Pros and Cons of Working as a Psychiatrist at the VA (Veterans Affairs)?

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I have heard negative things about working at the VA (oddly enough, mostly from a psych attending who works at a state psychiatric hospital). But in my area, the VA has several openings, and are seeking people from my residency program, right after graduation.

Any feedback regarding the VA experience would be appreciated. Thanks in advance!

Careful with working for the VA. The nurses and ancillary staff often leave something to be desired. The pay isn't as good as other offers, but they try to make up for it in their benefits package, ie health care coverage and retirement plan after 20 years of service. Although the package is attractive, think long and hard about the staff with whom you'll work. Good staff is something you don't really appreciate until you've been exposed to bad staff. Good luck.

Originally Posted by PsychMD2100

Careful with working for the VA. The nurses and ancillary staff often leave something to be desired.

Thanks for your reply PsychMD. Any rough estimates as to what a typical starting salary would be for a VA psychiatrist, right out of residency? Do they at least make over 100k as a starting salary?

Originally Posted by PsychMD2100

The pay isn't as good as other offers, but they try to make up for it in their benefits package, ie health care coverage and retirement plan after 20 years of service.

Does the VA system have outpatient psychiatric clinics? Or do they employ psychiatrists strictly for inpatient positions?

Originally Posted by prominence

Thanks for your reply PsychMD. Any rough estimates as to what a typical starting salary would be for a VA psychiatrist, right out of residency? Do they at least make over 100k as a starting salary?

Does the VA system have outpatient psychiatric clinics? Or do they employ psychiatrists strictly for inpatient positions?

1-2 yrs ago, I thought I heard someone say she started at $133K. I think she said they also used to offer student loan repayment, but recently discontinued it. Yes, they do have outpt.

Originally Posted by Kluver Bucy

1-2 yrs ago, I thought I heard someone say she started at $133K. I think she said they also used to offer student loan repayment, but recently discontinued it. Yes, they do have outpt.

thank you for the post kluver bucy.

Having worked at several VA's in several different departments as a medical student and resident, it seems like the staff vary a lot and different wards have pretty set ideas about how things are supposed to be. I absolutely wouldn't have wanted to take a job with the staff from one rotation. However, I think it takes a special kind of nurse to choose inpatient psychiatry and the staff from my inpatient rotations were pretty good. I don't suppose you rotated through the VA where there are openings? The other thing about the VA is the bureacracy. As a research assistant, I worked at the VA but was a university employee. My co-worker was a VA employee and had had to go through a mind-numbing week long orientation. It would be nice to not ever have to deal with insurance companies but I am not sure that the pain of dealing with the government bureacracy would be a fair trade.

but they try to make up for it in their benefits package, ie health care coverage and retirement plan after 20 years of service.

Anyone know how the benefits package work on pension if you were to work for example 15 years? Do you just completely lose out on it or do you get something back? Can you opt out of such benefits? (I got a feeling no one will be able to answer because it really varies per hospital or state).

Reason why I ask is a buddy of mine worked in a state hospital only for 1 year and he told me they took a huge amount of his salary out to go into this pension that he wasn't going to use anyways.

Haven't worked in a VA but the one attending that I know who has told me he hated it. He mentioned how it was all caught up in bureacracy and very few people gave a damn. There was some talk that things have gotten better at VA hospitals up until that Walter Reed hospital fiasco a few months back. Now it seems everyone's back to talking about how bad VA hospitals are again.

As bad as the stories you may hear, try to figure out what's going on in the specific hospital. There's plenty of VA hospitals and I'm sure some are better than others.

So far I have to agree that my personal experience with the VA has not been great. However, times being what they are, there is a TREMENDOUS need in this system, and I've just got to say "more power to ya" if you choose to take care of these guys (and gals).

One good thing I have found is that you are not "forced" by the attendings not to give certain diagnosis at VA hospitals, unlike the community hospitals where you are discouraged from using certain DSM diagnosis. Example being Substance induced Mood disorder because billing will be different.

A few other things I was curious about:

1. Do you need to become board-certified after accepting a position as a VA psychiatrist?

2. Also, do VA psychiatrists need malpractice insurance?

3. If one were to accept a position as a VA psychiatrist at a remote location for a hypotehtical starting salary of $135,000, and then later transfered to a VA in a more desirable location, would that psychiatrist's same salary (in this example, $135,000) necessarily transfer over?

If anyone can provide any insight, I would appreciate it.

Once again, thanks for all the helpful replies!

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Originally Posted by prominence

A few other things I was curious about:

1. Do you need to become board-certified after accepting a position as a VA psychiatrist?

2. Also, do VA psychiatrists need malpractice insurance?

3. If one were to accept a position as a VA psychiatrist at a remote location for a hypotehtical starting salary of $135,000, and then later transfered to a VA in a more desirable location, would that psychiatrist's same salary (in this example, $135,000) necessarily transfer over?

If anyone can provide any insight, I would appreciate it.

Once again, thanks for all the helpful replies!

I do believe that the VA covers you as far as the malpractice goes.

Prom--you know, if you're far enough along in residency to be thinking about job openings, it really would behoove you to start asking questions of prospective employers directly. Call 'em up, drop your CV in the mail, schedule an informational interview. You'll get far better, more authoritative answers this way, as well as starting to make meaningful contacts toward planning your future career. It will never hurt you to show interest in a potential job.

Unless you enjoy bureaucratic infighting, long discussions on processes and don't really care about your patients, I say stay away from the VA.

Originally Posted by TheWowEffect

One good thing I have found is that you are not "forced" by the attendings not to give certain diagnosis at VA hospitals,

That has not been my experience.

Originally Posted by OldPsychDoc

Prom--you know, if you're far enough along in residency to be thinking about job openings, it really would behoove you to start asking questions of prospective employers directly. Call 'em up, drop your CV in the mail, schedule an informational interview. You'll get far better, more authoritative answers this way, as well as starting to make meaningful contacts toward planning your future career. It will never hurt you to show interest in a potential job.

thanks for the advice oldpsychdoc. i'm just started my 3rd year, and i plan on contacting some of the VA locations i'm interested in at the end of this year.

Originally Posted by whopper

Anyone know how the benefits package work on pension if you were to work for example 15 years? Do you just completely lose out on it or do you get something back? Can you opt out of such benefits? (I got a feeling no one will be able to answer because it really varies per hospital or state).

Reason why I ask is a buddy of mine worked in a state hospital only for 1 year and he told me they took a huge amount of his salary out to go into this pension that he wasn't going to use anyways.

I haven't worked at the VA, but I have worked for the federal government (at NIH). I only worked for 2 years, but did have a chunk of salary go into my pension account. However, when you terminate your position, you are given the option of keeping the money in the account, which will mature when you are 65 OR you have the option of withdrawing the money and having the government write you a check. I chose the latter, and I don't remember there being any penalty.

I dealt with all of this through the Office of Personnel Management (OPM), which oversees personnel issues for all branches and departments of the government. So I imagine the same would hold for the VA.

Originally Posted by prominence

If one were to accept a position as a VA psychiatrist at a remote location for a hypotehtical starting salary of $135,000, and then later transfered to a VA in a more desirable location, would that psychiatrist's same salary (in this example, $135,000) necessarily transfer over?

Again, I'm not 100% sure about this, but my understanding is that it should. Every government position has a grade (e.g., GS-13) and that grade carries with it a specific salary range. You qualify for a specific grade based upon your qualifications - so you can only go up a grade, not down (after all, once you have an MD with X number of years of experience, you can't undo that). So if you made a lateral move within the VA, it would be expected that you would have the same (or larger) salary. Also remember that the government also adds an automatic cost of living increase every year.

That's interesting...so as a psychiatrist out of residency, about what rank can you start out with if you work at the VA?

I've only just started my PGY II year, but my mind is already wondering about what kind of work environment I want to be in when I graduate.

VA isn't looking too bad!

Originally Posted by Solideliquid

That's interesting...so as a psychiatrist out of residency, about what rank can you start out with if you work at the VA?

I've only just started my PGY II year, but my mind is already wondering about what kind of work environment I want to be in when I graduate.

VA isn't looking too bad!

You can do a search at:

http://www.usajobs.opm.gov

Type in "psychiatrist," and a number of positions will come up. It looks like the VA uses a different grading system than the GS (seems to start with VM). Click on a few ads and see what the salary range is - note that the salary on the initial search page will be the low end of the range.

I did a quick search, and it looks like it ranges from about $90K - $175K.

A Veteran's View of the VA

the VA has a really great computerized system - and its nationwide, so you can access patients' records from any VA system they've ever been seen at. everything is on the computer - not just labs and orders, but progress notes too. and the copy/paste feature totally works. it seems trivial, but it makes a big difference in the day-to-day tasks that comprise the majority of your day.

Originally Posted by DrRazberrySwirl

and the copy/paste feature totally works.

Yes, it works! It works to really create a huge "comedy of errors" at times. Some people will copy/paste indiscriminately without realizing that it will be read by others. At times, the same A/P runs for many years in outpatients. The computerized system, overall, is great.

Are the employment benefits for VA psychiatrists similar to those psychiatrists who work at the state psychiatric hospital?

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It depends on the state. VA benefits are likely to be better and more uniform than state benefits. The challenge of working at the VA is the quality of the other physicians and ancillary services. There's a lot of variation and sometimes quality suffers.

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