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Managing finances as a first year healthcare worker


Your first year as a healthcare worker can be a bit overwhelming. On top of navigating a new career filled with new people and new challenges, you’re trying to balance your personal budget between making student loan payments and having a life.

Lucky for you, you’re not alone. Plenty of people have been in your shoes. With several years of experience under their belts, Dr. T.J. Tipton, a urologist at Roper St. Francis Healthcare in Charleston, South Carolina; Erin Martin, a registered nurse at Community Hospital of Texas in Fort Worth; and David Erpenbach, a physician’s assistant at University Orthopedic Surgeons in Knoxville, Tennessee have all been there and lived to tell the tale.

Expectation versus reality 

Both Martin and Erpenbach expected their careers as healthcare workers to be stable and well-compensated, yet they both found their first years to be financially difficult. All three say pay varies widely based on geography.

“Depending on the specialty in which you are willing and able to specialize, and geographically where you are willing to practice, the gap between the potential floor and ceiling is enormous,” Tipton says.

Erpenbach noted a financial divide between urban and rural institutions. He says jobs in rural areas and areas of higher need are harder to fill, and thus command higher pay. However, he chose to work close to home in the city in which he lives.

Beyond this divide, Martin says that pay and working conditions will also vary from state to state based on local laws. She went to nursing school in Texas before moving to Tennessee and noticed a large gap in between the two states.

“Texas is consistently one of the top ten best states to be a nurse in, as far as pay and legal protections go,” she says. “After graduation, we ended up moving back to Tennessee, which is generally often in something like the bottom ten states to be a nurse in.”

In her first nursing job in Tennessee, she made $18 an hour, over a third less than she would have made in Texas.


It’s hard to negotiate for yourself when you’re still a new healthcare worker, but advocating for yourself is the best way to get what you need.

Finding opportunity

For Martin starting as an RN, this was a reality check that required her to adjust her expectations and find ways to succeed despite the difficulties. She found a new position which required her to work weekend nights. This qualified her for a program that gave her a salary bump. Eventually, she and her husband returned to Texas.

Faced with a similar problem, Erpenbach simply stuck to the same frugality as an early-career PA that got him through graduate school.

“It is easy when you start making steady, good money to go and start spending above your means,” he says, “but I tried to not change much and as a result was able to pay off my student loans in a few years despite the lower than expected pay starting out.”

While Tipton says, for a urologist, the pay between residency and practice are “night and day,” he follows a similar track as Erpenbach: no lifestyle changes until the student debt gets paid off. “I plan on driving my 2007 Honda Accord until the wheels fall off, at which point I will replace them and continue driving it!” he says.

Be your own best advocate

It’s hard to negotiate for yourself when you’re still a new healthcare worker, but advocating for yourself is the best way to get what you need, whether that’s better pay or other support around safety or staffing issues.

After four years and several job changes, Erpenbach’s pay finally lined up with his expectations. He blames much of this on his own lack of negotiating experience, but with practice he learned a few tricks. He recommends keeping a good, unbiased salary report on hand while negotiating, even for your first job. In particular, he suggests using the report put out by the American Academy of PAs.

Martin’s confidence as her own advocate grew after negotiating with her manager to get into the program that gave her that early salary boost. With nursing units commonly running as lean as possible, Martin says you should feel empowered to ask to be compensated for the long hours and extra work you’re putting in to cover for the short staff.

However, Tipton says it’s perfectly normal to feel a bit nervous or out-of-your-depth when advocating for yourself. Just don’t let that stop you.

“It is a bit intimidating negotiating numbers with a CEO or CFO of a multimillion-dollar facility with an incredible history and reputation in the area” the urologist says. “I would guess that most physicians, particularly early on in a career, are much like myself in that we don’t have the time or interest to be particularly savvy with such negotiations.”

“Hang in there”

As a newly minted healthcare worker, it may take a while to find your place in this new world.

If you’re struggling in your first nursing job, Martin says you may want to change specialties after a few years to find one you’re more comfortable and happy doing. She says she knows plenty of nurses who chose to do this after years of being unhappy in their jobs and realized they were simply in the wrong field of nursing.

“I worked in ICU for the better part of four years before I finally switched to a career in inpatient hospice and I will never go back. I absolutely love my job and feel so much more fulfilled now than I ever did in critical care, even though in so many ways I loved that job too.”

A lot of it comes down to experience, she says. The more knowledgeable and experienced you are as a healthcare worker, the more comfortable and confident and less anxiety-ridden you will be in your work. If you stick it out and find the right place for you things will get better, financially and otherwise.

“Hang in there and find your niche,” Martin says. “A lot of nurses get overwhelmed in the first year or even first few years, thinking they made a mistake becoming a nurse”

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