Heme/Onc Job at the VA?

[deleted1198173]

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Hello,

I am a prospective medical student really interested in heme/onc and I was considering pursuing the VA HPSP Scholarship which will pay for my schooling but require me to work for the VA after I'm done with residency/fellowship for 6 years + 1.5 years (0.5 years added for each year of fellowship). I am interested in heme/onc and this is a very big (and long) commitment so I want to make sure I understand what I would be getting myself into. If anyone has any experience with practicing in the VA it is much appreciated, my questions are:

• What is the typical compensation like working for the VA? I am hoping to work in the midwest.
  • I am aware it will be lower than private practice or community hospitals but how much lower are we talking (like less than 250k, -50%+)?
  • I know there are public salary tables https://www.va.gov/OHRM/Pay/2024/PhysicianDentist/AnnualPayRanges.pdf but they are ridiculously broad (121,000-400,000) and do not provide much specifics, and lump together many different specialties
• What is the demand for heme/onc VA positions in the midewest (not chicago), would I be able to find a position in the city I hope to continue living?
• What is the lifestyle like working at the VA (I assume its more laid back, more time with each patient, etc.)?
• Does working for the VA for many years right out of training restrict me from pursuing positions in private practice or community hospitals? Is there a stigma around working for the VA?

Thank you for everyone's help it is much appreciated!

 

[HemOncCheng]

based on my personal experience (as I heard from my friends, true cases), just the pasting recruitment season, VA retract contract of new hires due to budget issue of multiple sites last minutes (friends and friends' friends about to start in a couple of months)

 

[bobow98]

I looked up 3 oncologists that I know, all with 15+ years experience.
Range was 260-305k a year.
This is in line with what I was expecting to see.
Factor in 2-4% annual raises for federal employees and that's the growth trajectory.
Retirement plan is TSP, and pension is available (1% per year of service based on your best 3 years I believe).
If you want to be a VA lifer it is not a terrible deal but not as good as it used to be (used to be 2% per year of service pension if you started before 1982).

 

[HemeOncHopeful19]

I would NOT DO THE HPSP, that is a separate issue - isn't that the one where you are a military office afterward? SCAM

I worked for the VA for a bit. VA Heme/Onc is not a bad place to work at all, but I imagine it depends on your direct supervisor a lot (mine was awesome and supportive). Pay is around 300k so similar to academics but lifestyle is better than academics - if you are not in clinic then nobody cares whether or not you're grinding away at some grants or studies etc. Clinic usually ends around 330PM because by then the rest of the staff is ready to check out. Pharmacy is good to work with and you can generally get things approved pretty quickly if you're reasonble. If it is a *brand new drug that just came out and has never been used at ANY VA in the country before* then it can be difficult to get approved/ordered, but if you're trying to use an old drug for a *brand new indication that just came off the presses* it is probably easier to do at the VA than anywhere else in the country. The patients are generally super appreciative and good dudes, I imagine working Psych at the VA would be a totally different ballgame. If people have specific questions I could try to answer them.

I probably wouldn't want to work for the VA for 7 years and then try to go work in the community, mostly because at the VA you will see very little if any breast cancer and I think it'd be hard to go back to the community after 7 years of no breast.

The TSP (retirement) is decent but overrated nowadays IMO compared to prior when it took less of your salary upfront and paid out better at the back end. The health insurance is awesome and should probably be the way health insurance works for any job in the country: every year you can basically pick between plans of all the major insurers, so if they mess with their formularies or copays you can just hop to a different company... you know like actual competition for your business the way you do with your car or home insurance.

Perhaps also important you will be starting your Oncologist job in 2034 so who knows what the world will look like then

 

[bobow98]

What is the VA schedule like M-F and call situation etc?
Do you do 3, 4, or 5 days of clinic a week?
Patients a day?

 

[HemeOncHopeful19]

What is the VA schedule like M-F and call situation etc?
Do you do 3, 4, or 5 days of clinic a week?
Patients a day?

I don't want to post a super detailed schedule and make myself more doxxable than I already am but generally 3 days a week of clinic is the expectation - I imagine different VAs are completely different so YMMV. My boss has a "we work hard enough, if the government wants more out of us they can help us hire more people" attitude. Maybe 18-24 patients per day but that is with APP/Fellow help so you can still be done by 4-5PM unless something unusual has happened. When I'm on service I block my morning clinic slots and have full support in doing that from my boss.

Call is Q6-Q8 depending on how many docs we have a time, but it is extremely low stress because of fellows - I have literally never heard of an attending being needed overnight but I'm sure it has happened especially if SHTF and there was a new first year fellow I would be happy to head in and help.

Don't get me wrong I'd rather work with @gutonc (my spouse has no job option where he is) but the VA can be a good lifestyle balance if you aren't committed to chasing every last $. Other interesting bonuses such as 3 months PAID paternity/maternity leave so if you're young and planning to have kids that is essentially +25% salary on top, and there is pretty decent loan repayment that might add +10% to your overall pay. I've found all my colleagues in other departments to be excellent and we have good tumor boards etc. There are some downsides (beyond the obvious) mostly in that you're salaried so if someone in your group leaves/retires you are now on call that much more often while scrambling to hire a replacement and you aren't getting paid any extra for it. I have encountered a few sketchy referrals from PCPs (often independently practicing APPs...)

 

[gutonc]

I have encountered a few sketchy referrals from PCPs (often independently practicing APPs...)

A few? That's my entire patient panel.