By Guest Blogger Marquita Fields, DNP, FNP-BC
The caps are tossed in the air, there are no more discussion boards due, and you have submitted and closed out your Capstone or Project. Time to get to work! However, you quickly learn there is much to do and consider. The ink has barely dried on your degree and your head is in a tailspin looking at career opportunities, salary offers, malpractice insurance and everything in between. Before you get yourself in a tizzy, check out these tips to help you navigate your first year as a healthcare provider.
1 – Consider More Than a High Salary in a Job Offer
Although, it may be tempting with the student loans, or financial implications that incur from graduate school, the highest paying job offer may not be the best option. Definitely know your worth and what you bring to the prospective company, but you should keep in mind that providers often have other financial obligations that can quickly eat into that large salary. Credentialing can be a couple thousand dollars alone. Several of my colleagues have said that continuing education stipends are very important factors in the salary package. Some employers do not pay any continuing education money, while others pay several thousands. As an NP, you are required to have CME for your credentialing body as well as for your nursing license. Also, think about the payor source for your service. “The Centers for Medicare & Medicaid Services (CMS) is the single largest payer for health care in the United States. Nearly 90 million Americans rely on health care benefits through Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP).” Unless your practice is private insurance only, chances are, your organization will need you to be credentialed through CMS. The cost for Credentialing through CMS is just over $500. The details on job offers are just as important as the bottom-line salary. Consider the cost of health / malpractice insurance, retirement and student loans if you have them.
2 – Evaluate all of the Pros and Cons of a Position
Every job has its pros and cons. When researching for a position be sure to ask pertinent questions. So often in interviews for Provider roles we ask the same generic questions. What is my expected patient load in a day? Or do I take call or cover Weekends? Perhaps, we should add to those questions, ‘Is this position based on Relative Value Units (RVU’s) or Salary?’ RVU based positions may be beneficial for high need specialty areas, like Psychiatry or Pediatrics as the compensation is based exclusively on productivity, with no regard to a guaranteed 
base salary. Large corporations tend to lean more toward salary-based PA/NP jobs that offer income stability but may cap earning potential. More about RVU’s is located here https://www.cms.gov/apps/physician-fee-schedule/overview.aspx . Be sure the company you are working for understands your scope of practice as an NP or PA. I have had Peers inform me that some organizations did not fully understand the scope of these roles. This is a conversation to have during the interview. It is also important to familiarize yourself with your state’s guidelines for practice.
3 – Ask about Administration Time
Administration time (Admin Time) is a valuable commodity. Working as an advanced practice provider is more than just patient visits. The PA/NP has to follow up on phone or electronic medical record messages, laboratory and imaging results. Administration duties that go beyond the exam room are common. When establishing a work schedule or even in the interview process, the provider should be sure to ask about this space which is more commonly referred to as ‘Admin time’. For example, say you saw 18 patients on Friday and ordered labs. On Monday, these results would return, and some require you to schedule follow up, or even referral, if you are scheduled to be right back in the clinic to see 18 more patients you may not have the chance to perform these duties. Admin Time also helps if you have other projects like research or practice improvement in your responsibilities. Consider business/practice meetings and education in-services that are required for the provider to attend when thinking about Admin time. Some practices have this time built into schedules while others expect clinicians to work it in their day. It is important to have a clear definition of how and if you want to incorporate Admin Time in your schedule before you start your role.
4 – Pursue Work-Life Balance
With all the duties and responsibilities of being a Healthcare Provider at any practice, remember to keep yourself healthy. If a schedule or workload interrupts the time you have with the people you care about most or for self-care, then it is not healthy. Many organizations have begun incorporating mindful moments into the workplace as an avenue to prevent burnout. I once had a position where I worked 7am to 6pm Monday through Friday and worked on my laptop or on call until bedtime every night as well as most weekends. This job interrupted precious time with my family, time for myself and I quickly resented it and resigned after just 1 year. Whatever that balance is for you, it is important that you maintain it and allow yourself to be at the most optimal state. We can better care for our patients when we are at a healthy state which includes being rested, not stressed and physically healthy. Commit to making yourself (your most important patient) a priority by preventing burnout. Here are a few tips located here: https://www.healthline.com/health/tips-for-identifying-and-preventing-burnout
5 – Become active in Your Professional Organizations.
There are state and national organizations for nearly every specialty of NP and PA. It is important to get involved and be in the know. These organizations allow clinicians to continue to grow professionally and stay current on changes in the profession. I make it a point to attend at least one Nursing related conference every year if possible. The world of healthcare is rapidly evolving due to articles like COVID-19 Pandemic, legislature regarding full practice authority and marijuana legalization. You would be amazed at the many facets of diversity these organizations offer. Network often and purposefully. I often reach out to colleagues if I run across an area in their wheelhouse. There is much accuracy to the statement ‘two heads are better than one’. I have met some very knowledgeable and diverse friends at local conferences that I have stayed connected with.
With these tips, you can set yourself up for a happy career, where you focus on taking care of people, including yourself. Hopefully, the new and exciting profession you have just spent the last however many years working to enter is all that you dreamed it will be. There are so many aspects of being a healthcare provider that make it a satisfying and rewarding profession. Congratulations, now go be great and bring something to the profession to make it better because you are in it.
Marquita Fields, DNP, FNP-BC has a passion for diversity and excellence in clinical practice. She is a Family Nurse Practitioner with over 14 years of nursing experience. She is the founder of a Diversity in Advanced Practice Provider group in Greenville, North Carolina. In her spare time, she enjoys being with her husband and daughters, and being active in her faith community.