Mileage

When traveling to a new assignment, you have the option to fly to the site and be provided with a rental car, or you can choose to drive your own car. If you decide to drive your own car to the site then agencies will reimburse you with the mileage it took to get there. They will also provide you with the mileage it takes for you to return home (even if you end up just going to another assignment from there). If you choose this route, you will likely make a profit.

For example, if your site is 500 miles away and you were reimbursed $0.545/mile then you will get $270. After deducting $100 that you spent on gas, you will profit $170.

Another mileage benefit that some agencies provide is mileage to and from the site while you are on assignment. That means even though the agency is housing you, they will reimburse you mileage each time you drive to and from the site from your temporary apartment or hotel. Daily mileage is often given when you are doing a local assignment. However, depending on the agency, some will provide this benefit even when you are away on an assignment.

I wouldn’t necessarily expect this from all agencies, but it is a nice benefit when an agency does offer this. It will typically be listed on your contract as general “mileage”. Some agencies may specify your home city and your destination city to display that you will only receive mileage from this commute.

I am used to living about 5-10 minutes away from work so having daily mileage isn’t always essential. Yet, there was an instance where I worked for a rural community health center and the closest hotel was 1 hour away. I wasn’t thrilled about commuting 1 hour each way, but the daily mileage definitely made up for it. I made an extra $300+ each week from mileage alone. After deducting the cost of gas, I profited $200/week. Not bad, especially since it is tax free.

Health Insurance

I receive many questions about health insurance as a traveling nurse practitioner so I thought it deserved its own post. As a locum tenens provider, you have two main options to obtain health insurance (besides getting it through your spouse).

If you are working with a 1099 agency then you will have to purchase private health insurance. These plans can be costly, sometimes $300-400+ each month. The good thing is you can deduct these premiums on your taxes at the end of the year. The bad thing is that both premiums and deductibles are high.

If you choose to work through a W2 agency, then these agencies will provide you with health insurance. They usually offer 3 insurances to choose from, each of them is affordable. For instance, now I am using health insurance from my W2 agency and I pay $34/week, so $136/month is not bad. This insurance plan allows me to find an in-network doctor in each state I am working in.

Another good thing about W2 agencies that provide health insurance is that if you stop working with them for up to 30 days, you are still covered under their plan. So this is nice for those of us that like to take breaks in between assignments or time off to travel abroad. You won’t lose coverage for taking a few weeks off. However, they will retroactively deduct payments on your upcoming pay checks.

As I alternate between W2 and 1099 agencies frequently, my health insurance also changes. As long as I provide “proof of loss” of insurance, I can enroll in a new plan mid-year.

I can’t tell you which option is better for you. This varies depending on your age, medical history, and preferred method of payment. For instance, a healthy 25 year old may opt for increased paid through a 1099 agency and less benefits; versus a 48 year old may prefer paying higher taxes with a W2 agency in order to have good health insurance.

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.

 

Locums Make Stronger Nurse Practitioners

There is a new nurse practitioner that was recently hired at my current site. Watching her find her place during her first year of working as a nurse practitioner, reminded me how working as a locum tenens nurse practitioner has made me a stronger health care provider.

Working in various clinical settings and with different populations, we are constantly learning something new. Something new that we can apply to our future practice. I have gained some skill sets such as doing incision and drainages, joint injections, and skin biopsies. With much experience, I have also improved my differential diagnoses, and prescribing methods. I can think outside the box and see my patient holistically.

Being one of the first nurse practitioners to work at my current site, I could see that the new nurse practitioner did not have the support system she needed, being a new grad. Sometimes she would see my patients as walk-ins. I noticed she would give solumedrol IM injection for acute pain. In another instance, she saw my patient as a hospital discharge and failed to document that a chest xray done in the hospital incidentally noted a lung mass, which needed surveillance in 6 months.

I used these examples as teachable moments. For example: avoid solumedrol unless the patient has respiratory symptoms, especially in my diabetic patients. Read hospital records thoroughly and as nurses we are usually more thorough with our documentation in comparison to our peers. And how overlooking a diagnostic finding could lead to malpractice.

I also addressed my concern with the Medical Director. Virginia is not a full practice authority state. Thus, the new NP has a supervising physician. Besides being a name on a piece of paper, I believe the new NP definitely needed closer supervision. Even as an experienced nurse practitioner, some states I travel to may require physicians to review 5% of my charts or the first few dozen notes. The Medical Director assured me that the new NP’s supervising physician will play a closer role.

Most importantly, it is important to promote an encouraging vibe in the workplace setting. Luckily, after discussing some of my patients and concerns with the new NP, she started to ask me questions she was unsure about instead of proceeding with a wrong decision. For instance, she had a diabetic patient that could not tolerate metformin due to chronic kidney disease stage 4, and was unsure if she should add glimepiride to the patient’s plane of care, whom was already on glipizide. I discussed with her that the patient should not be on both due to increased risk of hypoglycemia, but as the patient was on a low dose of glipizide, she can titrate up.

It is not our duty to judge new nurse practitioners, as we all started somewhere. Even physicians can admit their first year working in medicine is challenging. Yet, many people are still unfamiliar with the role of a nurse practitioner. Which is why I believe it is crucial we make sure we provide competent care. This can be done by trying your foot in locum tenens to make you a stronger nurse practitioner, and to make sure we continue to mentor novice NP’s.

Bad Interviews

For the majority of locum tenens positions, a phone interview is done prior to a site offering you a position. They are typically less nerve wrenching in comparison to in-person interviews. In fact, I don’t even think twice about them anymore.

They typically start the same way where the company summarizes how they work and why they have a need at this time. Then they want you to talk about yourself and your background. Sometimes they may ask a few clinical questions as well.

It’s always funny to hear about interviews that went wrong. One of my close friends recited a story to me about an odd interview she had for a locum tenens position. Apparently the interviewer kept talking down to her, making my friend feel like she was on trial. The interviewer made it seem like she was not interested in offering a position to my friend. Then 5 minutes later, she called back asking if it was true that my friend was fluent in Spanish. My friend said yes, and the interviewer said ‘you got the job!’ Of course my friend did not accept.

One of my readers shared her experience interviewing for a locum tenens position. The interviewer told her that when she sees the word “locum tenens on a CV” she thinks to herself “what’s wrong with them, why can’t they get a job?” This didn’t make any sense considering that site was looking for a locum tenens provider, so should be well aware of how locum tenens can fit the needs of a practice.

Fortunately, I’ve had only one bad interviewing experience. The interviewer asked me tons of insurance specific questions that I couldn’t answer. She made me feel like an idiot for not knowing those answers. I didn’t care since my job is to treat patients, not to know the specific details for different health insurance providers. At the end, she still offered me the position, in which I declined.

I think the most important aspect of the interview is to feel like the site will be welcoming, patient, and understanding with you. Considering I will be joining them to provide help, I wouldn’t want to work somewhere that does not give off a positive vibe.

Anyone want to share some weird interview experiences?

5 Signs You Need a Different Recruiter

Our experience with our recruiter will make or break a locum tenens assignment or even our search process. This is why I cannot stress enough how important it is to have a good relationship with your recruiter. If you do not like your current recruiter, you can always contact the agency and ask for a different one!

Here are 5 signs that you need to change your recruiter:

  1. Unresponsive – Recruiters are known to blow up our phones and email us constantly. If you are having a hard time reaching your recruiter or if they do not respond to your phone calls, you know something isn’t right. With full time jobs, we shouldn’t have to be the one to chase down our recruiter.

 

  1. Belittling – There are recruiters out there that may speak to you in a condescending tone. You may ask for a certain type of job or pay rate and they may tell you it’s not going to happen. A good recruiter will hear what you are saying and work with you to meet a medium ground, not speak to you as if you are crazy.

 

  1. Unable to answer questions – If a recruiter has no idea when your eligible start date will be or how long your license will take, they should be able to contact someone to obtain those answers. Never settle for a “I’m not sure.” I noticed some agencies are hiring a lot of newbies that don’t seem to know what they are doing.

 

  1. Pushy – It is safe to say that most traveling Nurse Practitioners hate when recruiters can be pushy. When they continuously try to force you to accept a position you do not want or sketchily have you sign an agreement trying to bind you to something you did not agree to. My favorite is: “maybe you can work at this site for the next 3 months until something opens up in your location of interest”. No thanks.

 

  1. Not your Advocate – If you start an assignment and absolutely hate it, you should be comfortable enough to confide in your recruiter. This has happened to me on multiple occasions. My favorite recruiter served as my advocate and made sure my concerns were addressed. On the other hand, I had a bad recruiter who continued to put the site first and nothing was ever changed for my benefit.

 

A great recruiter is always following up with you, even when you are on a current assignment. They will take your needs into consideration and let you know when a compromise may be needed. Most importantly, your recruiter should be your advocate and encourage you in your field.

Questions from Readers

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.

 

  • How does housing work for locum tenens positions? Would I need to have my own housing for my “off” days?

 

Housing options vary by agency, sites, length of assignment, and locations. For the most part, the average locum tenens assignment is 3 months long and you will be provided an apartment or hotel for the duration of your assignment. So if you are off for the weekend, you will still be able to live in the accommodations provided.

 Some assignments only want local providers so they do not offer lodging. In these cases, people commute from their homes.

There are sites that will provide their own housing options, especially if they are located in rural areas. For instance, there was an Indian health services location that provided a house for each of its locum tenens providers to stay in. I also know of a remote facility that housed its providers in a dorm like building and offered free breakfast on the first floor.

Time Off


Americans have a reputation of being “workaholics”. Some companies only allow 1-2 weeks of vacation each year. Luckily with locum tenens, our vacation time can be as long as we want it to be. I calculated that last year in 2016, I took a total of 12 weeks vacation time. Isn’t that amazing?!

Anyways, I had been at my current assignment for almost 6 months, with my last vacation being about 3 months ago. I started to feel antsy being in the same place. And I noticed my patience starting to dwindle down and slowly became more irritable.

Just in time, my 3-week vacation came in. I was able to relax and take some time away from the daily commotion of working in the medical field. After recharging my batteries, I came back to work an entirely new person.

I was no longer stressed. I had an abundance of patience and took my time with my work. No poor scheduling or acute complex visit was going to ruin my day. I felt like I had more energy to listen to my patients and provide them with even better care.

The reason I bring this up is because I do not think there is a medical provider out there that is not familiar with “physician burnout”. Medical workforce burnout is troublesome because it enables us to become cynical about medicine and exhausted both physically and emotionally.

There are many factors that impact this burnout. Some of these include the amount of patients seen per day; amount of time allotted per patient; working with a challenging patient population; lack of admin time; the need for thorough documentation to avoid malpractice claims; and too many bureaucratic demands.

The best way to prevent burnout in the workplace is to allow frequent periods of vacation or time off. Working in locum tenens allows this flexibility. Many locum tenens nurse practitioners choose to take time off between assignments, while others choose to only work a part-time schedule. Although I do not think I will be taking off 12 weeks again this year, it will still be more than the average medical provider.

Questions from Readers

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.

 

What are some challenges of finding that first assignment?

 

The first assignment may be a bit challenging to find because as new travelers we are expecting the perfect job. After time we start to realize that we have to be a bit more open minded of the location and practice setting we are looking for.

 Another challenge is having recruiters take you seriously. Many nurse practitioners are curious about locum tenens and will talk to a recruiter about locum tenens options without being completely serious about it. Thus, recruiters do not like “wasting” their time with new travelers that may never accept a locum tenens position. I find that recruiters take you more seriously after completing your first assignment. I recommend networking with other travelers so they can refer you to their recruiter, as referrals are taken more seriously. I am always more than happy to get you in touch with some of my recruiters. 

Lastly, finding that first assignment is tricky if you do not already have the state license you are searching in. It is possible to work with an agency to obtain a license and then search for jobs. However, many sites do not want to hire you until your license comes through. I personally recommend you obtain the license yourself first, and then search for jobs with multiple agencies. This will increase the probability of you finding something that meets your needs. You can always be reimbursed for the license later on. I think new travelers have a misconception that the agency will do EVERYTHING for them, so applying for a license on their own isn’t ideal.