Here is the short notes version of what you should know!

What is the difference between being an employee and a contractor? 

If you are an employee, your employer issues you a check and pays your withholding taxes. Depending on your FTE you may qualify for vacation, sick time and other miscellaneous benefits. At the end of the year you will receive a W2 form. 

If you are a contractor, you are essentially being treated as if you were a business. You still get a check from the employer, but you are responsible for all payroll taxes and you do not qualify for any benefits.  At the end of the year you will be issued a 1099 form. 

What is the same? 

• Both require a contract and the contracts should cover pretty much the same things.
• You are subject to the policies and procedures of the organization.
• Both agreements may include non-competes.

What are the pros and cons? 

Pros:

• Employees can be eligible for employer benefits such as healthcare.
• Employees may participate in the employer's retirement programs (401K).
• Contractors can deduct many expenses that employees are not allowed to deduct, such as home office, car, mileage, cell phone, etc.

Cons:

• Contractors cannot draw unemployment.
• Contractors must pay their own payroll taxes, which may necessitate hiring an accountant.
• Contractors must buy and pay the full cost of their health insurance.
• Contractors do not get sick time or vacation from the employer.

What is the bottom line if I choose to work as a contractor?

• Add at least 25% to your hourly rate to cover your payroll taxes. For example, if you want to net $50 per hour then you need to charge at least $62.50 per hour.
  
• Clarify who will be paying your malpractice. Sometimes staffing companies will cover your malpractice if you are on an assignment, but it's not always the case. If you are responsible for your own malpractice, be sure that you budget the cost into your hourly rate.
  
• Find out what health insurance will cost you before you set your hourly rate so that you can build the expense into your rate.
  
• Consider using the services of an accountant to ensure you pay the proper taxes and maximize your deductions. Factor this cost into your rate, too.

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Over the course of my career I have worked with some great docs. They have been encouraging, helpful and generally treated me as a peer. During my education I had physician preceptors and early in my career I had physician mentors. In my practice I have consulted with physicians when I found it necessary and on more than one occasion I have had physicians consult with me. When I have had a need to interact with specialists, hospitalists or other physicians whom my patients were previously seeing (remember, I work in corrections so almost all my patients are new to me) I have been treated with the utmost respect. 

I get it, we are still in a recession and money is tight. Reimbursement is down and everyone is getting a little nervous about the impact of the new healthcare laws, but that is no excuse for this kind of behavior. For one thing, it's beneath them. Like me, most patients also like doctors so I can't believe any patient wants to read articles where their physician is acting like a schoolyard bully. Patients also really like US, so when doctors (or their organizations) go on record disparaging NPs and PAs it doesn't really play well with the public. It just looks petty and greedy. 

I have always discouraged the "us against them" mentality. I don't like it when we do it either. It doesn't advance our profession. Let's call a truce. We need to stop saying how much patients "like" us better and physicians need to lay off the insults. Neither of our professions is going anywhere and there are more than enough patients to go around. Negative dialogue is unproductive and distracting.    

Dear Mature Job Seeker: Employers are looking for two main characteristics when they hire an employee. The first characteristic is your skills and expertise. After 18 years in practice I think we can safely say you should have no problem meeting that standard. But having experience isn't enough, because the second thing most employers are looking for is employees who will stay with them for the long term. We all know that technically (and legally) an employer is not allowed to factor your age into their hiring decision, but I think we would both be kidding ourselves if we think that an employer is eager to hire someone who is within shouting distance of their retirement. The truth of the matter is that hiring a clinician is expensive and time consuming, and employers don't want to have to go through the hiring process every couple of years - especially during tough economic times.

One option you may want to consider is doing a temporary or locum tenens assignment. You might find that short-term assignments are a nice fit with where you are in your career journey. This is the one setting where long-term commitments are not required or expected. Assignments can range anywhere from a few weeks to a year in length. When I was recruiting I filled many of my temp positions with "mature" clinicians who liked to work temp positions because they enjoyed the freedom and the variety. And did I mention the pay? Temp jobs usually pay very well. If you are willing to travel the opportunities are even greater.

Teaching is another idea you might want to entertain. Many colleges and universities employ folks in our profession in an "adjunct" type position to work with nursing or other healthcare students. They may have a need for teaching or assisting with specific courses or for supervising the students in their clinical rotations.

Above all, no matter what your age, I never advise that you quit your current job until you have a new job secured.

When I was a student I once discussed this very subject with my physician preceptor. I was explaining to him how we can benefit a practice because we generate revenue without drastically raising expenses. I remember his response. "That's communism!" he proclaimed. "Why would you want to do that?"

At the time it sounded like a great selling point. I mean, in those days we were paid less but we also were not subjected to the same pressures in terms of workload and paperwork that plagued our physician colleagues. We were given longer appointment times and often dealt with the less complex patients. 

In 2013 that is no longer the case. Appointment times are shorter, medical complexity is higher and it is not uncommon for many of us to be the only provider on site. We certainly do the same paperwork and share much of the administrative/insurance headaches.

It seems we are now also facing a physician shortage. One of the leading reasons for the shortage is that physicians are deciding to leave practice - e.g., they are either just quitting or retiring early. The top reasons driving the decision for MDs to leave practice have to do with dissatisfaction. Not too surprisingly, they cite frustration with too much paperwork, too little time to spend with each patient and not enough pay. Sounds like "burnout" to me. 

So if doctors make more than we do and they are unhappy, how long will it be before we feel the same way? Don't get me wrong, I think it's great to be cost effective, but have you ever asked yourself why you would want to work as hard, get the same results, deal with the same hassles and then get paid less? Judging by the comments I see on various discussion forums many of us are beginning to feel just a wee bit taken advantage of by our employers. 

Perhaps it's time we re-evaluated this particular message.

The correct answer is really simple. If you are applying for a clinical position you should be submitting a resume. Why? Because resumes are short and sweet and when employers are hiring a clinician for direct care all they really want is a quick summary of your education, credentials and skills. Remember, the purpose of a resume is to get you in the door for an interview. 

On the other hand, a Curriculum Vitae (CV) is appropriate if you are applying for an academic, consulting, research or other non-clinical role. Why? Because a CV is significantly longer than a resume and includes all sorts of information that is rarely pertinent or relevant if you are applying for a traditional clinical position.

While a resume focuses on the triad of information I mentioned above, (education, license, skills) a CV goes further and can include presentations, publications, research, committees, continuing education or even your thesis or capstone project. A resume should be limited to 1-2 pages maximum but it's not unusual if a CV goes on for up to a dozen pages. 

So why so much confusion? Well one reason is that over the past few years employers and recruiters have begun to ask for a CV when what they really want is a resume. I don't know how or why this has become a trend but I can tell you it is not going away anytime soon. And furthermore, the inaccurate use of the term seems to go in only one direction. In other words, clinical positions quite often request a CV when they mean a resume but rarely does an educational or research position ask for a resume when they mean a CV. 

My advice: Don't worry about whether you call it a CV or a resume, just make sure that the content is relevant, appropriate and clearly shows that you meet the requirements of the position. If it's a traditional clinical position, keep your information more brief and focused on skills and experience. For academia or a consulting position you can feel free to get wordier - much wordier.  

Dear Career Coach: I have been applying for jobs and I have recently been on several interviews. I think (actually, I am pretty sure) that I will be receiving an offer from one clinic. The job sounded good and I think I would be happy there but I am not sure I want to accept the offer before I know the results of my other interviews. I don't want to tell them yes and then get a second offer and then change my mind. What should I do? 

Dear Reader: I know it seems stressful but it's actually a great problem to have! It's also not unusual. Most job seekers have multiple applications in process when they are looking for a new job. And that's OK, as long as you handle it properly. And how you handle multiple offers really just comes down to basic manners.

First and foremost, it is critical that you DO respond. It's really bad form to leave an offer hanging out there without some sort of answer. That doesn't mean you have to give the employer a definite "yes" or "no", you just have to tell them something. How much you tell them is up to you. 

So if the call comes, start by thanking them for the offer. 

Next, you can simply tell them you need some time to consider the offer. There is nothing wrong with asking for time as long as you are specific about how MUCH time. In general it is reasonable to ask for up to a week to decide, any longer than that is probably pushing it a bit far. 

How much you decide to tell them about WHY you need some time is up to you. If you want to share that you are still interviewing or waiting on another offer that's fine. Employers won't be surprised that you might have applied to more than one job and it's not necessarily a bad thing for them to know you have some options. However, you need not feel obliged to them anything more than that you need a few days to think it over. 

You can also buy some time by asking for the offer in writing. An offer really isn't an offer until the official paperwork shows up! You wouldn't want to turn down another job, or worse yet, QUIT a job until you have the new job offer in writing. This gives you a chance to fully digest the offer and should you be fortunate enough to receive that second job offer, you can then compare the two offers.    

I always tell job seekers that getting a job offer is a bit like receiving a marriage proposal. It's very flattering to know that you are wanted. But sometimes we can find ourselves so overwhelmed by the notion that someone truly desires us that we forget to consider whether the feeling is mutual. 

And like a marriage, committing to a new job is big step and shouldn't be left to one's emotions, because once done, it's not easy to undo. It's one of life's ironies (or jokes) that getting out of a bad relationship can be much more complicated than entering into one. I am asked by clinicians more often than you might imagine for advice about how they can end their employment. (We will leave that topic for another blog!)

So for those of you looking to begin a new job and to avoid a messy divorce I recommend you consider a longer engagement. Before you think I have completely gone off the rails let me explain. 

Ask for a "shadow" day. This has become more and more common in recent years. Requesting to spend a shift or two with one of their current providers, "shadowing" is a good way for both parties to get to know each other better. 

As a clinician, you will get a clearer idea of not only the job duties and patient flow but also the personality of the practice. Remember, an interview lasts usually no more than an hour and it's relatively easy for everyone to be on their best behavior. It's a little harder to hide dysfunction for an entire day. If there is an undercurrent of tension or disorganization you are going to pick up on it. 

So what's in it for the employer? A good fit, that's what employers get out of the shadow. Employers are just as eager to find an employee who fits in with their practice culture as you are to find a practice that fits you. A happy employee is a long term employee.  As I have said many times before, clinicians rarely leave jobs where they are happy even if they can make better money elsewhere. Great pay and benefits aren't enough for happiness. Now that I think about it, that is the case for many marriages as well. 

Dear Career Coach: What can I do to get employers to notice my application? I would like to know if there is anything you can recommend that will increase my chances of landing an interview. Can you help?

Dear Job Seeker: Obviously it is important that your resume show the employer that you possess the right qualification and skills for the job. However, you also need to convince them that you have a genuine interest and a strong desire for the position. 

Employers tell me that if you are able to clearly articulate the reason you are applying for the position then they will be more likely to want to interview you. So how do you demonstrate to a potential employer you have a passion for their position? I have a couple tips to help you. 

1. Research the employer. Learning about their culture, mission and history is one way to show an employer you are interested in them. The information you gather will help you to emphasize why you are the right fit for them. And if you get a call or an interview it will also help you to formulate the right questions to ask. Start by checking out their website or Facebook page.
2. Make clear the reason WHY you want this position and make sure that your reason makes sense. The best tool for you to express your motivating reason is the cover letter. Use your cover letter to explain why you feel drawn to the position. Perhaps you have previously worked with this population or specialty before. Or maybe your reason is that you did a clinical rotation in their organization. If you know someone who is a current employee who has inspired you to apply that is perfectly good reason as well. (Name dropping is allowed!) Just remember that whatever your rationale, it needs to be employer-centered and show clear benefit to the employer. For example, proclaiming that you want the job because the hours or commute better suits your lifestyle is not helpful. 
3. Don't "over-apply" or be a "serial applier." When employers see you submitting several applications for several different positions it makes you look like you either don't know what you want to do or that you are desperate. Neither of those options is very attractive. Think carefully before applying; if you aren't sure why you want the job, then you are unlikely to convince anyone else why you would want it either. 

Job seekers always ask me what they can do to make their resumes stand out and get noticed. Today, I will put on my recruiter/employer hat and offer you a few suggestions to make your resume more effective. 

When I give your resume its first look there are basically 3 things that I need to see and see quickly.

1. Your education. I need to see immediately if you meet the educational requirement for my position. I want to see the college or university you attended, what date you graduated and what degree you earned. Because most of us are awarded a more general degree (such as science or arts) I will additionally need to see your area of study. By this I mean whether you are a nurse practitioner (and what specialty) or if you are a physician assistant. Keep this entry simple and uncluttered so that I can easily identify each of these specific pieces of information. Don't force me to dig for it! 
2. Your certification. Create a section devoted ONLY to your certifications and licenses. Don't hide this information in other sections of your resume. Remember, I am skimming your resume and if you are unclear I could pass you over. Also state the status of your certifications and licenses. I really need to know if you are current. DO NOT include any of your license numbers; instead, you should note "current" and provide the expiration date after each entry. Failing to include your status might cause the computer, which reads your resume before I do, to disregard you as unqualified.
   
3. Your skills. I want to see these in your work history, not in a separate free floating section. I want to know what skills you have, as well as when and where you used these skills. Oh, and because I am ultimately only interested in if you are a good fit for MY job, I would like you to tailor your resume for ME. Don't clutter up your work history section with skills that are general. I know you can "assess, diagnose and prescribe". I need you to give me specifics. And nurses, I realize you had mad ICU skills, but those are not of much use to most outpatient clinic practices. Sorry.

Pearl: If you expect to have your resume noticed, focus on these 3 areas. Do not make potential employers work too hard to determine if you meet the job requirements.  

Happy New Year! Is your resolution for 2013 to start or increase your social networking skills? If you have been meaning to get a more active online presence this year, I have 5 quick tips for you.

1. Keep it positive. Current and potential employers now regularly check the internet to see what you might be doing online. Negative comments about your current job or your co-workers can make you look like a complainer. Or worse yet, it may label you as a trouble maker. It could also get you fired. We are just beginning to hear stories of employees who disparaged their employer and then lost their jobs. 
2. Never, ever tell stories about your patients on your social media sites. It doesn't matter if you don't mention the patient's name, or if it is a positive heartwarming story; it is still considered a serious breach of confidentiality and can get you into legal trouble.   
3. If you want to capitalize on the professional networking aspect then you need to do more than sign up. If you want to make the most out of your connections on sites such as LinkedIn, then you will need to participate. Join the networking groups and then regularly chime in on the discussions or pose a question.
4. Don't curse or repost profanity. Stay away from highly controversial topics like politics or religion. It pays to be neutral. Be careful of pictures you choose to share. Pictures of you drinking or partying aren't professional. And trust me when I say no one wants to see you in your bathing suit.
5. You are judged by the company you keep. Who you like and who you associate with online are also visible so choose your "friends" wisely. Even if you mark your profile as private what you share and post on others pages makes you very visible. Keep it clean and keep your "likes" G-rated. 

Social media can be a great way to gain visibility, show off your tech skills and do some serious networking if done correctly. If you have some less than flattering posts out there all is not lost. Although you can't completely remove them, don't worry.  You can post a batch of new posts which can push those old unwanted posts further down and make them much less likely to be seen.

Need some practice?  Join me at www.Facebook.com/NPCareerCoach or www.linkedin.com/in/reneedahring

As I sit down to write my final blog for the year 2012 I was struggling to come up with an appropriate topic to mark the occasion. I was thinking back to when I first began writing this blog in 2009 and it occurred to me that maybe I should tell you how it all started and how I came to be the Career Coach.

Three years ago I was still part of a small but rapidly growing staffing agency for NPs and PAs - an agency that in fact was NP owned and operated. For almost 5 years I was doing recruiting for temporary and permanent positions in addition to my own clinical practice. During that time I reviewed countless resumes, arranged multitudes of interviews and became the proud parent of more than a few successful job placements. 

I came to understand that as a recruiter I occupied what I like to call a very unique "matchmaking" position. On one side I had the NPs and PAs coming to me seeking jobs and on the other I had employers looking to fill jobs. In order to be successful as a recruiter, I quickly learned it was necessary to understand the needs and wants of both parties. 

I also learned that some of the best clinicians can produce some of the worst resumes! We may be great at healthcare but our job seeking skills were on life support. Then I thought back to the job search advice I had received when I was a student and realized it wasn't - well - very good advice at all. Most instructors have little insight into what a hiring manager wants from an applicant. Professional resume writers and career counselors are not especially helpful either since they have little to no understanding of our professions or their advice is geared toward the non-clinical job seekers. 

I wanted to share the inside information I had with my NP and PA colleagues to help them conduct a more successful job search. I took a chance, pitched an idea and ADVANCE generously offered me a forum to share my knowledge with you on a bi-weekly basis. And so, "Career Coach" was born. 

Many of you have written or called me with questions and suggestions over the last 3 years. My goal is to provide you with helpful information and I would very much love to hear from you. Please take a minute and visit my website www.nursepractitionerjobsearch.com  or Facebook www.Facebook.com/NPCareerCoach  and share with me any ideas or topics you would like to see featured in my future blogs or columns. 

Season's greetings and best wishes for a happy New Year!

Thanks for reading,

Renee

Dear Career Coach: I will be graduating this May as a new nurse practitioner. I am concerned about the advice not to skip dates because it may cause my application to be rejected by HR computer systems. Before beginning my studies I had no direct health care experience and so I am unsure about how to make a resume that doesn't have a big gap in my employment. 

Dear Reader: I can see where you might find this advice to be confusing! Many new clinicians ask about how to handle their previous work history, so you aren't alone. I understand my advice seems contradictory, so let me explain.

When you are looking for a job as a new NP or PA, employers (and their computer systems) aren't terribly concerned with what you did before you decided to go to NP or PA school, so gaps in employment prior to school are not a relevant issue. For all intents and purposes, your work history begins the day you finish school.

Because you are competing against other applicants who will have actual practice experience, there really is nothing you did prior to becoming an NP or PA (especially if it was non-medical) that is going to tip the scales in your favor. Your experience working at Starbucks or in construction is not going to be the deciding factor. So leave it out. In other words, non-NP or PA experience can't trump NP or PA experience, so you shouldn't waste any of your precious resume space on it.  

Many new grads worry that a spotty work history prior may reflect badly on their work ethics, but most employers understand that the fact that you made it through NP or PA school is a positive predictor of your drive and motivation. 

So focus your resume on your current skills and accomplishments. The computer is smart enough to start the clock after your graduation. Including your previous work history, especially if unrelated or inconsistent, will serve only to muddy the waters. 

One exception is military service, because that does speak to your character and many employers like to hire vets. You may need to find a creative way of letting them know you are a vet without besides putting it into your work history. One solution is to make a separate heading titled "Military Service." 

If you are looking for a new job you have probably been researching what to include in your resume.  I know it is certainly one of the most frequent questions readers ask me. Today, however, I am going to reverse direction and tell you 5 things you should NOT include in your resume. 

1. Never, ever include your license numbers or your social security number on your resume.  I see this all the time (which is why it's #1 on my list!) So if you are guilty of putting your license numbers on your resume I have only 2 words for you -"identity theft." It's risky and employers don't need this information until they are ready to hire you. Yes, I know you want to let them know you are licensed, but instead of sharing your vital information you can just note "current" or give an expiration date after each of your certifications or licenses and that will suffice. 
2. There are some personal elements that should never be part of a professional resume in the year 2012. These include your religion, marital status, your height, weight or pretty much any other physical description of yourself. It might go over well in a personal ad, but when it comes to your resume it's just too much information. Granted, I don't see this frequently but I do see it enough that I feel compelled to include it on this list. 
3. "Passed boards on 1^st attempt." If you think this is an impressive statement then we really need to talk! (And it won't be about hiring you.) Some things are just better left unsaid. I honestly don't know what possesses some people to put remarks like this in their resumes but they do it with a fair amount of regularity. I mean, did you not expect to pass the first time? 
4. Keep your references to yourself! If you put the names of your references in your resume it may lead potential employers to believe that it is OK if they contact your references. Believe me, neither you nor your references want this to happen. The appropriate time to disclose your references is when a job offer is pending or on the table. Oh, and there is also no need to include the "references upon request" heading in your resume anymore either.  Don't waste precious space on your resume only to state the obvious.
5. Grade point average. I know this is going to hurt your feelings, but no one cares. Let me say it again, but slower. NO. ONE. CARES.  There, I said it.  Adding your grade point average is just pretentious or foolish - depending on what your GPA was.

I just returned from a national conference and as I promised you on my NP Career Coach Facebook page, I am going to report to you what employers and recruiters are saying about the resumes they have been receiving from our professions.

1. Employers can't hire you if they can't contact you. Recruiters tell me that a startling number of candidates are neglecting to include their contact information on their resumes. At a minimum, you need to include at least an email address. Email has become the preferred method of contact so if you don't have an email account, you should get one. Telephone numbers are important to include as well. It's not the end of the world if you don't have your address on your resume, but I am still recommending that job seekers include it. 
2. Not enough specifics about your skill set. Employers want to know what skills you possess and where you obtained these skills. This means if you are a seasoned practitioner your skills should be under the job where you performed them. If you are a new grad the skills employers are interested in hearing about are the skills you obtained in your clinical rotations. Highlight those rotations that provided you with the experience that fits the position you are seeking. And be specific. They get it that you "assessed and provided quality care." What they really want is for you to define and quantify your experiences. 
3. Cover letters. Recruiters tell me they get some great resumes from some great practitioners that may not be quite the right fit for the job they applied for BUT may be right for a different position - that is IF the candidate is interested in pursuing other opportunities. Employers have no way of knowing if you are open to different positions, other specialties, relocation or travel positions unless you tell them. Use your cover letter to share your aspirations and interests if you want to stay on the radar for other openings. 

The market is improving. I found a great deal of enthusiasm and interest in hiring both NPs and PAs. While the employers did express a desire to see some improvement in your resumes, they told me that you all still did a better job than the physicians when it comes to your resumes. They told me some tales of MDs submitting paper resumes that were outdated, and rather than creating a new resume, the doc would write in (by hand) their most recent information on their old resume!

You can download a resume template from my website www.nursepractitionerjobsearch.com

I was recently speaking with a group of students who will be graduating this year about their current clinical rotations and how things are going. Many of the students had been at at least one of their clinical sites since beginning their programs and were now feeling quite comfortable. Some students even stated that a nurse or two had asked if they would be staying after graduation. "So, would you like to work there?" I asked. "Oh yes, I love it there!" was the overwhelming response. Naturally, I asked if they had made any inquiries or taken any steps to pursue future employment at their clinical locations.

They looked at each other, looked at me and after a few seconds of silence they admitted to feeling uncomfortable broaching the subject of potential employment at their clinical sites. They shared that they felt some hesitation because they were worried that asking about future work might be viewed as overstepping boundaries or considered to be too "pushy" or "forward." 

Let's talk about that perception. 

Networking is still the number one way that NPs and PAs find jobs. I can't say or stress that often enough. This is especially true for the coveted family practice and primary care positions. It's as true for the new grad as it is for the seasoned clinician: Employers like to hire individuals that have some connection to their current employees. 

In this day and age when the scope of what a former employer or colleague is allowed to disclose when giving references is limited by law, many employers don't feel entirely comfortable depending primarily on "outside" recommendations.  In other words, a reference or referral from a trusted employee, who values the organization and with whom the employer knows well, is worth its weight in gold. I mean, would you stick your neck out to recommend someone to your boss if you weren't completely sure about the skills and character of that clinician? Not if you value your job!

What does this mean? It means that your clinical host would more than likely welcome your statement of interest in their clinic. It's not pushy to express interest or inquire about job opportunities. It's actually rather flattering if you think about it. Now, I am not saying you have to ask on a daily basis, but it's ok to state your interest and ask if you can submit your resume.