VA Psychiatry

[Chianti]

Any insight into what starting salaries are in the VA system for a board-certified psychiatrist?

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[F0nzie]

98k base salary + adjusted salary to fair market value

 

[TexasPhysician]

I've seen around 180k

 

[twright]

98k base salary + adjusted salary to fair market value

Woah. That seems a little low. How sizeable is the "adjustment"?

 

[vistaril]

Woah. That seems a little low. How sizeable is the "adjustment"?

the average salary nationwide for a 100% outpt VA fulltime psychiatrist who is just out of residency and starting out will be 155-158k. Maybe a little more or a little less depending on the location and the exact nature of the job.

It's a job that is considered not too demanding. You won't have to see as many pts as you would doing outpt cmhc, but in exchange for that the starting pay is a little less.

You will also be expected to cover consults(depending which VA it is) and occasional emergency call.

 

[PikminOC]

A VA psychiatrist board certified that I know working for the past 5 years makes 151 in a large major city. Don't forget the benefits are very good! Little or no call, low malpractice chance,

 

[vistaril]

A VA psychiatrist board certified that I know working for the past 5 years makes 151 in a large major city. Don't forget the benefits are very good! Little or no call, low malpractice chance,

yes, but those benefits(and the main benefit is the retirement) only fully vests after some ungodly number of years right? If someone works say 4 years at a VA, they actually do worse relative to other practitioners in terms of retirement because some private hospital corporate like places will match up to a certain amount every year in an ira type thing....

overall I agree that va benefits and lifestyle are very good though for psyhiatry.

Making 150 sorta blows though.

some of the jobs have a good bit of competition because, again, the workload and stress for many va positions is very light

 

[whopper]

The state job I had was like the VA. Very little work and paid about 150K.

I chose to work 32 hours a week, then do a court gig and private practice for a total of 50-60 hrs a week of work for over 250K a year. The combination also nicely complemented each other because work expectations were quite low. Seriously, I got all my work done at the state hospital after 2-3 hours of work a day and I wasn't slacking. I literally could not do anymore than I was doing. You got a psychotic guy, you got his stabilized, and then you can't discharge him because the court won't allow it for another 2-3 months so you're writing a note over and over again saying the guy is stable and awaiting discharge. I started doing psychotherapy, real in depth therapy, and wrote some reports on the order of 30+ pages (usually the creepy interesting ones or the malingerers) with some patients because I had nothing to do.

You could've worked there for 20 hours a week and still got full benefits if you paid about 20% of it, but you got credit into the pension plan. 25 years of employment means you get half your salary as pension for the rest of your life + lifetime benefits. What a lot of docs did was work less than 40, do work elsewhere that paid more (e.g. private practice), then at 23 years, work full-time at the state hospital, then retire because the pension is based on the salary of the last 2 years of work.

Based on my calculations, and I wrote this in another thread...if I intentionally chose to do the highest paying jobs I know of in the area, I could do 350K a year for about 40-50 hours a week of work, but I'd have no benefits or pension. If I worked for the state (doing 20 hours for the state), mixed that with a court gig and did private practice, I could make about 250-275K for 50 hours a week, but then after 25 years retire with a pension of 90K a year (by today's rates) because those last 2 years I'd just max my hours and do 50-60 hours for the state those last two years. That IMHO is actually far more profitable all things considered. Think about it. If you retire at age 65, live another 15 years, that's way over $1 million over that time with full-benefits for no work at all. Realistically speaking, I'd do part time work and make about another 100K during that time.

The risk with this strategy is the state could get rid of the pension plan, but I'd doubt it. I know of no case where this ever happened, but that is a risk.

The job I'm at now with the university, it pays very well for an academic position: at about 200K, but I can't work anywhere else and while there's a pension it's no where near as good as the one I could get with the state or VA, plus I'm working my tail off all the time, where as in the state job, I had time to take it easy, read the paper, lift weights, and catch old episodes of Deadwood on the laptop.

My old state employer asked me to return there with a promotion into the administration, and that would just up the pension potential even more, and I'd be on a yellow brick road to the chief clinical officer position with about 10 years of work and I'd be able to still work on the side at other places.

All of this is a headache. I've been going to work pretty much everyday constantly thinking I should switch jobs yet again.

 

[toothless rufus]

The state job I had was like the VA. Very little work and paid about 150K.

I chose to work 32 hours a week, then do a court gig and private practice for a total of 50-60 hrs a week of work for over 250K a year. The combination also nicely complemented each other because work expectations were quite low. Seriously, I got all my work done at the state hospital after 2-3 hours of work a day and I wasn't slacking. I literally could not do anymore than I was doing. You got a psychotic guy, you got his stabilized, and then you can't discharge him because the court won't allow it for another 2-3 months so you're writing a note over and over again saying the guy is stable and awaiting discharge. I started doing psychotherapy, real in depth therapy, and wrote some reports on the order of 30+ pages (usually the creepy interesting ones or the malingerers) with some patients because I had nothing to do.

You could've worked there for 20 hours a week and still got full benefits if you paid about 20% of it, but you got credit into the pension plan. 25 years of employment means you get half your salary as pension for the rest of your life + lifetime benefits. What a lot of docs did was work less than 40, do work elsewhere that paid more (e.g. private practice), then at 23 years, work full-time at the state hospital, then retire because the pension is based on the salary of the last 2 years of work.

Based on my calculations, and I wrote this in another thread...if I intentionally chose to do the highest paying jobs I know of in the area, I could do 350K a year for about 40-50 hours a week of work, but I'd have no benefits or pension. If I worked for the state (doing 20 hours for the state), mixed that with a court gig and did private practice, I could make about 250-275K for 50 hours a week, but then after 25 years retire with a pension of 90K a year (by today's rates) because those last 2 years I'd just max my hours and do 50-60 hours for the state those last two years. That IMHO is actually far more profitable all things considered. Think about it. If you retire at age 65, live another 15 years, that's way over $1 million over that time with full-benefits for no work at all. Realistically speaking, I'd do part time work and make about another 100K during that time.

The risk with this strategy is the state could get rid of the pension plan, but I'd doubt it. I know of no case where this ever happened, but that is a risk.

The job I'm at now with the university, it pays very well for an academic position: at about 200K, but I can't work anywhere else and while there's a pension it's no where near as good as the one I could get with the state or VA, plus I'm working my tail off all the time, where as in the state job, I had time to take it easy, read the paper, lift weights, and catch old episodes of Deadwood on the laptop.

My old state employer asked me to return there with a promotion into the administration, and that would just up the pension potential even more, and I'd be on a yellow brick road to the chief clinical officer position with about 10 years of work and I'd be able to still work on the side at other places.

All of this is a headache. I've been going to work pretty much everyday constantly thinking I should switch jobs yet again.

Wow I'd go back to the state job ASAP. Good salary and benefits, work as much as you want and have a lot of free time vs what sounds like work work work. What's holding you back?!

 

[whopper]

I didn't feel like I was living up to my skills, I enjoy teaching, like working with medstudents and residents, and I'm working with literally some of the best doctors in the country. Paul Keck, Doug Mossman, Mike Keys to name a few, all named top 100 doctors in the country, then people who may not be namebrand but of such high quality (e.g. Keck's former research nurse), that it's reassuring. I feel like I'm a part of something I can believe in.

Being in this environment is like a Starfleet cadet getting an assignment on the starship Enterprise. When I talk to other doctors at this institution, I now don't have to fear that I'll be talking to some idiot diagnosing every cluster B patient with bipolar disorder and then treating it with Gabapentin.

Just to give you a few examples, I have an OCD treatment resistant patient, and one of the top guys in the field stabilizes him on Tramadol, I get to talk directly to one of the nation's top researchers on TMS, and I had a borderline patient where I actually had the time to do psychotherapy and refer her to a DBT therapist.

But, getting older and having a kid, sometimes I think my family would be better off with me working for the state because I'd come home with a heck of a lot more energy, and our financial futures would likely be better.

It boils down to me to doing dream job where I'm working my tail off for about 200K for 45 hours a week of work a week (+ weekend calls once a month) plus I get to do some high profile private forensic cases (the university owns this-they get cases in other states), or do something that I'd still enjoy, be much more relaxed, but I don't get to teach, don't get to be part of the A-Team, have to tolerate incompetence around me, but I'd make much more money.

 

[vistaril]

The job I'm at now with the university, it pays very well for an academic position: at about 200K, but I can't work anywhere else and while there's a pension it's no where near as good as the one I could get with the state or VA.

that's the downside of taking most academic jobs.

Im not going to work in academia, even though I could stay. It pays about 160, but there is the no compete thing. If they would allow people to take the occasional weekend coverage/rounding at an OSH or something once a month in addition to some on your own outpt contracting, then I could get my salary into a more reasoable level(220ish)......but Im not going to work for 160k a year. Just not going to do it.

the thing about the outpt VA jobs, though, in terms of getting extra work, is that you actually have to be there from 8-5ish.....you may not be doing anything for a good part of the day, but you just can't go off and work elsewhere at like 2pm or something. That limits any extra work to weekends and evenings, and a lot of people like to have their weekends and evenings off.

Like you said, you had cobbled together jobs to get your salary to over 250k, but you said that was 50-60 hrs a week and Im guessing of that there were some occasional weekends and evenings. My goal would be to preferably make 250k+, very rarely work weekends, and rarely if ever work evenings/nights.

My fiance is already getting offers with groups that fairly quickly get her into the 550ish level if she is really willing to hustle(ie q7 call, many weekends) and if she wants to rarely do call, evenigs or weekends 350+.....much much different, but then again I wouldnt do that for 1 million.

 

[whopper]

It pays about 160, but there is the no compete thing.

Yeah, I don't know how U of Cincinnati gets to pay their doctors more compared to a lot of places. I've seen some people enter academia making 125K. I actually do make more than 200K because the university has a deal where if you bring in more money than most docs, they pay you more and I'm doing that. Every month I see an extra paycheck due to the extra productivity. Despite this, I'd still be making even more if I were in business for myself.

Another advantage with being with the university is my malpractice is completely covered by them. A word of advice, if you work for an institution that claims to cover your malpractice, some may not protect you if push comes to shove. A buddy of mine worked for the state, he was sued, and even though the state-by contract was supposed to provide him with a lawyer, they did not. He was forced to either get his own lawyer and pay it himself.

How this translates to me is a buddy of mine in the dept at the university was sued, and the institution paid for all of his legal defenses, all of which went in the 6 figure range for the price of the legal defense, so I know being there, they'll do their end and not leave me to fend for myself if I get in trouble. For all of you medstudents and residents reading this, you got to make sure if you're in an institution that provides malpractice, ask people who've been there about their track record. I know several that get malpractice insurance anyway or incorporate themselves even if working for the state for added levels of protection.

Vistaril, if your fiance's going to be making good money, this certainly takes off the pressure to make money. I'd recommend putting more money into something you'd enjoy than being driven by the money. Of course do what you find best.

 

[twright]

People who go academic aren't in it for the money. I've got friends pulling down $110-120K starting out at UCSF and MGH. Primary research, that is. (Primary clinical you do take a hit but, as you can see below, it's not as bad.)

 

[PikminOC]

I have seen alot of new job openings with county and private hospitals are cutting way back on retirement benefits for new hires. It's not the same as it was years ago due to dwindling economies.

 

[notdeadyet]

And keep in min that some of those great county and state pensions are not being paid out at the rate they were promised...

 

[SteinUmStein]

And keep in min that some of those great county and state pensions are not being paid out at the rate they were promised...

I know very little about psychiatry, but I do know that counting on any government agency to pay out promised pensions/retirement benefits in 5, 10, or 15+ years is a recipe for disaster. Don't put yourself in a situation where you're counting on the financial solvency of a government entity.

 

[vistaril]

And keep in min that some of those great county and state pensions are not being paid out at the rate they were promised...

which state pension specifically has not paid out like promised? I know some states have raised the buy in a bit, but Im unaware of any that has defaulted on it's obligation(even to some amount)

the ridiculous thing is when 22 year old workers just *now* take state jobs, they are still being enrolled in the same ridiculous defined benefit plans......it's one thing for states to pay for pensions when they've already made the obligations for many years. But they are still taking *new* hires and promising this......it's like they don't even see a problem.

 

[whopper]

I know very little about psychiatry, but I do know that counting on any government agency to pay out promised pensions/retirement benefits in 5, 10, or 15+ years is a recipe for disaster. Don't put yourself in a situation where you're counting on the financial solvency of a government entity.

If this were Greece, Spain, or Portugal, I wouldn't count on it at all.

I have, however, never ever seen anyone in the U.S. not get their government pensions with the exception of one town (forgot the name) on an CBS Sunday Morning episode and that town's idiot city hall spent their way into financial oblivion. The town is the equivalent of Greece and each politician bucked the problem to the next person. City workers aren't getting their pension.

I don't think that'd happen in the US, despite that our spending is way out of control now. I do think it'll be fixed despite that 1/2 the population doesn't seem to undersatnd this is a problem at all. I wouldn't be surprised if the government pulled a fast one and made someone work 30 years instead of 25 because -people are living longer.

In NJ, the governor there massively cut spending, but to my knowledge didn't touch pensions. (Someone correct me if I'm wrong).

In honesty, one could argue that with the huge deficits, pensions are a possible thing the gov may take away. No one can predict the future, but IMHO it's to the degree where I'd bet on getting the pension.

 

[whopper]

http://www.cbsnews.com/video/watch/?id=7401732n

This wasn't the town, it was a different one but it fits the same bill. It's in Rhode Island. Also read that San Bernadino, CA declared bankruptcy.

Mind you these are towns. If you do the VA the federal gov would have to go bankrupt for your pension to be screwed. A government, if it promised you a pension has to pay for it unless something like bankruptcy occurs. While I don't think that's going to happen, and without trying to get political, the current spending the government's engaging cannot sustain itself at it's current course.

Personally, IMHO, with people living longer and medical expenses going up, pensions will have to require more years of service but hey, I don't see anyone advocating for this.

Addendum: The gov cannot revoke a pension if you already met the requirements unless they declare bankruptcy, but until you meet the requirements, they could prevent you from getting one. E.g. if you need 25 years to get 1/2 your salary, they could prevent you from getting it after working 24.5 years (though you'd be promised all the pension benefits you would've earned up to that point). How risk is it? You're going to have to make that decision on your own. Personally I'd bank that they would fulfill the pension given that I've hardly ever seen any governments not pay a pension or dramatically change the arrangement unless that government went bankrupt. It's a risk like investing in a stock.