How to Choose a Clinical Practice: NPs and PAs
By Author: Bethany Golden, MSN, RN, CNM
Editor: Elizabeth Moran, MSN, RN, CPNP-PC
Let’s start from the premise that you have been offered a clinical position. Your potential employer has decided your skills, talent and expertise are exactly what they are looking for. Alas —after weeks, or even months, of uncertainty throughout the interview process, you finally find yourself in the driver’s seat! Before even beginning to negotiate though, it is important to decide if this position is the right fit for you. There are a number of elements to be considered about a new NP or PA role, even above and beyond an enticing salary and compensation package, and this decision requires having an honest conversation with yourself about what job satisfaction looks like to you.
Choosing the right clinical practice is a similar process to other aspects of life where we seek out a compatible match. For example, when choosing a partner or friends, you look for shared values while appreciating each other’s differences — a delicate balancing act creates for the perfect complement. While discovering each other’s unique characteristics can often present new challenges, it also promotes great learning and growth.
Most importantly, the relationship clicks because you enjoy spending time together. Ideally, we all seek out healthy, mutually beneficial and reciprocal relationships. By having this same expectation for your clinical practice, you can ensure you find your right workplace match.
To determine whether a job opportunity is right for you, start by asking yourself the following 5 questions:
#1 Does this position meet both my work-life balance desires and financial needs?
You will need to be your own detective and discover if this job is a great, good, fair or poor match for your needs and desires. First, ask yourself how the details of this position will impact your work-life balance. How many days a week will be required of me to work and will this include nights or weekends? How many hours will I work each day or shift? Is the best or most efficient method to commute by walking, public transport, or car? How will the length and method of my commute impact my loved ones? Are there expectations to take the call or work overtime? How many patients will I be expected to see per clinic session versus how much time do I feel necessary to provide quality patient care? How will my patients be scheduled and what are my thoughts on no-shows or being double-booked? What proportion of my time would I like to devote to direct patient care vs. administrative duties? Will I frequently be charting from home because my days in clinic are too busy?
Next, consider the financial logistics of accepting this position. What is the salary being offered and is it both in line with the typical market for clinicians in this state, as well as adequate to meet my personal and financial needs? What is my benefit package and does it include health, dental, and vision insurance, PTO, 401k match, reimbursement for state and federal licensure, etc.? What is the malpractice coverage and is there a tail? Keep in mind that some workplaces have rigid salary structures based on experience level, but benefits may be somewhere they can be more flexible, In fact, benefits can even add an additional 25-33% of your compensation package!
#2 Is this the best setting and work culture for me?
Next, you need to evaluate the setting and work culture, keeping in mind again that the question is: is this a good match for me? More than ever, healthcare delivery is happening in a wide variety of settings: hospitals, clinics, mobile vans, free standing surgical centers, pharmacies, workplaces, schools, home-care, and even telehealth remote from home. What type of setting is best for me in order to thrive? Where do I want to spend my days? Is a small practice or large practice more my preference and why? Do I value a team approach or working as a solo practitioner? What qualities do I seek in my ideal co-workers be? What will my relationship with my supervisor be like? Would I rather work in a hospital or clinic? Community health center or a private practice? Public health not-for-profit or a more corporate setting? Do I chase the adrenaline of a fast pace setting or prefer a slower paced workstyle where I have more time to think through my clinical decisions? Will I ever be the only clinician at this site and how ready do I feel for that level of responsibility?
A good work culture is one that supports clinicians on a daily basis, by creating an environment of safety, inclusion, and positivity. Hopefully during your interview process you were able to get a sense, either from other employees or a shadowing experience, of how gratitude is demonstrated at your potential workplace. Did it seem like all staff are treated fairly and as equals, or is there a strict hierarchy? How is collaboration fostered? Can you give feedback and how is it received? How does the other staff prefer to communicate with each other? Does the staff feel respected and heard? Does the staff encourage use of all PTO, or is the work culture here not to take the maximum vacation allowance? Is it an expectation that you will be doing unpaid work from home? What is the turn-over rate and how does the organization do with retaining its staff?
#3 Does this opportunity further my goals as a professional?
For new graduates versus senior clinicians, different questions may arise while determining if this job is right. However, one question is very relevant to both: how will I spend my days and how will that impact my future?
New grads are often looking for more exposure to gain a variety of experience, therefore answering the following questions will be most helpful: What area of interest will I gain by working here? What areas will I miss out on? What will I be exposed to in terms of health conditions, procedures, types of patients, and wellness models? Who will be my mentor, preceptor, and are there others who will be willing to answer my clinical questions too? What types of support will I have as I get acclimated to my new career in this new setting? Will I have a ramp up schedule and what will that look like, or will I be expected to start at my full patient load? (If you are a new grad, please see these guidelines for identifying an effective orientation!) What new skills will I acquire at this location? Will this setting foster continuing my education by financing or pre-allocating funds for CMEs and providing paid time off for conferences? Will I be eligible for any loan repayment plans?
More senior clinicians will want to ask themselves: What skills have I honed already and prefer to use in my practice, and can I do that here? Will this setting bring me new, positive challenges which lend to continued growth — how so? Does the organization encourage and pay for professional development even for seasoned clinicians, including CMEs, journal clubs, and conference attendance? Can I precept and teach? Is it my choice or required? Are there avenues to have even greater impact in the field beyond this setting, i.e. on boards or committees, through public speaking opportunities, or in leadership roles? Is it common for clinicians to do research in this setting and if not, would it be welcomed?
#4 What are the institution’s values?
What is the stated mission of this institution? Are the actions of the leadership in sync with this? How do my own values compare? Do they advertise to all, but refuse Medicaid? How would you feel if the organization’s mission and beliefs limited your practice? For instance, if you are in the field of reproductive health and are hired by a Catholic owned hospital system, can you still offer the full spectrum of contraceptive and comprehensive women’s health services that you would like?
#5 Is the timing right for this position?
It is important to also evaluate what other goals you may have for yourself and/or your family. For instance, is there anyone ill who needs special insurance coverage? Are you planning on expanding your family and thus, will you need paid maternity or paternity leave? Do you have any upcoming plans to relocate? Are you planning your retirement and does this organization offer an impressive match or other incentives, such as a pension plan?
Good luck with this exciting next step of your career journey!
No job is perfect, but if you consider these 5 overarching questions you are sure to make an informed decision regarding this important next step in your career. Good luck, and to the new grads for more resources sign up for our student EBook – welcome to this wonderful profession! To find your dream job, Search Melnic Jobs! If you would like to discuss what clinical practice is right for you, please start your journey with Melnic!
Bethany Golden is a nurse-midwife and healthcare strategist. As a member of reproductive health clinical and research teams in New York City, Bay Area, Chicago, Fiji, and Nicaragua, she has cared for underserved families in a variety of settings: community health clinics, hospitals, private practice, Planned Parenthood, and rural villages. She consults for reproductive healthcare not for profits and tech companies on healthcare operations, strategy and partnership formation identifying key stakeholders. In 2002, she co-founded and continues to operate ICAS/Juntos Adelante, a not-for-profit that focuses on health and human rights in Nicaragua that partner from local leaders who identify community-initiated/grassroots projects that strengthen the health infrastructure. She earned her BA in History from Brown University in 1995 and her MSN and Certificate in Nurse-Midwifery from Yale University in 2003.