ToFNPandBeyond

For those who own their own business, please recommend your CPA. I'm looking one who is obviously well-versed in tax law who is aggressive at lowering my tax liabilities. Thank you!

$3500 isn't that much less when considering an NP salary...and especially when you factor in your overall happiness. It's kind of a no brainer.

Hi, I have sent you a PM ?

Yes, you tell them you can only address 1-2 problems due to the limited time you have to fully and adequately address their concerns, then inform them (should they start to drag you down the rabbit hole of problems), that you can schedule a follow up to address their other concerns. Keyword being follow-up. This allows you to stay on track, and allows the pt to feel they will eventually get their other issues addressed. Now I'll admit that I'm not too familiar with med evals...if you are not able to do follow-up appts, then my advice doesn't apply. But generally speaking, this is what I usually say to my patients, and it leaves everyone for the most part feeling satisfied.

Beware California residents: I was informed (upon my inquiry, and last minute), that they are now currently not authorized to accept California residents. So, if you applied and got accepted for fall 2020, like me, it's a no-go for you.

You bring up very valid concerns that many in the medical/nursing field shy away from talking about. You're correct, many of these psychotropic, and other pharmaceutical meds, have a whole host of side effects. And when you get into a situation of polypharmacy, which usually happens in the field of psychiatry, as well as family medicine, then you end up treating the side effects from the meds (WITH MORE MEDS LOL), in addition to, or sometimes in lieu of, the actual medical condition. However, you'll likely experience this dilemma iN other fields as well. For example, in primary care where I use to work, I knew of many ppl who were quick to treat pre-diabetes or mild elevated lipids with meds instead of lifestyle changes and monitoring. Are they wrong to do so? It's debatable.... I work in psych, and I've adopted the approach of if it's essential (I.e. affecting quality of life, ability to do ADLs, or is severe) , I treat with meds. If not, I provide education, motivational interviewing, and other resources so that they can manage without meds, and I state my rationale. The beauty of being a provider is that you can choose how you want to practice. Not everyone will need meds. Now, from a billing standpoint, politics do come into play. You wouldn't be able to do this with every pt, but that's kind of the point...you won't need to, because in psych, you see the full spectrum of illness and severity. Hope this helps.

No advice unfortuntely, but just support for how frustrating that is. They should at least honor the fact that you completed the psych NP part of your program and passed the boards. Esp since you being withdrawn from the program was due to COVID19....horrible!

Simple: the psych NP is trained and well versed in everything psych, and you as an FNP are not. Yes, you are prescribing suboxone, but the psych NP is probably doing the same, plus psych med mgmt, plus initial evaluations, which can easily take 60-90 minutes. Her higher level of expertise in psych over your limited expertise by virtue of your family medicine education means she deserves to be compensated more than you. I work in psych as an FNP and understand this clearly. I see all follow up appts doing med mgmt, like my fellow psych NP colleague, but I do not do initial evals as this is rightfully reserved for the psych NP with training.

So I take it your employer provides an office manager that you don't have to pay for? Do they complete prior authorizations, scheduling and other admin work for you? That would be so ideal!

Ouch! Your tax liability will be through the roof if you're not actively trying to reduce your tax liability (incorporate, business expense right offs, etc.)... I would only consider doing 1099 if I can reduce my tax liability, otherwise uncle Sam will be taking a HUGE chunk of your profits and you'd be better off making less money for more gain ??‍♀️ However, Myoglobin, do you have an assistant that helps with scheduling and other admin tasks? I'm curious to know how does it work when you work as a 1099 co-op style with other 1099 providers, and you need assistance with admin grunt work? Does the owner provide an assistant that you all share, or are you responsible for hiring your own assistant through the money you earn? Ty for your response! ?

This is so ideal and is what I aspire to do! Please do update us with how working as an IC 1099 has worked out for you!

Myoglobin, can you explain how you save on taxes as a 1099 employee making the high income that you do?

My general rule of thumb regarding appropriate salary standards is that if I am not making more than what I borrowed for school (plus interest), then I am making too low of a salary to earn a living and pay off my debt. 80K is quite low. I imagine you probably borrowed more than that to obtain your degree.

I hear you. I work in private practice/psych outpatient and it's relatively the same issue. I do psych follow-ups and it's 20 min back to back with a "30 min" break and "admin time" that is only 20 min at the end of the day... I have to hope for either camcellations or quick follow-ups to complete all the other admin things I need to do and to feel "caught up". But it can be difficult, esp with COVID19 and everyone being anxious about it... So no, you're not alone.

I use epocrates paid version and consider it a great investment!

It'll likely take you less than 2 years as it'll be a post masters cert in FNP. As stated above, don't do it unless you want to be liable should something go wrong. I'd argue most psych practices you'd work for would also disagree with you prescribing meds outside the context of psych for fear of liability on their practice.

Yes, but your quality of life is s$%& as you don't have the time to enjoy the $ you make working all those OT hours... I wish ppl considered this very important point every time they make the argument that RNs can make equivalent to what NPs make.

I did direct-entry. No one cared about my measly 2 years of broken "school nursing" experience I obtained while in grad school because fellow students and peers beat the fear of god in me that I wouldn't get a job without one. Got 3 job offers before I graduated ? Not a single one asked, cared or considered my RN experience to work in primary care. You will be fine.

Have you considered telehealth? Many postings now d/t COVID19. Some places will even help you get licensed in their state.

I couldn't agree more OP. I sometimes chuckle at the laundry list of acronyms that all say the same thing. It's like "we get it, you're accomplished" ?

No, ended up applying for and getting into Wilkes

We've been using doxy.me and it has been super user-friendly. It's simple to set up an account for providers. From there, your MA can send the link to patients and they type their names and are good to go. So far, insurances have been lenient regarding reimbursement. Even medicare in CA is allowing telemedicine from home and are reimbursing for it, so long as we provide proper documentation.

I hope the tuition is that cheap! I'll be paying OOP

I don't see how this would be illegal.... Not wise, probably, seeing you have scant adult care experience, but you are an FNP, and so therefore, well within your scope of practice and educational training to care for the adult population. They could very well argue that point if you made a fuss or took legal action. You are free to decline the transfer and accept the risk associated with that, but again, I don't see anything illegal about this?‍♀️