The Green and Red Flags of the NP/PA Job Hunt

Whether you are a new graduate or an experienced advanced practice clinician (APC) looking for a change, navigating the job market can be daunting. There’s much more to unpack than just the salary, and the most important details are never going to be found on the job posting.

To help you find the right fit the first time, let’s look at the green and red flags you should be looking for in physician assistant jobs and nurse practitioner roles.

Hiring you is a long-term investment, and it's risky

Hiring a new APC is a risk for any clinic or hospital, and when it doesn’t work out, there can be serious consequences for both parties. From the moment you accept a job offer, the long and arduous process of credentialing begins, which can take anywhere from 60 to 90 days. If you are a new grad (or new to the speciality), add on another 30-90 days of orientation.

This means it might take six months just to get hired, credentialled, and oriented. Add to that the several months it will take you to become efficient in your new role. This all translates to about a year of time spent getting you to where you need to be. If it doesn’t work out, that means it is back to square one for both you and the employer. For the company, this means significant losses in time, revenue, and productivity. It means worse access for patients. And for you, it means more time without a paycheck.

Orientation and professional development

An established and robust orientation program is a big green flag. There should be a clearly written orientation manual with goals, objectives, and timelines. Whether it is another APC or a physician, there should be a dedicated person who helps you navigate credentialing and orientation. This process should be laid out in an easy-to-understand method during the interview.

Since working as an APC involves a lifetime of learning, another green flag is an established professional development program. We all have to get continuing education to keep our license, so at the bare minimum, there should be funds available to go towards things like podcasts, bootcamps, and conferences.

Many organizations will also have institutional memberships to other resources, such as UpToDate. While continuing education funds should be the bare minimum, ideally, the clinic or organization you are interviewing with will also have some sort of dedicated continuing education program in the form of journal clubs, SIM training, and procedural labs, as well as designated time off for education.

Green flags:

• Robust continuing education funds

• Comprehensive onboarding and orientation program

• Dedicated preceptors

• Regular continuing education events and opportunities

Red flags:

• No continuing education reimbursement

• No emphasis on national/regional conference attendance

• No opportunities for professional development in the department/clinic

• Unclear or unorganized orientation process

Admin hours

This is one of the most important and often overlooked parts of any APC job, whether you are working in a hospital or clinic setting. Regardless of your role, you are going to have work that follows you home: catching up on charts at home after a long shift in the ED, responding to patient messages in a primary care clinic, or looking at patients' labs and scans on a Sunday evening to prepare for another week in an oncology clinic.

Whatever setting you work in, chances are you are going to be doing additional work “off the clock” — this is what administrative time is for. Admin time should not be considered a “perk”; it should be an assumed part of your schedule each week. A friend of mine recently started a job in a primary care clinic, where her schedule is 3 days in-person and 1 day doing telehealth from home. The 5th day, she sees patients in the morning clinic, then has the afternoon for “admin time” to catch up on charts and respond to patient messages. This is the sort of schedule that keeps clinicians around for the long haul.

This isn’t a fringe benefit; it should be a standard part of any APC job, just like insurance and a 401K. Regardless of your role, no APC should work 40 hours a week clinically, as the job requires much more than the time spent in direct patient care. At a minimum, there should be at least 4 hours carved out of your schedule for non-clinical administrative duties each week.

If this isn’t clearly laid out during the interview process, address it and make sure you get it in writing. This is such a standard part of APC jobs that it should raise a big red flag if the employer is pushing back on it.

Admin roles

In addition to standard admin hours, many facilities and clinics have opportunities for outstanding APCs to take on administrative roles in exchange for the coveted “shift buy-down.” These roles include team lead, unit educator, or preceptor. While very small private practices may not have these opportunities, many community and academic centers will have these roles in place.

The APC team lead will usually be involved in the hiring and onboarding process, handle schedules, attend meetings, and address any disciplinary issues that arise. These responsibilities usually come with some sort of pay stipend, but more importantly, a decrease in clinical shifts to account for the time needed to carry out these tasks.

Clinical educators serve as the primary preceptors for new graduates, as well as PA and NP students. The educator helps guide new hires through onboarding and orientation. They organize student rotations, feedback, and evaluations. This role is another great way to give an APC with a passion for education an opportunity to help foster growth in the department in exchange for a decrease in clinical shifts.

Green flags:

• Dedicated admin hours for charting and messaging

• Dedicated telehealth days (when applicable)

• Leadership and professional growth opportunities

Red flags:

• No protected admin hours for charting and messages

• Working more than 144 clinical hours in a month

• No leadership opportunities

A different kind of practice autonomy

Does the facility have a dedicated APC leadership team? Do you have a voice in decisions regarding your workflow?

These are all questions that you need to be thinking about. Whatever setting you are working in, you should have some sort of voice or vote when it comes to administrative matters. If you are working in a hospital system, there should be a dedicated APP administrator to advocate for you.

I knew an NP who was working in a busy cardiology practice. The nurse manager was, overall, a good administrator, but there was one major issue. When patients called for an appointment, the nurse manager would OK the double and triple booking of appointments for the APCs when physician schedules were full.

Her rationale was that these were “quick rechecks” that would be “in and out”. In reality, these were often patients with acute exacerbations of chronic conditions that ended up requiring a lot of time to sort out. The APCs would raise their concerns, but with no official APC administrator to advocate, it fell on deaf ears. Eventually, multiple APCs left the practice, and HR finally stepped in after hearing the same complaints during exit interviews, but by then, the damage had been done.

These are the sort of red flags that can be easy to miss if you don’t know the questions to ask. Make sure there is a clear leadership structure in place with clearly defined roles and responsibilities. Reach out to other APCs working in the practice, and ask them what the most challenging part of their role is.

One other specific scenario that I would advise extreme caution on: taking a job at a private practice that is either brand new or has never had an APP before. Navigating everything from the scope of practice to conflict resolution takes professional maturity and experience. For a new grad, this can be very challenging without a seasoned veteran to lean on. Learning the foundations of your new profession in a facility or clinic with a strong track record of success will help put you on the right path early on.

Green flags:

• A dedicated APP team lead or voice in administration

• Opportunities for leadership development or practice ownership

• Patient scheduling autonomy and flexibility

Red flags:

• No clear advanced practice leadership

• No administrative opportunities or options for practice ownership

• No say in patient scheduling

• Inflexible patient scheduling or staffing

• No history of previous APCs in the practice

Compensation

I’ll say it with all the audacity in the world: Pay should be a lower priority. I’ve seen too many clinicians lured into toxic jobs by a hefty salary.

When you are looking at your student loan payments or your empty savings account, that big number starts to look very enticing. People find themselves shackled to toxic jobs while trying to maintain an overextended lifestyle, instead of trimming their spending so they can afford to take a less stressful job with a lower salary.

There are more than a few jobs out there that try to sugarcoat major issues with massive paychecks. If you are looking at a job listing for neurosurgery promising an 8-4:30 work schedule with a salary $20-30k more than competing positions, that's about as realistic as the Mobile Leprechaun.

That being said, pay obviously matters. The compensation package, including all benefits, should be clearly outlined during the hiring process. It is also important to know how the clinic or institution handles raises, how often they look at market-based adjustments, and any incentive programs such as Relative Value Units (RVUs). Make sure to ask about overtime rates, and any special situations such as mandatory sick-call.

Green flags:

• Clear compensation package

• Performance-based bonuses

• Regular raises and market evaluations

• Generous overtime pay

Red flags:

• Pay well below or above the market standard

• No performance-based incentives

• No clear record of raises and market evaluations

• No incentives for overtime

Do your homework

After all the time spent in school and clinical rotations, there can be a strong temptation to just take the first job you are offered. Many new graduates find themselves in very competitive markets, and even getting an interview can be a challenge. But before you rush to say yes, take a few days and do some research. Reach out to someone with contacts in the hospital or practice for their input. Connect with other APCs on social media or through professional organizations to get input on how your offer stacks up against other clinics and institutions.

At the very least, reach out to one of your professors or preceptors for advice. They remember what it was like to be in your shoes and are a great resource.

And if all else fails, shoot me an email. I would be more than happy to look things over and give you my two cents: NP@hippoeducation.com.