Howdy Texas!


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!

Guest Blog: Rural California

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

Goals in 2018

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.

 

5 Ways Travel Nursing Can Help You Pay Off Student Loans

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!

Why I did not take the Perm Traveling gig

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.

Aruba Trip

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.

Onto The Next One

After I decided to leave the assignment in Tampa, FL early, I was planning on just taking a vacation. However, one of my recruiters insisted he had the perfect assignment for me. It would only be 3 weeks long (covering an FMLA) and would consist of working with a migrant community of mostly Hispanics and Haitians. Since I speak some Spanish and Haitian Creole, I figured why not.

The agency had already submitted 10 candidates that the site was reviewing. My recruiter was confident that I still had a chance because of my work experience and language skills. They selected me as one of the top 3 candidates and proceeded with a phone interview. It seemed like a good place to work, so when they offered me the job I said yes.

The site was about 2 hours from my home in Miami, FL so I was provided with a hotel during the weekdays, and I went home during the weekend. I was reimbursed for daily mileage to work and mileage home each weekend. Since I had a long commute, the site even allowed me to leave 1 hour early each day (paid for full shift) to make up for it.

This is a community medical center, one of the goods ones as I portrayed in my previous post. Since it was a brief assignment, I didn’t expect an extensive training. My first day, I completed the mandatory OSHA/HIPPA etc. training during the morning. In the afternoon, I was introduced to the EHR system. The funny thing is they originally offered me a scribe. Meaning, I wouldn’t have to document, there would be someone following me and documenting my encounter with the patient. I thought, wow that’s neat. Some of the providers here have scribes, if they aren’t comfortable or too slow with the EHR. That’s a nice gesture to support their PCPs.

I told the manager that I didn’t need a scribe, as I am used to jumping into places and learning the systems quickly.

They used Athena EHR which was straightforward, and by the next day I was already pretty competent. They also had an IT person on site available to me in case I needed any assistance.

I really enjoyed working at this community medical center. I had two medical assistants, which meant I never had to wait or look for help. The patients were pleasant, not as demanding as the previous practice I was at. My schedule was fair – I averaged about 12-14 patients per day (of course there were no shows).

Another funny thing is that everyone was so impressed. They were surprised how quick I was, and told me that the patients were used to waiting 2-3 hours to be seen. They were also amazed by how quickly I learned how to use the EHR system. I have been used to working with such a complex elderly population over the past 1.5 years that these average patients seemed so ‘basic’ to me.

I forgot how easy it is to manage a 40 year old patient with just hypertension and hyperlipidemia versus managing an 82 year old patient with hypertension, hyperlipidemia, diabetes, heart failure, angina, arthritis, hepatitis C, cancer, depression, insomnia, obesity, glaucoma, kidney disease. No joke!

The only challenge for me at this site was getting accustomed to the diagnostic coding and billing sections again. I had been working in a ‘managed care’ setting over the past 1.5 years so the diagnostic coding is much different. For instance, at this community medical center I had to make sure I specified physical exam with or without abnormal findings, normal or abnormal BMI (and which value). In comparison to the managed care setting, we didn’t use those diagnoses much. We mostly focused on HCC codes, which are codes that can bill at a higher rate and represent how sick our patient is. So if a patient was overweight, it didn’t matter as much as if a patient was morbidly obese, if that makes sense (billing wise, not medically).

Like anything though, the more you start to do something again the more it becomes familiar. It was the same with doing well child check ups. I was so used to treating complex geriatric patients that I had to do a few well child exams before I was confident in them again.

In conclusion, this assignment deserves an A+. On my last day, the CEO came all the way to our clinic just to meet me and tell me “I have heard such great things about you!” He came prepared to make me a permanent offer, but I told him (in a nice way) not to even bother J. He told me they would love to have me again when there is another need. I definitely wouldn’t mind helping them again. I hope other sites can take a lesson from this one – PCPs like to be appreciated!

 

 

FQHC’s Aren’t All Bad

Whenever I meet other nurse practitioners or physicians on assignment, they’ll talk about their prior experience working in a Federally Qualified Health Center (FQHC)/community health centers.

They will tell stories about seeing over 30 patients a day, being mistreated and unappreciated, and places that are really disorganized. As a traveling nurse practitioner, I have already worked at 5 different FQHCs. And guess what, they aren’t all bad!

When I tell the other providers that there are actually some really great FQHCs out there, they look at me in shock. I do agree that most of them are pretty awful because “it’s all about the numbers”. However, I have come across 2 so far that are incredible!

For those of you that have been following me since the beginning, you may recall my first assignment out of Florida. This was a FQHC in Washington State that was extremely organized and well-run. Patient per day ratios were fair, about 14-18 patients per day. They allotted 30 minutes for new patient appointments. There were standard protocols in place that allowed medical assistants to help PCPs with immunizations, acute rapid testing, and even health screenings. PCPs were given admin time, 1 day a week where they could catch up on medication refills and paperwork.

After my awful experience working in Tampa, Florida, I ended up taking a brief assignment in a FQHC in south Florida. I felt spoiled having 2 medical assistants just for me, and seeing a fair 14-16 patients per day. The EHR was straightforward and there was an IT person on-site daily to help if needed. If there was an issue, such as having too many physicals scheduled in one day, the staff quickly corrected this without push-back. Leadership was amazing too. The center manager and medical director made themselves available and constantly offered positive feedback.

It’s such a wonderful feeling to look forward to going to work and being enabled to provide the appropriate care you strive for. So don’t be afraid of traveling as a nurse practitioner. Sure you may stumble upon some awful assignments, but most of them you can handle for the brief 3 months. If there is one you do not feel comfortable staying at any longer, you can just leave. Although there are some bad assignments, there are definitely plenty of great places too.

 

Mileage

When traveling to a new assignment, you have the option to fly to the site and be provided with a rental car, or you can choose to drive your own car. If you decide to drive your own car to the site then agencies will reimburse you with the mileage it took to get there. They will also provide you with the mileage it takes for you to return home (even if you end up just going to another assignment from there). If you choose this route, you will likely make a profit.

For example, if your site is 500 miles away and you were reimbursed $0.545/mile then you will get $270. After deducting $100 that you spent on gas, you will profit $170.

Another mileage benefit that some agencies provide is mileage to and from the site while you are on assignment. That means even though the agency is housing you, they will reimburse you mileage each time you drive to and from the site from your temporary apartment or hotel. Daily mileage is often given when you are doing a local assignment. However, depending on the agency, some will provide this benefit even when you are away on an assignment.

I wouldn’t necessarily expect this from all agencies, but it is a nice benefit when an agency does offer this. It will typically be listed on your contract as general “mileage”. Some agencies may specify your home city and your destination city to display that you will only receive mileage from this commute.

I am used to living about 5-10 minutes away from work so having daily mileage isn’t always essential. Yet, there was an instance where I worked for a rural community health center and the closest hotel was 1 hour away. I wasn’t thrilled about commuting 1 hour each way, but the daily mileage definitely made up for it. I made an extra $300+ each week from mileage alone. After deducting the cost of gas, I profited $200/week. Not bad, especially since it is tax free.

Proving Myself as a Locums

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.