Thoughts on this VA heavy residency program?

[Medicine Mamba]

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[clozareal]

I don't agree with the bias against the VA in terms of training. The VA has a ton of different specialized clinics, with some of the cutting edge research and clinical care, so you definitely learn a ton. I think it's diverse enough of a training.

Harvard South Shore is a great program. I think you'll learn a lot there.

You can't learn everything in residency and there will be gaps in your training. You can fill that in elsewhere in your training or choose not to work in areas that have that gap. The secret that residents don't know until they become attendings is that you don't stop learning after your residency is done.

 

[mcatqueen]

I agree with clozareal. VA isn't that bad. The biggest things are: don't lose your PIV card, CPRS is like going back in a time warp to the 90s, and expect to wait on the phone a long time when you need to get in contact with IT, etc for help.

 

[J ROD]

I did about half my training at VA and most of my outpatient months. I found no holes in my outpatient ability with adults. Children I did not see as many outpatient but I am not child anyway and prefer not to see. I found I was allowed more autonomy which greatly helped me when I walked in Day 1 as an attending. I like CPRS....I would say more 80's lol. As long as you got a good reader PIV card is sort of cool to me. I just could not handle the lower pay and administration/inertia.

 

[TexasPhysician]

I think it’s all relative. I don’t think mostly VA is a good mix for training. It seems obvious, but diversity is important.

HSS is clearly the least well regarded of all Harvard affiliated programs. It has a history of having issues, but I haven’t kept up with it lately. At times, I’ve heard a lot of long commutes.

I know some that have trained there. Generally speaking, everyone I’ve talked to from there would have chosen another Harvard program if they could have gotten in elsewhere.

That said, if we are comparing no-name community program to HSS, I’d probably choose HSS.

 

[Medicine Mamba]

Thanks for the responses. For what it's worth, the program is UCLA/VA, not HSS, lol.

 

[Stagg737]

The biggest concern is diversity of inpatient experience at VAs. I’ve rotated through or worked at 5, and will say that while I felt my training was good it definitely lacked diversity, specifically the lack of exposure to female patients.

That being said, it sounds like the UCLA program goes out of its way to make sure you do get a more diverse experience, especially with your outpatient year and flexible 4th year. Seeing a diverse array of patients is important, but if you don’t have good attendings who are supportive to guide you then the actual learning from that diversity can be a lot more limited. I know nothing about UCLA VA, but sounds pretty solid from what you describe.

 

[comp1]

15% of all VA patients are female and that roughly matches the inpatient VA psych population as well. I'm definitely VA for life, so not exactly unbiased. CPRS came out in the mid-90's. I saw 80's EMRs at the start of med school and CPRS really is very, very 90's. 80's EMRs were entirely text. There is a text based EMR under CPRS called VistA, but it got a Windows 3.1 overlay in CPRS. It's also not going anywhere. The Cerner project is a nearly unmitigated disaster and I anticipate it might get shut down entirely. IMHO, it was not a good idea as it was a no bid contract which never should happen for the largest healthcare organization in the world. The BEST thing about the VA EMR is that it DOES date to the mid 90's. You have literally decades of information on patients and psych patients are often horrific historians. You also have records from Puerto Rico to the Philippines and everywhere in between, PLUS military records. It helps out so much for peregrinating psychotic patients. You get to REALLY help people. The resources are nearly unlimited. You can send someone to rehab easily. Heck you can send someone across the country for highly specialized trauma therapy that focuses on sexual trauma in only men. No veteran has to be homeless, there's always resources if they're willing to access them. This is so different from general county psych patients who are just "streeted." The VAST majority of veterans never got anywhere near combat. So the PTSD you see will generally be community standard childhood traumas. Schizophrenia is very common inpatient as families send a lot prodromal 18-22 year old sons into the military to "fix them" which at the very least does get them social support for the rest of their lives. Workloads are light, attendings have time to actually teach. Teaching and research are the other two pillars of the VA along with clinical care. Good managers know you have to have a strong education program to recruit staff. Yes, there's malingering because potentially a lot of money is involved, but at least you have the actual time and resources to devote neuropsych testing to it. It's just great. Rank the VA program high.

 

[mcatqueen]

The VA also has adequate funding to hire social workers, unlike some other settings. Social workers are truly a blessing in helping navigate the system and helping patients access the resources.

 

[mistafab]

VA is excellent training.

However, I would have some concern if it was such a large majority of the training. Not a dealbreaker but not ideal.

 

[clozareal]

Thanks for the responses. For what it's worth, the program is UCLA/VA, not HSS, lol.

UCLA/VA seems like a solid program with great faculty and you get didactics and rotate with the other UCLA residents. Just fill in your gaps during PGY4 year and you'll be fine. You also have access to the faculty practice association as part of UCLA so you can get a mentor there if you want to do more therapy or private practice. There's lots of opportunities to moonlight with your free time as well to fill in any gaps if you want.

Living in West LA is great too. Good weather, good food. However, bad traffic and cost of living is high. The culture is much more relaxed than the East Coast, but probably not as much as the midwest.

 

[comp1]

I just commented on the VA in general, but West LA in specific is an absolute flagship of a facility. The VA is great in general, but West LA is great in particular with specialists of all kinds. You'll be lucky to match there. I'd say cost of living would be my biggest concern, but I believe they have a slightly adjusted salary rate that will mitigate this to a small extent.

 

[littlefred]

Vouch for UCLA/VA. Did a fellowship there and loved it.

 

[Stagg737]

Not trying to derail, because the question is about a specific VA program which sounds fantastic, but there's A LOT of viewing the VA through rose colored glasses here and the saying "if you've been to 1 VA, you've been to 1 VA" is absolutely true. Of the 5 I referenced, one was very solid, 3 were good (not the best but would get treatment there myself), and 1 I wouldn't allow a dying rat to get within 10 miles of other than a couple of the outpatient service lines (psych being one of them). Ironically the last was the one veterans had the best things to say about despite me personally seeing some absolutely horrifying things happen at. Some things that are worth more contextualization imo:

Spoiler: EMR

EMR (CPRS) is an incredibly unintuitive system that can be very difficult to jump right into. However, once you figure it out it's actually not horrible and the fact that it's over 25 years old and still fully functional with only one major update ~20 years ago is pretty incredible. You can get decades of records from across the country which is also amazing, although downloading or searching those records can take foooooreeeevvvveeerrrr. I remember searching someone's chart who had records back to the early 2000's and we jokingly decided to time how long it would take. It took 14 minutes to search for 1 term. DoD records (active duty) were also in a separate part of the chart that required extra steps to access and sometimes were not available at all. Unless this was updated in the past 2.5 years this is also still mostly true. Not shocked to here the PowerCharts update with Cerner went south, may actually be for the best though. I'll take Epic over CPRS 1000% of the time, but it is far from the worst EMR and at worst tolerable.

Spoiler: Specialty programs

The access to all these wonderful programs talked about above is not as straightforward as advertised. There were times when I spent weeks (working with hospitals IPVAP coordinator/manager for one of the programs mentioned) just trying to figure out if patients would qualify for some of these programs and sometimes never got responses. I also had several veterans who should have easily qualify get rejected. The VA I spent the most time at ended up referring a large percentage of our patients to private docs because of the long wait to get services through our local systems, which weren't bad but grossly overburdened. Idk that I call that specialty care "VA care" because it's being referred out, but at least the vets could have access when it was necessary. Housing was also not always the guarantee that was stated above and I had many vets that didn't qualify for MHICM or other housing programs for various reasons beyond their current control (typically d/t some kind of historical problem, usually criminal). For all those negatives though, it was far easier to get vets access to social programs, and sometimes medical care, than it is at non-VA hospitals. For all the shortcomings I do wish it was possible for the general population to have some of the programs that are set up for vets.

Spoiler: Social Work

The comment about social workers is also in the vein of "if you've worked at 1 VA, you've worked at 1 VA". One of the VAs I worked at had 1 social worker for the medical floor and the ER and realistically 4 would have been full staffing. The main one I worked at in residency (over half my intern year) was great my first 1.5 years but then 3/4 left and they struggled heavily to keep anyone for a while and were relying on 2 SW students who left when they finished training d/t an unreasonable workload. SW at the CMHC I rotated through in residency was much better overall, but again this will vary by location.

I'm generally neutral about the VA as a whole. The VA outpatient director where I did residency tried to recruit me, but I declined (mostly because I have no interest in FT outpt). I did consider other positions within the VA, but ultimately went with an academic program where the pay and benefits were similar with more tolerable bureaucracy. I do think being able to have rotations at a VA is a great experience in residency and strongly advocate for it so long as it's not the sole setting and you get to experience non-VA settings as well, as the patient populations are vastly different ime, both in terms of pathology and general perspectives. Sounds like UCLA/VA is a great place and I wouldn't hesitate to rank them highly if content in this thread is true.

I just commented on the VA in general, but West LA in specific is an absolute flagship of a facility. The VA is great in general, but West LA is great in particular with specialists of all kinds. You'll be lucky to match there. I'd say cost of living would be my biggest concern, but I believe they have a slightly adjusted salary rate that will mitigate this to a small extent.

According to 2 sub-I's we had earlier this year all the UCLA programs are unionized for residents and per the UCLA website PGY-1 salary starts at $85k with a monthly $1,000 housing stipend. I would assume that would be true for the OP's program if it's a UCLA program, but would obviously contact them if I was the OP.

 

[brosa]

The VAs around where I live are very bad. Lack of staff and poor training. It's a snowball, bad VA Will attact bad psychiatrist/other employees which will make the VA worse.

I would rather be at any program than a VA one based on the ones around here. I have no idea how's a good VA, never seen one lol

 

[comp1]

The comment above about community care referrals to places that were grossly overburdened is so telling. When you're outside of the VA, community care is ALL you have! And yep, mental health is horribly overburdened everywhere. And yeah, it definitely sucks when a veteran can't get into the exact perfect program you want, but at least they can go somewhere. It's really about comparing with the general community, particularly those patients with similar socioeconomic statuses, where the VA shines. And yep, I wish CPRS and JLV were faster too, at least you have access to the records unlike a random community or academic hospital where the psychotic patient in the ED just remains an enigma to all.

 

[Lexanoob]

I can’t imagine just training at the VA having been at two metropolitian VAs in my past through training (I also have been lucky to experience multiple hospital systems as part of my training). I have encountered a ton of people, including me, who would want to avoid working here despite great benefits, particularly as a woman. Some people would be impacted by these dynamics like myself, and others won’t. It would be helpful to figure out for yourself if it is something you would be impacted by, especially if you have a VA at your medical school, although it seems like the worst case scenario would be to endure 2-3 years of it.

 

[comp1]

Being female and to a slightly lesser extent a racial minority is a consideration. The VA has gone a great ways to reducing sexual harassment from patients on VA campuses. You'll see posters up everywhere and lots more staff have gotten comfortable filing disruptive behavior reports regarding it, but it does happen and I assume a bit more than in the community. All that said...this is still West LA. I think you'll find many community hospitals around the country that are worse than the West LA VA in this respect.