How many patients per day do VA doctors see?

[Socrates25]

There have been several feelgood articles published by mainstream media about how salaried doctors at the VA are supposedly "happier" because they get paid on a flat salary and therefore they dont have to schedule 35 patients a day in order to run a profit. However, none of those articles ever interview or cite an actual doctor who really works at a VA clinic.

So, whats the deal here?

Whats a typical number of patients per day that a VA doc would see? If they really do see only a limited panel of say, 15 patients per day, then I would be impressed.

---

Members don't see this ad.

 

[orbitsurgMD]

A lot of specialty VA clinics are run by residents with the attending seeing relatively few patients of his own.

 

[rahul0774]

My father works in a VA Clinic located in a midsized city, and I can tell you for a fact that he sees no more than 10 patients on a bad day. Now, this may not be the norm for all VA doctors i.e. he is a chief of a particular speciality, but I can tell you that he has loved the lifestyle. No call, enough said.

 

[notdeadyet]

It's going to be hard to get an answer to this. It's going to depend on the specialty. It's also going to depend on if its a medical center or CBOC. And where.

The VAs all use the same EMR, but the acuity, volume, and culture differ radically between them.

 

[jabreal00]

My wife moonlighted at the VA in Baltimore during the weekends while she was in fellowship. It was extremely quiet on the weekends often times with nothing at all to do. I am sure it's busier during the week but nothing compared to civilian or even active duty. I am a subspecialist, and when not in procedures I see clinic. I see 15 patients a day in clinic which isn't bad and is a good steady pace (30 mins for new and 15 mins for established). I think the VA is less than that.

 

[sonofva]

the va docs where i currently live are slammed all the time. but i live in an area that is mainly retirees, and a high preponderance of vets...my dad worked at the va elsewhere after he retired from the army, and he probably saw 15 patients a day.

most of the people that i know at the va aren't frustrated because of the patient numbers, they are frustrated because of the bureaucracy. noone i know really seems to think its a good job anymore because of the red tape/admin nonsense to deal with all the time.

 

[VHADOC]

Insofar as the VA is huge with many different locations and specialties, there is great differences in # patients per day.

-Primary care or specialist?
-Working with residents or without?
-Geographic location with disproportionately more/less vets with acute needs?
-Policy of local VA to be #1 in the nation on every metric vs accepting average?
-Chronically below staffing (T.O.) levels requiring 5 physicians to see 7 panels?
-Chronically below staffing such that many patients have many deferred problems that need to be addressed? [one of the biggest problems in my book]

When I started in primary care the number was 25-30/day. When changing to the medical home model the face-to-face number decreased to less than half this but this didn't mean I went home earlier.

Going out on a politically incorrect limb here: the VA has a reputation for physicians being out the door one minute before closing time. I would generalize that this is true primarily in the larger medical centers that are disproportionately staffed by foreign-born physicians just putting in their time until they can get better visas or otherwise get out of the VA. In contrast, VA physicians who choose to work at the VA for sense of duty et al will routinely work an extra hour + per day (not including routinely through lunch). This paragraph is a generalization and applies to my primary care experience working in VA medical centers in two large cities.

In the last few years primary care providers have been required to assist with the medical disability processes presumably for lack of disability assessment providers. If you aren't keen on giving a 26yo obese vet disability for OSA, low back pain, knee pain, headaches, and the ever present tinnitus, this can suck.

For anyone even remotely considering joining the VA, I would offer this idea: go to the usajobs website every month or so and see which VA locations are hiring. There are some locations that are always hiring which generally equals high turnover. Think twice about working in such an area.

Otherwise the VA has a locums program that allows you to work as a locums throughout the VA system which would provide the seriously interested with a means to take a dip before taking a plunge.

 

[d2305]

Aren't most of the VA disability physicals done by contract providers? They tried to get me to do them, but I declined. I think it was LHI.

 

[VHADOC]

There is a significant backlog of disability claims and different VA centers are doing different things to cut down this wait time, to include using PCPs. Consider googling the recent opinion piece by LtCol Gade in the WSJ for a snapshot of the current situation. He quotes the average vet is currently applying for 8 different disabling conditions (I thought it was over 9). Also consider reading the postings at hadit dot com where claims applicants share advice on their claim fishing expeditions.

 

[notdeadyet]

Going out on a politically incorrect limb here: the VA has a reputation for physicians being out the door one minute before closing time. I would generalize that this is true primarily in the larger medical centers that are disproportionately staffed by foreign-born physicians just putting in their time until they can get better visas or otherwise get out of the VA.

I would put a caveat that I would exclude many of the large medical center VAs that are tightly affiliated with academic institution. Many of those VAs are research heavy and have academia-calliber attendings.

 

[VHA doc too]

VHA DOC correct and well spoken. All VA's different. Our facility is hospital based with many outreach or satellite clinics. Politics & administrative pressures started to increase in 2006. Our site had a history of great stability in all aspects. This drastically changed. We have lost 70 providers since 06. Physicians seeing 16 to 18
patients with additional 2 overbooks from ED. Seletal
crew with Docs doing work of 2.5 providers and NP seeing 6 pt's. While this does not seem daunting, it does not reflect the work. Our site has not
replaced 5 Docs that have left and whose pts have not had any continuity with some not being seen in 18 months.
They present with significant comorbidities when they do. This throws off your schedule
and increases provider risk. It was common to have up to 7 of these a day (pt's were syllable being carried under
providers name who might have left 2 years ago). This
brings to question where are your pt's that you saw a year ago that day. Only other doctor did not have them on their schedule and was
experiencing same. All this means that your panel was not constant. Panel size markedly changing month to month. Sometimes by as much as 300 plus and sometimes minus.
Certainly that many pt's did not die or transfer to another VA.
PCP panels were still being
kept but the remaining 2 Docs had to perform all the missing Docs work (med refills both in the system and private sources, handwriting narcotic slips, disability renewal or review forms on pt's never
seen, fighting off hovercraft requests, functional capacity forms, aide forms and the like. Not to mention the new addition of the virtual pt aka My healthy vet which had to be answered in 48 hours or the
additional communication engine which had to be done w/I 12 hours. All of this as well as 300 + alerts that had to be done daily. And oh yes, screening pt's for surgery by chart review (remember these
pt's are other PCP pt's not been seen by you). Vacations were not vacations as you still had to do your alerts & renewals and etc by remote laptop. We were averaging 43 hours of work time during vacation. That did not mean that when you returned to
work you had a clean slate. This just meant the bare minimum was done to keep you "under the radar". Most VAs have admin time, not ours. There was a moratorium on meetings. We were to sign in then leave to see pt's in clinic. Interesting to have
staff meetings where medical staff is not represented. Hmm...

This is not true for other VA's. Some have great leadership and still value the physician.
Battle creek, Toledo cboc and Ashlund have had little atrophy of staff and have maintained consistency of leadership.

Looking on the government site use to b a good way to see thru the problematic VA's. Now many are not listing more than one one job rec at a time because admin knows this as well now. My VA has 5 provider openings, had 4 for the past two years with only one job rec on line. I have been proud to work & grow in the VA system for 15 years. I recently left my site but am looking for a healthier VA. It was so toxic that I left instead of transfer as there was no time for personal life let alone look for job. The last remaining doc at my site has put his notice in for same reasons.

This does not mean the VA is not a good place to work or find passion in your career choice. VHA doc mentioned locums as a vehicle to explore the atmosphere of any VA this is true and would urge the same. VA Locum only pays 85 dollars an hour but worth the knowledge you will gain. Not to mention they can not overload locums! So, here I am getting to ready to do locums after being on top of my financial food chain. Why? Because I loved taking care of the Vets and have a unique understanding of them. So as I look forward to finding a new VA or CBOC, I encourage all to consider this possibility. Choose well, very well.