Among MDs, there is the saying "if you've seen one VA, you've seen one VA." I would tend to echo that.
Just like IHS (where I work now), some are probably fantastic VA hospitals and VA Pod depts, and some might be dreadful. I agree that a lot of the jobs posted aren't really available... a lot go to transfer docs from other VA/IHS/etc but had to be advertised/interviewed openly as a formality. They will take Navtive Americans from that area > Native Americans not from that area > Vets from that area > Vets not from that area >>> anyone else. It says that flat out on the cover page of the IHS and VA applications.
As I see it (again, each place is diff DPMs, diff staffing, diff funding, diff leadership, diff ortho relationship, diff ER relations, etc etc):
Pros:
-fairly good hours, fairly predictable hours
-call schedule typically reasonable (unless you get understaffed, then you will be on call a ton until DPM spot gets filled... see below)
-fairly secure jobs (also a bigtime downside, see below)... a lot of barriers to entry or getting rid of you
-below avg salary but decent dependable income when you figure in benefits... incl student loan help if IHS or a bit larger salary if VAMC,
-wider scope of practice than most non-govt hospitals
Cons:
-seems everyone wants to be an administrator and take days off for meetings, create meetings and committees, block their schedule, etc (since pure salary)
-relatively little control of your staffing, marketing, supplies, Rx formulary, DME, etc (much like many MSG and hosp jobs)
-OR days can be painfully slow turnovers when you are accustomed to private
-takes for-ev-er to get/start/transfer the job or fill a position of need (doc, wound RN... even secretary, assistants, etc)
-some very low trained or lazy staff/docs/admins at some locations... sometimes bordering on incompetent (and insanely hard to get rid of them... they just bounce around to/from other depts in the building or to/from other govt hospitals... essentially untouchable if veteran, native amer, seniority, etc status)
-easy to get complacent and fall way behind on standards of care and innovations over the years if you don't self-start by reading and seeking good CME aggressively. Even at VAs that have a residency, most are not very high level residencies and your colleagues are overall less likely to be go-getters than private or hosp/MSG (either became that way or were that way all along)
...all in all, if you have a positive attitude, you will do well anywhere. It is all a learning experience. You have to find what works for you. If you do govt work, do yourself a favor, check your ego, see your patients and do cases, and stay the heck out of any administration role. Ever 😉
