Traveling NP

I am honored to have been named 2024 Locum Tenens Nurse Practitioner of the Year by Barton Associates! This inaugural award comes with a $2500 stipend and donates an additional $2500 to my charity of choice which is my family’s non-profit organization: Hope for Haiti’s Children. It is an amazing honor and I am truly grateful to live a life as a Traveling NP. See below for the link for the blog article and they also created a brief video interviewing me.

https://www.bartonassociates.com/blog/2024-locum-tenens-nurse-practitioner-of-the-year-sophia-khawly-msn-arnp-fnp-bc

I wrote this article for NPschools.com about what to ask when shadowing an NP. I think this is helpful for NP students, novice NPs, and even traveling NPs since we sometimes shadow other providers as part of our orientation.

https://www.npschools.com/blog/what-to-ask-when-shadowing-an-np

I chose to work in Massachusetts partially because its close proximity to many popular towns in New England. Although I worked in central Massachusetts, it was still within 30 min-2 hours of nearby towns. Here are my top recommended day or weekend trips nearby.

Boston:

I preferred not to live in Boston due the major traffic, but I enjoyed being close enough to take advantage of the history and culture. Since it is a large city, there is a lot to do and it is very diverse. I have been to Boston several times in the past, but it was my first-time visiting Cambridge – where Harvard is.

I recommend visiting: Boston Common Park; Boston Tea Party Museum and Ships; Isabella Stewart Gardner Museum; Freedom Trail tour; Boston Harbor, Downtown etc.

Newport, RI:

This is a cute New England town. I met up with my friend and we did the Cliff Walk. It was fun and you got to see some beautiful mansions on the coast. I thought it was going to be a boardwalk type of walk, but it did require climbing over some large rocks, so make sure you wear sneakers! The weather was perfect. We lucked out with a nice breeze and sunshine. They have famous mansions in town that were previously owned by the Vanderbilt’s or made as copies of French Palaces. They were gorgeous!

Hartford, CT:

Hartford is only 30 minutes from Springfield, MA so I actually flew  in and out of that airport. West Hartford is a nice area. They have Mark Twain’s House and Museum; Wasdworth Atheneium Museum; and Elizabeth Park Conservatory which are fun.

Cape Cod:

Cape Cod is gorgeous! I love the rocky landscape. It was nice to walk along the beaches and there were a lot of people doing water sports activities. They have lighthouses and views similar to parts of Maine. I recommend going to National Seashore.  They have a boat you can go on to cruise around. You can also go whale watching but I am saving that experience to do with my partner. I also recommend going to Pronvincetown all the way at the end for the shops.

Martha’s Vineyard:

I didn’t have the chance to go to Martha’s Vineyard but I heard from co-workers and friends that it is a lovely place to visit. You can take the ferry and spend the day there. There are a lot of cute shops and restaurants. Some people even go to the beach there but the water would be too cold for a Floridian.

Berkshires in the Fall:

This is where the New Yorkers and New Englanders go when they want to get away from the city. Being there for fall was absolutely beautiful! It was only a 40-minute drive from where I was working. I wasn’t there for peak leaf peeping but fortunately was able to see some red leaves which are my favorite.

I successfully received my Lifetime Platinum Status with Marriott! This will come in handy when I travel for leisure as I will get free room upgrades, free breakfast, and lounge access. Not to mention late check out, and other perks – for Life!

I agreed to extend my time in MA for 3 weeks. After last year’s snow car accident, I didn’t want to get stuck in a similar situation. So, I did not agree to the 6-week extension that would keep me here until November. By extending 3 weeks, I will be able to experience New England fall for the first couple of weeks in October. Fall is my favorite time of year. I am taking the remainder of the year off for the Holidays, so I figured working an extra few weeks wouldn’t hurt.

Of course, I never extend for free. I asked for an extra $5/hour to extend. An extra $5/hour for 3 weeks is only an extra $600. It’s not life changing, but I like to utilize my negotiation skills. My recruiter originally told me the site wasn’t looking to increase the rate. Not surprising because who is ever “looking” to do that? But I knew how desperate they were because it didn’t look like those physicians on FMLA were coming back anytime soon.

Thus, I told them it would be a deal breaker. I wasn’t surprised when the site agreed to increase my hourly rate, and I then confirmed the 3 week extension.

Every time I take a sabbatical, the first month off is a bit challenging. I miss work, I miss being productive, I wonder if I should be working more. Then by the 3^rd month, I’m like – I cannot imagine myself going back to work. I am enjoying my freedom and stress-free life.

Going back to work this time after spending 3 months in Barcelona was difficult. I couldn’t imagine myself seeing 20 patients per day again. My previous job before the sabbatical was chill since it was a new clinic, we were only seeing a few patients per day. Fortunately, I was given a ramp up schedule in MA so I wasn’t just thrown in.

Starting my 2^nd month in the assignment, which is when you really know if the assignment is good or bad, is when I started to feel overwhelmed. I dreaded going to work and felt burned out by the end of the day. I think it was because that’s when I started seeing majority of the physician’s patients that is out on FMLA, and there was a lot of catching up to do (patient wise).

I think I was also having imposter syndrome. Normally I am a confident NP, considering I have over 10 years of experience and have worked with so many different populations, and followed so many different providers. But coming back from a sabbatical I felt a bit rusty and not as sharp as usual. After 1-2 weeks, this subsided and once I felt confident in myself again, I no longer felt overwhelmed.

Even though taking 3-6 months off every year is rewarding, it can definitely take a toll on you professionally. I have to remind myself after starting to work each time after a sabbatical, that it is ok for me to be a little rusty in the beginning. But practicing in healthcare is similar to riding a bike, eventually it all comes back to you.

Many traveling nurse practitioners have a high deductible health insurance plan (HDHP). This is either because they are getting it from a W2 agency or are self-insuring. If you have a HDHP, then this post is for you.

Having a HDHP allows you to contribute to a Health Savings Account. The maximum contributions for a single person in 2024 are $4150 and $8300 for a family. The money in this account can be invested and used long-term. Do not confuse this with a Flexible Spending Account which is owned by an employer, and needs to be used by the end of the calendar year. An HSA is owned by you and is an investment account.

The HSA is often referred to as a triple tax savings account. This is because money is contributed to the account pre-tax. It grows in the account tax free. And it is withdrawn tax free, as long as it is used for health care costs.

For example, if I wanted to contribute $1000 to my HSA, it would be taken out of my paycheck before income taxes are paid. Or if I am a 1099 worker, I can deduct the contribution on my taxes. Then I would select a fund in my HSA to invest my $1000. Let’s say in that same year I had a dental procedure done. I can withdraw the funds from my HSA to cover the expenses of the dental procedure, without paying taxes. However, this is not recommended.

Instead, it is recommended that you hold on to the receipt of the dental procedure, and allow the money in the HSA to invest and compound long term. Fast forward to retirement age, I want to live off of my HSA. I can withdraw money tax free, as long as I have medical receipts for proof, even from 20 years ago. Let’s say my HSA has now grown to $100,000. Now I would withdraw the $1000 to reimburse me for paying for the dental procedure many years ago, tax free. And at that point I can use the $1000 for my everyday life. I can withdraw more money from that $100,000 growth as long as I have other health care related expenses in the past to support it.

For HSA purposes, healthcare costs can include a variety of expenses such as: medicare premiums, doctor visits, medications, acupuncture, women’s tampons, contact lenses, dental work etc. So, there are many items you can easily reimburse yourself for using over the years.

This is not financial advice, and is a bit more complicated then it appears. Please do your own research and feel free to read this article for a better understanding.

HSA – The Ultimate Retirement Account

I recently interviewed my friend that is an Aesthetic NP and business owner for NPschools.com. Check out the article if you are interested in transitioning into this specialty:

https://www.npschools.com/blog/day-in-the-life-of-an-aesthetic-np

Working in MA has had its ups and downs. I am working at a hospital owned internal medicine practice. The first week was orientation which was good because I wasn’t thrown into seeing patients. I learned the EHR and shadowed. I found out that week that I would be working between two clinics which I wasn’t aware of before starting. I am mostly covering vacations in one clinic and then the other clinic has two physicians on FMLA that I am covering.

Apparently the two physicians have been in and out of work over the last year, so patients are frustrated that they haven’t been able to get in to be seen. Most of them haven’t had any labs done in the last 12 months, nor are aware of test results they completed over the last 6 months. I work 3-4 days at this clinic which can be exhausting, since the patients often come with a list of 12 problems they need addressed since they haven’t been seen in a year. 

At the other clinic, I mostly see acute visits and hospital follow ups. The patients are friendly at both clinics and are quite diverse – a mixture of Irish, Russian, Puerto Rican, Italian, and Polish patients. I do miss seeing children because pediatric patients are usually more straightforward and have less problems than adults. They make it a nice balance between seeing complex adult patients.

I like that I have admin time, 30 minutes before lunch and 1 hour before the end of the day. It definitely helps me stay on schedule and to finish my workflow. Most of the time I am able to finish early, which is always a plus. During the interview, the site made it seem like I would be seeing 20-22 patients per day. However, they allow 40 minutes for ER/hospital follow ups and for patients that are 80 and older. So, it is unlikely I will ever see that many patients per day. I think the most patients I have seen per day is 15.

There are many other NPs and PA’s that work at the clinics that are very friendly. They warned me about some of the physicians in the practice, that they can be petty and have you send THEIR patient refills if you saw their patient last for even an acute unrelated visit. This happened to me when I saw a patient for ER discharge for headache. The following week I was on vacation, and when I returned, there was a message in my inbox about the patient requesting a different medication for their headache. Their PCP told the patient I was on vacation and they would have to wait until I return (even though they are the PCP), which I found ridiculous.

About 6 weeks into the assignment, I was asked to extend. I told them I would let them know when it’s closer to the end. If I did extend, it would only be for a few weeks, not months. My main incentive is that I would be able to experience my favorite season here, which is Fall!

Occasionally, 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.

• Can I work with multiple agencies at once to find an assignment?

Yes, I highly recommend working with 3-5 agencies at one time when searching for an assignment. This will increase your options and the probability of finding an assignment in the location you are interested in. It can also be beneficial to have multiple assignment offers to negotiate an increased rate. Recruiters understand that you will be working with other agencies so they will not take it personally or be upset.

As a traveling nurse practitioner for 9 years now, I have never taken a housing stipend while on assignment. I have always just had the agency and site cover and book my housing. I know many traveling NPs that have taken housing stipends and some of them ask why I have never pursued that option. There are many reasons I have never asked for or opted for a housing stipend. Having a housing stipend can be beneficial, because you can find housing on your own at a cheaper rate and pocket the extra money.

Personally, the extra profit isn’t worth it to me. I prefer to have my agency book my housing. Initially, I had them find housing options for me and I selected one of them. But nowadays I find my own housing and then have the agency book it for me. 

One reason I don’t choose the housing stipend is because I rarely work 13 weeks straight on an assignment. I tend to have other social activities that require me to take at least 1 week off per assignment. When the agency covers my housing, they will pay monthly for my housing including the week I am off. When an agency offers a housing stipend, they often try to give you only 75% of your housing stipend for the month that you take 1 week off. In their eyes, since you aren’t working the entire month then they will not reimburse you for housing for the entire month. 

Another reason I do not prefer the housing stipend is because I tend to be non-committal. After working over 26 different assignments, I know that not every assignment will be a good one. I have left assignments early several times when it was not the right fit. I have found that when an agency pays for your housing, you can easily break the apartment lease and suffer no repercussions. This may be different if you have your own contract that you are using the housing stipend to pay for, and may have difficulty ending the lease early or would have to pay some extra fees. Although I have gotten better at selecting the ideal assignments for me over the years, (I haven’t had to leave an assignment early in the last 7 years), I like to know I have the option to do so if needed. 

Additionally, I already save 90% of my income so I don’t think I need to nickel and dime every last dollar or opportunity. For example, sometimes I am given a 2-bedroom house or apartment, and I don’t even consider renting out the second bedroom because I prefer my privacy. Most of the time I stay in really nice places such as apartments on the beach, condos with a city view, or spacious houses with extra rooms for guests. These places tend to be expensive about $4-5k per month in inexpensive states such as Florida and Kentucky. If I asked for a housing stipend in these type of states, they would only offer half of that as a stipend, about ~$2k/month, because they know I could easily find housing in that range. Since I am a nomad, I like to have a comfortable place to live.

Although I find housing on my own but have the agency pay for it, I don’t want the added responsibility. I don’t want to have to set up the contract and give a deposit. I don’t want to pay up front and have to wait weeks to be reimbursed. I often find housing on furnishedfinder.com. It has a reputation for being reliable but I do not want the risk of paying a deposit/1^st month’s rent for a place that might be a scam.

Some locations such as California can be expensive and have limited housing options. I prefer that the ultimate responsibility of housing falls on the agency and not on me. So, if there are no options they will just have to increase their budget until they find me something, which has definitely happened in the past. In addition, I like to stay at extended stay hotels occasionally so that I can earn elite status and points for travel during my leisure time. Sometimes these hotels (such as Marriott residence inn) can cost $150/night which would equal to $4600/month. Most of the time, this would be more expensive than a housing stipend provided. 

Anyways, I have shared many of my personal reasons for never taking a housing stipend. I may be open to it in the future though if I find housing on my own that would allow me to profit at least $1k/month from the housing stipend. I know several traveling NPs that have profited a similar amount before. 

Please share in the comments below, your experiences and preferences between taking a housing stipend vs having the agency book your housing.