Traveling NP

Since I needed to escape Chicago for winter, my current assignment offered me to work at some of their other locations. I ended up agreeing to work at one of their clinics in Kentucky because this is where they had the greatest need at the time. I wasn’t too excited about going to Kentucky, because what’s really there? I was mostly doing it as a favor to my job since they gave me several bonuses that I shouldn’t have qualified for since I am a contractor.

However, most of my friends that had visited Kentucky said it’s nicer than you’d expect. I also asked around and heard the physicians at the Kentucky clinics were more amiable compared to the ones in Chicago.

When I got to Kentucky, I immediately felt homesick. Somewhat for Miami, since I was there for a few weeks for the holidays. But mostly for Chicago. I felt weird thinking that I was going to be working in the exact same facility but with completely different people. I asked myself what I was doing here?!

Fortunately, my first day went well. My sources were correct, the PCPs in the Kentucky clinic were very friendly. The medical director even gave me a hug – she was so excited to see me! My schedule was empty so I offered to help the other PCPs with their patients but they all told me “no thank you”. And if they asked me to see a walk-in that belonged to the PCP that was no longer there, they asked me a hundred times if I was okay with it. They wanted to make sure I wasn’t overwhelmed, which was sweet. If only they knew how much I have previously put up with.

The best part is all of the PCPs seem to get along well. They make jokes together, talk about life, and even complain about patients together. I had gotten accustomed to the poor PCP relationships in Chicago, I forgot what it was like not to be in a toxic environment.

My boss from Chicago is currently also managing the Kentucky market. He passed by to see me on my first day which I really appreciated. He told me the clinic in Chicago I worked in is already going crazy without me, and he/they can’t wait for me to come back in Spring.

I am glad things turned out well in Kentucky because it’s too cold for me to return to Chicago at this time. I can handle the 50 degree weather in Kentucky, no wind, and the sun going down at 5:30 pm (the sun goes down by 4 pm in Chicago).

Over 3 years ago, I started working as a locums for a geriatric practice that only accepts Medicare advantage plans. This company has clinics throughout the USA and continues to grow. Since then I have worked with them on and off because I truly admire their mission, and I like being accountable for my patient care. My most recent experience with them was in Chicago. I thought I was only going there for 3 months but kept extending because I really enjoyed it.

On day 1, the medical director was confident that he could convince me to become permanent. I laughed it off because that’s always the intention of sites, especially considering that his particular company has been trying to get me to go permanent with them for years now.

Surprisingly after my last extension, I was open to a discussion with him about going permanent with them. I was upfront about how I had previous offers from the company that didn’t match my needs. The medical director was also aware that it would be impossible for me to survive winter in Chicago.

Part of the offer was that I could spend 9 months out of the year in Chicago, and during winter months, I could work at one of their other markets in a warmer state. That seemed like a win-win to me.

There would definitely be a salary increase to make it worth it since my housing and car would no longer be paid for. I would also be eligible for quarterly bonuses since the particular clinic I work in is part of a shared savings plan. These bonuses can be up to $10k per quarter. In addition, if I made partner, which I easily could if I continued the way I have been practicing, I would qualify for an additional $5k bonus per quarter.

There is no time commitment, unless I want a sign on bonus. In that case I would have to commit to 1-2 years, which doesn’t seem like much.  

I was actually open to accepting the offer, considering the job only gets easier with time since you get to know your patients so well. And like I have said before, I have a special relationship with all of my patients here. However, once again it came down to PTO. When the chief medical officer of the company previously made me an offer (years ago), he would only provide 6 weeks PTO. I am used to taking 10 weeks off per year, so I could at most compromise to 8 weeks PTO.

The market president had a hard time fathoming how I would be able to provide great care to my patient panel if I am gone for 3 months (working in another market) and then gone for another 2 months (on PTO). I know it sounds ridiculous but in reality, I had already proved it can work. I accumulated my patient panel after winter (3 months of the year had passed). And throughout the 9 months I worked there I was gone for 8 weeks total for vacation.

I was still able to have the best patient outcomes in the market. I always had the least (if none) patients in the hospital. I had the highest Hedis score in the market. I was the first provider to have 80% and 90% of my patients flu vaccinated. I placed the least amount of referrals. And I was able to code high risk diseases well to get my overall risk panel significantly higher.

Since we couldn’t exactly come to an agreement, we decided to do a “trial period”. I was planning on ending my time in Chicago at the end of December due to winter. So I agreed to help them in one of their other markets for the next 3 months. The plan is for me to possibly return to Chicago in spring and pick up my patient panel there. This is a “trial” to see if we can actually make this permanent plan work.

This plan may seem a bit crazy but I honestly wouldn’t mind continuing to work in Chicago with my current patient panel. The medical director desperately wants to make it work since my clinic profited tons of money over the past 9 months thanks to me.

Stay tuned for where I am going next….

Sadly, my time in Chicago is coming to an end. Saying bye to my patients has been tough. We honestly treat each other like family. Some of them I have seen monthly or even weekly over the past 9 months of me working here.

My sister laughs whenever I talk about how sad I am to leave my patients. I think it’s difficult for an outsider to understand the bond I have with the patients. We clearly have a strong bond because I somehow made it to 80+ days without any patients in the hospital which is unheard of at our company.

My supervisors are trying to figure out a way to reward me for this but I feel like they don’t need to. It’s my job and something I enjoy doing. I ended up getting 90% of my patients flu vaccinated so my team gets an extra PTO day and $200/person. That’s a nice benefit J

Fortunately, the new physician started and we have slowly begun transferring my patients to her. She is very sweet and pretty quick, which is something my patients will appreciate. I told my patients I may come back in the spring so that has made saying goodbye a little bit easier.

I am looking forward to going home for the holidays so I can be in the sunshine state. Cold, windy, overcast weather gets old after a while. Stay tuned for what’s next.

Do you tend use the same one or two agencies to travel with?

I always recommend being in contact with at least 5 or 6 agencies at any given time. This will increase your job options. To date I have worked with 7 different agencies. I tend to use some more than the others. Ultimately, I just select which agency to work with depending on the job available at that time. It may be tedious to fill out all of the credentialing paperwork, but it will be worth it in the end. 

I am often asked what my favorite travel assignment was. After working in over 20 different settings, it’s hard to pinpoint just one. I think I can narrow it down to my top 3.

Washington State. This was my first locums assignment away from home. I had such a positive experience. I remember the clinic being well run, the medical assistants being industrious, and the fulfillment I felt for taking care of an underserved population. Had my first experience away from home been bad, who knows, I could have easily quit being a traveling nurse practitioner.

San Diego. To be honest, I did not like working at this site. However, living in San Diego was an amazing experience. It is probably the only city I would live in outside of Florida. I like that it is diverse, not too crowded, and there is so much to do outdoors. I would love to return there some day.

Virginia. This was the first assignment that I extended and ended up staying there for 1 year. I really enjoyed working at this geriatric practice that allowed me to be accountable for my patients outcomes. I especially loved forming relationships with my patients. I even briefly considered staying there permanently! I have continued to work for this site in different parts of the USA.

What has been your favorite assignment so far?

In the spirit of Thanksgiving and the upcoming holidays, I wanted to reflect on how lucky I feel and how thankful I am for my life. Here are the top 10 things I am grateful for:

1. Travel – I love the opportunity I have to travel both for work and for leisure. My favorite part about traveling is learning new things and experiencing new adventures.
   
2. Family – I am fortunate to have such a large and loving family that I can return to in Miami any opportunity I get. Of course, they always ask me the same question: “when are you moving back to Miami for good?”
   
3. Friends – I am lucky to have a vast network of friends. Pretty much in every state I travel to for work, I already know at least one person there.
   
4. Being a Nurse Practitioner – What a challenging and fulfilling career. I am grateful for every step that led me to become a traveling nurse practitioner.
   
5. Health – Over the past few years I have made my health a priority and have managed to lose a significant amount of weight. I also make sure to stay physically active which helps tremendously with mental health as well.
   
6. Being an American – As corny as that may sound, freedom and liberty is priceless. I have had an opportunity to work in Saudi Arabia for a significant salary, but there is no price for freedom.
   
7. God – He always has my best interests at heart and continues to bless me on a daily basis.
   
8. Financial Stability – Being debt free, having little expenses, and plenty of savings is uplifting. This allows me to have a carefree attitude about life and allows me to feel like anything is possible.
   
9. Knowledge – I have read 25 books so far this year. I am thankful for knowledge that allows me to keep an open mind and see different perspectives.
   
10. Culture – I feel empowered being multilingual and having a cultural background to share with my peers.

What are you grateful for this year?

Nowadays, most people look up flights using google.com. You can find a one-way flight for half of the cost of roundtrip. Many years ago, it was cheaper to book a roundtrip flight than 2 one ways. Presently, you can find 2 one ways for the same price of a round trip flight.

We often automatically search for flights in economy, not realizing you can frequently find business/first class flights for the same price, cheaper, or only $20 more.

After negotiating my recent extension, I requested reimbursement for a roundtrip flight home for Thanksgiving. I knew the flights would be pricey since this is prime time for flying.

Looking for a one-way flight from Miami to Chicago on the Sunday after thanksgiving were pricing at $680 for economy. That’s pretty expensive considering I can fly roundtrip to Europe for $680 from Miami. Regular economy flights from Miami to Chicago are usually ~$150.

I watched the flight for several weeks with no change. Then one day I decided to check the business/first class flights instead. Surprisingly, I found one way flights from Miami to Chicago on the Sunday after thanksgiving for $650 in Business/First class! This was $30 cheaper than in economy.

I went ahead and booked the flight for business/first class. I submitted the receipt to my agency, and they reimbursed me the following week. Now I get to end an incredible Thanksgiving week flying in style!

Moral of the story: always double check prices in business/first class.

A couple of months ago, I shared my experience training one of the new nurse practitioners in the Chicago Market. We’ve kept in touch since then. She reaches out to me when she has a clinical question or just to say hi. Reminder: we do not work in the same clinic.

She voiced her frustration with the Assistant Medical Director (AMD) at her clinic, who is supposed to be her mentor. Instead, the new nurse practitioner feels bullied by the AMD. Apparently, the AMD told her she should consider quitting and working at CVS minute clinic instead because it would be much easier.

Fortunately, the Chief Medical Officer (in charge of all physicians and nurse practitioners, including the AMD) said he didn’t agree with this statement and the AMD had no right to say that. He met with the AMD and told her that it is her responsibility to make sure the new nurse practitioner is successful.

I was recently able to spend a day shadowing the new nurse practitioner and have noticed she has improved a lot. She has become more familiar with the electronic medical record system and is quite thorough with her patients. She has also gained more confidence in her medical knowledge, which is a result from her studying for hours each day after work.

We discussed ways she could improve such as trying alternative treatments prior to referring to a specialist for any little thing. She also needs to work on multitasking, such as typing and placing orders while patients are talking.

The most important thing I noticed was that her patients love her. Her patient panel is mostly Polish speaking patients since she is the only Polish speaking provider in the clinic. I think that’s enough reason in itself for the company to continue investing in molding her into a better provider.

I just wanted to give an update and let you know that the new nurse practitioner is doing just fine. A little reminder for you new providers out there – don’t give up and be sure to find a mentor!

Of course, I did! Minus the occasional work place drama between the other PCPs, I really like my job. I really enjoy taking care of my current patient panel. They are the nicest group of patients I’ve ever had! In fact, after my big trip, they were more interested in talking about my trip than their medical problems.

We have such a great relationship that they come to me for anything instead of going to the hospital. Prior to my trip, I even had 30 days of 0 patients in the hospital. This was a HUGE deal. Apparently, I was the only PCP in the market that had ever accomplished this.

Just a reminder all of our patients are 65+ years old with many co-morbidities, so out of a patient panel of 300-400 patients, there is usually at least one patient in the hospital at any given time. The fact that my patients avoid the hospital and come to me instead for any urgent issues means they trust me.

In fact, as soon as I went on my trip a bunch of my patients went to the ER for any little thing. The moment I came back they stopped.  To the point that I was able to once again, have another 30 days of 0 patients in the hospital! And it’s not because I have the least sick patients. There is a scoring system we use, and my panel is the sickest panel in my clinic.

Leadership was impressed so they gave me an extra bonus (not conditional to me extending).

Once I came back from my trip and realized I actually missed my patients, I agreed to extend. Unfortunately, the extension is brief, only an extra 6 weeks. This is because I need to get out of Chicago before it starts snowing like crazy (Miami native here).

There is a new physician starting this month to take over my panel. By me extending I am providing a warm hand off. It will take her 3 months to accumulate my panel but at least the patients can be stable by the time they get to her; and I can give her some insight into the more complex ones.

Some of my patients know I am leaving. They found out when they tried to get their relatives to transfer to me and the front desk told them I would be leaving soon. I joked with the patients that I was going to Miami for winter, as some of them are going to Mexico for winter.

I told them a new doctor that is also Spanish speaking would be taking care of them when I am gone. They said that’s fine but asked when winter is over will I come back and can they transfer back to me? I kindly smiled and said “we will see.” Because honestly, you never know.

I took almost 3 weeks off from work to go down-under. On my way to Australia, I stopped in Fiji to relax a bit before the big journey. The people are so friendly and I loved watching the sunrise.

First stop in Australia was in Brisbane. We mostly went there so I could visit the Koala Lone Pine Sanctuary. My childhood dream came true when I got to hold a koala! It was definitely my favorite part of the trip. I was able to watch tons of koalas eat, sleep, cuddle, snore, pee, climb etc. for hours!

We were also able to hang out with the kangaroos and feed them. It felt like feeding a dog. Both the koalas and kangaroos were friendly contrary to what people believe.

Afterwards, we went to Sydney. Sydney was much bigger than Brisbane but I actually liked Brisbane more. Brisbane still had a city aspect to it but was much more beautified (lights and flowers everywhere, public pool and beach at the parks etc.).

Of course, we saw a show at the Sydney Opera house and went to both Manly and Bondi beach. I had heard Australia was expensive but it was quite similar to visiting/living in the USA.  

Next, we visited Bali, Indonesia. We stayed at a wonderful resort and never wanted to leave. With my Hilton status, I was upgraded to a huge suite that had a separate living room area. This was beneficial when we had the group over and needed some privacy. The Hilton also provided free continental breakfast to me and all of my guests. It was literally the best breakfast we ever had. There was a buffet assortment of cuisine from the USA, Japan, China, India, Vietnam, Indonesia, and Europe.

I liked Bali because the entire island was decorated with temple like gates so it had a zen vibe. People were very friendly and everything was really cheap. We hired a driver for an entire day for only $50. For some reason I expected the Balinese people to be poor just because the cost of living was low, but truthfully everyone seemed pretty comfortable. Although they greatly appreciated any tips they didn’t expect any.

The food was so good! We got a taste of the Balinese jungle life by swinging into the abyss and visiting some rice terraces. My friends loved the monkey forest but there was no comparison to the koalas for me :D. Bali also has a bunch of beach clubs in the evening which are quite fun.

It takes several hours to get anywhere in Bali because traffic is so bad. So, I recommend staying in different areas for a few days at a time if you plan on visiting there in the future.

We ended the trip with a few days in Singapore. If you’ve seen the movie “Crazy Rich Asians” you know why. It was 90 degrees but luckily our hotel had an infinity pool with gorgeous views.  

My favorite part of Singapore was the Super Grove Trees. These are electronic trees that have a music and light show at night time. Just incredible! I also really enjoyed the cloud forest nearby which reminded me of Avatar.

We went to the rooftop bar at Mandalay Bay hotel, which also had a light show at night. Singapore was cool but it had that Las Vegas/Dubai vibe – where you feel like it’s not a real place.

After being in what felt like another life for the past 3 weeks, it was a bit tough returning back to the real world. Luckily, I gave myself a few extra days to recuperate from the jet lag. It took me a good 3 days to adjust back to our time zone. Just to put it in perspective, Australia is 16 hours ahead of East Coast USA.

What an amazing trip! I was so fortunate to fly the 20 hours from Chicago to Brisbane in business class using my miles. This is the only way I was able to sleep a good 8 hours on the way there. Let me know if you want to book a similar trip in the future and I can help you acquire the necessary miles!