Academic, federal position - a few months in

[SmallBird]

I have had some ups and downs in my career, as I've worked to find a position that facilitated some academic engagement, reasonable compensation, and allowed me to feel good about my clinical work. No job is perfect, but after several months in a new position, I think I'm the happiest I've been since residency.

I took a federal position at an active duty military hospital that is a primary site for a residency program. I have a case load of 4-8 inpatients, and the residents do all the orders, notes, and busy work. I don't have any call or weekend work, and I get plenty of time to teach and do other academic work. The pay is low 300s, and the benefits are great. The bureaucracy is, unsurprisingly, very intense, and the time off isn't as generous as my prior job. Overall I feel very fortunate to have landed where I did!

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[TheRightMedication]

Nice! Sounds perfect to me

 

[vanfanal]

Glad you found something you like. It takes a couple of bad jobs to realise when you found something good. And thanks for sharing.

 

[untapped]

That sounds fantastic

 

[FlowRate]

time off isn't as generous as my prior job

Just curious if you're willing to share more details? Was the prior job very generous (8+ weeks) or is the new one stingy (like 4)?

 

[comp1]

Yeah this is the life.

 

[SmallBird]

Just curious if you're willing to share more details? Was the prior job very generous (8+ weeks) or is the new one stingy (like 4)?

I only get four weeks. My prior job was productivity based. I really like how I can take a sick day if I'm sick without worrying about reduced pay. I dislike not being able to plan multiple vacations a year

 

[Merovinge]

I only get four weeks. My prior job was productivity based. I really like how I can take a sick day if I'm sick without worrying about reduced pay. I dislike not being able to plan multiple vacations a year

Dawg, if you can't plan multiple vacations with 4 weeks of PTO your life is either super amazing (taking 2+ week long trips) or super rough (in that you're burning the PTO to take care of others).

 

[comp1]

When you're ready to move on with your patients and take your federal time with you...the VA offers the full 5 weeks of vacation starting plus the 2.5 weeks of sick leave. This still sounds like a pretty good job with the census and resident help. It's how all inpatients should run really so that you can focus on what the patient needs.

 

[SmallBird]

Dawg, if you can't plan multiple vacations with 4 weeks of PTO your life is either super amazing (taking 2+ week long trips) or super rough (in that you're burning the PTO to take care of others).

The main thing is having family overseas... I usually burn through two weeks visiting them or having them visit here. And then I often ended up taking a day or two to make a long weekend. But yeah its not terrible.

 

[SmallBird]

When you're ready to move on with your patients and take your federal time with you...the VA offers the full 5 weeks of vacation starting plus the 2.5 weeks of sick leave. This still sounds like a pretty good job with the census and resident help. It's how all inpatients should run really so that you can focus on what the patient needs.

Really wouldn't be the same fit... I really like working with younger patients, and the workload seems much higher at any VA position I've seen? But yeah those benefits are nice

 

[Celexa]

Really wouldn't be the same fit... I really like working with younger patients, and the workload seems much higher at any VA position I've seen? But yeah those benefits are nice

VA skews older but I do know of academic affiliated VAs with very similar workload. The availability of those positions varies a lot though and they tend to heavily favored by the their own residency graduates given the good benefits, relatively high pay compared to non-VA academia, and familiarity.

 

[MedMan80]

Desirable area?

 

[psych_0]

I have a case load of 4-8 inpatients, and the residents do all the orders, notes, and busy work.

I come in peace and with all due respect.....but you're saying someone pays you $300k+ to see 4-8 inpatients per day? What do you do all day? Are your hours like 8-10am daily? Is there a catch? Is this job in rural Idaho? There has to be a catch, right?

If there really is no catch and this job is in a place with a very low cost of living, I'd say you hit the lazy man's jackpot. Congrats!

 

[calvnandhobbs68]

I come in peace and with all due respect.....but you're saying someone pays you $300k+ to see 4-8 inpatients per day? What do you do all day? Are your hours like 8-10am daily? Is there a catch? Is this job in rural Idaho? There has to be a catch, right?

If there really is no catch and this job is in a place with a very low cost of living, I'd say you hit the lazy man's jackpot. Congrats!

Haha dude it’s a government job need they say more? The catch is that you have to deal with a bunch of stupid bureaucracy and a nurse is probably technically your supervisor.

As mentioned above, a lot of VA inpatients have a similar workload and also have residents (including the one I rotated at). They might not get 300 but they get paid fairly well. The catch is that they can’t do 8-10 day through, someone who works at the VA would know better but you had hours you were supposed to be there.

 

[MedMan80]

Haha dude it’s a government job need they say more? The catch is that you have to deal with a bunch of stupid bureaucracy and a nurse is probably technically your supervisor.

As mentioned above, a lot of VA inpatients have a similar workload and also have residents (including the one I rotated at). They might not get 300 but they get paid fairly well. The catch is that they can’t do 8-10 day through, someone who works at the VA would know better but you had hours you were supposed to be there.

Our VA workload in the NE busy area was 12 folks per attending.

 

[comp1]

That is not an abnormal workload for a federal inpatient job. Yes, there are VA's that are busier (as above), but I think 4-8 is actually closer to the average. And your day is busy, you're just doing a lot more for each patient than your typical 1099 community inpatient psychiatrist picking between antipsychotics. Yes, it's bureaucratic and it's often not at the exact top of your license, but it's actually very complicated to get people connected to the right services. The VA and most federal systems are amazing in that you can get a patient pretty darn much anything they could need or want (like say a military sexual trauma program that focuses exclusively on men thousands of miles away), but you (as the doctor) are going to have to work pretty hard to both find and get it setup. Yes, there are going to be social workers and others to help in a good system, but with how complex the system is, it's ultimately team effort.

 

[Stagg737]

Haha dude it’s a government job need they say more? The catch is that you have to deal with a bunch of stupid bureaucracy and a nurse is probably technically your supervisor.

As mentioned above, a lot of VA inpatients have a similar workload and also have residents (including the one I rotated at). They might not get 300 but they get paid fairly well. The catch is that they can’t do 8-10 day through, someone who works at the VA would know better but you had hours you were supposed to be there.

Even for VAs that would be pretty great pay for a cap of 8 patients per day and residents doing the actual work under you. Most of the psych docs at VAs that I know making that much are either at more rural locations or had higher administrative duties. All VA pay is open access though, so you can look up what psychiatrists at various VAs make. $300k is the maximum a staff psychiatrist can make at the VA without higher administrative duties though (Pay Table 2) : https://www.va.gov/OHRM/Pay/2023/PhysicianDentist/PayTables_20230730.pdf

It may be different since this is not the VA and is an active duty military hospital. I'd imagine that treating active members of the military with mental illness comes with a whole other level of bureaucracy beyond what we see with veterans at VA hospitals.

 

[comp1]

Definitely second checking the salaries of local psychiatrists in federal jobs anywhere you interview. Often the federal employers can only give salary ranges at the start of interviewing. You can get a more specific view checking particular salaries online. Search Federal Employee Salaries

 

[ObsequiousAplomb]

Even for VAs that would be pretty great pay for a cap of 8 patients per day and residents doing the actual work under you. Most of the psych docs at VAs that I know making that much are either at more rural locations or had higher administrative duties. All VA pay is open access though, so you can look up what psychiatrists at various VAs make. $300k is the maximum a staff psychiatrist can make at the VA without higher administrative duties though (Pay Table 2) : https://www.va.gov/OHRM/Pay/2023/PhysicianDentist/PayTables_20230730.pdf

It may be different since this is not the VA and is an active duty military hospital. I'd imagine that treating active members of the military with mental illness comes with a whole other level of bureaucracy beyond what we see with veterans at VA hospitals.

Yes. I would say that the bureaucracy is separate but equal. Different EHRs, different policies, different forms.
Much skinnier, healthier, younger bureaucrats inevitably telling you that you filed it incorrectly.

There are also some really interesting differences in the way the patient may approach recovery. Many of the active members it will be their first episode of whatever major mental illness and there's the potential that they can avoid being discharged if they reach a full and sustained recovery. If someone is having multiple inpatient admissions or has issues with treatment adherence, they get discharged and no longer receive their services from active duty military facilities. I don't know that there's that motivation to improve in the VA. Admittedly, there are also the people who are trying to make sure that they get discharged and with a high level of disability. Unlike the VA, where they're required to have a chronic illness to be eligible, most chronic illnesses make active duty soldiers ineligible for prolonged services. Either way, I don't think there's the same degree of "frequent flyers" or all that many comorbidities in the population.

 

[comp1]

Working in the VA and reviewing many, many DoD notes...I can tell you most definitely that many active duty service members are making absolutely certain that their issues are documented/demonstrated in such a way so as to guarantee particular disability ratings. Right or wrong, I've seen both. There are lots of Youtube videos on how to best do this. It probably is nice that there's at least a subset of your patient population who are motivated monetarily in the opposite direction, however.