VA Radiation Oncology jobs?

[Barcelona PSG]

Hi Folks,
What do you think about the VA radiation oncology Physician jobs? I have been to a couple of VAs, and it seems that, in general, nobody wants to work and are happy to keep referring patients to academic affiliates. Is this prevalent across all VA healthcare systems?

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[OTN]

My experience has not been the same- The VA medoncs I work with all work hard to do the best they can for their patients in the system in which they work.

 

[Doctorer]

I think this depends on the VA and its specific culture. I have known VA radiation oncologists that I'd be more than happy to send family members to. I have also seen VAs where that's definitely not the case. I do think that in general, it's fair to say that it's harder for VAs to attract/retain high quality talent across the board in terms of referring physicians.

 

[elementaryschooleconomics]

I've worked in/around 3 different VA hospitals. Like all hospitals, attitudes and quality varies greatly.

2/3 of them were actually pretty good!

 

[Ray D. Ayshun]

The saying is, I think, "if you've seen one VA, you've seen one VA."

 

[medgator]

I think this depends on the VA and its specific culture. I have known VA radiation oncologists that I'd be more than happy to send family members to. I have also seen VAs where that's definitely not the case. I do think that in general, it's fair to say that it's harder for VAs to attract/retain high quality talent across the board in terms of referring physicians.

Guessing the academically affiliated ones may turn in better work.

 

[Lamount]

I trained in a VA that had an excellent rad onc dept because it was associated with my academic center and was staffed by faculty... other VAs don't have rad onc at all, and refer all patients out. There are some VAs with VA-employed rad oncs... I have less experience with those, but I would imagine it is hit and miss. In general, working for a VA is an incredible stable job that often has a low bar staying employed. Any given service (be it medical or administrative) can be similarly hit and miss depending on whether the person on the other end of the phone cares about doing their job well. Everyone is pretty happy because they all leave by 430

 

[TheWallnerus]

Are there any VA rad onc depts in America that still don’t have IMRT? I know that a few didn’t as recently as 10 years ago.

 

[drowsy12]

that would be surprising to me if that was still the case

 

[Doctorer]

Guessing the academically affiliated ones may turn in better work.

I thought this was true until I began interacting with the "academic" surgeons/medoncs at my current local VA.

I think the above quote about seeing one VA is pretty spot on.

 

[deleted1180461]

Everyone is pretty happy because they all leave by 430

I’ve worked in a PP where staff would mutiny if they had to stay past 4. Even if it meant beam on at 7 am. post-Covid labor market.

Solution was to be a solo generalist in a hospital. Show up at 10 and stay till 8 if you want. ASTRO says I’m dangerous and rotten though.

 

[grenz]

Hi Folks,
What do you think about the VA radiation oncology Physician jobs? I have been to a couple of VAs, and it seems that, in general, nobody wants to work and are happy to keep referring patients to academic affiliates. Is this prevalent across all VA healthcare systems?

One point that hasn’t been mentioned but many could attest to if they rotated through the VA is it’s a very gratifying patient population to help. Many would not have health insurance if not for the VA. Others would have crappy insurance and be vulnerable to bad medicine.

 

[thecarbonionangle]

I always enjoyed and still enjoy working with the VA patients. I do a lot of re-irradiation/complex cases and get referred patients from multiple VAs in nearby states. I get the radiation plans. Some are good and some can be quite aweful (think someone contouring esophagus as GTV in a nonesophageal case, clearly a wax pencil era person). I would imagine working there has a lot to do with who works there. VAs are notorious for being very difficult to fire people, so bad apples can remain employed their whole career. It is also a highly unionized environment where everyone is in one except the physicians. I would never want to work at one but I do know people who are happy.

 

[Gfunk6]

As you can see by this thread, each VA facility is different and it is not necessarily fair to generalize - but I'll do it anyway!

PROs

• Generally great patients who are grateful with fairly diverse pathology.
• VA usually has everything under one roof including chemo, imaging, and labs so coordinating is a bit easier.
• Standardized EMR
• Government benefits are usually great; not sure if they still have pension but, if so, that would be a good reason to work in the VA long term

CONs

• Bureaucracy can be onerous and over-the-top. One of my colleagues is a VA Med Onc who is a fierce patient advocate. She frequently needs to be "creative" to get vets what they need.
• Pay is probably ok but not very competitive.
• There is definitely a "9-5" mentality which may be good or bad depending on your perspective.
• EMR is pretty inefficient from what I hear.

 

[Mandelin Rain]

Are there any VA rad onc depts in America that still don’t have IMRT? I know that a few didn’t as recently as 10 years ago.

The only place I ever witnessed RASO/LASO head and necks routinely (>10 years ago, tbf).

 

[Radonky]

VA docs felt the wheels were coming off when they had 10 patients on treatment between 3 physicians. Seemed like a nice job if you wanted a mellow atmosphere, not ideal for a new grad...my sense is that its a place where you go to retire, not build a career. Maybe if the VA is connected to an academic center its not a career dead end. I think they still get pension, and paid maternal/paternal leave

 

[Music Man Stan]

The primary "con" for a VA job is the maximum pay of $400K: https://www.va.gov/OHRM/Pay/2024/PhysicianDentist/PayTables.pdf

 

[medgator]

The primary "con" for a VA job is the maximum pay of $400K: https://www.va.gov/OHRM/Pay/2024/PhysicianDentist/PayTables.pdf

Can't make more than the POTUS!

 

[deleted1180461]

The benefits, PTO, hours, workload, and pension are substantial and should be factored in.

 

[medgator]

The benefits, PTO, hours, workload, and pension are substantial and should be factored in.

compared to being a Jr academic faculty lackey at a coastal PPS-exempt NCI center, I would take a VA job all day.

Even a few years in, it is abysmal at what some of the large NE centers pay their BC faculty.

 

[radoncftw]

The primary "con" for a VA job is the maximum pay of $400K: https://www.va.gov/OHRM/Pay/2024/PhysicianDentist/PayTables.pdf

compared to academic + HCOL salaries, this is pretty good. especially given workload

 

[Chartreuse Wombat]

Can't make more than the POTUS!

Dr Fauci can

Dr. Anthony Fauci is paid more than the president — here's how much he earns as he prepares to retire from public service

His salary is the highest in the federal government and has helped make him wealthy.

finance.yahoo.com

Nice retirement package as well

 

[DoctwoB]

compared to academic + HCOL salaries, this is pretty good. especially given workload

The workload is the key.

Can't speak to radonc but VA PCPs make low 200s instead of more like 300 in employed jobs. Benefits make up for some of that. But the main benefit is the pace of the work. 60/30 minute slots for new/existing patients instead of 30/15 like you typically see in the private world. Some people find practicing medicine at that pace much more enjoyable and worth the paycut.

 

[Mandelin Rain]

Working with vets is it's own bonus as well. Typically kind, appreciative, and in-need folks. Professionally rewarding for sure.

 

[medgator]

Working with vets is it's own bonus as well. Typically kind, appreciative, and in-need folks. Professionally rewarding for sure.

I've noticed many of my VA h&N pts tolerate tx like champs too. Many have been through a lot

 

[radoncftw]

I've noticed many of my VA h&N pts tolerate tx like champs too. Many have been through a lot

i think back to my residency experience at the VA very fondly.
Spent much of my intern year at the VA as a medicine resident
I only rotated there as a rad onc once, but it was great.
They do tolerate treatment well and have a pretty good perspective on life.
They are typically very appreciative
I have alot of family in the military as well so I have alot of respect for vets

 

[TheWallnerus]

I've noticed many of my VA h&N pts tolerate tx like champs too. Many have been through a lot

Alcoholics tolerate HN XRT better than non alcoholics, an unwritten rule of rad onc imho

 

[Mandelin Rain]

Alcoholics tolerate HN XRT better than non alcoholics, an unwritten rule of rad onc imho

There's no doubt about it.

 

[grenz]

I've noticed many of my VA h&N pts tolerate tx like champs too. Many have been through a lot

I’ll never forget after I consented one vet he said, “I’ve jumped out of a airplane over a battlefield in pitch black, so nothing scares me anymore.” Lots of perspective, and it reinforced to me why this is a unique pt population with unique needs best served by their own health system.

 

[deleted1180461]

Alcoholics tolerate HN XRT better than non alcoholics, an unwritten rule of rad onc imho

In terms of active substance use, agree as long as it's not to the point where they are too drunk to show up. Surprisingly, most of my meth-using patients tend to get through ok too and are surprisingly compliant. I mean, they're never going to stop using meth, ever. One of my patients described it as "like my coffee in the morning, i just need a little to get me going."

In terms of the worst substance to get someone actively using through H&N RT, that would be smoked/crack cocaine. Not even close.

 

[Ray D. Ayshun]

In terms of active substance use, agree as long as it's not to the point where they are too drunk to show up. Surprisingly, most of my meth-using patients tend to get through ok too and are surprisingly compliant. I mean, they're never going to stop using meth, ever. One of my patients described it as "like my coffee in the morning, i just need a little to get me going."

In terms of the worst substance to get someone actively using through H&N RT, that would be smoked/crack cocaine. Not even close.

the good thing about a HN patient who drinks 12 beers a day is you know he'll get at least 1200 calories/day.

 

[deleted1180461]

the good thing about a HN patient who drinks 12 beers a day is you know he'll get at least 1200 calories/day.

Are you even really a community rad onc if you don't have to deal with patients putting beer in their PEG tubes on a regular basis?

 

[Mandelin Rain]

"I don't drink any alcohol, just beer."

 

[medgator]

I’ll never forget after I consented one vet he said, “I’ve jumped out of a airplane over a battlefield in pitch black, so nothing scares me anymore.” Lots of perspective, and it reinforced to me why this is a unique pt population with unique needs best served by their own health system.

I've always felt they would be best be served by getting automatic Medicare with a well funded plan F secondary/supplement

 

[rahdonc]

good timing for this topic - there is an opening at VA Boston if anyone is interested feel free to DM me for info.

 

[deleted1180461]

good timing for this topic - there is an opening at VA Boston if anyone is interested feel free to DM me for info.

In Boston? That is an insanely good gig.

 

[A_DeMichele]

VA salary range is competitive for Boston RadOnc market

 

[medgator]

VA salary range is competitive for Boston RadOnc market

Considering what I've heard they pay junior faculty at haavad, I believe it

 

[radoncftw]

Considering what I've heard they pay junior faculty at haavad, I believe it

don't get why people would do that.

 

[seper]

don't get why people would do that.

what choice do people have if they need to live in Boston? You go to work for MGH or a Umass satellite, which pays the same of course

 

[Haybrant]

The primary "con" for a VA job is the maximum pay of $400K: https://www.va.gov/OHRM/Pay/2024/PhysicianDentist/PayTables.pdf

my understanding is that this is no longer the cap due to pact act provisions, could be much higher now

 

[ramsesthenice]

don't get why people would do that.

If you are a true academic, the upside is high. Lots of money and resources to get your research program going. Then you get to put the Harvard name all over your grant applications. Drug companies fawn over access to your clinical volume and pedigree. Many things definitely come easier to folks at Harvard, MSKCC etc. Do I think they should have to pick between those perks and competitive compensation? Not at all.

The other thing you have to understand is the “in” mentality. I went to a state school for undergrad then did my PhD at a top 5 program and people would openly, to my face say things like “man, it’s amazing everything you’ve done with a state education” and genuinely think it was a compliment. Being and staying among the elite means so much to a lot of people once they are in. There is a term called the golden handcuffs. I knew I didn’t want them. Went back to a good public university for med school and have worked at one my first almost 10 years as a faculty member. Probably could have had a more padded CV if I stayed in the race, but I’ve done pretty well for myself academically and managed to pad my investment portfolio in the process.

 

[deleted804959]

In the midst of purging online accounts I no longer use I fell down the rabbit hole and landed on this post. I'd like to give my opinion as a VA RadOnc. I enjoyed my VA rotation as a resident, even though the RadOnc service at that VA was...let's say...not amazing, because the patients are awesome and we had amazing physics and dosimetry. I went to a top residency program and intended to go into academics like a good little physician scientist, but I had the issue of a 3 body problem (minus gravity wells) so I was restricted geographically. The VA option (along with a faculty position at the nearby university) was presented by one of my mentors, and I was desperate so I followed up on it.

For me, I couldn't have been happier with my decision, but I also would have had no way of knowing that it was the perfect fit. Here are some point/counterpoints in no particular order, and certainly not meant to be exhaustive.

Salary
- max is 400k, and you would command more in the community (certainly not all academic institutions as per above discussion)
- max will be lifted in the very near future as a means for talent retention, salary per patient on your census is actually quite high (census is usually lighter than at PP or pure academic), and there are means to supplement your income through your academic affiliate (see below)

Physician quality
- 10 patients on-treat between 3 physicians being the cause for chaos sounds like hyperbole
- VA sites without academic affiliates and those in remote areas may suffer from this, but plan/treatment quality is something that the VA's National RadOnc Program (NROP) has tackled aggressively to equalize the quality of care (and hopefully light a fire under some physicians' butts to perform). Incompetence is not a problem at major VA centers, and new grads are unlikely to take a job in the VA boonies.

Bureaucracy
- I can't argue with this. This is 100% a daily problem for anything being done OUTSIDE of your department. The VA is very form-focused, meaning that the form has to be filled out correctly with the appropriate signature from the right person. The middleman glut is real.
- If you can gather your street smarts and aren't socially inept, you'll be able to finagle the things (imaging, send outs, housing, etc.) you want with little to no effort other than dropping a line to your colleague. I can get same-day PETs, but this requires knowing who to ask (and also that we have a cyclotron on-site) as some of my colleagues wait months. As with anything, a little social intelligence goes a long way.
- Also if your chief is smart (as all of ours are, humble brag) then they know what needs to be done to get new equipment, machines, etc. Our equipment is honestly fancier than many of the practices around us.

9-5
- The best lesson I learned from a visiting professor in residency was to protect your time as an attending. I have no problem compartmentalizing my clinical time to allow time for being a scientist, mentor, family man, etc.
- There are relatively few people at my VA or anyone else I work with through the NROP network who isn't working later in some shape or form, doing research, mentoring residents, etc. One may certainly treat it as a 9-5, but like anything, the individual will determine their level of work output and engagement.

EMR
- I freaking love CPRS (our EMR). I was/am a superuser for Epic, and I have to say that Epic is clunky, memory-hogging garbage. The beauty of CPRS to me is how bare-bones it is. It was a home-grown application made at the VA in the 1970s (I think) that can literally fit on a USB drive. It's so easy to pull CSV files for clinical research and you can make templates and "smart phrases" or whatever.
- There is a strong, idiotic, and poorly-informed/executed attempt to change our EMR to Cerner, which I hate more than Epic.

Something that was important to me (maybe not everyone else here) are that the research opportunities are amazing as are the funding streams for said research. Additionally, the VA allows you to be 150% committed, meaning that you can keep you full-time (8/8 in VA lingo) salary from the VA and pull in whatever else at a 50% time commitment. Clear as mud? So for me this means that I pull in my academic affiliate's max allowed through grant funding obtained through said academic affiliate, which thankfully brings me closer to 550k, which is pretty good for getting paid to do what I want to do.

BIG CON
The VA is subject to oversight by Congress, and thus the trends (and some heads) at any given time change with the political vagaries of the day. Added onto this that are specific politicians that you can Google who have made it their life goal to privatize the VA and gut it into an insurance company. As much as I love sending a Gleason 3+3 in 1/12 cores of a 20 cc prostate for 40+ fractions of fake IMRT in the community due to my perceived incompetence by these politicians, many providers (not only RadOncs) have started to push back against the Koch brothers' agenda.

Long post, hopefully was worth a read. DM me if interested in VA RadOnc jobs. I'll try to check this site more than once every 2 years.

 

[radoncftw]

In the midst of purging online accounts I no longer use I fell down the rabbit hole and landed on this post. I'd like to give my opinion as a VA RadOnc. I enjoyed my VA rotation as a resident, even though the RadOnc service at that VA was...let's say...not amazing, because the patients are awesome and we had amazing physics and dosimetry. I went to a top residency program and intended to go into academics like a good little physician scientist, but I had the issue of a 3 body problem (minus gravity wells) so I was restricted geographically. The VA option (along with a faculty position at the nearby university) was presented by one of my mentors, and I was desperate so I followed up on it.

For me, I couldn't have been happier with my decision, but I also would have had no way of knowing that it was the perfect fit. Here are some point/counterpoints in no particular order, and certainly not meant to be exhaustive.

Salary
- max is 400k, and you would command more in the community (certainly not all academic institutions as per above discussion)
- max will be lifted in the very near future as a means for talent retention, salary per patient on your census is actually quite high (census is usually lighter than at PP or pure academic), and there are means to supplement your income through your academic affiliate (see below)

Physician quality
- 10 patients on-treat between 3 physicians being the cause for chaos sounds like hyperbole
- VA sites without academic affiliates and those in remote areas may suffer from this, but plan/treatment quality is something that the VA's National RadOnc Program (NROP) has tackled aggressively to equalize the quality of care (and hopefully light a fire under some physicians' butts to perform). Incompetence is not a problem at major VA centers, and new grads are unlikely to take a job in the VA boonies.

Bureaucracy
- I can't argue with this. This is 100% a daily problem for anything being done OUTSIDE of your department. The VA is very form-focused, meaning that the form has to be filled out correctly with the appropriate signature from the right person. The middleman glut is real.
- If you can gather your street smarts and aren't socially inept, you'll be able to finagle the things (imaging, send outs, housing, etc.) you want with little to no effort other than dropping a line to your colleague. I can get same-day PETs, but this requires knowing who to ask (and also that we have a cyclotron on-site) as some of my colleagues wait months. As with anything, a little social intelligence goes a long way.
- Also if your chief is smart (as all of ours are, humble brag) then they know what needs to be done to get new equipment, machines, etc. Our equipment is honestly fancier than many of the practices around us.

9-5
- The best lesson I learned from a visiting professor in residency was to protect your time as an attending. I have no problem compartmentalizing my clinical time to allow time for being a scientist, mentor, family man, etc.
- There are relatively few people at my VA or anyone else I work with through the NROP network who isn't working later in some shape or form, doing research, mentoring residents, etc. One may certainly treat it as a 9-5, but like anything, the individual will determine their level of work output and engagement.

EMR
- I freaking love CPRS (our EMR). I was/am a superuser for Epic, and I have to say that Epic is clunky, memory-hogging garbage. The beauty of CPRS to me is how bare-bones it is. It was a home-grown application made at the VA in the 1970s (I think) that can literally fit on a USB drive. It's so easy to pull CSV files for clinical research and you can make templates and "smart phrases" or whatever.
- There is a strong, idiotic, and poorly-informed/executed attempt to change our EMR to Cerner, which I hate more than Epic.

Something that was important to me (maybe not everyone else here) are that the research opportunities are amazing as are the funding streams for said research. Additionally, the VA allows you to be 150% committed, meaning that you can keep you full-time (8/8 in VA lingo) salary from the VA and pull in whatever else at a 50% time commitment. Clear as mud? So for me this means that I pull in my academic affiliate's max allowed through grant funding obtained through said academic affiliate, which thankfully brings me closer to 550k, which is pretty good for getting paid to do what I want to do.

BIG CON
The VA is subject to oversight by Congress, and thus the trends (and some heads) at any given time change with the political vagaries of the day. Added onto this that are specific politicians that you can Google who have made it their life goal to privatize the VA and gut it into an insurance company. As much as I love sending a Gleason 3+3 in 1/12 cores of a 20 cc prostate for 40+ fractions of fake IMRT in the community due to my perceived incompetence by these politicians, many providers (not only RadOncs) have started to push back against the Koch brothers' agenda.

Long post, hopefully was worth a read. DM me if interested in VA RadOnc jobs. I'll try to check this site more than once every 2 years.

if the salary cap is lifted, i would probably leave my job immediately.
I agree with you that the current salary, the pay per QOL is quite high but if you can make 500k+ in a VA system with similar QOL that would be literal perfection.

 

[OTN]

A pro for me was the patients, the vets were a good group overall to care for when I was in training.

 

[randomname2018]

Formerly VA employed.

Overall, I would be very cautious in recommending VA employment to anyone, regardless of time out of residency. Each VA hospital and radiation oncology department vary significantly. Some are excellent, yet most are not.

 

[Haybrant]

if the salary cap is lifted, i would probably leave my job immediately.
I agree with you that the current salary, the pay per QOL is quite high but if you can make 500k+ in a VA system with similar QOL that would be literal perfection.

This is already possible it seems based on people I’ve spoken with. Id be all over the position the poster mentioned above if I didn’t just buy a house where I live

 

[ramsesthenice]

A pro for me was the patients, the vets were a good group overall to care for when I was in training.

They are pretty great. We have an excellent VA on our campus and vets make up about 25% of my volume. I see the good and the bad of the whole thing. It’s unfortunate that because we don’t have a linac in the building, I can’t have any 8ths regardless of how many vets I treat. Which means no access to their EMR. And then there are the lovely beurocratic issues. I have found ways around a lot of things but the single biggest hassle is getting access to trials for Vets. Some of our surgeons and med oncs have dual appointments and one absolute requirement is that all vets do chemo and surgery at the VA. And they have a separate IRB which is notoriously hard to mesh with our own. On top of that, the one and only person who can submit IRB or DOD applications only works half time and is gone by 2:00 everyday she is in office (which I believe doesn’t include Fridays). What it boils down to is vets are not able to enroll in any trials which involve chemo or surgery because those require approval from the VA IRB as well as our own which takes nothing short of an act of god to accomplish. If I could treat at the VA, problem would be solved.

Despite what I just said, I don’t think the political realities of our VA are much different than our NCI CCC. The specifics are different, but I agree with above that if you are resourceful, you can find work around a to most things. Where I trained also had a VA that was basically on campus and they did have linacs and rad oncs with dual appointments. It was pretty sweet and I can totally see doing it. For the research oriented folks, there is another perk. VA merit awards and many of the larger R01 equivalent DoD grants typically have higher fund rates than the RO1 and access to VA patients is huge for these. Only annoying thing is the study sections turn over yearly and you can’t resubmit a grant to address reviewer critiques. All submissions are treated as new submissions. I’ve had one go from an overall score of 1.5 (definitely a near miss) one year to 4.1 the next year with basically the same proposal. It’s a bit of a funny system, but it works out for a lot of people.

 

[randomname2018]

This is already possible it seems based on people I’ve spoken with. Id be all over the position the poster mentioned above if I didn’t just buy a house where I live

I would be exceedingly cautious here. What you are told and what occurs are often different things. It is no different than typical academic ****ery, except it's layered in bureaucracy. The VA will win. Always.

It is possible to exceed the 400k cap. How it's done is important, and when it's done, you often aren't educated enough to understand the difference.

 

[deleted804959]

Agree not all VAs are the same. My VA is inextricably linked with a nearby academic institution, so we open NRG, SWOG, etc. studies, and are aggressive (passively, of course, since it is RadOnc) at chart rounds about appropriateness/quality of treatments. We generally have the problem of too many trials (sometimes competing) at our VA...but it's a good problem to have. I've seen some dubious treatments from other VA RadOncs at places that may not recruit as quality folks, but I think that mirrors what a patient would receive in that community outside of the VA as well. I'm productive research-wise, but may not be so if I worked at a VA in BFE, and certainly not all RadOncs where I work (or at similar callibur places) are involved in any sort of research.

And just to be clear, I make over the salary cap (I've got a few more years before I hit it) at the VA by pulling in $ through my academic department/institution. If the cap is lifted, I might be swayed to stop dividing my time, and I have tried various side hustles to see if I could ever match what I could pull in as a physician/researcher with my academic institution, and the $/hour was not even close. We're a dual income household, live simply (some may disagree), and have no plans on retiring because we like what we do.

Please DM with any questions. I'll delete my account at the end of this month (not being dramatic, just getting rid of old accounts).