VA Psychiatry Questions

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JustAGuy said:
I was just quoting the person's scenario above me. Some of us have a lot of federal service already from before medicine. Worst case scenario would be 1.1 x 20 x 240 = $52800.



Like I said, you can potentially contribute up to $53k x 2 into individual 401(k)s. Any tax sheltered amount would be worthwhile to me.
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you guys are turning this thread into a snooze fest. :)
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JustAGuy said:
I was just quoting the person's scenario above me. Some of us have a lot of federal service already from before medicine. Worst case scenario would be 1.1 x 20 x 240 = $52800.



Like I said, you can potentially contribute up to $53k x 2 into individual 401(k)s. Any tax sheltered amount would be worthwhile to me.
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You can do that with any job, not just VA. And if you have many years in already then your pension scenario would be much different than anyone new to federal service. So, definitely go for it! Welcome to the team, as soon as the hiring freeze is over.


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JustAGuy said:
Pretty sure that doesn't include public health/safety people.
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So today we got a memo from Dr. Snyder, acting director of the VA. It turns out most VA positions are going to be exempt from the federal hiring freeze, especially anything clinically related. And some non clinical are not frozen, like housekeeping and cafeteria staff. Patients gotta eat and have a sanitary environment and all that. So that's good news.
 
J ROD said:
Curious? What is the average salary range at the VA? I know it can depends on location.....but I was curious as to have an idea. I really liked my time there. Especially helping the veterans that served us.
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Average starting - 220-230k. IMO it's too low for what you have to do.
 
What are the big additional duties at the VA versus another salaried gig? What's a common amount of call? Just curious as our VA seems to be able to attract high quality physicians overall.
 
SteinUmStein said:
What are the big additional duties at the VA versus another salaried gig? What's a common amount of call? Just curious as our VA seems to be able to attract high quality physicians overall.
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Other than calling no shows and doing some screenings every few months, I haven't noticed much in the way of additional duties. I would like to know this, too. Maybe it's much worse at other VAs. Call seems to vary depending on location. Some VA jobs have zero call.
 
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Remember there is no limit on what they can do to use you. You're salary unlike NPs who are hourly and must be paid OT beyond 40.
 
wolfvgang22 said:
So today we got a memo from Dr. Snyder, acting director of the VA. It turns out most VA positions are going to be exempt from the federal hiring freeze, especially anything clinically related. And some non clinical are not frozen, like housekeeping and cafeteria staff. Patients gotta eat and have a sanitary environment and all that. So that's good news.
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That is good! I can't wait until the jobs get posted on usajobs and actually filled. I know that there is sometimes a disconnect between memos and hiring actions. My small station has lost half its behavioral health staff (therapists/ SW /RN) since the election to transfers and non-fed opportunities. There are certainly concerns that the jobs either won't be filled or will take a year to do so.


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We have more SWs and PhDs than you can shake a stick at here. Getting MDs to come and stay is the problem. We always get "I love it here in your department but it's hard to justify moving/staying for the same or less pay to have more bureaucracy." And we aren't on the coasts, so people move there.

More pay and less paperwork for in demand MDs is the answer, if the VA is serious about treating veterans.
 
wolfvgang22 said:
We have more SWs and PhDs than you can shake a stick at here. Getting MDs to come and stay is the problem. We always get "I love it here in your department but it's hard to justify moving/staying for the same or less pay to have more bureaucracy." And we aren't on the coasts, so people move there.

More pay and less paperwork for in demand MDs is the answer, if the VA is serious about treating veterans.
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The alerts/paperwork at the VA is by far my biggest problem. It would be one thing if it was evidenced based interventions like pre-surgery checklists, but the non-evidence based bureaucracy is a crime when govt infects medicine.
 
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Merovinge said:
The alerts/paperwork at the VA is by far my biggest problem. It would be one thing if it was evidenced based interventions like pre-surgery checklists, but the non-evidence based bureaucracy is a crime when govt infects medicine.
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Agreed. The amount of useless information I am required to put in my evaluation reports is getting ridiculous. Also, they appear to change the required elements on a yearly basis, so I'm frequently getting new directives and such. Our abuse reporting mandate is especially egregious.
 
Shikima said:
Average starting - 220-230k. IMO it's too low for what you have to do.
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Interesting.

I'm deciding between several offers and so far this is our city's VA overview:

Midwest city with ~2M population
210 base + 120k/5yr EDRP (student loan repayment)
Outpt clinic, 1hr new, 30min f/u, avg 10-12pts/day, 0.5day/week office time, resident supervision 1day/week
Call: avg ~2 weekdays/mo, ~1weekend day Q6-7wks, resident in house until 10pm, rounds in AM as well on weekend days

Another VA facility nearby:
1hr away, 120k population, semi-rural but not really, capital of a fairly farmy state
Inpt, 230-240k base + above standard benefits
Not sure on pt load or calls yet as I need to hear more.

I did get an email from Fargo, ND VA recruiter....and should one be inclined to move to North Dakota....I'd presume their base should be quite a bit higher...250k+?

It's a bit tough since I do love the benefits (on paper at least....the TSP's super low cost index funds are right up my alley and the trifecta retirement seems nice) but some of the other issues listed already in here is a bit concerning.

There's also a common belief that VA benefits/compensation are essentially non-negotiable but one of the APA videos I just watched had a dude giving a talk about how someone "got everything they wanted" out of a VA in Georgia....
 
J ROD said:
I hear you are not allowed to work at other places or have your own private practice if more than 40% of your time is at the VA. Does anyone else know anything about this?
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I dunno if this varies by VA, but I was told this want a problem and that many psychiatrists at ours have private practices or pick up evening shifts elsewhere.
 
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J ROD said:
I hear you are not allowed to work at other places or have your own private practice if more than 40% of your time is at the VA. Does anyone else know anything about this?
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Incorrect. Many have a PP while working FT at the VA.
 
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Mapplicant said:
Interesting.

I'm deciding between several offers and so far this is our city's VA overview:

Midwest city with ~2M population
210 base + 120k/5yr EDRP (student loan repayment)
Outpt clinic, 1hr new, 30min f/u, avg 10-12pts/day, 0.5day/week office time, resident supervision 1day/week
Call: avg ~2 weekdays/mo, ~1weekend day Q6-7wks, resident in house until 10pm, rounds in AM as well on weekend days

Another VA facility nearby:
1hr away, 120k population, semi-rural but not really, capital of a fairly farmy state
Inpt, 230-240k base + above standard benefits
Not sure on pt load or calls yet as I need to hear more.

I did get an email from Fargo, ND VA recruiter....and should one be inclined to move to North Dakota....I'd presume their base should be quite a bit higher...250k+?

It's a bit tough since I do love the benefits (on paper at least....the TSP's super low cost index funds are right up my alley and the trifecta retirement seems nice) but some of the other issues listed already in here is a bit concerning.

There's also a common belief that VA benefits/compensation are essentially non-negotiable but one of the APA videos I just watched had a dude giving a talk about how someone "got everything they wanted" out of a VA in Georgia....
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Kind of low for W2 income. Don't forget, you'll lose 1/2 that to taxes.
 
Shikima said:
Kind of low for W2 income. Don't forget, you'll lose 1/2 that to taxes.
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Indeed. I went to a couple of "paycheck calculators" to see what the actual take home is and it ends up being somewhere close to 130-150k or so...
 
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JustAGuy said:
I dunno if this varies by VA, but I was told this want a problem and that many psychiatrists at ours have private practices or pick up evening shifts elsewhere.
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Shikima said:
Incorrect. Many have a PP while working FT at the VA.
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Great....because that was the major drawback I was concerned about. Thanks.
 
wolfvgang22 said:
Is 1099 any better after paying for your own healthcare and other benefits?
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Rumor has it that a former graduate of our program apparently is doing a 1099 gig with several hospitals covering their psych services (probably at least 40pts a day from what we hear) and he reoprtedly clears close to 500k gross...of course we also hear he is essentially Q1 call and works 1/2 days on weekends too with no days off and paying everything else himself....

Yeah unless a 1099 gig pays at least 350k+ I'd think it may not be worth having to pay everything else on your own.....(malpractice, health insurance, cme/license, etc....)
 
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Thread bump. Anyone actually know people that are earning the 250-264k base salaries in Federal Service per the 2017 pay ranges? I only ask because no one I know comes near that in base pay.
 
Shikima said:
I see 200-230k for VA.
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Pretty much where I'm at (base), though I'm also in a major metro that's not really known for great pay. When I first signed on it was significantly lower than that, but our department lobbied for raises the last couple years to keep us competitive.
 
keifernny2 said:
Thread bump. Anyone actually know people that are earning the 250-264k base salaries in Federal Service per the 2017 pay ranges? I only ask because no one I know comes near that in base pay.
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There are two psychiatrists in 2016 earning that at my VA, but they each have at least twenty years here. There's a third that joins them in 2017 but he's also sleep and child boarded. Most people at my VA earn 210-230k like mentioned above. But there are two inpatient psychiatrists who work 10-2 and make 225k..which if you ask me is a pretty good deal. There's a part time psychiatrist who works one day a week and earns 210k...
 
wannabie said:
But there are two inpatient psychiatrists who work 10-2 and make 225k..which if you ask me is a pretty good deal. There's a part time psychiatrist who works one day a week and earns 210k...
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You are going to have to explain this, because maybe I am stupid, but I don't understand it.
 
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Psychotic said:
You are going to have to explain this, because maybe I am stupid, but I don't understand it.
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I mean the attending (and sometimes the other) rolls into work between 09:30-10:00AM at the end of morning report, sees a patient or two, and then residents don't see the attending after 02:00PM and are asked to call to endorse patients. This attending made 226k in 2016. The other is the CL attending one day a week (on a resident dependent service) and sees ethics consults on that same day one day a week. This attending made 212k in 2016. Either could work two jobs pretty easily. That's a lot of taxpayer money I'd rather not be spending..but at this VA, the head of psychiatry doesn't mind!
 
wannabie said:
I mean the attending (and sometimes the other) rolls into work between 09:30-10:00AM at the end of morning report, sees a patient or two, and then residents don't see the attending after 02:00PM and are asked to call to endorse patients. This attending made 226k in 2016. The other is the CL attending one day a week (on a resident dependent service) and sees ethics consults on that same day one day a week. This attending made 212k in 2016. Either could work two jobs pretty easily. That's a lot of taxpayer money I'd rather not be spending..but at this VA, the head of psychiatry doesn't mind!
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How do I land such a job?
 
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wannabie said:
I mean the attending (and sometimes the other) rolls into work between 09:30-10:00AM at the end of morning report, sees a patient or two, and then residents don't see the attending after 02:00PM and are asked to call to endorse patients. This attending made 226k in 2016. The other is the CL attending one day a week (on a resident dependent service) and sees ethics consults on that same day one day a week. This attending made 212k in 2016. Either could work two jobs pretty easily. That's a lot of taxpayer money I'd rather not be spending..but at this VA, the head of psychiatry doesn't mind!
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As a concerned taxpayer, It is always your right to report this to the hospital director.

It may be helpful to give him the name of another psychiatrist who wants the job too.


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One reason why people tolerate the bureaucracy and low pay of some public psychiatry jobs is the slower work pace. Combined with the psychiatrist shortage, I've seen several places undergo staffing death spirals when the administration tries to impose a new work regime.

Sure, they can kick out psychiatrists who are working 1 day a week. But will anyone replace them? Or will the remaining psychiatrists get stuck with even more work because the admin can't find a replacement? Waitlists get longer and patients get sicker. In my experience, some labor is better than no labor at all.
 
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uname943 said:
One reason why people tolerate the bureaucracy and low pay of some public psychiatry jobs is the slower work pace. Combined with the psychiatrist shortage, I've seen several places undergo staffing death spirals when the administration tries to impose a new work regime.

Sure, they can kick out psychiatrists who are working 1 day a week. But will anyone replace them? Or will the remaining psychiatrists get stuck with even more work because the admin can't find a replacement? Waitlists get longer and patients get sicker. In my experience, some labor is better than no labor at all.
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They don't care. And no, the work load is not slower, just as busy. MSA have the power to double-book you without your ok because of management. Management doesn't do patient care and they keep whipping to see more, produce more because service chiefs and above get bigger bonuses for how productive people are. The work load is also dumped on others as one leaves.

Those that tolerate it are not very good at putting up boundaries, complacent or are institutionalized terribly.
 
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Shikima said:
They don't care. And no, the work load is not slower, just as busy. MSA have the power to double-book you without your ok because of management.
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That's why I used the word "some".

Management doesn't do patient care and they keep whipping to see more, produce more because service chiefs and above get bigger bonuses for how productive people are. The work load is also dumped on others as one leaves.
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And this is an example of why some psychiatrists leave public institutions where the administration become focused on productivity. Anecdotally I know of several public psychiatry places where the workload was low until the admin started to focus on productivity. Then people start leaving.
 
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Management are not known for their decency. They will push and push as long as they can get away with it.

They will only back off if you stop complying with their ridiculous demands. Or by imposing ridiculous demands on them. (They want you to see more patients? Demand more pay and more ancillary staff.)

If you don't meet their demands, what can they do? Fire you?

It is easier for you to get another job than them getting another psychiatrist.

My friend applied for jobs in the VA in his home state. The administration there kept stringing him along without a definite contract. So he accepted a position in another state. The psychiatrist in the first VA left and guess who came crawling asking my friend if he wanted a job?

Of course his answer was no.

---

This wasn't the VA, but it deals with administration:

It happened with me where the administrator kept demand something. For the first two times, I complied. I wanted to keep the peace. But after each compliance, demands increased. It was getting ridiculous to the point I had to do all this extra unnecessary work every day. She was never satisfied.

So I told her, "We can keep things as is or I will go work for your competitor." Her attitude and tone changed from demanding to supplicating. She made one final request. I ignored her request and kept things as is. Haven't heard a peep since.

Don't feel bad about playing hardball, because since medical school and residency, most likely you've been pushed around. Now that the power shifts to you, you no longer have to be meek and compliant. You can actually get your way.
 
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AD04 said:
My friend applied for jobs in the VA in his home state. The administration there kept stringing him along without a definite contract. So he accepted a position in another state. The psychiatrist in the first VA left and guess who came crawling asking my friend if he wanted a job?

Of course his answer was no.
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Now to be fair, this wasn't a particular admin being a dick so much as it's just how job offers work in the VA system. It's one of the more annoying quirks of the job, but just the nature of the beast that nothing is really put on paper until 90 days before the start date, and even then it's pretty nonspecific.
 
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WingedOx said:
Now to be fair, this wasn't a particular admin being a dick so much as it's just how job offers work in the VA system. It's one of the more annoying quirks of the job, but just the nature of the beast that nothing is really put on paper until 90 days before the start date, and even then it's pretty nonspecific.
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So is it approx 90 days out that you are offered a contract to sign? Prior to that, is it just handshakes? Or has something been created that legally ties you to the gig, even if you don't like the contract or agreement tendered at the 90 day mark?
 
For me it was a written (emailed) offer of a position, but I don't think anything was legally binding prior to getting the credentialing process started.
 
The VHA doesn't really have legally binding contracts. It's just a job like being a mailman. You can quit whenever you like.


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keifernny2 said:
The VHA doesn't really have legally binding contracts. It's just a job like being a mailman. You can quit whenever you like.


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Which is nice when you want to still collect a paycheck and receive health benefits while you look for a better job. Worked pretty well for me. No pressure, and I got to take my time until I found something I wanted, in an area I wanted.
 
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WisNeuro said:
Which is nice when you want to still collect a paycheck and receive health benefits while you look for a better job. Worked pretty well for me. No pressure, and I got to take my time until I found something I wanted, in an area I wanted.
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How much notice did you give? Since there is no contract, what is considered the honorable minimum notice? Will 2 weeks suffice?
 
Psychotic said:
How much notice did you give? Since there is no contract, what is considered the honorable minimum notice? Will 2 weeks suffice?
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I let my immediate coworkers know well in advance. I was involved in the training program and didn't want them to make intern/postdoc recruiting choices thinking I'd be there for the next cycle. After I had a job offer that I liked, I gave a 45-day notice. I've heard 30 and 45 days thrown around. This was more than enough for me as it takes a few months for the new place to onboard and get me credentialed. Additionally, the VA HR dept is full of the most incompetent people on earth, so I wanted there to be plenty of time to get everything done. That being said, they still screwed up my resignation and put me on LWOP instead of separating me. Took me a few phone calls and a few hours to get that sorted out.
 
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WingedOx said:
Now to be fair, this wasn't a particular admin being a dick so much as it's just how job offers work in the VA system. It's one of the more annoying quirks of the job, but just the nature of the beast that nothing is really put on paper until 90 days before the start date, and even then it's pretty nonspecific.
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I don't think the administrator was being a dick, just didn't care enough until they didn't have enough staff. My friend gave the first VA a few months head start but didn't hear anything definite. So he took a job with another VA where the administrator was serious and gave him a contract pronto.
 
AD04 said:
I don't think the administrator was being a dick, just didn't care enough until they didn't have enough staff. My friend gave the first VA a few months head start but didn't hear anything definite. So he took a job with another VA where the administrator was serious and gave him a contract pronto.
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You clearly didn't read this thread (nor my response).
 
If you're nitpicking at my use of the word "contract," I'm sure most people know what I mean.
 
keifernny2 said:
Thread bump. Anyone actually know people that are earning the 250-264k base salaries in Federal Service per the 2017 pay ranges? I only ask because no one I know comes near that in base pay.
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That's the starting pay for inpatient psychiatrists at a VA near me. They are having trouble recruiting and are in some of the highest home-value zip codes in the country though.
 
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