Returning to Bradenton, Florida

I worked in Bradenton, Florida at my usual geriatric clinic last summer. It was amazing living at the beach. They had hired 3 new physicians upon me leaving, so I didn’t think there would be a need to return for a while.

Since then, one physician retired and another one left for a different opportunity. So once again, they needed help. They asked me to come when I was in Virginia, but I told them I wasn’t available. And in fact, I wouldn’t be available until November.

They decided to hire another locum tenens nurse practitioner in the mean time. I was curious to see how that would turn out, because the nurse practitioner would be new to the model and would require several weeks of orientation. This is in comparison to me jumping in and seeing a full schedule of patients on my very first day.

I knew it wouldn’t work out if they held the same expectations for her as they did for me. Unsurprisingly, the locum tenens nurse practitioner only lasted a few weeks. The site decided to end her assignment early because she wasn’t meeting expectations. All I know is that she would take a long time with the patients, was always behind, and the other PCPs had to often help her catch up. This is unusual for a locums, we are typically more efficient and the ones jumping in to help the perm PCPs.

After that experience, the site said they would wait for me to come in November. I agreed to the assignment because the location is very convenient for the holidays. I will be within a 4-hour drive from home, so I can easily make it home for my week off during thanksgiving and my week off for Christmas. Not to mention that I will be in my ideal state for winter.

This is the third site I have returned to this year. That’s why it’s so important to maintain relationships and make a good impression. You never know when the site might need you again.

Malpractice Insurance Exceptions

Working in locum tenens is great because you can take off as much time as you want in between assignments. However, it starts to become complicated once you spend more than 6 months to 1 year away from practice.

Even if you were secure in your skills, the challenging part is obtaining malpractice insurance once you have been away from practice for a while. Typically, the absolute maximum time you can be away from practice is 2 years before malpractice insurance will unlikely credential you.

There is a loophole with this, and that is finding a job with the federal government. The federal government considers itself as your malpractice insurance. This means that if you were to work at an Indian Health Services facility, Veteran Affairs, the military, or some FQHC clinics, you would not need your own malpractice insurance.  So, if a patient from one of those work sites decides to sue you, it would go through the Attorney General.

Many states require nurse practitioners to carry malpractice insurance. Yet, there may be an exemption form you can complete which dictates that you practice exclusively as an employee for the federal government, so are exempt from carrying malpractice insurance.

I thought this was an interesting loophole and just wanted to share it with my readers. 

Managing 12 State Licenses

As a traveling nurse practitioner for the past 6 years, I have obtained 12 state licenses. It can be challenging to keep up with renewals and CEU requirements for each state, since they frequently vary.

I typically allow a license to expire when I am no longer working in that state. Of course, I keep my home state license active – which is Florida. Fortunately, the process for renewing expired state licenses isn’t that complicated. It just requires a renewal application and for you to pay the renewal fee. The renewal fee is often a bit more expensive after letting a license expire, compared to renewing it when it has not yet expired.

I believe renewing expired medical doctor licenses is much more complicated than for us nurse practitioners. Trying to renew a nurse practitioner license after it expires is often a quick process. I have had my license changed to active within minutes of submitting my application and the renewal fees.

My current active state licenses are: Florida, California, Arizona, Ohio, and Virginia.

My current inactive state licenses are: Washington, Colorado, Maine, Wisconsin, Texas, Kentucky, and Illinois.

Some of those inactive licenses I haven’t even used. But instead of continuing to renew them and waiting for an assignment, it just makes more sense to renew them after I have secured an assignment in that state. That way, I don’t have to waste hundreds of dollars on licenses I may not even use every couple of years.

Before renewing a license, I always double check the CEU requirements to make sure mine are up to date. I try to have 75 CEUs of pharmacology done within the past 2 years, at all times. This is because a lot of states require this upon licensure application. So, it makes it quicker to complete my new applications by having this ready.

Otherwise, I keep an excel document with all of my state licenses. This document lists expiration dates, CEU requirements, and alternative licenses needed (such as a furnishing license). I also list if the state requires a separate RN license application, or if they just use my multistate practice RN license from Florida (through the eNLC compact state agreement).  

Cards I Have Opened This Year

I only opened 2 new credit cards this year because I already have tons of points since travel has been limited the past 2 years. They were both business cards. I like business cards because your balance doesn’t show on your credit report, and they often have better bonuses than personal cards. I am able to qualify for a business credit cards as a sole proprietor.

The first card I applied for was the Chase Ink Cash Card. The requirement was to spend $7500 within 3 months to earn 75,000 bonus points. It comes with no annual fee which is great. This card also comes with 0% APR for the first 12 months which is nice if you need to make a major purchase that you want to pay off over time.

I like having chase points because I can easily use them to stay at any Hyatt hotel, fly Southwest or United, or book American Airlines flights through the British Airways partner. This card easily gives me $1500+ worth of travel.

The second card I applied for was the American Express Business Platinum card. The offer was to spend $15,000 within 3 months to earn 150,000 bonus points. It had a big spend requirement, but luckily, I was able to add my sister as an authorized user. She had just purchased a house which came with a lot of renovation expenses. She used the card to pay for the expenses and then gave me the cash to pay off the card.

It does come with a hefty fee of $595/year. However, the card comes with a lot of benefits that offset this fee. It comes with a $200/year flight credit; $400/year Dell credit; $100 TSA/Global Entry credit; $179 CLEAR credit; $10/month phone bill credit. These credits alone more than cover the cost of the annual fee. Not to mention it comes with a lounge pass and you have the benefit of using the card to enter the AMEX Centurion lounges at certain airports.

As someone who travels a lot, I appreciate the perks of this card. The large bonus offer was also beneficial. I can easily use these points to fly on Delta, Jetblue, and business class internationally. I can also transfer to Hilton or Marriott but I wouldn’t recommend that (the value is low). The bonus points offer I got from this card is worth at least $6,000.

I’ll link the two cards below in case you are interested in them.

Chase Ink Cash Card: https://www.referyourchasecard.com/21a/G6457Y9QQB

AMEX Business Platinum Card (offer has been decreased to 120k points): https://www.americanexpress.com/en-us/credit-cards/referral/prospect/business/A259D79B78A0FF210E4F391EDB88F0D6551F2855F36731AE2B8CE5C04CB3167AF500F554ADB5F49015B833D118F3F6F573F501BE36D9728184AA8BDBBF9BF07C0485D8BE7B870AE6A4B697F762C8FA41BEA42553B29591751B20BD4F76026AF8E035DAA82B26E0F92B3E1D4B97BCC70D8CFB648C3991689B5D0279806A96AA154B5CE0CA2F089EAA00E24D5D376D9405173BC0BB717BE334D33BFEAB91F95F02?CORID=S~O~P~H~I~K~L~c~l~2~5-1638495994849-1758008011&CPID=201329&GENCODE=349992468910932&extlink=US-MGM-SPA_WEB_MYCA-copypaste-1110-201329-GDHH%3A0005-1110-GDHH%3A0007

Guest Blog – Seasoned Locums Nurse Practitioner

Hi, my name is Christle! I decided to pursue locums for 4 years to mesh my love for travel with my love for providing healthcare to those in need. I also really loved that I could work independently of a company controlling my schedules, time off, and life in general!

I loved living and working in California. My favorite assignment was in Northern California where I worked for a community medical center. I enjoy working with community medical centers because they provide care to those who need it most. This assignment was also very close to awesome attractions (my hotel was literally next door to a vineyard) and staffed with amazing people.
 
Some of the challenges I have faced as a locums nurse practitioner was the lack of training and a general misunderstanding of my role as a locums in some locations. In addition, as a person of color, it was sometimes difficult to assimilate to the local environment.
 
My favorite agencies to work with are Alliance Recruiting and LPM recruiting. My recruiters for both of these agencies were generally very open and honest about the assignments. They were always willing to listen to my concerns and ensured I felt safe and cared for wherever I was headed.
 
Some tips I have for nurse practitioners new to locums include finding a great CPA to help with taxes especially as a 1099 contractor. For an assignment, be sure to get all of the details upfront and ensure that you have read the contract thoroughly before signing it. I recommend having at least a couple of years of experience as a nurse practitioner before you start doing locums, because training will be limited. Also, try to be open to locations that may not be popular.

Wrapping up in Ohio

As usual, this 3-month assignment went by quickly. I am actually sad to leave because I have had so much fun exploring the state, and work has been stress free. However, it just started getting cold my last 2 weeks so it’s a sign that it’s time for me to go. I have grown close to several of my coworkers and hope we keep in touch.

I have really enjoyed fall here. My last month, National Car rental asked me to return my current rental because it was due for an oil change. They ended up only having minivans and mustangs available for me to switch into. I definitely wasn’t going to opt for the minivan. I saw a bright yellow convertible mustang on display under upgrades and I jokingly asked if I could have that one. I was surprised when the agent said sure.

As corny as this sounds, having that convertible mustang made my last few weeks even more fun than it was. As a previous convertible sports car owner, I forgot how driving with the top down, wind on your face, and music blasting, can make you feel so alive! My favorite part was being able to drive through several metro parks with the top down to see fall foliage.

My time here has been great and I would love to stay if winter wasn’t quickly approaching. Ohio has been a pleasant surprise and I wouldn’t mind returning in the future. 

Interestingly, I was considering settling back down in Miami, FL next year. Yet, my time in Ohio was so wonderful that it reminded me how fun it is to travel and explore new places, even for work. Sorry family – looks like I won’t be moving back to Miami full time after all. 

Getting a Bonus in VA Beach

My previous assignment over the summer in Virginia Beach was with a geriatric clinic I often work for. They typically pay out a quarterly bonus to all employees depending on their performance. During my time there, I asked if I could be considered for the bonus even though I am a contractor, since I had a full patient panel that was doing relatively well.

The chief medical officer told me she would look into it. After my assignment ended, I knew the site was disappointed that I didn’t extend. However, I saw that my patient panel was still doing pretty well during the gap between me leaving and the new PCP starting. I figured I taught them the model well – to call us first instead of going to the hospital for any little thing.

So I reached out to the chief medical officer again to follow up on the bonus. She said that normally contractors aren’t given a bonus. I told her I understood that but I am not the typical contractor (for the company since I have worked with them on and off over the past 5 years); and that I have been given a performance bonus in the past.

She responded and said she really appreciated my help last quarter so was going to provide me with a one time bonus. I was very grateful and of course she snuck in the email to come back to Virginia when I finish in Ohio.

The bonus I received was $1200. I was thankful that my work was appreciated but a bit disappointed on the amount of the bonus. In the past I had been given $5000 per quarter as my bonus. But I had to remind myself that was when I had extended with the site multiple times. Even though the $1200 wasn’t as much as I was expecting, it is still better than nothing.

Anyways, the moral of the story is if you don’t ask – you get nothing! 

Two Bedroom Housing

If you travel with your children or a significant other, sometimes you want to have a bigger place to live while on assignment. The standard housing provided by your agency is a hotel or a 1 bedroom apartment. You have the option to get a 2 bedroom apartment but the agency will have you pay the cost difference between the 1 and 2 bedroom apartment from your paycheck.

However, when I was in San Diego, I was able to secure a two bedroom apartment without incurring any extra costs. How did I do this?

I asked the agency what the housing budget was per month (including rent, furniture, utilities etc.). Then I proceeded to look up housing options on Airbnb. I wanted a 2 bedroom place because I expected to have plenty of visitors during my assignment there.

I found a 2 bedroom apartment on Airbnb that was a bit above the monthly budget. I messaged the owner and asked if she could give me a discount since I would be renting from her for 3 months. Fortunately, she honored my request and provided the apartment for under budget.

I then forwarded the information to my housing representative from the agency. She went ahead and booked the apartment, no questions asked.

Had I found a short-term lease apartment that needed to be furnished etc., it would have been a completely different story. This is because a cheap 1 bedroom apartment would have been selected by the agency over the 2 bedroom apartment.

Thus, finding a 2 bedroom apartment on Airbnb or furnishedfinder.com that is within budget will allow you to have the extra space as a traveling nurse practitioner, without having to pay extra.