Question for Any VA psychiatrists ?

[keifernny2]

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Hi All, I took an outpatient job with the VA after I graduate next month and am working to set up my schedule.

I was just wondering if there were any VA OP psychiatrists here that could give some pointers on a good way to arrange things from a schedule standpoint to prevent any kind of burnout. I have heard that there is no admin time built into the schedule (which, from what I've seen, is pretty unusual for psychiatry, actually), but there are "telephone clinics," which can serve some purpose of that type.

Thanks!

 

[Shikima]

You're in for a treat. Spent residency and fellowship at the VA and currently am working at one now. First, find out if they will sponsor any admin time - for instance, I get 8 hours a week. Next, find out what your duty area will be and consist of - are you apart of the BHIP/PACT model or some other "specialty" service? This will give you insight into what your role will be. Find out what your consult/code orange/call obligations are. Will your time be face to face or VTEL? Telephone clinics don't exist for physicians, only nurses. Do you have a nurse? (currently I don't). There really isn't any way to "build" a schedule for efficiency and burn out prevention... just develop templates that you can use which can autopopulate as much data as possible so you don't have to type as much. Lastly, complete your notes with the Veteran in the room as well as doing all clinical reminders and other necessary paperwork.

Stick it out for a year, if you don't like the position, move on... you can float to another VA or hit the private sector.

 

[vistaril]

Hi All, I took an outpatient job with the VA after I graduate next month and am working to set up my schedule.

I was just wondering if there were any VA OP psychiatrists here that could give some pointers on a good way to arrange things from a schedule standpoint to prevent any kind of burnout. I have heard that there is no admin time built into the schedule (which, from what I've seen, is pretty unusual for psychiatry, actually), but there are "telephone clinics," which can serve some purpose of that type.

Thanks!

curious- whats the pay?

 

[Shikima]

curious- whats the pay?

You don't know until the board convienes, and then tells HR, and then HR will contact you. Usually you find out a day or 2 before you're to start. I think you need to verbally accept the offer and then you're scheduled into orientation and starting to work.

 

[vistaril]

You don't know until the board convienes, and then tells HR, and then HR will contact you. Usually you find out a day or 2 before you're to start. I think you need to verbally accept the offer and then you're scheduled into orientation and starting to work.

that seems pretty crazy....so what do you make there in your job?

 

[psychwanderer]

I curently work as an Program Support Asisistant at one of the VA hospitals in psychiatry services. I never asked any of the psychiatrists what their salary was, as that proabably isn't a very good topic to discuss; but if you go to USAJOBS.gov and type in psychiatry you can pull up a list of positions and see their salary ranges. This will give you a good idea on the salary range for these positions.

 

[notdeadyet]

I curently work as an Program Support Asisistant at one of the VA hospitals in psychiatry services. I never asked any of the psychiatrists what their salary was, as that proabably isn't a very good topic to discuss; but if you go to USAJOBS.gov and type in psychiatry you can pull up a list of positions and see their salary ranges. This will give you a good idea on the salary range for these positions.

Those ranges are pretty ridiculously large. The variance between position and location requires actually talking to psychiatrists working at a particular VA.

 

[PistolPete]

I heard starting pay is somewhere around 180-190k. A bit more once board certified and increases a few percent per year.

 

[TheWeeIceMan]

VA employee salaries are public record. I don't know if it's broken down by specialty, but if you do some searching, you could probably find typical psych pay.

 

[keifernny2]

You're in for a treat. Spent residency and fellowship at the VA and currently am working at one now. First, find out if they will sponsor any admin time - for instance, I get 8 hours a week. Next, find out what your duty area will be and consist of - are you apart of the BHIP/PACT model or some other "specialty" service? This will give you insight into what your role will be. Find out what your consult/code orange/call obligations are. Will your time be face to face or VTEL? Telephone clinics don't exist for physicians, only nurses. Do you have a nurse? (currently I don't). There really isn't any way to "build" a schedule for efficiency and burn out prevention... just develop templates that you can use which can autopopulate as much data as possible so you don't have to type as much. Lastly, complete your notes with the Veteran in the room as well as doing all clinical reminders and other necessary paperwork.

Stick it out for a year, if you don't like the position, move on... you can float to another VA or hit the private sector.

Thanks for the info! I'm going to be working in a CBOC, with a full behavioral health team there (they just didn't have any permanent psychiatrists). I do want to work to make sure it doesn't end up being just me churning through patients (as that ain't so satisfying of a job), but either way, if the admin doesn't work out, you're right, there's always the option to quit (there certainly are plenty of other psych jobs available in the area). I suspect I may have some leverage as they've been trying to fill this job for a while.

 

[st2205]

So how long is a typical contract you sign with the VA out patient? We're going to stay where we're at after residency for a year or two. OP VA is one of the possibilities.

 

[BestDoctorEver]

I curently work as an Program Support Asisistant at one of the VA hospitals in psychiatry services. I never asked any of the psychiatrists what their salary was, as that proabably isn't a very good topic to discuss; but if you go to USAJOBS.gov and type in psychiatry you can pull up a list of positions and see their salary ranges. This will give you a good idea on the salary range for these positions.

These salaries are strange...anywhere from 90k to 250k for psychiatrists... How the heck can one negotiate some of these offers that are almost 100k range?

 

[Leo Aquarius]

Let's not kid ourselves. The VA is not known for paying high salaries. Count on being paid less for the same hours you would work somewhere else. If someone can prove me wrong then I stand corrected.

 

[erg923]

These salaries are strange...anywhere from 90k to 250k for psychiatrists... How the heck can one negotiate some of these offers that are almost 100k range?

GSa salaries arent really "negotiaable. " The range covers everything from fresh out of training, to someone with 40 years of experience.

 

[F0nzie]

Let's not kid ourselves. The VA is not known for paying high salaries. Count on being paid less for the same hours you would work somewhere else. If someone can prove me wrong then I stand corrected.

If you stay with the VA for 20 years they will also pay you 20% of your highest salary for the rest of your life. This is a huge selling point for a lot of people.

190k is fair market value for almost every outpatient job in my area. As far as I can tell the VA has been good about keeping the wages fair.

 

[TexasPhysician]

curious- whats the pay?

My friend is starting an outpatient VA gig in July. Starts at $219k.

 

[Leo Aquarius]

If you stay with the VA for 20 years they will also pay you 20% of your highest salary for the rest of your life. This is a huge selling point for a lot of people.

190k is fair market value for almost every outpatient job in my area. As far as I can tell the VA has been good about keeping the wages fair.

Nice perk!

 

[TexasPhysician]

Sounds nice esp when considering the tacked on benefits.

Is this in TX?

Amarillo, TX

 

[splik]

If you stay with the VA for 20 years they will also pay you 20% of your highest salary for the rest of your life. This is a huge selling point for a lot of people.

I thought it was 30%? I know the old school attendings get 70% pension, and was told now it is 30%? (they reversed it)

 

[slappy]

Depends on how many years he/she's been in service. If it was ~20 years, it would be about 20%. For ~30 years of service, the pension would be approximately 1.1*30%.

 

[AcronymAllergy]

GSa salaries arent really "negotiaable. " The range covers everything from fresh out of training, to someone with 40 years of experience.

This, although physicians are on their own modified pay scale rather than the GS scale (same with nurses). Although what is negotiable would be things like signing bonus, loan repayment assistance, moving cost reimbursement, etc. I'd imagine that for psychiatry, you'd probably have a pretty high success rate with getting some or all of these perks. You just need to be sure that they're listed as options in the job posting itself.

As for the salary, as others have said, when you factor in the benefits (e.g., pension, retirement plan and matching, leave accumulation rate, insurances available, etc.), I don't know that the VA is much if at all behind many other employers. Particularly if you also factor in PSLF after 10 years (assuming it sticks around that long).

 

[bearpsychmd]

Its market pay plus your base, and only the base counts for retirement and tsp match. Its actually a much worse scale than the GS because you dont qualify for primum pay (working holidays, OT, schedule differential) like every other fed employee. And nurses have a similar but still different pay structure.

Taking relocation and recruitment bonuses may obligate you to some service or financial payback but just cause you sign a contract, to trade your labor for wages, does not mean you have to. Its not a military contract and slavery was abolished

 

[bth7]

What can I expect to be offered in terms of loan repayment by the VA?

 

[Shikima]

What can I expect to be offered in terms of loan repayment by the VA?

Crappy at best. It doesn't start until you are "accepted" into EDRP which the first check is about 18 mos after employment. And you have to show you've been making payments all along. Most you'll get is $60k total, and it's over 5 years.

 

[bth7]

That's terrible.

 

[heyjack70]

That's terrible.

Wait til the VA has a psychiatrist shortage. I'm sure things will improve then. /s

 

[bth7]

http://www.militarytimes.com/story/...cide-prevention-bill-clay-hunt-2015/21651841/

 

[Shikima]

http://www.militarytimes.com/story/...cide-prevention-bill-clay-hunt-2015/21651841/

I'm glad you brought this up. I've been watching the evolution of this and I wouldn't see this being expanded upon for quite a bit of time, despite the public verbalizing that they need more psychiatrists. In all, let's see what happens with the Senate and getting a signature. I'd also be interested in hearing what the final amount will be agreed upon by the law makers for loan repayment, I heard 120k? We'll see what happens I guess...

 

[bth7]

http://federalsoup.com/Articles/2014/09/18/VA-to-boost-pay-for-doctors-dentists.aspx?m=1

Well, this increase was already passed last Fall. For all docs, not just psychiatrists.

Now, there's another new psychiatry specific bill, but I think the program is going to be very small.

Anyone know if the first program with the increase is in effect?

 

[Baller MD]

http://federalsoup.com/Articles/2014/09/18/VA-to-boost-pay-for-doctors-dentists.aspx?m=1

Well, this increase was already passed last Fall. For all docs, not just psychiatrists.

Now, there's another new psychiatry specific bill, but I think the program is going to be very small.

Anyone know if the first program with the increase is in effect?

It's been in effect since November-December of last year.

 

[bth7]

It's been in effect since November-December of last year.

So what's the effect of new law? If I sign on to VA now, what can I expect to be offered on terms of loan repayment? Is it any better than what's described above?

 

[Igor4sugry]

Crappy at best. It doesn't start until you are "accepted" into EDRP which the first check is about 18 mos after employment. And you have to show you've been making payments all along. Most you'll get is $60k total, and it's over 5 years.

Reimbursement has been doubled to 120k. Also, the paygrade for psychiatrists was raised as well.

"The EDRP incentive assists health care professionals in reducing their qualifying loan
balances and aids in recruiting employees by reimbursing loan payments of up to
$120,000 over a five-year service period—the recently enacted Veterans Choice Act
doubled the maximum amount of reimbursement from $60,000."
source:http://www.disabledveterans.org/wp-...USH-All-Employee-Message-November-18-2014.pdf

Thats $24k/year x5yrs, pre-tax (I assume). So if this was part of salary I view this as extra $34k (assuming 30% tax rate).
My goal is to pay off student loans in under 5 years so this is a good deal.

Does VA qualify for PSLF?
How long does EDRP paperwork take to go through?

 

[bth7]

Reimbursement has been doubled to 120k. Also, the paygrade for psychiatrists was raised as well.

"The EDRP incentive assists health care professionals in reducing their qualifying loan
balances and aids in recruiting employees by reimbursing loan payments of up to
$120,000 over a five-year service period—the recently enacted Veterans Choice Act
doubled the maximum amount of reimbursement from $60,000."
source:http://www.disabledveterans.org/wp-...USH-All-Employee-Message-November-18-2014.pdf

Thats $24k/year x5yrs, pre-tax (I assume). So if this was part of salary I view this as extra $34k (assuming 30% tax rate).
My goal is to pay off student loans in under 5 years so this is a good deal.

Does VA qualify for PSLF?
How long does EDRP paperwork take to go through?

This is exactly what I'm wearing as well. I'm concerned there's a disceoency between what is offered on a website, and what actual practice is. 120k over 5 year is a decent deal. Not perfect. But decent.

What if I leave after 2? Do I get nothing? What if I go part time another a year, does it get pro-rated?

I have interview at the VA on 23rd Jan. I'll let you know what they tell me.

 

[SomeDoc]

It's good to see you back, bth

 

[bth7]

It's good to see you back, bth

I'm still kicking it. It's amazing how the years go by, perspectives change, priorities change.

🙂

But honestly I still really love psychiatry, I'm happy.

 

[Shikima]

So EDRP can only be offered only if it is included on the job announcement. It starts when the paperwork process is completed, anywhere from 3-9 months (in my experience) and you will get a check only after you provide proof that you paid on all loans for that year.

 

[Baller MD]

So EDRP can only be offered only if it is included on the job announcement. It starts when the paperwork process is completed, anywhere from 3-9 months (in my experience) and you will get a check only after you provide proof that you paid on all loans for that year.

Is it difficult to get the full EDRP amount?

 

[Shikima]

Is it difficult to get the full EDRP amount?

Not really. Just need to put up with the poisonous environment called federal service to get the full amount in 5 years.

 

[bth7]

Not really. Just need to put up with the poisonous environment called federal service to get the full amount in 5 years.

Can you just say a little but about what makes the environment poisonous? It would be really helpful to have a head up about what the problems are.

 

[Baller MD]

Can you just say a little but about what makes the environment poisonous? It would be really helpful to have a head up about what the problems are.

Or just PM us. I'm curious too.

 

[Shikima]

If you've served in the military, you'll understand the difficulties with federal service. If not, consider it an extension like residency. This point is also dependent upon who your service chief is and how severe the Axis II is for them. I've encountered enough personalities to know which personalities aren't compatible for private practice because the ego isn't stroked enough.

My experiences - I had "bosses" who were not physicians but PhD/SW. Often I was treated like a pack mule. In one instance, a colleague described it as being equivalent to a 'technician'. The lack of respect is reinforced through the system making an attempt to say everyone is equal in it - no difference between physicians, midlevels, and in one particular case, a pharmacist who was diagnosing and treating through dispensing of psychotropic medications. There was never any support offered for me with nursing or secretarial support. The lack of training is equally egregious - you'll be expected to take on duties at a moments notice and go along with the flow. Verbal admonishments with passive-aggressiveness is common place too. The system would just as soon throw you under the bus for a mistake if you weren't apart of 'the club' (this happened to a NP a few times that I worked with in an attempt to force a certain level of submissiveness). In all, the VA is very top heavy and laden with chief's everywhere. Very few indians can be found or continued to be retained.

I don't think central office really cares about the recruitment and retention of physicians as they say. The paltry increase in pay with a small amount of EDRP (when loans are well over 200k these days) doesn't make it worth while. The one good benefit, if you have the opportunity, is once you're in the system you can move around and go up/down the chain as you feel fit and desire.

As a physician, it's a good place if you'll be retiring and want the minimum of 5 years to receive some generic benefits towards retirement planning.

 

[erg923]

I can't comment on "poisonous environment" but can say that mixed messages abound in my VA. That is, service to veterans is everything, yet, without fail, unecessary barriers or regulations often prevent that and/or prevent one from making the most commonsensical clinical decisions/determinations.

 

[notdeadyet]

I'd also toss out there that the VA experience is going to vary radically from one to the next. CBOCs and more isolated VAs tend to run more malignant; VA's with heavy research funding and/or are tightly linked with decent residencies are going to be a very different kettle of fish.

 

[Shikima]

Again, I can only relate my experiences through anecdotes. There is a significant disconnect between the central office, those in middle management and the worker bees.

Not all VAs are the same and are not run similarly. Each location will have their particular cultural neuances.

 

[erg923]

Again, I can only relate my experiences through anecdotes. There is a significant disconnect between the central office, those in middle management and the worker bees.

Not all VAs are the same and are not run similarly. Each location will have their particular cultural neuances.

I am at CBOC of an academically affiliated VA (although there is not much research here), and still find many problems.

 

[myPsychAlt]

I'm headed to a VA this summer once residency ends, and I remain quietly optimistic. Salary is good for the area, they've recruited a ton of graduates and faculty from my current program and most (though not all) have been happy with the experience, and the VA paperwork headaches still probably beat out dealing with my state's medicaid program, which I've been dealing with for the last 4 years quite heavily.

The leadership matters though. If the person running your department/section has a mastery of making the various top-down mandates run smoothly, the VA system can be wonderfully integrated. If not, it becomes a hot mess. I've seen both in the VA I currently work at.

I actually enjoy the patient population at the VA believe it or not. There's something about the "grumpy old man" patients that require a unique skill set to get them on your side.

 

[Shikima]

I agree PsychAlt. I enjoy working with the Vets myself.... it is far too entrenched in bureaucratic nonsense to be a fully effective governmental organization. In reality, the paperwork and statistics matter, not the Vet care.

Unfortunately this opens up a large discussion about how Rome collapsed under its own weight and where we're headed.. blahblahblah.....

 

[whopper]

it is far too entrenched in bureaucratic nonsense to be a fully effective governmental organization.

In private practice, the problem I saw was that people only cared about the money. The good thing was that if there needed to be a change to improve the money making, it was done literally the same day if not a few days later. So I was all for that when it came to things that made more money but did improve patient care. Not everything that makes more money improves patient-care. A lot of things can make it worse.

In government jobs, there was no profit to be had by the employees, so the incentive to do something that was cost-effective that would have led to better care was essentially close to zero. If you tried to fix things, the person in charge of it had to actually get some more work done (oh no!) to make it a reality so it often-times nothing happened. It's the opposite problem-no efficiency. If you worked in a gov job and did great work, you usually made no more money and then the head of the dept gave you harder work while the guy who did jack-$hit gets easier work but you both get paid the same amount.

 

[erg923]

I agree PsychAlt. I enjoy working with the Vets myself.... it is far too entrenched in bureaucratic nonsense to be a fully effective governmental organization. In reality, the paperwork and statistics matter, not the Vet care.

Unfortunately this opens up a large discussion about how Rome collapsed under its own weight and where we're headed.. blahblahblah.....

While I "like" vets too, the copious amounts of vague depression and anxiety that I see day in and day out, is, well lets face it-not the most interesting psychiatry in the world. Its increasingly clear that psychiatry and psychology services are being relied upon to treat dysfunctional life circumstances.

 

[myPsychAlt]

While I "like" vets too, the copious amounts of vague depression and anxiety that I see day in and day out, is, well lets face it-not the most interesting psychiatry in the world. Its increasingly clear that psychiatry and psychology services are being relied upon to treat dysfunctional life circumstances.

Yeah, that's going to be just about any SES group though. It's the same thing at the academic setting where I'm at except it's highly somatic Hispanic women instead. It's frustrating no doubt. I should also note that my training is very heavy on the low SES populations, so it's not like I don't know what I'm getting into.