Update on VA legislation

[hypermobility]

As it stands today, the podiatry bill is included in the VA Mission Act, which is headed to the senate this week, and likely to presidents desk by Memorial Day. IF passes with our language (expected to), VA podiatry will become a great position.

This legislation gives parity in pay with physicians and dentists at the VA. In addition, allows podiatrists to obtain supervisory positions (Chief of Surgery, Chief of Staff, etc.)

BETHESDA, Md., May 17, 2018 /PRNewswire-USNewswire/ -- The American Podiatric Medical Association (APMA) applauds the approval of critically important legislation to support America's veterans. S 2372, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, passed the House of Representatives May 16 and will head to the Senate for consideration next week.


US Senators Johnny Isakson (R-GA) and Jon Tester (D-MT), chair and ranking member of the Senate Committee on Veterans' Affairs, praised the House approval of the bill and urged passage by the full Congress.

Included in S 2372 is language from APMA's VA Provider Equity Act that would enhance the ability of the Veterans Health Administration to recruit and retain well-trained podiatric physicians and surgeons, improving access to high-quality foot and ankle care for a population that suffers an inordinate number of lower extremity conditions.

"The recruitment challenges at the VA have reached a crisis level," said Dennis R. Frisch, DPM, APMA president. "Our veterans must not continue to face outrageous wait times for the care they need and deserve. The VA MISSION Act would directly address recruitment challenges and help ensure high-quality care for a most deserving population—America's heroes."

APMA urges the Senate to act swiftly to approve the VA MISSION Act and send it to President Trump for his signature.

Founded in 1912, the American Podiatric Medical Association (APMA), headquartered in Bethesda, Md., represents a vast majority of the estimated 18,000 podiatrists in the country. In addition to the national headquarters, APMA boasts 53 state component locations throughout the United States and its territories, as well as affiliated societies.

Peggy Tresky
301-581-9200

SOURCE American Podiatric Medical Association

---

Members don't see this ad.

 

[DexterMorganSK]

It's about time. Keeping my

 

[Windom Earle]

As it stands today, the podiatry bill is included in the VA Mission Act, which is headed to the senate this week, and likely to presidents desk by Memorial Day. IF passes with our language (expected to), VA podiatry will become a great position.

This legislation gives parity in pay with physicians and dentists at the VA. In addition, allows podiatrists to obtain supervisory positions (Chief of Surgery, Chief of Staff, etc.)

​

Sorry if this has been beat to death already, but what effect if any will this have on NON-VA podiatrists?

 

[de Ribas]

.

 

[VinegarStrokes]

I think it have been discussed on podiatry forums, but simply it will affect due to supply and demand. Though not immediately and greatly, it will definitely affect non-VA jobs as well.

In your belief, will the impact on non-VA podiatry jobs be positive or negative?

 

[de Ribas]

.

 

[GypsyHummus]

My thought is, when this goes into effect, it won’t be long for Medicaid and Medicare to adopt a higher pay scale for pods in the private sector. To my understanding, there are some states that pay a podiatrist less for the same procedure performed by a MD/DO. This will have a small effect in the short term, and a noticible effect long term.

It’s sad it took this long. Hopefully it passes. Trump is very pro veterans, so I think he will sign it.

Sorry if this has been beat to death already, but what effect if any will this have on NON-VA podiatrists?

 

[hypermobility]

Sorry if this has been beat to death already, but what effect if any will this have on NON-VA podiatrists?

As far as other federal services, none at this point, although it would likely set a precedent and make it easier for the other federal services (IHS, military, etc.) to follow suit.

Trump has stated via Twitter and with formal press releases through Sarah Sanders that he will sign the bill as soon as presented. The Mission Act funds the choice program that's set to expire May 31, until the new community care can be consolidated into one streamlined program. If doesn't get signed by May 31, veterans across the country would have their outside appointments cancelled or not paid for.

 

[DexterMorganSK]

Sorry if this has been beat to death already, but what effect if any will this have on NON-VA podiatrists?

In your belief, will the impact on non-VA podiatry jobs be positive or negative?

In my belief, overall it will be a positive impact.

If the bill passes, it will be HUGE for us in the real world as well...in the long-term.
Not only it will open more doors regarding employment, but it will also clear the stigma of a Podiatrist being "surgeons"
It will begin within the VA, but I am confident it will take precedence in hospitals/clinics/academics/etc as time goes on.

I hope it gets through!

 

[NTT123]

As far as other federal services, none at this point, although it would likely set a precedent and make it easier for the other federal services (IHS, military, etc.) to follow suit.

Trump has stated via Twitter and with formal press releases through Sarah Sanders that he will sign the bill as soon as presented. The Mission Act funds the choice program that's set to expire May 31, until the new community care can be consolidated into one streamlined program. If doesn't get signed by May 31, veterans across the country would have their outside appointments cancelled or not paid for.

The language of the bill that passed in house has changed and referring DPM as “Podiatric Surgeon”.

AAOS’s statement “ This amendment allows for salary increases for podiatrists but clarifies that podiatrists are not eligible for peer-review or clinical supervisory roles over MDs or DOs. Furthermore, it retains the official "podiatrist" designation, referring to them as podiatric surgeons, not physicians.“

With that said, will DPM be define as “ physician” in the VA?

Also, does anyone know the update about TRICARE?

APMA submitted comment a letter to Department of Defense back in January to
- update the TRICARE definition of physician at 32 CFR 199.2(b) to include podiatrists.
- permit DPMs to prescribe physical and occupational therapy (PT/OT) to patients.

Thank you.

 

[hypermobility]

The language of the bill that passed in house has changed and referring DPM as “Podiatric Surgeon”.

AAOS’s statement “ This amendment allows for salary increases for podiatrists but clarifies that podiatrists are not eligible for peer-review or clinical supervisory roles over MDs or DOs. Furthermore, it retains the official "podiatrist" designation, referring to them as podiatric surgeons, not physicians.“

With that said, will DPM be define as “ physician” in the VA?

Also, does anyone know the update about TRICARE?

APMA submitted comment a letter to Department of Defense back in January to
- update the TRICARE definition of physician at 32 CFR 199.2(b) to include podiatrists.
- permit DPMs to prescribe physical and occupational therapy (PT/OT) to patients.

Thank you.

The updated title 38 reading will have parity between MD/DO, DENTISTS, AND PODIATRIC SURGEONS. All three will have the aformentioned titles, however will be under the same pay grades, eligible for same positions, etc.

At the VA, clinical supervisory roles and peer-reviews are in specialty already. Meaning an Ortho does not perform peer-reviews on cardiovascular surgeons. Only an Ortho is allowed to perform a peer review on an Ortho.

Not sure about Tricare component.

 

[Utvolsdpm]

The vote will be Tuesday or Wednesday

 

[med2345]

Been waiting atleast 8 months for an update lol. Sweet

 

[med2345]

My thought is, when this goes into effect, it won’t be long for Medicaid and Medicare to adopt a higher pay scale for pods in the private sector. To my understanding, there are some states that pay a podiatrist less for the same procedure performed by a MD/DO. This will have a small effect in the short term, and a noticible effect long term.

It’s sad it took this long. Hopefully it passes. Trump is very pro veterans, so I think he will sign it.

That was my first thought and also competition for pay.. let's hope

 

[de Ribas]

.

 

[Utvolsdpm]

Will the law go into effect immediately ?

Essentially, yes. The pay increase should happen 30-45 days later (after the president signs) depending on the pay period.

 

[hypermobility]

Essentially, yes. The pay increase should happen 30-45 days later (after the president signs) depending on the pay period.

Not so sure about that. The wording of the legislation reads... "(2) APPLICATION.—The amendments made by paragraph (1) shall apply with respect to a pay period of the Department of Veterans Affairs beginning on or after the date that is 30 days after the date of the enactment of this Act."

The phrase "OR AFTER" gives some ambiguity. I expect it will be used to change the pay to the new fiscal year or Jan 1.

 

[Utvolsdpm]

Not so sure about that. The wording of the legislation reads... "(2) APPLICATION.—The amendments made by paragraph (1) shall apply with respect to a pay period of the Department of Veterans Affairs beginning on or after the date that is 30 days after the date of the enactment of this Act."

The phrase "OR AFTER" gives some ambiguity. I expect it will be used to change the pay to the new fiscal year or Jan 1.

That’s what I thought when I read it too, but in discussions with multiple people supposedly it will be within 30-45 days.

The pay periods are every two weeks, so maybe that allows some wiggle room depending on the day it passes.

I’ll keep you al updated as I learn more through the week. The other good thing is EDRP monies increase. I’m not sure how it affects those already enrolled but I am working on figuring that out.

 

[hypermobility]

That’s what I thought when I read it too, but in discussions with multiple people supposedly it will be within 30-45 days.

I know when NP's at one facility received an across the board pay increase, it didnt take effect immediately, but they did get HUGE back pay a year later.

 

[DexterMorganSK]

I know when NP's at one facility received an across the board pay increase, it didnt take effect immediately, but they did get HUGE back pay a year later.

Would you know starting avg salary within the VA if this bill passes for Pods?
For MD/DO PCPs, I believe it is around 170K.

 

[Utvolsdpm]

Would you know starting salary within the VA if this bill passes?
For MD/DO PCPs, I believe it is around 170K.

The goal stated in documentation 150k I believe. But as you’ve probably seen we will be on same pay scale as physicians, so should be the same. You can google physician pay scale for VA. I think there is another form of compensation added on top of that as well to make pay more competitive with practitioners in the community.


Edit: here’s the text that is based from:
Podiatrists. Section 502 would add podiatrists to the same pay schedule as physicians and dentists and thereby increase their pay. Currently, VA employs about 400 podiatrists nationwide at an average annual salary of about $130,000. On the basis of information from VA about the average increase necessary for podiatrists to move to a pay schedule comparable to that of physicians and dentists, CBO estimates that the base salary for podiatrists would increase by about 15 percent to $150,000 in 2018. In addition, using data on hiring from VA, CBO estimates that VA would be able to hire an additional 30 podiatrists because the increased pay would make working at VA more attractive. After accounting for projected pay raises, CBO estimates that implementing the provision would cost $60 million over the 2019-2023 period.

 

[hypermobility]

The goal stated in documentation 150k I believe. But as you’ve probably seen we will be on same pay scale as physicians, so should be the same. You can google physician pay scale for VA. I think there is another form of compensation added on top of that as well to make pay more competitive with practitioners in the community.


Edit: here’s the text that is based from:
Podiatrists. Section 502 would add podiatrists to the same pay schedule as physicians and dentists and thereby increase their pay. Currently, VA employs about 400 podiatrists nationwide at an average annual salary of about $130,000. On the basis of information from VA about the average increase necessary for podiatrists to move to a pay schedule comparable to that of physicians and dentists, CBO estimates that the base salary for podiatrists would increase by about 15 percent to $150,000 in 2018. In addition, using data on hiring from VA, CBO estimates that VA would be able to hire an additional 30 podiatrists because the increased pay would make working at VA more attractive. After accounting for projected pay raises, CBO estimates that implementing the provision would cost $60 million over the 2019-2023 period.

If the new base pay hovers around $150k, VA pods will feel a bit let down. This part of the legislation is really the “$250,000” question no one knows the answer to.

 

[Utvolsdpm]

I must admit, if the new base pay hovers around $150k, I will be a bit let down. This part of the legislation is really the “$250,000” question no one knows the answer to.

That’s just the base salary. What still isn’t factored in yet is market pay and performance pay. With all three forms of compensation, from what I’ve heard, practitioners should be starting at about 200k.

But you’re right, we have to wait and see what happens.

 

[dtrack22]

I mean the 2015 MGMA survery has the DPMs that are considered "surgical" and in practice for 3-7 years (no 1-2 yr data in the report), with a "median" salary of $266k and a "mean" of $290k.

$200k is the 25th %-ile. I don't think it changes much other than making VA positions much more attractive to new grads, who are comparing $200k per year (maybe) with the worse pay and worse benefits they would receive from a podiatry practice looking to hire. However, in a couple of years a huge majority of their peers will have passed them in terms of pay.

It will be good for the VA because they'll get more interest from DPMs period. Though, there aren't enough VA jobs for it to have any effect on the profession as a whole. Not to mention the VA is not at all a "leader" in terms of its own pay scales/policies/designations having any impact on large academic institutions or large hospital networks across the country. If you want legitimacy for the profession you're much better off with a regional powerhouse like Kaiser giving it to you and forcing everyone else to follow suit, than you are getting it from any government agency.

 

[Windom Earle]

My thought is, when this goes into effect, it won’t be long for Medicaid and Medicare to adopt a higher pay scale for pods in the private sector.

Could you please explain how that works?

 

[dtrack22]

Could you please explain how that works?

It won't

 

[DexterMorganSK]

If you want legitimacy for the profession you're much better off with a regional powerhouse like Kaiser giving it to you and forcing everyone else to follow suit, than you are getting it from any government agency.

So those graduating from programs like Kaiser and possibly working for them afterward, will get a competitive pay vs other residency programs?

 

[dtrack22]

So those graduating from programs like Kaiser and possibly working for them afterward, will get a competitive pay vs other residency programs?

No. I meant that any changes in the VA will not be some driving force as to how DPMs are treated from an employment or compensation standpoint in the commercial world. The VA could say "we are going to let DPMs run our hospitals and pay them $500k" and it would have absolutely no effect on how every other health system in the country treats podiatrists. Health systems like Kaiser, for example, or CHI or Tenet or Banner or Providence or HCA...are much more likely to move the needle in a given region with changes in how they employ and salary DPMs.

My statement has nothing to do with where an individual trains or works.

 

[hypermobility]

I mean the 2015 MGMA survery has the DPMs that are considered "surgical" and in practice for 3-7 years (no 1-2 yr data in the report), with a "median" salary of $266k and a "mean" of $290k.

$200k is the 25th %-ile. I don't think it changes much other than making VA positions much more attractive to new grads, who are comparing $200k per year (maybe) with the worse pay and worse benefits they would receive from a podiatry practice looking to hire. However, in a couple of years a huge majority of their peers will have passed them in terms of pay.

There are three work types at VA (podiatrist, podiatrist foot surgery, podiatrist F&A surgery), so I am assuming the given number above will reflect to the first work type. There are also included adjustments for Chief or higher administrative duties.

Take a solid base pay, add in locality pay, performance pay, federal pension, tsp retirement account, incredible health insurance, 26 paid days off per year, 13 days sick leave, and 11 federal holidays, and the VA will be a great position for many practitioners, not just those finishing residency.

 

[Utvolsdpm]

There are three work types at VA (podiatrist, podiatrist foot surgery, podiatrist F&A surgery), so I am assuming the given number above will reflect to the first work type. There are also included adjustments for Chief or higher administrative duties.

Take a solid base pay, add in locality pay, performance pay, federal pension, tsp retirement account, incredible health insurance, 26 paid days off per year, 13 days sick leave, and 11 federal holidays, and the VA will be a great position for many practitioners, not just those finishing residency.

It’s also great not having to worry about malpractice insurance.

 

[poditrained]

Just passed the Senate 92-5! On its way to Trump’s desk

 

[med2345]

Just passed the Senate 92-5! On its way to Trump’s desk

Woot woot been waiting on this for ages

 

[de Ribas]

Niceee

 

[Utvolsdpm]

Yay

 

[Lilmasie]

This is so amazing! I can’t wait for all the positive changes that are in store for this career.

 

[Windom Earle]

It won't

Care to elaborate?

 

[Lilmasie]

And I’m sure this was previously discussed, but since it is only speaking for veteran physicians, does that mean this bill doesnt affect podiatrists who don’t operate on veterans? In that case the avg. podiatrist wouldn’t really gain much? I’d appreciate if someone could fill me in on this!

 

[de Ribas]

.

 

[hematosis]

This is big news. Its a huge win for our profession, especially with ortho trying their best to stop it. Salary is just an added bonus to this victory. Its all about getting that respect.

Also, there are more than 400 DPM's in the VA as previously quoted here. its closer to 1k now (Podiatrist Salary Statistics). This number will definitely increase once the salary range is 200-250k similar to the physicians/dentist pay grade. I actually think this makes the VA a more lucrative place to work than other major hospitals like kaiser. VA benefits and retirement are unmatched and the workload is a joke. never have to worry about a law suit and your residents can do all the slave work. Especially for newer residents graduating with over 300k dept who can take advantage of the public loan forgiveness at the VA.

ref: https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/PayTablesRev.pdf

 

[ExperiencedDPM]

This is big news. Its a huge win for our profession, especially with ortho trying their best to stop it. Salary is just an added bonus to this victory. Its all about getting that respect.

Also, there are more than 400 DPM's in the VA as previously quoted here. its closer to 1k now (Podiatrist Salary Statistics). This number will definitely increase once the salary range is 200-250k similar to the physicians/dentist pay grade. I actually think this makes the VA a more lucrative place to work than other major hospitals like kaiser. VA benefits and retirement are unmatched and the workload is a joke. never have to worry about a law suit and your residents can do all the slave work. Especially for newer residents graduating with over 300k dept who can take advantage of the public loan forgiveness at the VA.

ref: https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/PayTablesRev.pdf

You DO have to worry about lawsuits. They are different than “civilian” malpractice suits and are Tort claims. There is no free pass if you make a surgical or medical error.

So cross that one off your list of advantages.

 

[Utvolsdpm]

You DO have to worry about lawsuits. They are different than “civilian” malpractice suits and are Tort claims. There is no free pass if you make a surgical or medical error.

So cross that one off your list of advantages.

The advantage is the US government gets sued and not the practioner so from what I understand they can’t come after your personal assets. That is some relief.

 

[deleted690619]

This is big news. Its a huge win for our profession, especially with ortho trying their best to stop it. Salary is just an added bonus to this victory. Its all about getting that respect.

Also, there are more than 400 DPM's in the VA as previously quoted here. its closer to 1k now (Podiatrist Salary Statistics). This number will definitely increase once the salary range is 200-250k similar to the physicians/dentist pay grade. I actually think this makes the VA a more lucrative place to work than other major hospitals like kaiser. VA benefits and retirement are unmatched and the workload is a joke. never have to worry about a law suit and your residents can do all the slave work. Especially for newer residents graduating with over 300k dept who can take advantage of the public loan forgiveness at the VA.

ref: https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/PayTablesRev.pdf

Sweet Jesus, I am salivating at this type of set up

 

[CaptainCool]

The advantage is the US government gets sued and not the practioner so from what I understand they can’t come after your personal assets. That is some relief.

Trump just passed a bill a few months ago making it easier to fire VA employees getting sued/ practice poorly

 

[Utvolsdpm]

Trump just passed a bill a few months ago making it easier to fire VA employees getting sued/ practice poorly

The tort law didn’t change. I have a copy of the verbiage at work I can share next week if people are interested. It’s still a suit against the federal government.

Additionally, if you pay dues you can belong to the union which is nice. The legislation that passed was mostly aimed at the suits/higher ups but in some cases it has been attempted to be used against nursing/staff. Overall it’s a very steady job.

 

[pacpod]

This is big news. Its a huge win for our profession, especially with ortho trying their best to stop it. Salary is just an added bonus to this victory. Its all about getting that respect.

Agree

 

[ExperiencedDPM]

Agree

Only problem is that an increased salary that is mandated by the government does not equate with more “respect” from anyone.

 

[hematosis]

Only problem is that an increased salary that is mandated by the government does not equate with more “respect” from anyone.

Its mandated by the government because its warranted.

Relax man. This is a step forward. Podiatrist are no longer clumped with allied health and instead in the same category as physicians and surgeons for pay grade. Soon, this will likely set premise for other government/military sector jobs and allow Podiatrist access to the same benefits/loan assistance programs etc.

 

[pacpod]

It doesn't force more respect but it certainly doesn't hurt. Regardless, it is a step forward.

 

[927926]

In your belief, will the impact on non-VA podiatry jobs be positive or negative?

Just by thinking about supply and demand, this should be a positive impact. 1) If pay is increased there would be at least a reasonable solid figure to go by to negotiate higher pay, per se at a private practice. 2) By the same token if more of these positions become available, the number of the podiatrists you hear getting low-balled right out of residency would decrease. In essence I believe competitiveness increases for the employer. All of this to an extent of course, and just my personal thoughts on it.

 

[Windom Earle]

Sweet Jesus, I am salivating at this type of set up

I am cautiously optimistic about this. But I do have some doubts about the avg salary reaching 220-250K.