Traveling NP

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.

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.

This is the first time I have returned to the exact same clinic. I have returned to the same company/markets before but not the exact same clinic. I felt very welcomed on my return and it was nice to catch up with everyone. There was one major surprise though.

I thought I was coming in to help absorb new patients. But it turned out that the company fired a physician the Friday prior to my start date. Apparently, she was being nasty to the staff and wouldn’t even see one of her patients as an acute visit that was audibly and visually throwing up blood in the hallway. I was surprised because she was very nice when I met her the year prior. The other providers think she had a psychotic break from all of the stress because she became a completely different person.

Anyways, this assignment turned out to be similar to the Virginia Beach one last year, where I had to absorb a patient panel pretty quickly. This patient panel had gone through 3 physicians within one year, so they weren’t the happiest. I totally get their frustrations but physicians are real people too. Their first doctor wanted to go part time to spend more time with her kids. The second one realized she didn’t like primary care and wanted to work in the hospital. And the third one I just explained above that she was let go.

The first couple of weeks were annoying have to hear patients complain about switching PCPs again. Several of them threatened to leave the practice, but at the end decided they were going to stay. So, my first few minutes were them was just allowing them to vent. It was a bit hectic because patients were calling trying to be seen right away for various reasons, but there was only one of me to accommodate all of these patients.

Now I am two months in and things have gotten much better. I have gotten to know the patients so it makes things easier. My hospital sick days have been pretty good as well. No one really micromanages me because they are just appreciative to have the coverage. I do have a handful of psych patients that call all of the time, but I try to set boundaries with them.

The company hired a physician and a nurse practitioner to start seeing patients in February. I am supposed to finish here in mid-February, but they really want me to stay longer so that I can help train the new nurse practitioner and to provide a few months buffer while the new PCPs accumulate patients. I usually like to make this decision the month before my contract ends, because it gives me enough time to evaluate how things are going. I’ll let you know my decision soon!

Check out this article I wrote for Comp Health’s Blog about some new challenges any NP can try within the new year. You can fine the article: Here!

Returning to Bradenton, Florida for winter season made finding housing a bit challenging, since all of the snowbirds go down there around that time. Monthly Airbnb’s are over $7k per month in the area. I didn’t prioritize living at the beach this time since the water is too cold for us Floridians this time of year.

Fortunately, my agency found me an apartment 15 minutes from work. It’s in a new suburb community with plenty of restaurant and shopping options. It is pretty spacious and they even gave me a sofa bed for guests. There is a community pool and gym.

I moved in the weekend after getting my covid booster in November. Once I moved in all my stuff, I started to feel horrible from the vaccine. I spent the rest of the weekend just lying in bed with chills and body aches. I was disappointed that internet and cable hadn’t been set up yet. Especially since my cellphone service wasn’t that great in the area. It would have been ideal to be able to watch tv or read stuff online when sick in bed.

I was told internet and cable would be set up Monday, so I tried not to be too disappointed. However, on Monday, I received an email from traveler’s haven (a housing agency that my travel agency often uses to assist them in finding housing). The email said only cable would be set up today and I had to go to Spectrum to pick up the wifi box and router.

I was like really? Who prioritizes cable over internet? Not to mention I still wasn’t feeling 100% after that vaccine. I knew I couldn’t spend another day without internet (first world problems), so I drove over to Spectrum after work and waited an hour in line to pick up the internet boxes.

I got home and set everything up, which took forever. Before I could use the internet, I had to activate the account. When I called to do so they wouldn’t let me since I didn’t have the code, considering traveler’s haven set up the account. I called Traveler’s haven and luckily someone answered and gave me the code. Four hours after finishing work I finally had internet.

Considering I was still recovering from the covid booster, I was a bit cranky and emailed my agency telling them how disappointed I was that internet hadn’t been set up prior to me moving in. I know there is a disclaimer that this may happen, but it has never happened to me in my past 6 years traveling with them.

They apologized and told me that traveler’s haven should have never sent me to pick up the wifi boxes. That they usually use a concierge service for that, and have never seen a provider sent to pick this up. Traveler’s haven sent me an apology as well with a $50 visa gift card for the inconvenience.

At least I know now if they ever tell me to pick up a wifi router again, I can tell them to send someone else.

Check out an article I wrote on NPschools.com on how nurse practitioners can explain their role to both patients and co-workers:

https://www.npschools.com/blog/nurse-practitioner-role

I am thrilled to say that this blog made it to top 5 nurse practitioner blogs of 2021! Check out the other top NP blogs here: https://www.npschools.com/blog/best-np-blogs

Thank you to my readers for all of the support! I enjoy sharing my experiences being a travel nurse practitioner and guiding those interested in starting this amazing lifestyle.

Florida is popular during winter. In fact, the average Airbnb rental for the winter months is about $4000-$5000/month. This isn’t California! So of course, my agency had a difficult time finding me housing initially.

I ended up having to stay in a hotel for my first week on assignment. Fortunately, I was able to find a Residence Inn Marriott which came with a kitchenette. However, one of the days I needed was sold out so the agency asked me what hotel I would like to stay in for that particular night.

My first reaction was to be annoyed. Who would want to move out of a hotel just to go stay at another hotel?

Then I remembered that since I am a Titanium member with Marriott they have a benefit which is a 48-hour guaranteed availability with a paid stay. So, I called the hotel and provided them with my Marriott rewards number and explained my situation. They instantly recognized my status and proceeded to find me a room on a “sold out night”.

This worked out really well because I was able to stay at the one hotel for the entire duration prior to me moving into my apartment. It was a nice surprising perk of having top tier status with the hotel. If you have status with any hotel chain, be sure to read the benefits and perks so you can be prepared when needed.

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.

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.