VA Pain Job; what does the VA pay and what are the benefits?

[Ligament]

What does the VA pay doctors PM&R residency trained and ABMS board certified, Pain Medicine Fellowship (Anesthesia based) trained and ABMS board certified physicians, and what are the other financial benefits?

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[hyperalgesia]

180-355 depending on the demand.

26 vaca days, 12 federal holidays, 12 sick days/year.

Pension is 1% of salary x years worked. If you work 10 years at 300k, when you retire at 62, you get 30k/year until death.

Other pros: It's really hard to get sued, it's really hard to lose your job. This translates into being able to practice how you want for the most part. No referral concerns. You get the same salary even if the hospital burns down. Very manageable workload.

Cons: The salary is poor, especially if you're ambitious. You have a boss, who could be a complete nightmare and treat you like a child. You can't change things, even if they are obvious. It can be a mental slog.

edit: I revised the lower end of the salary. Some VAs will be lower.

 

[SSdoc33]

280-355 depending on the demand.

26 vaca days, 12 federal holidays, 12 sick days/year.

Pension is 1% of salary x years worked. If you work 10 years at 300k, when you retire at 62, you get 30k/year until death.

Other pros: It's really hard to get sued, it's really hard to lose your job. This translates into being able to practice how you want for the most part. No referral concerns. You get the same salary even if the hospital burns down. Very manageable workload.

Cons: The salary is poor, especially if you're ambitious. You have a boss, who could be a complete nightmare and treat you like a child. You can't change things, even if they are obvious. It can be a mental slog.

Are there any productivity incentives? Is there a floor?

 

[hyperalgesia]

Are there any productivity incentives? Is there a floor?

No productivity incentive. There's a "performance bonus" of 15k which I INCLUDED in the salary range estimate above.

There's some amount of tsp matching, which is the federal version of 401k.

I will add that if you're looking at a very undeserved area and a very enthusiastic hospital leadership, you can demand a higher salary. They have to jump through hoops but they can get it for you if they're desperate.

But generally speaking, you are far more likely to be offered the lower end of the salary range.

 

[Agast]

Do the VA pain jobs require inpatient pain management as well though? I know opioids are frowned upon which is a plus.

 

[SommeRiver]

I can't work at the VA. I've been in the Decatur, GA and Palo Alto VA. All I do is argue and call out liars.

Special Operations history for me, deployed a lot, and I can't tolerate stolen valor.

Dudes come in talking about knee pain and the fact they had to wear boots during basic training - No sir...Nope.

Try to tell me about having a top secret file and they can't tell me what they did bc it is James Bond stuff...Nope.

Most are complete losers who lie and game the VA system.

 

[hyperalgesia]

Do the VA pain jobs require inpatient pain management as well though? I know opioids are frowned upon which is a plus.

Inpatient will be individually dependent on VA.

 

[deleted185747]

Health insurance is mostly paid for by the federal government, your portion is something like 30%. For my family of 6 I pay $124 each pay period.

Health insurance after retirement: the federal government continues to pay the same, and my portion will not increase for the same coverage until death.

In addition to pension there is also a TSP which is a 401k with matching something around $19,000/ year.

for inpatient pain consults, clinic, injections, you send the fellow or resident. Teach them well.

 

[deleted284725]

I can't work at the VA. I've been in the Decatur, GA and Palo Alto VA. All I do is argue and call out liars.

Special Operations history for me, deployed a lot, and I can't tolerate stolen valor.

Dudes come in talking about knee pain and the fact they had to wear boots during basic training - No sir...Nope.

Try to tell me about having a top secret file and they can't tell me what they did bc it is James Bond stuff...Nope.

Most are complete losers who lie and game the VA system.

This wasn’t my experience at any of the VAs I worked at. Just a bunch of pleasant but sad old Nam vets who barely talked about their service at all.

 

[SommeRiver]

This wasn’t my experience at any of the VAs I worked at. Just a bunch of pleasant but sad old Nam vets who barely talked about their service at all.

BS.

No one in the Decatur VA would agree with that; the Palo Alto VA less busy and bc of that less frequent yet overwhelmingly common.

Maybe it's bc of my background...

Your Nam vets are probably not actually Nam vets BTW. The majority were pogues who worked at Motor Transport or in administration billets.

If you're not a vet with an infantry-based speciality you wouldn't know any of that...

 

[deleted284725]

BS.

No one in the Decatur VA would agree with that; the Palo Alto VA less busy and bc of that less frequent yet overwhelmingly common.

Maybe it's bc of my background...

Your Nam vets are probably not actually Nam vets BTW. The majority were pogues who worked at Motor Transport or in administration billets.

If you're not a vet with an infantry-based speciality you wouldn't know any of that...

Just stating my experience there Dr Badass. I loved working with the veterans. I thought they were the most grateful and pleasant patients I’ve worked with. Having said that I probably wouldn’t want to work for the VA for all the reasons others have stated.

 

[Ligament]

Seems like an easy, nice life with room for family and hobbies.

 

[SommeRiver]

Just stating my experience there Dr Badass. I loved working with the veterans. I thought they were the most grateful and pleasant patients I’ve worked with. Having said that I probably wouldn’t want to work for the VA for all the reasons others have stated.

They're "grateful and pleasant" when you unknowingly help them scam the US government.

 

[hyperalgesia]

BS.

No one in the Decatur VA would agree with that; the Palo Alto VA less busy and bc of that less frequent yet overwhelmingly common.

Maybe it's bc of my background...

Your Nam vets are probably not actually Nam vets BTW. The majority were pogues who worked at Motor Transport or in administration billets.

If you're not a vet with an infantry-based speciality you wouldn't know any of that...

It's definitely a personal thing for you. You seem to be judging veterans more harshly than others. There are people from all walks that try to scam the system, whether it's VA or Medicare, or SS disability or workers comp or etc....

When you're on the job as a VA doc, you really don't get into this with patients. At least I don't. Whether you are a war hero or you never left training, it has zero bearing on how I will treat you.

Sometimes people want to talk about their service and I try to be a good listener. Some complain about what seems like minor pain. Others don't complain about what seems like major pain. I'm not there to judge whether you are a hero, it's all about how I can help (or not).

All disability and compensation/pension issues are NMD (not my department). I don't even determine if an injury is "service connected".

Am I virtue signalling now? lol

 

[SommeRiver]

It's definitely a personal thing for you. You seem to be judging veterans more harshly than others. There are people from all walks that try to scam the system, whether it's VA or Medicare, or SS disability or workers comp or etc....

When you're on the job as a VA doc, you really don't get into this with patients. At least I don't. Whether you are a war hero or you never left training, it has zero bearing on how I will treat you.

Sometimes people want to talk about their service and I try to be a good listener. Some complain about what seems like minor pain. Others don't complain about what seems like major pain. I'm not there to judge whether you are a hero or a coward, it's all about how I can help (or not).

All disability and compensation/pension issues are NMD (not my department). I don't even determine if an injury is "service connected".

Am I virtue signalling now? lol

VA fraud is outrageous and has spiraled out of control bc of the climate surrounding the GWoT in hopes this generation doesn't get spit on like the Vietnam generation.

The Vietnam era vets are the most dysfunctional dudes in that entire system, far inferior to their predecessors of WWII and Korea, and far inferior to their successors who went to Afghanistan and Iraq.

Much of the problems are not of their own making.

Society treated them poorly in general but the overwhelming majority of VA pts you see wearing Vietnam baseball caps claiming PTSD and battle scars NEVER took part in any of the things you think they took part in...

So why do I (tax paying man) have to pay 4k per month for a disability rating on a 71 yo cigarette smoker with peripheral neuropathy, A1C of 11, and a GFR 35? Why does that individual and his spouse get housebound benefits on top of his disability rating?

How is the VA (me - the tax payer) on the hook for that?

Why does a dude who served 4 warm/dry years in the Army get 4k per month of my money when he did nothing other than have a regular job that required green clothes?

I know individuals personally that scam the VA for THOUSANDS of dollars per month while working full time jobs.

To the other guy - Nothing I've said should be construed as my trying to be "Dr Badass." That is utterly false and has nothing to do with anything.

I am telling you those Nam vets were pogues with dry socks, and my personality can't handle the dishonesty and fraud.

 

[DoYouEvenLiftBro]

I thought there was also a CoL increase each year?
Also once you hit 20 years I believe that 1% is higher.

As PMR some VAs have a separate pain designation which pays higher than actual PMR but lower than anesthesia.

Also, going on Sommerivers point (thank you for your service btw), I was confused why a lot of vets wanted a bulky knee brace, turns out you can then get a clothes stipend, sometimes over a thousand/month because now you require new clothes to fit your brace...

 

[SommeRiver]

There are numerous scams in the VA, and when you're a loser with nothing to show for your 75 years on Earth other than having been in the military for a few years you know all of them.

VA disability is a lifestyle. You are at odds with the VA at all times, constant victimhood complaints.

A love of having a "VA story" bc it keeps you involved in something. Gives you a thing you can use to enter into a debate with street cred on your side.

Edit - Doctors with prior active duty experience should be recruited to the VA to put a stop to this BS. Society has skin in the game here bc the VA is bloated, inefficient, and expensive. The wheels are bogged down by endless paperwork, much of which is fraudulent to begin with and ought not exist.

The secondary gain is tremendous, and all it takes is a well-intentioned doctor to come in and say, "Thank you for your service."

That veteran is now justified in his pursuit of tax dollars bc he just received verification that his claims are legit.

Dude goes and buys a pack of Wild Horse cigarettes in the way home and refuses to use his insulin.

You cannot prove your back and neck and knees have anything to do with your service in the late 60s...You're an unhealthy dude and are no different than an individual who never served.

 

[cameroncarter]

I’m an incoming pain fellow and very interested in the VA to start my career!

Can someone talk about carving out time for education, research? I’m academically driven and am wondering how the VA differs from academic hospitals in this regard.

 

[hyperalgesia]

I’m an incoming pain fellow and very interested in the VA to start my career!

Can someone talk about carving out time for education, research? I’m academically driven and am wondering how the VA differs from academic hospitals in this regard.

Depending on the VA, there are some jobs that are part time VA and part time university. Whoever pays your salary will determine what you do.

If you are a FT VA doc, you can go through the Research department and apply for a research grant. If you get it, some portion of the grant money will reimburse your salary. For example, when you apply for a grant, you can say your whole project will occupy 25% of your time for 2 years. This must be approved by your supervisor.

If you are awarded the grant, the VA Office of R&D will reimburse your VA facility for 25% of your salary over 2 years. So your facility will basically relieve you of your clinical responsibilities for 2 years. But it's not always so simple as that. Your supervisor might want a piece of the action. They may require you to report on your progress on a monthly or quarterly basis. They may want to "lead" you through your project. That's in addition to the reports you have to make to the R&D Office to keep the money train going. This is all highly dependent on the local situation.

"Academic" time is really only going to apply if you are funded partly by a university. The VA and your supervisory chain are constantly evaluated based on your productivity in terms of patient encounters.

I think you can have about 1 week/year in conference time and reimbursement. I did this once or twice but tbh, the paperwork isn't worth it.

 

[clubdeac]

Pay can go up to 400k depending on the need at that particular VA. Only rule is you can't make more than the president. Yes, this is a real thing. And the benefits are you're done by 330-4pm every day, you have a captive audience, great vacation and even a little pension depending on how long you want to stay there.

 

[jsaul]

Pay can go up to 400k depending on the need at that particular VA. Only rule is you can't make more than the president. Yes, this is a real thing. And the benefits are you're done by 330-4pm every day, you have a captive audience, great vacation and even a little pension depending on how long you want to stay there.

Can't make more than what president,? Even neurosurgery?

 

[hyperalgesia]

Can't make more than what president,? Even neurosurgery?

POTUS. Correct.

 

[jsaul]

POTUS. Correct.

how do they recruit neurosurgeons, cardiac etc

 

[hyperalgesia]

how do they recruit neurosurgeons, cardiac etc

Not easily and not frequently.

There are situations though, where the private environment is very competitive but the doc can't move.

The VA does not have a non-compete and some of these people have PT academic appointments as well.

It's also not a bad situation when a doc is nearing retirement and slowing down, fed up with the destruction of medicine from insurance.

If you work at the VA for 5 years prior to retirement, you get a good value health insurance for life on top of Medicare.

An ortho colleague was nearing retirement at the VA but just got super frustrated with the VA and went to be a chair at a big hospital system. His tenure there was even shorter before he realized medicine just wasn't rewarding any more with all the BS.

 

[PainRehabMD]

I've seen 180-230k ranges for PM&R in the couple of the VA's I know. It doesn't matter whether you did anesthesia or PM&R based fellowships. Anesthesiologists get paid significantly more since your pay is determined by your base specialty. I have not seen productivity based bonus and the higher end of that range was for people who have been working there for a while.

 

[cowboydoc]

I've seen 180-230k ranges for PM&R in the couple of the VA's I know. It doesn't matter whether you did anesthesia or PM&R based fellowships. Anesthesiologists get paid significantly more since your pay is determined by your base specialty. I have not seen productivity based bonus and the higher end of that range was for people who have been working there for a while.

Our chief managed to get anesthesia matched pay in pain clinic as a PM&R doc. It sounded like a big deal. He was the chief of staff for the hospital, too, so he has some pull.

 

[PainRehabMD]

Our chief managed to get anesthesia matched pay in pain clinic as a PM&R doc. It sounded like a big deal. He was the chief of staff for the hospital, too, so he has some pull.

That's impressive. The chief of staff thing was likely indeed the reason.

 

[cowboydoc]

That's impressive. The chief of staff thing was likely indeed the reason.

I didn’t really understand the intricacies as a resident, but it sounded like a lot of $ for being in clinic 3.5 days a week.

 

[hyperalgesia]

I've seen 180-230k ranges for PM&R in the couple of the VA's I know. It doesn't matter whether you did anesthesia or PM&R based fellowships. Anesthesiologists get paid significantly more since your pay is determined by your base specialty. I have not seen productivity based bonus and the higher end of that range was for people who have been working there for a while.

The wording of the pay tables have been gradually changing over the years.

But as others have pointed out, the table is just a guideline for facilities. Any facility can exceed that if they need to, they just have to jump through a few hoops. It all comes down to how badly they want you.

In competitive areas, they really don't need you that bad. Don't bother bringing the MGMA data.