Traveling NP

For winter months, January – March, I knew I wanted to stay in Florida. I considered going to my favorite place – San Diego, CA, but it would be too challenging with the time difference and a long distance relationship. I had been asked to help out in Jacksonville in the past but I never had the chance. So, I reached out to my contact there to see if they had a need. 

Turns out they did! One clinic only had one PCP and they needed to off load some of her patients so she could focus more on her Medical Director role, while waiting for the new PCPs to start. The regional medical director assured me that it’s a nice well-run office, and not as chaotic as what I am likely accustomed to. 

I then let my agency know about the potential assignment so they could get everything in writing. Some of you may be wondering why I continue to work through the agency, when I am being contacted by the clinics directly for work opportunities. There is a legal agreement where I would have to go through the agency to work with this client unless we don’t work together for at least two years. 

The following week, my recruiter contacted me because she said the Jacksonville market didn’t want to pay my increased hourly rate that Bradenton was paying me. She asked if that was ok. I said no. She asked if I was willing to walk away, I said yes. She seemed uncomfortable having to call me about this. Probably because I am the one that got them that work opportunity in the first place, so the agency should be the one taking the cut, not me. I am sure she was pressured from her supervisor to contact me. 

Also, I have been working with this agency for 6 years and I know how things work. They don’t go to the site and say “hey pay Sophia $100/hour (for example)”. They say “hey we are charging $150/hour” and the site says yes or no. The site has no idea how much the agency is paying me. She made it seem like the site said no we want to pay Sophia $95/hour instead of $100/hour. When in reality, the site said we are only going to pay $145/hour. I have been playing this game for a while and my bosses often accidentally tell me how much they are paying. So, like I said before, the agency should be the one taking the cut, since I am the one doing the actual work. 

The next day, my recruiter called me back to let me know the good news. She said she had to go to the director to ask for permission for them to take the pay cut. The director said, of course, Sophia is the one that brought us the job! (Duh!) 

I am taking a week off in the middle of the assignment and I asked the agency to pay for my roundtrip flight home during that week (on top of the regular travel before and after the assignment). My recruiter said that the site said no they didn’t want to pay for that. I told her I didn’t ask for the site to pay for it, I asked for the agency to pay for it. And she said “oh my bad, yes we can pay for it.” I like how they are trying to get out of “losing” any money when I am the one doing part of their work getting these clients!

Anyways, I am looking forward to working in Jacksonville. I have several friends from college that live there that I would love to catch up with. My sister went to pharmacy school there so I am pretty familiar with the area. It is a bit colder than south Florida but still tolerable for someone that is anti-cold like me. 

I started listening to podcasts back in 2018 when I discovered one of the shows I watch for social reasons (to discuss with friends and family) – the Bachelor – had several of its contestants create a podcast for it. 

Fast forward to early 2020, when I discovered an entire world of finance podcasts. I love podcasts because you can listen to them while exercising, driving to work or long distances, on the plane, while cleaning, or just when relaxing in bed. I have absorbed a plethora of information from listening to podcasts alone. 

Below are my favorite financial podcasts that I listen to each week:

-Choose Fi

-BiggerPockets Money

-Afford Anything

-Earn and Invest

-I Will Teach You to be rich

-Trading Secrets

-MadFientist

-The White Coat Investor

-Journey to Launch

-Financial Samurai

-Rich and Regular

-Financial Freedom

Check them out and follow the ones that interest you. They vary from investing, side hustles, retiring early, finances for couples, overcoming scarcity mindset, real estate, etc. 

It is well known that women make 83 cents for every dollar a man earns. Part of the reason is that women are less likely to ask for a raise. Working as a locum tenens nurse practitioner, it is easier than ever to ask for a raise. The reason is because you have your recruiter that will act as the middle man. You tell your recruiter that you need a raise. Then they will ask the site for you for the raise. So, you get to avoid awkward conversations and trying to come up with reasons why you deserve the raise. 

If the site says no, the agency themselves may agree to the raise on their end. Or you can threaten to walk away, and the site may (often) change their mind and agree to the raise. 

One of my good friends is working as a traveling nurse practitioner in California, living her best life. She is on a 3-month assignment but told me she wants to extend for another 6-months. I told her that’s great and she should ask for a raise!

Her response was: “Since I am the one wanting to extend and they aren’t the ones asking me, I’d feel silly asking for a raise.”

I told her that even though she WANTS to extend, the site is likely ecstatic to have coverage for an additional 6 months! I told her she should definitely ask for a raise and the only bad thing they can say is no – which they likely wouldn’t. 

Unfortunately, my friend didn’t want to “risk” the assignment because she had already agreed to the extension and felt like it was too late to go back and ask for a raise (it wasn’t). I was a bit disappointed by this. 

Even though my friend is working in California (a high paying state) and I am working in Florida (a low paying state), I am making $15/hour more than her. The reason is because I know my worth and I am not afraid to ask for a raise.

So, to my fellow traveling nurse practitioners: please always negotiate the rate offered; ask for a raise or bonus when extending; and don’t be afraid to ask for your worth!

I was asked to extend in Bradenton right away, but I told them I would let them know during my last month. Three months later, I finally agreed to extend and was surprisingly told that they no longer needed the help. I was shocked because one of the PCPs had just left and they didn’t have any new PCPs lined up until 7 months later. I called my boss to discuss and he told me that the Tampa Region had hired an internal float nurse practitioner. She was already seeing patients in Tampa and they planned on sending her to help in Bradenton at the end of January. He assured me that the decision wasn’t his, that regional leadership made the call, and he kept on fighting for me and insisting that they did need me. He said in their eyes, they are mostly concerned about finances so they figured why pay me when they are already paying a salary for the float NP.

I was offended that regional leadership thought I was easily replaceable. Like not only did I already have my own patient panel, but I already knew the majority of the patients that belonged to the PCP that just left. They used to be mine, and they are a fragile panel as they have gone between 4 Physicians over the past 2 years. If I had been able to stay, I could have seen those patients while waiting for them to get established with their permanent PCP. And the patients would have been relieved to see a familiar face. 

But of course, regional leadership thinks they know best and haven’t even considered the need for patient retention. In all honesty, if they thought harder about the situation they could have ended the other locum NPs contract early since she is barely even seeing any patients. Now that’s what I call a waste of money. 

I was so disappointed by the regional leadership. But they have never worked at my clinic and seen patients directly (they are physicians) so they have no clue what type of patient population we serve. 

Job wise- I wasn’t desperate since I typically have a dozen clinics from this same company requesting my help at any given time. However, the next time the regional medical director came to the Bradenton clinic, I pulled him aside to chat. I told him how disappointed I was by their decision, and that I wasn’t planning on changing their mind since I have already committed to somewhere else. But I needed them to know what a mistake they made. 

He said the decision has nothing to do with me and he thinks I am amazing and they appreciate me so much. He said the issue is that this clinic keeps using me as a “band aid”, and he wants the leadership at the clinic (including my boss) to be accountable for retaining their PCPs. 

He said they plan on hiring 4 or 5 more permanent PCPs to help balance out the amount of complex patients, so that no one PCP feels overwhelmed. I told him that was easy to say but in the past 2 years that clinic has lost 10 providers. The main reason being the providers felt that the patients were too complex for them and felt overwhelmed, even if they were given a very slow ramp up schedule. 

During our clinic PCP meetings afterwards, the medical director kept saying how in January, there were going to be 800 patients without a PCP. So, the current PCPs had to work together to take care of these patients while waiting for the new PCPs to start. I feel like they made it seem like I just decided to leave and didn’t care that my peers were about to be overwhelmed. I am not a quitter, and I think they know that. Also, one of the new providers is a nurse practitioner, so I wonder who will train him?

Several of the physicians pulled me aside to discuss what happened, and I told them the truth. Afterwards, every time the Regional Medical Director came to our clinic, one of them would tell him how disappointed they were with his decision not to extend me. I spoke to the Center Director of the Bradenton clinic about this, and he said my boss was so upset when they decided they didn’t need me to extend anymore. I figured he was, because besides him, I am the only PCP in that clinic that has worked for the company for more than 2 years. He also told me the Center Director of the new clinic I was going to had asked him about me. And he told him: “Sophia is like having 3 providers in 1”. I thought that was so nice, and it was refreshing to be seen.

At the end of the day, I believe everything happens for a reason. As I explained in my last post, that I wasn’t having a good experience, so I was probably going to end up working there being miserable if I stayed any longer. I just didn’t want to give up on my patients and my colleagues. Even the medical director of my new job told me the clinic I am going to will be more organized and laid back than the chaos I am probably used to. So I am looking forward to working at a stress-free clinic. 

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.

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. 

Check out this article I wrote for Comp health’s blog about how I choose which agencies to work with:

https://comphealth.com/resources/choose-locum-tenens-agencies

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.

Check out this article I wrote for NPSchools.com about doing your research before becoming a traveling Nurse Practitioner:

https://www.npschools.com/blog/travel-np-tips

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.