Working as an Interventional Pain Physician at a VA hospital?

[drg123]

Some positions have opened up for me at VA hospitals as a pain physician. This would be my first job out of training. I know VAs can be bureaucratic and lower volume than non-gov jobs, but certain aspects are attractive, such as definite salary, no production pressure, limited obstacles to offering interventions of my choosing since no prior auth, good benefits and time off. Downsides as far as I can see are CPRS, salary ceiling, slowness and culture of staff, difficulty of moving from lower volume environment to higher volume environment in case switch out of VA later on. I'm PM&R background but would work as an interventional pain physician (ACGME fellowship trained).

What are people's thoughts/experiences with a VA pain job? I know it's also very site specific. As they say, 'when you've seen one VA, you've seen one VA'.

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[willabeast]

Location, location , location. There are a few VAs I would love to work at. In nice locations associated with excellent teaching hospitals/medical schools. For example La Jolla V.A. Nice place to work. Or at least it used to be, have not been back for many years.

 

[Espn123]

Biggest downside is likely financial

 

[Baron Samedi]

Prescribing culture and whose problem it ends up being varies drastically from VA to VA.

 

[drg123]

Biggest downside is likely financial

In absolute sense, yes. But from a per-effort rate, VA can't be beat. Probably like $100/RVU or more.

 

[BobBarker]

Don’t limit yourself early in your career.

 

[BobBarker]

what are you looking for as far as comp, patient load, etc? I am actively hiring and even if you want to work less than me we can make that work.

 

[TheLoneWolf]

Some positions have opened up for me at VA hospitals as a pain physician. This would be my first job out of training. I know VAs can be bureaucratic and lower volume than non-gov jobs, but certain aspects are attractive, such as definite salary, no production pressure, limited obstacles to offering interventions of my choosing since no prior auth, good benefits and time off. Downsides as far as I can see are CPRS, salary ceiling, slowness and culture of staff, difficulty of moving from lower volume environment to higher volume environment in case switch out of VA later on. I'm PM&R background but would work as an interventional pain physician (ACGME fellowship trained).

What are people's thoughts/experiences with a VA pain job? I know it's also very site specific. As they say, 'when you've seen one VA, you've seen one VA'.

I know a grad from my program, did residency and fellowship in same place and spent lots of time at the pain department at the VA. Joinwd the VA full time as 1 of 2 pain docs. Burned out and left pain altogether within 2 years.

 

[BobBarker]

How can one burn out at the VA? When I worked there for 6 months during fellowship the RFA machine did not work, so wasn’t possible to burn anything there.

 

[MitchLevi]

8 clinic pts before lunch, 7 injections after lunch.

A veritable wind tunnel of action.

 

[drg123]

I know a grad from my program, did residency and fellowship in same place and spent lots of time at the pain department at the VA. Joinwd the VA full time as 1 of 2 pain docs. Burned out and left pain altogether within 2 years.

thanks for the info. burnout is probably important to define here. did he get fed up with the bureaucratic hurdles or the amount of work he had to do? I suspect the former, but would be interested to know.

 

[BobBarker]

8 clinic pts before lunch, 7 injections after lunch.

A veritable wind tunnel of action.

Yes, exactly. We had a hell of a volleyball game at lunch though. Green scrubs dripping with sweat. Syrians are very intense about volleyball.

 

[Agast]

I have dreams about retiring to a VA clinic and working long enough to get those sweet sweet government benefits

 

[lobelsteve]

Yes, exactly. We had a hell of a volleyball game at lunch though. Green scrubs dripping with sweat. Syrians are very intense about volleyball.

When I was an intern in IM on VAMC rotation (ICU/floors), we had nightly basketball games in the gym at the hospital. Full court. Salem VAMC. Ahh, the good old days. Lunch with attendings, low census, Dr. Miki Mizuki beach house party.

 

[MitchLevi]

A busy procedure day is 10. This is despite the fact the line to get a clinic visit is months and months long.

 

[SSdoc33]

this is all about how you envision your work environment. i literally could not spend 30-45 minutes in a room with a patient. or 1-2 shots/hour. your day will drag on even though you dont have that many patients.

if you want this sort of pace and sort of life, then great, then VA is a good fit.

it isnt really even about the $$$. i would rather see 30 patients in a day than 10. it is hard to know this coming out of fellowship, but it is better to be busy at work than not busy. even for equal $$$ IMHO

 

[sloh]

Boredom is one of the most underrated and bad feelings ever. The VA.

 

[MitchLevi]

your day will drag on even though you dont have that many patients.

Can't agree more.

The slower the pace the worse I feel.

The VA forces inefficiency on you so it's impossible to streamline your service. You'll fight and bicker with your staff as if they're your peers (they're not your freaking peers btw).

They'll argue with you openly in front of pts and use passive-aggressive behavior knowing they can't be fired.

Private practice...That BS doesn't fly. I fired my first MA for that behavior, and I did it 1 week before Thanksgiving (single mother of 2). If you can't hire and fire avoid PP. It isn't easy.

I would avoid the VA until you're older.

 

[SC Tian]

Some historical HOPDs can be as bad even with high $ per RVU offered IMO

 

[Doctodd]

nobody mentioning the nursing/support staff? Im shocked.

 

[MitchLevi]

nobody mentioning the nursing/support staff? Im shocked.

I did.

 

[Baron Samedi]

nobody mentioning the nursing/support staff? Im shocked.

The worst is when you end up "supervising" them. I legitimately probably meet DSM criteria for PTSD after that experience.

 

[Agast]

Private practice...That BS doesn't fly. I fired my first MA for that behavior, and I did it 1 week before Thanksgiving (single mother of 2). If you can't hire and fire avoid PP. It isn't easy.

Egads, you’ll get a visit from the Ghost of Thanksgiving Past!

 

[hyperalgesia]

I think the best option nowadays is for your first job to give top priority to go where there is +++need and opportunity at a rural hospital (HOPD) in a LCOL area, where most people don't want to go but the hospital REALLY wants you. In a place like this, you have leverage.

After 15 years of building a practice at a local hospital to YOUR standards, then you can consider slowing down, going part time, moving to your desired area, etc.

The best way to capitalize on VA benefits is to go there 5 years before federal retirement age. 5 consecutive years prior to federal retirement is what gets you the coveted FEHB, which is affordable health insurance coverage post-retirement. By the way, ANY federal job gives you that. If you're burned out of medicine and want to work for Fish and Wildlife, you also get that. The money at VA, compared with the first example, is not in the same ballpark.

 

[clubdeac]

I worked there for 6 years. Great hrs but honestly depressing and psychologically stressful as crazy as that sounds.

I had one room to see patients. Had to room them myself. Came in every morning and had to rearrange the room as the cleaning staff from the night before would destroy my set up. Also had to do all the menial **** MAs are supposed to do. day after day of that you burn out. Death by a thousand cuts. I will say I was apparently the highest paid pain doc in the entire system so I was told and the hrs were great. And every VA is different

 

[Baron Samedi]

Working there is like eating ground up earthworms for every meal. You won't starve and you might eventually get used to it, but you deserve so much better.

 

[Agast]

Working there is like eating ground up earthworms for every meal. You won't starve and you might eventually get used to it, but you deserve so much better.

 

[epidural man]

Haha.

I saw a movie once - Called The Hunt for the Wilder People. It became my favorite movie of all time. Later, Taika Waititi did another movie called Jo Jo Rabbit. That then became my favorite movie.

He just did another one - Next Goal Wins. I haven't been in a theater in a while but went to see this. It was a great movie - but it didn't topple my favorite movie.

I really enjoyed the movie you link above as well as the TV series made from it. I also have enjoyed "Our Flag Means Death" on HBO.

And the best Thor was the one Waititi directed.

I've only seen a few episodes of Reservation Dogs when my wife is watching - but it looks high quality.

I tell ya - that Taika Waititi is good at this stuff.

 

[SeniorWrangler]

It’s gonna be slow and trying to speed things up will only cause pain, if you can accept that it’s not bad, they say. I just looked at the listings on USAJobs.gov and the compensation is not great for a proceduralist.