inpatient staffing at large teaching hospital vs. Veterans Affairs hospital

[applegirl89]

Hello! I was just wondering, for someone who's trying to gain experience working as an inpatient staff pharmacist, is it better to work at a large teach hospital or at the VA?

And as far as opportunities to grow as a pharmacist and being promoted into other clinical positions, which of the two settings would be more likely to let you do that? I've heard that Veterans Affairs hospitals won't consider you for their clinical positions unless you have residency background (regardless of years of work experience) or certifications. Is that true?

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[lord999]

If you've seen one VA, you've seen one VA. Inpatient staffing is all over the place due to the way the allocation system works (in VA speak, this is the OB/MCA 101 and 103 budget line to ARC VERA cost per patient rules). No, that isn't true, however, that only applies to pharmacists trained in the era before residency was a big thing (so before 2008 or so). If you are after that time, it is *possible* to promote from staff to clinical, but very rare, and it is a terminal promotion. Pharmacists without a residency usually promote to management or technical pharmacy (quality management (12, 13) , informatics (13, 14), research (13, 14), Inspector General or Consultant (14, 15, SES)) rather than clinical grades (clinical (12), specialist/clinic director (13-rarely 14), "coordinator"/associate chief of clinical and education (13, mostly 14)).

The way I phrase it is like this to 4th years in the two that I teach at:
1. Almost always, the university hospital or teaching hospital's pharmacists are paid better (somewhere between 10-25% normally) than the equivalent in VA. For certain classes of pharmacist like informatics or management, the difference can be far larger. The chief of the university hospital is paid somewhere between $275k and $290k depending on her performance, while the regional (VISN) director of VA pharmacy, the chief of the local VA pharmacy, and the GS-14 Associate Chiefs are all top coded at $158k (with minor difference in performance bonuses) with a much larger bureaucratic load living in the same city. If pay is your major factor, stick with the teaching hospital. I have specific information if your city is Phoenix or Portland as we just finished market surveys for both cities.

2. On the other hand, VA is kind of the closest to a hospital "chain" there is, and mobility within the federal government and willingness to allow pharmacists to work weird jobs is much higher than a hospital. It is a very common matter to start working in a VA hospital in one city, then transfer to another city due to family or you want to live here reasons. These changes can be made without losing seniority (Title 5 rules dictate that the only time local seniority may matter for personnel issues is when there is a tie, otherwise, the inception entry on date). You don't have that mobility with a teaching hospital, and all hospitals (VA and otherwise) go through bad leadership such that moving seems to be a better option. This also allows you to work jobs that aren't necessarily pharmacy, but are very interesting. The current Deputy Chief of Staff VHA, the Assistant IG (and four of the Deputy Assistant IGs), and two of the Deputy Undersecretaries are RPhs. There are quite a number of us in Benefits (Insurance Specialists) and IT (Architects and Chief Programmers) who like working from home rather than in the office and are paid on parity with our workaday counterparts.

 

[applegirl89]

If you've seen one VA, you've seen one VA. Inpatient staffing is all over the place due to the way the allocation system works (in VA speak, this is the OB/MCA 101 and 103 budget line to ARC VERA cost per patient rules). No, that isn't true, however, that only applies to pharmacists trained in the era before residency was a big thing (so before 2008 or so). If you are after that time, it is *possible* to promote from staff to clinical, but very rare, and it is a terminal promotion. Pharmacists without a residency usually promote to management or technical pharmacy (quality management (12, 13) , informatics (13, 14), research (13, 14), Inspector General or Consultant (14, 15, SES)) rather than clinical grades (clinical (12), specialist/clinic director (13-rarely 14), "coordinator"/associate chief of clinical and education (13, mostly 14)).

The way I phrase it is like this to 4th years in the two that I teach at:
1. Almost always, the university hospital or teaching hospital's pharmacists are paid better (somewhere between 10-25% normally) than the equivalent in VA. For certain classes of pharmacist like informatics or management, the difference can be far larger. The chief of the university hospital is paid somewhere between $275k and $290k depending on her performance, while the regional (VISN) director of VA pharmacy, the chief of the local VA pharmacy, and the GS-14 Associate Chiefs are all top coded at $158k (with minor difference in performance bonuses) with a much larger bureaucratic load living in the same city. If pay is your major factor, stick with the teaching hospital. I have specific information if your city is Phoenix or Portland as we just finished market surveys for both cities.

2. On the other hand, VA is kind of the closest to a hospital "chain" there is, and mobility within the federal government and willingness to allow pharmacists to work weird jobs is much higher than a hospital. It is a very common matter to start working in a VA hospital in one city, then transfer to another city due to family or you want to live here reasons. These changes can be made without losing seniority (Title 5 rules dictate that the only time local seniority may matter for personnel issues is when there is a tie, otherwise, the inception entry on date). You don't have that mobility with a teaching hospital, and all hospitals (VA and otherwise) go through bad leadership such that moving seems to be a better option. This also allows you to work jobs that aren't necessarily pharmacy, but are very interesting. The current Deputy Chief of Staff VHA, the Assistant IG (and four of the Deputy Assistant IGs), and two of the Deputy Undersecretaries are RPhs. There are quite a number of us in Benefits (Insurance Specialists) and IT (Architects and Chief Programmers) who like working from home rather than in the office and are paid on parity with our workaday counterparts.

Thank you for your input lord999!. What are the benefits of working at the VA? I have heard about the loan forgiveness program, but I don't really care about that because I already paid off a large portion of my student loans. And people have said that at the VA you get all these benefits like 401K matching and 11 federal holidays off and stable shifts..etc? how true is that? and does that depend on which VA you work at, like you said earlier.

 

[bacillus1]

Thank you for your input lord999!. What are the benefits of working at the VA? I have heard about the loan forgiveness program, but I don't really care about that because I already paid off a large portion of my student loans. And people have said that at the VA you get all these benefits like 401K matching and 11 federal holidays off and stable shifts..etc? how true is that? and does that depend on which VA you work at, like you said earlier.

This depends on the VA. My first VA job was every 2nd-3rd weekend which could be any shift, including overnight, as well as working about 3 federal holidays per year. My current job is M-F 8-4:30, no working evenings, weekends, nights or holidays. Both jobs have loan repayment, but many VA jobs now do not have it due to decreased funding. Matching is 100% for first 3% then 50% for next 2%, plus 1% even if you don't put anything in but you have to work over 3 years to keep it, so essentially you get 5% if you put in 5%. There's also pension on top of that, but you have to contribute a portion of your salary towards it. Days off start off at 13 vacation 13 sick, but your vacation days bump up to 20 after 3 years (residency counts). Also lord999 mentions mobility without losing seniority, which is nice if there are positions where you want to work. Finally, the biggest benefit is that it has historically been viewed as a stable job where it's difficult to fire someone or lay someone off, but who knows what it'll be like under the new presidency.

 

[lord999]

Thank you for your input lord999!. What are the benefits of working at the VA? I have heard about the loan forgiveness program, but I don't really care about that because I already paid off a large portion of my student loans. And people have said that at the VA you get all these benefits like 401K matching and 11 federal holidays off and stable shifts..etc? how true is that? and does that depend on which VA you work at, like you said earlier.

Everything to do with finance and leave with the exception of direct loan repayment (EDRP) or sponsorship for further study (EISP) is standardized through OPM.

https://www.opm.gov/policy-data-oversight/pay-leave/

Yes, the pay and holidays are pretty standard.

Here's where pharmacy is different though (due to Title 38):
1. We do not have to follow the Grade and Step appointment rules that the standard employee uses. We have the discretion to place someone at a higher initial pay or advance someone for unusual merit. Less likely today, but if you had applied five years ago, you could easily negotiate outside tenure in (meaning we would start you as if you had worked in our system the entire time). Not so much now since we have enough.

2. Shift assignments are more variable than Title 5. That means that you can be forced to work any shift that any pharmacist could work in your pharmacy (including nights). However, there are specific rules that have to be followed to not incur OT, and that's not easy.

And to those who are already tenured, even Trump can't reform the civil service so much that we lose career tenure (there are reasons having to do with court precedent on due process on this matter), but, Trump probably can easily shrink the VA by resource starving it like other presidents have done.

One other benefit that doesn't apply to me necessarily, but is "fair" is that salaries are known and set in stone. There's politicking in hospitals for pay differential and that's not necessarily fair or just, but the civil service's kind of systematic pay setting really cuts down on the gender discrimination and other subtle disadvantages if you don't negotiate. This is an opinion and not necessarily shared, but I actually think the federal government (not just VA) allows for fairly generous and lenient leave and alternate arrangements for parapregnancy matters more so than even the private hospitals.

But, remember, I drink the Kool-Aid. I made my choice, but I know that the VA is the bureaucratic swamp that it is.