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Career Coach

Locum Tenens Rates
February 10, 2016 2:47 PM by Renee Dahring
Dear NP Career Coach:  I am considering doing a locum tenens assignment. I have over 2 years of experience as a NP in urgent care where I treat some very high acuity patients. I am wondering what you think is a reasonable hourly rate? Can I also ask for all expenses such as travel, rental car, food, etc. to be paid? What about CME?

Dear Job Seeker:  Your hourly wage will really depend on the job you will be doing rather than the job you are leaving. Actually, now that I think about it that is true for all jobs whether they are temporary or permanent. However, you past experience is worth something and there may be some wiggle room to negotiate based on the skills you bring to the table.

When doing locums, you generally will get a really good wage OR you will get a generous stipend (we call them per diems) for expenses. In other words, the more you ask for one the less you get of the other. The reason for this is that employers have a defined pot of money set aside for each position and in the end it's all about how you wish to divide it up. 

Travel to and from the assignment and lodging are fairly standard to be covered and often the employer will arrange and pay for these expenses directly. Some travelers will ask for the lodging money as a per diem and then find their own lodging. Sometimes this works out well if they can find less expensive lodging.  

Per diems can also include meals, mileage or certain other types of expenses. The reason some travelers take more as per diem is that per diem money is not taxed so in some circumstances it effectively increases your compensation. However, when I say it isn't taxed that is true only up to a point. For instance, you can't say "I would like to be paid $10/hour and receive all the rest as a per diem" in order to avoid paying taxes. The IRS has is one step ahead of you and has established maximum per diem rates based on geographical area. And the geographical area is where you will be working and not where you are permanently living. So the bottom line is that you can ask for more on a per diem, but everything over the IRS rate will be taxed. You may need to speak with an accountant to determine what method will serve you best. 

Your malpractice should be covered by the agency. CME and PTO can be offered, but are not always standard in locums.

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Identifying Your References
January 27, 2016 9:25 AM by Renee Dahring
Are you graduating this spring? Now is the time to identify your references. Before you begin your search for your first job, fill out an application or send out your first resume you should know by now who you plan to use as your references. Actually, let me go a step further, you should also have confirmed with them whether or not they are willing to be a reference for you. 

New grads often put off creating a reference list until the last minute because they are not sure who to choose as a reference. I'm going to relieve some of your anxiety with these basic guidelines for choosing your references.

First, you should know that the standard number of references is three. 

Employers want references who can speak directly to your skills. Many reference forms will contain lists of specific skills and will ask your reference to rate you on your performance of those skills. In order to do that the person acting as your reference will need to have some direct knowledge of your performance. The person in the best position to evaluate your new skill set is a preceptor. Your preceptors have been working side by side with you and can attest to your strengths as well as your areas that need further development. Another option is an instructor who does your clinical site visits and has observed you during some clinical encounters.

Employers prefer that references have a similar background and education as the applicant. This means for a new grad the best references come from instructors and/or preceptors. These are the groups of individuals that have the best understanding of what your future job will demand and can best speak to whether or not you are suitable for that position. References from current or former co-workers such as RNs, social workers, etc. are not especially helpful. Supervisors are okay, but their knowledge is limited to how well you performed in your previous role and not your new role. References from non-medical persons should absolutely be avoided. 

Employers expect to see at least one person from your NP or PA program among your references. It is a major red flag if a new graduate cannot find anyone from their educational program who is willing to serve as a reference. Now is the time to approach your professors. As discussed above, choose one that has some relevancy to the job you seek and some knowledge of your skills. Don't seek a reference from the professor who taught an online lecture only class.

For practical purposes all of the references you choose should be folks that you think will respond in a timely manner. The disorganized and the procrastinator may be nice people, but they are the wrong people to rely on as a reference. In the lead up to an offer an employer may request references from two to three candidates in order to make the final selection. It's unrealistic to expect the employer to wait around too long for responses from your references. Choosing the preceptor or instructor who has piles of unfinished paperwork accumulating on their desk doesn't bode well for a prompt response.  

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Interview Follow-up
January 13, 2016 8:39 AM by Renee Dahring
Dear NP Career Coach:  I usually send a thank you letter after an interview on the same professional ivory resume paper and envelope as I use for my cover letter and CV. Is this acceptable? Or should I send an actual thank you note card? Recently I interviewed for a job and sent a thank you letter less than 48 hours after the interview. Is it okay for me to send a follow up email? And if so, what is appropriate to say?

Dear Job Seeker:  First of all, let me applaud you for your attention to common courtesy! In our busy and informal world too many applicants overlook this step which is too bad because a last impression can count almost as much as a first impression. Remember, people may not always remember what you said, but they will always remember how you made them feel. In my experience fewer than 20% will follow up with a formal "thank you". In addition, thank you notes are not just good manners; a note also serves as a nice gateway to opening further communication with your prospective employer.

In the past we tended to be more formal and recommended sending a thank you note card via snail mail. Times have changed; it's now perfectly acceptable to send a follow up email expressing your thanks. There is nothing wrong with your choice to send a thank you letter on paper (although if you are still sending out paper resumes we need to talk!). I guess what I am saying is really no wrong way to be polite.

What should you say in a thank you note? For the most part you want to keep it simple. Thank your interviewer(s) for their time and the opportunity to meet with them. Briefly reiterate - and I do mean briefly - why you are confident that you are a good fit for the position and their organization. Let them know that you remain very interested in the position. Close the note by indicating that you will follow up with them either by phone or email in a defined number of days, the usual is around one to two weeks. Hopefully you asked at the end of your interview about their timeframe for making the final hiring decision, this will help you decide how to time a follow up call or email. Just make sure that if you indicate you will follow up that you actually do follow through! Don't worry about seeming pushy. Hiring managers are used to receiving calls and emails following interviews. As long as you are polite and upbeat in any follow up correspondence you will leave a positive impression.

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The Gap After Graduation
December 16, 2015 8:53 AM by Renee Dahring
If you are looking for your first job you are probably wondering how much time will elapse from the time you graduate until you receive your first paycheck. Like most students you likely haven't been generating much income during your graduate program because your school demands have meant you haven't been able to work much or maybe not at all. In addition, when you factor your student loans in to the equation you are probably in negative territory when it comes to your finances. Oh, and did I mention the clock is ticking until you have to begin paying on those educational loans? It's not an understatement to say most new grads have some catching up to do. I'm sure you are feeling the pressure to get out there and start bringing in a salary ASAP.  

So realistically what are you looking at in terms of a timeframe? Let's review the steps that have to occur before you take your first paycheck to the bank. 

Everyone has to take boards. Even if you have a job secured you still need to factor in time to become certified. Some states have a special status that allows NPs to work after graduation and prior to certification, but in actual practice it rarely happens. In fact, I don't think I ever saw it happen. Why? You can't bill until you are credentialed and you can't be credentialed until you are board certified. Best case scenario if you submit your paperwork in to your certifying body promptly and your university verifies your status (which they can't do until after you graduate) you are probably looking at around 6-8 weeks post-graduation before you can even sit for your exam.

The next step is to be licensed as an NP in the state you will be working. Depending on your state you are looking at another 30 to 90 days. Some states are fairly speedy, but many are going to require verification from your school and all will ask for verification from your certifying body. These verifications must be sent directly to the board of nursing and so you are at the mercy of the turnaround time of each entity. If you are relocating or taking a job in a different state you also need to factor in obtaining an RN license in that state too. Thankfully that piece of the process is quicker, usually just a week or two.

Then you have credentialing. For the new practitioner this can also be a lengthy process and you can tack on at least another 90 days to complete this step.   

So what is the solution? For one thing, if you are working as an RN don't quit your job right after graduation! If you aren't currently employed, you might be able to negotiate working temporarily as an RN at your new place of employment before you start as an NP. Not ideal, but it will get you some income. It will also get you familiar with the EHR and the organization. 

So calm down, be realistic and plan for the "gap."
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Why Does Networking Matter?
December 2, 2015 10:05 AM by Renee Dahring
The old saying "it's not WHAT you know, but WHO you know" has been around a long time in relation to finding a new job. Over the years, networking consistently remains the number one way to find and land a job.

Having an inside or personal connection has always been a huge advantage to a job seeker and that is not likely to change. Of course in our profession WHAT you know is important too, but simply having the skills isn't always enough to get your foot in the door. 

Right now there are plenty of jobs out there, but you shouldn't let yourself be lulled into believing jobs are easy to land. In fact, in our current market the competition for each NP and PA position is quite strong and each job posted will attract dozens of applicants. To increase your chance of success, a personal referral can help you to stand out from the crowd of applicants. 

Why does networking matter? Employers have begun to mistrust the reference process. Laws prevent employers from disclosing truly helpful information about former employees. Job seekers also choose only references that they are confident will say positive things about their performance. That leaves potential employers with a rather biased sample with which to base their hiring decisions.

Everyone is on their best behavior during an interview so getting a real sense of the candidate's personality and how they might mesh with the current workplace culture is also tricky. I know a number of...umm... difficult personalities that initially present as quite amiable. Networking, while not perfect, does help to fill in the knowledge gaps.

Networking as a concept hasn't changed, but how we go about it is rapidly evolving. Networking in the good old days meant going to conferences or joining a professional organization. It meant staying in touch with former classmates and coworkers. In general it was a much longer process that one couldn't start just a few weeks before looking for a job. Those same methods are still sound strategies today so if that is what you have been doing I wouldn't advise that you stop. I would, however, advise that you add a digital component to your networking plan. 

Social media is the new networking tool and the great equalizer. You don't have to be limited to forging relationships with only people you have met in person. You can meet and connect online with employers and clinicians all over the country. 

Every platform, whether it's LinkedIn, Facebook or Twitter will allow you to reach out to others in your profession. Traditional mediums such as discussion boards still exist too. Join them all. But to be successful at digital networking you need to know it isn't enough just to sign up, you need to be engaged.

Lurking is not networking. You must be an active participant. That means posting comments and joining in the conversation. If you don't have a comment then ask a question. This is the "new networking" and the best way to find your next job.

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The Importance of Appearances
November 18, 2015 9:57 AM by Renee Dahring
Appearances are a touchy subject. Every time I write a blog on proper attire and grooming for an interview I can count on receiving a few comments from readers who take issue with my advice. Since I have devoted more than a few blogs to this topic and obviously it seems to hit a nerve with my audience it seems like a good idea to address some of my feedback.

Some of you wonder why I come back to this topic so frequently so perhaps I haven't made a good enough case as to why appearances matter, or to be more specific, WHY they SHOULD matter. I certainly applaud those of you who can look beyond appearance - it's an admirable trait and it says a great deal about your character. As healthcare providers we pride ourselves on being non-judgmental. We are educated to look for the positive and avoid stereotyping. But an interview is not a provider-patient relationship.

Employers are running a business and are seeking individuals who fit the image the organization is trying to project to the public. You, as their potential employee, are the face of their clinic or hospital. As a provider you are the point of contact for their clients - or in this day and age we call them customers. While customer may not seem so politically correct you have to agree that if anyone who is filling out a satisfaction survey could be deemed a customer. 

You, as the job seeker making a first impression, should dress in a manner that tells the prospective employer you respect them and the opportunity they are extending to you. When you show up at an interview looking less than business professional you are sending the wrong message. The message is that you don't take the job seriously, at least not seriously enough to dress the part. Employers tell me all the time that even though a dress suit is not expected daily wear for the job they still expect the candidate to wear one to the interview.

Some readers took issue with my assertion that your attire must be contemporary and not outdated. I understand that on the surface this too seems rather superficial, but I ask you again to look at the image you are sending. Dated clothing and hairstyles signal to the interviewer that you are out of touch or even worse is that you simply don't care. While not caring what others think might work in some settings it doesn't fly in an interview. Dressing as if you missed the last decade or two gives the impression you are behind the times in general. Out of touch with current trends is not an image any healthcare organization wishes to portray.

Our personal appearance should reflect the fact that we are respected professionals and we should dress in accordance. If you don't believe me just take a quick look at some marketing materials. Clinic brochures and websites only include employees that are smartly dressed and groomed.

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Job Market Trends
November 4, 2015 8:18 AM by Renee Dahring
I predict a tighter hiring market on the horizon. The shift has been gradual and subtle, but the signs are definitely there. I have had my suspicions for some time, nothing big mind you, but when it's all added together it indicates change.

NP markets are cyclical. I have seen periods where NPs were in high demand and salaries were through the roof. New grads were negotiating unheard of compensation packages. Then we had the recession and the implementation of the ACA. Initially this caused quite a hiccup in the market as employers were instituting hiring freezes and cutting clinical staff. This was a tough time to find a job. Nurse practitioners found themselves accepting stagnant wages and few benefits. Slowly things began to climb back. Employers discovered they actually needed more advanced practice clinicians not less. Hiring began to return although it took some time before salaries recovered and some benefit packages never did return to pre-recession levels.

Now that we have essentially figured out the Affordable Care Act there are new market factors impacting hiring that are having some interesting results. The most noticeable is the lack of part time jobs. Demand for NPs is strong, but you won't see many 2-3 day a week positions amongst the job listings, especially with the larger healthcare entities. One of the reasons for this are new regulations requiring employers to offer a full complement of benefits to part time employees. Great news if you were the employed part-timer without benefits, but not so great if you are looking to find a new part-time job.

The unintended consequence of this requirement made hiring part time workers less cost effective. This is a real shame in my opinion. I know of a number of very talented and experienced NPs that want to work only 2 or 3 days a week. Some because they have or are thinking of starting a family and others - like myself - reside on the other end of the career spectrum. 

Workers today are much more in tune with work-life balance and aren't as quick to sacrifice their private life. This generation values their "me" time. Pushing those folks into full time work in a field that is known for a high burnout rate is going to cost more in the long run.  

And what about the NP entrepreneurs who are working on creative new ventures, but still need a day or two of clinical work? Not to mention those who are teaching part time. Do employers really wish to erase those clinicians from the workforce? Seems penny wise and pound foolish if you ask me.
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Interview Faux Pas
October 21, 2015 9:02 AM by Renee Dahring
Have you ever been on a job interview that seemed to go well yet you never received a job offer? If I learned anything during the time I was recruiting it was that a candidate's perception of a successful interview can differ wildly from what a potential employer may perceive. 

As a recruiter my job was to follow up with both parties after an interview. Feedback I received from candidates would fall into what I would categorize as being on a more "feeling" or emotional level. The candidates take on the interview will be more subjective and tend to focus on whether or not they "connected" with the interviewer. Was the reception warm, did they make small talk or share a laugh?  If those things happened then the candidate felt fairly positive about the encounter. I chalk this up to nerves and the stress of interviewing.

From the employer perspective those things are important too. I have written before about the employer's strong motivation to find someone who is a good fit for the workplace culture. But the interviewer will be evaluating much more than good feelings during an interview. From the minute you walk in the door your interviewer will be evaluating a number of non-verbal cues. The interviewer will taking note of your posture and body language. Your attire will also be scrutinized. 

And unfortunately interviewers can be tuned in to what you might consider some pretty picky details too. I have sent a good number of candidates with stellar resumes and qualifications to an interview only to receive surprisingly negative feedback afterwards.  

These are the top complaints of hiring managers after an interview.

  • Inappropriate attire. No matter how casual the clinic atmosphere may be candidates are still expected to show up to the interview wearing business formal. Ladies, this means no open toed shoes or low cut blouses. Suits and ties for gentlemen. And make sure your dress clothes are from this decade - and fit properly. Outdated styles leave the wrong impression.

  • Too much perfume/cologne/makeup/jewelry - take your pick. Any or all of these are a serious mistake. I was doing an interview once where the applicant showed up wearing bright white eyeshadow. Honestly, that is all I could look at the entire time. Too bad for her that I was completely unable to focus on her qualifications. Remember, it's an interview not a date. Keep it simple and go fragrance free.

  • Consult your hairstylist before you begin your job search. This goes for both men and women. Negative feedback from interviewers about messy or poorly styled hair is more common than you imagine. Just as clothing can give the wrong impression so can a bad hair style or lack of hair style.

 You want an interviewer to remember you for your poise and skills and not be distracted by fashion faux pas.

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Think Before You Post
October 7, 2015 11:13 AM by Renee Dahring
This past week there has been a bit of a local scandal involving an "alleged" tweet by someone who really ought to know better. Apparently this person posted a rather inappropriate comment about a specific minority group. The tweet wasn't obscene and didn't contain any profane language but it was insensitive to say the least. Quite predictably folks are calling for his job and even more predictably he is claiming his account was hacked. 

By now you probably know where I am going with this post and yes this is going to be another reminder that you must be very careful when using any sort of social media. Have you ever heard the quote "Where do I go to get my reputation back?" Your image is priceless, and once it has been ruined you might not ever recover. It's a fact of life that negative news always outlasts the positive. 

Just because you don't post something outrageously offensive doesn't mean you aren't at risk. I know a whole bunch of clinicians who are perfectly nice people but you wouldn't necessarily know if from their social media posts. If your posts are overly negative or complaining you might be sending a message you don't mean to send. Yes, we all have a bad day but a constant stream of disappointment in the world gets old. And so does the self-righteousness. If you are a person who works with the public you should keep in mind that whenever you post a strong or controversial political viewpoint there is at least a 50/50 chance that someone is going to feel the opposite. And now you have probably just alienated them.

I wouldn't put too much faith in thinking you can keep your posts private either. Just one "like" or "share" and your words or images are no longer private. I know I see posts every day that I would bet my next paycheck that the author thought were private. 

Before you post anywhere ask yourself if you would feel comfortable sharing the post with your employer or any of your patients. Ask yourself if your post put your best side forward? If it doesn't then hit the delete button. Your post probably won't make the local news but it could easily end up on your boss's or patient's computer screen. The best case scenario for you is embarrassment; the worst is losing your job. And worse yet, if you have made reference to a patient you might get sued. Many employers now routinely keep an eye what their employees are up to on social media. It's also becoming very common to check Google and social media before hiring. 

Best to stick to posting cute baby animal videos and a few recipes.

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Empowering NPs & PAs
September 23, 2015 11:53 AM by Renee Dahring
This is really hard for me to say but here it goes: we should thank the ladies of "The View." In an ironic twist of fate that snarky remark insulting the Miss America with her "doctor's stethoscope" has unintentionally done more to advance the image of nursing profession than the pageant contestant they were mocking. Not only did the entire nursing community rise up to set the record straight but a good chunk of the public joined in to support us.  My Facebook feed has been full of some really great nursing memes this past week - I guess I can thank them for that too! 

So after we get past our outrage we need to examine why after all these years does the perception persist that physicians own healthcare? As nurse practitioners and physician assistants we have been fighting this bias for a long time. We have protested "see your doctor" and "consult a physician" messages in advertising and even made some progress but every day I still hear folks - even nurses - universally default to the term "doctor" when they really mean healthcare provider. (And yes, I know that NPs can be called Dr. too, so don't send me letters!)

Believe it or not, I was actually thinking about this subject a few days before "The View" controversy erupted. I happened to be reading a popular healthcare forum on the topic of teaching. This is a forum that includes physicians, NPs and PAs. I was taken aback at the number of physicians who said they wanted to teach in our NP or PA programs. Now maybe they meant well but it felt to me that the unspoken implication was that NPs and PAs needed to have some physician instruction if we expected to be doing a physician's job. 

Attention: we are not the Diet Coke of healthcare! We aren't the generic cheaper substitute for the Brand name product. I don't know how much clearer we as a profession can be about the fact that we are not trying to be mini physicians. Perhaps they missed the last several decades and did not notice that we are separate professions with our own body of knowledge and our own culture. Just because we do some of the same things and our professions intersect at times doesn't make us the "lite" version of an MD.  

And we have our own educators. There are plenty of talented folks in our own professions to be our teachers and our role models. I suggest that if MDs want to "help" us they can start by acknowledging us for what we are and stop talking about what we aren't.

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Making the Move
September 9, 2015 10:04 AM by Renee Dahring
Dear Career Coach: I am planning to seek a job in a completely new community. Currently I live in a small town and would like to relocate to a larger community within my state or possibly a long distance move to another region of the U.S. I am wondering if you can give me any advice about the best way to approach finding a job in a health system that I am completely unfamiliar with?

Dear Job Seeker:  You are wise to give some thought to your job search before you begin. Applying for jobs without a solid and well thought out plan is to set yourself up for failure. This is true whether you are looking locally or making a big move. 

As I was pondering an answer to your question it occurred to me that your situation is not that different from the challenges as a recruiter. Every day I was tasked with finding applicants that would be a good fit for positions with employers who were located in all different parts of the country. In order to find the right clinician and make a successful match it was imperative I learn about the culture of the organization. I will share the strategy that worked best for me.

Don't be afraid to ask questions. Get someone on the phone and ask them as many questions as you can think of about the job and their organization. Before you even begin telling them YOUR story you should start by asking about the people who work there. What types of personalities fit in best? What is the history of the job - who did it before and why did they leave? Next, ask them about the patients who attend that clinic. Are they young working families, retirees or a mix? Ask also about the community. Try to get a sense of what people who live there like to do for work and recreation. What are the major attractions? What challenges is the community facing? 

I know you are thinking this sounds like a lot to ask of a stranger but if you are genuinely interested people will respond to you. Of course, prior to your call you should have thoroughly researched all of the above. This will help you sound knowledgeable and ask questions that make sense. The internet is an invaluable tool to gather info. You can quickly and easily review the mission and value statements of prospective employers as well as if they have won any awards, have any initiatives or projects in the works. And here is the insider tip - look at the healthcare organization from the patient perspective. Pretend like you are thinking of going to their clinic for your healthcare - what would you like to know?

And lastly, contact any local professional organizations in the area you are thinking you might want to live and work. Most have a website and many have Facebook pages where you can interact with clinicians who already live there. 

Good luck and happy job searching!

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Hiring Trends
August 26, 2015 7:41 AM by Renee Dahring
Demand for NPs or PAs to fill permanent or direct hire positions fluctuates wildly. In the past decade I have seen both boom and bust markets. The economy most directly drives the ability of employers to hire. During the recession we saw a marked decrease in the number of open positions. Healthcare organizations were feeling the squeeze of falling revenue because they were unable to collect on outstanding bills and consumers started to avoid or cut back on healthcare visits. The recession coincided with the uncertainty about the implementation of the ACA which further complicated the job scene. Employers stopped hiring and in some cases even began to lay off or cut hours for many NPs and PAs.

After a rough year or two the economy began to stabilize and employers not only began to feel more confident about hiring they also seemed to have an "a-ha" moment about what hiring an advanced practice provider could mean to the bottom line. Doctors are expensive and since we can safely and effectively do much of what a physician does it made good financial sense to hire more of us. NPs saw job growth as employers began to recognize that NPs were a good fit for specialty practices too. Suddenly there seemed to be more than enough jobs to go around.

In contrast to all the fluctuation in direct hiring, the market for locum tenens NP/PA clinicians has consistently remained strong. There are several reasons locum providers remain a popular option. It should come as no surprise to anyone that the shortage of physicians has driven much of the demand. There are numbers of seasoned physicians hitting retirement and leaving the market. I know of several MDs that left direct care for administrative roles. The changing healthcare environment has been the last straw for other MDs. Let's face it, being a physician in family practice is not the same as it was twenty or thirty years ago. Many don't feel as respected or appreciated as they used to feel. They don't care for being reduced to the role of an "employee." And in their defense, employers aren't exactly doing much to make their docs feel they are valued. The end result is there are more physicians exiting primary care than entering. 

Practices that need clinicians turn to temporary employees in order to keep their doors open. NPs and PAs are the perfect solution. We can see the majority of patients that MDs can see. We have proven we can deliver quality care and we have a passion for primary care. We don't require boatloads of money and we don't bring an ego.
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The Benefits of Temporary Employees
August 12, 2015 8:05 AM by Renee Dahring
I am often asked why an employer would chose to hire a locum tenens or temporary NP or PA rather than just hiring someone for the position. Job seekers often are quick to jump to conclusions and assume that an employer is forced to seek temporary help out of desperation because they are not a good employer. This certainly can be the case but it doesn't happen as often as you might think. 

At first glance, hiring a locum tenens NP or PA doesn't seem to make good financial sense. I mean, aren't temporary employees expensive? Not only does the employer have to pay the clinician, they will also being paying a fee over and above the hourly wage the clinician is receiving to cover the services of the staffing agency. Doesn't make sense. 

Actually it does. While you many think of your wage as what you receive on your paycheck an employer has an entirely different view. Employers pay around 15-20% on top of the salary they pay you to cover their portion of your payroll taxes. Payroll taxes include social security, Medicare and unemployment.  When you are on a locum assignment these taxes will be the responsibility of the staffing agency. Many staffing agencies get around this by hiring you as a 1099 employee or a "contractor." This means you will pay the taxes yourself. 

Employers also consider benefits such as PTO, CME, malpractice and health insurance as part of your salary. As a locum tenens clinician the contracted employer is not obligated to provide any of these benefits to you because you are not directly employed by them. Some staffing agencies do offer some or all of these benefits - it depends. At any rate, the clinic or hospital doesn't have to add you to their policies and that can save them a great deal of time and money. 

The staffing agency incurs all the job search expenses too. It's not cheap to run ads, review applicants and conduct interviews. Many healthcare organizations have downsized their human resources staff and rely on outside agencies. Financially it often works out better for the employer to pay for these services only when they need them rather than maintaining a staff of their own. 

Long term commitments can be expensive in a market where demands and requirements are rapidly changing. Many employers are still nervous about adding permanent personnel in an uncertain healthcare environment. Patient demand may be up but reimbursements remain an issue. 

Locum tenens has long been known as the "try before you buy" option. Employers also want to make sure they hire the "right" person for the job. It's much harder to terminate than to hire. Bringing a clinician on temporarily gives both parties an easy out of things don't work out so well. 

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Landing a Job in Primary Care
July 29, 2015 8:16 AM by Renee Dahring

New grad NPs usually have a pretty specific idea in mind of where they would like to work after graduation, especially those who come out of a program that emphasized primary care. After all, you have spent the last two to three years learning how NPs are the solution to the primary care shortage so now you are excited to get out there and increase access! And many of you will find the job you seek. But for many others the search will not yield that ideal primary care position.  

Primary care jobs are more plentiful that they were a few years ago which is good news. But the availability of primary care jobs can vary a great deal depending on a number of factors. One is geography. There are areas of the country that have multiple openings and areas where the market is completely saturated. If you are in a tight market you are going to have a tougher time. 

Sometimes the jobs are “hidden.” Because primary care jobs are desirable and fill quickly many healthcare organizations don’t even need to advertise these positions.  Openings can be filled easily by word of mouth or referrals from current staff. When primary care jobs are advertised new grads will face considerable competition because there will be multiple applicants and many of these applicants will have previous experience. That works against you too. 

Employers have also increasingly been showing a hiring preference to the students who did their clinical rotations in their organization. This is obviously an advantage for the new grad who is interested in sticking with the same system but for new grads who are relocating or want a change it can be difficult to get noticed.  

If you are a few months post-graduation and still haven’t found that coveted primary care position you are probably now considering a job in a specialty care. This is where reality meets necessity. While your heart is in primary care you feel confident you can find satisfaction in a niche role too. But even so, you worry that diving into a specialty practice right out of school will ruin your future chances of ever finding your way back to primary care. One of the most frequent concerns I hear from new grads is “will I lose my skills if I take a different job?” 

Maybe, but I wouldn’t lose sleep over it. Yes you will lose some skills but that won’t completely disqualify you. Put it this way, you will be no worse off than where you started, which is as a new grad applying for a primary care job. Except you will be experienced. And depending on what type of specialty you choose you may actually gain some expertise in areas that will apply to primary care. Those are all advantages you don’t have now. Delaying your first job too long will ultimately hurt your skills and future job prospects more.

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The Dangers of Social Media
July 15, 2015 8:23 AM by Renee Dahring

If I want information about you the first place I turn to is the internet. This is where I will find out what you didn't tell me in your resume or interview. You might be surprised what I can learn with one quick Google search. 

My first stop is going to be your social media page(s). As your potential employer I want to see what image you are projecting to the world. Why? If I can find you so can your patients. If I am going to hire you I don't want you making my healthcare organization look bad. You are a professional and I expect to see you behaving like one.

The first thing I will notice is your photos. Let's face it, we only have "selfies" because we have social media. What I hope to see is tasteful photos of you. What I don't want to see is pictures of you drinking excessively or making rude gestures. If you are posting photos of yourself is revealing clothing I am going to question your judgement. 

Your comments will also tell me a great deal about you. We all have opinions but as your employer I will expect you to play nice with others. Social media can bring out the worst in people, especially when it comes to politics or other causes that people have strong feelings about. Posting snarky remarks, making fun of people you disagree with are not attractive personality traits. Self-righteousness wears thin too. How you behave online may translate into how you behave in the office and that is a chance I might not be willing to take.

I am also interested in what you are saying about your current job. If you are frequently complaining about your co-workers, your hours and your boss, that's not going to impress me. No employer wants negativity in the workplace. We've all worked with someone who just can't be pleased. Bad attitudes and back stabbing create a bad environment. If you are unhappy call a friend instead of posting it on Facebook. I don't want to hire you only to revisit your social media a few months later to find you are trashing your new job!

And finally, any posts about patients are a deal breaker, even if you aren't using their names. Posting anything about a patient is a serious breach of confidentiality. Posting about patients will not only get you fired, it may get you sued and in some cases it may bring criminal charges. 

And if you think this advice pertains only to job seekers you may want to think again. Current employers have been known to Google employers from time to time too. 

My advice? Stick to posting cat videos. Everyone loves cat videos.
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    Occupation: Nurse Practitioners and NP Recruiters
    Setting: correctional healthcare/career consulting/teaching
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