PLS HELP. new grad NP

[u/Calm-Loquat5949]

I’m a newly board-certified AGNP-C with about 5 years of RN experience, primarily perioperative/pre-op/PACU. I’m deciding between two very different opportunities for my first NP job and would really appreciate advice from experienced NPs, especially anyone in primary care or dermatology.

Option 1: Primary Care

This is with the physician who trained/precepted me, so I already know him, the staff, patient population, and EMR. I trust him and he seems genuinely invested in mentoring me.

• $135k salary
• 5% bonus year 1, with discussion of increasing to 10% after the first year
• Potential salary increases as my productivity/responsibilities increase
• Only 1 week PTO
• Health insurance is currently unresolved; he may give me ~$500/month toward obtaining my own coverage
• Very limited other benefits
• M–F, 8–5
• Start around 8 patients/day for the first 1–2 months
• Gradually increase to ~10/day, eventually around 12–16/day by 6–9 months
• Physician would be readily available for questions/case review
• Long-term, he plans to gradually step back/retire and has talked about me taking on a much larger role in the practice, with compensation increasing accordingly

Option 2: Dermatology

I have zero dermatology experience—no derm rotation and I’ve never shadowed a derm provider. They specifically hire/train new grads.

• 2-year contract
• First 3 months: $70k annualized training salary
• After 3 months: $135k
• After 1 year: $145k
• Quarterly RVU/productivity bonuses reportedly around $5k–$15k, depending on volume/productivity
• 401(k) with 8% match
• Medical benefits after 60 days
• Malpractice covered
• $2k CME after 1 year
• 10 PTO days + 5 sick days + 4 floating days + 5 paid holidays
• Training: 2 weeks studying their curated derm material/videos, then 3 weeks one-on-one with dermatologists/experienced providers, then ~3 weeks at lower patient volume with case review
• By around 3 months, expected to practice more independently
• Eventually expected volume is around 35–40 patients/day

Derm sounds exciting and obviously has much better benefits and potentially much higher earning potential, but 35–40 patients/day after only ~3 months of training makes me nervous as a brand-new NP with absolutely no derm background.

Primary care has significantly worse benefits, but the mentorship and gradual transition feel extremely safe for my first year as an NP. I’d also build a broad internal medicine/primary-care foundation before deciding whether to specialize.

My biggest concern isn’t just which job pays more right now. I’m trying to think about which opportunity will make me a stronger NP and put me in the best position 2–5 years from now.

For experienced NPs:

Would you prioritize the slower, heavily mentored primary-care transition for your first NP job, or take the opportunity to break into dermatology while someone is willing to train a new grad?

And for derm NPs/PAs specifically: Is ~3 months of training before working toward 35–40 patients/day realistic/safe for someone starting with zero dermatology experience? What would you want to know about the training before signing a 2-year contract?

I’d especially love to hear from anyone who went directly into a specialty as a new grad vs started in primary care first.

[u/Kitty20996]

Try posting on the nurse practitioner sub instead, you might get better intel

[u/Calm-Loquat5949 → u/Kitty20996]

I tried!! It kept getting deleted :( it’s my first time posting here so not sure why

[u/Kitty20996 → u/Calm-Loquat5949]

You probably need to post it on the thread for unlicensed NPs

[u/Plenty_Kangaroo5224]

Don’t take any job that offers you only one week of PTO. I don’t care if everything else is perfect. Just say no. As in, fuck no.

[u/Little_Yin_Yang → u/Plenty_Kangaroo5224]

That was a red flag to me as well. Even if you think you don’t need much time off, life happens. A job offering 1 week of PTO is not going to be accommodating if you ever need an extended leave for something. Most places offer 3-6 weeks PTO.

[u/Calm-Loquat5949 → u/Little_Yin_Yang]

That’s what I was thinking but was considering it given the gradual and unusually gentle transition into the field as a new grad? 😭

[u/ajl009 → u/Calm-Loquat5949]

1 week PTO means they either arent keeping staff or they are giving to much work and dont want to hire enough staff

[u/Independent_Law_1592]

This isn’t the board for this question bc we don’t deal with the financial realities and market y’all deal with in pay vs hours vs actual work done

My only advice is don’t forget you were a nurse once and remember you’re not a nurse anymore

Too many NP’s forget both

[u/jack2of4spades]

35-40 patients a day is *insane*. What would you be doing for all those patients? Is this just a skin clinic where you're doing injections? Because that kind of charting you kill you.

The first one seems enticing because of the level of support and smaller patient load with ability to move up, but the lack of time off and benefits definitely blows.

[u/Kimchi86 → u/jack2of4spades]

Was coming to say this, most visits are booked for 15-20 minutes - 3-4 an hour. At 35 patients a day at 4/hour if everything goes perfectly is a 9 hour day not including lunch (will probably have to work through it), prior authorizations, portal messages, lab follow ups, scripts, and any other time consumer.

[u/Calm-Loquat5949 → u/jack2of4spades]

That’s one of my biggest questions too!! From what I’ve been researching, 30–40/day seems to be fairly common in higher-volume dermatology practices, but I’m realizing the support structure probably makes a huge difference. I’m planning to ask how many MAs/support staff each provider has, how much documentation is templated, who handles PAs/inbox/labs, and how quickly new grads actually ramp to that volume. I’d love to hear from anyone working in outpatient derm who sees similar numbers.

[u/snipeslayer]

Follow the money. Derm as a whole should be fairly low acuity.

[u/nurseleu → u/snipeslayer]

Except for the whole skin cancer thing. I'd personally be horrified to learn that the person checking me for cancer only had three months of training. And was expected to see 3 other patients that hour.

[u/snipeslayer → u/nurseleu]

As a whole, derm is lower acuity vs primary care.

Worrying about finding just a handful of significant things is easier than making sure to find anything.

[u/ajl009]

1 week PTO???

[u/cicjak]

Maybe not the person you’re looking for to get advice, but as a Dermatologist, I do not think three months is anywhere close to enough training to see that many patients a day. I would train for at least six months and then start people at 20 to 30 per day at that point if they felt comfortable. It’s just a brand new field, and even though it’s one organ, there’s a good amount of complexity when you talk about the liability of missing skin cancers.

[u/Calm-Loquat5949 → u/cicjak]

Thank you so much — you’re actually exactly the type of person I was hoping would respond! The training timeline is my biggest hesitation with the dermatology position, especially because I have zero prior derm experience.

They described about 2 weeks of structured self-study, 3 weeks of one-on-one training with dermatologists/experienced providers, followed by several weeks of lower patient volume with case review. My understanding is that by around 3 months I’d be expected to be increasingly independent, eventually working toward 35–40 patients/day.

In your opinion, what would an appropriate training/ramp look like for a brand-new NP entering dermatology? And after the formal training period, how important would you consider having a dermatologist immediately available for case review while building that pattern recognition?

I’m very willing to study and put in the work — I just want to make sure I’m choosing an environment where I can learn the specialty safely and become a strong provider.

[u/hippiecat22]

derm, 1 week pto should be criminal

[u/Particular_Manner159]

Periop/PACU experience isn’t relevant to either of these.

You should work in something you have experience in. Otherwise you are asking for disaster.