Here's some other variations. Other possibilities will exist:
(1) Your patient population is probably going to be predominantly male. Its not 100%. But its skewed at a lot of places. You probably won't be seeing any children/young adolescents. Younger people are fun to take care of. Teenagers are often ungrateful brats, but I still like them.
(2) There's a lot of nailcare everywhere I've been. Not that other places don't also have this. But there's a lot.
(3) Some of the referrals ie. vascular surgery, may not be as aggressive or helpful as the referrals you receive at big hospital systems. Hate to paint too broadly - hope I'm wrong. I have an interventional cardiology group that is HELPFUL. Like came to us and said - we want to help you with PVD. They coordinate care with vascular surgery. They see people same day and book things pronto. In general, my vascular surgeon in residency was helpful albeit overworked. He also sometimes liked to say - try it, I'll bail you out if it fails.
Least favorite residency experience - our vascular team says the patient needs an intervention. The patient says - it has to be done at my VA. They get transferred with critical limb ischemia and tissue loss and pop back up in your podiatry clinic (what!?) a week later with a rotting, black gangrenous toe covered in bacitracin (what) telling you vascular didn't want to do anything and you should just amputate the toe and see what happens even though he's losing tissue elsewhere on the foot. Maybe overworked. Kind of feel like it could be a VA thing.
(4) Your colleagues may be sketchy as hell. My personal experience is that people who work at VA hospitals are jokingly either the best or the worst. Worst podiatrist I ever met was at a VA. Course next few worst after him were not. Saw a guy tell a kid who I'm pretty sure had a lisfranc dislocation he just needed custom orthotics - wasn't at a VA though.
(5) Its already been said above - your staff and assistants may be crazy lazy. At some point in your career if you are surgically busy and efficient as a surgeon it is possible you could have a surgery day where you book 5-8 surgeries in a day. I had an attending in residency who had 7 surgeries booked every week on his surgery day. Every hospital is different, but usually the joke about VAs is the rooms don't turn over. You'd be better off mopping the floors yourself. 3-4 cases is probably a day. I was at a VA hospital once with this brand new attending who also graduated from the program. He literally set the room up himself ie. tables and everything because it was a 4:30 add on pus case and he wanted it done.
(6) There may be a larger number of chronic disaster, uncontrolled diabetic, lifetime smokers who are just coming in to have ...epifix fraudulently smeared on their foot once a week for the rest of their life. Right now, in private practice - the number of people who I see where I'm like... this is hopeless just aren't that many. There may be a higher ratio of that compared to private practice.
(7) There's something to be said for .. "Capitalism". Obviously fee for service can lead to insane and ridiculous things ie. the more we do the more we are paid, but there can also be good things about it. We're motivated to offer more services. Hopefully we are cognizant of whether the things we are doing are also in the patient's interest. The tricky thing - and I'll touch on this more later - when you get show up, see 15-20 people, can't be sued, take your $150K and go home everywhere - that can produce someone who really truly is just there for the paycheck. Who isn't motivated. Who doesn't discuss possibilities. Someone who just sees the world only through the spectrum of what they know. They have a hammer and their patients feet are the nail.
(8) Bureaucracy. x 1000. Inability to change things. All sorts of weird problems. VAs have a tendency to shut down their operating rooms for revisions that are supposed to take a month and end up taking several years. There's a VA near me where the podiatrists drive 1.5 hours on their surgery day because that's the closest operating room.
(9) Female? Rampant sexual harassment. The number of times I heard an old man tell a young woman - can I just look at you while cut my nails or whatever. A plural number of times, per day.
(10) In hospital call responsibility is often nail consults. Not sure how others handle that, but in residency we drew a line and said hell no. That doesn't seem to happen at VAs.
That said. If the VA in my town offered me a job - I'd be there. I'd also be in the mountains every other weekend. Not busy? Income stays the same. Fluctuations and wild rides in the health insurance market? I've looked up VA insurance - its amazing. Health insurance is expensive - expect the cost of insurance for your family to be $12000-20000 if you had to pay out of pocket and the bullcrap thing is $$$s spent doesn't in any way guarantee quality since larger organizations have economies of scale. Female? Obviously harassment sucks, but I'm pretty sure you'll have an easier time taking time off for pregnancy and those early important months at a VA then you ever will for your private practice schmuck. The pay has gone up considerably - all federal employee salaries are public record - a few years ago before the recent law it seemed to me most people topped at like $150ish- something like that at 15-20 years. You start there now. You get a pension. Classic federal pensions for the last ...20 have been something like - for each year you serve earn 1% of your "top pay" where top pay is the average of your best 3 years. And you get a 401k through thrift savings and you get a match. And since the pay went up the match went up also. Vacation, time off, sick time, etc. You can't match those perks in PP. Potentially no call responsibility. No malpractice. Much lower expectations in documentation...
