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Hi
Any insight on what is it like working as general outpatient PMR doc for the VA?
Any insight on what is it like working as general outpatient PMR doc for the VA?
life as a outpatient VA PMR doc
- Thread starter AndyDufrane
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All the ones I've met are really happy (honestly though, just about every VA doctor I've met was happy). They get more time to spend with their patients, usually shorter hours too. Overall a "slower pace" it seems (note: I've only rotated at three VAs, so I can't speak for all of them). You do have to be willing to deal with the gov't bureaucracy that comes with the territory. And lousy cafeteria food... As well as a lower salary. But you if you're at a teaching VA you get to work with residents, and you also get some of the best patients in the US. The WWII vets are rare these days, but those guys are made out of steel.
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If it's Seattle then you get to have lunch here: http://fouleemarket.com/
During residence it was all you can eat for $3.00. Short distance to the international district for Pho🙂
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1) You would be off today (Washington's birthday). You would get a total of 10 Federal holidays.
2) Patient load would be about half what you see in private practice.
3) No call. No pager. Monday through Friday.
4) You are the gatekeeper. See most of the musculoskeletal and decide if they should see the spine/neurosurgeon.
5) If a patient No shows or cancels, you are not fretting about the loss of potential revenue.
6) Biggest drawback. Salary will be less than private practice. There is no incentive to squeeze another patient in your schedule, since it won't increase your salary (I guess you could do it to help the patient out 🙂)
7) I think you will get paid less than an anesthesiologist who does interventional pain. The VA bases your salary on your primary speciality and anesthesia has a higher salary grade than PMR.
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The VA bases your pay on a lot of stupid stuff that have nothing to do with nothing, like your age, if you have years of military service, etc. Before you get hired they tell of you vaguely of a range (which you can confirm from the VA jobs website) that might describe $100,000 - $200,000 for a job. Your pay is actually set by a panel after you get hired. That's what's so ridiculous about it. You could be making X or 2X, but won't know until after you've done months of paperwork and signed the contract. Even if you're not busy (i.e. no patients), you're still expected to be in the office 8-5 all day at the VA.
The MSK guy I worked with when I was in residency seemed laid back, relaxed, knowledgable (I think he had a ton of time to read all day). Pay at VA's is going to be reasonably competitive, you won't make the most but you get a ton of days off, and stuff like Columbus day off.
My SCI attending at VA once told me on a Friday afternoon, Hey i won't be here next week sorry (!) but they are forcing me to take a week off next week since otherwise I have too much days (!).
If that is important to you, then that should be a big factor. I think sometimes people get too caught up in attending compensation purely as a numerical salary figure and less on other factors.
Like others said you are a gatekeeper in a lot of facets but while you get some of the best patients (old vets WW2, Korea etc) you also get a lot of other patients that are equally as frustrating to work with and at times makes you question what they are doing there in the 1st place.
Here is my big question though, with fiscal cliff, and all sorts of other cuts possibly happening I don't know what will happen to VA budgets and doc reimbursements. I understand that at least in the past, going near the VA with the budget cut stick was risky for politicians since you could get a lot of electorate backlash. Then again, it can't be any worse than what everyone else is going through too.
My SCI attending at VA once told me on a Friday afternoon, Hey i won't be here next week sorry (!) but they are forcing me to take a week off next week since otherwise I have too much days (!).
If that is important to you, then that should be a big factor. I think sometimes people get too caught up in attending compensation purely as a numerical salary figure and less on other factors.
Like others said you are a gatekeeper in a lot of facets but while you get some of the best patients (old vets WW2, Korea etc) you also get a lot of other patients that are equally as frustrating to work with and at times makes you question what they are doing there in the 1st place.
Here is my big question though, with fiscal cliff, and all sorts of other cuts possibly happening I don't know what will happen to VA budgets and doc reimbursements. I understand that at least in the past, going near the VA with the budget cut stick was risky for politicians since you could get a lot of electorate backlash. Then again, it can't be any worse than what everyone else is going through too.
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It is very rare that you have no patients. It is about a 5-6 week wait for a physiatry appt at my VA. You are a salaried physician with set hours. It sets a bad precedent to let you leave early because you have no patients (you'll have clerks, secretaries, therapists wanting to leave early saying they are done with their work).
I think the VA is fairly safe with budget cuts with many veterans from Iraq and Afghanistan coming in for services.
Just a comment on this post from someone who has navigated the VA application and recruitment process as well:
1. The VA does base your pay on multiple factors; e.g. # of years as attending vs straight out of training, board certification(s), prior academic appointments etc. Additionally if you are prior military, specifically honorably discharged, you will have a leg up when competing with equivalently skilled applicants due to Veteran's Preference regulations. Prior federal service (military or otherwise) may affect number of vacation days, although most docs get the max of 26 vacation days per year in addition to the 10 paid federal holidays, little to no call, no weekends etc.
2. I am not sure any physician should really complain about having to work from 8-5 when there are many specialties working longer and harder hours with significant on call time.
In most VAs (leadership permitting) you can set your tour of duty. For example, my chosen tour will be from 7a-330p every day M-F. I had the option to work 4 x 10hr days, but liked being home by 4p every day. Pretty nice in my book, but I will have to be at work during my chosen tour. If I happen to not be busy, I will work on recruitment and education of my referral base (PCPs, Ortho, Neurosurgery, Neuro etc) to build my numbers so I am busy.
One positive is you are paid a salary and are not punished if patients no-show. A nice offset for having to be at work for 8.5 hours a day
3. It is true that there is a range of pay which is determined by a pay panel.
That pay panel looks at prior experience, fellowship training, additional board certification (e.g. EMG boarded in addition to PM&R board certified), and specific tasks expected of you (e.g. will you be Chief of Dept, Medical director of a clinic vs staff PM&R doc) when developing a pay offer within set tiers set for federal physician specialties. You may be able to negotiate above your tier, but the more experience you have and how much the given VA Med Ctr needs you will dictate success in that arena.
You do not have to sign a contract before knowing the salary. You do have to go through the application process, interview and be selected before a salary offer letter will be created. It is indeed a slow process (this is the federal govt) and can be frustrating.
4. To echo earlier posts on this thread. Almost all VA docs, especially the VA PM&R docs I have met and/or worked with have been happy.
FYI- I chose to join the VA, so my view may be skewed, but feel free to PM me with any questions.
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Does the VA do any recruiting while you're in residency? (Aside possibly from word of mouth advertising at your home program encouraging you to apply), or are most VA PM&R positions ones that we need to actively seek out? And if so, about what time during residency/fellowship should we start looking for positions? Around the same time we'd look for private practice jobs, or even earlier given the government's slow application process?
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https://www.usajobs.gov/JobSearch/Search/GetResults?Keyword=physiatrist&Location=&AutoCompleteSelected=False&search.x=0&search.y=0
That search will come up with all open Physiatrist positions as they are required to advertise federal positions through USAjobs. You can try to re-do the search with PM&R as well. I can second the extremely long hiring process for government jobs...check the announcements and see when you can apply. You might be able to start the process during your 4th year.
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Thanks! I'll keep that link/site in mind when I'm job searching ~3-4.5 years from now.
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I'm not saying the 8-5 is bad, I'm just pointing out that it is in fact an 8-5, whether you're working the whole time or not. In the community, there are these "stories" that doctors like to tell about lifestyles of the VA physician.
Try to look at it though from the point of view of someone whose looking, perhaps scrambling for a job. He's got an offer or two in hand already. He knows the salaries on those. But then he has to wait months for the VA to process his papers after he's already interviewed, for the panel to meet, and then to learn his salary (which could be $100K to $200K), before deciding. That's a lot of risk.
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It's a nice place to retire and "coast" through the downward slope of life 🙂
i disagree- some of the smarted doctors and well read doctors I know are in the VA. they are young whippersnappers
There is definitely risk with waiting. And yes your salary is variable. Having had a PP offer during the negotiation with the VA, I have lived it.
But you can discuss with the potential Dept Chief the likely salary range, as he/she know what their staff are making and recent hires are being paid. Assuming you trust the individual, you should have a good idea. Again, its supply vs demand. If they need you more than you need them, you will be more in the know during the process and your pay is likely to be in the higher end of the range.
I second the USAJOBS.gov comment above. This is where all the federal physician jobs are posted.
In answering an earlier question, depending on connections with your local program and/or your staff who may know leadership at other VAs, you may be able to find out about VA PM&R openings that have not yet been posted. Using those connections you can connect with PM&R leadership in those hospitals. You will likely still have to go through the USAJOBS process but you may have an "in"
Good luck as we can always use great PM&R docs to care for our veterans
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