Author Topic: Comparison of 4 job options for a new graduate Nurse Practitioner  (Read 1804 times)

jeepgirl8

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Thank you so much for any advice!  I am terrified of making a misstep in our financial future.

Life Situation:
   IRS filing status Married filing jointly
   Number & ages of dependents none yet but planned soon
   Currently reside in Memphis Tennessee
   Age Husband:38   Wife 37(me)

Gross Salary/Wages:
   H: (Engineer) 76k plus bonus typically 5k (but after taxes 2,500)
   W: (currently teaching Nursing at a community college on an 8 month contract pay is 53k spread over I receive 12 monthly paychecks.  I can stay in this position if I renew my yearly contract. monthly $4,535.50
   Total 129k
Pre-tax deductions: 401k, HSA, FSA, IRA, insurance, etc. - whatever you have
   H: 401K 12% + 3% employer match (6% into 401k, 6% into 401k Roth) 100% vested
   W: 401K 7% state portable retirement (9% match)
      
   HRSA (husband employer) contributing $150 per pay check.
   H insurance cost: High deductible $14 per paycheck ($3,500 deductible)   
   Wife: 80:20 plan $145 monthly (health vision and dental)
   
Other Ordinary Income: Provide sources and any relevant details, the more the better
   None
Qualified Dividends & Long Term Capital Gains:
   None
Rental Income, Actual Expenses, and Depreciation:    
   None

Adjusted Gross Income: This should equal the additions and subtractions above.
   approximately 100k
Taxes: Federal, state/local, and FICA. 
   H: Fed withholding $308
       FICA Ins $172
            FICA med $40
   W:Federal Income Tax $619.45
     FICA Medicare $63.65
     FICA Social Security $272.16

Current expenses:
Monthly current expenses
   Mortgage $1660 (on biweekly payment schedule with local credit union)
   Taxes and insurance $400
   Utilities $ 130 summer- $350 winter
   Car, Term Life insurance, $1 million umbrella policy $400
   AT&T internet $40
   Termite monitoring $35 (preventative) we live in the South 
   Gas    H: $160
      W: $ 400 monthly 
      Teaching (Nursing) position has a 40 mile commute each way (55 minutes of soul crushing drive on 2 lane country roads)
   Food: $350
   Eating out: $200   (this is significantly curtailed and we are planning to cut further)
   Cosmetics $30 (sunscreen)
   Car maintenance $100 (sometimes higher)
   Student loan $860
      Total: $4,985 monthly
Over the last year I have invested a significant portion of our income in interview costs in New Orleans and Denver, all paid in cash done as cheaply as possible.

Expected ER expenses: (optional, if relevant)
   We really haven’t discussed this at length.
   60k a year.
   Strong preference for Mobile, New Orleans or Southern Louisiana 
   
Assets: Amount & description - include current asset allocation plan if you have one
   H: 401k and 401K ROTH current employer 100k
   H: Roth $100 (just started)
   W: Retirement at teaching job 5k 
        401k ROTH prior employer 11k
        Vanguard Traditional IRA 37k   
        Vanguard ROTH 35k      
   Emergency Fund and Home repair fund 29k
      Total 227k 
   
Invested primarily in index funds. (Bogglehead style as much as possible)
We plan to begin purchasing renal homes to add to our assets.

Liabilities: Description, original loan amount, rate, original length, and monthly payment (which should be consistent with a spreadsheet PMT calculation).  Add current balance and time remaining if close to final payment.
   Mortgage Single Family home purchased 2006 (as a foreclosure on 30yr note
      Current Value $305k on zillow 
      loan balance 127k (6 years left to pay off at 15 year note at 2.99%)
      Original 30 year loan we put 57k down purchase price of 279k
if we deal with the major issues and repaint landscape (investing 20k of our cash reserves) we could likely sell for 350k
If we spend about 40k of our cash reserves to really make it sparkle we anticipate being able to sell for 400k

Student loan consolidated thru SoFI fixed rate 4.75% 10 year term
 W: 77k  (Ivy League of the South NOT worth the money.  Huge face palm)
   Total $204,00

Specific Question:
Which of these job options would be the most beneficial in the short/long term?

Job Hunt Background
I have been interviewing and finding the market for a new graduate nurse practitioner (even with 10 years of ICU & ER experience) very tight (Saturated) in Memphis, New Orleans and Denver. I have applied to over 80 positions, networked at local NP dinner meetings.  I have turned down 2 job offers for positions in New Orleans that were not a good fit (minimal support for new graduate or toxic work environment)




Option 1
   Keep teaching at the community college for another year and keep looking for a part time NP job on the weekends. These are   even more rare than full time NP positions and the hospitals/clinics prefer NPs with experience for the part time positions.
   I am concerned if I spend another year teaching that I will be classified as academic. (This has already come up in some   interviews).  I took the teaching position because it fell into my lap. I definitely prefer to be in the clinical setting as an NP using my degree.   
   

Option 2
   Located in Denver at an Osteoporosis Bone disease clinic 2 months of training. They are very supportive of a new graduate.
   Part time position 3 days a week paying $44/hour ($67,500 yearly) for 30 hours a week.   
   6% retirement match and $50 a month medical benefits
   Might become full time in a couple years.
   There is no noncompete clause but I would likely not be able to work as an NP in another position due to needing a physician to  cosign orders. So facilities prefer to hire experienced NP. I would search for an RN position probably paying $30 an hour     

Option 3
   Continue to apply for full time Nurse practitioner positions in New Orleans. Salary at the major hospital is 78k for new grads with a 4% retirement match.  The market is very saturated with new grads. 

Option 4
   Move forward in the interview process for a Nephrology (dialysis) located in Denver
   NP position paying 85k for 4 days a week. 6 months of training.  Very    supportive of new graduates.
   Retirement match is “good” but the manager didn’t know the match
   They recently absorbed another nephrology practice so they are the largest in town.  All their staff has been there between 5-10    years
   There is no guarantee that I would obtain this position.

Option 5
   Continue applying for full time NP positions in Memphis. Salary is usually 80k for full time
   (positions are few and far between)…dropping off resumes has not helps either


Other Factors

None of the NP positions have student loan repayment

Our plan is for me to relocate ahead of my husband while he performs the remaining sweat equity to sell our primary residence.  So I would be paying for an apartment and living expenses in Denver or New Orleans.  I would not be able to afford to fly home to visit so New Orleans is a more attractive 6 hour drive to Memphis until the house sells.  A studio apartment in Denver runs $1100-1500, New Orleans usually $900-1200 

Due to the fact that we both feel that purchasing a primary residence and future rental properties in Denver is prohibitive due to COL we would most likely relocate from Denver to a Southeastern state  after the sale of our home.

As an engineer, my husband has good opportunities in both Denver or New Orleans.  He can stay with his current company in Memphis.  However, long term his advancement (income) opportunities would be better in New Orleans or Denver.  By relocating to New Orleans or Denver his income would increase to 85-90k.  He is pretty much at his income ceiling in Memphis.

We would definitely like to begin a family soon so this plays a factor in our decision process as well. We don’t have family in any major city who can help with childcare. from my research child care cost is highest in Denver. (Daycare)

Our primary residence after relocation will be a duplex to apply us to house hack.

Updated information

The job offers that I declined consisted of

#1 A posiiton working in Urology as an NP. (Bladder and Prostate)
       
During the interview process the current NP informed me that the majority of the docs were "a-holes" and he wanted me to be  fully aware before accepting the position.  This statement lined up with my impression of the majority of the docs in the practice.

#2 A position as a Transplant Surgery NP

The position would be 2 weeks on days 2 weeks on nights with no option to transfer to days with seniority.  I would have been the sole provider with minimal phone back up. As a new graduate, even with ICU experience, it did not feel safe for my patients or my license


Regarding market saturation- there is a definite preference for NP's who can see all ages and have already gained experience as an NP.  I obtained certification to see adults and elderly because I love that population.  To treat children I would need to return to school for another semester and complete hours in a pediatric clinical setting. 

Employers often don't want to take a chance on a new graduate due to the concern that they will leave in a year.

My husband is supportive of finding employment for me as an NP since it will result in a pay increase allowing us to eliminate my student loan. However, he wants to maintain quality of life (so no rotating shifts).  He will likely have to travel for any position he takes as an engineer so once we have a child I could not maintain rotating shifts.   

His first choice is not Denver due to distance from family but he has strong contacts to find employment in both Denver and New Orleans.  He also feels it will be easier to live our more frugal lifestyle in New Orleans or another Southern city.  He prefers LCOL areas in the South but he needs to be near larger metro areas for his job opportunities.           
   
« Last Edit: June 13, 2016, 08:53:24 AM by jeepgirl8 »

lizzzi

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Re: Comparison of 4 job options for a new graduate Nurse Practitioner
« Reply #1 on: June 13, 2016, 05:47:35 AM »
Your post is complex, but what I'm thinking just off the top of my head is that you're driving yourself crazy over-thinking this. (I'm a BSN with an MPA, RN since 1971...not an NP though.) First of all, you and your husband could ask yourselves: in a perfect world where do you want to live...where would you really like it...where would you enjoy raising the child/children you plan to have? Then you can start investigating your NP positions in that area, assuming that the area works for him, too.  Perhaps you two could move to where you want to live permanently and then you (the wife) just work some regular nursing positions while you continue looking for an NP job and perhaps start your family. You have skills that are uber-portable...one of the benefits of being a nurse. I would put your life first, and the job second if that makes any sense.

ender

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Re: Comparison of 4 job options for a new graduate Nurse Practitioner
« Reply #2 on: June 13, 2016, 06:15:40 AM »
More information about why you turned down two jobs and then say the job market is saturated might be helpful.

You talk nearly exclusively about what you want to do - what does your husband think? What are his job prospects these towns? How on the same page are you guys about all this?

jeepgirl8

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Re: Comparison of 4 job options for a new graduate Nurse Practitioner
« Reply #3 on: June 13, 2016, 07:38:49 AM »
Lizzzi and Ender thank you so much for your help!! I am truly driving myself crazy.   


The job offers that I declined consisted of

#1 A posiiton working in Urology as an NP. (Bladder and Prostate)
       
During the interview process the current NP informed me that the majority of the docs were "a-holes" and he wanted me to be  fully aware before accepting the position.  This statement lined up with my impression of the majority of the docs in the practice.

#2 A position as a Transplant Surgery NP

The position would be 2 weeks on days 2 weeks on nights with no option to transfer to days with seniority.  I would have been the sole provider with minimal phone back up. As a new graduate, even with ICU experience, it did not feel safe for my patients or my license


Regarding market saturation- there is a definite preference for NP's who can see all ages and have already gained experience as an NP.  I obtained certification to see adults and elderly because I love that population.  To treat children I would need to return to school for another semester and complete hours in a pediatric clinical setting. 

Employers often don't want to take a chance on a new graduate due to the concern that they will leave in a year.

My husband is supportive of finding employment for me as an NP since it will result in a pay increase allowing us to eliminate my student loan. However, he wants to maintain quality of life (so no rotating shifts).  He will likely have to travel for any position he takes as an engineer so once we have a child I could not maintain rotating shifts.   

His first choice is not Denver due to distance from family but he has strong contacts to find employment in both Denver and New Orleans.  He also feels it will be easier to live our more frugal lifestyle in New Orleans or another Southern city.  He prefers LCOL areas in the South but he needs to be near larger metro areas for his job opportunities.           
   





Another Reader

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Re: Comparison of 4 job options for a new graduate Nurse Practitioner
« Reply #4 on: June 13, 2016, 07:58:44 AM »
Relocate to Denver for a part-time position?  I wouldn't.

I would pursue local options to get a couple years of experience and then try to move where you want to settle.  You will have more options with experience.  So, options 4 and 5 are the ones I would pursue.  And pay off those student loans ASAP. 

The Happy Philosopher

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Re: Comparison of 4 job options for a new graduate Nurse Practitioner
« Reply #5 on: June 13, 2016, 08:32:18 AM »
There are too many variables for any of us to make a rational decision for you, so I will give you some guiding principals that I have found to be true in medicine for me.

Job selection is important for docs, PA, NP, etc. A terrible and toxic job is not worth it, so salary becomes pretty much irrelevant (especially for a NP because the salary band you are working in is much narrower than a doc). I would only take a 'toxic' job if you didn't have to move in the hope that it was actually not as bad as you thought. At the vary least you can quit, gain some experience and be no worse off than before.

You have to decide how important where you live factors into this. For me this is critical, but different for everyone. Try and quantify how important the regional culture and being close to family is to you.

Consider doing some short term locums to figure out if you are a good fit for a job. Also consider expanding your job search to more geographic areas that include regions where they need NPs. If you are battling exclusively in tight job markets it's going to be way tougher to find a job you like.