1) What made you choose VA or AMC over the other? 2) Pros Cons list 3) Questions for Pay Scale at the VA

[studentdoctorsnetwork123]

Thank you so much for all the community's support!

I have 3 sets of questions I'd appreciate your thoughts on:

1) For folks who considered both AMC vs. VA, what factors made you choose one or the other in your career?

2) Pros & Cons list - Love to hear your thoughts on if there's anything else I should add to the list!

VA Pros
* More clear work-life balance
* Good starting pay / Job security
* VA trainees being hired (ability to be hired at different VAs)
* More focused on clinical/training/supervision than research (if that's important to you)
* Options to be part of research if one chooses to
* Valued as a member of health care team

VA Cons
* Cap out with pay early?
* Bureaucracy? (CPSS, slow decision making, etc.)

AMC Pros
* Does not cap out with pay as early as the VA? (I wonder if there is a significant difference between VA vs. AMC working in a location for 10 years)

AMC Cons
* Less structure, less of a "membership" feel when considering job opportunities? (More streamlined and "member" feel in the VA system)

3) A few questions regarding the Pay Scale for the VA sites

Q1: Could someone share the pay-scale system at the VA in the span of 10 years working at the VA? I think I heard that a licensed psychologist starts at GS-13. Is this true? If so, is this pay scale consistent across all VAs or different depending on what? for example, if I am a starting psychologist, do I start GS-# across the VAs? After how many years does the pay-grade get bumped? Is this also true across the VAs or is it dependent on each VAs?

Q2: In your experience/observation, does living in an expensive city ultimately yield more money in private practice (since you could charge more?) Or is it better to find a mediocre city and charge less? As an expensive city, I'm thinking of Palo Alto. Less expensive city (though still expensive). I'm thinking of Seattle, LA, NY.

Thank you so much!

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[AcronymAllergy]

To quickly reply while I have a sec RE: pay at the VA, psychologists are currently on the General Schedule (GS) scale, like you've said (and generally speaking). The rates for that scale are here: General Schedule

IIRC, an unlicensed psychologist starts at GS11, a licensed psychologist should start at GS12, and a licensed psychologist with 1 year of experience (which typically includes completing a formal postdoc) starts at a GS13. Your step can be negotiable if you have experience outside VA (e.g., if you're mid-career); otherwise, I've not often heard of people having luck negotiating beyond step 1.

The pay rate is dependent on where you work, per the above link. If you don't work in a specifically-designated locality, then you get the "rest of United States" pay rate typically. There are some exceptions, as other folks on this board have discussed (e.g., some folks have leadership who negotiated rates outside the standard GS scale). The standard rate of progression through steps is: automatic bump in step every 1 year for the first 3 steps (i.e., step 1 to 2, 2 to 3, and 3 to 4), then every 2 years for the next 3 steps, and finally every 3 years for the final 3 steps. Thus, if my math is correct, it takes about 18 years to get to step 10. Some VAs will give you a 1-step increase for attaining board certification.

It's not unusual for a small number of psychologists in a hospital to be at GS14, which usually includes things like mid-level management and, in some locations, directors of training. It's less common, but not unheard of, to have a GS15 psychologist, particularly if it's a larger VA (e.g., lead psychologist or other upper-level leadership).

Edit: to quickly add, I might actually lump CPRS as a "pro" for VA. It's old as all heck, but it works well for what we typically do with our notes. The bureaucracy part should probably count as Cons 1 through 10 if you're including things like clinical reminders, need to use certain systems within VA for charting (e.g., MHS), need to follow protocols for things like no-shows and "high risk" patients, need to give 45 days of notice to request leave, the actual process of requesting leave, anything and everything to do with scheduling, etc.

 

[cara susanna]

One thing... there are things available at some VAs that aren't at others. For instance, some VAs have more research opportunities than others. Anyway, I looked at AMCs vs. VAs for internship and the decision was made for me when I matched to a VA. But, I can still contribute to pros and cons of a VA career. Since I have ultimately never worked at an AMC, the pros and cons may also apply to them.

VA Pros:
- Access to great trainings, including EBP rollouts and certifications.
- In many cases, affiliation with AMCs.
- Focus on EBPs (again, varies across VAs)
- Not having to worry about session limits or insurance coverage (double edged sword, of course)
- Paid time off for all federal holidays, I think there are 11 or 12 of them
- I'm told our retirement/TSP is pretty good.
- I've always felt respected as a psychologist in this system.
- Centers of excellence, MIRECC, National Center for PTSD, and other great organizations that providers can access within our system.
- Opportunity to be involved in administrative roles, like coordinator positions.
- RVU and productivity requirements are pretty cushy compared to other settings, or so I've been told.

VA Cons:
- Bureaucracy
- Clinical reminders and other administrative stuff that is not clinically driven.
- Inane focus on numbers and metrics that don't really mean anything to people other than administrators over actual quality of care.
- Suicide prevention could fall in the above two categories, but Imma list it separately to make a point.
- Pushback or resistance to setting boundaries for patients
- Not the greatest equipment or facilities, although again this varies. Definitely not the most advanced technology, either.
- SERVICE CONNECTION
- Political pressure to do things that are against your clinical judgment (e.g., service dogs, complementary medicine) or politically-driven rather than clinically-driven
- No show calls
- Can't really flex your schedule and need 45 days notice for non-sick leave
- Not able to limit caseload or new patients.
- Very little control over your grid, having to rely on people to make grid changes or block your grid that often make mistakes
- It's weirdly hard and annoying to view notes from other VAs (JLV is the wooorst)
- Mental Health Suite. It deserves its own category!
- Non-VA care is a mess. Getting people into care for specialty services that the VA doesn't offer is actually really difficult, at least where I live.
- Our population is really infantilized and fragilized in this system. I hate to say this, but you will also run into entitlement and patients getting their way, even if it doesn't make sense clinically, because they knew how to work the system. It can be VERY difficult especially with personality disordered patients who will get their behaviors reinforced.

 

[erg923]

I am aware the VA can and does bill insurance when needed, but I agree that that their focus on numbers and productivity with essentially "monopoly money" is absurd. As is the historical mantra (at least when I was there) of "being a good steward of the tax payers dollars." The later was often used as an excuse to disallow flexible schedules sans the most extreme need or circumstance and enable/excuse sitting on your ass from 2-4:30 even if there was nothing you could do the rest of that day.

AMCs have some "monopoly money" in their budgets to work with too, however, there is also alot of real money that will drive your pay schedule and productivity there too. But, sitting in your seat even when class was not happening and just looking for work to do felt like high school and not something I could tolerate with the VA. Seeing patients near full-time was not something I wanted my career to be long-term anyway, though.

 

[cara susanna]

I am aware the VA can and does bill insurance when needed, but I agree that that their focus on numbers and productivity with essentially "monopoly money" is absurd. As is the historical mantra (at least when I was there) of "being a good steward of the tax payers dollars." The later was often used as an excuse to disallow flexible schedules sans the most extreme need or circumstance and enable/excuse sitting on your ass from 2-4:30 even if there was nothing you could do the rest of that day.

AMCs have some "monopoly money" in their budgets to work with too, however, there is also alot of real money that will drive your pay schedule and productivity there too. But, sitting in your seat even when class was not happening and just looking for work to do felt like high school and not something I could tolerate with the VA. Seeing patients near full-time was not something I really wanted my career to be long-term anyway, though.

For sure. I think I do well in the VA because I'm good at finding things to do or distract myself with. Shout out to the Kindle app on my phone, by the way.

 

[Sanman]

The big question here is do you plan to be very active in research? AMCs and some major VAs are draws because you make significantly more than at the University level, usually due a mix of clinical and research duties. If you are going for purely clinical, the VA has significantly more jobs available, IMO. As far as money, it really depends on the deal available at the AMC. If you are going straight clinical salary, I don't find the difference to be that great.

As far as expensive cities, PP is the answer by far if you have the start-up capital and the ability to build up a self-pay practice. VA payscales are set regionally, so it works out better to work in the lower cost areas of the region (For example, Boston region pay stretches to NH and ME, NYC region to PA, etc.). Working in the major city is usually the worst deal unless you are young and single (and still is a bad deal). In NYC, Hospital jobs and VA paid similar and none was anything close to PP.

 

[summerbabe]

I did not consider AMC but work in VA as an early career psychologist with no immediate plans for leaving. Agree with what others have said and I'll add these points:

- You can't beat the job security. Like you'd literally have to beat up a veteran to get fired.
- This will depend on facility/supervisor but I basically don't get bothered about metrics like RVUs since I'm within a broad acceptable range and my facility isn't as RVU crazy. Or if you are being bothered, that person knows they really can't do much to you except maybe force some uncomfortable conversations, deny you a $400-$800 yearly bonus that you lose a third of via taxes anyways, and maybe create a remediation plan that likely won't have much teeth.
- VA salaries and benefits go much, much further in lower CoL regions, like where I live so I'm fortunate that I don't feel the pressure to do PP stuff on the side for extra income.
- There are lots of opportunities to move to lateral clinical jobs once hired on, both at your facility, other VAs and now virtually as more virtual roles are being approved. This can help you stay refreshed, sharpen new skills, have a different clinical balance, get away from clinic specific drama, etc. There may also be opportunities to move up in admin (some people in my grad school/intern/postdoc cohorts have already received major promotions) but is that headache worth it?
- Ability to do research is available but navigating getting time bought out when you're a primary clinician can be challenging for a host of reasons. If research is a priority, things like MIRECC might be a better option.
- A major downside is when components of clinical care change suddenly due to shifting political winds. VHA is a healthcare organization whose head is a political appointee that serves at the pleasure of the President, and by extension, Congress. When political needs bump against things that make sense logically in providing health care, guess which one will win?
- There are a lot of bureaucratic demands. I see some clinicians get really stressed by this. Me personally, my conscientiousness for arbitrary things that either don't make sense or feel useless is pretty low so I know that I'm ignoring or not doing all of the things that I should do and I'm totally OK with that because my focus is on clinical care. And honestly, nobody has the time to micromanage and scrutinize me specifically to even know whether I'm going great, OK, or poorly, especially with lots of background bureaucratic processes that aren't as visible (e.g., closing encounters in a timely fashion which you will definitely get called out on versus how often you complete clinical reminders).

 

[studentdoctorsnetwork123]

e

To quickly reply while I have a sec RE: pay at the VA, psychologists are currently on the General Schedule (GS) scale, like you've said (and generally speaking). The rates for that scale are here: General Schedule

IIRC, an unlicensed psychologist starts at GS11, a licensed psychologist should start at GS12, and a licensed psychologist with 1 year of experience (which typically includes completing a formal postdoc) starts at a GS13. Your step can be negotiable if you have experience outside VA (e.g., if you're mid-career); otherwise, I've not often heard of people having luck negotiating beyond step 1.

The pay rate is dependent on where you work, per the above link. If you don't work in a specifically-designated locality, then you get the "rest of United States" pay rate typically. There are some exceptions, as other folks on this board have discussed (e.g., some folks have leadership who negotiated rates outside the standard GS scale). The standard rate of progression through steps is: automatic bump in step every 1 year for the first 3 steps (i.e., step 1 to 2, 2 to 3, and 3 to 4), then every 2 years for the next 3 steps, and finally every 3 years for the final 3 steps. Thus, if my math is correct, it takes about 18 years to get to step 10. Some VAs will give you a 1-step increase for attaining board certification.

It's not unusual for a small number of psychologists in a hospital to be at GS14, which usually includes things like mid-level management and, in some locations, directors of training. It's less common, but not unheard of, to have a GS15 psychologist, particularly if it's a larger VA (e.g., lead psychologist or other upper-level leadership).

Edit: to quickly add, I might actually lump CPRS as a "pro" for VA. It's old as all heck, but it works well for what we typically do with our notes. The bureaucracy part should probably count as Cons 1 through 10 if you're including things like clinical reminders, need to use certain systems within VA for charting (e.g., MHS), need to follow protocols for things like no-shows and "high risk" patients, need to give 45 days of notice to request leave, the actual process of requesting leave, anything and everything to do with scheduling, etc.

Oh woah, this is so extremely helpful! What a great lay out - just what I needed to hear.

A few follow-up questions (if you have more "seconds" 😊 )

1. Is it a typical route for one to get licensed immediately after a post-doc if one passes the EPPP? I'm wondering if the internship + 1-year post-doc hours would be enough for one to apply for the licensure. In sum, realistically, what's the process of licensure and how much time would one take to be licensed?

2. Also, is post-doc typically recommended for one's career? I heard some folks who got jobs immediately after internship and I also heard that those situations can be tricky if they want to move their jobs in the future and if the second job requires post-doc etc?

3. Would you mind sharing your thoughts on my question Q2 about whether living in a high cost of living locations would yield stronger pay overall? Based on your information I quickly searched up and found that 1) GS-12 SF is $102K, Seattle is $92K, LA is $95K, NY is $96K. What's confusing for me is, although SF has does have a significantly higher pay, I don't think the quality of life would be significantly higher than other places, because of SUCH high cost of living for SF. My question is, how accurately have these pay differentials taken account of the cost of living for each locations? Essentially I'm wondering, would getting paid more in SF offer similar lifestyle than living with lower pay in Seattle or LA?

Thanks so much for your thoughtful responses!

 

[PsychPhDone]

Oh woah, this is so extremely helpful! What a great lay out - just what I needed to hear.

A few follow-up questions (if you have more "seconds" 😊 )

1. Is it a typical route for one to get licensed immediately after a post-doc if one passes the EPPP? I'm wondering if the internship + 1-year post-doc hours would be enough for one to apply for the licensure. In sum, realistically, what's the process of licensure and how much time would one take to be licensed?

2. Also, is post-doc typically recommended for one's career? I heard some folks who got jobs immediately after internship and I also heard that those situations can be tricky if they want to move their jobs in the future and if the second job requires post-doc etc?

3. Would you mind sharing your thoughts on my question Q2 about whether living in a high cost of living locations would yield stronger pay overall? Based on your information I quickly searched up and found that 1) GS-12 SF is $102K, Seattle is $92K, LA is $95K, NY is $96K. What's confusing for me is, although SF has does have a significantly higher pay, I don't think the quality of life would be significantly higher than other places, because of SUCH high cost of living for SF. My question is, how accurately have these pay differentials taken account of the cost of living for each locations? Essentially I'm wondering, would getting paid more in SF offer similar lifestyle than living with lower pay in Seattle or LA?

Thanks so much for your thoughtful responses!

Bay area VAs have special salary rates that do not follow the GS tables.

 

[studentdoctorsnetwork123]

Bay area VAs have special salary rates that do not follow the GS tables.

Oh, can you say more? Where can we get that information? How much more do they make beyond the GS table? is it just the Bay Area? or are there other locations like NY/Seattle/LA that offers more than the GS table?

Does Palo Alto count as Bay Area?

 

[PsychPhDone]

Oh, can you say more? Where can we get that information? How much more do they make beyond the GS table? is it just the Bay Area? or are there other locations like NY/Seattle/LA that offers more than the GS table?

Does Palo Alto count as Bay Area?

Theoretically it's somewhere on opms site but I've never been able to find it reliably. Lots of different localities have SSR. It is usually mentioned in job postings in those locations. Alternatively you could reach out to any contacts you have at those sites or DM people on here.

 

[studentdoctorsnetwork123]

Theoretically it's somewhere on opms site but I've never been able to find it reliably. Lots of different localities have SSR. It is usually mentioned in job postings in those locations. Alternatively you could reach out to any contacts you have at those sites or DM people on here.

Would you mind sharing with me what you mean by SSR?

 

[summerbabe]

1. Is it a typical route for one to get licensed immediately after a post-doc if one passes the EPPP? I'm wondering if the internship + 1-year post-doc hours would be enough for one to apply for the licensure. In sum, realistically, what's the process of licensure and how much time would one take to be licensed?

Yes, that's typical. If possible, take and pass the EPPP during postdoc. It takes time to get approved to take it (by the state where you want to be licensed) and then time to find a test time so it needs some pre-planning.

Hours will depend on the state you're trying to get licensed in and whether you have enough. Typically with a formal postdoc, you should be fine, especially if you're paying attention to what your state requires anything specifically.

2. Also, is post-doc typically recommended for one's career? I heard some folks who got jobs immediately after internship and I also heard that those situations can be tricky if they want to move their jobs in the future and if the second job requires post-doc etc?

I did a VA postdoc and am glad I did. Yes, I sacrificed at least ~$20,000 compared to a GS-12 at that same facility but do not regret the decision. Plus, it made licensure a breeze and will help if I decide to get licensed in other states in the future. There will be lots of VA GS-12 jobs given major provider shortages around the country, as well as in the private sector.

Would you mind sharing with me what you mean by SSR?

SSR is Special Salary Rate. My understanding is that a facility can appeal to increase pay for specific professions based on local factors such as typical salaries for the region, # of unfilled positions, and how much turnover happens to recruit and retain staff. I don't know anything specifically about Bay Area VAs but the area has multiple independent systems so SSR and the specific amounts can be different per location or offered at one system but not at another.

As for how accurate pay differentials are, it's hard to say since cost of living can vary wildly in these metros (e.g., living with roommates versus apartment in the city versus commuting from the suburbs) and what your personal needs and preferences are. But when things like monthly property taxes in the Bay Area can be higher than whole mortgages in other parts of the country, probably not enough.

 

[studentdoctorsnetwork123]

One thing... there are things available at some VAs that aren't at others. For instance, some VAs have more research opportunities than others. Anyway, I looked at AMCs vs. VAs for internship and the decision was made for me when I matched to a VA. But, I can still contribute to pros and cons of a VA career. Since I have ultimately never worked at an AMC, the pros and cons may also apply to them.

VA Pros:
- Access to great trainings, including EBP rollouts and certifications.
- In many cases, affiliation with AMCs.
- Focus on EBPs (again, varies across VAs)
- Not having to worry about session limits or insurance coverage (double edged sword, of course)
- Paid time off for all federal holidays, I think there are 11 or 12 of them
- I'm told our retirement/TSP is pretty good.
- I've always felt respected as a psychologist in this system.
- Centers of excellence, MIRECC, National Center for PTSD, and other great organizations that providers can access within our system.
- Opportunity to be involved in administrative roles, like coordinator positions.
- RVU and productivity requirements are pretty cushy compared to other settings, or so I've been told.

VA Cons:
- Bureaucracy
- Clinical reminders and other administrative stuff that is not clinically driven.
- Inane focus on numbers and metrics that don't really mean anything to people other than administrators over actual quality of care.
- Suicide prevention could fall in the above two categories, but Imma list it separately to make a point.
- Pushback or resistance to setting boundaries for patients
- Not the greatest equipment or facilities, although again this varies. Definitely not the most advanced technology, either.
- SERVICE CONNECTION
- Political pressure to do things that are against your clinical judgment (e.g., service dogs, complementary medicine) or politically-driven rather than clinically-driven
- No show calls
- Can't really flex your schedule and need 45 days notice for non-sick leave
- Not able to limit caseload or new patients.
- Very little control over your grid, having to rely on people to make grid changes or block your grid that often make mistakes
- It's weirdly hard and annoying to view notes from other VAs (JLV is the wooorst)
- Mental Health Suite. It deserves its own category!
- Non-VA care is a mess. Getting people into care for specialty services that the VA doesn't offer is actually really difficult, at least where I live.
- Our population is really infantilized and fragilized in this system. I hate to say this, but you will also run into entitlement and patients getting their way, even if it doesn't make sense clinically, because they knew how to work the system. It can be VERY difficult especially with personality disordered patients who will get their behaviors reinforced.

Thank you SO much for your thorough responses! I'm not familiar with MIRECC, Center of Excellence, etc.

Would you mind sharing with me what they represent and how much of a deal it is to have those descriptions in the sites? Are those descriptions for training? or sites? Who offers those credentials?

 

[Ollie123]

Keep in mind that it also isn't entirely unheard of for people to have split appointments at the academically affiliated VAs (typically folks with a research component). We had folks with X% AMC effort and Y% VA effort. For some reason this was harder to work out on the clinical side for psychologists, though MDs do it all the time.

To me, one of the main upside of AMCs is they'll typically offer greater flexibility in what you do. Generally speaking, if you can find money to cover your effort to do something they are happy to let you do it. They also offer more pay on the high end. You won't typically see psychologists earning 200k at a VA. That's normal for mid-late career at an AMC (assuming you progress up the academic chain and take on admin roles).

I'm jealous of the astounding amount of stability the VAs offer though. AMCs will generally drop you like a hot potato the second you aren't covering 100% of your effort (due to grant funding drying up, poor clinic show rates, etc.). I've literally never heard of a psychologist being laid off or fired from a VA. If sweet federal benefits were not at stake, it might be a fun game to see what it would take for this to happen.

 

[cara susanna]

Keep in mind that it also isn't entirely unheard of for people to have split appointments at the academically affiliated VAs (typically folks with a research component). We had folks with X% AMC effort and Y% VA effort. For some reason this was harder to work out on the clinical side for psychologists, though MDs do it all the time.

To me, one of the main upside of AMCs is they'll typically offer greater flexibility in what you do. Generally speaking, if you can find money to cover your effort to do something they are happy to let you do it. They also offer more pay on the high end. You won't typically see psychologists earning 200k at a VA. That's normal for mid-late career at an AMC (assuming you progress up the academic chain and take on admin roles).

I'm jealous of the astounding amount of stability the VAs offer though. AMCs will generally drop you like a hot potato the second you aren't covering 100% of your effort (due to grant funding drying up, poor clinic show rates, etc.). I've literally never heard of a psychologist being laid off or fired from a VA. If sweet federal benefits were not at stake, it might be a fun game to see what it would take for this to happen.

I know a social worker (non-veteran) who was fired and we all thought the reason was BS. It was an incident that caught the attention of upper leadership. But I know another (non-veteran) social worker who was fired and the reason was not BS, lol.

It is EXTREMELY difficult to fire veteran employees, however.

 

[cara susanna]

Thank you SO much for your thorough responses! I'm not familiar with MIRECC, Center of Excellence, etc.

Would you mind sharing with me what they represent and how much of a deal it is to have those descriptions in the sites? Are those descriptions for training? or sites? Who offers those credentials?

Yup, so MIRECCs are mental health research centers--each geographical VA network (called a VISN) has one, usually consisting of two sites--and they specialize in certain topics. For instance, VISN 19 specializes in suicide and suicide prevention, VISN 21 in serious and persistent mental illness, etc. Centers of Excellence are similar. VA San Diego has a Center of Excellence for stress and mental health, VA Seattle has one for substance abuse, Canandaigua for suicide, Syracuse has one for integrated care, etc. The National Center for PTSD is across several sites, including Palo Alto and Boston, and they specialize, as the name implies, in PTSD. As a PTSD person, the NCPTSD is incredible and the resources they give us--trainings, seminars, patient education materials, research updates, consultation, smartphone apps, etc--are unparalleled.

Usually these sites have post doctoral fellowships. If you attend a MIRECC fellowship, you have access to all of the national MIRECC training resources. This includes weekly seminars, mostly to prepare you for VA research careers. I did a VA research post doc, not technically with a MIRECC but with another national research hub. Regardless, all of the research fellows were lumped in with the MIRECC fellows so we had access to all of the MIRECC resources/trainings, and it was amazing. You can also technically get hired for jobs at these places, but you would probably be hired as part of a grant or you would need to bring in your own funding. They're also, as you can imagine, quite competitive.

 

[AcronymAllergy]

I know a social worker (non-veteran) who was fired and we all thought the reason was BS. It was an incident that caught the attention of upper leadership. But I know another (non-veteran) social worker who was fired and the reason was not BS, lol.

It is EXTREMELY difficult to fire veteran employees, however.

That's unfortunate about the first social worker. I know of a few providers who, per my understanding, were strongly encouraged to leave, but I don't think I've ever heard of anyone being fired.

 

[oldschooliscool]

I'm in a similar position as the OP, trying to figure out VA vs AMC. One thing I keep coming back to is flexibility of schedules. In graduate school, I've really been spoiled by the ability to leave at 3:00pm if I want to hit the gym, or need to go to the dentist - there's no clocking in or clocking out, and there's nobody to check in with. As long as I'm not flaking on a meeting, class, or appointment, I'm good to go.

It seems like AMCs generally offer you this flexibility. Is that true?

It also seems like VAs do NOT offer you this flexibility. Is that true as well?

 

[summerbabe]

It also seems like VAs do NOT offer you this flexibility. Is that true as well?

A guaranteed salary that is not tied to productivity means you are expected to be at your duty station for the entirety of your tour of duty. And if you are absent without prior formal approval, you are AWOL (yes, the military vibes are intentional).

Additionally, planned leave needs to be requested 45 days in advance and can't impact patient care, which often leads to people using up way more of their sick leave for day of call outs, as opposed to their earned annual leave.

Are there people that take longer lunches or skip out a bit early or have supervisors who are ok with occasionally flexing your time? Sure. But don't count on it. Especially if you are in a fully clinical role at a VA where you're fully booked out weeks or months.

 

[WisNeuro]

Where's the AMC vs. VA vs. PP thread

 

[Pragma]

A guaranteed salary that is not tied to productivity means you are expected to be at your duty station for the entirety of your tour of duty. And if you are absent without prior formal approval, you are AWOL (yes, the military vibes are intentional).

Additionally, planned leave needs to be requested 45 days in advance and can't impact patient care, which often leads to people using up way more of their sick leave for day of call outs, as opposed to their earned annual leave.

Are there people that take longer lunches or skip out a bit early or have supervisors who are ok with occasionally flexing your time? Sure. But don't count on it. Especially if you are in a fully clinical role at a VA where you're fully booked out weeks or months.

Yes this definitely reflects my past VA experience.

 

[Pragma]

I'm in a similar position as the OP, trying to figure out VA vs AMC. One thing I keep coming back to is flexibility of schedules. In graduate school, I've really been spoiled by the ability to leave at 3:00pm if I want to hit the gym, or need to go to the dentist - there's no clocking in or clocking out, and there's nobody to check in with. As long as I'm not flaking on a meeting, class, or appointment, I'm good to go.

It seems like AMCs generally offer you this flexibility. Is that true?

It also seems like VAs do NOT offer you this flexibility. Is that true as well?

The amount of flexibility at an AMC will vary a lot depending on your role. Generally, yes there is more flexibility than at a VA. More if you have time bought out for more flexible activities (research, admin). If your clinical load is high you are not immune to logistics and institutional policies, so your flexibility is an important thing to ask about when considering a job. Where I am at you are allowed to self-determine your schedule and build in admin days. But it is not the level of grad school flexibility overall - more responsibilities to fit in. Maybe leaving at 3 works if you build it right and make up the time later. Generally, in AMCs you are looking at more weekly hours than VA positions but much of that has to do with your activities and personal efficiency, and will vary.

 

[studentdoctorsnetwork123]

The big question here is do you plan to be very active in research? AMCs and some major VAs are draws because you make significantly more than at the University level, usually due a mix of clinical and research duties. If you are going for purely clinical, the VA has significantly more jobs available, IMO. As far as money, it really depends on the deal available at the AMC. If you are going straight clinical salary, I don't find the difference to be that great.

As far as expensive cities, PP is the answer by far if you have the start-up capital and the ability to build up a self-pay practice. VA payscales are set regionally, so it works out better to work in the lower cost areas of the region (For example, Boston region pay stretches to NH and ME, NYC region to PA, etc.). Working in the major city is usually the worst deal unless you are young and single (and still is a bad deal). In NYC, Hospital jobs and VA paid similar and none was anything close to PP.

Thank you for this response! It seems like there's a special rate for VAs in the main city areas (according to some posts in this thread).

1) Do you or does anyone know how much this special rate is? (or where I can get the information?)

2) Even with the special, do you think it's a loss if working in a major city (San Francisco) rather than cities that are less expensive (Boston, Seattle, LA, relative to SF of course)

3) If we factor in PP on the side of VA jobs, do you think PP would be able to make more income if working in the big cities like SF? Do you think the amount of money we can make as psychologists in the big city can outweigh the cost of living of big cities? Another way to rephrase my question is, do you think the ratio of (Income : the cost of living) is greater in places like SF than in non-SF areas like Seattle/Boston? Is it worth being in the super expensive city or in terms of how much we can make, SF doesn’t really win out, perhaps?

 

[studentdoctorsnetwork123]

- VA salaries and benefits go much, much further in lower CoL regions, like where I live so I'm fortunate that I don't feel the pressure to do PP stuff on the side for extra income.

That's a good point actually. Living in less expensive CoL cities compared to higher CoL would yield more income ultimately. Similarly, a followup question is, do you think the ratio of (Income : the cost of living) is greater in places like SF than in non-SF areas like Seattle/Boston? Is it worth being in the super expensive city or in terms of how much we can make, SF doesn’t really win out, perhaps?

Also, would you mind sharing some examples of "bureaucratic demand" that you had observed? Thank you so much for your time and sharing your insights!

 

[studentdoctorsnetwork123]

Bay area VAs have special salary rates that do not follow the GS tables.

Do you know where I can find out more about the special salary rate? Is this an open source? Or more of inside information? If others are aware of this, that'd be very helpful!

 

[studentdoctorsnetwork123]

Theoretically it's somewhere on opms site but I've never been able to find it reliably. Lots of different localities have SSR. It is usually mentioned in job postings in those locations. Alternatively you could reach out to any contacts you have at those sites or DM people on here.

thank you so much!

 

[studentdoctorsnetwork123]

Keep in mind that it also isn't entirely unheard of for people to have split appointments at the academically affiliated VAs (typically folks with a research component). We had folks with X% AMC effort and Y% VA effort. For some reason this was harder to work out on the clinical side for psychologists, though MDs do it all the time.

To me, one of the main upside of AMCs is they'll typically offer greater flexibility in what you do. Generally speaking, if you can find money to cover your effort to do something they are happy to let you do it. They also offer more pay on the high end. You won't typically see psychologists earning 200k at a VA. That's normal for mid-late career at an AMC (assuming you progress up the academic chain and take on admin roles).

I'm jealous of the astounding amount of stability the VAs offer though. AMCs will generally drop you like a hot potato the second you aren't covering 100% of your effort (due to grant funding drying up, poor clinic show rates, etc.). I've literally never heard of a psychologist being laid off or fired from a VA. If sweet federal benefits were not at stake, it might be a fun game to see what it would take for this to happen.

This is a great point. I wonder who wins out in terms of the benefits between AMC vs. VA -- Does anyone have some knowledge about this? Specific examples would be also very helpful

 

[studentdoctorsnetwork123]

A guaranteed salary that is not tied to productivity means you are expected to be at your duty station for the entirety of your tour of duty. And if you are absent without prior formal approval, you are AWOL (yes, the military vibes are intentional).

Additionally, planned leave needs to be requested 45 days in advance and can't impact patient care, which often leads to people using up way more of their sick leave for day of call outs, as opposed to their earned annual leave.

Are there people that take longer lunches or skip out a bit early or have supervisors who are ok with occasionally flexing your time? Sure. But don't count on it. Especially if you are in a fully clinical role at a VA where you're fully booked out weeks or months.

Part of me also apprecaites having a tight structure bacuse this means that I am mentally focused on the work fully and I don't have to drag work home. I notice that I tend to do better when I have a stronger accountability. So VA might be a better context for me. I'd imagine if I need to go to doctor, VA would allow us to go to doctor somehow.

 

[Sanman]

Thank you for this response! It seems like there's a special rate for VAs in the main city areas (according to some posts in this thread).

1) Do you or does anyone know how much this special rate is? (or where I can get the information?)

2) Even with the special, do you think it's a loss if working in a major city (San Francisco) rather than cities that are less expensive (Boston, Seattle, LA, relative to SF of course)

3) If we factor in PP on the side of VA jobs, do you think PP would be able to make more income if working in the big cities like SF? Do you think the amount of money we can make as psychologists in the big city can outweigh the cost of living of big cities? Another way to rephrase my question is, do you think the ratio of (Income : the cost of living) is greater in places like SF than in non-SF areas like Seattle/Boston? Is it worth being in the super expensive city or in terms of how much we can make, SF doesn’t really win out, perhaps?

Special salary rates are not in all (or most) major cities. They are only in certain places for certain positions where it is difficult to recruit employees. Psychology in most major cities has not historically been hard to recruit. Location pay has to do with how much others are paying people in the region, not what they need to live.

In general, the just doing a PP side gig is not going to change too much due to the low volume and things like travel time between jobs. Especially if the cost of living is very high. Though, doing a PP side gig may be more lucrative than taking a promotion.

 

[Ollie123]

This is a great point. I wonder who wins out in terms of the benefits between AMC vs. VA -- Does anyone have some knowledge about this? Specific examples would be also very helpful

Tough to answer since the exact benefits will vary a fair bit by institution (for AMCs) and also the exact benefits you get will depend on the nature of the split. Both are generally top notch so any differences are likely to be nuanced.

I <believe> VA psychologists can get a federal pension. I don't know the details of it or what gets paid into it. AMCs you may or may not have access to a pension but if you do it will likely be a state one. To each their own, but I'm distrustful of state pensions. However, you can get good-to-ridiculous employer contributions (current institution is 9%, last one had a complicated formula but it was close to 12%). Insurance options are usually good through both. One big perk of AMCs for people with kids is that tuition benefits are common. My current institution's is pretty weak ($7500/year but only good if the kid attends our undergrad campus). My last institution's was insane (up to $60,000/year, usable at any accredited school). PTO is good both places but usually favors AMCs.

Just a couple examples. There are many differences but it will get pretty nuanced. Big picture is you're looking at top notch benefits both places that you are unlikely to see beat outside of a handful of exceedingly niche places (big tech with "free everything" on campus, my wife worked for a health insurance company that gave her free excellent health insurance, etc.).

 

[WisNeuro]

Tough to answer since the exact benefits will vary a fair bit by institution (for AMCs) and also the exact benefits you get will depend on the nature of the split. Both are generally top notch so any differences are likely to be nuanced.

I <believe> VA psychologists can get a federal pension. I don't know the details of it or what gets paid into it. AMCs you may or may not have access to a pension but if you do it will likely be a state one. To each their own, but I'm distrustful of state pensions. However, you can get good-to-ridiculous employer contributions (current institution is 9%, last one had a complicated formula but it was close to 12%). Insurance options are usually good through both. One big perk of AMCs for people with kids is that tuition benefits are common. My current institution's is pretty weak ($7500/year but only good if the kid attends our undergrad campus). My last institution's was insane (up to $60,000/year, usable at any accredited school). PTO is good both places but usually favors AMCs.

Just a couple examples. There are many differences but it will get pretty nuanced. Big picture is you're looking at top notch benefits both places that you are unlikely to see beat outside of a handful of exceedingly niche places (big tech with "free everything" on campus, my wife worked for a health insurance company that gave her free excellent health insurance, etc.).

They do, for now. The employee pays X percentage of each paycheck into it, and the VA pays into it a portion as well.

 

[Ollie123]

Just checked this since I was curious (and procrastinating a grant submission) - looks like 4.4% contribution required and gets you a pension that is 1.1% of your highest 3 years of salary * years of service.

My outrageously rough calculation suggests you'd need a touch over 11% annual real interest in the stock market to match this assuming 30 years of service at a fixed salary. 11% is hugely unlikely (historical rate is lower and most economists are predicting it will go down, not up). This was a back-of-the-napkin thing so its both reliant on unrealistic assumptions and fundamentally wrong because I partly hacked the math, but close enough for me to say this is somewhere between good and outstanding as pension deals go.

With that, I'd say access to the pension is probably the biggest benefit perk of VA employment.

 

[Sanman]

Just checked this since I was curious (and procrastinating a grant submission) - looks like 4.4% contribution required and gets you a pension that is 1.1% of your highest 3 years of salary * years of service.

My outrageously rough calculation suggests you'd need a touch over 11% annual real interest in the stock market to match this assuming 30 years of service at a fixed salary. 11% is hugely unlikely (historical rate is lower and most economists are predicting it will go down, not up). This was a back-of-the-napkin thing so its both reliant on unrealistic assumptions and fundamentally wrong because I partly hacked the math, but close enough for me to say this is somewhere between good and outstanding as pension deals go.

With that, I'd say access to the pension is probably the biggest benefit perk of VA employment.

If you think that is good, the contribution was 0.8% not that long ago with the same payout.

 

[WisNeuro]

Just checked this since I was curious (and procrastinating a grant submission) - looks like 4.4% contribution required and gets you a pension that is 1.1% of your highest 3 years of salary * years of service.

My outrageously rough calculation suggests you'd need a touch over 11% annual real interest in the stock market to match this assuming 30 years of service at a fixed salary. 11% is hugely unlikely (historical rate is lower and most economists are predicting it will go down, not up). This was a back-of-the-napkin thing so its both reliant on unrealistic assumptions and fundamentally wrong because I partly hacked the math, but close enough for me to say this is somewhere between good and outstanding as pension deals go.

With that, I'd say access to the pension is probably the biggest benefit perk of VA employment.

But, the back of the napkin math has to also account for the much lower ceiling of salary compared to private practice. It can look very good, until you look at what your salary could be, and the ways that you can shield money from taxes with certain business arrangements.

 

[Ollie123]

But, the back of the napkin math has to also account for the much lower ceiling of salary compared to private practice. It can look very good, until you look at what your salary could be, and the ways that you can shield money from taxes with certain business arrangements.

But...then it wouldn't be napkin math?

No seriously, that wasn't meant as an endorsement of VA gigs as a whole. Pay is low past entry-level, especially for those in higher-demand specialties or with other ways to generate revenue. If you would just be booking 6-8 insurance-based 45-min individual therapy visits/day anyways (which is probably most PP folks?) I don't think it would be far off (and might even come out ahead) but you're not prioritizing income anyways if you go that route. Nothing wrong with that - its a choice point and most of us could have made a heck of a lot more money in other fields anyways - it just becomes a bit apples and oranges at some point.

 

[WisNeuro]

But...then it wouldn't be napkin math?

No seriously, that wasn't meant as an endorsement of VA gigs as a whole. Pay is low past entry-level, especially for those in higher-demand specialties or with other ways to generate revenue. If you would just be booking 6-8 insurance-based 45-min individual therapy visits/day anyways (which is probably most PP folks?) I don't think it would be far off (and might even come out ahead) but you're not prioritizing income anyways if you go that route. Nothing wrong with that - its a choice point and most of us could have made a heck of a lot more money in other fields anyways - it just becomes a bit apples and oranges at some point.

I generally agree with you. But, I also believe that many people overestimate the pension and underestimate the income potential outside of the VA when making financial decisions. It's definitely not a bad gig, but you can just easily work far less, with more flexibility, and earn far more outside of it. If it's something you are passionate about and fulfilled, that's a different story. But, I run into a lot of people who think it's a better financial decision, simply because they have never run the numbers

 

[R. Matey]

I generally agree with you. But, I also believe that many people overestimate the pension and underestimate the income potential outside of the VA when making financial decisions. It's definitely not a bad gig, but you can just easily work far less, with more flexibility, and earn far more outside of it

Would you say this is true for psychotherapy practices though? I mean neuropsych is one thing...therapy for depression another.

 

[Sanman]

Would you say this is true for psychotherapy practices though? I mean neuropsych is one thing...therapy for depression another.

I think that would depend on how busy you are in the salaried position. Booking 7 patients and working late with extra CSREs or barely booking 5 with some non-clinical duties? Using your leave time regularly or not? There are folks on here that work a lot who are significantly out earning any VA salary. There are plenty who work less that will not or only break even.

 

[WisNeuro]

Would you say this is true for psychotherapy practices though? I mean neuropsych is one thing...therapy for depression another.

There it probably depends on their payor mix. Though, the time not spent in VA meetings and whatnot equates to a good deal more time for clinical work

 

[R. Matey]

There it probably depends on their payor mix. Though, the time not spent in VA meetings and whatnot equates to a good deal more time for clinical work

Lol, given that I would pay to spend less time in meetings, I see your point there.

 

[PsychPhDone]

Just checked this since I was curious (and procrastinating a grant submission) - looks like 4.4% contribution required and gets you a pension that is 1.1% of your highest 3 years of salary * years of service.

My outrageously rough calculation suggests you'd need a touch over 11% annual real interest in the stock market to match this assuming 30 years of service at a fixed salary. 11% is hugely unlikely (historical rate is lower and most economists are predicting it will go down, not up). This was a back-of-the-napkin thing so its both reliant on unrealistic assumptions and fundamentally wrong because I partly hacked the math, but close enough for me to say this is somewhere between good and outstanding as pension deals go.

With that, I'd say access to the pension is probably the biggest benefit perk of VA employment.

For anyone doing additional napkin math, there is also TSP in VA, which includes up to a 5% employer match. ETA: you also get to keep your health insurance if you've had it for a certain number of years.

I still do not quite understand my retirement.

 

[WisNeuro]

For anyone doing additional napkin math, there is also TSP in VA, which includes up to a 5% employer match. ETA: you also get to keep your health insurance if you've had it for a certain number of years.

I still do not quite understand my retirement.

Yeah, it;s equivalent to a good 401k/403b. Though with many of the big institutions having pretty low ERs these days, the TSP is no longer unique in that regard.

 

[AcronymAllergy]

Small point of clarification on Ollie's informative post above about VA pension: IIRC, it's 1% per year worked of your high three until/unless you hit, I believe, 30 years of service; then it gets bumped to 1.1%. I think there are a few other situations in which you get that bump before 30 years.

If you leave VA before retirement, you have the option of keeping your pension contribution with them and then drawing once you're eligible (and assuming you're vested, which I think occurs at 5 years), or taking your portion of the contribution with you. Your contribution will likely not be very much; maybe $20-30k after 10 years. Assuming you worked at VA for 10 years and your high 3 was 110k, that means your pension would be 11k/year once you start drawing. Or, if you stayed all 30 years with that same high 3, you'd be drawing about 36k/year.

You still get Social Security (assuming it's there) as well, although I believe your pension can affect your SS payment.

Edit to add: Yep, TSP is another "leg" of the VA retirement system (FERS). It's generally great, as the returns are decent and the fees are ridiculously low (well under 1%, I believe). The match is better than many employers nowadays but obviously not all.

Although most folks I know consider the benefit PsychPhDone mentioned (i.e., carrying insurance over into retirement) as the biggest benefit of a VA career. It's why some folks will return for ~5 or so years before retiring. The only sticking point is that you must begin drawing your retirement immediately upon leaving VA if you want to keep your insurance, as they take your insurance payment from it. If you delay drawing your retirement after leaving VA, you can't take your insurance with you. At least to the best of my knowledge.

 

[Sanman]

Small point of clarification on Ollie's informative post above about VA pension: IIRC, it's 1% per year worked of your high three until/unless you hit, I believe, 30 years of service; then it gets bumped to 1.1%. I think there are a few other situations in which you get that bump before 30 years.

If you leave VA before retirement, you have the option of keeping your pension contribution with them and then drawing once you're eligible (and assuming you're vested, which I think occurs at 5 years), or taking your portion of the contribution with you. Your contribution will likely not be very much; maybe $20-30k after 10 years. Assuming you worked at VA for 10 years and your high 3 was 110k, that means your pension would be 11k/year once you start drawing. Or, if you stayed all 30 years with that same high 3, you'd be drawing about 36k/year.

You still get Social Security (assuming it's there) as well, although I believe your pension can affect your SS payment.

Edit to add: Yep, TSP is another "leg" of the VA retirement system (FERS). It's generally great, as the returns are decent and the fees are ridiculously low (well under 1%, I believe). The match is better than many employers nowadays but obviously not all.

Although most folks I know consider the benefit PsychPhDone mentioned (i.e., carrying insurance over into retirement) as the biggest benefit of a VA career. It's why some folks will return for ~5 or so years before retiring. The only sticking point is that you must begin drawing your retirement immediately upon leaving VA if you want to keep your insurance, as they take your insurance payment from it. If you delay drawing your retirement after leaving VA, you can't take your insurance with you. At least to the best of my knowledge.

Well AA, saved me a lot of typing. This seems accurate as far as what I have read.

 

[AvoidingAvoidance]

Does anyone know if Psychologists at the Philadelphia VA are getting paid at a Special Salary Rate and if so, how it's calculated?