Outpatient VA

[DOswag]

Advertisement - Members don't see this ad

VA docs, it's been a while since I rotated through VA in residency and most of that was inpatient and ER. I did a rotation in med school with an outpatient VA doc but that would've been around 2012-2013 so it's been a minute. How many patients do you see on a typical day? When I rotated there it was 1 hour intakes and 30 minutes for follow ups as well. I've considered working for the VA in the past as I am prior Air Force and could use my active duty time for pension etc and am aware VA typically has great benefits. I'm happy with my current gig but just curious about other opportunities out there.

 

[comp1]

Sounds about right. Schedules vary from 5-8's, 4-10's and then like 9 hour days with one day off every other week. Typically you get about 20% admin time, so you can sort of do the math for how many patients you might see. Resident supervision changes things too. Indeed the benefits are quite a lot. And of course outpatient isn't the only option. They often have CL/ED, inpatient and primary care integration jobs available too. Heck some have IOP/PHPs. Almost every VA has prescriber positions available as well, even with the recent switch to billets that might have impacted other types of providers. Any open prescriber positions were highly prioritized for maintaining. That said, listings got really messed up (read: lost) recently, so you may have to reach out directly to an internal VA physician recruiter (not locums). Don't rely solely on whatever is specifically listed on usajobs.gov. You are very correct about your active duty time counting towards your pension.

 

[brosa]

Wild how VAs can change. Around here, residents and attendings would often get double booked and see a lot of patients.

 

[comp1]

Double bookings happen, but are generally frowned upon. Much more common are no shows or same day cancellations as there is no penalty for patients (other than missing out on travel pay).

 

[DOswag]

Sounds about right. Schedules vary from 5-8's, 4-10's and then like 9 hour days with one day off every other week. Typically you get about 20% admin time, so you can sort of do the math for how many patients you might see. Resident supervision changes things too. Indeed the benefits are quite a lot. And of course outpatient isn't the only option. They often have CL/ED, inpatient and primary care integration jobs available too. Heck some have IOP/PHPs. Almost every VA has prescriber positions available as well, even with the recent switch to billets that might have impacted other types of providers. Any open prescriber positions were highly prioritized for maintaining. That said, listings got really messed up (read: lost) recently, so you may have to reach out directly to an internal VA physician recruiter (not locums). Don't rely solely on whatever is specifically listed on usajobs.gov. You are very correct about your active duty time counting towards your pension.

@comp1 I'm assuming you are working for the VA currently or have worked with them. Are you prior service as well? I am just wondering how different it is going from active duty to the VA comparing the amount of admin/bureaucratic bs we had to deal with on active duty as far as extra documentation, extra pointless meetings etc. I absolutely hated that in the AF and really scared me away from the VA though I have heard others say it isn't as bad with the VA though still a necessary evil to contend with. I currently work 4-10's and really enjoy my 3 day weekends

 

[Stagg737]

VA docs, it's been a while since I rotated through VA in residency and most of that was inpatient and ER. I did a rotation in med school with an outpatient VA doc but that would've been around 2012-2013 so it's been a minute. How many patients do you see on a typical day? When I rotated there it was 1 hour intakes and 30 minutes for follow ups as well. I've considered working for the VA in the past as I am prior Air Force and could use my active duty time for pension etc and am aware VA typically has great benefits. I'm happy with my current gig but just curious about other opportunities out there.

That is pretty much what our local VA is. Problem is the number of notes you have to write for that 60 minute intake (actual note, annual DV screen, SAFE note or some similar 4-part acronym, annual goals of care note, CSSR-S + CSRE if positive) can be a nightmare. I loathed intakes because all of those were requirements in 2022 where I was at. Maybe other VAs don’t do all of those, but when I was a resident we were told they were a “national policy” and I know the local VA still does them all.

Sounds about right. Schedules vary from 5-8's, 4-10's and then like 9 hour days with one day off every other week. Typically you get about 20% admin time, so you can sort of do the math for how many patients you might see. Resident supervision changes things too. Indeed the benefits are quite a lot. And of course outpatient isn't the only option. They often have CL/ED, inpatient and primary care integration jobs available too. Heck some have IOP/PHPs. Almost every VA has prescriber positions available as well, even with the recent switch to billets that might have impacted other types of providers. Any open prescriber positions were highly prioritized for maintaining. That said, listings got really messed up (read: lost) recently, so you may have to reach out directly to an internal VA physician recruiter (not locums). Don't rely solely on whatever is specifically listed on usajobs.gov. You are very correct about your active duty time counting towards your pension.

Agree with majority of this, 20% admin time seems like a dream though. None of our local VAs or CBOCs get that much, I think they’re closer to 10% (1 hr for a 8 hr day). After the shut down and all the talk about eliminating the VA there was a mass exodus from our local major VA. Both inpatient docs left and now there is 1, several outpatient positions have opened up and they’re now on their third outpatient director. Idk what other cities are like, but a lot of the events of the past few years have spooked a lot of people who work in the VA that I know.

 

[Jules A]

In my experience with 2 attempts at VA the patient work load was light with frequent no shows but admin tasks and required scales were cumbersome. Many of the patients were amazing and there was a great deal of satisfaction helping some who had received subpar mental health care however in my opinion the system is set up to foster illness and malingering. Every ailment they are diagnosed with can provide more money. This is especially frustrating because the sickest who would actually benefit from all the funds and programs tend to not recognize the need or lack the ability to work the system. When I was there the first time the flavor of the month was benzos and most recently I was inundated with stimulants often at absurd doses. The health benefits were good but expensive, time off and retirement contributions outstanding. I decided the value in never again hearing “this is why vets blow their brains out” when not doing whatever it is the patient demanded-priceless.

 

[comp1]

Yeah there are a lot of mandatory scales that aren't always clinically indicated, although I think less than the DoD. The VA doesn't have to justify its care to private payers, but it does have to justify it to Congress and all those scales are how it tries to. It's very true that there is built in secondary gain for patients that is completely unique in degree. I can see how it would be off putting (at least initially), but the cool thing is that you CAN help those patients who really need it and aren't able to figure out the system themselves. That always made it worth it. The resources always exist, which isn't true for most systems, particularly for the seriously mentally ill.

 

[MrFlyGuy]

So some people are saying the workload is light and some people are saying the docs are double booked and barely have air to breathe.

Seems very clinic dependent. How about the primary care integration jobs,.can they be busy or mostly chill?

 

[comp1]

I mean anything can be anything... Call up your local physician recruiter from usajobs.gov and ask to speak with the chief psychiatrist of the VA you are interested in. Don't rely on the description of the specific jobs listed, ask the chief directly.

 

[kookfu]

Sounds about right. Schedules vary from 5-8's, 4-10's and then like 9 hour days with one day off every other week. Typically you get about 20% admin time, so you can sort of do the math for how many patients you might see. Resident supervision changes things too. Indeed the benefits are quite a lot. And of course outpatient isn't the only option. They often have CL/ED, inpatient and primary care integration jobs available too. Heck some have IOP/PHPs. Almost every VA has prescriber positions available as well, even with the recent switch to billets that might have impacted other types of providers. Any open prescriber positions were highly prioritized for maintaining. That said, listings got really messed up (read: lost) recently, so you may have to reach out directly to an internal VA physician recruiter (not locums). Don't rely solely on whatever is specifically listed on usajobs.gov. You are very correct about your active duty time counting towards your pension.

I see use of the terms "prescriber" and "provider," please stop, especially here. We are physicians; NPs and pharmacists want us to use those terms so that they can manipulate the public into thinking it's equivalent training. The VA does a lot to blur those lines and is part of the problem. For me, this issue has been one of demoralizing factors about working at the VA. Incentivized malingering is also a burnout factor.

Overall though, I like working at the VA. The clinical documentation burden seems lower at the VA compared to the DoD, at least through reviewing the DoD notes. VA is a great gig for a new doc, especially if you have loans (EDRP) which significantly raises the salary since that money is not taxed. It's nice to be in a system with lots of other doctors and consultants when you're early in your career. Your military experience will be a huge assett with gaining patient trust. Also, with all of the vacation/sick time off at the VA, many people moonlight.

 

[comp1]

It's a genuine issue as to how to describe the NPs, PAs, clinical pharmacists (who can prescribe at the VA) and MD/DOs together as a group. From a managerial and scheduling perspective, they do need a group description that clearly separates them from LCSWs, psychologists, LMFTs, LPCCs, etc. However, as the poster above said, any sort of grouping tends to offend. Fortunately, there are plenty of patients and jobs available (even currently) for everybody at the VA!