Any VA ER docs out there?

[cyanide12345678]

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Considering a move to the VA for career longevity. Anyone here at the VA?

How many monthly shifts are you doing? What’s your job satisfaction like compared to community gigs?

Did the VA help with your career longevity?

This might be my last attempt at career longevity before i call it a day from clinical medicine.

 

[Dr Mantis Toboggan]

Considering a move to the VA for career longevity. Anyone here at the VA?

How many monthly shifts are you doing? What’s your job satisfaction like compared to community gigs?

Did the VA help with your career longevity?

This might be my last attempt at career longevity before i call it a day from clinical medicine.

in general a full time VA doc is going to work 80 hours every 2 weeks, so 2080 hours per year minus 11 federal holidays minus leave (8 hours every 2 week pay period).

So 2080-88-208=1,784 hours per year or 149 hours per month. That’s a lot of hours for not amazing pay for the most part. A lot of VA ERs can be fairly slow but not all of them. If you could get a day shift only job somehow (some places they have moonlighters do the nights) it could be decent.

There are some perks, insurance etc is very good. In general I found the VA works better for office based specialties who don’t have to be in the hospital 24/7.

But, if you’ve seen one VA, then you’ve seen one VA. Maybe your job is better somehow.

 

[cyanide12345678]

in general a full time VA doc is going to work 80 hours every 2 weeks, so 2080 hours per year minus 11 federal holidays minus leave (8 hours every 2 week pay period).

So 2080-88-208=1,784 hours per year or 149 hours per month. That’s a lot of hours for not amazing pay for the most part. A lot of VA ERs can be fairly slow but not all of them. If you could get a day shift only job somehow (some places they have moonlighters do the nights) it could be decent.

There are some perks, insurance etc is very good. In general I found the VA works better for office based specialties who don’t have to be in the hospital 24/7.

But, if you’ve seen one VA, then you’ve seen one VA. Maybe your job is better somehow.

Except this place counts 36 hrs clinically as equivalent to 40 hours, so 12x12 is full time.

And there’s 26 pto days, 13 sick days, 11 federal holidays, and 5 cme days for a total of 440 hrs. So it’s more like 2080 x 0.9 =1,872 after subtracting admin time that you dont do much for

1872 minus 440 = 1432 hrs full time per year after subtracting paid time off

 

[HoosierdaddyO]

My best friend works at a DoD Military Hospital as GS provider. I think it sounds like a much sweeter deal than the VA with same benefits and better pay and patient population. Lmk if you are interested more in that world as well.

 

[EctopicFetus]

I always find it interesting when EM docs look. To the VA. Maybe there is something special there. I get the generally slower pace, the general older male only patients, no peds, etc. But the pay isnt awesome, benefits are good and I dont know a single EM trained doc who spent more than a few years there. Most go there at the end of their career cause it is easy and “boring”.

I realize we all have a different mindset with our jobs, the new grads want high volume high acuity, the mid career folks have tremendous variability imo and then at the end of the career, there are the ones who will want very slow jobs with decent pay (some dont even care about the pay).

 

[JacobMcCandles]

I always find it interesting when EM docs look. To the VA. Maybe there is something special there. I get the generally slower pace, the general older male only patients, no peds, etc. But the pay isnt awesome, benefits are good and I dont know a single EM trained doc who spent more than a few years there. Most go there at the end of their career cause it is easy and “boring”.

I realize we all have a different mindset with our jobs, the new grads want high volume high acuity, the mid career folks have tremendous variability imo and then at the end of the career, there are the ones who will want very slow jobs with decent pay (some dont even care about the pay).

I had always thought many times it was because of the free healthcare after 'X' number of years. Depending on the number of years required it may not be a bad deal for someone retiring early and looking to bridge to Medicare but being employed at the VA in any capacity seems awful.

 

[JacobMcCandles]

Considering a move to the VA for career longevity. Anyone here at the VA?

Did something change with your job? I thought you found some spots where you had a low patient per hour and decent pay?

 

[cyanide12345678]

Did something change with your job? I thought you found some spots where you had a low patient per hour and decent pay?

I do. I had a couple of shifts where the midshift NP/PA shift was uncovered. I went home pretty annoyed on those days because this staffing issue has been on going for 6 months. I opened a Pandora’s box that day by talking to a lot of recruiters, and now kind of in a position where I’m genuinely liking what the VA has to offer.

- a lot of coverage and doc shifts - roughly 1.2 pph (actually less than my current place).
- no peds
- no ob (we occasionally have nightmare situations without OB coverage)
- specialist back ups that I’m not used to at my critical access
- shorter commute - 1 hr less driving per day of work
- slow chill pace similar to current job
- only a small pay cut when you account for the 55 days of paid time off (currently making 335k for 1296 annual hours vs 320k for 1432 hours)
- better insurance and lower out of pocket premiums for benefits
- pension at age 57
- slightly better employer tsp match
- boluses of 6-10 patients per hour are very hard at critical access when it’s just you.
- less nights (current job only has AM or PM shifts with 50% split. VA job has 8 shifts a day with only 1 true over night from 7 pm to 7 am. So much less pure over night shifts will get replaced by a bunch of mid day shifts).
- No lawsuits, though granted i live in a great malpractice state.
- cost of living salary increases every year based on inflation and every 2 years a ‘step’ adjustment which is some 4k more. This cola adjustment in 5 years might in fact mean the VA income becomes higher per hour than current job in 5 years, assuming the other stays stagnant.
- 55 days of paid time off, so no making up for shifts after a vacation.
- paid time off of 55 days itself results in another 6 shifts of paid time off, so in reality, 1 year of work gets you 3.5 months of paid time off.

The docs there genuinely seem happy. So yeah…genuinely considering a move.

 

[AlmostAnMD]

Jesus that's brutal

The part that stands out to me the most is the one hour LESS driving per day. awful....HOW FAR are you driving now per day?

WFH is very spoiling. I don't experience traffic, at least non-cat related traffic. I get easily annoyed now going out and driving and hitting just a few stoplights now.

 

[Groove]

I do. I had a couple of shifts where the midshift NP/PA shift was uncovered. I went home pretty annoyed on those days because this staffing issue has been on going for 6 months. I opened a Pandora’s box that day by talking to a lot of recruiters, and now kind of in a position where I’m genuinely liking what the VA has to offer.

- a lot of coverage and doc shifts - roughly 1.2 pph (actually less than my current place).
- no peds
- no ob (we occasionally have nightmare situations without OB coverage)
- specialist back ups that I’m not used to at my critical access
- shorter commute - 1 hr less driving per day of work
- slow chill pace similar to current job
- only a small pay cut when you account for the 55 days of paid time off (currently making 335k for 1296 annual hours vs 320k for 1432 hours)
- better insurance and lower out of pocket premiums for benefits
- pension at age 57
- slightly better employer tsp match
- boluses of 6-10 patients per hour are very hard at critical access when it’s just you.
- less nights (current job only has AM or PM shifts with 50% split. VA job has 8 shifts a day with only 1 true over night from 7 pm to 7 am. So much less pure over night shifts will get replaced by a bunch of mid day shifts).
- No lawsuits, though granted i live in a great malpractice state.
- cost of living salary increases every year based on inflation and every 2 years a ‘step’ adjustment which is some 4k more. This cola adjustment in 5 years might in fact mean the VA income becomes higher per hour than current job in 5 years, assuming the other stays stagnant.

The docs there genuinely seem happy. So yeah…genuinely considering a move.

I'm sold. I say go for it. VA has always been an option for me and I hear it's a complete elephant graveyard for EM docs and for good reason. Low acuity, better schedule, etc.. The only reason I've avoided it is due to the hour requirements for FT. I'm also in my 50s so I lose out on all the benefits and extra pension I'd get if I had started sooner. So, not really an option for me anymore but in your situation....I say go for it. The 1h less driving is huge btw closely followed by the 1.2pph + sovereign immunity.

 

[RustedFox]

My best friend works at a DoD Military Hospital as GS provider. I think it sounds like a much sweeter deal than the VA with same benefits and better pay and patient population. Lmk if you are interested more in that world as well.

What is a GS provider?

 

[Helpful Troll]

What is a GS provider?

Likely Government Service. GS* defines the pay scale. GS9 GS11 GS14... within each GS level there are steps based on time in service. It's the civilian medical providers, admin, and physicians working at DOD hospitals.

 

[EMdoc235]

I do. I had a couple of shifts where the midshift NP/PA shift was uncovered. I went home pretty annoyed on those days because this staffing issue has been on going for 6 months. I opened a Pandora’s box that day by talking to a lot of recruiters, and now kind of in a position where I’m genuinely liking what the VA has to offer.

- a lot of coverage and doc shifts - roughly 1.2 pph (actually less than my current place).
- no peds
- no ob (we occasionally have nightmare situations without OB coverage)
- specialist back ups that I’m not used to at my critical access
- shorter commute - 1 hr less driving per day of work
- slow chill pace similar to current job
- only a small pay cut when you account for the 55 days of paid time off (currently making 335k for 1296 annual hours vs 320k for 1432 hours)
- better insurance and lower out of pocket premiums for benefits
- pension at age 57
- slightly better employer tsp match
- boluses of 6-10 patients per hour are very hard at critical access when it’s just you.
- less nights (current job only has AM or PM shifts with 50% split. VA job has 8 shifts a day with only 1 true over night from 7 pm to 7 am. So much less pure over night shifts will get replaced by a bunch of mid day shifts).
- No lawsuits, though granted i live in a great malpractice state.
- cost of living salary increases every year based on inflation and every 2 years a ‘step’ adjustment which is some 4k more. This cola adjustment in 5 years might in fact mean the VA income becomes higher per hour than current job in 5 years, assuming the other stays stagnant.
- 55 days of paid time off, so no making up for shifts after a vacation.
- paid time off of 55 days itself results in another 6 shifts of paid time off, so in reality, 1 year of work gets you 3.5 months of paid time off.

The docs there genuinely seem happy. So yeah…genuinely considering a move.

That sounds pretty nice. I'd take a paycut to not see any OB or peds. Also no lawsuits and pension after 57 is nice. Would probably consider it if I'm still interested in working in 8 years and have enough for retirement.

 

[endo]

A couple of things:

There is some conversion factor for pph VA vs community. For me, my avg 2 pph in the community and 1pph at the VA feel about the same, as the EMR and general obstruction to forward movement at VA is challenging.

You have to adapt to VA culture / bureaucracy. You can’t change it and it can drive you crazy if you let it.

There are still a few markedly subpar docs at the VA which I don’t see as much of in the community.

 

[cyanide12345678]

That sounds pretty nice. I'd take a paycut to not see any OB or peds. Also no lawsuits and pension after 57 is nice. Would probably consider it if I'm still interested in working in 8 years and have enough for retirement.

That’s the thing, i just have to get over the mental hurdle of a pay cut and 1 extra shift per month.

But otherwise we’re almost at a point of financial independence - 2.6m net worth already. Even with the paycut, family income would remain around 700k in reality (320k, plus wife’s 260k, plus passive income streams between real estate syndications, Amazon and Walmart generating some 100-130k). Our expenses are just 120k now that one kid only goes to day care (soon to be 0 in 3 years). We’re honestly 2 years away from hitting our 4% rule number.

The downsides to the VA gig are:
1) cprs
2) 10 monthly shifts on average rather than my current 9 (which ruins my plans For going down to 8 shifts next year since they’re exclusive hiring 1.0 fte right now.
3) lower income per hour
4) loss of access to 457 so one less tax deferred bucket

 

[cyanide12345678]

A couple of things:

There is some conversion factor for pph VA vs community. For me, my avg 2 pph in the community and 1pph at the VA feel about the same, as the EMR and general obstruction to forward movement at VA is challenging.

You have to adapt to VA culture / bureaucracy. You can’t change it and it can drive you crazy if you let it.

There are still a few markedly subpar docs at the VA which I don’t see as much of in the community.

Agreed. That’s what i keep hearing

 

[cyanide12345678]

I'm sold. I say go for it. VA has always been an option for me and I hear it's a complete elephant graveyard for EM docs and for good reason. Low acuity, better schedule, etc.. The only reason I've avoided it is due to the hour requirements for FT. I'm also in my 50s so I lose out on all the benefits and extra pension I'd get if I had started sooner. So, not really an option for me anymore but in your situation....I say go for it. The 1h less driving is huge btw closely followed by the 1.2pph + sovereign immunity.

Actually the way I’m understanding things, joining in your 50s is the best time for most efficient return on your time investment at the va.

You just do 5 years, get a small 15k/year pension at 57 and you retire with 5 or so years (I’m not sure if you absolutely need 10 years for the pension, i think minimum is 5), no waiting around to get that pension, and most importantly you continue VA subsidized healthcare insurance premiums from 57 to 65 until you hit Medicare age. To get that subsidized insurance rate you just need 5 years of service. And those 5 years essentially get you 8 years of extra 15k/yr from the government towards your benefits.

That’s my understanding.

 

[Groove]

Actually the way I’m understanding things, joining in your 50s is the best time for most efficient return on your time investment at the va.

You just do 5 years, get a small 15k/year pension at 57 and you retire with 5 or so years (I’m not sure if you absolutely need 10 years for the pension, i think minimum is 5), no waiting around to get that pension, and most importantly you continue VA subsidized healthcare insurance premiums from 57 to 65 until you hit Medicare age. To get that subsidized insurance rate you just need 5 years of service. And those 5 years essentially get you 8 years of extra 15k/yr from the government towards your benefits.

That’s my understanding.

You've made me curious. I'm backing down to 100 hours next year and had anticipated quitting entirely in 3 to 5 so that pension and benefits doesn't actually sound very bad to someone like me, especially with that 1.2pph. I'm going to reach out to our local VA and do some more research.

AI seems to think the pension is life long upon retirement. Is that true?

 

[cyanide12345678]

You've made me curious. I'm backing down to 100 hours next year and had anticipated quitting entirely in 3 to 5 so that pension and benefits doesn't actually sound very bad to someone like me, especially with that 1.2pph. I'm going to reach out to our local VA and do some more research.

AI seems to think the pension is life long upon retirement. Is that true?

Yes, until you die.

There may even be a survivor benefit.

If you live to 80, that’s 23 years of pay out.

I on the other hand, if i work 10 years, then I’m 47, then i have to wait 10 years before i can get my pension from the VA. So from a mathematical stand point, im better off making a higher income and investing that higher income in sp500, and letting time compound my returns, because by 20 years, the lower income plus the fact that I’m paying 4.4% of salary into my pension, likely was worse off than my investing equivalent funds in sp500.

I think 47 is likely the perfect age to join the VA. I wouldn’t hesitate as much if i was a decade older.

 

[HoosierdaddyO]

So a GS physician is essentially as someone stated above the civilian physician that works for the government…you’re a federal employee with all the federal benefits. However, there are two sides to being a federal physician. There is the VA and then also the department of the Defense where you essentially work at a military treatment facility think of BAMC, Madigan, Walter Reed and there are otherwise plenty smaller more community-eqsue military hospitals. Pay is anywhere from 300-345 per year. The hours are pretty legit usually about 130 hours of clinical time however there are 11 federal holidays in a year and you get a shift reduction essentially for every federal holiday so that brings you down to about 120 hours per month, but you also get your federal leave and your sick leave which a cruise pretty significantly in overtime. You can start taking one maybe two shifts off each month as that progresses. Patient population is amazing. You see women you see the elderly retired and their spouses, and you see otherwise young healthy individuals but there’s a fair amount of acuity. The pension and benefits are amazing and it’s not the VA. Your skills aren’t gonna absolutely die. I genuinely think it’s the golden secret of emergency medicine to work for a department of defense as a GS physician in the ER. Ohhh plus it gets you out of the BS rat race dealing with the worst of society day after day. Longer term happiness for sure.

Happy to answer questions about this unicorn of a job for ER docs.

 

[Apollyon]

The one thing no one has mentioned is that, bar none, the patient base is the best and most grateful you'll ever have. You will love those pts, and they will love you back. Also. American heroes.