Happy New Grad NP in Rural Primary Care Clinic

Hello everyone! Just wanted to provide an update and also some encouragement to NP students and new grad NPs. I recently started my first NP job in a rural clinic and am very happy. Those of you who are concerned about starting an NP career - please consider working in an underserved area. Unfortunately, there is a lot of gloom and doom on this forum that can be very discouraging to NP students and new grads, but I can assure you that it is not reality unless you let it be so. New grad NPs that are willing to go where the work is will have no trouble finding a job with good working conditions and good pay. In addition, be careful to ask the right questions during the interview process to make sure the job is a good fit.

Following a grueling job search, I was fortunate to receive multiple job offers in California and surrounding Western States, all interesting jobs with good pay. After careful consideration, I accepted a position in a rural mountain community in California at a Federally Qualified Health Clinic (FQHC). The clinic facility is new and state of the art and also provides dental and mental health services. The deciding factor for me was that I just really liked the staff and "clicked" with them during the interview and got a really good vibe. Lesson: trust your gut feeling about a job opportunity.

My first 3 days were training and orientation on the E H R and administrative protocols. Starting Day 4, I saw 6 patients per day. The clinic started me off with easy cases and are gradually adding in more complex patients. This will slowly be ramped up over 6 months (or longer) until it reaches 18 patients per 8-hour day. I am now up to 10 patients per day. The other providers, both MDs and NPs, really took me under their wing, actively mentoring me and checking on me. They encouraged me to ask them questions and would even come in to see my patient if I asked them to. They told me they did not expect a new grad NP to know anything and have been very kind and patient. There is a spirit of team work and collaboration and even the experienced NPs frequently ask the MDs questions and for a 2^nd opinion on patients. The providers also collaborate closely with the mental health team (LCSWs, psychologists, and a psychiatrist). I am fortunate to share an office with an experienced and brilliant MD and he is a great teacher; we also get along well personally and have the same weird sense of humor. Of course, I am stressed out and worried as a new grad NP, but the workload has been manageable. Lesson: make sure the prospective employer has realistic expectations of a new grad NP and a good support/learning system.

Another important lesson is that a good Medical Assistant (MA) is worth their weight in gold! Our clinic has excellent MAs and each provider is assigned one dedicated MA. We also have an LVN and an RN. They have been integral to my ramp up as a new NP.

My patients have been nice (knock on wood), with a small-town friendliness. They are thrilled that I am a permanent hire and will be here at least 2 years. Our Medical Director has done a great job of discouraging drug seekers from coming to our clinic.

What is it like to work in a rural clinic? Personally, I like it, but it is an adjustment for a city girl. The scenery here is beautiful - mountains and trees. The main industries are tourism and lumber. Our area is famous for fishing, hiking, camping, hunting, and golf, with several national and state parks nearby; downhill skiing resorts and large lakes are 1-2 hours away. The town is very small, but it has a supermarket, drug store, movie theatre, and other essential shopping. The nearest rural hospital is 20 miles away, on a good wide road. There are medical airlift services to the nearest small city 50 miles away and to UC Davis and San Francisco if necessary. The people are very friendly. And there is no traffic! I live within walking distance of the clinic on a nice quiet street with a wonderful mountain view. There is a city of 100,000 people less than one hour drive away, with all major shopping requirements, and a civic center that gets big name entertainment acts. Amazon and mail order are also very popular. The closest city is also a major tourist attraction due to beautiful scenery and abundant outdoor recreation.

The cost of living is very low. A 1 BR apartment rents for about $500 per month. A small starter home can be purchased for $100K or so. I am paid the same as in San Francisco, where the average 1 BR apartment rents for $3,000 per month.

This clinic fulfills the Nurse Corps Scholarship public service requirement. It is also eligible for federal and state loan repayment and forgiveness programs. The compensation is excellent and the benefits are ok. They really want to retain providers, so work hard to accommodate them and are continuously recruiting. We are treated well and are left alone to do our jobs.

Potential downsides of the rural lifestyle: this small town does have several restaurants and pubs because it is a tourist attraction, but obviously the choices are limited compared to a big city. The people here are down to earth, and there are no "gourmet" options (which is fine with me). For a young single person, the social options are more limited than in a city. However, there are many community and church activities, and this is a good way to meet people. It is also easy to go to Redding, Sacramento, Lake Tahoe, Reno, or San Francisco for the weekend. Rural areas tend to be more conservative politically, which some people might find problematic. Everyone knows everyone and word spreads fast, so as a provider, one must be on their best behavior at all times. This also creates an interesting, and at times awkward dynamic, as the office staff knows all the patients and their business. My biggest frustration is that all the specialists are at least one hour away and the specialists are in short supply in this region, so it can take a long time for patients to see a specialist. This means we have to do more at the clinic, but this is a good learning experience.

For NP students and new grads: Please consider working in an underserved area. This doesn't mean you have to go rural - all big cities have such areas, too, either in the city or within a 30 minute drive. Here in California, even San Francisco, Los Angeles, and San Diego have underserved areas and communities. All of inland California has a shortage of providers, and that includes large cities like Sacramento and Fresno, which are also university towns with lots of young professionals and are still affordable. If you have an interview opportunity in such an area, go and check it out - you might be pleasantly surprised. The more flexible you are on location, the more opportunities you will have. Consider cost of living when evaluating compensation, too. $100K in an affordable area is going to go a lot further than $125K in San Francisco or Los Angeles. In an area which has a shortage of providers, the employer will be highly motivated to keep you, so they will likely make a much greater effort to properly train you and provide good working conditions. NPs with RN experience - you may very well take a pay cut with your first NP job.

I didn't have RN work experience, and no one in primary care cared - I got 9 job offers and have received very positive feedback on my job performance so far from other providers, the nursing staff, and patients. Yes, I have a lot to learn and am working hard on that. A patient recently gave me a big fresh trout he had just caught, and cleaned and gutted it for me. I was tickled pink! Many of the office staff came over to look at the fish and give me cooking ideas. (I will be having some staff over to share the fish).

The other providers have very realistic expectations of a new grad NP. They were very clear they expected me to "know nothing" my first year and are more than happy to teach me when necessary. Even my office mate, a brilliant MD with 30 years inpatient and outpatient experience, admits when he doesn't know something and is always checking uptodate and other resources to make sure he has the latest information. (Oh, and in an unsolicited comment, he said he preferred an NP without RN experience because he found them more likely to think for themselves as they have not been conditioned to just carry out provider orders - his words not mine, so don't get mad at me). So ask the right interview questions and do some shadowing if possible to ensure the job is a good fit with realistic ramp up and patient load expectations.

Reading some posters' negative comments about NP job prospects and pay and unrealistic expectations of new grad NPs on this forum caused me much needless stress and worry. Yes, there are great opportunities out there, but it is up to NPs to be flexible and put in the effort to find them.