NP Jobs Red Flags

July 7, 2023 Briana Juskowiak

There are a number of reasons that the nurse practitioner job you are looking at could raise concerns. Could be just a vague sense of something being off or it could be massive but you’re willing to risk it because beggars can’t be choosers and you just need to get that year’s worth of experience. Either way, those weird vibes are there for a reason. In this post I will talk about the most common red flags, which ones are minor and which are major, and how to drill down to the root of whether or not that flag is a game changer. This will include the three most concerning interview red flags and the top three questions I believe you should ask to tease out the nature of the red flags. I know the market is tough out there, but if you have the ability to more closely match a good fit for you, especially if it is your first job as an NP, you should. You are a catch, and you shouldn’t be the only one bending over backwards to prove your value. NPs who start their career with a more healthy job end up happier, more fulfilled, and supported in ways that promote longevity in this field.

There are five main components of the job acquisition process in which concerning words, actions, or implications can arise. Money, the job itself, the people, the contract, and interview. In each section the number of correlating red flags indicates how much of a concern I feel it represents.

Money

Income is a huge factor, and for many people the number one factor when choosing their next job. But as we all know, money is not everything, and sometimes pay is above standard to compensate for other factors that make a job miserable. So an above average offer in and of itself is cause for questions.

🚩 As far as a specific number, that is an impossible feat to generalize. Pay varies greatly based on your region, specialty, and time commitment. I suggest searching your area to find out the going rate for your specific field. If the offer you are given is > 20% above or below the standard I would want to do some investigating.

🚩 If there are no or poor benefits offered (PTO, overtime, etc). Included in this are the incidentals for which most employers foot the bill.

Malpractice. Guys, this is a large amount of money paid per year. Think 3K or more. If you are 1099 they may make you pay this, but if you are W2 there is ZERO reason you should have to pay it.
DEA. At the time of this authoring, this will set you back around $900. Now, for specialties in which a DEA will be rarely or never needed, it makes sense that it would not be paid by the employer. For example, in critical care this is not covered. For good reason, it is incredibly rare that I need to write a prescription, much less for a controlled substance. However, for any outpatient or disposition heavy team I would expect this to be a provided term.
In general, if it is a regulatory fee required to perform your job, the employer should pay for it. Period.

🚩 🚩 🚩Large sign on bonus. What this tells me is they are in need of someone fast. Indicates desperation. It also tells me they value acquisition over retention. If you value getting the best quality; quickly you will offer a higher salary. This is money that returns year after year as opposed to a one time get you in the door shiny object.

The Job Itself

Things that make the job miserable, perhaps despite a robust income. This is probably the biggest component to job satisfaction so pay close attention here.

Work-life balance.

🚩 Compare the workload, job difficulty, and time spent (on the job or after-hours) to how much money you earn.
- Look up the average census for your specialty. Are they expecting more than average?
- Do they include admin time? This is paid time spent in non face to face work. All the “extra” stuff you do involved in pt care: note writing, responding to pt requests/calls, following up on labs, billing. Now, I hear that many outpt places do not include this, but if they do this is a HUGE factor guys. The higher this number the less time you will spend doing work at home. Average seems to be around 4h. I would ask for 8 and se what they say.
- Can you set your own hours? Can you leave when your workload is completed?
- How much support staff is available to you? If inpt are there folks who do all the executive type work (schedule, CME reimbursement, registration requirements, etc). If outpt are the medical assistants, nurses, front office staff? I have heard horror stories of NPs whose workday is significantly harder and longer bc their job duties include checking patients in, obtaining vitals, accepting payment, etc.

Reward.

🚩 🚩 Low or even no autonomy. Listen, I know if you are a new grad this doesn’t sound like the end of the world. Right now you are scared to death and a lot of hand holding sounds supportive actually. But trust me when I say there will come a time when this will make you feel trapped, de-valued, and can be truly de-moralizing. You went to school for a long time. The ability to practice to your scope is huge when it comes to job satisfaction.
- Ask them questions like “Tell me about your work distribution with NPs?” or “How do you define collaboration with NPs?”

Support.

🚩 Training. Do they value you as a provider and desire to bring you up to your highest performing level?
- Is the orientation time frame appropriate for your setting and role? For a broad service like hospitalist, intensivist, primary care, internal medicine you want way longer.
- If clinic or high census team is there a ramp up time period? An example might be in outpt starting week 2 with 5 pts/day and progressing to full panel within a month or two. For primary care I hear around 20 is the higher end. For urgent care it would be upwards of 30-40 (that sounds like too much to me but this isn’t my specialty). You will need to do a fair amount of research to discover what the norm is for your specialty.
- What access do you have to continuing medical education? A robust reimbursement fund? Access to a university system that offers tons of free lectures/trainings/sim labs.
🚩 🚩 How much support staff is available to you? If inpt are there folks who do all the executive type work (schedule, CME reimbursement, registration requirements, etc). If outpt are the medical assistants, nurses, front office staff? I have heard horror stories of NPs whose workday is significantly harder and longer bc their job duties include checking patients in, obtaining vitals, accepting payment, etc.

People

Anyone involved in hiring, future team members, director, administrators, possibly the recruiting staff.

🚩 They give you vague answers, don’t respond to request, take a long time to reply. If you feel like you have to pester them, this type of involvement isn’t likely to be different once you are an employee.
🚩 🚩 They pressure you to make a decision quickly without adequate time to contemplate.
🚩 🚩🚩 🚩 They decline a request for a shadow day. Why? There is zero reason I can deduce that a team would not want you shadowing except that they have something to hide.
🚩 They talk bad about other people.
🚩 They rescind an offer immediately after you counter. You dodged a bullet friend.
🚩 This last one is very debatable and feels super discriminatory. But, I have heard it enough on forums that I feel obliged to state it. If the practice owner’s (non medical) spouse is heavily involved in the hiring/managing of employees. When a non medical person is dictating your practice life can be difficult.

Contract

Read with extreme caution. Sometimes a one-off sentence buried at the bottom induces a hard-stop red flag. Know what you are committing yourself to; some NPs hire lawyers and that is fine. Try to find a NP specific contract lawyer. There are several FB groups dedicated specifically to contract negotiation, search those for legal support in your area.

🚩 🚩🚩 🚩 Any factor that makes it hard for you to leave or renegotiate.
- Long contract term. Think 3 yrs or greater. That is 3 years you are stuck with those terms. Lot’s of personal and social changes occur in 3 years. Inflation, family dynamics, different income needs, work dynamics, there are so many factors that you can’t predict which can occur. You will not be able to renegotiate that pay for a long time. Or, you get into the job and find all that on call time equates to a huge workload and you decide you aren’t being paid enough for the hassle. You stuck friend.
- Longer than normal notice is required. Industry standard is 3 months. Anything over that - may not be a big game changer for you but should raise the question “Why are they so worried I will leave?”
- Big geographic or long time frame for a non compete clause. This states you will not perform a similar service within a certain radius for a certain length of time. Again - why do they want to keep you from leaving. A good team is able to retain staff and do not need to impose such strict regulations. This makes me think they have had turnover issues.
- Require a long term of service or else you will have to repay a sign on bonus or loan repayment. I would think in excess of five years is high.

Major Interview 🚩

🚩 🚩No medical people are in your interview. Are they just too busy? Do they feel you can be delegated to others? The big problem here aside from the aforementioned is that you won’t have the opportunity to ask medical/practice related questions like collaboration, etc.
🚩 🚩 Constant interruptions. Excessively. Or looking at their phone regularly.
🚩 🚩 Asking illegal questions. Some examples include are you married, do you have plans to become pregnant, what duties do you have outside of work, what is your religion/ethnicity.

Bree Juskowiak