to give you whatever you want. Pts dont understand all the risks, they just see the commercials and want it. On the one hand you want to help but as a provider you have to weigh the risks and benefits, and many medications really need adequate follow up. i'm glad to hear I shouldn't feel "obligated" to prescribe a medication for a patient that i don't feel comfortable with f/u or the SE of the medication.

I am a locums FNP working mainly ER/UC. Currently i'm in a family practice clinic but only for 1 month. They don't have a provider after me except for 1 day/week and they were lacking a provider for a few months before. It is a rural area with no other healthcare and closest hospital/clinic is 45 min away from one clinic.. also I staff another clinic 1 day week, which is 1.5 hrs away from nearest healthcare and they were without a provider for 2+ months. I want these patients to have as adequate healthcare as possible but am wary about starting some medications due to lack of follow up. For example, Chantix, has black box warning esp. for SI. I really don't want to start this in someone without adequate f/u and close monitoring, especially since I don't have a lot of experience with this medication. Another one is Ambien, also r/t the SE. Others including antidepressants, these people need f/u. i went ahead and prescribed for one pt but a limited amount, and she will have to get f/u somewhere in order to get it refilled. Another example is that I don't write for hydrocodone 10s. I think it is higher risk for overdose, there is a lot of drug seeking/abuse that happens in the ED. And if someone truly is in pain they can take 2x of the 5mg. Do any of you have similar experiences. Or other reasons that you won't/don't prescribed certain medications?

Also these clinics only treat very basic things. I called once to see if i could get some prednisone and inhaler for my asthma and they are not allowed to treat that. It is basically very low skill use. I think it is a waste of our skills as NPs and would be afraid I would lose skills if I only worked in such a clinic. a True urgent care is much better use of our brains and education.

This seems like very good pay. I'm an independent contractor and when a few companies tried to hire me for this job i don't remember it being that good. As well as they expected you to print ~20pages per patient and fax them back every day, all at your own expense. Printing/faxing is also a cost that has to be considered. As well as milage to/from the sites.

well.. just med school ist 4 yrs. If you are a NP you might have some of the pre-reqs done but def. do not need more then 1-2 years to do them. You could do them at a community college etc while you work as a NP. So you really then have 4 years med school which if you are already a NP part of will be easier (examining pt etc.. most likely the last 2 yrs) and the first 2 years are like a FT job with extra studying time wise. You don't have to go 300k in debt? you don't have to go to harvard... I plan on going to med school in TX where its 6000-10000/year, money i can save before I ever start. So really you can avoid a lot of debt. And you can choose which field you go into. You don't have to open your own practice. I like EM and those docs work ~10 shifts/month. No on call, and don't take the work home.. And they make good money. Doesn't sound that bad to me. There are also other fields that are family friendly. I also don't plan on working FT or 5 days/week, so you have choices. Lots of Docs choose to work their guts out. Its a choice. You can do this in any job/profession.

YUp, Got the books to study for the MCAT which i plan to take early 2012 and Apply May 2012. I always wanted to be a Doc and thought I would be satisfied as a NP. I am very satisfied as a FNP if it doesn't work out. Reasons: More knowledge. People listen to you and believe what you say. Midlevels put up with a lot of crap that Docs just don't/won't tolerate Ability to work overseas, my BF is from Germany and we want to eventually live there and NPs don't exist. My life: BS Biology/Chem minor (pre-med) MCAT #1 --> didn't study, bad... Accepted to German Med school (I speak german) -->decided FNP route instead. BSN accelerated MS FNP (3 years Peds RN while in Masters program) re-took PHysics last spring (i had taken it in Germany and med schools don't take out of country classes) All other classes are taken. Working 3 years as locum tenens FNP mostly UC/ED.

"I will likely end up working in one of these clinics at some point, but will I compromise my clinical work ethic for the sake of a having a job?" I would recommend not working in a retail or UC clinic, if you want to practice evidence based medicine. I have been doing locums and am becoming more and more frustrated with being told "how" to practice. Basically I am told to give the patients what they want. If i don't then I don't have a job. If the patient is unhappy for any reason, I am the problem, and I am the one they will get rid of. I got "talked to" by the non-medical office manager at one clinic because I had 2 patients one right after the other that left angry. Pt.1 had URI which I gave her OTC/URI instructions, she was mad b/c she had pd cash, UC clinic and did not receive antibiotics. Pt.2 had a painful umbiliical hernia and was mad b/c his insurance told him he could go to this clinic and get everything done. He was mad because I referred him to a surgeon and would not perform the surgery myself in the clinic. So i got reprimanded. They called Pt.1 back and the next doc went overkill gave her steroid shot and antibiotics. The non-medical office manager then "believes" I did the wrong thing because the MD "Gave a SHOT" so she must have been super sick and i was just too dumb to see it... The MD told me I did the right thing and he was just trying to suck up as well. My experience has been if the patient is paying cash or they are upper class you better give them what they want or you won't have a job. Practicing evidence based medicine is becoming less and less because its become a drive through McDonalds type based medicine in the US. The customer (yes they really are becoming just customers) come in, and tell you what they would like to order. If you don't get the order right, they will find another fast food restaurant that will meet there needs. Its all about business, its really sad.. not many places care anymore..

Yes, i think i may have posted another more recent post on my travels. I have been doing locums now for 3 years, and have worked in MA, CA, NM, CO, TX, and i have FL license but haven't worked there yet. Yes, the locums co pd for my DEA $550 so that was good. Most will pay for any licenses and such that are required. I will try to find the link to the other post or update more later. Feel free to ask any specific questions.

I don't know what to tell you other then what I already posted... It's been 3.5 years since I took the exam and truthfully I don't remember much how I studied other then what I already posted. I wouldn't worry so much, you can only do the best you can, thats all you can do! Good luck!! I've been working all over the USA working as a traveling/locum tenens NP, having fun, getting lots of experience! If you are willing to move anywhere you can pretty much get any job you want.