About 10 years ago I was just starting my FNP program, when I was checking out a popular nursing website that featured a thread asking other NP’s, “what is the best NP job you have ever heard of”? One of the answers talked about an NP living in Manila, taking care of diplomats at the embassy, getting free housing, and making a solid NP wage in a place where your dollar can go far. This person was of course a Medical Provider (at the time I think they were called Medical Practitioner’s) working for the Foreign Service.

As soon as I read this, I took to the internet and researched as much as I could. It sounded too good to be true. Even as a nurse I had always entertained working abroad, but could never really justify it since most other places we can work like New Zealand or Australia cost a fortune to live in, and the wages are much lower. To my surprise however, the job did exist. The only problem was I was over a year away from graduating, and even once you become an FNP, they want you to have 5 years of post graduate experience. The job was put in my back pocket as a sort of “dream job”, to be considered at another time in the far off future. Over the years I would continue to get updates about job openings, try and learn as much as I could, and discuss it with my wife as a “what if” sort of fantasy job that wasn’t quite tangible.

Fast forward from that initial moment 8 years, it is the summer of 2020, and I am 6 years post FNP graduation and pretty deep into my advance practice career, near the top of my field in terms of wages and autonomy. My experience is a nice balance of primary care, mostly adult-gero, but some peds thrown in, as well as higher acuity hospital based care. I have noticed the frequency of Medical Provider job openings has taken an uptick over the last year, and I wake up one morning in July 2020 to see that once again, there is an opening.

At this point in time I was working as a hospitalist in an independent practice state, where I admit, treat, and discharge patients all on my own without any sort of physician oversite. The salary is over 200k a year and comes with robust benefits. My spouse is also a Nurse Practitioner, working for a nephrology service, and doing well for herself too. We live a very comfortable life in West Texas, have family and lots of friends nearby, and our daughter is starting to form meaningful friendships as well. Why give all this up and pursue a job in the Foreign Service if it means taking a heavy pay cut, leaving friends and family, my spouse not working for long stretches of time, and likely moving to countries that have a reputation that no one would want to visit?

Sometimes I think I am crazy for applying for the Foreign Service. My wife knew I had long dreamed about this job, and when I saw that opening in July 2020, it was the first time since I met the minimum requirements, that I considered applying. She and I spent days weighing the pros and cons of applying. Although the salary hit I will take is substantial, the differentials early on in hardship posts would bring it closer, the benefits are far superior with the healthcare plans costing a fraction of my companies plan, the retirement plan/pension being unheard of in the private sector, and the free housing amounts to tens of thousands of dollars a year in savings. To be honest, the bigger loss would be losing my spouse’s wages. Fortunately, we are in a place where our only debt is our mortgage, and living on the single wage would still give us a comfortable life. Hats off to my wife, she hasn’t been lukewarm or hesitant about this at all, being encouraging and almost as excited as me.

Another big factor in applying for the job for me is the professional growth. I love my current job as a hospitalist, but Nurse Practitioners don’t really climb the corporate ladder in the company I work for. My salary has also remained the same since I started 3 years ago, so although it is nice, I technically am making less money now than I was 3 years ago due to inflation and the roll back of some benefits like CME, plus increasing insurance premiums. In the State Department, promotions are much more commonplace, Medical Provider’s can be found in senior leadership positions, and even if you don’t get a grade or step promotion (sort of similar to military pay scales), congress usually passes cost of living wage increases each year. Throw in that your job, is actually a series of jobs over the years, in changing environments across the world representing your country, and you have something that is very appealing to me.

The last two major deciding factors were leaving our friends and family, and relocating our daughter (soon to be daughters) every few years. Ultimately, my wife and I figured it would be easier to apply for the job now, when they are younger and a bit more adaptable in making friends, versus a teenager with deeper social circles. My 6 year old has some great friendships, but her “best friend” is always changing. She can meet a kid at the pool, spend hours playing with them, become “best friends”, but then not remember their name the next day. I also really like the thought of my kids going to nice, private international schools for free, where they are with a variety of other children, often diplomatic children from around the world, picking up new languages, and learning how to adapt and cope with changing environments.

Regarding friends and family, this is honestly the tougher decision, more so for me. My wife has the majority of her family in the Philippines, so she is used to being away from them, but she does have some very close friends where we live. Both my parents live close by, and 3 out of my 4 grandparents are still alive in the area as well. Thankfully, my parents are still in their early 60’s and very capable of visiting us worldwide, but chances are my grandparents in their late 80’s and early 90’s won’t be with us a decade from now, and taking this job means seeing them much less so close to the end of their life. Ultimately though, all of our friendships are strong enough to endure being away from periods of time, and have done so in the past for college, relocations, etc. I believe many of them would visit us no matter where we end up in the world. I guess we might found out how true that is.

After lots of discussion, my spouse and I both agreed it was worth a shot. We both understood the process is very long, and it’s not like even if I get a final offer, I have to take it. In the end, it’s better to have the choice versus not trying and regretting it. The professional and personal growth, travel opportunities, and ability to represent our country abroad won over the cons, and I applied. It’s been nearly a year since then, and I am in the tail end of the process, waiting on security clearances before being added onto the register. Ideally, a year from now I will be in orientation, anxiously awaiting my first assignment location.

Thanks for reading,

–Nick