Best Employers for Psychiatrists 2026

[TerraceHouse]

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Anybody work for companies/organizations that they're really happy about and would like to share/recommend? I've actually positive reviews about the VA lately despite the known paperwork, tour of duty, bureaucracy stuff. Seems like the low volume compared to private sector wins out in a lot of ways. Surprised to find Kaiser with more positive reviews despite hearing how stressful it can be to have to answer to all of the eMessages.

 

[comp1]

Yes, VA. Time from recruitment to starting with patients is now 30 days and of course any state license is good anywhere. $200k loan payback, pro rated over 5 years. 10 holidays, 26 vacation days, 5 CME, 13 sicks days accruing from day 1. $15,000 annual bonus that is generally easy to achieve. The $1000 annual for CME is kind of silly, but it is still there by Congressional statute. Some places have hiring and relocation incentives (slightly rare). Resident/med student supervision without the university paycut. And the literal mean salary of whatever the geographic area; it has to be re-proven and adjusted (up) every 2 years by the local admin. There's no negotiation about salaries because it's not a local decision or pulled out of some local pot, it just is what it is based on the local average. No limits on moonlighting outside your tour of duty. No billing/insurance and you can generally get patients whatever level or sort of care you want with minimal fuss. If there isn't a VA job posted next to you on usajobs.gov, reach out to the recruiter of the job that is closest to you and there probably is one where you want. With the new 30 days to start, job postings have to be pulled and reposted very regularly. However, physicians (and nurses) can always be hired non-competitively, ie not from a job posting.

 

[TerraceHouse]

Yes, VA. Time from recruitment to starting with patients is now 30 days and of course any state license is good anywhere. $200k loan payback, pro rated over 5 years. 10 holidays, 26 vacation days, 5 CME, 13 sicks days accruing from day 1. $15,000 annual bonus that is generally easy to achieve. The $1000 annual for CME is kind of silly, but it is still there by Congressional statute. Some places have hiring and relocation incentives (slightly rare). Resident/med student supervision without the university paycut. And the literal mean salary of whatever the geographic area; it has to be re-proven and adjusted (up) every 2 years by the local admin. There's no negotiation about salaries because it's not a local decision or pulled out of some local pot, it just is what it is based on the local average. No limits on moonlighting outside your tour of duty. No billing/insurance and you can generally get patients whatever level or sort of care you want with minimal fuss. If there isn't a VA job posted next to you on usajobs.gov, reach out to the recruiter of the job that is closest to you and there probably is one where you want. With the new 30 days to start, job postings have to be pulled and reposted very regularly. However, physicians (and nurses) can always be hired non-competitively, ie not from a job posting.

That's awesome. Thanks for this info. From what I've heard/read, overall sentiment seems to be trending positive working for VA as a psychiatrist.

 

[NeedAdvicelol]

I'm not sure what the job market is like where you're looking, but it may be more helpful to first list out the types of arrangements you want to avoid and then go from there. Many times you may have an ideal setup in mind, then poke around and realize that what you're looking for does not exist in your target area. For me, it’s less about which organization is considered good per se, but what exact role within an organization.

Generally speaking, I usually avoid telehealth companies or large organizations that are VC or PE backed. Have many friends who worked for them and most are burning out (even in ones with 30min followups), realizing the only thing management really cares about is profit (veiled in gimmicks like "improving access" or "patient satisfaction" etc.) Not sure about Kaiser's structure but I think they are non-profit, which is more principled on paper. However definitely do your research as many of them are run like for-profit entities these days. I heard they work you a bit harder, but the comp fairly reflects the work.

There is a saying that if you've seen one VA, you've seen one VA. There are roles you’d want to pass on and roles that are a better fit depending on your personal goals. Might be lower volume on paper, but you have to understand often you end up doing more work per patient due to the bureaucracy. Every VA is different, and a GS 15 with the same role description at one VA can work twice as much (or less) compared to a similar role at another. I think their payment system is tiered/adjusted and usually ends up being slightly below market rates, but might be worth looking at especially if you have loans.

The best roles are rarely posted and usually fill internally. Its rarely generalizable to say one org consistently offers better arrangements than another. For instance, during my residency, the outpatient attending role always had openings since it was a high volume high acuity grind. However, the PHP role was always filled since it was slower paced and resident run, meaning less notes/dealing with hassles for the attending. You find these better roles usually through connections or internally at a place you're already working at. Maybe from that standpoint it's better to join a hospital system in the beginning, stick around to see what opens up and snatch it if it's good. That being said, there are lucky people who land their ideal job right off the bat and I hope that happens to you. Good luck.

 

[TerraceHouse]

I'm not sure what the job market is like where you're looking, but it may be more helpful to first list out the types of arrangements you want to avoid and then go from there. Many times you may have an ideal setup in mind, then poke around and realize that what you're looking for does not exist in your target area. For me, it’s less about which organization is considered good per se, but what exact role within an organization.

Generally speaking, I usually avoid telehealth companies or large organizations that are VC or PE backed. Have many friends who worked for them and most are burning out (even in ones with 30min followups), realizing the only thing management really cares about is profit (veiled in gimmicks like "improving access" or "patient satisfaction" etc.) Not sure about Kaiser's structure but I think they are non-profit, which is more principled on paper. However definitely do your research as many of them are run like for-profit entities these days. I heard they work you a bit harder, but the comp fairly reflects the work.

There is a saying that if you've seen one VA, you've seen one VA. There are roles you’d want to pass on and roles that are a better fit depending on your personal goals. Might be lower volume on paper, but you have to understand often you end up doing more work per patient due to the bureaucracy. Every VA is different, and a GS 15 with the same role description at one VA can work twice as much (or less) compared to a similar role at another. I think their payment system is tiered/adjusted and usually ends up being slightly below market rates, but might be worth looking at especially if you have loans.

The best roles are rarely posted and usually fill internally. Its rarely generalizable to say one org consistently offers better arrangements than another. For instance, during my residency, the outpatient attending role always had openings since it was a high volume high acuity grind. However, the PHP role was always filled since it was slower paced and resident run, meaning less notes/dealing with hassles for the attending. You find these better roles usually through connections or internally at a place you're already working at. Maybe from that standpoint it's better to join a hospital system in the beginning, stick around to see what opens up and snatch it if it's good. That being said, there are lucky people who land their ideal job right off the bat and I hope that happens to you. Good luck.

Thank you. This makes sense. Perhaps I asked the way I did because I tend to categorize the orgs and cluster them this way from what I've seen per job postings:
For profit health system - usually HCA, UHS, Lifepoint (___ Springs)
Government - VA, active duty/reserve military branch, prison system or state hospital
PE/VC type of telehealth - mindcare, talkiatry, headspace, included health, iris, etc
PE/VC type of outpatient or TMS centered practices - mindful health, serenity
Academics - university based systems

Anyone seeing or heard of jobs (perhaps even if not posted but rather filled internally) that don't fit into these categories? They seem to make up most of the stuff I see on linkedin.

Also, what roles / setting are most psychiatrists finding themselves NOT burnt out and really happy in?

 

[NeedAdvicelol]

Thank you. This makes sense. Perhaps I asked the way I did because I tend to categorize the orgs and cluster them this way from what I've seen per job postings:
For profit health system - usually HCA, UHS, Lifepoint (___ Springs)
Government - VA, active duty/reserve military branch, prison system or state hospital
PE/VC type of telehealth - mindcare, talkiatry, headspace, included health, iris, etc
PE/VC type of outpatient or TMS centered practices - mindful health, serenity
Academics - university based systems

Anyone seeing or heard of jobs (perhaps even if not posted but rather filled internally) that don't fit into these categories? They seem to make up most of the stuff I see on linkedin.

Also, what roles / setting are most psychiatrists finding themselves NOT burnt out and really happy in?

Locums can be its own category. Essentially you’re filling in for a hard to fill slot (can be any setting), but the catch is they pay you hourly instead of a salary. So no benefits. But the hourly rate is usually higher than what you’d get as a W2 to make up for it.

Internal or non-advertised roles often times are management-based, where you take on less clinical duties and more supervisory or policy making. They’re competitive to get since you’re often paid more than a pure clinical staff, yet have less heavy lifting to do.

Another category you’re missing is physician-owned private or group practices. They’re usually outpatient and can vary a lot, very much practice based. But I’ve seen some good arrangements where you’re paid a direct proportion of collections, assuming you maintain a certain caseload. Much more fair than telehealth orgs with a murky reimbursement system.

The best jobs are never on LinkedIn or any job hosting sites. These sites usually charge the HR dept to post and well, if you have to pay to advertise a spot that says something about its desirability. Better to look at internal sites than these conglomerates (I.e some health systems own physician recruitment site)

 

[TerraceHouse]

Locums can be its own category. Essentially you’re filling in for a hard to fill slot (can be any setting), but the catch is they pay you hourly instead of a salary. So no benefits. But the hourly rate is usually higher than what you’d get as a W2 to make up for it.

Internal or non-advertised roles often times are management-based, where you take on less clinical duties and more supervisory or policy making. They’re competitive to get since you’re often paid more than a pure clinical staff, yet have less heavy lifting to do.

Another category you’re missing is physician-owned private or group practices. They’re usually outpatient and can vary a lot, very much practice based. But I’ve seen some good arrangements where you’re paid a direct proportion of collections, assuming you maintain a certain caseload. Much more fair than telehealth orgs with a murky reimbursement system.

The best jobs are never on LinkedIn or any job hosting sites. These sites usually charge the HR dept to post and well, if you have to pay to advertise a spot that says something about its desirability. Better to look at internal sites than these conglomerates (I.e some health systems own physician recruitment site)

Super helpful

 

[Stagg737]

There is a saying that if you've seen one VA, you've seen one VA. There are roles you’d want to pass on and roles that are a better fit depending on your personal goals. Might be lower volume on paper, but you have to understand often you end up doing more work per patient due to the bureaucracy. Every VA is different, and a GS 15 with the same role description at one VA can work twice as much (or less) compared to a similar role at another. I think their payment system is tiered/adjusted and usually ends up being slightly below market rates, but might be worth looking at especially if you have loans.

This. Some VAs are fantastic. I have former co-residents who love their VA jobs. Meanwhile the VA in my city is continuously short-staffed and has had 3 different outpatient directors in the past 4 years. The last one who quit left and is employed by Talkiatry and says it's 1000% percent better. That VA has actually had 3-4 attendings leave for Talkiatry and all of them feel Talkiatry is significantly better. Take that how you will.

And the literal mean salary of whatever the geographic area; it has to be re-proven and adjusted (up) every 2 years by the local admin. There's no negotiation about salaries because it's not a local decision or pulled out of some local pot, it just is what it is based on the local average.

The VA has some great perks, but this is one of those things that's "true" per the source they use but completely false in reality. Our local VA salary is ~260k/yr. Other than the VA, there is only one practice/location in the city that I'm aware of paying less than $275k and I know our local landscape very well. The VA says salaries are "the literal mean", but the sources they use to determine that (often BLS) are quite off.

The best jobs are never on LinkedIn or any job hosting sites. These sites usually charge the HR dept to post and well, if you have to pay to advertise a spot that says something about its desirability. Better to look at internal sites than these conglomerates (I.e some health systems own physician recruitment site)

Again, this. The jobs that are posted are almost never the desirable ones and a good amount of our residents who go outpatient find their employment by calling practices up and asking if there is available space for them to start there. They typically make significantly more than those who just search for job postings and get employed (I'm talking $50k-$100k difference).

Thank you. This makes sense. Perhaps I asked the way I did because I tend to categorize the orgs and cluster them this way from what I've seen per job postings:
For profit health system - usually HCA, UHS, Lifepoint (___ Springs)
Government - VA, active duty/reserve military branch, prison system or state hospital
PE/VC type of telehealth - mindcare, talkiatry, headspace, included health, iris, etc
PE/VC type of outpatient or TMS centered practices - mindful health, serenity
Academics - university based systems

Anyone seeing or heard of jobs (perhaps even if not posted but rather filled internally) that don't fit into these categories? They seem to make up most of the stuff I see on linkedin.

Also, what roles / setting are most psychiatrists finding themselves NOT burnt out and really happy in?

There's also several companies that run residential or PHP/IOP programs across multiple states. Typically for-profit places but not necessarily PE style ownership and often have some kind of substance or dual diagnosis angle. Our metro area has 2 which have locations in 2-3 different non-adjacent states. Can DM an example if you want.

 

[comp1]

If you really believe the salary is significantly lower than the local average, you can bring your evidence to the system's chief psychiatrist and they can include it in the biannual review. Making sure the salary is average really is a serious deal; it's required by law and every system is of course motivated to get the salary as high as they can. I am not saying every VA does this perfectly, but unlike negotiation of individual salaries, this is something that can be addressed relatively easily if the data is there at the biannual review. It doesn't have to come from BLS if something demonstrably better is out there. All that said, BLS data is not complete junk and has some basis in reality. I find that people's eyes tend to get drawn to high salaries, but not as much the lower ones.

 

[DareGreatly]

If you really believe the salary is significantly lower than the local average, you can bring your evidence to the system's chief psychiatrist and they can include it in the biannual review. Making sure the salary is average really is a serious deal; it's required by law and every system is of course motivated to get the salary as high as they can. I am not saying every VA does this perfectly, but unlike negotiation of individual salaries, this is something that can be addressed relatively easily if the data is there at the biannual review. It doesn't have to come from BLS if something demonstrably better is out there. All that said, BLS data is not complete junk and has some basis in reality. I find that people's eyes tend to get drawn to high salaries, but not as much the lower ones.

I interviewed with a couple VA systems when I was coming out of residency. One doc told me the biggest thing you have to adjust to in the VA is the undercurrent of how disability ratings affect care/presentation. As in, there is disincentive to materially improve clinically as a patient, and this can affect their motivation to present for treatment to begin with. What is your experience with all of that?

 

[comp1]

I mean it balances out. You get to work with honest to goodness war heroes too. People who enlist in the military tend to come from lower than average socioeconomic strata and tend to have more early life trauma as well. You trust, but verify what patients report. If a patient is understating their recovery or not putting in the effort, you patiently and professionally call them out on it, just like anywhere else. It certainly beats dealing with Social Security Disability by a wide mile and honestly some of that private disability insurance. At least the VA very clearly separates out the role of treating provider (VHA) from the disability rating providers (VBA). It got a lot better when the VA leadership clarified some stuff about recovery and disability ratings too. It is hard to get furious at someone maybe stretching things to get $40k a year in the VA system when you have hospital CEOs getting tens of millions inappropriately in other systems. At least VA leadership cannot make more than the President. I can definitely say it does not reduce motivation to present. The lack of a fee for no shows might, but not disability ratings.

 

[Taddy Mason]

My core outpatient clinic and where I did some other rotations in fellowship was at, what I've been repeatedly told, is one of the BEST VAs to work for in the country. It was absolutely soul sucking and I have no desire to ever have anything to do with the VA for the rest of my career. If it really was one of the best VAs I can't even imagine what the ****ty ones are like...

 

[TerraceHouse]

My core outpatient clinic and where I did some other rotations in fellowship was at, what I've been repeatedly told, is one of the BEST VAs to work for in the country. It was absolutely soul sucking and I have no desire to ever have anything to do with the VA for the rest of my career. If it really was one of the best VAs I can't even imagine what the ****ty ones are like...

Lol what were the soul sucking parts of it

 

[TerraceHouse]

This. Some VAs are fantastic. I have former co-residents who love their VA jobs. Meanwhile the VA in my city is continuously short-staffed and has had 3 different outpatient directors in the past 4 years. The last one who quit left and is employed by Talkiatry and says it's 1000% percent better. That VA has actually had 3-4 attendings leave for Talkiatry and all of them feel Talkiatry is significantly better. Take that how you will.


The VA has some great perks, but this is one of those things that's "true" per the source they use but completely false in reality. Our local VA salary is ~260k/yr. Other than the VA, there is only one practice/location in the city that I'm aware of paying less than $275k and I know our local landscape very well. The VA says salaries are "the literal mean", but the sources they use to determine that (often BLS) are quite off.


Again, this. The jobs that are posted are almost never the desirable ones and a good amount of our residents who go outpatient find their employment by calling practices up and asking if there is available space for them to start there. They typically make significantly more than those who just search for job postings and get employed (I'm talking $50k-$100k difference).


There's also several companies that run residential or PHP/IOP programs across multiple states. Typically for-profit places but not necessarily PE style ownership and often have some kind of substance or dual diagnosis angle. Our metro area has 2 which have locations in 2-3 different non-adjacent states. Can DM an example if you want.

I've heard a good amount of psychiatrists say they like it at talkiatry but I've also had co-residents who left because the pay for the volume just wasn't worth it after a while. You're right, though. Maybe I oughta call up some local private practices and see if they have any openings as it seems like a more fair split. What do you think is normal volume for outpatient in a group practice? Like 15 pts per day?

 

[DareGreatly]

I've heard a good amount of psychiatrists say they like it at talkiatry but I've also had co-residents who left because the pay for the volume just wasn't worth it after a while. You're right, though. Maybe I oughta call up some local private practices and see if they have any openings as it seems like a more fair split. What do you think is normal volume for outpatient in a group practice? Like 15 pts per day?

I mean, if they're paying a split, you should mostly be in control of your schedule. 15 pts a day would be a pretty high volume for outpatient. I would target something more like 8-10 per day to avoid burning yourself out. Of course, what the appropriate volume is depends on the type of patients.

 

[Stagg737]

If you really believe the salary is significantly lower than the local average, you can bring your evidence to the system's chief psychiatrist and they can include it in the biannual review. Making sure the salary is average really is a serious deal; it's required by law and every system is of course motivated to get the salary as high as they can. I am not saying every VA does this perfectly, but unlike negotiation of individual salaries, this is something that can be addressed relatively easily if the data is there at the biannual review. It doesn't have to come from BLS if something demonstrably better is out there. All that said, BLS data is not complete junk and has some basis in reality. I find that people's eyes tend to get drawn to high salaries, but not as much the lower ones.

Why would I bother? I don’t work there and don’t plan to. You look at literally any of the major salary organizations (medscape, merit Hawkins, MGMA, etc) and the average salary in our city is $50k higher than what BLS says. And I’m not talking total compensation. The VA here intentionally keeps it low and points to BLS from what I understand. Part of why they can’t retain outpatient docs other than former military docs dedicated to their veterans. I’m happy to DM more about specifics, but don’t want to name names in thread.

Lol what were the soul sucking parts of it

Writing 3-5 notes for a single encounter, having to do a comprehensive suicide assessment (CSRE) for anyone with passive SI and expecting to stay on schedule, obvious malingering and high rates of ASPD traits/crazy entitlement, patients demanding higher service connection, etc. There are plenty of great patients there, I loved some of mine and some were some of my favorite people I’ve worked with. But for every 1 of them there were 5 who were entitled a-holes yelling at me because I supposedly didn’t take their PTSD seriously because I wouldn’t give them benzos or told them they needed therapy and there wasn’t a magic pill to fix their problems. It’s a tough patient population by nature since so many of them have seen actual war, but there’s also a TON of personality issues that the VA creates policies to just make worse instead of setting boundaries like they need to.

I've heard a good amount of psychiatrists say they like it at talkiatry but I've also had co-residents who left because the pay for the volume just wasn't worth it after a while. You're right, though. Maybe I oughta call up some local private practices and see if they have any openings as it seems like a more fair split. What do you think is normal volume for outpatient in a group practice? Like 15 pts per day?

I’d actually say 15 in a day is pretty typical for an established practice where they’re all follow ups. 8-12 is more reasonable if there are new patient slots or you’re doing hour long therapy with some patients. I’d say more than 15 a day should warrant questions about how they’re scheduling patients and expectations as that’s either moving into a 10 hour work day (which some docs like doing that 4 days a week) or 15-20 minute follow ups. The few outpatient jobs I’ve really considered expected 12-15 patients per day. I don’t think that’s unreasonable at all unless they’re very high acuity or they want you seeing multiple new people every day.

 

[calvnandhobbs68]

You get to work with honest to goodness war heroes too.

Lol I mean sure sometimes. The vast majority of the time you're dealing with guys who did a 4 year enlistment in their 20s who now qualify for VA healthcare indefinitely.

 

[Taddy Mason]

Lol I mean sure sometimes. The vast majority of the time you're dealing with guys who did a 4 year enlistment in their 20s who now qualify for VA healthcare indefinitely.

I lost track of the number of patients I had who got injured during basic training or just after (not combat related) and didn’t even serve their 4 years because of the injury but felt like they were entitled higher service connection than what they were receiving.

 

[TerraceHouse]

This is certainly good and helpful information about the VA, joining an established private practice that's not PE/VC backed, about PHP/IOP programs. Any other settings, roles, orgs other docs would recommend? Any other strategies aside from looking on own and reaching out and cold messaging/networking for the more desirable positions? Thanks in advance!

 

[brosa]

I find the idea of "war hero" very interesting, considering the US mostly attacks poor countries in the past decades. I mostly view VA population as poor people who got taken advantage from the military and now are left out with bad care and poor assistance.

I also had a bad experience with the VA, they offered me a bad job, and said it could take up to 10 months to start getting paid. I asked what people did in the meantime, people just shrugged "I don't know, locums?". Then they realized I was not an American citizen and said they couldn't give me the job anyway because I did not qualify.

Many months later they started calling me on a weekly basis saying they changed the criteria and now they could hire me. I did not even bother replying.

 

[Merovinge]

This is certainly good and helpful information about the VA, joining an established private practice that's not PE/VC backed, about PHP/IOP programs. Any other settings, roles, orgs other docs would recommend? Any other strategies aside from looking on own and reaching out and cold messaging/networking for the more desirable positions? Thanks in advance!

Most of the best work is exactly from networking (make sure you are at your local APA/AACAP/state psychiatric association/whatever the equivalent is for the other psych subspecialities). Nothing wrong with cold calling either, I did a lot of that to both find my moonlighting position as a fellow and early on in my career. If you can't handle the friction, you will not reap the same rewards, it's exactly the same thing I tell my patients.

 

[mistafab]

Speaking up here for the VA. I do love my primary VA gig. Really fantastic for people who like that cup of tea. Not for everyone, but the VA is so vast that there are a lot of niche jobs you can pretty much find something that suits you if you're okay with the obvious problems including bureaucracy, high rate of personality disorders and malingering, and arbitrary policies and general government-imposed problems that can out of nowhere jeapordize your job.

As an example of arbitrary problems with huge consequences - you may just one day show up and somehow your entire government clearance disappeared. You require the clearance in order to log in and work your job. You are now forced to go on a 3 week side quest working full time to get the problem fixed and prove you are, in fact, the same person who was hired for the job you've been doing for years. You must contact 14 bafflingly useless humanoids who respond to one email a week. You must physically go to several offices and wait in their waiting room for 3 hours each. All criteria must be met within 3 weeks or somehow you will be forced to be fired due to a law enacted in 1946. BTW you walk in and someone got stabbed at valet. Thank you for your service. You find out half a year later that someone in an office typed your name in wrong on a single data sheet that ended up causing this whole thing. Thanks again for your service. Code green to the valet!

The above scenario was an almost literal situation (changed for additional laughs and anonymity) that happened to my coworker. They were out of commission for weeks trying to keep their job. At one point, they had to physically not come to campus for several days or they would be automatically fired (apparently, some dumb rule says they can't be fired off campus). Absolutely nothing close to this stuff happens outside the VA. You boss loves you. Your patients love you. You're somehow almost fired because someone typed your name in wrong, which started a bureaucratic cascade that almost destroys your career there.

 

[Taddy Mason]

Lol what were the soul sucking parts of it

The bureaucracy and unnecessary paperwork as others have mentioned. Having to see patients no matter what regardless of when they showed-up for their appointment (oh, you missed your 12pm appointment but managed to get here at 4:50...yeah I'll jump on that right now and see and accommodate you...). Having access to amazing resources for patients (e.g., groups, various types of CBT, work programs, interdisciplinary clinics, IOPs/PHPs, etc.) but the wait list for said programs are months (sometimes over a year) out, and/or patients are successfully referred but don't show-up, participate, or engage despite that being what they really need. Lots of entitlement and personality disorders that the VA system enables and doesn't allow you to establish appropriate boundaries. Being micromanaged. Having to put up with pharmacists, psychologists, and even NPs telling YOU how to practice medicine/psychiatry. The god awful EMR (though on the plus side it goes back decades which can be amazing for more complicated patients, but still the layout makes even that burdensome). Patients double dipping and seeing providers in the community and the VA (this allowed multiple patients of mine to successfully get multiple scripts for gabapentin and pregabalin beings it's not controlled at the federal level so the VA scripts wouldn't show-up in state PDMPs and the VA providers rarely bothered to check state PDMPs). I also had a patient who was abusing clozapine of all things (long story as to how he ended-up on it as he had no history to justify ever being placed on antipsychotics) and was getting it from both the community and the VA. I could go on but I think the above should give you some perspective.

 

[FatherPsychiatry]

This is certainly good and helpful information about the VA, joining an established private practice that's not PE/VC backed, about PHP/IOP programs. Any other settings, roles, orgs other docs would recommend? Any other strategies aside from looking on own and reaching out and cold messaging/networking for the more desirable positions? Thanks in advance!

Another plug for corrections, but again, your #1 best bet over and over is to actually talk to psychiatrists who work/worked in a setting before. Just like people talk about the VA here, everything is very site specific despite being "one system", so you're not gonna know much useful information until you actually interface with the boots on the ground. Job postings, recruiters etc usually don't have much helpful info IMO. Networking with alumni or your local APA chapter are good ways to make these useful connections. Ask your program director for contact info; I get a text/call or two every year from current residents asking me job stuff and don't mind at all.

I wasn't thinking about corrections until I did fellowship (not needed to work in corrections but rotating here was part of it), and after talking to alumni and other current psychiatrists working here, decided it would be a good fit, and I've been in jail since.

 

[TerraceHouse]

Geez louise. Anybody have experience in corrections or working as a psychiatrist for the Navy? Just thinking outside of the box and from what I've seen around who's hiring. But yes, thank you to those who encouraged looking off job post sites but rather directly networking/reaching out to other folks in the realm.

 

[TerraceHouse]

Another plug for corrections, but again, your #1 best bet over and over is to actually talk to psychiatrists who work/worked in a setting before. Just like people talk about the VA here, everything is very site specific despite being "one system", so you're not gonna know much useful information until you actually interface with the boots on the ground. Job postings, recruiters etc usually don't have much helpful info IMO. Networking with alumni or your local APA chapter are good ways to make these useful connections. Ask your program director for contact info; I get a text/call or two every year from current residents asking me job stuff and don't mind at all.

I wasn't thinking about corrections until I did fellowship (not needed to work in corrections but rotating here was part of it), and after talking to alumni and other current psychiatrists working here, decided it would be a good fit, and I've been in jail since.

Thank you for sharing this. Can I ask if California or a diff state? Jail vs prison? Any concerns around safety or board complaints if prison population can make frivolous complaints? Working with deputies? Again, appreciate all of this knowledge y'all are sharing.

 

[FatherPsychiatry]

Thank you for sharing this. Can I ask if California or a diff state? Jail vs prison? Any concerns around safety or board complaints if prison population can make frivolous complaints? Working with deputies? Again, appreciate all of this knowledge y'all are sharing.

California. jail. overall less safety concerns than when I worked in the psych ER, inpatient etc. Way less board complaints in jail setting than prison, but from what I know and hear from my colleagues that worked in prisons before, the complaints / lawsuits usually never go anywhere. working with deputies is usually fine, probably about the same mix of good/bad relationships as nurses on an inpatient unit. But yeah, even in my large jail system, you could have a very different experience depending on where/which unit(s) you work on, so definitely should network before going on. Happy to discuss more in PMs if you have more detailed Qs.

 

[comp1]

The VA is now fully integrated with state PDMP's and actually tacked on a pretty darn amazing PDMP autogenerate function to the old and new EMRs. In terms of waiting weeks to months for a given service, I can't say that never happens, but it certainly happens MUCH less than it did 2-3 years ago. Basically patients are entitled to community resources if the VA can't accommodate them in a reasonable period of time and reasonable is determined by the requesting VA provider. Now if there's no community resources, that may still be an issue for a given area, but it's not VA specific.

 

[TerraceHouse]

The VA is now fully integrated with state PDMP's and actually tacked on a pretty darn amazing PDMP autogenerate function to the old and new EMRs. In terms of waiting weeks to months for a given service, I can't say that never happens, but it certainly happens MUCH less than it did 2-3 years ago. Basically patients are entitled to community resources if the VA can't accommodate them in a reasonable period of time and reasonable is determined by the requesting VA provider. Now if there's no community resources, that may still be an issue for a given area, but it's not VA specific.

It does seem like a lot of criticisms about the VA has gotten better in recent years and clearly yourself and other psychiatrists I've talked to who work for VA like it enough that they see themselves staying there their whole career. With that said, is there any strategy you've implemented that's helped you to do well and achieve high job satisfaction working in the VA and how do you avoid the parts that might not be as enjoyable or try and make the best of it? Curious to learn

 

[the5thelement]

I interviewed with a couple VA systems when I was coming out of residency. One doc told me the biggest thing you have to adjust to in the VA is the undercurrent of how disability ratings affect care/presentation. As in, there is disincentive to materially improve clinically as a patient, and this can affect their motivation to present for treatment to begin with. What is your experience with all of that?

After several years working for the VA, I got the feeling the patients didnt really have any motivation /did not want to get better (perhaps for fear of losing service connection). The professional satisfaction you get from treating and seeing people heal was just not there for me. I wish I could check that at the door but just couldn't. You only get one life and my satisfaction with what I do day in day out is paramount. Compared to county with ****tier pay and sicker patients , I prefer the county jobs.

 

[comp1]

I get the stress from patients maybe not being as motivated towards recovery as we'd all like, but I have done county work and I would definitely always prefer having access to resources that someone could use even if only a small subset of patients chose to use them. The absolute bare bones minimal (at best) access to services in Medicaid funded clinics drove me crazy. The pay was less than the VA, but still competed with (or was) academics.

 

[Stagg737]

I get the stress from patients maybe not being as motivated towards recovery as we'd all like, but I have done county work and I would definitely always prefer having access to resources that someone could use even if only a small subset of patients chose to use them. The absolute bare bones minimal (at best) access to services in Medicaid funded clinics drove me crazy. The pay was less than the VA, but still competed with (or was) academics.

I would take motivated patients who are lacking resources over unmotivated or lazy patients with access to resources any day. Working with people who can/do have insight but don't really want to get better is draining and often feels like a waste of time. That certainly isn't unique to the VA, but the VA is one of the few settings where there is often incentive to not get better.

 

[calvnandhobbs68]

I would take motivated patients who are lacking resources over unmotivated or lazy patients with access to resources any day. Working with people who can/do have insight but don't really want to get better is draining and often feels like a waste of time. That certainly isn't unique to the VA, but the VA is one of the few settings where there is often incentive to not get better.

I think coupled with the fact that psychiatry (besides maybe pain) is THE speciality that's ripe for abuse in such a system ends up causing the negative or checked out approach people have. It's almost all subjective so what are you supposed to do when someone who's level of disability is directly tied to the financial support they get from your system who is on their 20th med, done TMS and IV ketamine, referred to every available therapy service under the sun still says they're too depressed to work? I mean ECT I guess lol but yeah there's not going to be a perfect system and that's one of the major frustrations I've heard as well.

I guess (although this is just my guess) that a lot of clinicians just end up not thinking about it too hard to keep themselves from burning out and just keep saying they have treatment refractory depression or whatever indefinitely.

 

[Stagg737]

I think coupled with the fact that psychiatry (besides maybe pain) is THE speciality that's ripe for abuse in such a system ends up causing the negative or checked out approach people have. It's almost all subjective so what are you supposed to do when someone who's level of disability is directly tied to the financial support they get from your system who is on their 20th med, done TMS and IV ketamine, referred to every available therapy service under the sun still says they're too depressed to work? I mean ECT I guess lol but yeah there's not going to be a perfect system and that's one of the major frustrations I've heard as well.

I guess (although this is just my guess) that a lot of clinicians just end up not thinking about it too hard to keep themselves from burning out and just keep saying they have treatment refractory depression or whatever indefinitely.

I feel this post, but that wasn’t even what I was talking about. I was more referencing patients at the VA who just don't seem to care and keep coming back saying their depression is so bad but only want a magic pill. Not willing to do therapy or procedural options and sometimes asking for controlled substances. The typical patient that just wants to feel better instead of working to actually get better.

 

[TerraceHouse]

Yes, VA. Time from recruitment to starting with patients is now 30 days and of course any state license is good anywhere. $200k loan payback, pro rated over 5 years. 10 holidays, 26 vacation days, 5 CME, 13 sicks days accruing from day 1. $15,000 annual bonus that is generally easy to achieve. The $1000 annual for CME is kind of silly, but it is still there by Congressional statute. Some places have hiring and relocation incentives (slightly rare). Resident/med student supervision without the university paycut. And the literal mean salary of whatever the geographic area; it has to be re-proven and adjusted (up) every 2 years by the local admin. There's no negotiation about salaries because it's not a local decision or pulled out of some local pot, it just is what it is based on the local average. No limits on moonlighting outside your tour of duty. No billing/insurance and you can generally get patients whatever level or sort of care you want with minimal fuss. If there isn't a VA job posted next to you on usajobs.gov, reach out to the recruiter of the job that is closest to you and there probably is one where you want. With the new 30 days to start, job postings have to be pulled and reposted very regularly. However, physicians (and nurses) can always be hired non-competitively, ie not from a job posting.

I was going to ask... what's the likelihood of a psychiatrist hired by the VA receiving the 200k loan payback via edrp? I heard it's often given to rural sites but let's just say suburbs of a city metro for example. High chance of applying and getting it?

 

[TerraceHouse]

Another plug for corrections, but again, your #1 best bet over and over is to actually talk to psychiatrists who work/worked in a setting before. Just like people talk about the VA here, everything is very site specific despite being "one system", so you're not gonna know much useful information until you actually interface with the boots on the ground. Job postings, recruiters etc usually don't have much helpful info IMO. Networking with alumni or your local APA chapter are good ways to make these useful connections. Ask your program director for contact info; I get a text/call or two every year from current residents asking me job stuff and don't mind at all.

I wasn't thinking about corrections until I did fellowship (not needed to work in corrections but rotating here was part of it), and after talking to alumni and other current psychiatrists working here, decided it would be a good fit, and I've been in jail since.

Is working with the inmate population better than the VA population as many have described on here? I'm surprised that despite there being a VA within 5 minutes of our residency, we literally didn't do a single VA rotation throughout residency. We did do a one-month jail rotation which wasn't bad and we saw about 3-4 pt encounters the whole day we were there. There was a lot of bickering between the officers and the head psychologist there while I was there.

 

[MedMan80]

I did a solid year of VA in my training, it was soul sucking. Inpatient was okay, but the beaurocracy and the constant seeking of a PTSD diagnosis got to me. Maybe that was just my VA..., i heard the Ann Arbor VA is awesome, generally the attendings hung around and were allowed to moonlight what they wanted.

 

[comp1]

EDRP is based on your job title at the VA, not the location. Physicians are eligible for EDRP. You will get it if you take a VA job. It's not a maybe sort of situation. The only problem I have seen for employees is when they forget to enroll within 120 days of starting, but that was very much on them and heck, we even got an exception for that mess. Moonlighting outside your TOD is also allowed everywhere. It's not even considered their business unless you're doing some sort of self dealing with veteran care in the community which you would need to discuss. I would also recommend inpatient, but I'd recommend that everywhere, not just the VA.

 

[TerraceHouse]

EDRP is based on your job title at the VA, not the location. Physicians are eligible for EDRP. You will get it if you take a VA job. It's not a maybe sort of situation. The only problem I have seen for employees is when they forget to enroll within 120 days of starting, but that was very much on them and heck, we even got an exception for that mess. Moonlighting outside your TOD is also allowed everywhere. It's not even considered their business unless you're doing some sort of self dealing with veteran care in the community which you would need to discuss. I would also recommend inpatient, but I'd recommend that everywhere, not just the VA.

What do you think about PCMHI role at a CBOC? Sounded cushy.

 

[Ahamis]

I would take motivated patients who are lacking resources over unmotivated or lazy patients with access to resources any day. Working with people who can/do have insight but don't really want to get better is draining and often feels like a waste of time. That certainly isn't unique to the VA, but the VA is one of the few settings where there is often incentive to not get better.

“It is part of the cure to wish to be cured.” SENECA

I always have this saying in my mind when deciding whether I want to work with a specific patient.
Some patients just don't want to get better, unfortunately.

 

[Stagg737]

What do you think about PCMHI role at a CBOC? Sounded cushy.

1000% depends on the CBOC. The one I was familiar with in residency had a pharmacist acting as the psychiatrist and it was…not good.

That said, I wouldn’t want any outpatient role, but all the pluses of being an outpatient doc are moot at the VA. I imagine that would be the same if you were embedded at a CBOC. Maybe it would be better, but it could also be worse since you might not have staff used to handling MH aspects of patients.

 

[comp1]

PCMHI could be cush, I would certainly prefer it over BHIP if doing outpatient. Kinda the CL of outpatient. Theoretically dealing with the least acute of the whole system by definition. In terms of CBOC, I mean I would certainly prefer to be at a main hospital site, but if it is a city you like, could be good. Try to get residents.

 

[clozareal]

Kaiser is very location dependent.

The best employer is yourself.

 

[mistafab]

I was going to ask... what's the likelihood of a psychiatrist hired by the VA receiving the 200k loan payback via edrp? I heard it's often given to rural sites but let's just say suburbs of a city metro for example. High chance of applying and getting it?

The likelihood is 100% if the specific position is EDRP eligible and the physician applies for EDRP during the application window after starting. I am on EDRP and am in a major metro; I live in the burbs.

Any specific job in the VA will post if it is EDRP eligible. This is job by job, not site by site. There are positions in my location that are not EDRP and are on the same pay scale as me.

 

[comp1]

I haven't seen any posted physician jobs that lack EDRP eligibility or ever seen a non-compete selected without it. I guess it is possible, but they must be very rare.

 

[Stagg737]

PCMHI could be cush, I would certainly prefer it over BHIP if doing outpatient. Kinda the CL of outpatient. Theoretically dealing with the least acute of the whole system by definition. In terms of CBOC, I mean I would certainly prefer to be at a main hospital site, but if it is a city you like, could be good. Try to get residents.

I mean, this is essentially what my outpatient clinic is but it is definitely not dealing with the least acute. I could see that being more true at the VA, but if you’re at a CBOC that doesn’t have a major hospital or psych department nearby I could see it being much like my clinic where it’s just anything the PCPs don’t know what to do with. From “SSRI didn’t work, help with next steps” to “Patient is on 15 meds and is now asking for stimulants, eval for ADHD”. I would not assume that a PCMHI clinic will be low acuity.

 

[comp1]

I didn"t mean low acuity exactly, just least acute. There's literally a pyramid graphic of mental health care and PCMHI is at the base.

 

[prominence]

Is working with the inmate population better than the VA population as many have described on here? I'm surprised that despite there being a VA within 5 minutes of our residency, we literally didn't do a single VA rotation throughout residency. We did do a one-month jail rotation which wasn't bad and we saw about 3-4 pt encounters the whole day we were there. There was a lot of bickering between the officers and the head psychologist there while I was there.

Bump

 

[lobstar]

Bump

VA- big bureaucracy, your boss might be a social worker, incentivizes
patients to not get better, delusion you can stop all suicide, paperwork x100. Decent money, minimal to no malpractice risk, some very appreciative veterans, full spectrum of psych problems but mostly PTSD, good benefits.

Prison- moderate bureaucracy, your boss might be a warden/guard, expectation to fix violent personality disorders with 4 antipsychotics, check your phone in at the door, become an expert in the comorbid intellectual disability, psychosis, and personality disorder. Good money, essentially no malpractice risk, some very appreciative inmates.

 

[TerraceHouse]

VA- big bureaucracy, your boss might be a social worker, incentivizes
patients to not get better, delusion you can stop all suicide, paperwork x100. Decent money, minimal to no malpractice risk, some very appreciative veterans, full spectrum of psych problems but mostly PTSD, good benefits.

Prison- moderate bureaucracy, your boss might be a warden/guard, expectation to fix violent personality disorders with 4 antipsychotics, check your phone in at the door, become an expert in the comorbid intellectual disability, psychosis, and personality disorder. Good money, essentially no malpractice risk, some very appreciative inmates.

I currently work a private sector telepsych job right now and honestly both of what you describe (VA or prison) sounds way better and more sustainable.