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The Gigs I have been offered are low and the thoughts of low pay + government red tape seems like a bad deal.
Every VA is different, but for me there were positives to working there which eventually were overcome by the negatives.
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I get locums emails reading, "VA shifts available, any license will do, immediate credentials" then, "Pay below market, but help your country out"
or
"VA position avail, $235/hr in the middle of nowhere". No way I would do $235 requiring travel to deal with the pencil pushers. I did some of my training at a VA hospital and the consulting docs were essentially useless. The mantra of "least amount of work possible" fit 90% of the docs I worked with.
or
"VA position avail, $235/hr in the middle of nowhere". No way I would do $235 requiring travel to deal with the pencil pushers. I did some of my training at a VA hospital and the consulting docs were essentially useless. The mantra of "least amount of work possible" fit 90% of the docs I worked with.
Welcome to the future of EM under "Medicare for All". #threadhijack
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deleted941485
GOVT: YOU WILL RENDER SERVICES!! Weather you want to or not.
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deleted497653
I’ve worked for the VA and can confirm most of what is said here is true. Veterans can either be the best people or your worst nightmare. And they have no hesitation making a fuss about things most people would let roll off their shoulders. But hey... you get 26 vacation days a year....(sarcasm)
Two months at a "good" VA. Nurses were lazy and largely incompetent at emergency medicine. Doctors were usually terrible too. The only time the ED nurses worked hard was when they were trying to find a policy that would let them get out of something they were uncomfortable with... like a cardioversion. The who department turned into a bunch over scholars of government regulations looking for their way out of providing care of a condition other than CHF, COPD, or diabesity.
Why do we think this will have a happy ending when implemented nationwide? I'm for getting rid of the VA system all together and giving Veterans one of the Medicare Advantage plans.
I know several board certified EM graduates from my program who are working at a VA. All say it is amazing.
The pay they receive is generous. Sure, it's government work, with government bureaucracy, but I'll work for the government over a CMG any day. The benefits they get are decent as well, and it's really really hard for a VA doctor to get sued.
Yes you are essentially an after hours urgent care for VA patients with lots of chronic medical complaints, but if job stability and benefits is what you want combined with a favorable medicolegal climate, the VA may be a good option. The pay is better than straight academics, less than straight community, which may be a good balance for some.
The pay they receive is generous. Sure, it's government work, with government bureaucracy, but I'll work for the government over a CMG any day. The benefits they get are decent as well, and it's really really hard for a VA doctor to get sued.
Yes you are essentially an after hours urgent care for VA patients with lots of chronic medical complaints, but if job stability and benefits is what you want combined with a favorable medicolegal climate, the VA may be a good option. The pay is better than straight academics, less than straight community, which may be a good balance for some.
Also heard this
Yea...well we 'll end up like the rest of the world, where everybody except the rich have to wait 2 years to get anything done, our outcomes will be the same, and we will save money.
Someone (or some corporation or entity) needs to spend 1B in advertising over the next 5 years advertising "less medical care is good", "learn to develop coping skills", "we will not give you a diagnosis for your chronic pain", and "if you use a physician more than 12 times a year, < 65, then you have to pay out of your own pocket or we will let you die."
Americans have no friggin coping skills with anything medically related. It's really sad.
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Have you published the other reasons?
I think you have at some point!
We need to make it a sticky on this forum. For easy access.
I think you have at some point!
We need to make it a sticky on this forum. For easy access.
I have considered making a formal and numbered list, but I think the comedy is better with random numbers or whatever fits the situation best. That, and my blood pressure would remain elevated.
Raney Schauer
The impossible flavor of your own completion.
As a veteran, with all due respect (none at all after this comment), you can go straight to hell.
You're making a logical error here.
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deleted480308
What specifically do you think they were saying that was upsetting?
Raney Schauer
The impossible flavor of your own completion.
Every veteran employee I've come across in the system has been nothing but professional, hardworking and willing to go to any length possible to resolve issues and create solutions and thing #1 up there took dump on all of them. I take exception to that. @ me, please. Let's do this.
Hooo boy.
I thank you for your service and apologize for causing offense. I will edit my post.
Oh good grief. Everyone is so sensitive these days.
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deleted480308
It seemed like they were saying “some” to me, and even if they edited it out and backed down I’M going to disagree with you here
I’m military now and have worked with a lot of prior service folks in various fields. A lot of great people. But To claim they are all consummate professionals is inaccurate. A DD214 doesn’t cure character flaws, some people have both.
Calm down with the “come at me” stuff, we’re all adults talking
I'm a veteran myself and have spent significant time rotating at a VA. I agree with the post you got all butt-hurt about.
As a vet, I agree with what was said. Many vets, a good portion are look at me, woe is me, give me a discount for my service ******. A bit harsh but damn it’s annoying sometimes.
Hurr durr. I've worked some wonderful veterans and some not so wonderful veterans. People are people. I wouldn't want my care at a VA. Serving the US in the military is wonderful and great contribution to society, but lots of the veteran worshiping propaganda seem tailored for the cheap seats. Keep drinking the koolaid.
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But you've proposed expanding this system to the entire US.#threadhijack
Have I? I actually have not. Can you please quote my post?
No, I didn't think so.
"Medmal? Pretty hard to get sued as a military, VA or IHS doc already. "
My apologies if you made this seem like you would prefer it to our current medical system. Your limited statement made it appear you are in support.
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deleted109597
I've considered a VA or two.
Not for long, but mainly because they wanted to pay ~half the going rate for EPs in this country. And I would have to travel.
Now, some of that can be from whatever firm they use to recruit that is stealing 50% of the monies, but I doubt it's entirely that.
Shouldn't be hard for the VA to come up with at set rate that they can use to get physicians with. And yet I haven't seen it.
Not for long, but mainly because they wanted to pay ~half the going rate for EPs in this country. And I would have to travel.
Now, some of that can be from whatever firm they use to recruit that is stealing 50% of the monies, but I doubt it's entirely that.
Shouldn't be hard for the VA to come up with at set rate that they can use to get physicians with. And yet I haven't seen it.
Every time I’ve spoken directly to the VA recruiting, it’s been the same song and dance. On the surface, it seems like a great deal and an improvement in scenery but once you start digging into the specifics, it’s not so great. For starters, I want to say the minimum hours required for full time is excessive. I vaguely remember it being something on the order of 144 hours a month or something like that. The compensation is salaried and works out to be around 300K or a little less in my neck of the woods. The benefits are nice, but not what I would call earth shattering and certainly not commensurate with private practice pay lost in the endeavor. The idea of sovereign immunity and not having to worry as much about lawsuits is definitely a plus though it’s incorrect to say that you “can’t be sued” working for the VA.
I would probably only consider it if community pay precariously dropped, I needed the litigation ”protection”, or I needed the health insurance. However, with the hour requirements for full time and access to all the benefits, you def can’t work “part time”. It may have actually been more than 144 hours for full time. I just remember doing a double take and asking him to repeat the hours required for full time. It was somewhere between 140-160 and I just remember thinking “Wow, really?”. I used to have it all in a spreadsheet and after calculating the value on benefits and other things, minus the FT requirements, I just remember it was a pretty terrible hourly rate. (In my case, I would have had to give up about 175K in earnings potential for the same amount of hours.)
Anybody talked to VA recently and have the scoop? I’d be curious to see if anything has changed.
I would probably only consider it if community pay precariously dropped, I needed the litigation ”protection”, or I needed the health insurance. However, with the hour requirements for full time and access to all the benefits, you def can’t work “part time”. It may have actually been more than 144 hours for full time. I just remember doing a double take and asking him to repeat the hours required for full time. It was somewhere between 140-160 and I just remember thinking “Wow, really?”. I used to have it all in a spreadsheet and after calculating the value on benefits and other things, minus the FT requirements, I just remember it was a pretty terrible hourly rate. (In my case, I would have had to give up about 175K in earnings potential for the same amount of hours.)
Anybody talked to VA recently and have the scoop? I’d be curious to see if anything has changed.
The VA bases everything as though you were a full time outpatient doctor.
80 hours per week per pay period ( q2 weeks) = 2080 hours per year
annual leave earned, 8 hrs per pay period = 208 hours
10 federal holidays = 80 hours
so 2080-208-80 = 1792 hours per year
But oh wait ER can’t close on MLK day so you may be working there anyway, and they don’t have to flex you another day off, etc. They can also mandate more hours and full time docs do not receive overtime.
As a VA employee pay is limited by federal pay tables based on tier, in my area that’s 240k a year, so 133/hr. If they pay a staffing company it can be higher because you are not the employee. Now, that’s not far from ****ty USACS pay in some areas apparently. So it can be an OK option for some folks (if you are 5 years away from federal pension, etc). But not for most of us.
Granted money isn’t everything, but it’s a lot.
80 hours per week per pay period ( q2 weeks) = 2080 hours per year
annual leave earned, 8 hrs per pay period = 208 hours
10 federal holidays = 80 hours
so 2080-208-80 = 1792 hours per year
But oh wait ER can’t close on MLK day so you may be working there anyway, and they don’t have to flex you another day off, etc. They can also mandate more hours and full time docs do not receive overtime.
As a VA employee pay is limited by federal pay tables based on tier, in my area that’s 240k a year, so 133/hr. If they pay a staffing company it can be higher because you are not the employee. Now, that’s not far from ****ty USACS pay in some areas apparently. So it can be an OK option for some folks (if you are 5 years away from federal pension, etc). But not for most of us.
Granted money isn’t everything, but it’s a lot.
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I tried locum at a few VAs and absolutely loved it & was amazed at the coverage and amount of providers for the patient volume.
I’ve applied & been offered full time opportunities. I agree with the ease of work (0.5 pph) compared to what we all are used to in the private arena & would like to add job protection when pay is down in a lot of EM currently & protection from contract groups and/or the hospital administrators. Sovereign Immunity is of course another consideration.
The biggest seller for me is the paid time off since I just work my other locum job in those days off. That’s worth just over 100,000 in benefits alone.
This is what I calculated for VA work 13-14 shifts/month ( its reasonable to take 1-2 days of leave every month then it’s 12-13 shifts or less depending how you use leave).
$275,000-$310,000 base salary depending on the site. Keep in mind the biggest benefit is an earlier start in the VA system for pay increase is as it is in the military & goes up every year about $3,000 or more. After 10 yrs you’ll always make more than starting 10 yrs from now & be closer to that current advertised top pay salary of $348,000.
+101,190 in PTO benefits ( 30 PTO days, 13 sick days , 5 days CME, 14 days military reserve )
—————
$376,190
+15,000 Performance Annual Bonus
+40,000 Student loan Reimbursement x 5 yrs
+22,550 401 K contribution
——————
453,740
+ add whatever Side Prn/locum work you want to do when off .
Some VAs have a large pool of fee basis or locums to cover nights/weekends/holidays, some do not. Weekends and holidays do not count toward time off.
I think this is at least better than most are getting working in a freestanding or small volume ER.
If you can handle the 24 hr shifts that may be the next consideration if you want less days work.
I’ve applied & been offered full time opportunities. I agree with the ease of work (0.5 pph) compared to what we all are used to in the private arena & would like to add job protection when pay is down in a lot of EM currently & protection from contract groups and/or the hospital administrators. Sovereign Immunity is of course another consideration.
The biggest seller for me is the paid time off since I just work my other locum job in those days off. That’s worth just over 100,000 in benefits alone.
This is what I calculated for VA work 13-14 shifts/month ( its reasonable to take 1-2 days of leave every month then it’s 12-13 shifts or less depending how you use leave).
$275,000-$310,000 base salary depending on the site. Keep in mind the biggest benefit is an earlier start in the VA system for pay increase is as it is in the military & goes up every year about $3,000 or more. After 10 yrs you’ll always make more than starting 10 yrs from now & be closer to that current advertised top pay salary of $348,000.
+101,190 in PTO benefits ( 30 PTO days, 13 sick days , 5 days CME, 14 days military reserve )
—————
$376,190
+15,000 Performance Annual Bonus
+40,000 Student loan Reimbursement x 5 yrs
+22,550 401 K contribution
——————
453,740
+ add whatever Side Prn/locum work you want to do when off .
Some VAs have a large pool of fee basis or locums to cover nights/weekends/holidays, some do not. Weekends and holidays do not count toward time off.
I think this is at least better than most are getting working in a freestanding or small volume ER.
If you can handle the 24 hr shifts that may be the next consideration if you want less days work.
certainly better base pay than I was making. They promised me 40k for loan repayment too but that pot of money was empty by the time I was eligible to apply for it (wanna say after the first year) so I never saw a dime of that. it’s 40 total of course over 5 years, not 200. every VA is different and I’m sure some of them are great.
It’s gone up from 120k to 200k now total & you could still qualify for student loan forgiveness (PSLF) after 10 years
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My experiences when I was a resident rotating at a VA ED that converted from family medicine doctors to Board certified EM doctors.
Obviously high variability between different VAs given some are staffed by BCEM and some by family docs. What I had heard of the ED prior to board certified doctors was a glorified urgent care where the doctors treated it as a family medicine clinic with LOS of 5-6+ hours and a waiting room that never emptied despite low PPH. Where patient just showed up in the morning, and sat around the entire day until they can be see by the night doctor.
Negatives:
EMR sucks. VistA/CPRS is the worst, and I am to this day confused by the people who touts it. Orders, notes, chart review takes 10x longer than Epic. Each chart is essential a giant block of text.
Inefficient: Orders will get ignored forever.
Bureacracy can get in the way. Remember a postsurgical hemorrhagic shock patient that required 3 surgical residents to get stat blood delivered (because the right forms were not done) and the OR set up because they didn't fill out the right forms.
Pros:
Everyone has followup. Everyone can get specialty referral. All their prescriptions filled on discharge.
Psych is easy. There is plenty abuse just like anywhere, but inhouse mental house makes dispo easy.
Immunity.
Volume was easy, but after the conversion, volume and acuity kicked up, which is harder when things are so inefficient.
Payscale was above market for region (after conversion to BCEM) and good benefits. Obviously regional based on description of low pay in earlier posts.
Very grateful consultants after dealing with family medicine doctors in the ED.
Minimal amount of pelvic exams
Personally I would not work at a VA ED, because the inefficiencies makes me want to tear my hair out if there is any reasonable volume.
Obviously high variability between different VAs given some are staffed by BCEM and some by family docs. What I had heard of the ED prior to board certified doctors was a glorified urgent care where the doctors treated it as a family medicine clinic with LOS of 5-6+ hours and a waiting room that never emptied despite low PPH. Where patient just showed up in the morning, and sat around the entire day until they can be see by the night doctor.
Negatives:
EMR sucks. VistA/CPRS is the worst, and I am to this day confused by the people who touts it. Orders, notes, chart review takes 10x longer than Epic. Each chart is essential a giant block of text.
Inefficient: Orders will get ignored forever.
Bureacracy can get in the way. Remember a postsurgical hemorrhagic shock patient that required 3 surgical residents to get stat blood delivered (because the right forms were not done) and the OR set up because they didn't fill out the right forms.
Pros:
Everyone has followup. Everyone can get specialty referral. All their prescriptions filled on discharge.
Psych is easy. There is plenty abuse just like anywhere, but inhouse mental house makes dispo easy.
Immunity.
Volume was easy, but after the conversion, volume and acuity kicked up, which is harder when things are so inefficient.
Payscale was above market for region (after conversion to BCEM) and good benefits. Obviously regional based on description of low pay in earlier posts.
Very grateful consultants after dealing with family medicine doctors in the ED.
Minimal amount of pelvic exams
Personally I would not work at a VA ED, because the inefficiencies makes me want to tear my hair out if there is any reasonable volume.
Your boss, Chief of Medicine, at the VA ED is likely IM/FP so if you don’t like that then the VA is not for you. Btw, in private sector your CMO is likely a FP/IM who did or does EM as well.
There are plenty of Board Certified Emergency Medicine docs who are FP/IM (ABPS) who the consultants, including Hospitalist, prefer to work with since they actually may still work the floors as Hospitals and have a closer relationship then a plain EM doc.
Meditech is the worst EMR not CPRS/Vista for which the VA is transitioning to Cerner.
There are plenty of Board Certified Emergency Medicine docs who are FP/IM (ABPS) who the consultants, including Hospitalist, prefer to work with since they actually may still work the floors as Hospitals and have a closer relationship then a plain EM doc.
Meditech is the worst EMR not CPRS/Vista for which the VA is transitioning to Cerner.
I don't think anyone is suggesting that having a chief of medicine who is IM/FP is in any way a problem. If the chief of emergency medicine is IM/FP, that's a different conversation and more likely than not just speaks to the inability of whatever site this is to attract ABEM docs.
I have met literally zero people in my life who are "board certified EM docs" who have their boards from ABPS. That said, I also work in an area where there is no IM/FM coverage in EDs anywhere near me. A quick search of ABPS shows that several states don't even recognize ABPS board certification at the state level let alone at the individual hospital level. This seems to make sense as an ABPS emergency medicine board doesn't seem to require, you know, training in emergency medicine.
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That isn't board certified...
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ABPS is not a legitimate board certification for EM - sorry.
We've been our own ABMS specialty board since 1979.
Forty-one years.
It's time for other docs to stop pretending they are "board certified" in my specialty.
Stop trying to deceive the public. Own what you are.
We've been our own ABMS specialty board since 1979.
Forty-one years.
It's time for other docs to stop pretending they are "board certified" in my specialty.
Stop trying to deceive the public. Own what you are.
We have already had this conversation in my other thread. State Boards & Hospital Privileging boards have honored the experience & knowledge of ABPS physicians who are also EM who chose not to be a part of ABEM.
Some have, though most of the "acceptance" seems to be taking advantage of the fact that being board certified is not more specifically defined within the state legislature. As indicated above, this is a patchwork acceptance at best. Some states have taken the step of further defining board certification and they do not recognize ABPS as a valid board, some going so far as to prohibit advertising that you're board certified.
You mean "who do not meet the requirements for ABEM certification." Let's be honest here. There isn't a single ABPS "board certified EM doc" who wouldn't jump on the opportunity to convert their credentials to ABEM certification if they could.
ABPS is literally using a technicality to call yourself board certified. It's like the guy with an PhD in anthropology from the University of Phoenix walking into a hospital and insisting that everyone call him "Dr." It's just disingenuous.
I didn't realize the ABPS is an offshoot of AAPS. This all makes much more sense.
I am note aware of any state that requires board certification for licensure, or cares about board certification in any way. If there is one or two, it is only one or two. In the states of which I am familiar, specialty is "self reported" and is specifically noted as "self reported." I could say I was a neurosurgeon in my licensing application.
There are a number of locations that will grant privileges to people who are not board certified. In fact, arguably our best orthopedic surgeon was not board certified. Granted he is in his late 50's. The fact that some hospitals will grant privileges to people with ABPS "board certification" is undercut by the fact that they will also grant privileges to people with NO board certification of any type.
At least where I have worked, we classed ABPS certification in the same category as "no certification."
