Finding Our Path

By Jenifer J. Ausiello, DNP, APRN, AGNP-C, ACHPN, CPC, CPMA

Several years ago, I was working as a Nurse Practitioner in a hospital setting for an amazing Infectious Disease practice. The doctor I worked with was known to be one of the best in the city. He was in high demand and therefore, I had to work hard to support him. My typical day consisted of working 16+ hours at the hospital rounding on patients and several hours of charting at home afterward most days. I was making ok money, but it was a fraction of what my boss was collecting for my services. I knew I was worth more than I was being paid, AND with the hours I was putting in, I had no time left for a personal life.


Luckily, I met my wife at the hospital. She was a nurse on the oncology floor working 12-hour days. We met and fell in love at the hospital and most of our time together was spent there, during our shifts. Had it just been the two of us, this may have an acceptable lifestyle for us. Something to note here is that we each brought 4 children into the relationship. Yes, you heard me correctly. We had a total of 8 children. My future wife and I quickly realized that spending more time together, and with our growing family was the most important thing to us both. We wanted more time together, outside the hospital.


Since my checks were dependent upon the money I brought into the practice each month, I knew I couldn’t decrease my work hours without taking a pay cut. I was struggling with how to spend more time at home and still support this new family. I was torn between supporting my boss / making the money we needed to pay the bills and spending more time at home / trying to figure out where the money would come from.


As contract re-negotiation approached at work, I started taking stock of my contribution to the company. I knew the care I provided to the patients was excellent and that my visits were uncaptured revenue for my boss. He was physically unable to see the number of patients we had each day. Without me there, he would be missing out on all that revenue. So, I went into the negotiation, planning to ask for a larger percentage of my collections, something we had already been talking about the year prior when the company structure had changed. Of course, the plans had gone by the wayside, as often happens in busy practices. But now was my time! I was ready to stand up for what I was worth. I presented them with what I felt was a fair value for my services. I listened to the counteroffer, and stood there, floored… They wanted me to take a pay cut! I wanted to quit right then and there. I could not believe it. I did not have a Plan B in place, so I stayed. But I spent weeks agonizing over how I could make and keep the money I worked for and spend more time with my family.


Not many people know this, and my wife will tell you all about it complete with reenactments and impersonations if given the chance, but I am compelled to do math when I am uncertain about financial matters. I love to figure out the numbers and make sense of choices in front of me. I knew the reimbursement rates for my hospital visits and decided to look up reimbursement rates for office visits and home visits. I figured out that if I was able to keep all the money collected for my own visits, I would be able to make the same money with less than half the number of visits I was currently doing in the hospital! My wife and I decided right then that we would open our own practice for the home-bound elderly and disabled population, and everything changed.


My wife was able to quit her job and work full time on starting our business and return to school. I was able to transition to a part time position elsewhere while we grew our practice. We still had to deal with the long hours of hard work, but we were in it together. In the end, we were starting on the journey that would land us here, helping others get and keep the money they deserve for their hard work.