Category: Uncategorized

Thinking about my next assignment I knew I wanted to go somewhere new. However, it was still winter so my options were naturally limited. I decided that the most important factor in choosing my next assignment would be that it would have to be in Texas. I already had a license there that I never used.

I have always been interested in working as a locums nurse practitioner in Texas. I was curious to see why many young professionals opted to move there. Were the abundance of jobs and affordable houses worth it?

I wasn’t in a rush to start working, thus I had enough flexibility to be patient until a job in Texas opened up. It seems that finding a locums position in Texas isn’t that simple. Like Florida, Texas is one of those states that is saturated with nurse practitioners. This means they don’t have has many locum needs, and if they do, they prefer local candidates.

Fortunately, it only took about one week for something to come up. My main goal was to get to Texas. I was willing to sacrifice pay and job type, just to end up there. So, I ended up settling for a home assessment gig (more on that in my next post).

Has Texas lived up to the hype? As a matter of fact, yes! Despite their reputation, Texans are sincerely the nicest people I have ever met. They greet you everywhere you go and everyone has a smile on their face. They are so friendly that they even go out of their way to make conversation with homeless people, instead of pretending they don’t see them like most Americans. Texans are also patriotic and are so proud to be both American and Texan.

Texas has multiple major cities, each with its own flavor. There is an abundance of young professionals, so it’s great being able to make friends on my level. Of course, the houses are beautiful AND cheap (coming from Miami). The traffic isn’t major (outside of Houston and Dallas), and people know how to drive (compared to Miami). Gas is cheap (duh). Food is delicious.

A few drawbacks: everyone has a truck here – except me. My convertible doesn’t fit in but seems to get a lot of compliments (since everyone is so nice remember?). It can be scary sometimes being in a small sports car in between nothing but trucks. Texas is a bit dusty/dirty. There is more dirt than grass, which leads to outdoor items (mainly car) staying dirty all of the time. There is no Publix supermarket (if you aren’t from the south east, you won’t understand what you are missing out on). Florida beaches > Texas beaches.

Fortunately, I won’t be here during the summer. The weather has been cool, and I get to avoid the scorching heat.

When the day comes that I settle down, I wouldn’t mind living in Texas. It’s only a 2.5 hour flight to Miami and the people have undeniably won me over!

Wide open spaces, clear starry nights, deer in my back yard on a daily basis and an extremely low cost of living are reasons why I’ve chosen to work in rural California.  My friends often ask “Do you really live in the country in California?”  Yes I tell them and I love it!

I’ve been a nurse practitioner since 2011 and love what I do. It’s a second career for me  My former career had me working as a corporate executive for large pharmaceutical companies. I got tired of flying coast to coast on private Gulfstream jets, dining at 5 star Michelin restaurants and staying at swanky hotels while working way into the evening to meet the next quarter’s numbers for Wall Street.  Some ask how could you get tired of that.  I say, do it for 5 years and tell me how you feel. You really have no life beyond “the job”. I sold my soul to corporate American while in my 30s and never will again.

Being a nurse practitioner in rural Southern California is not bad at all. My patients are happy to see me and for the most part I enjoy going to work every day. I’m close enough to the big cities to enjoy what most people consider So Cal. It takes me an hour to get to LA and an hour and a half to get to Ventura so I can enjoy my boat.

I’ve chosen to work in locations that are within an hour or two from the ocean as on the weekends I spend my time on my yacht.

Rural medical clinics generally have to pay their locums a higher hourly rate as not many providers want to live in the country. The higher rates are great as the cost of living around the rural clinics is usually 1/2 to 2/3 less than living in the city.  There are drawbacks to living in the country. My water gets trucked in as I have no city water service.  I have to use satellite internet as the cable providers don’t come out here .  The closest real grocery store is 45 minutes away and any type of city dweller dining/entertainment is also an hour’s drive away.

You can get used to it quickly when you see the $ piling up in your bank account from the low cost of living and the higher rates of pay you get as a locum. I would never do this job as a full time clinic employee. The clinics will always ask you to join full time but my experience has been you can make an extra $100,000 a year as a locum.  Of course you have to buy your own benefits, plan your own retirement and pay self employment taxes but in the end it works out for me.  I wouldn’t do anything else for a  NP job and plan on staying a rural NP for as long as I can.

-Ben

With the new year, I knew that I definitely did not want to work as much as last year. I somehow got caught up in being a workaholic. This is a big no-no for a millennial. I told myself that this year I would take more time to travel abroad, and possibly more time off to focus on myself.

As both a locum and as a nurse practitioner, it’s quite easy to fall into the trap of workaholism. Recruiters are forever letting you know when there is a job available and asking you when you are next available. Sometimes, you just have to learn to say no and even establish some distance between yourself and recruiters.

Recently there have been two comments made by friends of mine that have enabled me to reflect. One fellow nurse told me: “you are lucky you get to travel everywhere!” As tiring as locums can be at times, she is right. In my opinion, there is nothing better than being able to travel to new places. I am sure locums hear this all of the time, but I think I hadn’t heard it in a while.

The second comment was from a good friend that is interested in becoming a traveling nurse practitioner. She told me: “I just started reading your blog and I am so excited to start!” I was actually surprised by her statement because she used to tell me she had no interest in traveling in general. I asked her what exactly made her excited from my blog, and she told me: “one of your first posts about working in Washington state.”

I looked up this post on my site and read it for the first time in about 2 years. I realized I had appreciated the smallest things at that time, and how spoiled I have become.

I am hoping this reflection will allow me to take on my next assignment with a different perspective.

 

I recently wrote an article for www.travelnursing.org on how travel nurses can take advantage of their new occupation to pay off student loans. Some of it is also relevant to traveling nurse practitioners.

Check out the original article here.

One of the most amazing benefits of being a travel nurse, is being afforded the opportunity to pay off student loans. By following an appropriate budget and using extra income allotted from travel nursing, you may be able to eliminate student loan debt faster than expected.

1) Non-Taxed housing stipend – While working as a travel nurse you will have the choice to receive a non-taxed housing stipend or have your agency coordinate housing. If you’re looking to pay down debt, we recommend taking the stipend and living within your means. By saving on housing costs you can then “pocket” the remaining stipend to put towards paying off your student loans instead. As an added bonus, you can also opt for a housing stipend from your agency. Some travel nurses will rent out a basic room or purchase second-hand furniture (to sell when they leave) – this additional cash will come in handy to pay off debt.

2) Meal and incidental stipend – Travel nurses receive non-taxed stipends for meals and other incidentals while they are away working. This can be an additional few hundred dollars beyond your weekly paycheck. In many cases, they also receive non-taxed travel stipends to alleviate some of the costs incurred from traveling from place to place. Most agencies reimburse $500-$1000 of travel expenses per assignment.  This helps you save money on necessary expenses and provides available funds to pay off your student loans.

3) High pay – It is quite well known that working as a travel nurse pays better than working as a staff nurse. In some states, such as California, nurses are even paid double the typical pay in other states. Commit yourself to continue living on your previous salary and use this extra income to get rid of your student loan debt!

4) You don’t shop as much when traveling – When living out of a suitcase, you cannot afford to shop due to limited space. Most professionals have a shopping budget, but as a travel nurse there is no need for shopping. Since you cannot buy tons of things and bring them around with you, many travel nurses avoid shopping altogether. This allows more savings towards student loans.

5) Work overtime – The majority of nursing shifts are three 12-hour shifts. This allows nurses 4 days off, plenty of time to be out and about wasting money. Instead, it makes more sense to pick up extra shifts at work. This way, you can make time and a half pay to use towards paying off your student loans, instead of blowing your budget.

Plenty of travel nurses have been successful paying off their student loans. Many of them account the above benefits of travel nursing that enabled them to become student loan debt free. If you are tired of carrying around the burden of student loans, sign up today to begin an exciting career in travel nursing!

Last December I had shared an offer I received for a really great permanent traveling position. If you aren’t already aware, it was a “permanent traveling” position, because I would still be able to travel to multiple states but I would be working as a permanent employee to one employer. No more agencies.

As some of you may have noticed, I did not accept their incredible offer. Here are the main reasons why:

• I loved working for their clinics in Virginia. Yet, I hated working for some of their clinics in Florida. This showed me that all of their clinics are not equally enjoyable to work in.
• I am not ready for such a commitment. I am turning 30 years old at the end of this year and I don’t want any restraints on my vacation time. I am planning on many wonderful trips abroad and don’t think 6 weeks PTO (including holidays) is going to cut it.
• I do not want to give up my tax breaks. I have often highlighted the pros of working both 1099 and W2 as a locum tenens nurse practitioner. If I became a permanent W2 employee, the taxes I would be paying would almost double.
• I don’t want to become a slave to healthcare. Unfortunately, healthcare in the USA doesn’t allow providers with enough time with their patients, resulting in less than optimal outcomes for patients. It is a high demanding environment, leading to increased stress and work hours. No thank you.

As amazing as the opportunity was, I knew in my gut I had to turn it down. On the bright side, that opportunity will always be there, if I am ever ready for it.

After completing my assignment at the FQHC in Southern Florida, I was ecstatic because I finally had time to go on a trip! I hadn’t been abroad since last summer since Hurricane Irma had other plans for me.

After living in cold Virginia for one year, I lost all of my color. Thus, I knew my first trip of 2018 would need to be somewhere with plenty of sunshine!

I decided to go to Aruba because since it is close to the equator that meant it is warm year round. Even though it was February, I knew the water in Aruba would still be warm enough to swim in.

I went on the trip with my sister, who was also mentally exhausted from recently changing jobs. We definitely enjoyed our brief getaway, which allowed us to catch up on sleep, sunbathing, and relaxation.

We also enjoyed snorkeling and hanging out at the beach with these fun birds:

I was very interested in seeing the culture of Aruba. The natives spoke an Afro-Portugese creole language, called Papiamento. However, I was most impressed that the majority of them also spoke English, Dutch, Spanish, and even sometimes French. They were very friendly and we ended up being there during their “Carnival”. This is a dance party/parade that runs on main streets throughout the island, lasting days. I have to admit that the Haitian Carnival is way more chaotic ;).

Our last day in Aruba, I made sure to enjoy a Dutch Pancake, and it did not disappoint! It reminded me of a thicker version of a French crepe. I would recommend Aruba for a quick getaway (it was only a 3 hour flight from Miami) and the water was warm as expected.

To my fellow locums out there, I don’t know about you but each time I tackle a new assignment I feel like I have to “prove myself”. I have to prove that I am a good locum tenens provider. That I am a quick learner, that I can see a lot of patients, that I can be thorough – covering health maintenance and quality measures; and that I can document well – not missing any important codes.

The funny thing is often the site has low expectations. They just need someone that’s going to be able to jump in and provide coverage while they recruit someone permanent or their permanent provider returns. Most of the time they aren’t expecting superman or superwoman.

Working as a traveling nurse practitioner for almost 3 years now, I have come across several other locum tenens providers. It’s interesting to see the variety from the locum tenens pool. Many other locum tenens providers are fine doing the bare minimum. Some don’t pay attention during our meetings or read their emails to learn how they can improve their documentation or care for the patients at this particular site.

I think it is the overachiever in me that feels like I need to exceed expectations. I guess I should take the pressure off of myself. In fact, locum tenens means filling a temporary need. The site and staff are usually so happy to have us helping out that they don’t even bother judging us.

 

 

I am wondering if my “I don’t take bs” attitude translates into me being a diva. As demonstrated in my prior experiences, I often stand up for others and myself. I think since I have worked in so many different settings, I know what a GOOD work environment is. I know that it is absolutely possible to work somewhere that is pleasant and not overwhelming. I also know what a GOOD recruiter is and what a GOOD deal looks like, so I do not want to settle.

There are 2 main aspects of working locum tenens that sometimes irritates me and causes my “inner diva” to come out.

1. Being overwhelmed at work. Whether it is due to being scheduled with too many patients, lack of leadership in the office, no admin time, or lack of assistive staff.
2. When recruiters speak to me as a car salesman, acting like taking this job is equivalent to buying a car. They say things like: even though this job doesn’t pay well nor is it in an ideal location, at least you will have work.

My responses to these problems:

1. When asked to see certain patients (last minute) I will say NO just to make a point. I will request a change from either management or from my agency. If they are reluctant to change anything I will use the “it’s my license on the line” talk. In the back of my mind, I always consider just leaving if things do not improve.
2. “At least you will have work”. Hi, I am not desperate. I’ll just say NO if I don’t like something. For instance, sometimes a recruiter will try to get away with giving you poor housing options, such as staying at a motel 8 (ew). When you demand better options they will say “can you at least stay there for this week until we find something else?” The answer is NO. No, I will not travel all the way there for a “possibility”.

Do I overreact sometimes? Yes, I am human. But who else will speak up for myself if not me?

So am I a Diva? Perhaps at times 😛

 

One of the most common questions I receive is regarding the stability of being a locum tenens nurse practitioner. Is there consistent work? Are there periods or gaps with no jobs available? Looking back at the past year, 2017, one thing is clear. I worked way too much! More so, I worked more than I originally planned. I meant to spend most of 2017 traveling abroad but accidentally got caught up in work.

As soon as I finished my assignment in Virginia and needed to be home in Miami after Hurricane Irma, I was able to start working on another assignment. The only ‘gap’ was the 1 week road trip I purposely took on my way down to Florida. Once I completed my assignment in Miami, I had another assignment waiting for me, in which I started the following Monday.

To further illustrate the consistency and abundance of locum tenens job, is how quickly I was able to obtain an assignment after leaving the site in Tampa, Florida. I decided to leave that assignment early (I made this decision on a Wednesday). The following day, Thursday, I notified my recruiters that I would be available for another assignment. Friday was my last day in Tampa, FL, and during my lunch break I was already being interviewed for another job. By Friday afternoon, I had already been offered and accepted my next assignment. This new job started the following week. Luckily, it was right after new years so I had Monday off to recuperate.

My family and friends were impressed about how quickly I was able to get a new assignment. Personally, I wasn’t surprised because that’s just part of being a traveling nurse practitioner. I work with about a dozen recruiters at any given time to provide me with as many job prospects as possible. That’s why I always encourage my readers to credential with various agencies, and not limit yourselves to just one or two. There is a primary care provider shortage in America – someone is bound to have a job opening for us! J

As a quick summary, I spent the past year working in Virginia for a geriatric clinic that follows a preventative care model. I am currently working in Florida for the same clinic, as they have clinics in multiple states and continue to expand.

My previous post animated part of a discussion I had with the Chief Medical Officer of the company, in regards to nurse practitioners. The main purpose of the conversation though, was for the CMO to see what my goals were and if the company could hire me as their internal locums/traveler.

I alluded to having a similar conversation previously with their Chief Financial Officer. And how I told him that I wanted to continue with my current agency for now, until I had a better grasp of the various markets.

The CMO told me that he definitely sees the value in having an internal locums, especially as they continue to grow. He said he would love to invest in me to develop into a leadership role eventually. Meaning I would either oversee a larger traveling team in the future, or even manage all other nurse practitioners in the market. He said as a contractor it wouldn’t make sense for him to invest in me, so that is one of the main reasons he wants me to become directly employed with the company.

He asked me what I was currently being paid and told me he could increase that. (Side note, I already get paid significantly more than the permanent nurse practitioners, even those with 20 years of experience, since I am a traveler). He said he could also offer me a sign on bonus and yearly bonuses as well. The company would of course cover all of my travel, lodging and licensing fees. He said they would also provide me with a weekly dining stipend, and cover flights whenever I wanted to go home in the middle of an assignment.

In addition, I would have the same benefits as the other employees such as 401K, health insurance, CME allowance, and PTO. The company would also guarantee me with a yearly schedule where I am in a different location every 3 months or less.

After the CMO made all of these offers, I think he was surprised to hear me say “we’ll see”. Financially he was offering me a whole lot, but my priority has always been freedom and flexibility. Although I would continue being a traveler, I would be restricted to practicing in locations the company has clinics in. On the bright side, they are continuing to expand and are opening up new centers in several different states by mid next year.

At the end of our meeting, we agreed to allow me some time to feel out the new center I was in and to think things through. We set up an appointment to meet again next month.

I am extremely grateful for the offers he made me, and especially for the fact that he sees something in me that would make him want to invest in me as a leader. I would be honored to manage and help other travelers and nurse practitioners.

It honestly seems like an unbelievable opportunity for me to grow in an incredible company. My main hesitation is how much flexibility will I have? Will I still be able to take time off in between or during assignments to travel abroad? Perhaps I could negotiate this in my contract. The average PCP has about 4 weeks of PTO but I will definitely need more than that even if it’s unpaid. Will I still be able to leave an assignment early if I absolutely hate the place (whether it’s the people or location)? Maybe I can have them agree that if I don’t like a center I can give a 30-day notice the same way I do with my agency.

On the plus side, they will give me a schedule so I can actually plan where I will be in advance for once. Am I ready for a commitment? I guess worse comes to worse I can always quit and become a regular locum tenens nurse practitioner again J

I would love to know your thoughts! Should I go for it???