Traveling NP

My first month working in this new geriatric clinic was great. But then things quickly changed. That’s why I normally wait until the end of the 2nd month to decide if I want to extend. 

One day the clinic manager told me the medical director said I would be on call one weekend in January. I told her I do not do call and will make sure my agency notifies the medical director. Which they did. That’s actually the first time as a locum I have ever been asked to take call.

Then one day HR announced that the locums NPs cannot see patients alone. There has to be a physician on site for billing purposes. That was random since the physician at my clinic had been on vacation for a week and I was working by myself the entire time. Everything went smoothly. Not to mention that I have an autonomous NP license in Florida. Normally to bill under the physician (very common for locums) they just add the physician’s name to the billing versus making sure the physician is physically in the building. Weird. 

Now working in January, it has been more challenging working in this clinic. Since they are expecting to have a lot of new patients in January and February, they changed the one hour appointments for new patients to 40 minutes. They are trying to get in as many new patients as possible. I mentioned before that the MAs take 1 hour for the intake with the new patients. This has been a struggle. It has been impossible to get them to cut that time in half. 

My first 2 days back from the holidays I was upset at work. I had a new patient scheduled at 3:30pm. The new patient visits typically take 2 hours long between them coming in late, filling out their new patient paperwork, the MAs intake, and their visit with me. There was no way I was going to finish on time at 5pm. Then the following day, I had an add on for a new patient at 11:20 am. There was no way I was going to make it to lunch at 12pm. I requested they move those patients, but I saw this as being a daily problem.

So I called the medical director and told him I wanted to change my schedule, because I did not want new patients being scheduled as the last patient of the morning and afternoon shifts. I could still see the same amount of patients but I wanted the new ones to be earlier. He said that the schedules are fixed for all of the PCPs so I could not change mine. He told me a lot of the other PCPs are also complaining but just to be patient while the clinic manager works on making the MAs more efficient. 

I think it would be better if they had the patients come in an hour early to have their intake completed by the MA, and then complete their appointments with the provider at their scheduled time slot. It’s all a work in progress since the clinic is so new. I hope they figure out the best system because we aren’t there as of yet. 

The following week, I was told that locums nurse practitioners couldn’t see new patients anymore. They wanted to bill under the physician so they wanted the locums nurse practitioners to only see established patients. Apparently, since they are a new practice, they are being closely watched by the state, so they have to do everything by the book. I felt bad for the physician in my clinic because that meant he was going to be busier. It benefited me since I no longer have the stress of seeing new patients, whose visits can take 2 hours or more. 

The work has slowed down again for me, I only see about 2-3 patients per day. One time I saw 5 patients and it was great. But I guess I can’t complain. Since the clinics are so new, there is a lot of work to be done. I am not sure what it would be like to work at one of their more established clinics, but I would be open to it in the future. 

I had a fun time being interviewed for the Money Noticias Podcast a few months ago.

Check out the podcast episode below and let me know what you think!

How to Reach Financial Freedom and Millionaire Status as a Travel Nurse Practitioner with Sophia

Listen on Apple Podcasts: https://podcasts.apple.com/us/podcast/money-noticias/id1665412564?i=1000651747047

“In this episode of Money Noticias podcast, Sunem and Israel interview Sophia, a second-generation Haitian-American from Miami, FL. She has been a nurse for over 15 years and currently works as a Traveling Nurse Practitioner. She has worked in 10 different states and traveled to over 50 countries for leisure. Sophia became financially independent in her early 30’s and recently started offering financial coaching to her peers. In this episode you will learn: How Sophia achieved financial independence in her early 30s through her career as a nurse and traveling nurse practitioner. The importance of tracking expenses and investing in index funds for financial success. Sophia’s experience with real estate investments and being a landlord with her sister. Tips on travel hacking to travel on a budget and using credit card rewards for flights and hotels. Sophia’s approach to using money as a tool to live a life she loves, including taking sabbaticals and mini-retirements. Strategies for reaching financial independence and starting on the path to financial success.”

When I first became a traveling nurse practitioner, I remember easily profiting $30k from one 3-month assignment alone (after taxes and expenses). $30k was enough money to cover my expenses for one year. After having this amount in savings, I felt invincible. I no longer felt pressured to work to earn income. If I didn’t like a job or the agency wasn’t giving me what I wanted, I threatened to leave. And this was not an empty threat. Why put up with a stressful environment when I could afford to take time off?

Years later, I learned that there is a term for this. Those in the financial independence space call it an “F-You fund.” Once you have enough money in savings to cover your expenses for at least a year, you are more comfortable asking your employer for things you want. For instance, if you ask your employer for a 3-month sabbatical and they say no, in your head you say “F-you” and can choose to quit on the spot. You feel empowered to do what you want because you can afford it. At the same time, once an employer sees you do not NEED to be there, they are more willing to work with you.

For example, let’s say you want to work remotely and your employer says no. When you give your two week’s notice and your employer is surprised, they may be willing to work with you after all and grant your request to work remotely. Having that F-You Fund enables you to ask for what you want without being afraid of repercussions. The worst your employer can say is No, and if you do not want to accept their no, you have the option to leave.

Besides having 3 to 6 months of emergency savings, I think having a year’s worth of expenses saved up is very beneficial. It allows you to feel more empowered in the workplace. You don’t have that pressure that you NEED to be working in order to make ends meet. It provides a lot of freedom. It allows you the option to take a mini-retirement or go part-time for a certain period of time. It also makes people feel more comfortable asking for a raise. Having an F-You fund as a traveling nurse practitioner is powerful.

In January 2022, I started working telemedicine on the side to prepare for my 3-month sabbatical. I ended up barely working telemedicine during my sabbatical because I was pretty busy. I then quit telemedicine in October 2022, because the pay structure changed from hourly to per patient. The platform wasn’t busy enough to see several patients per hour. So instead, you were technically “on call” and someone from the telemedicine company would text you if there was a patient waiting. This didn’t match with my standard of living so I ended up resigning. 

In 2023, when I took another 3 month sabbatical, I had more free time and sort of wished I had some per diem telemedicine work available. Since I was planning on taking November and December off for the holidays, I decided to apply for telemedicine work. I liked having the option to work a few hours a week if I wanted. Plus I wanted the option to work remotely in case I decided to live abroad while waiting for my boyfriend to get his US visa.

While in Colorado, I ended up finding a good telemedicine company to work for. I did the training on the weekends and picked up a few shifts to get familiar with the platforms. This company offered a mixture of synchronous and asynchronous visits, which I liked. Sync visits are video or phone visits. Async are messaging visits. The messaging visits are when the patient completes a questionnaire regarding a certain medical topic and you review their answers, message them for any clarifications, and then prescribe the medication. 

I was trained to work with 3 different companies on the platform. Initially I was a bit annoyed because each platform has their own guidelines to follow so it was time consuming to refer to the guidelines. For example, one company wants you to give a 90 day supply of medication without further refills while another company wants you to give a 30 day supply with 1 refill. Each company also has certain snippets you have to use during the visit, so you have to make sure you send the required snippets before, during, and after the visits. Eventually you get used to it and it doesn’t take too long. 

At first I was disappointed to learn how little they pay for the async visits. Depending on the company it can range from $6-10/async visit. The video sync visits pay pretty well at $20-27/visit. Eventually, you get used to doing the async visits that it literally can take 1 minute, so $6 per 1 minute of work is not bad. 

The nice part is you can just jump online and complete async visits whenever you want. In order to complete sync visits though, you have to schedule yourself ahead of time. I usually only schedule myself when there are incentives. For instance, on the weekends during busy hours the telemedicine company offers an extra $25-50/hour to sign up for shifts. So, I would get paid that hourly rate in addition to the per visit. Often this ends up being $100/hour.

Not bad to make $100/hour while in the comfort of your home. I am usually multi-tasking by reading, watching my show, or doing housework too. And I am happy to help patients get simple treatment for basic things like a UTI, yeast infection, or acne. The patients are very grateful and nice so it can be pretty rewarding. The video visits tend to be basic cold symptoms or rash. The async visits are usually chronic medication refills, ED, UTI, birth control, or herpes. 

So far it has been nice to make an extra few thousand dollars per month working telemedicine. I have been trying to use this income as “fun money”. Treating myself to things or others I normally wouldn’t. In 2024, I plan on spending a few months in Europe with my boyfriend again, so I will be glad to have the option to work telemedicine. This is great for when I want to be productive or keep up with my skills and make some extra cash to splurge. 

Sometimes I wonder why don’t I give up in person care and just do telemedicine because it is so easy…. I think if I ever come to the point that I do not want to travel for work anymore I would just transition to telemedicine part time. 

Check out this article I wrote about the different NP specialties and who would be a good fit for each one vs some of the cons:

https://www.npschools.com/blog/how-to-choose-an-np-specialization

I had worked in Bradenton, Florida on and off for 2.5 years. During that time, I became close to several of my coworkers. Clearwater, FL is a one-hour drive from Bradenton, FL. So, while I am on my current assignment, I planned a get together with some of my prior co-workers. Some of them still work at the same clinic, while others do not.

It was actually so much fun and I am glad I was able to get us together. I was impressed that 95% of the people I invited made it. There is something special about people you work/worked with. Only they can understand the good and bad times at work. We laughed the entire time, reminiscent of the past but also catching each other up with the current.

We had such a good time that everyone agreed to do it again soon. This time I may invite a few extra people. Even as a traveling nurse practitioner, I am still able to form strong connections in the workplace. Although I cant see or talk to them on a regular basis, it is still worth catching up time to time. 

I am working for a brand-new clinic in Clearwater, Florida. They just opened one month prior to me starting. They are a Medicare advantage plan clinic, seeing geriatric patients only. My orientation and training was one week long which was nice. I had a full day of EHR training which was needed. I had used this EHR before but 7 years ago. Part of the reason I decided to move forward with this assignment instead of postponing it when I was tired from my travels, was because I knew the first week I wouldn’t be seeing patients. 

I shadowed the other providers and completed HIPPA and OSHA training for the millionth time. There is only one physician at my clinic but he is really nice. I am covering a nurse practitioner that is on maternity leave. Everyone is really friendly and welcoming. The clinic itself is big, but the staff size is small. I am used to working in a similar geriatric clinic with 50 employees in one clinic vs 8 employees here. The company has multiple new clinics in the Tampa area. The company has been around for a couple of years and have other clinics throughout the USA, but they are still learning/growing. 

It has been very interesting working at a brand new clinic vs the geriatric clinic I normally work at that has been around for 30+ years. The MAs are very helpful here during the new patient visits in gathering the intake. They do half of my job by asking about the patients screenings, fall risk, ADLs, dementia screening, social/family/medical history, and medications etc. It takes them an hour to gather all of this information. This may be an issue once the clinic is busier seeing several new patients per day. So far I only see 2 new patients per day and maybe 1 or 2 follow ups. I believe in January it will be a bit busier, but no where as busy as what I am accustomed to. 

In the other geriatric clinic, I would often see 4-5 new patients per day and 8-10 follow ups. This clinic provides 1 hour visits for new patients and 30 minutes for follow ups which is nice. Since it hasn’t been that busy, it has given the staff time to figure things out. I am not a big fan of the EHR for this model. We are using e-clinical works here. For a patient that has 35 diagnoses and 15 medications, the EHR makes it difficult to multitask within the chart. So, if I am typing in my assessment and plan I cannot simply refer back to the labs. I would have to exit that area and click into the labs separately. This makes the documentation pretty time consuming. 

I prefer the other geriatric clinic’s EHR because it is an internal one they created, so it is very PCP friendly. Also, we have to send our consult notes to billing to review before we can sign off on them which is weird. Especially for managed care since we do not bill per encounter.

My current clinic is less strict about referrals which is nice. They do not have to be approved by management (for now). We don’t have a nurse to oversee the MAs or a social worker/case manager yet. I believe they will hire for this when the clinics get more busy. In fact, the MAs even have to process referrals since we do not have a referrals coordinator yet.

The patients have been very pleasant and not as complex as I am used to. Probably because the Clearwater, FL area has a higher socioeconomic community than other areas I have practiced (in regards to the geriatric population). 

It’s nice not being super busy, and being able to spend as much time as I want with complex patients. I think about how the other geriatric clinic has PCPs seeing 18-20 patients per day, which is crazy. I think the maximum patients per day seen with this company is 10-12. I do appreciate how well organized the other geriatric clinics are, but they’ve had decades to figure things out. Working for a newer company/clinic definitely has its challenges. 

For example, we do not have all the typical in house medications we would need yet such as Kenalog for joint injections or even lidocaine. The MAs are not IV therapy trained so if a patient needs IV fluids either the physician or I would have to start an IV, even though it has been years since either of us have done one. We don’t have an xray tech or an ECHO tech. We are just practicing at a limited capacity. 

I am enjoying my time so far, but I will see how things go to see if I would want to help them at other clinics in the future. 

As I have mentioned in the past, I always get a work rental through National. If you do not drive your own car to an assignment, the agency will provide you with a rental car for free. Even if the agency uses their own preferred rental car company, I always request that they book my rental car through National.

I love using National because you can choose from a multitude of cars off the lot, instead of just taking whatever the car company gives you. Additionally, once you rent with them for a certain amount of time, you easily become an Elite member and get free upgrades (meaning you can choose even nicer cars from the elite section). 

For my Clearwater, FL assignment I was happy to get an Audi Q3 as my rental car. My agency booked a standard rental car through National, and when I went to pick up my car, they had an Audi Q3 available in the elite section. So, I was able to upgrade to this car for free. I have always been a car person and used to have an Audi personally, before I gave it up after being a full-time locums nurse practitioner. 

I forgot how smooth yet sporty, Audis can be. It definitely makes my commutes more enjoyable and I find them to be more fun. I am grateful to be driving a car I normally would purchase on my own, but at no cost to me. Being a traveling nurse practitioner not only allows you to save on the cost of having your own car, but you can even drive luxurious cars for free! The best part is that I am not responsible for any maintenance but can drive a car of my choosing. As I have recommended many times in the past, travel NPs – use National!

At the end of 2023 I was interviewed on the Millionaires Unveiled Podcast.

They labeled my episode as ‘Livin’ La Vida Locum Tenen’ which I think is creative and funny. It’s only a 30 min episode so check it out in apple podcast or Spotify:

https://podcasts.apple.com/us/podcast/millionaires-unveiled/id1313152833?i=1000645991454

Public service announcement: If you have not renewed your DEA certification since 2023, there is a new requirement that you have to complete 8 hours of controlled substance training prior to renewal. 

Something to keep in mind about being a travel NP is that you can only use your DEA certification one state/location at a time. So, after practicing in Colorado, I needed to transfer my DEA to Florida. Normally the agency I work with does this for me. However, I did it myself this time since I am working with a new agency. 

You just have to go on the DEA website and change the address of practice on file. I forgot it can take a few weeks for it to become effective. Pretty much, I had to wait for the FL DEA office to approve the transfer. 

I had already started my assignment before my DEA was active in FL. Luckily, I hadn’t needed to prescribe any controlled substances yet. It took 3 weeks for my DEA to become active in FL. 

I know a locums nurse practitioner that has two separate DEA certifications so that she can keep one in each state she practices. She usually goes back and forth between two states to work without much notice so this works for her. This requires two separate registrations with the DEA.

This is something to keep in mind if you are not taking any time off between assignments and plan to work in a different state right after your current assignment.