Working in Colorado

I am working between two clinics. One of them is 1 minute from my hotel, and the other one is 15 minutes which is great. The clinic that is further out has a cafeteria which gives free lunch to providers. They have an amazing salad bar and the food is pretty good.

The town ended up being more rural than I thought. I have worked rural health before, but there is a helicopter at the clinic and a tiny hospital here with just a few beds. They consider themselves to be frontier rural since there isn’t a major hospital within 1 hour from here. A lot of the patients are ranchers and farmers.

On my first day, I was a bit nervous because I wasn’t sure if the patient population would be of higher acuity than I am used to. The physician that was orienting me mentioned they do a lot of casting and suturing, which is more like an urgent care. She also said I would be seeing things there that I have never seen before in my life.

My experience is more primary care and that is my comfort level. But they told me there will always be another provider with me at the clinic so if I don’t feel comfortable doing a procedure, I can just let them know.  The scheduling department asked me what procedures or types of patients I am not comfortable with so they can avoid putting them on my schedule.

They had me on a ramp up schedule seeing 1 patient per hour my first week, which was nice. It allowed me to figure out how the clinic is run. My orientation was only a couple of hours of introduction to the EHR. The patients are scheduled at 30-minute intervals. If they are a hospital follow up or an adult physical, they are scheduled at 60-minute intervals. That’s one thing I like about working in rural health, you get plenty of time with the patients. I am seeing about 14-18 patients per day. Even on a day when my schedule is full, I don’t feel overwhelmed.

The majority of the patients I see are with acute cold symptoms, workers compensation, sports physicals, well child checks, hospital follow ups, and other acute complaints like UTIs or back pain. They keep established patients following up for their routine visits with their PCP. I am enjoying having pediatric patients again.

Everyone here is really nice. The staff is friendly and helpful. The patients are very appreciative and are not the typical antibiotic or opioid seekers you may find in other areas. I have been seeing a lot of pediatric patients which I am happy about, since I needed that experience. Not to mention the kids have been super cute and easy patients. They are definitely less complex than the geriatric population I am used to seeing.

There are a few cons working here. One con is sometimes they accept patients that should really just go to the ER. I don’t think anyone is triaging these calls. For instance, I had a 6-week old baby with new onset seizures on my schedule (in the acute visit slot). I had to tell them to call the mom and bring the baby to the ER, as there isn’t much I could do for them in the clinic.

I also don’t like that the last patient is scheduled at 4:30pm, and we finish at 5pm. So, if the patient shows up a bit late, by the time they are roomed, it’s 4:45pm. I wish they gave the last 30 min as admin time to catch up on notes.

All in all, it’s been a great assignment so far and I am really enjoying my time here!

Reactivating State Licenses

I have a total of 12 active and inactive state licenses. I do not keep them all active at the same time because it can get pretty expensive. I just have 3 or 4 licenses active at any given time to increase my job options.

Earlier this year, I received an opportunity to help a physician owned practice remotely (per diem). This required me to reactivate all of my inactive state licenses. It has been interesting to see how each state differs from this process. Just to clarify, I am using the term reactivate, because you can only renew your licenses if it has been less than a year (in most states) since it has expired. Reactivation fees are more than renewal fees. My Florida, Ohio, and Arizona licenses were already active.  

After paying the reactivation fees, my California licenses were active within a few hours, which was awesome. Besides doing the application online, I had to upload proof of my CEUs. My Texas, Colorado, Maine, and Virginia licenses took 1 day to be active after paying the fees. I did these online and the process was straightforward.

My Wisconsin license took 1 month to reactivate, only because they needed a copy of my multistate RN license. So, they mailed me a letter with the email address to send them the document. After submitting the document, my license was active within days.

The remaining 3 states have been the most complicated ones to reactivate. Kentucky required me to obtain fingerprints AGAIN. This is in comparison to the other states that just recognize the fingerprints you already have on file from initial licensure. I am sure most of you can agree obtaining fingerprints is annoying. The facilities that do the fingerprints are only open during hours that I am working, so I try to go during my lunch break.

Then both Illinois and Washington state only accept paper applications for reactivating licenses. What are we, in the stone ages? Not to mention, I had to reactivate both the RN and NP licenses since these are still not compact license states.

Illinois requires 80 hours of CEUs which you have to submit proof of. This was crazy to me since FL (my home state) only requires 24 hours of CEUs every 2 years. I had to spend days acquiring the other dozens of hours. Additionally, Washington requests proof of recent employment in another state in order to reactivate your licenses. It took 3 weeks to get my licenses reactivated. However, even though I paid $435 to reactivate those licenses, they are going to expire in 4 months because renewal is during the month of your birthday -_-

I’ll keep in mind the states that are not as “reactivation friendly”, to avoid having my licenses lapse there again in the future. States like CA are “reactivation friendly” but the fees are drastically more expensive compared to just renewing.

Choosing to Work in Colorado

I have always wanted to go to Colorado, especially to visit the parks and go hiking. So, I decided to get licensed there. I am only interested in working there during summer months since I hate the cold. Unfortunately, Colorado doesn’t always have a plethora of locum tenens job options.  So, when a family practice opportunity became available starting in July, I jumped on the opportunity.

The site is in a small town called Limon, which is 1 hour east of Denver. I have worked rural health before, but lately I prefer being within 1 hour of a large city. One benefit of working rural health is that you aren’t swamped with patients the way you are in urban areas. For instance, at this site, patients are scheduled in 30-minute intervals. The average amount of patients seen per day is 10-15 per provider. This means, I won’t get burnt out.

Working in rural areas means there is a limited supply of housing options. The site has a house they use for their locums, but it is currently in use. Thus, I will be staying in an extended stay hotel for at least the first month. This isn’t my normal preference. Especially, because none of the hotels in Limon have a kitchenette.

They secured a Holiday Inn Express for me to stay in. I am provided with a suite which is nice, so the room is spacious. It does have a microwave and kitchenette. The hotel also has free breakfast as an option.

I asked for my agency to send me a hotplate so I can at least cook some things on a frying pan. They did not hesitate and sent me a $50 amazon gift card to purchase the hot plate and frying pan which I appreciated. Just a reminder – that you don’t get what you don’t ask for. I don’t mind staying at this hotel because I actually need to accumulate some points for this hotel brand, so I can use when I travel to Asia later this or next year.

It’s the first time I am working outside of Florida and not with the geriatric clinics in 2 years. I have to admit that I am a bit nervous about the transition. I am looking forward to working in a new state and having some new experiences.

Interviewing for Locum Tenens Positions

Before Covid, interviews for locum tenens positions were so casual. The site would call you for a brief phone interview. They just wanted to talk about the site, ask you a few questions, and answer any questions you may have. These phone calls were often merely 15-30 minutes long.

In the past, I have taken these phone interviews while on lunch break at work; driving on my way home; or cooking dinner. In fact, the geriatric clinic I normally work for, has an extensive interview process for their permanent providers. It entails 5 or 6 interviews with different leaders, shadowing one of the other providers, touring the clinic etc. Ironically, my phone interview for them as a locums ended up only being 10 minutes while I was laying at the pool. And I ended up working with them on and off over the past 7 years.

Fast forward to now, and it seems like ever since Covid happened, many sites realized they can do interviews by video now (instead of just phone). As a result, many of them are requesting video interviews. This was annoying to me while I was in Europe recently, because I had to make sure I was home and looking sharp when it was time for the video interview. I couldn’t just answer my phone on the fly like I am used to.

In fact, I was so mad at myself for moving forward with a video interview for the California job (as I mentioned in my previous post), that I didn’t really want. I remember I was traveling in Luxembourg, and had to make sure I was at the hotel in time for the interview. And guess what?! The interview took 1.5 hours! I was like ‘are you serious’?

They ended up asking me tons of questions as if I was a permanent hire. They said they had to fill out a questionnaire for HR, which is why they had so many questions. I was even more annoyed because deep down I knew I didn’t even want to work there. And here I was wasting 1.5 hours of my life when I was visiting a new country for the first time. I had to apologize to my friend as well, because I thought the interview would only take 30 minutes.

During my recent job search, I was reminded of a pet peeve of mine. Normally, the agency schedules the phone interview, then provides our phone number to the site, and then someone from the site will call us for the interview. Yet, I was reminded that Barton Associates doesn’t do it this way. They are the only agency that I know of that has one of their lead recruiters do a three-way call between you and the site.

So, the lead recruiter is listening in during the entire interview. I personally do not like that. It seems sketchy and as if I am child being supervised by my parent. I am not sure why they listen in, if it’s because they want to make sure you don’t talk numbers with the client or to see how the interview went etc.

I don’t think they even pay attention because one time the Medical Director was saying why they were so interested in me (I worked with a previous company many times that they are very familiar with). Then they spent the remainder of the interview explaining the site and how things would work. At the end of the interview the Lead Recruiter told me to explain to the site why I would be a good fit for them. Which proved she wasn’t listening because the Medical Director had already spent 5 minutes saying he knew I was a good fit since I had worked at a similar company.

Do any of you have any recent interesting interview experiences you would like to share?

Financial Coaching – TheWealthyNP

I’ve gotten really into finances over the last 4 years. Luckily I was already doing everything right before that, such as investing in my retirement accounts and in real estate. I have been helping my close friends and family work on their financial goals over the past few years – such as paying off student loans, investing in the stock market, and increasing their savings. I have really enjoyed it and decided to take the next step and become a financial coach.

I created a new account on instagram called TheWealthyNP (follow me there!) to help educate other people on personal finance. I’ll be posting fun financial topics and offer opportunities for 1:1 coaching.

I became a millionaire in my early 30’s, while only working 8 months or less each year. I paid off $50k in student loans in 3 years. I invest in the stock market for my future and retirement. And I own 3 real estate properties.

Follow me on instagram @thewealthynp if you also want to reach financial freedom!

Working as a Nurse Practitioner Abroad

Locum Tenens for Nurse Practitioners in other countries isnt as prevalent as it is for physicians. I wrote an article about which countries abroad recognize nurse practitioners for full-time positions. The salary for NPs is significantly lower abroad than in the USA (this is also true for physicians). Check out the article below:

https://www.npschools.com/blog/working-in-nursing-abroad

The Benefits of Acupuncture

I recently wrote an article sharing my thoughts on the benefits of acupuncture. A lot of providers are not aware of its effect on illness and health. I have plenty of experience having patients do acupuncture with great relief. Especially elderly patients that cannot take most prescriptive pain medications or anti-inflammatories.

https://www.npschools.com/blog/benefits-of-acupuncture

Searching for an Assignment after my Mini-Retirement

When I started my mini-retirement this summer, I wasn’t exactly sure how long I would be gone for. I figured it would be 3 months at a minimum, but I didn’t want to commit to any jobs until last minute. Finally, at the end of May I decided I would go back to work at the beginning of July. From my previous experiences, searching 1 month ahead of time in a state I am already licensed in, is more than enough time.

I had interviewed with a few sites that I liked, but then found out the credentialing could take 60-90 days. I was surprised that this ended up being more common than I thought. I didn’t want to wait until August or September to start working.

So, my search criteria priorities quickly became:

-Credentialing in less than 30 days

-Site needs to be in a state that is currently warm for summer but normally too cold for me to visit outside of summer

-Patients need to be all ages

I was initially nervous when the majority of the sites seemed to have the longest credentialing. It had been a while since I was the one actively searching for an assignment versus sites just pursuing me. Since I am a family nurse practitioner, I needed experience working with pediatrics to keep my credentialing active. It had been 2 years (outside of telemedicine) since I had worked with any children.

Thus, I couldn’t work at the geriatric clinics I normally work with. I felt like I was a newbie traveling nurse practitioner all over again. I didn’t stress out because I knew that job opportunities can change day to day.

There was an assignment in Florida I really wanted but they wanted me to start the following week, and I still had plans to travel in Europe for the remainder of the month. Therefore, they went with someone else.

Soon after, I had 3 solid options to choose from. I ended up prioritizing location. One of the options was in Maine. I had worked in Maine before and really enjoyed it, so I didn’t mind returning there. The facility seemed very fair as far as scheduling and workplace culture.

The other option was in California, right outside of San Francisco. This was honestly just my backup option. I didn’t really want to work there, especially because as a locums now you have to be paid as a W2 employee in CA, and I wanted to get paid as a 1099 contractor (because you can take home more of the pay). It was my backup option because CA is always desperate for traveling nurse practitioners.

I ended up choosing my 3rd option which I will share in another post. I just found it interesting that many sites seem to be looking for coverage way in advance than they used to be. I remember in the past, the sites wanted someone that is available to start within a couple of weeks or the same month. Now, a lot of the listings are for positions 3 months from now. I am sure many people like knowing what they are doing in advance, but I have gotten used to being a last minute planner when it comes to choosing an assignment.