Generous Psychiatry VA Salaries?

[prominence]

I currently work in the VA system as an outpatient psychiatrist and I am looking to switch to another VA. While I enjoy working with veterans, I cannot tolerate my department’s leadership and am looking for a fresh start elsewhere.

I am not restricted to any particular region of the country.

I realize this is a specific question but can anyone recommend a VA that is more generous as far as paying high base salaries to outpatient VA psychiatrists compared to the “average VA?” Each VA is not the same as far as salary goes. Salary is not the only factor to consider but it would be helpful in narrowing down choices.

Does anyone know of any VA’s that match the salary of a psychiatrist’s current VA if a switch is eventually made and the new VA has generally lower psychiatrist salaries?

An alternate consideration would be if a VA did not have any required on-call responsibilities or at least lack of on-call rounding on weekends. Does anyone know of any VA’s with such a setup?

Any recommendations would be greatly appreciated.

Thank you in advance.

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[wolfvgang22]

I currently work in the VA system as an outpatient psychiatrist and I am looking to switch to another VA. While I enjoy working with veterans, I cannot tolerate my department’s leadership and am looking for a fresh start elsewhere.

I am not restricted to any particular region of the country.

I realize this is a specific question but can anyone recommend a VA that is more generous as far as paying high base salaries to outpatient VA psychiatrists compared to the “average VA?” Each VA is not the same as far as salary goes. Salary is not the only factor to consider but it would be helpful in narrowing down choices.

Does anyone know of any VA’s that match the salary of a psychiatrist’s current VA if a switch is eventually made and the new VA has generally lower psychiatrist salaries?

An alternate consideration would be if a VA did not have any required on-call responsibilities or at least lack of on-call rounding on weekends. Does anyone know of any VA’s with such a setup?

Any recommendations would be greatly appreciated.

Thank you in advance.

I sent you a PM.

 

[Monocles]

Why not consider academia, community, or corporate jobs?

In the VA you'll get bogged down in administrative nightmares, monolithic structures that never change, and even more stubborn people who refuse to leave their post until they die almost anywhere in the country. Just from speaking with friends who have worked in more VA heavy programs almost everyone hates their VA leadership in their part of the country.

 

[SourceOfDenial]

As the saying goes...if you’ve been to one VA, you’ve been to one VA.

 

[wolfvgang22]

Well, Monocles, there are three sides to every story.

I have worked in the VA for half a decade now, and our local leadership is pretty good, so that is not on my list of complaints. Several recent studies have shown VA mental health care as being high quality and evidence based, and anecdotally I think that is true. Yes, there is a lot of bureaucracy and limitations and too much paperwork, but we provide a lot of very good mental health care that these people would never be able to get outside the VA in our community, because the resources don't exist. That is very true in a lot of places on the U.S. I wish non-veterans in my community had access to the care my patients have! Often I'm sad because there is not much good quality or even mediocre quality care available for a veteran's non-veteran family or non-veteran friends. I see some veterans complain because they have never known how hard it is trying to get good, affordable psychiatric care outside the VA in my region. Also, the VA supports a lot of academic work, and are often attached to academic centers, if you haven't noticed.

I will add, there is nothing wrong personally with a little job security, being able to put down roots, and not having to worry about running a practice or moving from job to job. Sure, we make less money, and it isn't glamorous working in the VA.

Don't get me wrong, the VA isn't at all perfect, and I've seen and heard about bad ones, but I've also seen really good ones. Hating on anything government run like the VA is easy, because the government has to be pretty transparent because it's all tax funded and therefore held accountable in the media and in Congress, while private organizations hide their dirty laundry more.

 

[calvnandhobbs68]

Several recent studies have shown VA mental health care as being high quality and evidence based, and anecdotally I think that is true. Yes, there is a lot of bureaucracy and limitations and too much paperwork, but we provide a lot of very good mental health care that these people would never be able to get outside the VA in our community, because the resources don't exist. That is very true in a lot of places on the U.S. I wish non-veterans in my community had access to the care my patients have! Often I'm sad because there is not much good quality or even mediocre quality care available for a veteran's non-veteran family or non-veteran friends. I see some veterans complain because they have never known how hard it is trying to get good, affordable psychiatric care outside the VA in my region. Also, the VA supports a lot of academic work, and are often attached to academic centers, if you haven't noticed.

Definitely, there's a lot satisfying about being able to discharge homeless patients straight to the VA dom or an actual structured homeless program (vs dropping them back off at a shelter which is what basically happens a lot of places) or the ability to get VARC to see someone fairly quickly and get them set up with an IOP or even inpatient rehab in a reasonable timeframe. There's also something to be said for being able to look up someone's records even if they went to a VA on the other side of the country, especially in psychiatry where past history and collateral is so important. The VA is definitely the most integrated national mental health system I've seen.

 

[Stagg737]

Well, Monocles, there are three sides to every story.

I have worked in the VA for half a decade now, and our local leadership is pretty good, so that is not on my list of complaints. Several recent studies have shown VA mental health care as being high quality and evidence based, and anecdotally I think that is true. Yes, there is a lot of bureaucracy and limitations and too much paperwork, but we provide a lot of very good mental health care that these people would never be able to get outside the VA in our community, because the resources don't exist. That is very true in a lot of places on the U.S. I wish non-veterans in my community had access to the care my patients have! Often I'm sad because there is not much good quality or even mediocre quality care available for a veteran's non-veteran family or non-veteran friends. I see some veterans complain because they have never known how hard it is trying to get good, affordable psychiatric care outside the VA in my region. Also, the VA supports a lot of academic work, and are often attached to academic centers, if you haven't noticed.

I will add, there is nothing wrong personally with a little job security, being able to put down roots, and not having to worry about running a practice or moving from job to job. Sure, we make less money, and it isn't glamorous working in the VA.

Don't get me wrong, the VA isn't at all perfect, and I've seen and heard about bad ones, but I've also seen really good ones. Hating on anything government run like the VA is easy, because the government has to be pretty transparent because it's all tax funded and therefore held accountable in the media and in Congress, while private organizations hide their dirty laundry more.

I'll stop crapping on the bureaucratic nightmare that is the VA when they figure out how to actually implement their new suicide prevention policy. I've spoken to a few people that are a bit higher up in terms of QI projects (as I'm trying to get involved with these projects) and policy implementation at our VA and all of them have said the program is a largely political stunt with no evidence behind it and has been horrible to roll out. I know our service has gotten a lot worse since the policy's implementation and we are seeing more unnecessary and inappropriate consults than we can count.

No, not all VAs are equal, but the administrative nightmares are prevalent throughout the system. Especially since many of their policies are nationally mandated.

Definitely, there's a lot satisfying about being able to discharge homeless patients straight to the VA dom or an actual structured homeless program (vs dropping them back off at a shelter which is what basically happens a lot of places) or the ability to get VARC to see someone fairly quickly and get them set up with an IOP or even inpatient rehab in a reasonable timeframe. There's also something to be said for being able to look up someone's records even if they went to a VA on the other side of the country, especially in psychiatry where past history and collateral is so important. The VA is definitely the most integrated national mental health system I've seen.

There are some good things, but these resources are not universally available. The 3 VAs I've worked at had 1 dom between the 3 of them, no IOP or PHP programs, wait for inpt substance rehab is typically 6-8 weeks (since the inpt rehab at one of those locations apparently closed in the last year), and veterans are commonly d/c'd to shelters d/t lack of available resources for homeless programs (to be fair, this may be due to number of veterans and not due to programs/housing not existing). Being able to access records from any VA hospital is nice, but JLV is a pretty crappy system compared to pretty much every EMR other than CPRS. Are there good things about the system? Yes. Are there things which legitimately baffle and infuriate me on an almost daily basis with the system? Yes.

 

[wolfvgang22]

I'll stop crapping on the bureaucratic nightmare that is the VA when they figure out how to actually implement their new suicide prevention policy. I've spoken to a few people that are a bit higher up in terms of QI projects (as I'm trying to get involved with these projects) and policy implementation at our VA and all of them have said the program is a largely political stunt with no evidence behind it and has been horrible to roll out. I know our service has gotten a lot worse since the policy's implementation and we are seeing more unnecessary and inappropriate consults than we can count.

No, not all VAs are equal, but the administrative nightmares are prevalent throughout the system. Especially since many of their policies are nationally mandated.



There are some good things, but these resources are not universally available. The 3 VAs I've worked at had 1 dom between the 3 of them, no IOP or PHP programs, wait for inpt substance rehab is typically 6-8 weeks (since the inpt rehab at one of those locations apparently closed in the last year), and veterans are commonly d/c'd to shelters d/t lack of available resources for homeless programs (to be fair, this may be due to number of veterans and not due to programs/housing not existing). Being able to access records from any VA hospital is nice, but JLV is a pretty crappy system compared to pretty much every EMR other than CPRS. Are there good things about the system? Yes. Are there things which legitimately baffle and infuriate me on an almost daily basis with the system? Yes.

Who asked you to stop crapping on anything? Get it all out. No need to constipate. I'll just, you know, stand way over here.

 

[Stagg737]

Who asked you to stop crapping on anything? Get it all out. No need to constipate. I'll just, you know, stand way over here.

Needed that little vent after last week. Believe it or not I don't hate our VA and have actually considered a job there (and still potentially would), but every so often a week comes along that reminds me how miserable it can be working there.

 

[WisNeuro]

Needed that little vent after last week. Believe it or not I don't hate our VA and have actually considered a job there (and still potentially would), but every so often a week comes along that reminds me how miserable it can be working there.

In terms of patient care, far exceeds most of what I see outside of the VA. Incredibly easy to get my patients referred to services after my evaluation, with low wait list times. Now, even if I can get someone in to a specialist after seeing me, the wait is usually 2-3 times what I was used to in the VA. I never had a problem with the care that patients received, most things to the contrary are straight out lies in the service of political point-getting. My only problem was in getting pay and benefits commensurate with what my peers outside of the system were making. In terms of total compensation, I probably am about 20-25% higher than where I'd be in the VA, working about 30 hrs a week, with a ton of flexibility. So, I'm all about crapping over some of the provider stuff, but in the VAs I was a part of, the patient care was great.

 

[Stagg737]

In terms of patient care, far exceeds most of what I see outside of the VA. Incredibly easy to get my patients referred to services after my evaluation, with low wait list times. Now, even if I can get someone in to a specialist after seeing me, the wait is usually 2-3 times what I was used to in the VA. I never had a problem with the care that patients received, most things to the contrary are straight out lies in the service of political point-getting. My only problem was in getting pay and benefits commensurate with what my peers outside of the system were making. In terms of total compensation, I probably am about 20-25% higher than where I'd be in the VA, working about 30 hrs a week, with a ton of flexibility. So, I'm all about crapping over some of the provider stuff, but in the VAs I was a part of, the patient care was great.

And I'd say some of this varies from VA to VA. The bolded isn't true at my "home" VA and the underlined is definitely not true (at least on the psych side of things) with some services completely non-existent. Patient care is a mix imo, but patient population also likely plays a very significant role in this.

 

[WisNeuro]

And I'd say some of this varies from VA to VA. The bolded isn't true at my "home" VA and the underlined is definitely not true (at least on the psych side of things) with some services completely non-existent. Patient care is a mix imo, but patient population also likely plays a very significant role in this.

I've found it true at all of mine. I've trained/worked at two flagships, and two mid size. And, I've worked at the one in my current city as well, huge difference. I'll grant that it's not universal, but it's most likely better on average than places outside of the system where the Vets would need to seek care if they did not have the VA. As for the waits, the reports back from the expanded Choice program has thus far shown much longer waits for specialty services in the private sector. System is not perfect by any means, but it's nowhere near the picture pointed by the demagogues.

 

[Sushirolls]

I've found it true at all of mine. I've trained/worked at two flagships, and two mid size. And, I've worked at the one in my current city as well, huge difference. I'll grant that it's not universal, but it's most likely better on average than places outside of the system where the Vets would need to seek care if they did not have the VA. As for the waits, the reports back from the expanded Choice program has thus far shown much longer waits for specialty services in the private sector. System is not perfect by any means, but it's nowhere near the picture pointed by the demagogues.

That's because they have torpedoed any earnest effort of the program. Those insurance subsidiaries require "treatment plan" documents and forms similar to the waste seen in CMHC. The assessment and plan in the Psychiatrist note is sufficient. But no, you have to magically predict how many visits the patient will need over the year, and regurgitate everything in your progress note on to their form. "Ain't no body got time for that" -Sweet Brown. Even attempting to say "see clinical note" and fax that to them, doesn't cut it. So you are faced with extra paperwork time keeping you from seeing one more patient, and at a pay rate that is equal to medicare or less (typically less). That's a double hit.

The expanded choice program is a farce.

 

[wolfvgang22]

The CHOICE program in the VA is a farce for the region I'm in for psychiatry because there is not a single psychiatrist within 500 miles who will participate. Psychiatrists in our region are all doing just fine with plenty of their own patients at a higher reimbursement rate, thank you very much, lol.
The national VA can mandate sending veterans outside the VA until they are blue in the face here, it won't help because the doctors aren't there.

 

[Stagg737]

I've found it true at all of mine. I've trained/worked at two flagships, and two mid size. And, I've worked at the one in my current city as well, huge difference. I'll grant that it's not universal, but it's most likely better on average than places outside of the system where the Vets would need to seek care if they did not have the VA. As for the waits, the reports back from the expanded Choice program has thus far shown much longer waits for specialty services in the private sector. System is not perfect by any means, but it's nowhere near the picture pointed by the demagogues.

Again, I've found this to vary significantly. I've worked at 4 different VAs throughout med school and residency and my father has worked at 3 (different ones from me) and there was significant variance between quality and availability of services. This isn't much different than the quality variance in the private sector. Again though, I think there's a huge difference between the veteran population and the gen pop in terms of needs making this comparison something other than apples to apples. I don't think the VA is a complete failure/disaster as a system (though though I do think trying to model the US health system after it would be), but I also think it's a system that has a lot of problems that should not exist given the way it's set up.

 

[notdeadyet]

Out California way there are some good salaries. I know of a VA that was starting at $265K annually (granted, in an expensive locale). I don’t work there, but I’ve been very happy with my salary, don’t have much call, and feel we deliver good care.

 

[nolapsych]

Out California way there are some good salaries. I know of a VA that was starting at $265K annually (granted, in an expensive locale). I don’t work there, but I’ve been very happy with my salary, don’t have much call, and feel we deliver good care.

I'm in Negotiation with a VA in CA now, would appreciate some help as I feel I'm getting lowballed.

 

[cara susanna]

I'll stop crapping on the bureaucratic nightmare that is the VA when they figure out how to actually implement their new suicide prevention policy. I've spoken to a few people that are a bit higher up in terms of QI projects (as I'm trying to get involved with these projects) and policy implementation at our VA and all of them have said the program is a largely political stunt with no evidence behind it and has been horrible to roll out. I know our service has gotten a lot worse since the policy's implementation and we are seeing more unnecessary and inappropriate consults than we can count.

No, not all VAs are equal, but the administrative nightmares are prevalent throughout the system. Especially since many of their policies are nationally mandated.

I know that your post is from March, but... would you be willing to elaborate on which specific suicide prevention measures you're referring to? You can PM me if you're not comfortable sharing publicly.

 

[dl2dp2]

I'm in Negotiation with a VA in CA now, would appreciate some help as I feel I'm getting lowballed.

Here are the salary latest off my recruiter grapevine:

VAs in 2nd tier locations are competing with large HMOs like Kaiser and are starting to offer 300k salaries. Kaiser has offered some 300k+

Top academic facilities are starting to offer 250k salaries to full-time clinicians. VAs associated with academic groups tend to match similar salaries. I think if you start the negotiation at such a location with 250k they would not blink. Ending somewhere in the upper 200s would be reasonable.

 

[comp1]

VA salaries are all public. You can search for any VA physician's salary online. Look up your interviewers' salaries and you'll get an idea of what they could offer you. However, I hadn't really heard of the VA being able to really negotiate a salary like private companies can. Salaries are, I thought, set by a salary board and weren't really tied to a specific individual, but instead a specific position in a specific location.

 

[wolfvgang22]

VA salaries are all public. You can search for any VA physician's salary online. Look up your interviewers' salaries and you'll get an idea of what they could offer you. However, I hadn't really heard of the VA being able to really negotiate a salary like private companies can. Salaries are, I thought, set by a salary board and weren't really tied to a specific individual, but instead a specific position in a specific location.

Not exactly true. While the salaries of myself and my colleagues in the VA are listed online, the information is now 3 to 4 years old, so actually somewhat lower than we actually get paid now. Also, it doesnt include performance pay bonuses which ranges between $3k and $15k per year (I get $15k most years, typically dispersed in March.) Finally, while there is a supposed cap on psychiatrist salary it is not really set in stone. I'm getting paid more right now myself. I won't go into my specific situation in public here, but I'm happy to discuss it privately. You can negotiate just like anywhere else. The local VA leadership just has to be motivated to do so.

 

[yanks26dmb]

Common to be able to negotiate for more time off each year too? Id ideally like to find a job with 8-12 weeks off. Not sure if this is possible anywhere in psych though.

 

[psychapp121]

Common to be able to negotiate for more time off each year too? Id ideally like to find a job with 8-12 weeks off. Not sure if this is possible anywhere in psych though.

why would it not be possible in psych?

 

[yanks26dmb]

why would it not be possible in psych?

Was just thinking there may be more continuity of care needed in our field, so 3 months off a year might be a stretch.

 

[dl2dp2]

continuity

This is possible if you do shift based. Do only 12-hour ER/night weekend coverage shifts, $200*12*4*36. This is doable. Not really my cup of tea, but it exists and can be found. It may even exist in VA/state hospital systems.

It's also relatively easy to find 6-month locum gigs that pay 10g per week, though you'd have to travel around the country.

 

[FlowRate]

Not exactly true. While the salaries of myself and my colleagues in the VA are listed online, the information is now 3 to 4 years old, so actually somewhat lower than we actually get paid now. Also, it doesnt include performance pay bonuses which ranges between $3k and $15k per year (I get $15k most years, typically dispersed in March.) Finally, while there is a supposed cap on psychiatrist salary it is not really set in stone. I'm getting paid more right now myself. I won't go into my specific situation in public here, but I'm happy to discuss it privately. You can negotiate just like anywhere else. The local VA leadership just has to be motivated to do so.

Seems like there's a bit of room to fudge your "experience" rating, perhaps? (I forget what they call it exactly, but the VA asks you to list all possible relevant experiences.)

 

[reca]

This is possible if you do shift based. Do only 12-hour ER/night weekend coverage shifts, $200*12*4*36. This is doable. Not really my cup of tea, but it exists and can be found. It may even exist in VA/state hospital systems.

Seems pretty high for VA. They pay moonlighters around 140/hr where I am at.

 

[wolfvgang22]

Seems like there's a bit of room to fudge your "experience" rating, perhaps? (I forget what they call it exactly, but the VA asks you to list all possible relevant experiences.)

No, no fudging required. There is s critical shortage of psychiatrists.