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It's possible at VAs with substantial affiliations with major academic centers. There were exclusivly CL psychiatrists employed by the VAs at my medical school and residency and they worked with trainees from the respective residency programs.

You got less complex/fewer zebras/lower acuity cases compared to the quaternary centers next door but there was still decent variety. Not my preferred setting but it's a good gig for lots of people who don't mind the VA... VA-ness.

Edit: The folks with CL jobs I know were board certified in CL whether that meant having been grandfathered in or having done a fellowship, but I don't know if that would have been required.
 
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VA hospitals vary greatly in size from less than 40 beds to over 500. The larger the size, the more likely they have a dedicated CL position. Almost none are going to require a CL fellowship. There are very, very few CL fellowship trained psychiatrists in the country and VA's could not fill their positions if they required that. The VA also can't offer more pay for subspecialty fellowship training. Experience in something similar to CL, maybe a dual board in FM, job experience, or even a fair amount of residency experience would be more than sufficient.
In my experience, most VA's have dedicated inpatient psychiatrists who also do CL since they both don't require dedicated scheduling unlike outpatient. Outpatient providers have certain scheduling metrics that don't mesh well with inpatient work where they don't apply. The whole see your inpatients in the morning and outpatients in the afternoon is relatively rare in the VA, although I'm sure it exists. You seemed to describe something like outpatient CL. In the VA, this is called Primary Care Mental Health Integration where a psychiatrist is stationed in the primary care clinic and available all day to assist and assess with mild to moderate mental health patients presenting to their PCPs. This also has the possibility for CL med floor consults since it also isn't subject exactly the same to outpatient scheduling metrics, but again, I see inpatient people doing CL a lot more often. It just works better to mix it with inpatient in terms of flow because many (most?) of the med floor consults will be at least indirectly pushing to transfer behaviorally problematic med floor patients to the psych unit. In terms of specialty care, I'm not entirely sure what you mean. The VA is mostly a generalist organization, excepting things like PTSD or those conditions that are extremely common amongst veterans. It contracts out the rare stuff. There are VAs that do things like organ transplants and bariatric surgery, but these are quite rare.
For more concrete advice, you can always check usajobs.gov and contact the physician recruiter for the site listed on the job even if it isn't quite the exact job you were looking for. Tell them what you are looking for and please remember that everywhere is hard up for in person providers. So whenever you're reaching out to a physician recruiter, please immediately mention that you plan to be in person. It will get you higher up on a lot of lists. A lot of applicants seem to assume that all positions are at least potentially virtual and there's a lot of pressure from directors to avoid hiring/making new virtual positions whenever possible since most of our veterans are still not digital natives.
 
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Other than the salary (which would be the highest starting in the VA system based on locality pay), the job above should be relatively common within the VA.
 
reca said:
I know someone who got a full time C/L job at Palo Alto VA right out of residency. No C/L training at all. 320k a year and sees like 3-4 patients a day. Wouldn't be a bad gig if you can stomach the VA.
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Can they leave when not seeing those 3-4 patients?
 
VA work is by tour of duty. You are available during your tour of duty. Thus, on CL you'll be available for consults as they come in during the day. For inpatient, you'll be available for nursing issues or new admissions during your tour of duty. Ideally, you'd be covering the ED too so that you can be the one making decisions about those admissions during your tour of duty. For outpatient, you'll be scheduled during your tour of duty or, in some cases, have space for outpatient walk-in's. It's very convenient for the med floor to not always have to wait until the next day for their consults to be seen. Obviously for consult and inpatient work, the VA is not micromanaging every minute of your day.
 
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comp1 said:
VA work is by tour of duty, not by patient. You are available during your tour of duty. Thus, you'll be available for consults as they come in during the day. It's very convenient for the med floor to not always have to wait until the next day for their consults to be seen.
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So if a psychiatrist only has 3 patients on schedule per day, and it seems to be a regular thing, how viable is it for them to essentially do something like inpatient or pp on the side? Would they be working themselves to death or would it essentially be the equivalent of a full-time job wrt hrs?
 
You won't have a schedule of patients for consult. You'll be seeing consults as they pop up in the EMR or following up on ones who need it from the day prior (a smaller number generally). Similarly, the inpatient unit will have a set of patients, but those will be in flux throughout the day. Some will be admitted, some will be discharging. You're responsible for those during your tour of duty. It's not feasible or allowed to have a second job DURING your tour of duty. However, a second job outside of your 40 hour tour of duty is absolutely doable and extremely common. The VA has no restrictions on that whatsoever and in some way encourages it since physicians are the only employee group that can't be paid for overtime (can only receive comp days). Having two jobs with one of them being the VA is no more or less onerous than having a second job with somebody else employing you full time. It's definitely not for everyone.
 
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Do the salaries that are public knowledge (on federal salary database searches) include market pay as well? Because some of the salaries are lower than what I thought they would be.
 
Base salaries are laughably low. Nurses make more than this. What's wrong with VA HR?
 
Market pay is usually more than the base salary. They also review the local market pay once every 2 years (it may or may not change though; totally depends on the chief/VA). But yeah, the total salary is still lagging behind the private/community.
 
The salary is going to start around $260k. It'll be lower some places and higher others, but likely within a couple $10k's unless you're directly comparing Birmingham to Palo Alto. If you're seeing like $130k's, it's just the base salary. Reach out to the recruiter for something close to the ball park.
 
320k a year starting jobs (excluding hiring bonuses etc) aren't quite common except at the PAVA which has the highest cost of living in the country. I would say MOST VA jobs are dedicated to a specific thing. Certain things go well together like inpatient psych and CL since both aren't scheduled. Mixing in PCMHI might work, but it's not quite the same as inpatient consult work since the majority of work they do is actually brief scheduled med management follow-ups. Generally the VA works quite differently than old timey inpatient work where you'd see your inpatients in the morning and outpatients in the afternoon. The nurses expect you to be available during the whole time of your shift. So I get why you are thinking maybe split it up by days and sure, but then they have to find (and retain) another doctor who is interested in the inverse of your split. All of that said, the VA, like everywhere, is extremely hard up for mental health providers of all types everywhere. And you should view everything as negotiable, except the salary which is set by Congress. Reach out to your local or desired location physician recruiter by searching for psychiatrist on usajobs.gov. You can ignore the specifics of the job listed unless that in particular interests you.
 
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