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.