VA jobs - insiders only?

[619]

I was offered an interview at buffalo recently for a part time 0.4 FTE (2 days a week only) general podiatry position with little to no surgical availability. In the email it said the salary was 52-60k for two days depending upon experience.

A friend of mine at a different VA was offered 98k for 3 days a week part time

This is not a bad gig for someone who wants to open his own practice. 2 days a week for about $50K/year income is enough to live on while you grow your practice the remaining 3 days a week. With the VA, you don't have to worry about non-compete clause.

Anyone who does this, 99% guaranteed after your 1st year, you will make more money than being an associate and in year 2 when you quit the VA gig and expand your practice to 5 days a week, the sky is the limit in terms of your income.

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[heybrother]

This is not a bad gig for someone who wants to open his own practice. 2 days a week for about $50K/year income is enough to live on while you grow your practice the remaining 3 days a week. With the VA, you don't have to worry about non-compete clause.

Anyone who does this, 99% guaranteed after your 1st year, you will make more money than being an associate and in year 2 when you quit the VA gig and expand your practice to 5 days a week, the sky is the limit in terms of your income.

That's a solid way to look at it. I saw a part time VA job in my town but it was 10 minutes from expiring and when I thought about it afterwards I wondered how I'd even make it work.

My weirder thought still was - no one is going to move to my town for 2 days of work. None of the other pods in town are hiring or will ever be able to hire anyone. And no new office has opened. So I'm pretty certain that the next town hours away that "owns" my town's VA is probably just sending someone and the job position was a formality.

Its all such a weird process. Like if you wanted to fill 1-2 days of work at a VA in a small town you'd think you'd ask DPMs already in town, but maybe everything has to go through their website.

 

[DYK343]

That's a solid way to look at it. I saw a part time VA job in my town but it was 10 minutes from expiring and when I thought about it afterwards I wondered how I'd even make it work.

My weirder thought still was - no one is going to move to my town for 2 days of work. None of the other pods in town are hiring or will ever be able to hire anyone. And no new office has opened. So I'm pretty certain that the next town hours away that "owns" my town's VA is probably just sending someone and the job position was a formality.

Its all such a weird process. Like if you wanted to fill 1-2 days of work at a VA in a small town you'd think you'd ask DPMs already in town, but maybe everything has to go through their website.

Anything that ends in .gov will never be logical or efficient.

 

[619]

Like if you wanted to fill 1-2 days of work at a VA in a small town you'd think you'd ask DPMs already in town, but maybe everything has to go through their website.

I believe per federal law, all jobs must be posted online, newspaper, job forums etc to the public even though they probably already have a candidate lined up. Their "chosen" candidate still have to apply for the job on the website, do the formal interview, etc to prevent any look of favoritism.

I know it sounds like legalized corruption but this is how the world works. Life is about getting your foot in the door.

 

[GreenHousePub]

in year 2 when you quit the VA gig

Why would you ever do that lol

 

[heybrother]

Why would you ever do that lol

I think the argument is you could make more money if you ran an busy clinic on your own working those 2 days.

Here are my "VA Strategies". They don't necessarily focus on maximizing revenue but they could come with their own perks.

-Let's say you somehow became financially successful young and want to work less. Paying for health insurance is what keeps a lot of people working because they can't get Medicare. You could literally acquire insurance through the VA, only work whatever # of days, AND be malpractice proof protecting your wealth.

-$98K working 3 days at a VA vs $100K your first year as an associate. Work 3 days a week. Give up on fame and glory. Live frugal. Do ABPM. 4 day weekend with your kids every week. Afternoon delight your wife. No need to start a practice.

-Work 2 days a week at the VA. You now have far fewer clinic spots to fill. If you are in an area like I am where a bunch of the commercial insurances are racing to the bottom - screw them. Only accept Medicare, good Blue Cross plans ie. no HMO, and local exotics that pay well. You don't need 100 patients a week. You jokingly need ...50. If you don't accept Humana then you never have to spend a week appealing all the Humana claims that were denied. This strategy doesn't maximize revenue per se but you know when you get paid you're getting paid your worth.

-The Screw Owning a Practice Plan. 2/5 days are already spoken for. Find a local WHC that wants a podiatrist. Now 3 days are spoken for. Find a Critical Access Hospital looking for a podiatrist to come 2-4 times a month and run a clinic in which they provide the nursing staff. Critical access hospitals bill differently than normal hospitals. That's some variation of 3.5-4 days rihgt there. Side hustle, house call, or take the day off for the rest.

-The Low Overhead. You're already getting your 401k and health insurance through the VA so no need to feel inclined to buy these for your employees who are all part time. Run low overhead clinic that only needs 2-3 days of staff. Hell, make your wife answer the phone the days you aren't working.

-And the Coup de grace. Hire an associate to work those 2 days you aren't there. Tell him there's tons of untapped potential because you probably aren't operating much. Have you wife keep a close eye on him while you're away.

 

[Pronation]

-And the Coup de grace. Hire an associate to work those 2 days you aren't there. Tell him there's tons of untapped potential because you probably aren't operating much. Have you wife keep a close eye on him while you're away.

Ah yes, the ole' "seeking an associate with very strong rearfoot and ankle surgery skills. Must be very ambitious, a real go getter, and must love Medicaid."

 

[619]

I think the argument is you could make more money if you ran an busy clinic on your own working those 2 days

YES this is very correct. I know this first hand since owning my own practice. You can see 8-10 patients a day and still make wayyy more per day than at a VA clinic seeing 50 patients/day or whatever the VA throws at you.

If you do the maths, making $50k/year working 2 days a week is max about $550-$600/day (I know my maths is off but you get the point). Folks that own their clinic (and actually look at every EOB) knows that a new patient visit for common stuffs like ingrown toenail, Heel pain, anything MSK pathology where you take x-ray, injection, DME etc, you make a killing on those patients.

So yes, at year 2, you quit your part time VA gig and expand your practice, less headache and more $$$.

 

[619]

You could literally acquire insurance through the VA, only work whatever # of days

I am not 100% sure but I think you can only get health insurance through the VA if you are a full time employee.

It's hard to pull full time working 2 days a week however it could be possible with 3 days a week doing 12 hours shift and then some.

Regardless I like your proposed plan. I will rather take $98K working 3 days at a VA vs $100K first year as an associate. My reason is with the VA, you get full benefits if you do 3 days and get full time. As an associate you get nothing working for low pay; No health insurance or some ****ty health insurance plan, No retirement benefits etc.

 

[GreenHousePub]

So yes, at year 2, you quit your part time VA gig and expand your practice, less headache and more $$$.

What part of owning your own practice involves less of a headache?

At the VA you go home after work.

At your practice you finish your notes, then work on the latest crises with the girls at the front desk, find out about the insurance claims rejections you just got, order supplies for the next day, schedule surgeries and have to cancel appointments around it.

Not to mention the cost of independent health insurance for you and your family.

 

[Utvolsdpm]

I am not 100% sure but I think you can only get health insurance through the VA if you are a full time employee.

It's hard to pull full time working 2 days a week however it could be possible with 3 days a week doing 12 hours shift and then some.

Regardless I like your proposed plan. I will rather take $98K working 3 days at a VA vs $100K first year as an associate. My reason is with the VA, you get full benefits if you do 3 days and get full time. As an associate you get nothing working for low pay; No health insurance or some ****ty health insurance plan, No retirement benefits etc.

I know it’s possible to work part time (one day a week, patients scheduled 8-1130) and get full health insurance coverage for yourself and family. Not sure how much of the paycheck that eats up though.

 

[heybrother]

I know it’s possible to work part time (one day a week, patients scheduled 8-1130) and get full health insurance coverage for yourself and family. Not sure how much of the paycheck that eats up though.

Probably a lot, but there are tools for finding the price of federal insurance and BCBS FEP Focus appears to cost 1/4th of what I pay for my family's inferior insurance. The things offered to small businesses are usually pathetic.

 

[Shiyuan]

So... the VA requires a state license from any state to practice at a VA facility. Is the scope of practice at said VA facility reflective of your state license or the state you are practicing?

Like if I had a TX license practicing in PA, which scope would be followed? I imagine it’s the state you are in but wanted to clarify.

 

[Scrantonicity]

So... the VA requires a state license from any state to practice at a VA facility. Is the scope of practice at said VA facility reflective of your state license or the state you are practicing?

Like if I had a TX license practicing in PA, which scope would be followed? I imagine it’s the state you are in but wanted to clarify.

My guess is it's whatever the bylaws of that VA tell you, which may or may not go perfectly along the lines of that state's laws. I say this with zero experience working in a VA, but that's the sense I get from others who have.

 

[Feli]

So... the VA requires a state license from any state to practice at a VA facility. Is the scope of practice at said VA facility reflective of your state license or the state you are practicing?

Like if I had a TX license practicing in PA, which scope would be followed? I imagine it’s the state you are in but wanted to clarify.

You get basically whatever privileges you get in the VA/IHS... logs, comfort level, training/certs (if your chief understands that), facility needs, etc etc. State scope doesn't matter... since they are federal.

In some VA/IHS hospitals, podiatrists do BKA and get their own STSG or ASIS auto or first assist Gen/Ortho and various stuff which is not in any state DPM scope. Some may do calc and ankle fx while others barely even give surg shoes to 4th digit fx and all met fx ORIF or beyond go to Ortho or a different area VA pods. In other spots, DPMs do basically nothing but C&C and wounds. It is all dependent on chief/facility/peers/etc. "If you've seen one VA, you've seen one VA."

 

[Pronation]

You get basically whatever privileges you get in the VA/IHS... logs, comfort level, training/certs (if your chief understands that), facility needs, etc etc. State scope doesn't matter... since they are federal.

In some VA/IHS hospitals, podiatrists do BKA and get their own STSG or ASIS auto or first assist Gen/Ortho and various stuff which is not in any state DPM scope. Some may do calc and ankle fx while others barely even give surg shoes to 4th digit fx and all met fx ORIF or beyond go to Ortho or a different area VA pods. In other spots, DPMs do basically nothing but C&C and wounds. It is all dependent on chief/facility/peers/etc. "If you've seen one VA, you've seen one VA."

Interesting. I've never heard of a DPM doing a BKA anywhere outside of residency.

 

[Scrantonicity]

Interesting. I've never heard of a DPM doing a BKA anywhere outside of residency.

Probably happens on the reservations...probably difficult getting surgeons over there...why don't we hear from anyone on these forums that works in ihs (or have I missed it)? I see there's a job opening in New Mexico right now. I just wonder what it's actually like. On one hand, the benefits seem amazing (especially the student loan part)--but the more I think about some of the nuances behind it...could be a tough gig compared to VA.

 

[HardRoadPaved]

Ah yes, the ole' "seeking an associate with very strong rearfoot and ankle surgery skills. Must be very ambitious, a real go getter, and must love Medicaid."

but the real catch is when you get there you find out it's nothing but chip and clip.

 

[Pronation]

but the real catch is when you get there you find out it's nothing but chip and clip.

Well yea, the ad did say must be very ambitious. It will be the associate's job to go and convince the rest of the community that Bubba's Chip'N'Clip Hut has now upgraded their rusty old instruments and is now doing more than medical grade pedicures!

 

[heybrother]

I see there's a job opening in New Mexico right now. I just wonder what it's actually like. On one hand, the benefits seem amazing (especially the student loan part)--but the more I think about some of the nuances behind it...could be a tough gig compared to VA.

I'll let you know dude. I'm already working on it with my wife.



Me to my wife: Hey. How would you feel about moving to Shiprock, New Mexico.

Her: No.

Me: but you've never even heard of it.

Her: I already lived in a trash town for your residency. Is there a VA there?

Me: the Navajo nation is there.

Her: pass.

Okay. Someone else can have it.

 

[Scrantonicity]

I'll let you know dude. I'm already working on it with my wife.



Me to my wife: Hey. How would you feel about moving to Shiprock, New Mexico.

Her: No.

Me: but you've never even heard of it.

Her: I already lived in a trash town for your residency. Is there a VA there?

Me: the Navajo nation is there.

Her: pass.

Okay. Someone else can have it.

Haha! That was almost word for word my convo with my wife. To be fair, Farmington is only a 30 minute commute from Shiprock--they have a Chick Fil-A, so can't be all bad??? Yeah, pass.

 

[Shiyuan]

Question for all current VA/IHS docs... When I am looking at the application process, pretty much all of the openings say the only “required document” is a resume/CV.

Did y’all also provide a cover letter, pod school transcript and/or VA form 10-2850? Or anything else for that matter?

 

[Feli]

Haha! That was almost word for word my convo with my wife. To be fair, Farmington is only a 30 minute commute from Shiprock--they have a Chick Fil-A, so can't be all bad??? Yeah, pass.

...Me to my wife: Hey. How would you feel about moving to Shiprock, New Mexico....

Yeah, you probably don't want that job.
The pay and benefits? Ok, now we're talking...
The location? "Money often costs too much."

It would be different if you could live in Cortez (small but cool) or even Farmington (kinda rough and industrial in most parts, but has stuff to do) and just commute for call and clinic in Shiprock, but that's not how it is. If you visited the Shiprock hospital and the adjacent employee housing (aka trailers) and the town itself, I doubt you even wanted to out finish the interview day tour. I hope they got somebody good, but Shiprock is a much rougher sell than most other IHS since it is so far from freeways to any major metro city/airport/etc.

 

[Shiyuan]

Not trying to get into the vaccine politics here, but moreso just curious:

For those VA clinical staff exempted from the COVID vaccine(s) for religious/medical reasons, what is the current VA policy for PPE, testing, etc.?

 

[GreenHousePub]

pod school transcript

What job that you are applying for cares about your grades?

 

[Shiyuan]

What job that you are applying for cares about your grades?

Good point. It’s just the opening’s verbiage for required docs kinda stinks.

 

[Carpe Phalanges]

I've noticed a lot of the VA job postings right now are specifically labeled "only open to current federal employees of the agency." Would this make doing a VA residency wise if you are hoping for a VA job?

 

[Feli]

I've noticed a lot of the VA job postings right now are specifically labeled "only open to current federal employees of the agency." Would this make doing a VA residency wise if you are hoping for a VA job?

View attachment 348245

They have to be advertised/offered that way... at first (vets pref, then current VA employ, then past VA employ/train, then general). They can open them up later to general (might or may not get to that point).

I would tell you that you can do a lot better than VA jobs, but if that is honestly what you want (you have shadowed, you like the jobs, you are sure that is almost certainly your top choice for your whole career), then it would not hurt to do residency in VA system- except that you will be significantly limited outside of the system (due to much different patients/economics/billing/HR/etc out in private hosp/PP/MSG/etc).

 

[Carpe Phalanges]

They have to be advertised/offered that way... at first (vets pref, then current VA employ, then past VA employ/train, then general). They can open them up later to general (might or may not get to that point).

I would tell you that you can do a lot better than VA jobs, but if that is honestly what you want (you have shadowed, you like the jobs, you are sure that is almost certainly your top choice for your whole career), then it would not hurt to do residency in VA system- except that you will be significantly limited outside of the system (due to much different patients/economics/billing/HR/etc out in private hosp/PP/MSG/etc).

Thank you for the advice!

 

[FootDoc99]

I've been a VA podiatrist for several years. Did my residency at a VA, went to private practice and then came back. A lot of VA jobs is who you know. Typically, the Podiatry chief has the option to recruit their staff. It is easier to recruit someone you know and trust then to take a chance on someone you don't know. Since it is hard to fire someone, hiring someone is very important as you will be stuck with them for years. I joined the VA when Trump passed the Mission act which move Podiatrist to Tier 1 salary scale as other MDs. Tier 1 doctor at the VA includes Primary care, rheumatology, ID, with a max salary of 242k. My salary is 220k+ with great benefits (5 weeks of vacations, 2 weeks of sick leave, 11 federal holidays) . VA salary differs from VA hospital systems as the local chief of staff determines the pay of podiatrist. Old system was centralized and on a GS scale I believe. Doing a VA residency increases your chances of a VA job after residency as they typically hire from within.

 

[DexterMorganSK]

I've been a VA podiatrist for several years. Did my residency at a VA, went to private practice and then came back. A lot of VA jobs is who you know. Typically, the Podiatry chief has the option to recruit their staff. It is easier to recruit someone you know and trust then to take a chance on someone you don't know. Since it is hard to fire someone, hiring someone is very important as you will be stuck with them for years. I joined the VA when Trump passed the Mission act which move Podiatrist to Tier 1 salary scale as other MDs. Tier 1 doctor at the VA includes Primary care, rheumatology, ID, with a max salary of 242k. My salary is 220k+ with great benefits (5 weeks of vacations, 2 weeks of sick leave, 11 federal holidays) . VA salary differs from VA hospital systems as the local chief of staff determines the pay of podiatrist. Old system was centralized and on a GS scale I believe. Doing a VA residency increases your chances of a VA job after residency as they typically hire from within.

For our students, could you talk a little more about how much you started with and if the table below is accurate (in terms of the starting salary).
Also, any info on loan forgiveness within the VA would be great.

 

[FootDoc99]

So the table is a little confusing. Total salary consists of base pay + Market pay. The 111k is the base pay and the difference in you total salary is your market pay. The local VA admin will determine how much market pay you get. My salary is 220k+ and an annual performance pay which is approx 10-14k per year.

In term so student loan forgiveness, I am currently halfway thru PSLF of 10 years. The 3 years as a VA resident counts as long as you are paying. It is tax free and forgiven after 120 payments. Huge benefit.

I've kinda broken down my total compensation at the VA:

+Salary plus bonus: 240K ($3600 salary increase every 2 years, plus cost of living adjustments)
+TSP match(401k): 9k
+Health insurance benefit: 7-8K
+Time off benefits: 26 days vacation, 10 days sick, 11 federal holidays: 40K (not including 3 months of paid maturity/paternity leave)
+Life insurance benefit: 500 a year.
+Pension is calculated with this equation: (Highest 3 year salary) x (years of service ) x 1 Percent(add 10% bonus if retire after 62)= Annual annuity
I plan on doing a total of 33 years at the VA. Using my current salary, my Pension is estimated to be 81.5K per year when I retire.
+Add PSLF forgiveness after 10 years, tax free.
+ Disability Benefit (60% of annual salary 1st year, then 40% of annual pay)

 

[Shiyuan]

110k for market pay is pretty good.

 

[PTPuser]

So the table is a little confusing. Total salary consists of base pay + Market pay. The 111k is the base pay and the difference in you total salary is your market pay. The local VA admin will determine how much market pay you get. My salary is 220k+ and an annual performance pay which is approx 10-14k per year.

In term so student loan forgiveness, I am currently halfway thru PSLF of 10 years. The 3 years as a VA resident counts as long as you are paying. It is tax free and forgiven after 120 payments. Huge benefit.

I've kinda broken down my total compensation at the VA:

+Salary plus bonus: 240K ($3600 salary increase every 2 years, plus cost of living adjustments)
+TSP match(401k): 9k
+Health insurance benefit: 7-8K
+Time off benefits: 26 days vacation, 10 days sick, 11 federal holidays: 40K (not including 3 months of paid maturity/paternity leave)
+Life insurance benefit: 500 a year.
+Pension is calculated with this equation: (Highest 3 year salary) x (years of service ) x 1 Percent(add 10% bonus if retire after 62)= Annual annuity
I plan on doing a total of 33 years at the VA. Using my current salary, my Pension is estimated to be 81.5K per year when I retire.
+Add PSLF forgiveness after 10 years, tax free.
+ Disability Benefit (60% of annual salary 1st year, then 40% of annual pay)

That's it. We're gatekeeping. Let's delete this post for us class of 2024, please, cause I want a VA spot
All my classmates are dying to do these fancy, hardcore stuff. I'm ready for that VA life!

Could you please talk a bit about your current set up in terms of scheduled, clinic, surgery, scope etc? Thank you!

 

[wanderer534]

So the table is a little confusing. Total salary consists of base pay + Market pay. The 111k is the base pay and the difference in you total salary is your market pay. The local VA admin will determine how much market pay you get. My salary is 220k+ and an annual performance pay which is approx 10-14k per year.

In term so student loan forgiveness, I am currently halfway thru PSLF of 10 years. The 3 years as a VA resident counts as long as you are paying. It is tax free and forgiven after 120 payments. Huge benefit.

I've kinda broken down my total compensation at the VA:

+Salary plus bonus: 240K ($3600 salary increase every 2 years, plus cost of living adjustments)
+TSP match(401k): 9k
+Health insurance benefit: 7-8K
+Time off benefits: 26 days vacation, 10 days sick, 11 federal holidays: 40K (not including 3 months of paid maturity/paternity leave)
+Life insurance benefit: 500 a year.
+Pension is calculated with this equation: (Highest 3 year salary) x (years of service ) x 1 Percent(add 10% bonus if retire after 62)= Annual annuity
I plan on doing a total of 33 years at the VA. Using my current salary, my Pension is estimated to be 81.5K per year when I retire.
+Add PSLF forgiveness after 10 years, tax free.
+ Disability Benefit (60% of annual salary 1st year, then 40% of annual pay)

Hey! Thanks so much for this. I'm a medical student and I'm looking into how VA jobs work for after residency. Your post clears a lot up!

Question: Did you do EDRP at all? If you make IBR or PAYE payments towards your PSLF, does the EDRP benefit reimburse those? I've heard online they do but I was hoping to hear from someone who's actually done it/gotten reimbursed. Thank you!

 

[Utvolsdpm]

Hey! Thanks so much for this. I'm a medical student and I'm looking into how VA jobs work for after residency. Your post clears a lot up!

Question: Did you do EDRP at all? If you make IBR or PAYE payments towards your PSLF, does the EDRP benefit reimburse those? I've heard online they do but I was hoping to hear from someone who's actually done it/gotten reimbursed. Thank you!

So edpr and pslf are different entities. You can do both at the same time. Edrp is basically - you make loan payments and you get reimbursed after 1 year of service (used to be 24k a year, now I think it’s up to 48k/yr typically for 5 yrs). I think most people are familiar with pslf (qualifying payments for 10 years then the remained is forgiven - for qualifying loans)

Edit: to get into edrp you have to apply after you start working at the va. It can take a number of months to get enrolled. At that time you basically get a contract that says how much money you will get reimbursed after each year of service. You can make payments however you want. During Covid with zero interest I’ve just been making one lump payment.

 

[wakaflocka88]

Hey! Thanks so much for this. I'm a medical student and I'm looking into how VA jobs work for after residency. Your post clears a lot up!

Question: Did you do EDRP at all? If you make IBR or PAYE payments towards your PSLF, does the EDRP benefit reimburse those? I've heard online they do but I was hoping to hear from someone who's actually done it/gotten reimbursed. Thank you!

You mean a podiatry student

 

[Weirdy]

You mean a podiatry student

Judging by their post history, they are an actual MD student.

Laugh reacted because also assumed they were podiatry. They are not.

 

[JewOnThis]

So the table is a little confusing. Total salary consists of base pay + Market pay. The 111k is the base pay and the difference in you total salary is your market pay. The local VA admin will determine how much market pay you get. My salary is 220k+ and an annual performance pay which is approx 10-14k per year.

In term so student loan forgiveness, I am currently halfway thru PSLF of 10 years. The 3 years as a VA resident counts as long as you are paying. It is tax free and forgiven after 120 payments. Huge benefit.

I've kinda broken down my total compensation at the VA:

+Salary plus bonus: 240K ($3600 salary increase every 2 years, plus cost of living adjustments)
+TSP match(401k): 9k
+Health insurance benefit: 7-8K
+Time off benefits: 26 days vacation, 10 days sick, 11 federal holidays: 40K (not including 3 months of paid maturity/paternity leave)
+Life insurance benefit: 500 a year.
+Pension is calculated with this equation: (Highest 3 year salary) x (years of service ) x 1 Percent(add 10% bonus if retire after 62)= Annual annuity
I plan on doing a total of 33 years at the VA. Using my current salary, my Pension is estimated to be 81.5K per year when I retire.
+Add PSLF forgiveness after 10 years, tax free.
+ Disability Benefit (60% of annual salary 1st year, then 40% of annual pay)

I don’t know any of my colleagues making 220K. 4 of them are residency directors.

 

[Utvolsdpm]

I do. You can look up 2020 salaries as it’s public information. One of the highest paid facilities is Cincinnati for whatever reason.

I don’t know any of my colleagues making 220K. 4 of them are residency directors.

 

[Feli]

I don’t know any of my colleagues making 220K. 4 of them are residency directors.

If you are not grossing 220k and you're working full-time for a (non-govt) hospital or in PP of some sort (pod/MSG/ortho), you are absolutely doing something wrong. I don't even think that's possible for hospital W2 anymore unless perhaps it's very rural where COL is ultra-low and/or non-surgical DPM. Even a non-surgical DPM should clear that in most private sector setups (on their W2 gross, not just on their annual clinic collections... which should be 500k easy after the first couple years, usually much higher). Anyone beyond 1st or 2nd year associate that does not clear 200k gross has an amazingly bad associate contract (base/percent too low), they don't utilize the revenue services of the office or work available (see more pts, do more injects/surg/ultrasound/DME/etc), or they are in an office that just doesn't have the revenue services and patient volume available for them to succeed. Obviously, only the middle one is fixable... the other two with bad contract or bad volume/services are reasons to look for a new job asap.

In VA/IHS, it was much more variable pre-2015ish. Now, any current govt DPM should definitely be should be starting over 200k since the parity act (unless it's a tribal IHS place without parity) with good benefits, but the ceiling is very low compared to any PP or hospital job, as was mentioned above... basically just tiny annual or biyearly raises and COL adjusts. It is pretty political as to job quality since so much depends on having a good/poor chief of podiatry. I would sure guess and hope the VA chief of pod or residency directors make over 250k plus benefits, but I doubt they make over 300k unless they have ridiculous seniority, they are in bed with chief or surg or their superiors, or they work in a very high COL area where that adjustment can be tweaked.

The VA or IHS work is fine, but the biggest downside by far is that it's typically just a race to the bottom since there is little/no incentive to perform well or see more patients or make more revenue (for docs or assistants or desk staff or anyone)... if you do produce well, you end up almost discouraged or ostracized by the unavoidable VA network and who wants to sit around and see 10-15pts/day and do 1 surgery per week and cash their checks. My MD colleagues in PP MSG teased me for this when I left for that environment, and they were absolutely right. This is the same reason most VA residencies are mediocre at best: limited by inevitable social loafing due to the overall setup. It is fine work and one could do a lot worse, but it should be an option for DPMs, not a top target IMO. I think it is crazy AF to see so many people kinda aiming for average and even planning their residency to that end when there are much greener pastures in terms of income and productivity. Jmo.

 

[wakaflocka88]

If you are not grossing 220k and you're working full-time for a (non-govt) hospital or in PP of some sort (pod/MSG/ortho), you are absolutely doing something wrong. I don't even think that's possible for hospital W2 anymore unless perhaps it's very rural where COL is ultra-low and/or non-surgical DPM. Even a non-surgical DPM should clear that in most private sector setups (on their W2 gross, not just on their annual clinic collections... which should be 500k easy after the first couple years, usually much higher). Anyone beyond 1st or 2nd year associate that does not clear 200k gross has an amazingly bad associate contract (base/percent too low), they don't utilize the revenue services of the office or work available (see more pts, do more injects/surg/ultrasound/DME/etc), or they are in an office that just doesn't have the revenue services and patient volume available for them to succeed. Obviously, only the middle one is fixable... the other two with bad contract or bad volume/services are reasons to look for a new job asap.

In VA/IHS, it was much more variable pre-2015ish. Now, any current govt DPM should definitely be should be starting over 200k since the parity act (unless it's a tribal IHS place without parity) with good benefits, but the ceiling is very low compared to any PP or hospital job, as was mentioned above... basically just tiny annual or biyearly raises and COL adjusts. It is pretty political as to job quality since so much depends on having a good/poor chief of podiatry. I would sure guess and hope the VA chief of pod or residency directors make over 250k plus benefits, but I doubt they make over 300k unless they have ridiculous seniority, they are in bed with chief or surg or their superiors, or they work in a very high COL area where that adjustment can be tweaked.

The VA or IHS work is fine, but the biggest downside by far is that it's typically just a race to the bottom since there is little/no incentive to perform well or see more patients or make more revenue (for docs or assistants or desk staff or anyone)... if you do produce well, you end up almost discouraged or ostracized by the unavoidable VA network and who wants to sit around and see 10-15pts/day and do 1 surgery per week and cash their checks. My MD colleagues in PP MSG teased me for this when I left for that environment, and they were absolutely right. This is the same reason most VA residencies are mediocre at best: limited by inevitable social loafing due to the overall setup. It is fine work and one could do a lot worse, but it should be an option for DPMs, not a top target IMO. I think it is crazy AF to see so many people kinda aiming for average and even planning their residency to that end when there are much greener pastures in terms of income and productivity. Jmo.

Great info. What made you decide to go the IHS route?

 

[CutsWithFury]

The VA or IHS work is fine, but the biggest downside by far is that it's typically just a race to the bottom since there is little/no incentive to perform well or see more patients or make more revenue (for docs or assistants or desk staff or anyone)... if you do produce well, you end up almost discouraged or ostracized by the unavoidable VA network and who wants to sit around and see 10-15pts/day and do 1 surgery per week and cash their checks. My MD colleagues in PP MSG teased me for this when I left for that environment, and they were absolutely right. This is the same reason most VA residencies are mediocre at best: limited by inevitable social loafing due to the overall setup. It is fine work and one could do a lot worse, but it should be an option for DPMs, not a top target IMO. I think it is crazy AF to see so many people kinda aiming for average and even planning their residency to that end when there are much greener pastures in terms of income and productivity. Jmo.

I've interviewed at two VA programs so far and DPMs there fully acknowledged this culture. They even said that once you make it past the 2 year probation period it is VERY hard to get fired from the VA hospital. Most people do it for the excellent medical benefits, overall benefits and the pension (which you can't get from any other hospital job). It is slow work but it is a steady paycheck with ultimate job security. I can see the appeal.

I honestly wouldn't mind because it means more time with my family outside of work which is more important to me. There are soooooooooooooooooooooooo many different a less stressful ways to make money than killing yourself doing podiatry/surgery. I hate to say it.

At my hospital job I am averaging 1000 RVUs per month and with salary and maxing out my bonus I was making just under 500K (gross income) per year. Sounds awesome right? Well I have zero time for wife, young children. I have no friends, no hobbies. I chart through the weekend.

I could spend more time trading crypto and make comparable money. For real.

I got MELD tokens airdropped to me for delegating my ADA to the MELD ISPO. Want to know how much that MELD was worth on the first day? $70,000! $70K in one day. I could have sold it and called it a year in terms of having money for bills etc.

So many other ways to make money. I feel like podiatry is especially prone to getting hyper focused on their own productivity, contracts, etc because the pay is so variable. I feel like if our salary was consistent and more fair the profession would be less competitive and toxic.

My employment is probably the most desirable job for 99.9% of podiatrists because they are making 75-100K per year as an associate. But for me...it is no longer a great option for my physical and mental health. So yeah thats when VA work becomes a great option and I don't think it should be frowned upon.

You know who is getting screwed? The associate getting taken advantage of by their PP owner, doing great work, producing a lot, and only taking home 120-150K at the end of the day. That is a reality for a lot of podiatrists. I just made more than half their salary from trading crypto. There are better ways to make money than being a podiatrist.

 

[HardRoadPaved]

At my hospital job I am averaging 1000 RVUs per month and with salary and maxing out my bonus I was making just under 500K (gross income) per year. Sounds awesome right? Well I have zero time for wife, young children. I have no friends, no hobbies. I chart through the weekend.

PP ownership is pretty similar. This is why if you have a brain, drive, an amazing spouse (especially if you have kids) and cant get a gig at a respectable msg/ortho practice, then you should open shop.

 

[CutsWithFury]

PP ownership is pretty similar. This is why if you have a brain, drive, an amazing spouse (especially if you have kids) and cant get a gig at a respectable msg/ortho practice, then you should open shop.

I think PP ownership is a viable option. Insurance companies are gangsters so having knowledgeable staff is paramount. Location is key. It is not an impossible opportunity as more and more of my colleagues my age have gone down that road already. So they are obviously doing it. But it is not easy. Requires you taking out a loan if you are not independently wealthy. Requires amazing family support. Lots of variables. No guaranteed retirement. The nuances of running a private practice are there and are sometimes learned through mistakes which can be costly. Long term it can be awesome. Short term can be very trying for a young doctor and their young family. Everyone needs to be on board.

 

[PTPuser]

At the end of the day, I just want to do good work, make decent money for my skills, appropriately pay off my loans without feeling like I have to sacrifice more time and energy to my job, spend time with my family who are also getting older as well...if it means that I'm "selling out" by going DVA, then so be it.

 

[msuDPM]

I've interviewed at two VA programs so far and DPMs there fully acknowledged this culture. They even said that once you make it past the 2 year probation period it is VERY hard to get fired from the VA hospital. Most people do it for the excellent medical benefits, overall benefits and the pension (which you can't get from any other hospital job). It is slow work but it is a steady paycheck with ultimate job security. I can see the appeal.

I honestly wouldn't mind because it means more time with my family outside of work which is more important to me. There are soooooooooooooooooooooooo many different a less stressful ways to make money than killing yourself doing podiatry/surgery. I hate to say it.

At my hospital job I am averaging 1000 RVUs per month and with salary and maxing out my bonus I was making just under 500K (gross income) per year. Sounds awesome right? Well I have zero time for wife, young children. I have no friends, no hobbies. I chart through the weekend.

I could spend more time trading crypto and make comparable money. For real.

I got MELD tokens airdropped to me for delegating my ADA to the MELD ISPO. Want to know how much that MELD was worth on the first day? $70,000! $70K in one day. I could have sold it and called it a year in terms of having money for bills etc.

So many other ways to make money. I feel like podiatry is especially prone to getting hyper focused on their own productivity, contracts, etc because the pay is so variable. I feel like if our salary was consistent and more fair the profession would be less competitive and toxic.

My employment is probably the most desirable job for 99.9% of podiatrists because they are making 75-100K per year as an associate. But for me...it is no longer a great option for my physical and mental health. So yeah thats when VA work becomes a great option and I don't think it should be frowned upon.

You know who is getting screwed? The associate getting taken advantage of by their PP owner, doing great work, producing a lot, and only taking home 120-150K at the end of the day. That is a reality for a lot of podiatrists. I just made more than half their salary from trading crypto. There are better ways to make money than being a podiatrist.

Preach! Pretty done with this "fancy" hospital gig.

 

[heybrother]

I hope ya'll find what you are looking for. Am a partner in my practice now. Number one issue for me now is how insurance pays us.

 

[HardRoadPaved]

Insurance companies are gangsters

Oh you mean like finding out one payer changed my fee schedule without notice and could not find anything in their system to show they gave me notice for cutting E/M rates 20%? Also when you go to argue they claim I need to give them written notice I want to appeal for rates to be increased and it may take several weeks?

PP is not for the faint of heart and must be a self-starter. On the flip side I dont take any call and deal with pus foot at 2am/holidays.

 

[Feli]

Great info. What made you decide to go the IHS route?

I just didn't know a lot about it. I had never rotated or clerked or done training or job in VA/IHS, and I was looking for a change of pace. Working for hospitals as FTE in Detroit was not really an option due to scarcity of those jobs and ortho politics, so that sounded new also. The idea of higher guarantee salary and student loan IHS bonuses sounded fine, and I had a lot of friends living in the Phoenix metro that I could meet for weekends and trips and parks and stuff. It didn't ultimately work since I didn't like the pushback on big cases or doing trauma (as opposed to sending it out to other hospitals) or efficiency or producing. It was also bad luck that the facility I was at had a particularly weird dynamic with the chief letting a crony DPM in the pod dept make the rules for call/supplies/etc (that favoritism will basically crush any IHS/VA job since doc job security is high, as was said). In almost any other setup, the dysfunctional pod would have been out due to low production and not getting along with his team, but in govt setup, the dept was hamstrung by that... so I did my 2yrs and got out asap. I still stay in touch with the other docs there, and they are tiptoeing toward the door for the same unfortunate reasoning.

The leadership and cultures really make or break VA/IHS facilities... "if you've seen one VA, you've seen one VA." The Phoenix VA had had the meltdown for similar reasoning shortly before I got to Ariz (and they are still not exactly high functioning with new leadership per word round the campfire). It is sad, because there is usually enough funding, enough salary to attract decent docs, enough resources and facility to do good care. It all hinges on competent leadership and finding ways to motivate support staff and docs who have EXTREME job security and get paid the same whether they schedule and treat five office patients per day or thirty five... complete opposite of PP. Some of the other depts (ER, IM) at the same IHS facility that I was at seemed to work well, find good docs, and do pretty good care. The leadership is key, and the leadership picks and retains who they want (as VA doc99 said above).

The MSG (mostly endo) that I was in prior to IHS was pretty good, but I was on % and starting to hit the income ceiling unless I got more staffing/pts or better payers. It was an area with a lot of immigrants and a lot of MCA/MCR. Neither of those things was going to happen (higher volume or better payers and per pt avg), and like godfather says below , it's all about the payers in PP of any sort (pod/MSG/ortho) when you are on productivity.
The pod (and a bit of vasc/path) large group I'm in now post-IHS has good-to-excellent payers and many many streams of income available (a few of which I barely even use... could boost my collections if I tap some offerings better), so I do very well with good autonomy and very reasonable hours (zero call/inpts/weekends unless I want it) after the unavoidable early months of staying a bit late making good EMR templates and learning how the offices run, making PCP connections, etc. I view it as almost being an owner... my slice of the pie is smaller, but it is a big pie due to all the services and good volume they give me (would be very tough to do that solo). It is the porridge that Goldilocks chose imo.

I hope ya'll find what you are looking for. Am a partner in my practice now. Number one issue for me now is how insurance pays us.

I've interviewed at two VA programs so far and DPMs there fully acknowledged this culture. They even said that once you make it past the 2 year probation period it is VERY hard to get fired from the VA hospital. Most people do it for the excellent medical benefits, overall benefits and the pension (which you can't get from any other hospital job). It is slow work but it is a steady paycheck with ultimate job security. I can see the appeal....
... physical and mental health. So yeah thats when VA work becomes a great option and I don't think it should be frowned upon...

Yeah, I agree. The only real viable options I've found for having work/life balance and getting good income are owner, PP with good payers (and good contract), or hosp FTE work where you can limit your call/weekends (this includes VA). Some of the hospital jobs with bad hours or PP jobs with crummy compensation or without the tools (services/payers) to ramp your collections are roads to nowhere... either broke and frustrated or totally burnt out, as you said.

...I'm not frowning on VA work. I would potentially consider it again. It is a fine choice, as I said a few times above. It is definitely improved with parity pay act. It is just a big culture shock from productivity setup to the straight salary model (so collection, RVU, etc mean almost nothing), and the income is pretty average. It is not the best place to find numbers/diversity for boards. It is honorable work and not bad if the leadership is good (can say that for any employ job), but I sure don't think it should be the definite top choice for people in residency or not even in residency yet. It is very extreme to read more and more posts about people considering taking a VA residency to make it such a main goal to work in VA afterwards (just like taking some certain fellowship to target ortho job or working in that group that runs the fellowship). One can obviously be interviewed or selected for govt jobs (as we did) without a VA residency, and the overall skill set might be better and more diverse at a lot of non-VA programs. The few VAs that are considered above avg programs are considered that since they let their residents out to private hospitals and ASCs to get more cases and variety. That is all I was getting at: VA residency with goal of VA job is narrow, but good training will always be good training and good skills.

...In the vast majority of hospital employ jobs (VA or private), your career will peak when you're still in your 30s. You income will plateau since you're maxed on wRVUs (or very limited VA/IHS salary structure), and you can basically just hope for COL raises after that. You should be far from broke and should have gotten numbers for boards and some fun cases along the way, but burnout or bureaucracy can be substantial (depending mainly on structure/leadership).
PP group employ is usually a lot easier to put your foot down on the work/life balance, but the income can be very sketchy and variable without good payers, good contract %, and many lucrative services offered within the group/contract. It is a personal choice. I have found I strongly prefer the latter PP assoc/partner/owner (so I have some autonomy and if I'm not doing well on $$, it's my own damn fault), but it takes some bad setups to appreciate a good one.