How is the VA as an employer for family medicine?

[cyanide12345678]

Asking for my wife. Anyone here working for the VA? What's compensation like usually for the VA? Benefits I'm assuming will be above average, agreed?

What's the average patient load per day, and the average work week like, is it mostly 4.5 clinic days basically? I'm sure the girls will vary based on location, but just getting a general idea of job satisfaction of VA vs community.

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[deleted87716]

The VA typically pays less than you'd be able to make in the private sector.

https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/PayTablesRev.pdf

https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/FinalAnnualPayRanges.pdf

 

[cyanide12345678]

The VA typically pays less than you'd be able to make in the private sector.

https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/PayTablesRev.pdf

https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/FinalAnnualPayRanges.pdf

That wide range from 103k to 225k doesn't mean much. I'm guessing where you start is based on experience and location and their difficulty in recruiting. But realistically, what are most people saying compensation wise? I mean...are you guys really starting at 103k? I doubt anyone is taking that much of a pay cut.

 

[deleted87716]

That wide range from 103k to 225k doesn't mean much. I'm guessing where you start is based on experience and location and their difficulty in recruiting. But realistically, what are most people saying compensation wise? I mean...are you guys really starting at 103k? I doubt anyone is taking that much of a pay cut.

I'm sure there are some good docs at the VA, but most of the people I know who have gone to work there were either easing into retirement or couldn't work anywhere else.

 

[DoubleBogey]

Generally, the VA is where physicians go to die, your learning/exposure will not grow but remain stagnant. Salaries are starting around $185-210k from people I know who interviewed there for primary care.
Light schedule, good retirement with federal holidays off are pluses.
Don’t get me wrong, I very much enjoyed caring for Vets, but just not a place where you can grow as an attending

 

[galactus]

That wide range from 103k to 225k doesn't mean much. I'm guessing where you start is based on experience and location and their difficulty in recruiting. But realistically, what are most people saying compensation wise? I mean...are you guys really starting at 103k? I doubt anyone is taking that much of a pay cut.

The VA tends to be a lower salary compared to academic medical centers, however I have friends who love practicing medicine at the VA exclusively, and some of those friends are even in surgical fields! Yes it's lower pay, but as previous posters mentioned people go to the VA as they are easing into retirement, or a pretty relaxed schedule. Getting federal holidays off is a big plus. I work for an academic medical center and my institution only recognizes half of them. There was one year where both X-mas and NYE were on weekdays, and our clinic was fully open both days!

 

[cyanide12345678]

185k for a cushy job isn't bad I think. That's only about a 10-15% paycut. I'm assuming they probably see 10-15% patients less anyway. As an ER doctor, if I ever worked the VA, my paycut would be tremendous, but the paycut in family medicine doesn't seem to be that bad and may be worth a slow pace stress free life.

 

[AFMD]

Average is probably closer to 200K or more for primary care. If you stay long term, retirement benefits are quite excellent. I like the actual 40 hour work week, the 30-60 minute appointments, and team support. I can do specialty e-consults for advice on how to treat anything so I don't have to send vets to specialists if I don't want. Of course, I can still send them if I'd like. The other providers and pharmacists are very helpful. There are many opportunities for CME and further training, mini-residencies,. grand rounds, etc. I have time to read and learn how to manage more and more issues on my own. I'm always learning more and honing my clinical skills. I play a very small role in some of the research that is done with some of my patients, but I'm not really into research. You can make a lot more crushing through 5 patients an hour and working more hours in private practice if you'd like, but that's not my cup of tea.

Veterans tend to be more male, older, and more complicated. I still have many patients in their 20s, male and female. I don't see pediatrics anymore, which was hard to let go of. I can do women's health, musculoskeletal stuff, addiction, procedures, etc. as I am interested. We obviously don't do OB (although I have pregnant patients), and I don't do inpatient anymore.

There is a lot of bureaucracy and paperwork (computer work I guess). In my experience, there is a fair amount of paperwork private practice with insurance. There is more at the VA for sure, but not a soul sucking amount. If paperwork is your least favorite part of your job, then the VA might not be for you.

The biggest thing is probably how well you like to work within a system, or if you like to do you own thing. If you don't like playing in the sandbox, the VA is not for you. Specialists, pharmacists, and some policies will change how your patients are managed or limit the options if you like to try non-traditional treatments. If you like following the most mainstream guidelines, then it really shouldn't affect you much.

I've heard a lot of negative things about the VA from physician, but only ones who have never worked at a VA. I've never spoken to a physician (or other provider) that had many negative things to say, but there are pros and cons.

 

[DoubleBogey]

Average is probably closer to 200K or more for primary care. If you stay long term, retirement benefits are quite excellent. I like the actual 40 hour work week, the 30-60 minute appointments, and team support. I can do specialty e-consults for advice on how to treat anything so I don't have to send vets to specialists if I don't want. Of course, I can still send them if I'd like. The other providers and pharmacists are very helpful. There are many opportunities for CME and further training, mini-residencies,. grand rounds, etc. I have time to read and learn how to manage more and more issues on my own. I'm always learning more and honing my clinical skills. I play a very small role in some of the research that is done with some of my patients, but I'm not really into research. You can make a lot more crushing through 5 patients an hour and working more hours in private practice if you'd like, but that's not my cup of tea.

Veterans tend to be more male, older, and more complicated. I still have many patients in their 20s, male and female. I don't see pediatrics anymore, which was hard to let go of. I can do women's health, musculoskeletal stuff, addiction, procedures, etc. as I am interested. We obviously don't do OB (although I have pregnant patients), and I don't do inpatient anymore.

There is a lot of bureaucracy and paperwork (computer work I guess). In my experience, there is a fair amount of paperwork private practice with insurance. There is more at the VA for sure, but not a soul sucking amount. If paperwork is your least favorite part of your job, then the VA might not be for you.

The biggest thing is probably how well you like to work within a system, or if you like to do you own thing. If you don't like playing in the sandbox, the VA is not for you. Specialists, pharmacists, and some policies will change how your patients are managed or limit the options if you like to try non-traditional treatments. If you like following the most mainstream guidelines, then it really shouldn't affect you much.

I've heard a lot of negative things about the VA from physician, but only ones who have never worked at a VA. I've never spoken to a physician (or other provider) that had many negative things to say, but there are pros and cons.

FYI: you don’t have to be seeing 5 patients an hour to be killing it, 3/hr will suffice with appropriate documentation working a 36hr work week - to each their own

 

[baseballer]

Average is probably closer to 200K or more for primary care. If you stay long term, retirement benefits are quite excellent. I like the actual 40 hour work week, the 30-60 minute appointments, and team support. I can do specialty e-consults for advice on how to treat anything so I don't have to send vets to specialists if I don't want. Of course, I can still send them if I'd like. The other providers and pharmacists are very helpful. There are many opportunities for CME and further training, mini-residencies,. grand rounds, etc. I have time to read and learn how to manage more and more issues on my own. I'm always learning more and honing my clinical skills. I play a very small role in some of the research that is done with some of my patients, but I'm not really into research. You can make a lot more crushing through 5 patients an hour and working more hours in private practice if you'd like, but that's not my cup of tea.

Veterans tend to be more male, older, and more complicated. I still have many patients in their 20s, male and female. I don't see pediatrics anymore, which was hard to let go of. I can do women's health, musculoskeletal stuff, addiction, procedures, etc. as I am interested. We obviously don't do OB (although I have pregnant patients), and I don't do inpatient anymore.

There is a lot of bureaucracy and paperwork (computer work I guess). In my experience, there is a fair amount of paperwork private practice with insurance. There is more at the VA for sure, but not a soul sucking amount. If paperwork is your least favorite part of your job, then the VA might not be for you.

The biggest thing is probably how well you like to work within a system, or if you like to do you own thing. If you don't like playing in the sandbox, the VA is not for you. Specialists, pharmacists, and some policies will change how your patients are managed or limit the options if you like to try non-traditional treatments. If you like following the most mainstream guidelines, then it really shouldn't affect you much.

I've heard a lot of negative things about the VA from physician, but only ones who have never worked at a VA. I've never spoken to a physician (or other provider) that had many negative things to say, but there are pros and cons.

How many patients do you average per day? Are you allotted 30 minutes for an office visit and 60 minutes for a physical? What do the retirement benefits entail and how many years do you work to become eligible? How does litigation risk compare to private practice? Thanks for and interested to hear your insight!

 

[VA Hopeful Dr]

How many patients do you average per day? Are you allotted 30 minutes for an office visit and 60 minutes for a physical? What do the retirement benefits entail and how many years do you work to become eligible? How does litigation risk compare to private practice? Thanks for and interested to hear your insight!

Retirement is years of service times 1.1 times average highest salary for 3 years.

So let's say you work 25 years. You're average highest salary is 200k. Your pension will be 55k/year.

 

[AFMD]

FYI: you don’t have to be seeing 5 patients an hour to be killing it, 3/hr will suffice with appropriate documentation working a 36hr work week - to each their own

At another job that didn't work out I would have made about 170-180k a year seeing 3 an hour for 36 hours a week on average. Most would make more than that in the VA, but I see your point. It's perfectly possible to have a reasonable schedule in private practice. I just prefer to not worry about production or collections, or any of that at all.

How many patients do you average per day? Are you allotted 30 minutes for an office visit and 60 minutes for a physical? What do the retirement benefits entail and how many years do you work to become eligible? How does litigation risk compare to private practice? Thanks for and interested to hear your insight!

I'm still ramping up. They have most slowly increase over the course of a year to around 30 hours a week of patient contact time with half hour appointments for established patients, and an hour for new patients. The final panel is usually around 1000-1200 patients for physicians. Patients are complicated in my experience though.

Healthcare workers in the VA have immunity to individual liability under to federal law (statutory immunity).

Retirement is years of service times 1.1 times average highest salary for 3 years.

So let's say you work 25 years. You're average highest salary is 200k. Your pension will be 55k/year.

This is part of retirement called the FERS annuity. You'll have TSP fund as well, which is the federal government equivalent to a 401k. The VA matches essential 4% of your annual salary in the fund if you're paying into it. That's around 8k a year or more which over 20 years at 5% is more than 250k extra in your retirement, or over 500k over 30 years. I think I did the math right. This on top of what you saved yourself. Other private jobs will likely have 401k matches as well.

You can keep your health insurance paying what you paid while you were working with the employer contribution if you work there for at least 5 years I think as well.

It's all about what your goals are, and what the pros and cons you care about the most.

 

[baseballer]

Thanks so much for the detailed replies! Definitely food for thought.

 

[kaymazaaa]

I'm considering a career as a PCP in the VA system and was wondering if they allow you to moonlight? Also how many patients are PCPs seeing on average per day?

 

[VA Hopeful Dr]

I'm considering a career as a PCP in the VA system and was wondering if they allow you to moonlight? Also how many patients are PCPs seeing on average per day?

Why?

 

[Mad Jack]

I'm considering a career as a PCP in the VA system and was wondering if they allow you to moonlight? Also how many patients are PCPs seeing on average per day?

The VA does allow you to moonlight and has no restriction with regard to your ability to hold other positions so long as they don't present a true conflict of interest with the federal government, nor do they make you sign any form of noncompete.

 

[kaymazaaa]

Why?

The ability to have 49 days off out of the year. 30/60 min appointments. Pension. Sure the base salary is lower but you can potentially make even more money moonlighting on your days off and with that combination of W2 and 1099 income it certainly makes it intriguing. You can deduct a lot of business expenses working as an independent contractor doing side gigs.

 

[SKaminski]

Question. I am very drawn to work 4 day work weeks, with 3 day weekends. I understand I would work longer during those four days, likely working 10 hours four days a week. Is this something the VA accommodates?

 

[DoubleBogey]

If moonlighting and your primary job is at the VA, malpractice insurance will become an issue

 

[VA Hopeful Dr]

Question. I am very drawn to work 4 day work weeks, with 3 day weekends. I understand I would work longer during those four days, likely working 10 hours four days a week. Is this something the VA accommodates?

They offered me that same set up once. But so does my current employer. Working 4 days a week is not at all uncommon.

 

[VA Hopeful Dr]

The ability to have 49 days off out of the year. 30/60 min appointments. Pension. Sure the base salary is lower but you can potentially make even more money moonlighting on your days off and with that combination of W2 and 1099 income it certainly makes it intriguing. You can deduct a lot of business expenses working as an independent contractor doing side gigs.

So you want to have more days off for less money so you can work on those days off? Why not just get a good paying job out of the gate? Most places will let you do what you want with your schedule. My wife has 20 minute follow ups and 40 minute new patient appointments. She's on track to break 200k working 4 days a week. Oh, and we have a pension too.

 

[septoplasty]

So you want to have more days off for less money so you can work on those days off? Why not just get a good paying job out of the gate? Most places will let you do what you want with your schedule. My wife has 20 minute follow ups and 40 minute new patient appointments. She's on track to break 200k working 4 days a week. Oh, and we have a pension too.

But does she get 49 days off a year? Lol.
I'd imagine one may not use all 49 days off a year on vacay, in that scenario, if the'yre able to spend even 20 days working at the UC, that's an extra 20k of income. Grossing 235-245k and still having 30 days off a year. I'm with the other guy, the numbers favour the VA. Sure the complexity is higher, but man, that sounds kush haha.

 

[septoplasty]

If moonlighting and your primary job is at the VA, malpractice insurance will become an issue

I've never seen this as an issue, usually the 'moonlighting' will/should give insurance (+tail), if they don't, than its a ****ty moonlighting job.

 

[VA Hopeful Dr]

But does she get 49 days off a year? Lol.
I'd imagine one may not use all 49 days off a year on vacay, in that scenario, if the'yre able to spend even 20 days working at the UC, that's an extra 20k of income. Grossing 235-245k and still having 30 days off a year. I'm with the other guy, the numbers favour the VA. Sure the complexity is higher, but man, that sounds kush haha.

Well let's see, she only works 4 days a week. So compared to full time VA work that's 52 days off right there. I think she ended up taking probably 20 off outside of that not including holidays (8 of those).

Beyond that, the VA pays terribly. Starting pay for a new FP is anywhere from 105k to 180k. More importantly, it maxes out at 240k but that requires a number of years of service. Most FPs I know beat that within 18 months.

The numbers almost never favor the VA, that's kinda the point. If they did, more people would want to work there.

 

[NITRAS]

Just lurking, but probably shouldn’t mention how many days I have off a year.

 

[kaymazaaa]

So you want to have more days off for less money so you can work on those days off? Why not just get a good paying job out of the gate? Most places will let you do what you want with your schedule. My wife has 20 minute follow ups and 40 minute new patient appointments. She's on track to break 200k working 4 days a week. Oh, and we have a pension too.

Because I've encountered quite a bit of W2 jobs that don't allow you to moonlight. The ability to moonlight on the side allows you open up a solo 401k allowing you to save more for retirement and reduce your taxable income, deduct business expenses etc.

Well that's a different story then if off the bat they're offering you 100 - 180k. If they offered 180-220k that would certainly be more reasonable. I was just curious about the lifestyle and compensation just to weigh my options. Thanks for the input.

 

[kaymazaaa]

So you want to have more days off for less money so you can work on those days off? Why not just get a good paying job out of the gate? Most places will let you do what you want with your schedule. My wife has 20 minute follow ups and 40 minute new patient appointments. She's on track to break 200k working 4 days a week. Oh, and we have a pension too.

How many patients does she see per day?

 

[septoplasty]

Well let's see, she only works 4 days a week. So compared to full time VA work that's 52 days off right there. I think she ended up taking probably 20 off outside of that not including holidays (8 of those).

Beyond that, the VA pays terribly. Starting pay for a new FP is anywhere from 105k to 180k. More importantly, it maxes out at 240k but that requires a number of years of service. Most FPs I know beat that within 18 months.

The numbers almost never favor the VA, that's kinda the point. If they did, more people would want to work there.

I still think the VA is good though, its a set schedule, and when one is finished, they're not taking work home. Now this may not be the case for your wife, but how many FM docs spend more time in the clinic post work to finish charting etc.? This isn't something the VA allows in the first place, so not taking charts home with you is another benefit I see.

You're right about the salary difference though.

The other benefit I see w/ the VA is a lack of needing to practice defensive medicine.

 

[VA Hopeful Dr]

How many patients does she see per day?

Never more than 20, averages around 18

 

[VA Hopeful Dr]

I still think the VA is good though, its a set schedule, and when one is finished, they're not taking work home. Now this may not be the case for your wife, but how many FM docs spend more time in the clinic post work to finish charting etc.? This isn't something the VA allows in the first place, so not taking charts home with you is another benefit I see.

You're right about the salary difference though.

The other benefit I see w/ the VA is a lack of needing to practice defensive medicine.

Pros: great benefits, no lawsuits, serving vets

Cons: low pay, God awful bureaucracy

 

[aafisahar]

Pros: great benefits, no lawsuits, serving vets

Cons: low pay, God awful bureaucracy

disagree about all this. Friends who took PCP jobs in the VA system were getting 200k-220k/year (Hines/Jesse Brown [Chicago VAs]/Seattle FWIW) while friends who took VA jobs as hospitalists were sighing for 220-250k; one got a great job in ND for ~280k for 18 weeks or something ridiculous like that, plus great benefits (lots of student loan repayement, retirement, etc etc). No liability so you can practice medicine how you want. No worrying about what the patient can and can't get covered or afford; For example, I was able to get patients PCS9K inhibitors fairly routinely for ~30/month, you need the proper documentation and proper patient, but it's a hell of a lot easier than the civilian world (never saw repatha or praluent in the civilian world fwiw). Sure, there's bureaucracy but on the whole, it's similar to private insurance. Really the thing that makes the VA difficult is CPRS and the politics between departments.

 

[VA Hopeful Dr]

disagree about all this. Friends who took PCP jobs in the VA system were getting 200k-220k/year (Hines/Jesse Brown [Chicago VAs]/Seattle FWIW) while friends who took VA jobs as hospitalists were sighing for 220-250k; one got a great job in ND for ~280k for 18 weeks or something ridiculous like that, plus great benefits (lots of student loan repayement, retirement, etc etc). No liability so you can practice medicine how you want. No worrying about what the patient can and can't get covered or afford; For example, I was able to get patients PCS9K inhibitors fairly routinely for ~30/month, you need the proper documentation and proper patient, but it's a hell of a lot easier than the civilian world (never saw repatha or praluent in the civilian world fwiw). Sure, there's bureaucracy but on the whole, it's similar to private insurance. Really the thing that makes the VA difficult is CPRS and the politics between departments.

I can get a non-VA job in ND for 300k base and 75k loan repayment per year for up to 5 years tomorrow, 4 days per week so forgive me if I'm not impressed with that.

I've put 2 people on Praluent in the past 2 weeks with nothing more than my signature on the PA form. Highest cost was I think $50/month. Paperwork is only a problem in regular practice if you don't train your staff well. I haven't done more than sign a form in months.

As for Chicago and Seattle, COL is pretty high in both places. When I applied for a VA job 3 years ago in the SE they offered 150k. The other employers in town were starting at 200k and with production bonus most were making more like 250-280k. A quick search reveals that most non-academic jobs in Chicago are going for around 250k at present.

 

[absolutdokta]

No liability so you can practice medicine how you want.

Are VA doctors experimenting on patients? Not trying to facetious but as I near my end on the active duty side I have definitely considered a VA job. I’ve never seen the whole “no liability” stuff as an added bonus, aside from not having to pay malpractice insurance (unless that’s what you meant). I try to practice the best evidenced based medicine I can and if I go off the beaten path at all it’s after thorough discussion with the patient. If you’re out there being “rogue” and get the government sued whether or not you’re named you’re still gonna be answering questions and could risk your credentials....and that you do have answer yes to when applying for/renewing a license. So is it really that much of an added bonus? Again....not having to pay malpractice is the real bonus, but the risk is just the same imo

 

[DoubleBogey]

Are VA doctors experimenting on patients? Not trying to facetious but as I near my end on the active duty side I have definitely considered a VA job. I’ve never seen the whole “no liability” stuff as an added bonus, aside from not having to pay malpractice insurance (unless that’s what you meant). I try to practice the best evidenced based medicine I can and if I go off the beaten path at all it’s after thorough discussion with the patient. If you’re out there being “rogue” and get the government sued whether or not you’re named you’re still gonna be answering questions and could risk your credentials....and that you do have answer yes to when applying for/renewing a license. So is it really that much of an added bonus? Again....not having to pay malpractice is the real bonus, but the risk is just the same imo

Generally your employer covers your malpractice, unless you’re private practice which then is on you.

I would venture to say that lawsuits happen with even practicing within the evidence and standard of treatment. While you likely will win, you still have the stress of the deposition, public awareness of the trial and the trial itself (if it goes to trial). I have personally seen what some of my colleagues have gone through with a malpractice suit, very stressful to say the least. So, no risk of malpractice suits would be a positive in my book.

 

[absolutdokta]

Generally your employer covers your malpractice, unless you’re private practice which then is on you.

I would venture to say that lawsuits happen with even practicing within the evidence and standard of treatment. While you likely will win, you still have the stress of the deposition, public awareness of the trial and the trial itself (if it goes to trial). I have personally seen what some of my colleagues have gone through with a malpractice suit, very stressful to say the least. So, no risk of malpractice suits would be a positive in my book.

And then you have those that practice for 30+ years and don’t have it happen at all. And I know plenty of those. So?

 

[septoplasty]

And then you have those that practice for 30+ years and don’t have it happen at all. And I know plenty of those. So?

Well, stats prove say otherwise.
Regardless, even if there is a 5% chance that you're going be at the end of a litigation, that's 5% too high. Even if you "win" the suit (which there is never of anyways), still not a fun time, as the toll it takes is long standing and multilayered.

Another one of those things wrong with America and the medical system here.

 

[deleted87716]

Well, stats prove say otherwise.

Statistically, 1 in 3 FPs are sued at least once. So, may the odds be forever in your favor.

1 in 3 physicians has been sued; by age 55, 1 in 2 hit with suit

Specialty, age and gender tied to liability risk, says new research. Reforms are needed to fix the liability system that imposes high burdens on U.S. health care.

www.ama-assn.org