VA emergency medicine

[hopethisworks]

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I'm on a VA HPSP scholarship and have some time to payback as part of my contract. I'm considering emergency medicine with a fellowship in critical care. Anyone know if the VA will hire a physician to work in both the ICU and ER? If anyone is a past VA HPSP scholarship physician now working in the VA system, please DM me I'd love to ask some questions.

 

[WhatJobDoIPick]

I'm on a VA HPSP scholarship and have some time to payback as part of my contract. I'm considering emergency medicine with a fellowship in critical care. Anyone know if the VA will hire a physician to work in both the ICU and ER? If anyone is a past VA HPSP scholarship physician now working in the VA system, please DM me I'd love to ask some questions.

Do Pulm / CCM. More flexibility to fall back on Pulm clinic type stuff. EM is trash

 

[inspirationmd]

I'm on a VA HPSP scholarship and have some time to payback as part of my contract. I'm considering emergency medicine with a fellowship in critical care. Anyone know if the VA will hire a physician to work in both the ICU and ER? If anyone is a past VA HPSP scholarship physician now working in the VA system, please DM me I'd love to ask some questions.

I was entertaining leaving one of my positions and taking a job with a VA. They already had one emergency physician intensivist employed who did a week every two months in the ICU in the VA in addition to her emergency medicine obligation. I believe they defined it as 75% EM 25% critical care.

They also were willing to work with me to do both before they tried to screw me with the tele-work promises for the administrative time I would have. If you do decide you want do emergency medicine and then a critical care fellowship there are options within the VA system. If you go on USA jobs.gov you can clearly see some positions just for intensivist only.

That said, pulmonary critical care will give you more options in the military and VA health system. They seem to be a little behind on the split that’s happening with pulmonology and critical care medicine in the private world.

 

[hopethisworks]

I was entertaining leaving one of my positions and taking a job with a VA. They already had one emergency physician intensivist employed who did a week every two months in the ICU in the VA in addition to her emergency medicine obligation. I believe they defined it as 75% EM 25% critical care.

They also were willing to work with me to do both before they tried to screw me with the tele-work promises for the administrative time I would have. If you do decide you want do emergency medicine and then a critical care fellowship there are options within the VA system. If you go on USA jobs.gov you can clearly see some positions just for intensivist only.

That said, pulmonary critical care will give you more options in the military and VA health system. They seem to be a little behind on the split that’s happening with pulmonology and critical care medicine in the private world.

Did your friend ever comment on acuity at her ED? I worry i'll lose skills learned in residency by the time my service commitment expires.

 

[EctopicFetus]

Do Pulm / CCM. More flexibility to fall back on Pulm clinic type stuff. EM is trash

All the IM/CC folks i know want to bail on the ICU part and do pulm. This makes the EM guy with no pulm training good for them. I imagine plenty of options however you will be treated like the 2nd class ICU doc they view you to be. The only value is doing the work they dont want. Not to be too much of an A hole.. but it’s also how many EM docs view their PEM counterparts. Usually lower pay, unequal tracks, many cant be partners in SDGs etc.

 

[comp1]

The VA HPSP is so new that I'm not sure if you'll get a lot of people reaching out with personal experience, but I'm really glad it's being used and welcome to the VA. In terms of working the ED and ICU, maybe? VA emergency departments are typically very low acuity on average compared to the community. I don't anticipate there's a lot of MDs working there who are also very interested in stuff going on in a MICU. It would have to work out with what are likely two respective service lines' scheduling and FTE distribution. It's a bit unicornish. It wasn't all that far back where it was much more common to see FM and OB/Gyn MDs in the VA EDs than board certified EM MDs.

 

[endo]

Our VA could definitely make a spot for you under normal circumstances. Right now all positions are locked, pending the reduction in force. VA ICUs definitely need docs, but I think they’re paid less than the ED docs.

 

[hopethisworks]

Our VA could definitely make a spot for you under normal circumstances. Right now all positions are locked, pending the reduction in force. VA ICUs definitely need docs, but I think they’re paid less than the ED docs.

What are your initial thoughts regarding the future of the VA? Are you thinking they will stop hiring doctors all together?

 

[Tiger26]

If I had a crystal ball for the VA’s future, I’d predict that over time, about 90% of care will shift to the private sector. The VA will likely retain responsibility for areas where it has unique expertise or where conditions are highly prevalent among veterans—like spinal cord injuries, amputation and prosthetic care, and mental health.

As a nation, there’s little justification for maintaining a parallel healthcare system to treat conditions that are already well-managed in the broader medical community.

 

[endo]

What are your initial thoughts regarding the future of the VA? Are you thinking they will stop hiring doctors all together?

Long-term I don’t know. Short-term, docs, nurses and other clinical staff are being told they can’t take early retirement in the RIF (reduction in force). So they apparently don’t want to get rid of them and we are still hiring. Every community is different but where I’m at, doctor’s appointments are easier to come by at the VA than the community for most specialties. Privatizing will make things worse when vets can’t get appointments. For now, the job is still better than a CMG. We still don’t have Press Ganey, docs don’t worry about pph or accurate billing capture and our staffing is way better than most CMGs. The normal problems with the VA endure (bureaucracy, old EMR, etc)

 

[Old_Mil]

Do Pulm / CCM. More flexibility to fall back on Pulm clinic type stuff. EM is trash

This.

In EM, the entire hospital system is designed to route people to your door and kick your ass with minimal staffing.

In the ICU, the entire hospital system is designed to keep people from your door.

But honestly, I'd consider something like FM or IM (probably IM) where you have a lot of independence to work outside the established medical bureaucracy and specialize if you want.