Hello, I was wondering if anyone can shed some light on what it’s like working outpatient for Veteran Affairs. Specifically concerning the patient load/ time you get to spend with patients, culture of the VA, and work/life balance. I am looking in Northeast. Any idea on salaries? I am hoping to also qualify for pslf by working for them. Thanks
Outpatient VA
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Salaries should be public. If you know of any Docs in the same field as yours, you can check. Culture is slow but the days off on holidays are nice and I heard their retirement packages aren't bad either.
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I have multiple friends who now work in the VA system full time. There are pros and cons.
Lighter patient loads than private practice, usually fully salaried at rates a little lower than PP. Great retirement benefits with potential for early retirement. Usually contracts allow moonlighting etc outside of the VA system if you want more cash. There’s a lot of lifestyle reasons to work at a VA if you’re willing to accept lower amounts of reimbursement (but for less crazy workload). Northeast salaries probably 160k+ range I think. Lots of CME and paid holiday benefits. Most VA are also affiliated with academic centers so you have the ability to work with residents and fellows if you so wish.
The downside is that wait times for tests and procedures and such at the VA can be very long and require a decent amount of paperwork... thus many people get frustrated (understandably) and seek care outside anyway. Also VA nurses and MA/staff generally are terrible and slow and lazy, as anyone who has worked at a VA in residency can attest to. If you’ve ever been in a good private practice environment with great nurses and MAs and secretaries you will see the difference in how much more efficient and pleasant your workday can be.
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The problem is that once you've seen one VA, you've seen one VA (and only that VA). Culture, workload, etc. can all vary dramatically from site to site so it's hard to generalize.
As an integrated healthcare system you generally do not have to deal with third party insurance pre-authorizations, pharmacy non-formulary requests are pretty straightforward (and can be done directly from CPRS), billing and documentation is generally less onerous than at the attached academic affiliate and referrals are still mostly within the VA. You'll be able to access consult results from other VAs either through JLV or CPRS remote access. This has changed with Choice and accessing non-VA referrals is more painful as you have to open each scanned document separately.
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Can’t speak to being an attending at the VA but my VA primary care clinic was probably the most painful part of my residency and is shaping up to be the most painful part of my fellowship as well
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Other stuff not mentioned yet:
Pro-malpractice lawsuits are essentially never brought against va employees outside of attempted murder because of the Patient population and the mandate that you be sued alongside the US government in federal court.
Note requirements arent as stringent as pp because you aren't billing an insurance company though they can still be audited internally and are codes the same for internal tracking purposes.
Con-very rare to get fired from a VA so ****ty employees in all fields stick around or get hired and you can't do anything about it without years of accumulated evidence.
Can take obscene amounts of time to get things done, like 2 months for a stress test or pet scan unless you know someone or live in a resource rich area.
Pro-malpractice lawsuits are essentially never brought against va employees outside of attempted murder because of the Patient population and the mandate that you be sued alongside the US government in federal court.
Note requirements arent as stringent as pp because you aren't billing an insurance company though they can still be audited internally and are codes the same for internal tracking purposes.
Con-very rare to get fired from a VA so ****ty employees in all fields stick around or get hired and you can't do anything about it without years of accumulated evidence.
Can take obscene amounts of time to get things done, like 2 months for a stress test or pet scan unless you know someone or live in a resource rich area.
Why so bad? I am hoping the VA will be a place I can spend quality time with patients and that it will be different than the current setting I am in where its all about seeing as many patients as possible. I realize the pay will be less but I’m hoping it will be a better working environement and with good benefits. Problem is I never worked at a VA during residency and don’t know anyone currently working at one.
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I know a psychiatrist that seemed to like the trade off of doing it
never had anything negative to say, just that they had taken a paycut to do it, liked the patients, liked the hours, but had great benefits, and after like 15 or 20 years, had like no debt, and had the sort of pension that they could truly retire on, but they "retired" to a very comfortable private practice in a nice area doing med management/psychotherapy and some med student teaching
They basically put in their time in what sounded like a decent psychiatrist gig, and then was able to have the practice it sounds like is the psychiatrist ideal, in that it was whatever they wanted it to look like, which for a lot of docs in general if they actually like their field, is having control over your time and who you see, plus some "academic" time which such docs like too
they talked about how the big trade off was less money, but that ultimately it let them work less, and in a way they enjoyed
I don't know that you can achieve what they did, but they were a psych mentor I have for many, many years, and if I had gone that way, I would have tried to go their way as much as I could have
Now, is the VA route still the way? I don't know what debt repayment and pensions and all that works out to now, and how overworked or compensated you might be now at the VA.
ETA: Sorry, thought this was the psych forum. In any case it looks like others have seconded some aspects of a psychiatrist's experience there.
never had anything negative to say, just that they had taken a paycut to do it, liked the patients, liked the hours, but had great benefits, and after like 15 or 20 years, had like no debt, and had the sort of pension that they could truly retire on, but they "retired" to a very comfortable private practice in a nice area doing med management/psychotherapy and some med student teaching
They basically put in their time in what sounded like a decent psychiatrist gig, and then was able to have the practice it sounds like is the psychiatrist ideal, in that it was whatever they wanted it to look like, which for a lot of docs in general if they actually like their field, is having control over your time and who you see, plus some "academic" time which such docs like too
they talked about how the big trade off was less money, but that ultimately it let them work less, and in a way they enjoyed
I don't know that you can achieve what they did, but they were a psych mentor I have for many, many years, and if I had gone that way, I would have tried to go their way as much as I could have
Now, is the VA route still the way? I don't know what debt repayment and pensions and all that works out to now, and how overworked or compensated you might be now at the VA.
ETA: Sorry, thought this was the psych forum. In any case it looks like others have seconded some aspects of a psychiatrist's experience there.
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This means nothing, but all the doctors I met at the VA seemed happier at the VA than almost anywhere. However, a lot of people despise the VA. So it's really a matter of self selection, there is no universal stance on the VA from docs in my experience.
Except my favorite anecdote. "You want to know what the VA hospital is like and what it has that makes it different from other hospitals? Well, just imagine a regular hospital, like any other in almost every way, but entirely encased in molasses."
Except my favorite anecdote. "You want to know what the VA hospital is like and what it has that makes it different from other hospitals? Well, just imagine a regular hospital, like any other in almost every way, but entirely encased in molasses."
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Understand that your feelings on this may be completely different than mine, but the main reasons are:
- having almost zero ancillary staff. I have to clean my own room, room my own patients, obtain my own records from outside hospitals/clinics (I can try to have someone do it but it's hit or miss whether it'll actually get done and tracking them down is painful)
- the patients are nice, but they often talk slowly and ramble on about things completely unrelated to the questions I'm asking, making the history take twice as long as in my private clinics. They also in general have extremely complex medical histories, so despite having more time with the patients I always feel more behind at the VA than other clinics. I can typically see twice the number of patients in the three other clinics I've worked at.
- I don't like CPRS. It takes way longer to write notes than in any other clinic I've worked in and it can be hard to find things within CPRS, and I've been working in a VA clinic weekly for 4 years.
-Many of them do not seem to care at all about their health which can be frustrating. This latter point is present to some degree in other clinics but I find it much more prevalent at the VA.
- the pace of the VA is very slow and lackadaisical, which is drastically different than other clinics I've been in. People are more likely to seem annoyed or avoid work when asked to do things that are their job.
All that being said, I think the mission of the VA is a noble one and they do a lot of things right, namely the amount of services offered is fantastic and the mental health side of things is much better than what I see in the private world (unless the patients have $$$). I think there are personality types that love working at the VA, I'm just not one of them. You may love it so don't knock it until you at least try it.
That VA pension package is nuts. Work 20 years at the VA (coughPSLFcough) and your pension is basically half your salary for 30 years. If you live within your means you can retire at 55 and sit on you boat with a frosty beer or work part time at a community hospital and enjoy two incomes
If any work would qualify for PSLF and not get denied I would have to imagine the VA would not get rejected. (I know the qualifications, I’m just saying for those afraid they will get rejected after they apply).
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I thought civilians including physicians who work at the VA get the same retirement system as all other federal government employees which currently is FERS, is this not true? FERS doesn’t provide basically half your salary after 20 years to my knowledge, the formula for retirement if you are under 62 years old or less than 20 years is 1% of your high three average salary for each year of service so in your example (e.g. working 20 years and retiring less than 62, your salary would be 20% of your high three average salary and not basically 50%). Does anyone which is correct, do va physicians get fers retirement?
