Civilian contractors

[38special]

How are civilian physicians contacted to work at military medical centers and smaller treatment facilities? Are civilians in all specialties used this way?

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[colbgw02]

How are civilian physicians contacted to work at military medical centers and smaller treatment facilities? Are civilians in all specialties used this way?

How are they contacted? I don't understand. They advertise the position and physicians apply, just like any other job.

In my experience, almost all specialties use civilian contractors. It seems like the ones that don't are the higher paid ones, e.g. neurosurgery, rad onc, plastics, but I have no idea how universal that phenomenon is. That may be because the pay for those contracts isn't competitive because of some pretty stupid ceilings, albeit soft ceilings, placed on federal salaries.

 

[IlDestriero]

How are they contacted? I don't understand. They advertise the position and physicians apply, just like any other job.

In my experience, almost all specialties use civilian contractors. It seems like the ones that don't are the higher paid ones, e.g. neurosurgery, rad onc, plastics, but I have no idea how universal that phenomenon is. That may be because the pay for those contracts isn't competitive because of some pretty stupid ceilings, albeit soft ceilings, placed on federal salaries.

The civilian contractors are not limited in their compensation. They are not federal employees. The Navy paid the anesthesia contractors about twice as much as the AD Anesthesiologists where I used to work. They also never took call. Great job.

 

[bogatyr]

The civilian contractors are not limited in their compensation. They are not federal employees. The Navy paid the anesthesia contractors about twice as much as the AD Anesthesiologists where I used to work. They also never took call. Great job.

Civilian contracts are limited by federal law. Nobody can get paid more than the president, so the max salary is $400k per year. They can sort of get around this by saying that the neurosurgeon, for example, is working 1.5 FTE, so he gets $600k. Contracting in general is pretty confusing, with multiple options such as whether it is a personal services contract, NSPS, or GS. Each has its own benefits and drawbacks. The contractors that I work side-by-side with get paid 2x - 3x more than me.

 

[colbgw02]

The civilian contractors are not limited in their compensation. They are not federal employees. The Navy paid the anesthesia contractors about twice as much as the AD Anesthesiologists where I used to work. They also never took call. Great job.

Yes, they are, as bogatyr pointed out. Also, whether or not they are direct federal employees is region dependent. In most places, the government hires a go-between firm to handle the contract. Less frequently, people sign contracts directly with the federal government.

Regardless, their compensation is limited because of federal law, which is ultimately the source of the income. There are ways around this law (hence my soft ceiling comment), to include special exceptions based on regional market forces as well as the >1 FTE loophole that bogatyr mentioned.

Besides, how exactly is citing civilian anesthesiologists making twice as much as AD ones indicative of compensation limit? The civilian contractors in my department make 2.5 to 3 times as much as their AD counterparts, but their salary is still limited.

 

[IlDestriero]

Besides, how exactly is citing civilian anesthesiologists making twice as much as AD ones indicative of compensation limit? The contractors in my department make 2.5 to 3 times as much as their AD counterparts, but their salary is still limited.

It was not proof of compensation limits or the lack thereof, it was a correction of an earlier comment that specialist contractors are poorly compensated. That's a good salary for no call, no weekends, all the military holidays, out by 4 and no malpractice. Perhaps the highest paid subspecialists are SOL?
I guess it was close to the soft limit afterall. I should have picked a higher paid specialty.

 

[pgg]

It was not proof of compensation limits or the lack thereof, it was a correction of an earlier comment that specialist contractors are poorly compensated. That's a good salary for no call, no weekends, all the military holidays, out by 4 and no malpractice. Perhaps the highest paid subspecialists are SOL?
I guess it was close to the soft limit afterall. I should have picked a higher paid specialty.

Don't forget ... no deployments. 🙂

Civilian contractors seem to be pretty happy people for the most part. I've known more than a couple who left active duty on a Friday and showed up Monday to do the same job as a contractor.

 

[38special]

Are most civilian contractors former AD? Is there animosity between AD attendings and civilians?

It seems like seeking one of these positions would be a great way to get to work for the troops at home without having to deploy.

Is that seen as a cop-out by AD physicians? Are there too few of these positions to actually consider trying get one?

I would love the military. My fiancee would not. Is it realistic to "find" a job at Walter Reed, Tripler, or wherever as an attending, without going FAP or direct commission?

 

[The White Coat Investor]

It can be a great gig. The job security is for sucks though. Trust me, the military can fire you overnight if it feels like it.

 

[Ascultator]

Anyone know of or work with Army Medicine Civilian Corps ?
http://www.civilianmedicaljobs.com/?id=1

As someone else mentioned, I too want to work with a military population but not yet ready to commit to a military obligation.

Can anyone comment on job satisfaction, workload, etc at places like this? So far I see physician openings on their site at most CONUS bases from what it looks like.

...what about job security though? ActiveDutyMD didn't seem to impressed:

It can be a great gig. The job security is for sucks though. Trust me, the military can fire you overnight if it feels like it.

Thanks --

 

[kanyuek]

Anyone know of or work with Army Medicine Civilian Corps ?
http://www.civilianmedicaljobs.com/?id=1

As someone else mentioned, I too want to work with a military population but not yet ready to commit to a military obligation.

Can anyone comment on job satisfaction, workload, etc at places like this? So far I see physician openings on their site at most CONUS bases from what it looks like.

...what about job security though? ActiveDutyMD didn't seem to impressed:



I got pay $62.00 an hour for 40 hours as a staff physician; the contract physician got pay $180.00 an hour and can work 36 hours to 48 hours !

Yes, the Army can fire you anytime that's why I stay in an motel and pack up anytime they fire me and go home !

 

[kanyuek]

I have been here for 10 months and see doctors come and go ! There is really no security in the Army and the physicians are not respected or treated fairly. I learn my lesson and do one NARSUM a day !

 

[Kingfisher]

At my hospital the civilian contractors have (mostly) all been there for like 14+ years. The exceptions were provider spouses that left with their wife/husband when they transferred. Some would take call. There had to be some specific wording in their contract as they still had a work hours limit, so time on call and rounding meant less clinic time that week.

 

[epsilonprodigy]

Can anyone comment on any significant differences between a "general schedule" physician and a civilian contractor? (I'm mostly concerned with job security and number of opportunities available.) Also, does anyone have any thoughts on what specialties will have to most availability to civilians?

If any civilian contractors or GS physicians are reading this, I'd love it if you sent me a PM. I'm trying to line things up that will maximize my chances in military medicine from the get-go. (Finally made peace with the fact that joining up is too complicated, at least for now. )

 

[IlDestriero]

The anesthesia group that I'm familiar with that contacts with one of the military hospitals has to renegotiate their contract every 3 years. So, I'd say your job security is the length of your group or individual contract. Provide high quality service at the market rate and you should get renewed. Rock the boat and ask for too much and you'll be outbid.

 

[zenman]

I have been here for 10 months and see doctors come and go ! There is really no security in the Army and the physicians are not respected or treated fairly. I learn my lesson and do one NARSUM a day !

I'm a civilian Psych NP contractor through Trustaff. There are 5-6 of us here through the same company others through different staffing companies. The work is not as difficult as civilian world and pays better. There is multiple layers of management, however, and this damn AHLTA sucks. I'm not that worried about getting kicked out of a job in mental health though. We have a good team here and it's a pleasant place to work.

 

[colbgw02]

Can anyone comment on any significant differences between a "general schedule" physician and a civilian contractor? (I'm mostly concerned with job security and number of opportunities available.) Also, does anyone have any thoughts on what specialties will have to most availability to civilians?

If any civilian contractors or GS physicians are reading this, I'd love it if you sent me a PM. I'm trying to line things up that will maximize my chances in military medicine from the get-go. (Finally made peace with the fact that joining up is too complicated, at least for now. )

GS positions are employed and, therefore, come with all of benefits and trappings of federal service. Their job security is considerably higher, because - after a year long probationary period - it takes nearly an act of Congress to be fired. The biggest benefit is that you'll get a retirement, provided that you stay long enough.

Contract positions pay more, often considerably more, but that is a "burdened" rate, meaning that taxes, retirement, health insurance, etc., are all on you. The contracts I'm most familiar with are renewed annually and reviewed every 5 years. Technically, a contract can be terminated at any time, provided you're given the obligatory notice period, so the job security is an issue. Anecdotally, I've never seen a contract be terminated unexpectedly or not renewed. However, the budgetary worries could change that.

In my experience, both types of positions have their malpractice covered.

 

[cautionmaster]

I'm a civilian Psych NP contractor through Trustaff. There are 5-6 of us here through the same company others through different staffing companies. The work is not as difficult as civilian world and pays better. There is multiple layers of management, however, and this damn AHLTA sucks. I'm not that worried about getting kicked out of a job in mental health though. We have a good team here and it's a pleasant place to work.

Yes, the micromanagement and counter productive EMR is a drag. But alas, you have found nice employment in military psychiatry which you said is relatively easy and comes with good job security.


On a totally unrelated note:
http://www.cbsnews.com/8301-201_162-57563857/u.s-military-suicides-exceed-combat-deaths/

 

[zenman]

GS positions are employed and, therefore, come with all of benefits and trappings of federal service. Their job security is considerably higher, because - after a year long probationary period - it takes nearly an act of Congress to be fired. The biggest benefit is that you'll get a retirement, provided that you stay long enough.

Contract positions pay more, often considerably more, but that is a "burdened" rate, meaning that taxes, retirement, health insurance, etc., are all on you. The contracts I'm most familiar with are renewed annually and reviewed every 5 years. Technically, a contract can be terminated at any time, provided you're given the obligatory notice period, so the job security is an issue. Anecdotally, I've never seen a contract be terminated unexpectedly or not renewed. However, the budgetary worries could change that.

In my experience, both types of positions have their malpractice covered.

My contract position is not a 1099. All federal and state taxes are taken out and I also have retirement and health coverage. It is for 1 yr at a time. But I'm a gypsy!

 

[zenman]

Yes, the micromanagement and counter productive EMR is a drag. But alas, you have found nice employment in military psychiatry which you said is relatively easy and comes with good job security.


On a totally unrelated note:
http://www.cbsnews.com/8301-201_162-57563857/u.s-military-suicides-exceed-combat-deaths/

Well, if we'd quit fighting useless wars. I'm still trying to figure out why we were fighting in Vietnam....

 

[epsilonprodigy]

This is great info! So, how do I get there....any ways for a civilian to up the chances of getting such a job after training? There's the obvious stuff: work hard, do well on the boards, get the best residency possible and do well there, etc. I'm also hoping to make some connections through my school, and maybe even by taking a summer travel assignment at a military hospital (I'm a non-trad and was a nurse in my previous life.) Any other suggestions for the hopefuls?

How are the prospects for civilian surgeons in the next few years?

 

[colbgw02]

My contract position is not a 1099. All federal and state taxes are taken out and I also have retirement and health coverage. It is for 1 yr at a time. But I'm a gypsy!

Good for you. That sounds like a unique, but good, situation, especially if it allows you to remain relatively free of the burdensome non-clinical requirements.

For what it's worth, I suspect the IRS would consider you to be an employee. If the government is withholding payroll taxes for you, then you are pretty much an employee. You may not be in a GS position, but you're not a contractor in the sense that most civilian physicians with the military are.

And while I'm on the subject, my understanding of the law is that even "true" contractors shouldn't be considered such. If the government is telling you when to show up to work and when you can leave, then that's an employer/employee relationship. To date, the IRS seems to be looking the other way for professionals, like physicians. However, this mischaracterization of what it means to be a contractor is present throughout medicine, and I wonder if/when the IRS will decide to crack down.

I'm not a lawyer, so maybe there's a legal workaround that I'm not aware of.

 

[zenman]

Good for you. That sounds like a unique, but good, situation, especially if it allows you to remain relatively free of the burdensome non-clinical requirements.

For what it's worth, I suspect the IRS would consider you to be an employee. If the government is withholding payroll taxes for you, then you are pretty much an employee. You may not be in a GS position, but you're not a contractor in the sense that most civilian physicians with the military are.

And while I'm on the subject, my understanding of the law is that even "true" contractors shouldn't be considered such. If the government is telling you when to show up to work and when you can leave, then that's an employer/employee relationship. To date, the IRS seems to be looking the other way for professionals, like physicians. However, this mischaracterization of what it means to be a contractor is present throughout medicine, and I wonder if/when the IRS will decide to crack down.

I'm not a lawyer, so maybe there's a legal workaround that I'm not aware of.

I'm called a civilian contractor. The military pays Trustaff, they take a cut, and my check comes from Trustaff. Trustaff takes out all the taxes. It is a good gig.

 

[colbgw02]

I'm called a civilian contractor. The military pays Trustaff, they take a cut, and my check comes from Trustaff. Trustaff takes out all the taxes. It is a good gig.

That sounds like the set-up for the civilians where I trained (although Trustaff was not the third party), so I think you're considered an employee of Trustaff. My understanding of the legalese is that this workaround, whereby a third-party accepts the contract and then hires employees, is - strictly speaking - not kosher. As I said, I don't pretend to understand all of the nuances of it, but it appears that military medicine - like so many other entities - is willing to exploit the IRS's lack of enforcement.

 

[zenman]

That sounds like the set-up for the civilians where I trained (although Trustaff was not the third party), so I think you're considered an employee of Trustaff. My understanding of the legalese is that this workaround, whereby a third-party accepts the contract and then hires employees, is - strictly speaking - not kosher. As I said, I don't pretend to understand all of the nuances of it, but it appears that military medicine - like so many other entities - is willing to exploit the IRS's lack of enforcement.

I don't know all the legalese either but exploiting the IRS sounds like a good thing.