Third Time Working in Bradenton

My third time working in Bradenton, wasn’t as great as the last time. Patient wise – I feel like I had an easier patient panel than the previous time. However, the work culture was different and there was constant drama. I think it stemmed down from leadership. Most of leadership was poor there – lack of communication, lack of incentives etc. I did like the center director because he did not micromanage. However, the assistant manager there is literally an airhead and loved to gossip. She would show up to our major meetings 30 minutes late and then ask questions about the portion she missed. The fact that leadership would show up late to the meeting illustrated that she didn’t take the meeting seriously and why should any of the staff do so.

One of the nurse practitioners I trained last time was difficult to deal with. She was constantly in my business, even remarked one time that I didn’t wash my hands long enough in her opinion. In this clinic, there are two sections where the PCPs sit. I have always sat in the front area and the other PCPs sit in the back area. Since I trained the 2 nurse practitioners last time, they stayed in the front area with me, and even after I left. 

So, when I came back, I went back to the front seating area but wanted that one NP to move to the back because I didn’t like her negative energy. When they tried to move her she had the nerve to say “I am the permanent PCP so I am not moving”. She was upset that they were favoring me but at the same time she forgot that I was the one who trained her out of the goodness of my heart- something that the majority of new providers do not get. 

Ultimately, she was moved, and she threw a little fit. Eventually she got over it. To be honest, the front desk staff and leadership wanted her moved as well because she was “tyrannizing” the staff constantly. The next issue was a lot of my previous patients saw me in the clinic and they requested to switch back to me. This same NP got upset over this and forbid it to happen. Technically it’s the patient’s choice but I didn’t make a big deal since I was only going to be there temporary again, and tried to remind the patients of this. 

Even my boss picked up on her attitude towards me and he was surprised since I never did anything to her except help her. He told me not to worry and told me she was likely just jealous. I suppose he is right because one time she took a week off for vacation and I asked her if she felt well rested. She responded “well not 3 months well rested”. Which I found to be a passive aggressive comment towards the fact that I took the summer off. 

Anyways, this was only one of my issues. The supervisor of the medical assistants kept picking on my medical assistant. He would even yell at her as if she was a child. So, one time I stood up for her and he started yelling at me too. I think he was too comfortable with me because he would never yell at one of the other PCPs. Eventually they let go of my medical assistant for a lame reason, and leadership didn’t even bother to notify me. I just knew because my MA called me afterwards. 

I ended up having no medical assistant for almost a month. The supervisor of the MAs would never communicate with me to let me know who is working with me that day, so I always had to guess or beg someone else’s MA to help me. 

There was even no recognition when I went weeks with no patients in the hospital. I started to feel detached from the clinic. No longer enthusiastic in participating in meetings or huddles. There was a physician that left during my assignment, and her last month she barely even came to work. She turned all of her patient visits to telehealth. And she no longer attended any of the meetings. 

I still wanted to see my patients but I didn’t feel inclined to go above and beyond to help other providers or keep staff accountable. Then one day, I received a phone call from the recruiter of the new region I would be working in. She said to me, “So nice to meet you! You are a legend with the company! Everyone always has such great things to say about you.” I really appreciated that and she reminded me that unlike the physician who left, I am still going to be working with this same company and want to keep my good reputation.

My last day, I literally had a patient that cried. I was so touched since I have only known her for 3 months. She was just grateful that I helped heal her chronic wound. I met an insurance broker on my last day as well, and he told me he heard about me from my patients and that they are all so disappointed that I am leaving. Although I didn’t have a good experience this time, I am appreciative of being able to spend time with some of my colleagues there that I am close to, and my local friends. In my next post, I will explain further on why I didn’t extend.

Having other Locums Nurse Practitioners

One of my fellow blog readers ended up working with the same company as me but at the St. Petersburg, Florida site. It’s about 45 minutes from my assignment in Bradenton. We didn’t have the chance to meet in person, because she was told she didn’t need to go to the regional meetings, although I always go to them (and they expect me there).

It was cool to connect with her over the phone and to guide her a bit as she adjusted to working with the company for the first time. She even asked me to look at her notes when I had the chance to make sure she was doing everything correctly – which she was. 

Her training was brief – about one week for orientation and to shadow other providers. She agreed that working with this company is a learning curve and the patients are quite sick. Unfortunately, there wasn’t another nurse practitioner at her clinic that could train her further. 

The following month, my clinic hired another locums nurse practitioner. After her orientation, I suggested that I train her a few extra days so that she could get a hang of things. 

Unfortunately, I didn’t have a good experience with this locums nurse practitioner. She kept showing up to work at least 20 minutes late. She had quite an attitude that I thought maybe was just towards me, but then other employees started commenting on it as well. She told our employer that she speaks Spanish but when we went to see the Spanish speaking patients, she asked me to translate. Now I know why sometimes potential locums sites will ask for you to speak some medical Spanish during the job interview.

Additionally, the patients complained about her – they didn’t want to see her again. I am not sure if it was an attitude issue or a knowledge issue. She tried to stir up some drama telling my referrals person that people told her my referral person, the girl who sits next to her, and me are a clique and to stay away from us. This was during her first week – when no one even spoke to her besides me so I doubt anyone told her that and I thought it was weird for her to even bring that up. What new person would instigate drama? Not to mention that my referrals person and the girl next to her are one of the most liked people at the clinic.

Normally, as a locums my job ramps you up quickly. One week seeing 5 patients a day, then 8 patients, then 12, then 16 etc. They started her slowly at 3 patients per day and when they wanted to increase her schedule to 5 patients per day – three weeks later, she said she wasn’t comfortable with that. I found that strange since she has over 10 years of experience, and only 1 out of her 3 scheduled patients even showed up per day. Seeing 5 patients per day is absolutely nothing, and I was surprised she wasn’t bored out of her mind. 

Our Medical Director decided one day to make her the walk-in provider. We have 20-30 walk-ins per day so I was curious how that was going to work. You can’t go from seeing 2-3 patients per day to seeing 20 patients per day. On her first day being the walk-in provider, as expected, she failed. There were so many walk-ins waiting, that the other PCPs ended up having to see their own walk-ins. I think she ended up seeing 10 patients that day but obviously that wasn’t ALL of the walk-in patients. So the following day, she went back to her 5 scheduled patients per day – no longer the walk-in provider.

The funny thing is the locums nurse practitioner wants to become permanent here but she is clearly not a good fit. It’s not only a ‘needs more training’ thing, but her attitude doesn’t mesh well with the culture here. In fact, she has a negative 100% patient satisfaction rate. Based on patient surveys, they complained that she is rude and without compassion, and they never want to see her again. Our boss agreed that she isn’t a good fit. I am not sure why they don’t just end her contract early.

At least leadership will learn that not every locums is like me. And I don’t like when the new locums nurse practitioner tries to compare herself to me. I leave work early once I finish with my patients and work flow. So the locums nurse practitioner made a comment to someone else that next time she will negotiate that in her contract too. People want to make demands when they barely start working with a company. Meanwhile, I worked my butt off to show my worth and that’s why over 6 years later I can do what I want. 

Questions from Readers – January

I haven’t had one of these posts in a while, but feel free to continue to send your questions my way. I had written a post about asking and receiving an extension bonus at one of my assignments. A reader asked:

“Is there a reason you asked for a bonus instead of a higher hourly rate since bonuses are taxed so high?”

My response was: when extending an assignment, the agency/site will typically agree to a $5/hour increase in rate. For a 3-month assignment, this is only a $2500 “bonus”. So, by asking for a $5000 bonus, I am technically getting more. I also like the idea of a bonus because they pay it up front, so the money is in my hands sooner than later to invest etc. 

I also commented on how my bonuses are often in Florida where there is no state income tax, so this is an additional win. When extending, I love to receive a bonus. When returning to a previous assignment, that is typically when I will ask for a $5-10/hour raise (when changing sites).

Everyone does it differently, but in my experience sometimes sites/agencies are reluctant to give a raise for an extension and will often try to only offer a couple of dollars more per hour. 

With the site that often gives me extension bonuses, my first assignment with them when they asked me to extend, I asked for an increased rate, but they told me no. However, after I completed the extension they gave me a $5000 bonus as a “thank you” (without me even asking). So, I realized then that they are more likely to give a bonus than increase my rate, so that’s why I continue to ask for extension bonuses instead of increasing my hourly rate.

I Reached Financial Independence!

Although I took a mini retirement for 3 months this summer and lived in Spain, I still managed to obtain financial independence (FI) soon after. Financial independence is when you have enough money and investments saved up that can cover your expenses for the remainder of your life without having to work. You can calculate what your financial independence number is by multiplying your yearly expenses by 25. For example, if you spend $40,000 per year and multiply that by 25, you would get $1,000,000. That means you would need to have $1,000,000 in savings and investments to use to live off of for the rest of your life. 

Reaching my financial independence number was just like any other day. I didn’t feel different. That’s why it’s important to focus on the journey instead of the destination. I make sure that the way I am living my life currently is how I would want to be living even if I was financially free. It’s also significant to notate that I took 3 months off for my mini retirement and still reached my goals. This was due to compound interest and the power of real estate. My 3 months off with no income did not impact my financial independence goals. I was hoping to reach my number by 35 years old but I reached it early at 33.  

When I first found out about the FIRE movement I was excited to retire as soon as possible. Then realism set in and I realized I do value my career and profession. I still wanted to reach financial independence because I believe that should be everyone’s goal. You never know when you may become disabled and no longer able to work or want to take an extended amount of time off to be there for a loved one. Now that I have reached FI I think my next goal will be to reach Fat FIRE. 

Fat FIRE is when you budget for $100,000 worth of yearly expenses. This means your FIRE number would have to be $2.5 million. I don’t think I would need that much, but it’s always nice to have an extra cushion. At the same time, I will be cutting back on how much I work. I mentioned in previous posts that I want to work only 6 months total out of the year. I will continue to save and invest but not as aggressively. I will rely on the power of compound interest over a few years to get me to that fat FI number. Once you reach that million-dollar mark, it’s incredible how quickly your money compounds. 

In the meantime, I am work optional. I will continue doing locum tenens and working 3 months at a time. I plan to continue doing mini retirements as a I had a good experience in Europe and transitioning back to work was easier than I expected. My focus is also to spend more and save less. I am content with my life and level of spending. But I would like to spend more on treating other people and start a donor advised fund where I can increase my contribution to charities. 

Life Has Changed

My friends have gotten used to me working as a traveling nurse practitioner for over 7 years now. They are always asking me about my next adventure. I have worked only in Florida over this past year, and many of them are surprised. They are surprised I am not traveling to work somewhere new. The reality is that – Life Has Changed. 

My priority isn’t just travel somewhere new and have fun, new experiences. I am more focused on working somewhere I enjoy and being close to home when needed. For example, this fall I had several weddings and baby showers to attend at home so I didn’t want to have to travel from afar often. I also have nieces and nephews now that I want to see frequently. 

Some of my family have asked me why I don’t just work locally in Miami, FL and take an assignment there. The truth is I am spoiled now. I don’t like to commute to work in traffic, and since I wouldn’t be “traveling” to work in Miami, additional housing or a rental car wouldn’t be covered for me. 

For winter, I considered going back to my favorite place – San Diego, CA. However, since my time in Europe, I am in a long-distance relationship with someone that lives in Europe. So, it’s easier for my relationship to stay on the East Coast instead of having an even more challenging time difference. My partner plans on moving to the USA eventually, and he is open to traveling with me for work when I want to. So, life changes, and I just adapt. I still want to be a traveling nurse practitioner but it’s going to look a bit different each year. 

Top 10 Finance Books

It surprises me how many healthcare professionals are clueless when it comes to finances and investing. We often spend too much time studying medicine that we fail to study finances and what to do with our income. 

Most of the books below talk about some form of saving, spending, and investing. Here are the top finance books I enjoyed reading and recommend depending on your interests.

1. The White Coat Investor by Dr. James Dahle

Financial book targeted towards healthcare professionals on saving and investing.

2. I Will Teach You to be Rich by Ramit Sethi

I like this book because it doesn’t only talk about the obvious things like save save save. It talks about automating your finances so that you do not have to think about it too much, and how to spend on things that are most important to you. 

3. The Simple Path to Wealth by JL Collins

Great book for someone that wants to invest in the stock market but doesn’t know where to begin. He talks about how you can easily invest in index funds and why index funds will always increase in value.

4. Set for Life by Scott Trench

This is a good read for young professionals because it shows you the power of saving your first $25k and how that provides you with options. 

5. Retire Early with Real Estate by Coach Carson

For those that are looking into investing in real estate, this is an easy read in how to get started. 

6. Quit Like a Millionaire by Kristy Shen and Bryce Leung

This is about a young Canadian couple that retired early at 30 years old. They are now spending less than $40k a year traveling full time. Great read for someone that wants to be nomadic and how to get there. 

7. Die with Zero by Bill Perkins

Great read for those closer to retirement. It talks about how you need less money to retire than you think and why you should take multiple mini retirements while you are young and your body is able to do things you wouldn’t able to do when you are older. Such as hiking, adventure sports, and traveling.

8. Taking Stock by Jordan Grumet

Written by a hospice doctor that helps you figure out your purpose in life and how your finances can shape that. 

9. Cashing Out by Julien and Kiersten Saunders

Written by an African-American couple on how everyone should have a 15-year career and then begin another chapter in their life as an entrepreneur or retired person. 

10. Financial Freedom by Grant Sabatier

This book is geared towards millennials and an example of how one can reach financial freedom early in life. 

Feel free to email me once you’ve read some of these books to let me know your thoughts!