The Top Airline Card

Although I prefer flying Delta over American Airlines, Miami International Airport is a hub for American. So, I often find myself flying American Airlines since they have more flights coming in and out of Miami – especially non-stop flights.

I wouldn’t say I have a favorite airline credit card, but if I had to choose one it would be the Barclay Aviator AA credit card. By having this card, I am able to check in my first baggage free (and other companions on the same reservation). This is great for someone who is always traveling. Those $30 baggage fees accumulate quickly.

What I also like about this card is that there is no minimum spend requirement. You just have to make one purchase with the card and you get the signup bonus offer which is usually around 60k AA miles. It comes with an annual fee of $99 but it may still be worth renewing each year if you are traveling enough to receive the free baggage benefit. 

An additional benefit, is that the card comes with preferred boarding. AA has nine boarding groups. Being a card holder allows you to board with group 5 (after first class flyers, elite members, military etc.) This can be helpful when traveling with a carryon and wanting to secure overhead bin space.

This card is offered as both a personal and business card product. Which means, technically you can sign up for both cards separately to earn the sign-up bonus on each one. 

Annoying Peers

I don’t think I have complained about other providers I worked with in a while. That’s because over the past 2 years, the other providers have been great. 

I do have a couple of synopses to share though. When I worked in Ohio, there was a physician there that we jokingly said he thought he was working in Grey’s Anatomy. He was a know it all that was only one year out from residency. Every single day he thought he was diagnosing a patient with an emergency disorder. For instance, one patient he thought she was having a pulmonary embolism and ordered a stat CT scan. Her only symptom was shortness of breath, which is common for patients 65+ years old. The CT scan ended up being negative. Then he had a patient that was beaten up by their son and had a bunch of bruises, pain, and swelling. The same physician thought that the patient was having compartment syndrome and sent him for a stat CT scan, which also ended up being negative. 

We call this the “zebra”. It refers to medical students thinking patients have a complex problem when in reality they have a common and straightforward disorder. This happened on a daily basis and it got annoying. Because one, he made the patients nervous about something that was obviously not complex. And two, he prided himself on not referring to specialists yet drove up costs for the patients by ordering all of these expensive imaging.

Fast forward to my current job in Florida. One of the physicians is 9 months in, older guy with lots of experience. He told me he loved nurse practitioners and had a lot of them at his previous practice. I later learned why he loved us so much – he was used to nurse practitioners helping the physicians with their workload. This is completely different to our current practice where each provider, including the nurse practitioners, have our own patient panel. 

Whenever he was asked to see a walk-in, he would tell them to ask me. They had to be like “No, she is already seeing another walk-in”. Whenever he didn’t like a patient, he would just have them switch to me. If a new patient wanted to come in sooner than scheduled, he would tell the front desk to schedule them with me. Whereas, I was already the most booked out provider since I was taking in a lot of new patients. So, the new patient he was trying to defer would have been able to get a sooner appointment 4 weeks earlier if scheduled with him versus me. I think he thought I was his assistant!

At our weekly meetings where we discuss our sickest patient, he always had something to say about one of mine. The patient is a needy woman, with history of cirrhosis, GI bleed, and chronic pain. He told me to make sure I am not prescribing her NSAIDs for her pain. My response was “duh”. This physician has a GI background so I was surprised he didn’t want to be this patient’s PCP. I later learned it’s because he doesn’t want any of the “needy” patients. I finally had to have a discussion with him to let him know I am not his assistant, and that he needs to learn how to manage his patient panel independently, the way I am managing mine. 

Anyways, I thought it was hilarious to work with these physicians above and just wanted to share some “struggles” of being a traveling nurse practitioner. 

Work Culture at Bradenton

I have officially begun my extension in Bradenton, Florida. I forgot how much easier work gets when you know the patients well. I have already formed relationships with patients and they admit they are excited for their PCP visits. It is rewarding to see patient’s health improve and to see your hard work pay off. Even though at times I feel restless, wanting to go somewhere new, I have to confess I am enjoying my time here.

The work culture in this office is pretty amazing. We are a big office with over 40 employees. Everyone is excited to get to work and support each other. We share lots of laughs and fun times. There is a culture team that makes sure we celebrate birthdays once a month, which includes lunch and cake. There is always some type of themed event to get the clinic excited – such as mardi gras or pajama day.

Everyone is great, from front desk to case management. Leadership is wonderful. They don’t micromanage and are very understanding. They have high energy and make sure you feel supported. This is the type of leadership I love. We have a quick huddle every morning and the enthusiasm is contagious – something I haven’t seen in other centers.

The other PCPs always joke that I never seem stressed and somehow always stay on schedule. Some of them are new and are still adjusting. I try to reassure them that it’s a bit challenging in the beginning, but it definitely gets easier over time once you see the same patients over and over. The seasoned PCPs tell them someday they can be at my “level” where I am constantly laughing and carefree, and improving patient outcomes even though I have one of the most complex and sickest patient panels.  

It’s nice to have that feeling where you don’t dread going to work, and you feel loved and supported. I still have plenty to do socially, because of the holidays I hadn’t had the chance to meet up with many of my local friends. I am glad I extended because I still have time to meet up with them. Since I will be staying through spring, I will be moving to a different apartment closer to the beach as well.

If I wasn’t a nomad, I wouldn’t mind working here forever. It’s funny, because every single day someone asks me to stay permanently. Even the provider sitting next to me is like “you must be tired of hearing that”. When I came back from a one week vacation, everyone was so excited to see me, I felt like I had been gone on maternity leave or something. I was given gifts, hugs, and food. My boss even told me I was welcome back permanently after my 3 month summer hiatus if I wanted.

Creating an Army of Travel Nurse Practitioners

I have been working on and off for the same geriatric outpatient clinic network since 2016. They have clinics in multiple states and continue to expand in new territories. The new PCP orientation and training has been extended from 2 weeks to 4 weeks. 

This has led to a demand for temporary coverage. If a provider goes on FMLA or quits suddenly, the process to find a new physician and from the date in which they can start seeing patients, can take 3-6 months or longer. By the time the new physician is hired, they have to complete the 4-week orientation and training, and then they have a ramp up schedule of seeing 5 patients the first week, then 6 patients the following week, then 8 weeks the following week etc. 

A patient panel of 300-400 can take 4-6 months to be transitioned into the new providers schedule. Hence, suddenly I am being flooded on a daily basis with requests to provide coverage at a different clinic. I am a quick fix because I can start seeing a full schedule of patients on day 1. Sure it’s nice to feel wanted, but there is clearly a need that I, alone, cannot fill.

The company does hire locum tenens clinicians to cover on a temporary basis. However, I am the only clinician that has worked with the company multiple of times in several different markets. So even these locum tenens providers would need to do the 1 month training and ramp up schedule. I remember when I first started working with the company, the CEO at the time had asked me if I was interested in going permanently with them and being in charge of building a team of other travel nurse practitioners. 

At the time (and currently), I did not want to transition to a permanent position. But at this point, I have a strong relationship with the company. Enough that I am willing to assist in building and training a team of other travel nurse practitioners for them. Of course, I would not do this for free, but it would be nice to have other similar providers to be available when there is a need (and there is always a need). 

I reached out to the CEO to see if they were interested in hiring a group of travel nurse practitioners. Ones that could complete their orientation and be assigned to me for further training. So that when there is a need, they would be able to start right away – seeing a full schedule of patients. Normally, the new physicians complete orientation and begin seeing patients per ramp up schedule. Working with this company is a huge learning curve for any provider, but especially for nurse practitioners. 

Personally, I learned a lot my first year with the company, and fortunately I had a geriatrician sitting next to me that I could go to for any questions. I have helped train several nurse practitioners after they completed their orientation, and they all verbalized without that extra support from me, they wouldn’t have made it. 

So if the company does decide to move forward with proactively hiring travel nurse practitioners, whether via a locum tenens agency or internally, I would like to help in the success of these travel nurse practitioners. Since I extended in Bradenton, I have 3 months I can do this. It’s challenging to train other providers when you don’t know the patients yourself (in this model). Since I know my current panel, that would make it easier.

Let me know if you are interested in getting trained for this travel nurse practitioner position so I can let the company know! They are definitely interested in this. 

Extension Bonus

While working in Bradenton, Florida, I had 5 other markets from the same company ask me to come help them. It was of course the clinics from Virginia and Ohio asking me to come back. And several new clinics from Tennessee, New Orleans, and Jacksonville, FL. I told them I wasn’t available until the fall. 

Meanwhile, my current job was begging me to stay. I know I say that all of the time, but they literally went hard. On my first day my boss already asked me what they could do to keep me permanently. Then on my second day, everyone from leadership came to meet with me individually to see what they could do to keep me permanently or even for an extra 3 months.

Even the CEO told them good luck since I never want to stay anywhere. I told everyone to relax since I usually decide last minute depending on how things go here. I also told them I had planned on going to Spain after this assignment, so I was flexible. 

They hired a permanent nurse practitioner that is supposed to finish her orientation by my last day. So, they really wanted me to stay longer to help train her, to make sure she is successful and stays long term. This would also be beneficial because I would take care of my patient panel while the new nurse practitioner and a new physician slowly acquire the patients. 

When I felt confident that I would be comfortable extending, I emailed my agency telling them that I was requested to extend my time, and I would for an extension bonus. In the past, I have been given a $5k extension bonus for 3 months. This time I wanted to ask for more for multiple reasons. 

1.       I was postponing my 3 month break to Spain, so literally had nothing to lose

2.       Not to brag but I am a high commodity, multiple other clinics were requesting my help

3.       Not only would I be extending for 3 months, but I was also going to be training the new nurse practitioner

At first, I was going to ask for $10k because I heard that they had offered physicians from the other clinics to come help us for that amount but they all said no. But then I thought about how I would be training the new NP and would need something on top of that. 

I decided to request a $15k extension bonus to extend for 3 months. I thought it was a lot to ask for but I really had nothing to lose since I wanted to go to Europe anyway. I had stumbled upon my boss one day, and he asked me if I was open to staying. I told him it depends on the offer and he asked what amount I was looking for. I told him $10k for the extension – he didn’t seem to think it was a big deal. And then I said but I would need something on top of that for the training. He told me that’s fine, ask for whatever I want because they appreciate me so much and would keep me as long as I wanted to be here.

So guess what?! They said yes to the $15k. I am glad I literally had nothing to lose since I really just wanted to go to Spain. It allowed me to ask for something that seemed outrageous. I had even asked some physicians that had helped for 3 months at other clinics what kind of bonus they were given in the past, and they told me just $5k. I am glad I was able to negotiate my worth. That’s the power of not NEEDING to work.

Trying out Telemedicine

Due to the covid pandemic, telemedicine has blown up. At one point due the pandemic, patients were not even able to go in to see their PCPs. Since then, telemedicine restrictions have eased allowing providers licensed in multiple states to treat patients in those given states. 

In 2020, my friend had recommended a telemedicine site she was working with per diem. I signed up for it but never actually picked up any shifts. You were paid per visit and I hated sitting around waiting for patients to join. My friend told me sometimes she waited hours without seeing any patients. 

Fast forward to 2022, I am planning on cutting back on the amount of time I spend working. I decided to try out telemedicine because it is flexible. I could work from home if I decided to move back full time to Miami, Florida, or if I decided to travel abroad for fun. 

Fortunately, I found a Telemedicine company that pays per shift instead of per visit. So if I am signed up for an 8 hour shift, I am paid hourly even if no patients are seen. They also pay a differential per state being covered. For example, the most states we can cover at a time is 4 states. For each additional state after the first one, I am paid an extra $10/h for covering that state. Thus, my hourly pay ranges from $60-$100/hour. 

The job itself is straightforward. These are urgent care visits that last several minutes. Patients are so appreciative to get their medical treatment from the comfort of their home vs having to wait hours at an urgent care. Some examples of reasons for visits include pink eye, cold symptoms, rash, or UTI. 

I have really enjoyed the telemedicine experience because it is flexible, so I can pick up as little to as many shifts as I want. The visits are pretty easy and I like to help patients with the convenience. My favorite part is that I am able to multi-task while covering telemedicine. 

While waiting for patients to check in, I monitor the screen on my laptop, and do other things. For example, I take care of house chores or work on my blog. I read or watch a TV show. So technically, it’s like getting paid to do my activities of daily living. 

The only challenge of working telemedicine is that there can at times be some technical difficulties. It’s important to be computer savy and patient with these hiccups. 

My telemedicine company has a contract with amazon, providing services to their employees. They require one-week training which I do not have the time for right now. If I decide to pursue telemedicine full time, I will definitely pursue the amazon opportunity at a later date.  This would guarantee me more shifts if needed. 

Practicing telemedicine is a positive experience and I recommend that everyone dabble in it at some point.

How I am able to save $100k+ a year as a traveling nurse practitioner

Working as a traveling nurse practitioner for the past 6 years has enabled me to save a lot of my income and grow my net worth tremendously. In fact, I have been able to save more than $100,000 of my income per year working in locum tenens.

These are the following reasons I have been able to save this much.

-Housing: A nice perk of working in locum tenens, is that housing is provided. This allows me to save on rent or a mortgage. The average American spends 30% of their income on housing. Fortunately, I am able to save that expense and invest instead. Personally, I rent a room from my sisters’ house in Miami, so that I have a place to stay when I go home and to keep my belongings. This only costs me a few hundred dollars per month. Eventually I may get my own place and rent it on Airbnb when I am gone.

-Car: I had a beautiful audi s5 convertible during my first 3 years of being a traveling nurse practitioner. Even though the agency provided me with mileage to bring the car with me, I often left it at home if my assignment was too far. This ended up being a waste of $800/mo for a car payment, not even including the car insurance. Although I was sad to let go of my car, I have benefited from saving over $11,000 per year being carless. The agency provides me with a rental car while on assignment, and it’s easier flying to sites instead of driving long distances.

-401k: I often work with Comp Health because they provide benefits such as health insurance and a 401k. I max out my 401k each year and take advantage of the match offered by Comp Health. In 2021, the current maximum to contribute to a 401k is $19,500 which also allows me to save on income taxes too.

-Taxes: I like to mix up the agencies I use each year so that I can get some 1099 work. By working as a sole proprietor, this allows me to deduct a lot of my expenses during tax time. I can deduct license costs, CEUs, work related travel, books, uniforms, etc.

-Budgeting: Working as a traveling nurse practitioner I often take one month off at a time. If I am not working, I am not getting paid. There is no PTO in locum tenens. This has forced me to budget so that I can cover my expenses during the months I am off and not having money come in. I am not super strict with my budget but it gives me an idea of my monthly expenses which are minimal. It’s difficult to save if you do not keep track of your expenses.

-No debt: I was able to pay off $50k of student loans my first three years working as a nurse practitioner. I do not carry and consumer debt such as credit card debt or a personal loan.

Being able to have a high savings rate as a traveling nurse practitioner does have its challenges. I make sure to constantly network so that I have an assignment lined up up to 6 months in advance. That way I have income coming in when I want to. I also choose not to have a car or my own place back home, even though I can afford to. This allows me to save 90% of my take home pay.