Back in the Game


After working at one assignment for the past year, I had to get back in the groove of working in locums again. I was used to working with the most amazing recruiter, which made me have high expectations for all other recruiters.

My priority for my next assignment was for it to be a 1099 job. I had worked most of the year with a W2 agency and had also paid tons of taxes to Uncle Sam. I needed to work with a 1099 agency to allow me to have more tax deductions at the end of the year. Unfortunately, this meant that I couldn’t continue working with my favorite recruiter for my next assignment.

My experiences so far have been a bit rocky. Prior to presenting me to an assignment, I felt like this one recruiter/account manager put me on the spot as if it was an official interview. He asked me “what is special about you, that would make me want to present you to my site”? I was appalled because I know I am great, but I didn’t feel as if I needed to explain to him the reasons why. Because the reality is that by me working with this site, I would be providing him with his income. This is a type of question I wouldn’t mind answering someone interviewing me from the site, but not the agency….

Another recruiter called me SEVEN times in one day! I kid you not. If this were a relationship I would have broken it off long ago! Another one of my pet peeves is when I am not scheduled for a phone interview with a site, but the site will just randomly call me. I think it is more professional when you provide your recruiter with good interview times, and then they confirm the time the site will be calling you. Instead, I had a site call me during the mid-afternoon while I was at work. Then we were playing phone tag for the rest of the week.

I decided to accept a brief assignment with a new agency I haven’t worked with before. The credentialing process hasn’t been the smoothest. For instance, I was told by my recruiter to go to a lab site and request a urine drug test (without an order). Usually the agency provides me with a confirmation form for the urine drug test and I just bring in that paper to my scheduled appointment. I called the lab site prior just in case and they told me I needed to register for the urine drug test prior. I informed my recruiter, and she gave me a number to register for the test. When I called, they said the place of employment had to register me. -_-

The issue was resolved but sometimes it boggles my mind because don’t these people deal with this on a regular basis?

Another credentialing contact person requested I sign the protocol with my supervising physician. She only sent me the last page to sign via email. I had to let her know that I would not sign a protocol without seeing the complete set. Also, the board of nursing requires the original protocol with original blue signatures. Typically the agency will fed-ex me the protocol to sign and send back to them via fed-ex. So just printing the protocol and scanning it back to them wouldn’t make it official.

Many of my readers have shared some of their frustrations when starting locum tenens, and unfortunately a lot of them are due to their recruiter/agency. I was so used to working with some great recruiters and agencies, I almost forgot how bad others could be. Alas, I had to continue working with this agency because the assignment they offered really matched my current needs. I was a bit disappointed that my recruiter didn’t ask me how everything went after my first day of the assignment. It was something I was used to when working with other recruiters, and I think it’s a nice gesture.

After writing this, I am going to send my favorite recruiter some flowers as a big Thank You for Being Awesome! This pretty much sums up why I often advise my readers to reach out to me personally, to recommend specific agencies and recruiters, because they are not all created equally.

Ending of a Yearlong Assignment

The end of my yearlong assignment in Virginia was bittersweet. When I finally accepted that I needed to move on, I was reminded of one of the best parts of locum tenens – looking forward to the end. The things that used to bother me before didn’t bother me anymore. If the medical assistants were short staffed and took forever to bring my patient back, I no longer cared. The demanding or pessimistic patient that normally frustrates me, no longer impacted me.

It was tough to say good-bye to my patients. For some reason the majority of them were in a good mood during my last visit with them. For example, one of them randomly said: “You are really great. I’ve never had anyone explain things to me the way that you do.” This made it hard to tell her I was leaving. During a follow up with another patient, he said: “Man, you are the best! You remember everything about me and follow up on things from last visit. You review notes from my specialist before I see you. You don’t just fix everything with a pill. You explain things thoroughly and find natural ways for me to improve.” After telling him that I was leaving, he nearly caused a scene.

Many of the patients were extremely disappointed, some even cried (both men and women). I re-focused them to realizing that most importantly their health had improved significantly over the past year, and they know what to do to continue on that path. I also reassured them that since I would be working in their Florida clinic, I would be able to check on them from time to time and perhaps even see them again in the future.

I think I became too attached to the patients, but with our healthcare model, it was hard not to. The patients came every month or even more frequently, some I spoke to via phone on a weekly basis. I knew their husbands and wives pretty well too. Our goal is to keep our patients out of the hospital, and the only way I knew how to do that was to develop trust and bond with them.

My last day was extremely sad. I had never cried so much in my life. Not only was I going to miss my patients but I was going to miss my co-workers too. Our clinic is big with about 50 employees, more than half of them I was really close to. Any time one of the physicians or medical assistants would mention they were sad I was leaving, I would break down and cry. I was even super close to the Medical Director, who honestly acted like my guardian angel while I was there. It was weird knowing I wouldn’t be seeing them on a daily basis anymore. On the bright side, the Medical Director promised to fly me up for their annual holiday party and we agreed I could always come back in the future to help out when I wanted to.

The clinic surprised me with a sweet party. Everyone went around in a circle and said some nice words about me. The Center Manager told me he was so glad that I came because I brought a new uplifting energy to the clinic and between the other PCPs. The clinic also surprised with me with this beautiful gift:

I never knew leaving a job would be this hard! Yet, I am so grateful for my experiences there over the past year, and will continue to cherish the relationships I have built. I am looking forward to my next adventure and will try not to stay at one place as long again.

Philadelphia

During one of holiday weekends, I went to Philadelphia to visit for the first time. It was a 5-hour drive but I opted for the 1 hour flight instead.

I had a fantastic time in Philly! It was pretty diverse and there was so much to do. I visited tons of museums, including looking at my favorite artists.

My visit also reminded me of why it is so great to be an American! I toured the independence hall and the liberty bell. It’s crazy to think that our forefathers had the courage to rebel against Great Britain, the most powerful country in the world at that time. It’s even more amazing to think that the 13 original colonies all united together to fight for their beliefs.

Why I Decided Not To Go Perm

My previous post demonstrated all of the good reasons I should become permanent at my current assignment. I’ll now explain why I chose not to go that route.

I actually spent a few days leaning towards going permanent. There are two main reasons that I chose not to. The first reason is that I received my extension bonus and realized after taxes I was only going to take half of it home. This reminded me that one of the main reasons I love working in locum tenens, is that I can alternate between being a W2 employee and being a 1099 contractor. This allows me to deduct more taxes at the end of the year.

I am currently working as a W2 employee and was reminded that I needed to work the remaining 3 months of the year as a 1099 contractor, or else I would be paying $60k in taxes at the end of the year! As much as I love my current job, I don’t think any job is worth working just for your income to go to uncle sam.

The idea of becoming a partner at the clinic initially sparked my interest. I compared my current salary and benefits with those I would earn if I were to become a partner. An experienced nurse practitioner at my job confided in me her current salary, and just by being a traveler I was making $20k more than her. In addition, by being a partner, after the initial raise and the quarterly bonuses, this would equate to an extra $20k. I calculated the cost of my living arrangements for the past year and recognized that my job had paid $20k over the past year for my rent, furniture rental, cable/internet, and electricity.

So just to review, becoming a permanent employee could possibly push me back $20k. Even if it didn’t, becoming a partner wasn’t even worth it because I was already receiving the financial benefit through my covered housing costs alone.

The other main reason I decided not to go permanent is because the longer I stay at my assignment, the more drama I began to notice. I observed that the working environment isn’t always quite fair. Some physicians have an easier case load than others, while the most hard working physicians often go unnoticed. I also had some issues with a couple of my medical assistants, where they get too comfortable with you that they think they don’t need to do their job. I had been working in locums for so long, that I had forgotten about the annoying bureaucratic issues of working at a permanent job.

I asked a handful of people for advice; most people told me that if I liked my job then I should consider staying. I never saw myself settling down in Virginia, but wondered if the job was worth it. We do spend the majority of our time at work. And it would just be a year or two, and I am pretty sure my job would still allow me to travel abroad all of the time.

My sister who knows me best was the only person that told me not to stay permanently and to continue being a traveler. She told me not to think about the patients because they come and go. She told me that I am living the best kind of life being able to travel and have constant new experiences, as well as tons of freedom. She told me that I am still young and should think a bit more selfishly.

That pretty much sums up the main reasons I decided not to stay permanently. What do you guys think? Did I make the right decision?

How I Almost Went Perm

When I realized I only had 1 more month left of my year long assignment, I found myself becoming sad. I was close to my co-workers and I truly cared about the 250+ patients in my panel. I began to wonder if I could see myself working anywhere else.

I mentioned to one of the physicians that it was bittersweet that the end was near. She replied that I should consider becoming permanent. She told me that I wouldn’t have to stay there forever, but could commit to 1 or 2 years. I laughed because I never even thought a permanent job would be an option for me.

Yet, I started to ponder over the idea of staying there permanently. The clinic wanted me to help them open one of their new clinics in Florida afterwards. I thought about how I would have to start all over. I would have to get to know 250+ patients from scratch, in comparison to already knowing my current patient panel pretty well. The most challenging time at my job were the first 6-9 months becoming familiar with the patients and helping them become stable. Afterwards, my patients improved so much, that their frequent visits with me became a breeze.

My patient outcomes were really good, that I could have easily become on track for partner status. Becoming a partner with the firm meant an automatic raise, quarterly bonuses, and some other perks such as an easier referral process.

Although there was a permanent physician starting right after my assignment was ending, I knew me staying would really help the clinic. I could continue to carry my current patient panel, while the new physician accepted all of the new patients. Our clinic was growing very quickly, about 50 new patients per month, and there was no provider for them to go to. Nurse practitioners at my site have a panel of about 250 patients, where as the physicians have a panel of 400 patients.

This meant that I could continue with my current panel since I was already maxed out. I wouldn’t even have to take any new patients. Or the physician gave me the idea that if I agreed to stay permanently, I could discuss with the medical director that I would stay with the possibility of giving a handful of my most complex patients to one of the partner physicians. Since those partner physicians have been there for years, their panel should be really stable since they have a long-term relationship with their patients, and could afford to acquire a few more complex patients to their panel.

This all sounded pretty great, but my next posting will be about the reasons why I did not choose to stay permanently.

Locum Tenens Blogs – September 2017

 

This month, I enjoyed reading Nurse Practitioners: Doing What You Love, Loving What You Do from TinkBird which gives some suggestions on how nurse practitioners can empower themselves.

 

How Will Working With Millennials Change Your Healthcare Career? was an interesting article to read since I am a millennial myself. I liked how it mentioned that locum tenens may be a good fit for many millennials.

I also recommend checking out these two articles from Barton Associate’s Blog:

7 Reasons to Work With a Locum Tenens Agency Instead of a Medical Group

7 Ways Healthcare Professionals Can Reduce Stress and Burnout

 

 

Questions from Readers – September

Each month I will include a blog entry answering some of the most common questions I get from readers about locum tenens as a nurse practitioner. Feel free to comment any questions you have or email me at travelingNP.com@gmail.com.

 

  • I have worked at a permanent job for over 10 years. I am now interested in trying out locum tenens, but I am a bit worried about the transition. You always seem so confident so was wondering if you had any tips for us newbies?

 

This is an example of a pretty common question I get from my readers. I think any major step in life can be a bit nerve wrecking; this includes buying a house or getting married. Nothing in life is guaranteed but if you want to start a new adventure, travel to new places, and build yourself professionally; working in locum tenens can be a great option!

Here are a few tips of I have for those of you initially starting a career as a locum tenens nurse practitioner:

-Stay open minded, especially with your first assignment. Your first assignment will be a learning curve, so don’t think you HAVE to go to the best place on earth. (I have seen a lot of you act on this advice, which is great).

-Work with multiple agencies. To increase your probability of finding the right assignment, you are going to have to work with more than one agency. Yes this means tedious paperwork, but it pays off in the end. You can also compare benefits and choose which one you prefer. (Example: working W2 vs 1099, living in a hotel vs having an apartment).

-Always look for your next assignment. After working the first month of your current assignment, you should already be thinking about where you are going next. Should you be working on obtaining another license? Start looking at states you are interested in to see if there are job options there that meet your needs. The last month at your current assignment is crucial, as that’s when most jobs will open up (last minute). You can easily have your next assignment secured 1 to 4 weeks in advance.

 

South America

My most recent international trip was to South America. I went to Colombia, Argentina, and Chile. I was originally supposed to go to Brazil as well but my visa didn’t make it in time.


My first stop was in Buenos Aires, Argentina. The first day I was there, I witnessed the person next to me get his Iphone stolen from him right out of his hands. This was definitely eye opening since I thought Argentina would be the safest place in South America. My favorite part of Argentina was watching a tango show one evening.

After a few days I went to Santiago, Chile. Ironically, it had been the last place I was looking forward to going to but ended up liking it the most. I think the combination of being in a big city with snow capped mountains and awesome seafood did the trick! The weather was a bit cold but I enjoyed being outside with the awesome scenery.

To end the trip, I went to Cartagena, Colombia, which is a small town on the coast. The people were very friendly and hard workers. No one begged for money, but everyone was hustling and trying to sell you something. I had a lot of fun and enjoyed visiting Castillo San Felipe de Barajas, which is a super-fort built long ago by the Spanish.

This was my second time in South America (I had gone to Peru a few years ago). As always, I enjoyed learning about the local culture and trying new things. I hope to get back down there to visit Brazil once my visa comes through.

Florida Nurse Practitioners

Finally some good news for Florida Nurse Practitioners! Starting on January 19th, 2018, Florida RN’s will be able to convert their licenses to a multi-state license. This means we will be able to join the Nurse Licensure Compact. As a result, we will be able to acquire quicker licensing endorsements when applying in the other 25 states that are part of the Nurse Licensure Compact. Some of these states include: Texas, North Carolina, Georgia, Maryland, Missouri, and Utah. Although we may use our RN Florida license in these other states, we will still need to obtain new ARNP licenses. However, the wait time will be cut in half since we won’t have to wait for 2 licenses to be processed.

For more information, visit Enhanced Nurse Licensure Compact Implementation.