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Goldenfox has 12 years experience.

Goldenfox's Latest Activity

  1. Goldenfox

    1st NP Job: Pain Management, bad move?

    David, 27 patients is not high for pain management clinics. I worked in one as a locum and I was seeing an average of 40 a day. If you're having trouble finding a job and this is all there is for now, take it so you can gain some experience, but go into it with both eyes wide open. Most people who own/run pain clinics are greedy and unethical. Always be on the lookout for anything that could jeopardize the license that you worked so hard for. The state government and the DEA will have you under a microscope. There are legitimate pain clinics...a few. Most are still pill mills. Get some experience but don't plan on staying in this venue too long. It is not respected by the medical community because of all the fraud and fake clinical practice associated with 'pain management', be looking for your next job as soon as you hit three months. Its kinda like the home health risk assessment type jobs that are everywhere now. You really don't want that stuff occupying too much real estate on your CV because it doesn't impress anyone. The clinic I worked in was owned by people who had no clue. They had no health care training or background. They told me they are businesspeople who went to a seminar about the best way to make good and quick ROI. And pain management was it. They were greedy, but not entirely bad people. I had to teach them things. Many things....things that would make their clinic financially successful---BUT, that they had to make it real, and actually do the workups, and provide service that can be rationalized and not just be giving out candy to drug seekers. They wanted me to stay on there. I was making them a LOT of money, and they offered me a really good salary to stay. But if you are a serious clinician you need to move on after a while. It becomes rote, and there is no real challenge to it. If you are prescribing narcotics, take the time to do your assessments, order the appropriate diagnostics, and make sure to review the drug screens. Anything or any patient that you have a bad feeling about always trust your instincts. Don't be afraid to set limits with your patients. Some of them will try to bully and manipulate you. And document everything objectively. If the DEA shows up for an audit you must have no reason at all to worrying about anything. $100k is low. I would ask for more. Also, in pain management its not so much the contract that you have to watch out for its the ethics of the place itself. Do they follow the law? Are they serving patients who have real pain management needs or are they just doing easy assessments and writing prescriptions. You will quickly figure this out.
  2. Goldenfox

    Switching offices

    How much do you like this job? My experience in dealing with these types of private practices where family and nepotism hold sway is that you will not win if you try to take them on. They will always choose their family and close friends over you. 'Putting your foot down' is not an option because they don't care at all about your opinion on the matter---not enough to ask you anyway. Of course the office manager approved it. He/she does whatever the practice owner says. You won't like hearing this but they have already made the decision. You will eventually be making a decision of a different type....whether to stay and be treated like a rug or find a better opportunity and leave.
  3. Goldenfox

    Contract Penalty fee $30,000

    Why do you really like this company? Think, for a moment, about why they would put that particular language (about the $30,000) in the contract? Is it for any other reason than to screw the unsuspecting NP who accepts a job there then later figures out that the place sucks and decides to leave? Whenever you approach relationships of any sort with any employer always remember one thing---they are not your friend, so keep it professional and be discretely looking out for your own interests as much as they look out for theirs (and they are ALWAYS looking out for theirs). Do not sign that contract. If the place was so wonderful that no one would want to leave after 3 months that language would not be in it.
  4. Goldenfox

    Self Employed

    Even if you are not a person of faith, I wish you God's blessings and much success with your plans to start your own business. It is so very rare that I encounter other NPs who are even thinking in this direction. It is one of the best decisions you will ever make. I recently started myself. The freedom...the potential... First thing - don't talk yourself out of doing it. Second thing - don't let other people talk you out of doing it. Expect that a lot of envious and ill-wishing people will try to discourage you. Ignore them. Everything depends on which state you plan to practice in. The laws vary considerably. It is best if you don't plan on doing this in an anti-NP state that puts many unnecessary restrictions on NP practice (if you live in one of those, move). This is not the same as requiring physician collaboration. Even in states that don't require physician collaboration you will find that you still benefit from a collaboration arrangement for a number of reasons. Start with a resource guide like Carolyn Buppert's book on NP business practice and legal stuff. She gives very good advice on how to make up a simple business plan to do exactly what you are thinking about. Invest the needed time to do research and to write up your business/marketing plan. Look for inexpensive office space that is off the beaten path but easy for people to find, and preferably one in which the landlord is willing to include buildout at no additional cost to you. You can set up the place very simply and inexpensively and it still looks good. Since you're doing psych you won't need to buy or lease expensive equipment for diagnostics or procedures. Budget for a full-time office assistant and a part-time mental health counselor.
  5. You seem a bit judgmental. I remember a time when college education was much more affordable. I also worked full time while I was in school and paid my way through my RN and BSN degrees. But that was all a very long time ago. Most available non-professional jobs these days don't pay enough for young people to work and fully pay for today's college costs out of pocket. And newer accreditation rules no longer allow most health science programs to give students very long to complete their credits anymore either. So, dragging things out while you work to save and do a class here and there in between is no longer a strategy that works for most in modern academia. If a student hasn't finished the degree within x number of years the validity of certain credits become null, and the student has to re-take these credits in order to meet the graduation requirements. According to you, if a student inquires about student loan forgiveness programs before applying for a loan this means that the student doesn't intend to repay the loan. This is not true. You pride yourself on being a good planner, so you should appreciate that good financial planning means carefully researching all of one's options before making major financial commitments. Student loan forgiveness programs are not a freebie for the new graduate. He or she is trading part of payment for their labor in exchange for a reduction of their student loan balance. This deal works ok form some, but not so great for others---for a variety of reasons. Students are still being sucked in by the misinformation about college education and student loans. The law requires that they are educated about borrowing this money before they receive it but most still don't really understand. The lenders are charging interest on the loan amounts from day one, and a few thousand dollars easily becomes many thousands of dollars after several years. And a big surprise is waiting for the borrower after graduation when the payments become due. We don't know for a fact that most graduates default because they never intended to repay from the start. It is possible that many looked for a long time and couldn't find jobs that pay enough for them to pay back the loans AND live on without having to scrounge, so they gave up. Sure, many nurses make decent money---IF they can find a job. In many areas getting a job as a new grad RN isn't so easy anymore. And the pay isn't always so great either. Also, many, MANY new RNs decide after only a short time that they hate bedside nursing and either go back to school or quit the field entirely and take a lower paying job doing something else that they like more. But they still have to pay back the loans, perhaps with even less income, or take out new loans to pursue a different career. There are many variables. For-profit, or not, college, and the co-conspirator textbook publishers, and the student loan hawks are a major con job on the nation's youth. And government intervention to prevent delinquent borrowers from earning an income was an extremely bad idea, but I'm not surprised that it came from Florida---the worst state in the union for nurses.
  6. Goldenfox

    Telemedicine and Locums NPs

    I used to do both. There are reputable companies out there that post these jobs (there used to be, anyway). You apply to them just like any other job. As a locum, you will be traveling to the location, but be certain its in your contract that they are going to pay all the logistics costs. Many of them now want the NP to pay the travel and housing costs out of an all inclusive rate, and the hourly pay is often not enough for this. Telemedicine, in my experience, is a waste of time. A few of these companies are actually good. Most are not. These days its usually a company that figured out a way to make big money off selling DMEs though they typically only pay you a relative pittance ($20 to $30) for each one that you prescribe. If you decide to do this make sure that you are licensed to practice in whatever state your patient lives in. And if the state requires a collaborating physician you are typically required to bring your own.
  7. Goldenfox

    CRNA School and Debt Advice

    A word of advice...look for a cheaper school. Avoid taking on that much more debt. As a nurse you may not be privy to the terms that these student loan programs make available to physician students. Also consider that subsidized graduate loans are capped. Beyond a certain amount you will be paying higher interest rates...and it does add up over time, even if you are in forebarance. But as a CRNA you can pay this off and do well income-wise. How? Open your own pain clinic. You'll be swimming in the money.
  8. Goldenfox

    Oversupply of Nurse Practitioners

    Re-read your post and make a note of how many times you used the words "I", "me", and "my". Your view of the situation is myopic. You see everything only from the point of view that fits your individual situation. Consider for a moment that not everyone who is or who will become a nurse practitioner is like you or has circumstances exactly like yours. For example, not everyone can just move. And moving is not always a solution either. Everyone's life, finances, and family situation is unique to them. What is "lovely?" What is "affordable?" What is "good?" What is "bad?" Do you not see that experience is subjective, and that most of these descriptors are frequently nothing more than a point of view? What you have written is YOUR point of view and a description of your own situation. Many other NPs have had very different experiences. When others tell about their experiences and observations its not just a matter of 'negativity' as you choose to view it, its another perspective of reality. And when the majority of these perspectives tell a very different story than yours then maybe that is of significance? Circumstances can change. Not every new grad NP stays in the big coastal cities. Some ARE relocating for job opportunities. I am happy for you that you are successful but you need to understand that your utopia can change too. Others have posted here about how that happened to them.
  9. Goldenfox

    Starting An NP Business: Finding Investors?

    Good advice from JulesA. You have options, but everything depends on what kind of business you plan to do, where you will open it, and how you plan to run it. Have you written a business plan? The marketing and financials are the most important components, and you should have these in place before you can logically make the decision to proceed with the business or not. If you don't know where you're going to get the money that you need to float the business for the first 6 months to a year then you are not ready. Don't just do basic market research. Write a formal business plan. It doesn't have to be an elaborate one but it serves as your guide for every decision that you will make about the business. If you apply for a loan from a bank, or credit union even if through the SBA they will want to see that business plan. Network with other providers, think about partnerships, and also look into writing for grants. I didn't have any investors. I started up mostly with cash from my own savings. I also applied to my bank and my credit union for a line of credit--- which wasn't as tough as I thought it might be. The space that I leased is not in a prime location but it is close enough in the way that people can easily find me. It is nice and roomy and the contractor did the buildout for a reasonable fee. The landlord even threw in some extras for free. I did not buy a lot of expensive furniture and equipment. I don't like cheap things so I did invest in decent quality furniture, and I personally did the decor so that the place looks professional and good. A couple pieces of equipment are leased at very affordable rates...which, for me, made more sense than spending tens of thousands of dollars on buying them upfront. Later when I make more money I may reconsider buying, although there are certain tax advantages to leasing. All I'm saying is you don't have to spend $100,000k+ to set up a spot and hang your shingle.
  10. Goldenfox

    New NP, embarrassing salary offer!

    True, but ask yourself why that is. We must remember that RN and NP are two very different professions and stop comparing them. The principles of economics don't change. Supply vs demand. It really is as simple as that. The corporate hogs and private practices earn vast amounts of money off an NP when they offer an NP a cheap salary and no benefits. They are billing the insurance companies/Medicare/Medicaid for clinician rates and they simply put all of the difference into their pockets while telling you, the NP, that if you work harder you might get a raise in a couple years. If you are an NP who is struggling to find a job in an oversaturated job market you might be tempted to take a low paying job that is offered to you. That is exactly what happens in many situations but some are too embarassed to admit it so they often exaggerate their income when talking about it. On the other hand, RNs are not revenue generators but the very experienced ones who work efficiently and minimize errors (and potential lawsuits) AND are willing to put up with the insane politics and other BS in the hospitals are getting harder and harder to find. So the RN pay is likely to go up more in the future.
  11. Goldenfox

    Did you keep your RN license and why?

    Because you have to.
  12. Goldenfox

    Future of Nurse Practitioners

    NP education is not a bad thing if you really want to be a clinician and you have completely ruled out medical school as an option. Look for a good school that has an excellent training program AND won't put you into ridiculous amounts of student loan debt. If this is truly your passion, research it very carefully first. Just know going in that you're probably not going to make the big bucks working as an NP if you're working for somebody else, and if you're in an area where there are already a lot of NPs it may be very difficult to get a job at all. Are you flexible with moving to where the opportunities are? I will be honest, if I was a younger person just starting out today or with just a few years in, I would not go to NP school now---unless I was planning to open my own business later on. Entrepreneurship is an area that precious few NPs ever even think about. It is also an area that very few educational institutions even mention in NP programs. The glut is mostly with the family NPs. Many don't really want to be clinicians, they just don't want to do bedside nursing anymore. Your own drive and attitude will play a role in your success. That you plan to specialize is a plus.
  13. Goldenfox

    Future of Nurse Practitioners

    Part of your post is incorrect. Nearly every specialty area in medicine has advanced certification programs for clinicians who don't have board bona fides but want to specialize. This includes cardiology. Here is just one example: About Us | Cardiovascular Credentialing | ABCMCertification.com - American Board of Cardiovascular Medicine Some reputable brick and mortar universities even offer the CV subspecialty in their program. Cardiovascular Subspecialty Some of these NP certification programs are more stringent than others. I remember looking into the one for dermatology some time ago but I was not qualified because they require 3,000 clinical practice hours in the field before they will allow you to apply to take the certification exam. I have seen that other certification programs have similar requirenments, which, I believe, is a good thing.
  14. Goldenfox

    Oversupply of Nurse Practitioners

    Sorry to hear this happened to you. This is sad. $85,000 for an NP in a state like California. Before I became an NP I worked as an ICU travel RN in California. Don't want to date myself, but that was a while ago. Actually, quite a good while ago, and I was earning more than $85,000 a year. I know many RNs in California who earn as much or more than the average NP salary there now. This happened to a friend of mine a while back too. This was the point at which I realized what had actually happened to this profession and decided to become self-employed. This very thing will eventually happen to every NP who is earning a high salary. No reason at all for them to pay us big money with full benefits when they have thousands of new grads hungry to accept low pay and no benefits just to have a job. Most RNs don't want to do bedside nursing anymore but I suspect that many who became NPs to get away from the bedside will eventually either go back to the bedside or quit nursing altogether.
  15. Goldenfox

    Gave up DNP

    ^This. Thank you for telling it like it is, TraumaRN. I once was a DNP student and gave it up too. I came to terms with myself. I'm not all that young anymore. College is ridiculously expensive and DNPs do not earn any more money, practice privileges,or respect than NPs who don't have a DNP, so the ROI is terrible. Definitely wasn't worth going into serious student loan debt for---not for me.
  16. Goldenfox


    The most important benefits are that liability is shifted from you, personally, to the LLC. If you are sued, its the LLC that gets sued, not you personally. So, your personal assets are not exposed to risk as they would be if you were not operating as a LLC. Also, even if you are working in a state that doesn't collect income tax you are still liable for federal income tax. Operating as a LLC can lower your tax liability because under certain circumstances you are able to deduct more business-related expenses than you would be able to do otherwise. Someone above said that she is already able to deduct all of her business expenses. That may have been so in 2011 when this thread was originally started, but the tax laws have changed significantly since then, and there are now limits on what an individual who isn't incorporated may be able to deduct. Many companies that offer IC contracts don't bother explaining this, and unfortunately, many nurses who work as contractors don't ask. If you are working as an IC you should definitely consider incorporating. It means doing a bit of paperwork and paying the fees to incorporate as a LLC but overall its worth the effort.

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