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Career Coach

Showcasing Your Experience as a New Grad
March 18, 2015 8:36 AM by Renee Dahring
It's spring! And that means one thing - New Grads. I am going to devote my next few blogs to the graduating class of 2015. 

First, let's talk about communicating experience on your resume. New Grads have 2 common misconceptions.

Until I have my first NP or PA job I have no experience. 

If you believe this you are selling yourself and your skills short. Your clinical rotations are your most recent and most relevant experience and it is critical that your rotations be front and center on your resume. Create a section on your resume and label it something like "student experience" or "clinical rotations." Under this heading you will list each of your clinical sites much as you would list a paid job.  Note the number of hours in each rotation, the focus of the rotation (peds, gyn, etc.) and the skills you mastered during that rotation. It's also helpful to give an example of the number of patients you saw each day - this gives the prospective employer an idea of your productivity. Consult your clinical logs if you need a reminder of what sort of cases and patients you were seeing. Avoid uninformative statements like "proficient at physical exams, assessing and diagnosing." That is the definition of a NP/PA rather than a summary of your individual accomplishments and it won't help you stand out from other applicants. Focus instead on skills you mastered or conditions you managed.

My jobs before and during school count as my experience.  

This is a common mistake. NPs tend to want to highlight their nursing experience. Employers want to know that you worked as a nurse but you shouldn't over emphasize this section on your resume. Remember, you are competing against experienced NPs for positions. Experienced NPs that were also nurses too! You shouldn't devote valuable resume space to detailing your job duties as an RN. A simple one or two line entry is sufficient. If employers want to know more about your nursing position they will ask you in an interview. 

PAs should follow the same principal for your previous healthcare related jobs. Include the position, but keep it simple. The name of the employer, dates of employment and your job title should be sufficient. 

For both NP and PA new grads it isn't necessary to prove to an employer you are reliable and can hold a job. It's understood that if you can make it through a grueling NP or PA program you are no slouch. New grad NPs and PAs should also NEVER include non-medical or non-healthcare work experience on their resume. The only exception is if you were in the military or held a high level position such as a CEO. 

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Are You Using the Right Resume Style?
March 4, 2015 8:32 AM by Renee Dahring
Resumes come in a variety of styles. If you are a new graduate or a seasoned NP/PA about to embark on a job search trying to figure out what resume style is appropriate can be extremely frustrating. Your resume is your first contact with a potential employer and you want to get it right. No one has ever been offered a job based on a resume alone; however, there are plenty of applicants who were passed over because of their resumes. Often candidates are passed over not necessarily because their resume was inaccurate, but because it was not the right style and format for our profession. 

Let's review the 2 most popular resume styles:

The "functional resume" uses category headings to organize your information.  You might see headings such as "skills" or "experience" with a short (or not so short!) paragraph underneath with further details. The paragraph is a sort of summary paragraph and is not job specific.  In other words the explanation is a collection of duties or accomplishments acquired from a variety of positions or experiences. 

Chronological resumes are organized by date and guide the reader through the applicant's background starting with the most recent first and working backwards in time. Each job is listed separately and includes the particular skills the candidate accomplished under each previous job. In this style the reader knows exactly what you did and when you did it. Chorological resumes use separate headings for your education, licenses and previous work experience. 

So which style do healthcare recruiters and hiring managers prefer? 

The answer is chronological. The functional resume is suited more to the business world than it is to healthcare. In our professions we like to be able to follow the job seekers professional development over time. It's important to us to know what type of setting the candidate performed certain types of procedures and skills. The functional resume tends to backburner dates in favor of highlighting experiences. It's very disorienting to us if we are unable to determine what your particular role or duties were in each of your past positions. We get very nervous if dates are not clear to us. It makes us wonder if the job seeker is hiding something (like job hopping) if dates are murky. 

We also prefer a more traditional resume. Fancy formatting and unique fonts on your resume don't impress us. Including photos and graphics on your resume also does you no favors. No need for famous or inspiring quotes - we are really only interested in the facts. Your resume needs only to communicate how your skills match an employer's needs.

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Job Market Myths
February 18, 2015 8:40 AM by Renee Dahring
As nurse practitioners, we have been enjoying a pretty strong market. Jobs have been relatively plentiful and compensation has been steadily increasing despite a rather slow economic recovery. Many states have removed or are in the process of removing barriers to our practice. We are gaining visibility in the media. Our jobs are rated year after year as being highly desirable. In general, we are in a good place as a profession. 

But before you get too excited I want to let you in on two of the most common market myths that are currently circulating.

Myth #1:  That job has YOUR name on it. Don't worry, the position is yours for the taking. Right now there are so many advanced practice positions open that employers are short staffed and desperate to hire.  

Truth: Yes, there are more jobs than ever, but that doesn't mean you can count your chickens before they hatch. We may be in a good market but with a lot of openings, but it still remains a very competitive market. Recruiters assure me that for each position they post there is still a large applicant pool. If you want the job you must remain competitive, so you must take care not to let your guard down and get sloppy with your applications. 

Myth #2: Everyone is making big bucks.  I know, because all my NP and PA "friends" on Facebook are talking about earning a boatload of money.

Truth:  Don't believe everything you read. Social media has empowered job seekers in many ways, but it can also lead to some bragging. Candidates are falling prey to other clinician's boasts of huge wages which may or may not be true. This "keeping up with the Joneses" mentality is leading clinicians to think they are worth more than the market will bear. Making outrageous demands for salaries because of what you read on your colleagues social media site can very quickly derail a viable job offer. You will damage your reputation and employers will dismiss you as unreasonable. The smart thing to do is to do your homework in your specialty and geographic area before you start negotiating.

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What Not to Do During an Interview
February 4, 2015 8:04 AM by Renee Dahring
The old saying about not getting a second chance to make a first impression is absolutely true.  They say a person forms their opinion of you within the first 10 minutes of meeting you. If you want that opinion to be positive when you are going for an interview then you need to know what not to do to spoil your chances.   

Here are 5 interview fails that will leave a bad impression. 

  • 1. Perfume. This is probably the most frequent complaint I heard from hiring managers. Many healthcare organizations have policies that prohibit wearing scented products so when you show up for an interview and you are wearing your favorite perfume you come off looking a little insensitive (pardon the pun).
  • 2. BYOB - bring your own beverage. Showing up with your resume in one hand and a beverage in the other. Finish your Starbucks before your interview please. You give the impression that you are a little too comfortable when you come sauntering in to the room carrying your mocha latte or Diet Coke. I don't know what looks worse, holding and sipping on it during your interview or simply plopping it down on a table next to you.
  • 3. Chewing gum. Tacky, tacky, tacky. No one wants to see you chew gum. NO ONE. You might as well stamp the words "inappropriate" on your forehead.
  • 4. Watch your %*&# language. I shouldn't have to tell you not to swear but an alarming number of you will use an off color word during your interview. And while I am on the topic of language you also need to watch the slang. For example "do you guys offer health insurance?" The phrase "you guys" is not acceptable business language.
  • 5. Purses and bags. It is fine to carry your handbag in to your interview but please tidy it up first. A purse that is open and overflowing with papers and other bits of your life is highly distracting to your interviewer and can leave the impression that you are a disorganized person. One can only imagine what your desk and workspace might look like! And therein lies the problem.
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Are Recruiters Ignoring Your Resume?
January 21, 2015 8:03 AM by Renee Dahring
Are you becoming frustrated because you have been applying for jobs and don't receive any response? Does it seem that even though you have all the right qualifications that your applications are still unanswered? 

Time to take a look at your tactics. 

Here are 3 reasons that recruiters will ignore you and your resume.

  1. You submitted a generic resume. Resumes are not "one size fits all." Many applicants erroneously believe they can create one master resume and it will be sufficient for each and every job application. Well, it isn't. I don't care whether jobs are plentiful or tight, employers still expect to receive a resume that is tailored to the position for which you are applying. In other words, if you are applying for a position working with elderly patients you can safely leave off your pediatric skills. In fact, leaving descriptions of those unasked for skills on your resume is a signal to a potential employer. Your resume is a marketing tool and when you try to market skills for which an employer has no interest you come off looking like you didn't pay any attention to the job description. Yes, it takes a little extra time to customize your resume for each job but if you really want to be considered for the position you will put in the additional effort.
  2. Death by mass application. If you are clicking and submitting an application for every NP or PA opening within an organization you won't be taken seriously. Multiple applications say "I am desperate" rather than "I really want to work for you." Every recruiter can name least at least a dozen applicants names that they are sick of seeing come across their computer screen. You really need to avoid multiple applications because it can cause even the most qualified candidates to be ignored - it's that serious of an error. I mean no one can be a good fit for every job! Be aware too that this is a mistake that can have a very long half-life and can haunt you for years to come because digital applications often stay in the system for a very long time.
  3. Seeking specialty jobs unrelated to your current specialty. There is nothing wrong with wanting to make a practice change but if you wish to leave one specialty for another you better provide some context for the recruiter. If you don't, they may assume you are motivated by other reasons, such as salary or hours, rather than the position. Take a few minutes to compose a cover letter explaining your motivation for change. Better yet call and talk to a real person so they can keep an eye out for your application. Many organizations use a computer program to sort through resumes and may not see your resume as a potential match if your experience has been in a different specialty.
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Are You Active in Your Professional Organization?
January 7, 2015 9:19 AM by Renee Dahring
It's 2015 and do you know where your professional membership status is? 

This year it will be more important than ever to get involved with your local and national organizations.  This past year marked the beginning of healthcare reform in the USA.  Love it or hate the Affordable Care became law.  As you may have noticed, the focus was almost entirely on enrollment numbers.  Getting people signed up dominated the news.  Getting people covered was the narrative for 2014.

In 2015 I predict that emerging story lines will be divided between two issues: access and cost.  As Americans are quickly finding out, coverage does not equal care.  It's great that more people are insured but who is going to see them?  And if the newly insured are fortunate enough to find a primary provider there is still the problem of cost.  At this point the ACA didn't address the out of control healthcare costs.  Early reports indicate that healthcare spending is down as whole but if you look further into the data it appears that the savings may be due to high deductibles and copays.  In other words, we aren't sure yet if Americans are spending their healthcare dollars wiser or simply foregoing care in order to save money. 

As NPs and PAs we understand that we have a large role to play in saving patients money.  We also know our patients well and have great ideas for ways to improve healthcare delivery while maintaining quality.  Many of us are pioneers in developing innovative care delivery systems. 

Which brings me back to why you need to get involved.  We need to be part of these discussions on both a local and national level.  Venting in an online forum or social media site may feel good but to have a real impact on how care is delivered - and by whom - requires an organization.  So unless you want physicians and politicians having all the say in how you do your job you it's critical that you start joining your professional organizations.  Change and reform requires influence on a large scale.  And unfortunately it all takes money.  Money for lobbyists, money for public relations and money for educational campaigns.  That money comes from your dues. 

Happy 2015!
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Holiday Gratitude
December 23, 2014 10:41 AM by Renee Dahring
With all that is going on in the world it can be easy to forget there are a lot of good things that happen every day. One of the ways we can count our blessings starts with being grateful to others. Every one of us have people in our life who have supported us in one way or another in our career path. Maybe it was an encouraging word that helped us through a rough day. Maybe they shared a clinical tip or a piece of advice. I bet many of you found your current job because of a tip or recommendation from colleague or friend. Whatever it is, big or small, take a few minutes this holiday season to let them know that you appreciate them.

Get some holiday greeting or note cards and start writing. Sending hand written notes used to be so common, it's really a shame we have moved away from that tradition. Email is better than nothing, just the fact that you took the time to write a personal email shows you were thinking about the recipient.

I know you are saying to yourself "I don't have time for this" but you don't have to write more than a line or two. Taking a few seconds to let someone know you value their friendship will brighten that person's day.

So what are you waiting for? Start making your list. I guarantee when you start thinking about all the kindness and good in people it will brighten your day too. And that's a good thing.

I would like to start my list by thanking the people at Advance -- especially Michelle Perron -- your enthusiasm is inspiring. What a great opportunity you have given me! Your encouragement and belief in what I do has led me to meet some incredible NPs and PAs (and hopefully helped a few) and it all started with this blog.  

Happy Hanukkah, Merry Christmas and Happy New Year.

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Interview Questions
December 11, 2014 3:31 PM by Renee Dahring

I've conducted many interviews over the years and can tell you that nothing sinks an otherwise successful interview faster than the candidate who asks no questions. Many candidates seem to feel it is acceptable when asked if they have questions to answer with "no, I think you answered them all". Really? You want to commit to spending most of your waking hours in my workplace and you can't think of one thing to ask me? As an interviewer I am left to wonder if the applicant is either dishonest or disinterested. Surely there are a couple questions they could conjure up for me.

I understand that some job seekers feel a little intimidated or don't want to come off as too forward but employers really do expect you to ask some questions. Asking questions shows you are thoughtful and have done your homework. It shows you are engaged and interested in the position. If you are one of those people who just aren't sure what to ask I have some suggestions.

  • How many patients will I be expected to see each day? This is such a great question it should be mandatory. If I had a dollar for every clinician who was unhappy in their current position due to patient volume I wouldn't be a poor blogger! Asking about the length of appointment times is another must ask question and can prevent a whole lot of future heartache. One of the most common reasons for termination is productivity (or lack thereof). In other words the clinician was unable to see enough patients per day.
  • How long is the orientation? What will be my patient load during orientation? This is not only great information for you to have but it tells the employer you are thinking about what it takes to be successful in their organization.
  • What are you looking for in your next employee? This question shows the employer you are thinking about more than just your own needs. It also provides you with key information that you can include when you send your follow up note after the interview. "I am confident I possess (name the aforementioned characteristics) and will be an asset to your clinic".

It can be OK to ask about money and benefits but it is generally better if you wait until the employer brings it up first. You never want compensation to be your opening question. In fact, I maintain that you should know what the salary range is BEFORE getting to the interview stage. If the pay is not acceptable to you then you shouldn't be interviewing. And as a final reminder, no matter what the responses to your questions you must never try to bargain for something different. Save the negotiating until after you have received an offer. The interview is for gathering information not making decisions.

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Why Do You Want To Work Here?
November 26, 2014 11:21 AM by Renee Dahring

Careful -- how you answer this could make or break your job prospects. 

Obviously, if you are looking for a new job you have put a great deal of thought into your decision. I'm sure if I asked you to list your reasons you would have plenty. But will a potential employer find your reasons as compelling as you do? 

When explaining to an employer why you want a specific job, you must keep one principle in mind: it's not about what you WANT - it's about what the employer NEEDS. Look at your list; if the reasons you have listed revolve around what the job will do for you, it's time to rethink your list. Sure, it's important that you be happy and to reach your personal goals - provided your happiness and goals are of benefit to the employer. I am not saying you need to completely abandon your reasons, but you might just need to reframe them. 

For example: "I have always wanted to work in dermatology, it's been a dream of mine since I graduated."

Now, employers will certainly appreciate that you have a passion, but you need to show the employer how your passion will benefit their practice. Talk about your experience with dermatology; if you don't have experience, tell them what learning opportunities you have engaged in to ready yourself for their job. Let them know how your passion becomes a plus for their patients - and thus their practice. That's what they want to hear. 

If your list of reasons includes things like better hours, a shorter commute or just better pay, I recommend you keep that to yourself, because they aren't likely to shed a positive light on your motives! Instead, talk about your skills and how they match the qualifications for the position. You can talk about wanting to use your skill set to a greater degree than you are able to in your current position, which benefits both you and the employer. 

Perhaps you want out of your current environment because you don't like your co-workers, your boss or it's just not a pleasant place to work. While that all may be true, that is better left unsaid. Never go negative; instead of telling the employer what you are running away from, you can tell them what it is that you are running towards. Research the employer before you interview so that you can illustrate to them how your values and goals align with the mission and vision of their organization. Explain how you bring to the table exactly what they need. Another win-win. You show the employer you have done your homework and, well, a little flattery never hurts!

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You're Fired! Now What?
November 12, 2014 3:31 PM by Renee Dahring

Just to be clear, I don't mean a layoff due to restructuring or downsizing. Many employers have been faced with making some hard staffing decisions in this economy so if you were terminated because of something out of your control a prospective employer probably won't hold that against you. 

But if the situation was more complicated, I can offer you a couple suggestions. 

First of all, don't explain it on paper. Sensitive topics are better delivered to a live person either on the phone or face to face instead of in a cover letter or on your resume. And for the record, it's always better to disclose sooner rather than later.

Never lie. If you are asked about why you left your previous position you must be honest. You can't outrun the truth, sooner or later it will come out and it won't bode well for you. One of the few grounds an employer can use as cause for immediate termination is providing false information in an application or interview. 

But you needn't go into the gory details either. Initially offer a limited explanation such as "it wasn't a good fit" or "we came to a mutual decision I would be happier elsewhere" or "we disagreed." Often times that will be sufficient. But if the prospective employer requests more information then try to be concise and stick to the facts. Resist the urge to over-explain or editorialize as that often makes you look bad.

If possible, try to find out what your previous employer says is the reason you were let go. It might surprise you to find out that employers often give vague politically correct answers when asked and are quite cautious about disclosing details about terminations. 

There are also ways to phrase your shortcomings that sound less negative. Avoid words like "problem" or "mistake." Choose softer, less negative words. Instead of saying, "I had a problem getting my paperwork done," it will sound better if you say, "I needed to improve my time management skills." I don't mean to imply that you should minimize, but no need to make things sound worse than they were either. 

If you were let go for performance reasons, you should be prepared to state what you have done to remediate the problem. Employers are not averse to giving second chances if they feel that they are earned. This means that right after you share the reason for termination you should let them know what you have done to fix it. For example: "My productivity was low because of my computer skills, so I have taken some computer classes". 

Stay positive. Never disparage your former employer (even if they might deserve it!). Don't put down your previous supervisor or co-workers. That just makes you look petty and spiteful. 

If your transgression was more serious, please see my previous article: Overcoming Negatives in Your Work History.

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Recording Dates
October 29, 2014 3:11 PM by Renee Dahring

Time flies and memory fades. Remember that Seinfeld episode where the character lost one old piece of information in order to make room for every new piece of information learned? At least I think it was Seinfeld, I can't remember for sure...

I'm sure you have all had the experience of filling out a job application and found yourself struggling to recall specific dates. Most of us can remember an event, but recalling the date the event occurred is another matter entirely. I know I do.

Over the years, I have served on a number of committees, boards and special projects. Sometimes I can recall where we met and what was accomplished, but seldom can I give you accurate dates for when I participated in these activities. I can also tell you the names of many interesting people I have met or worked with at one time or another, but don't ask me the year we first met - true even for close friends, as well as more casual work associates.     

Normally this isn't a big deal, unless you are filling out a job application or providing a list of references. Dates are very important when applying for a job. Lack of dates can be a red flag and citing incorrect dates can make you appear dishonest. You also want to receive credit for your past leadership roles and activities but that can't happen if you don't remember all of them. 

Here is a tip to help you stay organized. Create a log. Go to your computer and open a word document and give a name like "work related accomplishments." List everything you can remember doing that is above and beyond your basic work duties. Don't worry about dates for the past activities for now, just get as much of what you do remember recorded. Once you remember or locate the dates you can add them.   

From this point forward, add an entry for each new activity as they occur. For instance: if you are asked to be a preceptor this month, go to the document and add an entry that says "preceptor for Sally Student from United College." It doesn't have to be pretty; this list is just for you. 

The next time you need this information, it will be readily available. As an added measure, you may want to keep a copy on one of the cloud servers (Google drive, iCloud, etc.) so it is accessible from anywhere and immune to computer crashes.

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Beware: Social Media
October 15, 2014 11:54 AM by Renee Dahring

CAUTION! You could be one status update or tweet away from losing your job. 

Now that I have your attention, I would like to remind everyone that what you choose to share on social media can have a negative impact on your employment. We live in an age where we are more connected than ever so you need to think carefully before you hit the "post" button. One of the most seductive things about social media sites is that it feels very personal, but the reality is that it is actually very public. Even if you set your profile to be private your posts can become visible when others comment on your status or if you post a comment on a public page. You also never know when one of your 100+ closest friends might decide to share one of your "private" posts. 

I know it's very tempting after a particularly stressful day at work to turn to your favorite social media and post your frustrations. We can all relate to a difficult day or a difficult boss and it can feel very cathartic to go on a snarky rant and then watch the "like" count pile up. Your friend's well-meaning comments may feel supportive to you but I guarantee your employer won't see it that way. Text and emails can be forwarded so if you feel you need to vent it's safer to do it the old fashioned way - face to face or on the telephone. 

Never, ever share a patient story online. This is considered a privacy violation and in addition to getting you fired it may also land you in some legal trouble too. It may seem harmless enough to post something funny or touching that a patient said or did but your post is considered a breach of confidentiality. Even if you don't use the patients name it is still possible that a reader can put two and two together and guess who you might be talking about. 

Your employer also may have a thing or two to say if you are posting or responding to others posts frequently during the work day. Because posts are time stamped it's easy to tell if you were on the clock or not. The last thing you want is to give the impression that you are distracted or have too much time on your hands at work. 

I would also like to remind you to watch the tone of your social media posts. Complaining and being overly critical of others online makes you look like a negative person to both your employer and your patients. Always avoid swearing and inappropriate pictures. Steer clear of controversial topics. Be Switzerland and stay neutral. And post only cute cat videos - that should keep you safe.

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Five Strategies to Sabotage Your Next Job
October 8, 2014 1:12 PM by Renee Dahring

Here are some sure ways to sabotage your next position while job hunting:

  1. Applying for a new job until you are clear about what it would take for you to leave your present job. Employers hate fishing expeditions. Before you start sending out applications ask yourself what it will take for you to make the move. Is it salary or schedule? What exactly is it that you want to change? Before you submit your resume you ought to be certain that the job you are seeking has what you seek. If you need more money and you see a job ad with a similar salary range as your current position it makes no sense to start the application process. If you know the commute is too long before you hit "apply" then it will also be too long when you are offered the position too.
  2. Determine your bottom line, then change it. Employers dislike negotiations as much as you do. If your job requirements are moving targets, don't be surprised if you negotiate yourself right out of a new job. Not only is changing your mind bad manners it makes you look flaky and half-committed to a job change. No one wants to hire someone that seems ambivalent BEFORE they even start working.
  3. Insist on negotiating everything. When we say "everything is negotiable" that doesn't mean we want you to negotiate every item in the offer! They say in a good negotiation neither party will get everything they want - and it's true. A better approach is to direct your negotiating energy towards the ONE thing that will make the job most attractive to you. After all, isn't that what is most important? Let go of the small stuff and concentrate on the one item that will keep you happy. (see #1)
  4. Dragging out the process. Protracted and lengthy negotiations are a no-no. The longer you take to come to an agreement the less attractive your employment prospects. You have heard the saying "out of sight out of mind"? Reply promptly, if you need time to consider then communicate that to the employer and then stick to your deadline. Hint, if you need more than a week to decide you have probably entered diva territory.
  5. Thinking in dollars instead of in percentages. Job seekers get too hung up on the numbers when negotiating salary. It's difficult to get a feel for whether or not your salary counter offer is reasonable if you are looking at only the dollar amount. For example, the employer has offered you $95K as a base salary but you want to counter with $105K. However, If you did the math you will find that the additional $10K per year you are countering results in a difference of a little over 10%. Ask for that much and the odds are your counter will be turned down plus you run the risk of appearing as unreasonable. In this current economy and job market you should limit your requests for salary increases to 3% of the initial offer.
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Non-traditional or New Practices
September 19, 2014 2:01 PM by Renee Dahring

Proceed carefully when considering a position with a new clinic or practice that is not yet open or established, especially if the clinic is embarking on a "non-traditional" or "new healthcare model." Jobs like these can turn out to be the best thing you ever did or the biggest nightmare of your career. 

The sales pitch for these types of jobs can be intoxicating. Owners or investors are obviously excited about their new venture and it's easy to get caught up in their enthusiasm. You might think that due to their lack of experience and optimism that only new grads are vulnerable, but I have seen this happen to a fair share of seasoned clinicians too. 

I have nothing against innovation or start-up companies, but before you commit it's wise to put your excitement on hold and do some research. Find out everything you can about your potential employer and their background.   

Here is what I recommend: 

  1. Ask to see the resume of the medical director. How long have they been in practice? Where did they do their residency? Are they board certified? In case you weren't aware, a doctor can be licensed after one year of residency. Verify that their experience matches the practice needs. Just like us, MDs should stick to their "scope of practice" too.
  2. Make sure you meet the medical director in PERSON. Don't just settle for a medical director who is only "on paper". Ask them how they define the role of an NP or PA. Have they ever worked with an advanced practice clinician before? What do they see as the role of a medical director? ***The first two points are critical If you are a PA or an NP working in a state that requires a practice agreements with a physician.
  3. Play detective and Google the names of everyone involved. If you can't find much info about them online that should raise some red flags. 
  4. Who will be your supervisor? If the owner is a lay person, they hopefully had enough foresight to hire a manager with healthcare background and experience. Unfortunately, I have seen owners try to do it all, especially if the company is small. The problem is that folks who come from the business world don't always have a good understanding of our professions and may put pressure on you to assume duties or tasks that might be outside of your scope of practice. Performing duties that fall under your scope leads to job dissatisfaction, and pressure to work over your scope can put your license in jeopardy.
  5. What is the mission of the practice? Will you be required to sell or recommend products or services? Many of these new models have a "retail" portion. To keep your ethics intact, find out where the line is drawn between medicine and product marketing.

Get as much in writing as possible. Not just pay and benefits but also your hours and duties.  New ventures can be work in progress and things can change rapidly.

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Dear "Supervising/Collaborating" Physician
September 3, 2014 1:07 PM by Renee Dahring

Dear "Supervising/Collaborating" Physician,

Our relationship has to change. 

It's not you, it's me. I have changed. I have grown and matured. I am not the same nurse practitioner I was when we first met. I have been around awhile now; I am no longer a new profession that is trying to find my role in the healthcare world. I have been working hard, and over the last few decades I have gained experience and confidence. I feel I have proven myself, and now I have the studies to prove that I consistently provide quality patient care that has equal or better outcomes. You seem surprised - you say that you don't understand why I feel need to move on. I recognize that you are hurt because you thought our relationship was fine and that we seemed to be getting along so well. I suppose this is part of the problem, you haven't really been paying attention. The truth is this relationship has been working better for you than it has for me.

I need some space. I'm not okay with these "agreements" you have been forcing me to sign. Yes, I know you feel somewhat protective when it comes to the practice of medicine, but the bottom line is that you are a physician and I am a nurse practitioner. As time goes on, I have begun to realize that it just doesn't seem right that one profession can determine the fate of another. You and I are different. You need to accept that just because we do some of the same things does not mean you have the right to be in control of my practice. Perhaps you aren't aware of this, but many of your colleagues have been charging us an obscene amount of money for these "supervisory" agreements. Why should we pay a lot of money for a signature on a piece of paper that doesn't result in any benefit to our patients or improve healthcare? In fact, all this paperwork has actually decreased access to care by adding unnecessary restrictions on my practice and adding more cost to an already overburdened healthcare system.

We can still be friends. I value the relationship we have had over the years and hope I can still count on you to be there when I need you. But for our friendship to move forward, you are going to have to trust me. You will have to trust that I was educated to know my limits and that I know when it is time to refer my patients. The only thing that is changing is that we will no longer need such a formal agreement. You see, I have also noticed you don't treat other professionals the same way you treat me. I find it hard to believe that we need to have a written agreement with each other when I see you freely collaborating with your colleagues. Just because I want to end the "supervision" part of our relationship doesn't mean I don't respect your knowledge. We will still work together, but now it will be as peers that both bring valuable contributions to patient care. 

Sincerely,

The Nurse Practitioner

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    Occupation: Nurse Practitioners and NP Recruiters
    Setting: correctional healthcare/career consulting/teaching
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