VA Radiation Oncology jobs?

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Barcelona PSG

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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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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.
 
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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.
 
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Doctorer said:
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.
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Guessing the academically affiliated ones may turn in better work.
 
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
 
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.
 
that would be surprising to me if that was still the case
 
medgator said:
Guessing the academically affiliated ones may turn in better work.
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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.
 
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Lamount said:
Everyone is pretty happy because they all leave by 430
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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.
 
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Barcelona PSG said:
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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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.
 
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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.
 
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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.
 
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TheWallnerus said:
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.
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The only place I ever witnessed RASO/LASO head and necks routinely (>10 years ago, tbf).
 
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
 
The benefits, PTO, hours, workload, and pension are substantial and should be factored in.
 
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MidwestRadOnc said:
The benefits, PTO, hours, workload, and pension are substantial and should be factored in.
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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.
 
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radoncftw said:
compared to academic + HCOL salaries, this is pretty good. especially given workload
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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.
 
Working with vets is it's own bonus as well. Typically kind, appreciative, and in-need folks. Professionally rewarding for sure.
 
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medgator said:
I've noticed many of my VA h&N pts tolerate tx like champs too. Many have been through a lot
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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
 
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TheWallnerus said:
Alcoholics tolerate HN XRT better than non alcoholics, an unwritten rule of rad onc imho
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need a drink GIF


There's no doubt about it.
 
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medgator said:
I've noticed many of my VA h&N pts tolerate tx like champs too. Many have been through a lot
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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.
 
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TheWallnerus said:
Alcoholics tolerate HN XRT better than non alcoholics, an unwritten rule of rad onc imho
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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.
 
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MidwestRadOnc said:
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.
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the good thing about a HN patient who drinks 12 beers a day is you know he'll get at least 1200 calories/day.
 
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Ray D. Ayshun said:
the good thing about a HN patient who drinks 12 beers a day is you know he'll get at least 1200 calories/day.
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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?
 
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"I don't drink any alcohol, just beer."
 
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grenz said:
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.
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I've always felt they would be best be served by getting automatic Medicare with a well funded plan F secondary/supplement
 
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good timing for this topic - there is an opening at VA Boston if anyone is interested feel free to DM me for info.
 
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radoncftw said:
don't get why people would do that.
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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
 
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