Being a VA physician?

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Not a VA doc but had considered a couple VA positions in the mix when looking this last year. Many of the pros/cons already discussed here. I’ll add one more minor headache - I couldn’t get an official salary offer number until going through the whole hiring process.

There’s also an old adage: if you’ve seen one VA, you’ve seen….one VA. The variance between them can be staggering. Even at the same VA, things can depend heavily on your particular admins. Yes this is the case everywhere, but the level of bureaucracy makes it especially onerous. I watched a great attending quit in frustration after building our service line into the best in the VA system and winning national recognition for it; the person who replaced them had it much easier because the higher ups finally relented on the issues that drove the first one away.

For ENT the numbers starting seemed to be in the 275-325 range. Comparable to many academic jobs, yet much lower than PP. The benefits are legit though, and combining their 401k match with pension plus social security can end up being a pretty nice deal especially with lifetime health insurance.
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operaman said:
Not a VA doc but had considered a couple VA positions in the mix when looking this last year. Many of the pros/cons already discussed here. I’ll add one more minor headache - I couldn’t get an official salary offer number until going through the whole hiring process.

There’s also an old adage: if you’ve seen one VA, you’ve seen….one VA. The variance between them can be staggering. Even at the same VA, things can depend heavily on your particular admins. Yes this is the case everywhere, but the level of bureaucracy makes it especially onerous. I watched a great attending quit in frustration after building our service line into the best in the VA system and winning national recognition for it; the person who replaced them had it much easier because the higher ups finally relented on the issues that drove the first one away.

For ENT the numbers starting seemed to be in the 275-325 range. Comparable to many academic jobs, yet much lower than PP. The benefits are legit though, and combining their 401k match with pension plus social security can end up being a pretty nice deal especially with lifetime health insurance.
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Funny you say that, all the uni residents and fellows agreed the other VA sites they experienced in other med schools/residencies had the exact same fundamental cultural problem. There is just zero motive for anyone to try hard or excel at their job. Everyone ranges from dangerously incompetent (e.g. admin threw out residents' credentials so they couldn't get into the EMR on their first ICU call shifts) to competent but unwilling to take any work they could otherwise dodge (e.g. psych service refusing to take patient whose only active issue was suicidality, because the psych nurses "aren't comfortable administering [home PO beta blocker]"

There might be different degrees of bad but I don't believe there's any VA out there where the staff and docs treat their work similarly to private or high quality academic systems. It's the reason the VA gets away with poor pay, the benefits are nice of course but the real unspoken tradeoff is that you get paid less but will also exert yourself way less and will never lose the job.
 
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efle said:
VAs suck. Like, universally. There is no financial incentive to provide efficient or high quality care, and there is no threat of losing your job for being terrible at it.

No carrot. No stick. People sit around trying to do as little work as possible.

I cannot emphasize enough how horrible this makes the entire culture. Actual example: Nurse busy making personal calls and texting all day lets pressor bag run out for critically ill intubated patient, only notices when I stop by and bring to their attention patient MAP is tanked to 50, for god knows how long.

That kind of thing is business as usual for the VA, if I was part of a hospital or group's hiring process I would consider a long period of VA employment to be a black mark against anybody. The culture and quality of VA care is just so shockingly bad that I don't think I'd want to work with anybody who willingly immersed themselves in it.
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The running joke when we are rotating at our VA is that physician orders become physician suggestions, regardless of how critical the order is.
 
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efle said:
Funny you say that, all the uni residents and fellows agreed the other VA sites they experienced in other med schools/residencies had the exact same fundamental cultural problem. There is just zero motive for anyone to try hard or excel at their job. Everyone ranges from dangerously incompetent (e.g. admin threw out residents' credentials so they couldn't get into the EMR on their first ICU call shifts) to competent but unwilling to take any work they could otherwise dodge (e.g. psych service refusing to take patient whose only active issue was suicidality, because the psych nurses "aren't comfortable administering [home PO beta blocker]"

There might be different degrees of bad but I don't believe there's any VA out there where the staff and docs treat their work similarly to private or high quality academic systems. It's the reason the VA gets away with poor pay, the benefits are nice of course but the real unspoken tradeoff is that you get paid less but will also exert yourself way less and will never lose the job.
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It’s like the old joke: what’s the difference between a VA nurse and a bullet?

A bullet only kills one person at a time and a bullet will actually draw blood
 
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I can't imagine working at the VA. It feels like being constantly boxed into a corner in an infinite number of ways.
 
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Our local VA is paying Rads like 350 + small bonus. Problem with VA is if you get hired, you have a job for life so lots of lazy low productive employees from the Chief to RNs. Everybody tries to dump work on each other. Can't get rid of the dead wood. Not a culture I would thrive in.
 
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operaman said:
It’s like the old joke: what’s the difference between a VA nurse and a bullet?

A bullet only kills one person at a time and a bullet will actually draw blood
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Another I heard: A bullet can be fired

Lowkey though, some crazy stories were passed around. I know at least a few are true because they led to absurd policies the residents now deal with daily. PM me if you want specific examples, they're nuts
 
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Not all VAs are created equal either. Some are run horrendously and others do significantly better. The VA I worked at as a resident was a crap show. The psychologists ran the mental health department and had so many policies and crazy rules that doing a simple new patient could take nearly two hours. Which is not ideal when they schedule like 20 people on your schedule.

The benefits do seem legit. A 5% retirement match is higher than anywhere ive seen
 
My wife is a family practice physician, been there for 4 years. All I can say is that they are burning her out. She pulls all-nighters just to keep on top of her "alerts".. sometimes as many as 100 a day. And if you get behind you get reprimanded. If you like that kind of crap then go work for them, they have a high attrition rate, why not be part of the cycle?
 
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Historically, the VA was mostly for older docs who were getting closer to retirement and wanted to cut back, or those who were just slow/inefficient and couldn't keep up with the fast pace of PP, and didn't mind having to deal with all the government bureaucracy. Depending on your specialty, as a physician you're probably taking anywhere from a $100-200k pay cut per year from what you may make in the private sector. In exchange have better job stability and and in most cases a cushier schedule with lower productivity requirements. It also seems to be a more attractive option for when a specific specialty facing a poor job market; when that happens the pay difference between the VA and the private sector becomes much smaller. And nowadays, I also see physicians who want more work/life balance work there, as well as those with large medical student debt and want to go for PSLF.

It does seem to be a better deal for other healthcare professionals especially midlevels and pharmacists since the pay difference for them working for the VA versus the private sector is much smaller while they still have a much lighter workload at the vA.
 
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THe VA is a corrupt bureaucratic wasteland
 
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Matthew9Thirtyfive said:
Translation: my limited experience has shaped an opinion that I now believe to be fact despite the experiences of others.

Got it.

Cue another “they are all the same dude” post.
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Dude all of the posts are the same, dude
 
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efle said:
What's the difference? Do some other VA sites actually fire people for half-assing their job or pay based off productivity?
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There are VAs where most of the people working there actually want to be there, so the amount of people half-assing their jobs and rising a GS job because they can’t work in a real setting is fairly small. I’ve been to VAs where the patient population mostly really enjoys their experience and the people working there are there on purpose.

Unfortunately it’s a minority. Most of them seem to be black holes of bureaucratic red tape and stone cold killers. But there are diamonds in the rough.
 
Rather than relying on the impressions of one physician at one VA hospital it might be wise to look at the reports issued by the Government Accountability Office (GAO) regarding the Veterans Administration's Health Services. Here are a few.
www.gao.gov

Veterans Health Care: Addressing High Risk Concerns for Oversight and Accountability Are Key to Ensuring Quality of Care and Patient Safety

We testified about the Department of Veterans Affairs' ongoing struggles to oversee its health care system, including its ability to provide quality...
www.gao.gov www.gao.gov
www.gao.gov

VA Health Care: Efforts Needed to Ensure Effective Use and Appropriate Staffing of Suicide Prevention Teams

An average of 18 veterans died by suicide each day in 2018. As a result, suicide prevention is the top clinical priority for the Department of...
www.gao.gov www.gao.gov
www.gao.gov

Veterans Health Administration: Regional Networks Need Improved Oversight and Clearly Defined Roles and Responsibilities

The Veterans Health Administration expects to provide medical care to more than 7 million veterans this year. It uses 18 regional networks to manage...
www.gao.gov www.gao.gov
 
Obnoxious Dad said:
Rather than relying on the impressions of one physician at one VA hospital it might be wise to look at the reports issued by the Government Accountability Office (GAO) regarding the Veterans Administration's Health Services. Here are a few.
www.gao.gov

Veterans Health Care: Addressing High Risk Concerns for Oversight and Accountability Are Key to Ensuring Quality of Care and Patient Safety

We testified about the Department of Veterans Affairs' ongoing struggles to oversee its health care system, including its ability to provide quality...
www.gao.gov www.gao.gov
www.gao.gov

VA Health Care: Efforts Needed to Ensure Effective Use and Appropriate Staffing of Suicide Prevention Teams

An average of 18 veterans died by suicide each day in 2018. As a result, suicide prevention is the top clinical priority for the Department of...
www.gao.gov www.gao.gov
www.gao.gov

Veterans Health Administration: Regional Networks Need Improved Oversight and Clearly Defined Roles and Responsibilities

The Veterans Health Administration expects to provide medical care to more than 7 million veterans this year. It uses 18 regional networks to manage...
www.gao.gov www.gao.gov
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They're all the same dude!
 
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Have you guys ever been to VA Palo Alto? They have sushi in the cafeteria!

Edit: Vs VA Spokane....they don't even really have neurology.
 
"Michael E. DeBakey Veterans Affairs (main campus) in Houston, TX has an opening for a body, chest, or msk radiologist due to retirement and scanner expansion. Great work life balance job with super colleague staff always available for consults or back up.

Mixed studies ranging from body/msk MR, general, oncologic, ultrasound and radiographs depending on skill set. No nuclear, breast or neuro required. Light procedures including fluoroscopy and arthrograms (shoulders/hips - msk rads will handle small joints). Teaching staff to Baylor College of Medicine radiology residents.

Working hours 8am-4:30 pm Monday-Friday. After hours/weekends/holidays staffed by combination of fellows and NTP Teleradiology.

PTO includes 26 annual leave days, 13 sick days, 11 federal holidays, and 5 cme (55 days/11 weeks). Excellent health care and retirement benefits.

Salary range 320-350 with eligibility for 15k performance bonus. No internal moonlighting currently however no restrictions on external moonlighting. No non compete clause."

Reposted from another message board.
 
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Zitibake said:
Hi everyone! I was interested in possibly working at a VA in my future after residency. This is something I have been interested in/looking into for a while and I am planning on shadowing and possibly getting involved with volunteering at a facility to further explore this option. I wanted to ask some questions about what it is like being a physician in the VA.

Mainly, I have had trouble finding info on what physicians are paid as a VA employee right out of residency. Online I was able to find documents/pay schedules and I was a bit confused, as many salaries/pay grades seem to vary and a some salaries were very low (around 100k). I'm not sure if I'm missing something here/misunderstanding, so I wanted to ask how VA physicians are paid and if there is a place I can find out more information about this/view these salaries. As someone with a considerable amount of student debt this is something I will need to be mindful of for my/my family's future. I'm not sure if this makes a difference, but I am considering anesthesia as a specialty at the moment.

Also, does anybody have insight on if working at the VA makes you a marketable candidate for employment in a private practice or private hospital system? I don't plan on leaving where I am hired, but wanted to keep this in mind as I move forward so I don't limit my options.

If anyone has insight I'd also like to know what the work environment is like. I am planning on shadowing so I'll find this out myself, but I thought I'd ask.

Thanks!
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Va primary care is 200 to 220k depending on loc right out the box. Thats usually with 6 weeks paid vacation and partial pension vested at 5 years. Not the worst deal ever, but then you have to deal with the VA admins/office support staff which can be close to the worse deal ever. In my VA away I could see the attendings still having to fill out there own PAs like they were residents. Definitely has some cons.
 
DrPembleton said:
Relatively new VA attending. $260Kish base + up to $15K bonus yearly at a Midwest facility doing about 25 patient contact hours weekly. There is a base pay based on your grade, but there is a COLA adjustment--the majority of my pay is actually COLA adjustment. People are right that there is a lot of bureaucracy attached to the VA, but that's what the other 15 hours are for. Their EMR (CPRS) is a dinosaur, but various facilities are switching to Cerner, though I have mixed feelings about that platform too. Could the pay be better? Sure, but I'm glad to have a stable, salaried job with a reasonable patient load whereas a few of my co-residents had their job offers rescinded due to COVID or are getting grinded down by unreasonable case load.

Edit: I forgot to mention, great benefits. Up to 5% match on their 401K equivalent, which is an additional $13K free annually for me. There's also a pension that's calculated as 1% * average of highest 3 salary years * # of years worked.
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Be fearful of the VAs version of Cerner. I will give you a hint: it isnt the Cerner your remember from med school, its the Dx spec with all the features removed and then customized by an army of trained monkeys to add as many clicks as possible to documentation while still requiring significant typing.
 
Matthew9Thirtyfive said:
When you’ve seen one VA, you’ve seen one VA. They do not universally suck. Many of them have a lot of problems. There are some fantastic VAs.
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I havent seen a fantastic VA yet, but I agree that each one is a little different.
 
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BorntobeDO? said:
I havent seen a fantastic VA yet, but I agree that each one is a little different.
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I can only speak for the care I receive and a short rotation through it last year but the Minneapolis VA hospital is pretty great. I've always received good care, all the patients I saw were very appreciative of the care they received, and every physician spoke highly of working there.

I will add that in my experience Minnesota has been a strong supporter of their veterans. That may help explain why it's VA health system is strong.
 
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Like any government job, probably very low stress but also not many opportunities for advancement. Lower than market pay but benefits that probably compensate for the lower pay.

I heard the house of reps just passed a bill making it even harder to fire government employees. Not sure if this applies to VA, but if it does, could probably do anything short of gross malpractice and keep job
 
voxveritatisetlucis said:
Like any government job, probably very low stress but also not many opportunities for advancement. Lower than market pay but benefits that probably compensate for the lower pay.

I heard the house of reps just passed a bill making it even harder to fire government employees. Not sure if this applies to VA, but if it does, could probably do anything short of gross malpractice and keep job
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I mean in my experience working at any large corporation, it's almost impossible to get fired...even with sexual harassment allegations, so although it is true its very hard to get fired, I don't think that should really be a driving factor in whether or not you work for the VA because odds are it's not easy to be fired at any large healthcare facility.

I just did a rotation in Montana, and yeah, low stress due to patient load but also low stress because of the incredibly effective integration of mental health services and social work. On top of that, almost ZERO stress of "Oh god, my patient needs X,Y, and Z can I get insurance to cover it?" because it's pretty much all covered.

The VA isn't for everyone. Their physician salary isn't the highest but it really isn't the lowest either, plus the benefits are awesome. There is plenty of opportunity for advancement, in the same way, there is any other hospital (taking more administrative roles). The patient population isn't the most diverse, although it is definitely getting much more diverse (ie not just Vietnam Vets anymore). Maybe because I am also a patient in the VA system, but it was an awesome experience for me and I highly encourage anyone else to at least try it out.
 
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Doctorswithborders013 said:
I mean in my experience working at any large corporation, it's almost impossible to get fired...even with sexual harassment allegations, so although it is true its very hard to get fired, I don't think that should really be a driving factor in whether or not you work for the VA because odds are it's not easy to be fired at any large healthcare facility.

I just did a rotation in Montana, and yeah, low stress due to patient load but also low stress because of the incredibly effective integration of mental health services and social work. On top of that, almost ZERO stress of "Oh god, my patient needs X,Y, and Z can I get insurance to cover it?" because it's pretty much all covered.

The VA isn't for everyone. Their physician salary isn't the highest but it really isn't the lowest either, plus the benefits are awesome. There is plenty of opportunity for advancement, in the same way, there is any other hospital (taking more administrative roles). The patient population isn't the most diverse, although it is definitely getting much more diverse (ie not just Vietnam Vets anymore). Maybe because I am also a patient in the VA system, but it was an awesome experience for me and I highly encourage anyone else to at least try it out.
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VA is a dump and should be shut down. It will never be fixed. Shut it down. All qualified vets should be placed on medicare or its equivalent
 
IT was a while ago but I worked/did a residency in a VA. A large part of it was anesthesia and the OR in surgeries. I feel grateful I had that time. It was attached to a large academic center and I do think it makes a difference. Everyone's comments have merit. The young me was ready to get out and not deal with all the red tape, some unmotivated employees, and prove to myself I could thrive in the private sector . IT is a great learning atmosphere as most vets are laid back, used to having to wait and wait, a lot have interesting stories. That part is great. Money in any capacity is not part of the equation so that eliminates a big stress issue for everyone.

If you are an amateur historian, there is a real fringe benefit of having the time to talk to your patient. Because of the particular VA I was in, I really felt like the vets got pretty decent care and most of the vets felt the same way. Sure there were some services where they had to wait forever .

Buzzwords like lifestyle positions were not around back in the day. But working in the VA sure is relaxing if you can mentally give up a lot of things like control and realize that your salary is your salary. IF you are a nutcutter who wants to make bank, obviously the VAMC is not for you.

I could even see working there as a semi-retired job. In summary, it depends what you want and who you are. It could drive you batty or be heaven. This is written with years of perspective of course. YMMV
 
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Here's a pretty decent link that provides some good info on pay and benefits.

issuu.com

Total Rewards of VA Employment Brochure - Physicians Careers

As a physician at the U.S. Department of Veterans Affairs (VA), you have more than a job — you have a mission to serve Veterans who’ve borne the battle with honor. In carrying out this mission, you’ll discover a career with competitive pay, opportunities for growth and mobility, a wealth of...
issuu.com issuu.com

I rotated at a VA in med school and worked at one throughout residency. I'm also a psychiatrist. I thoroughly enjoyed my time at the VA and working with vets. I plan to work at the VA once my active duty service commitment is completed (next year woo hoo!). At least for psychiatrist, the pay isn't that bad and the benefits are great. In residency, all the psychiatrist I worked with loved it and worked hard to provide good care for their patients. Many of them were also prior service so likely used to the bureaucracy, most said it was even less than active duty red tape/bureaucracy...

As a psychiatrist most pay I've seen is in the 230-240K range. There's one currently near where I'm located that's offering 270-280K. You get bumps in pay every few years and then 15K bonus is supposedly pretty easy to hit. Many of the docs I've worked with moonlight on weekends and seems you can pretty easily clear 300K. Most positions offer loan repayment of 200K over 5 years. The benefits are pretty top notch. The VA in San Antonio seemed to provide pretty solid care as a whole for veterans again lending credence to the often quoted phrase "if you've seen one VA, you've seen one VA."

VA Hopeful Dr said:
I've never actually worked for the VA, the VA in my username is for the state of Virginia
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lol as many others thought, I totally assumed you had been hopeful and were likely now working for the VA...
 
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