Working at the VA

[iownmle]

So I really don't understand why people think VA benefits are so great. I am private sector offers similar if not better benefits plus more salary. Also I don't understand what the complaints about VA red tape are. I mean, private hospitals have to deal with prior auth and arguing with insurance. You don't do that in the VA. I feel like VA is really a place that makes less for less work. It's not that bad and it's not that great.

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[WisNeuro]

So I really don't understand why people think VA benefits are so great. I am private sector offers similar if not better benefits plus more salary. Also I don't understand what the complaints about VA red tape are. I mean, private hospitals have to deal with prior auth and arguing with insurance. You don't do that in the VA. I feel like VA is really a place that makes less for less work. It's not that bad and it's not that great.

Don't you have people to do that for you in your hospital?

 

[Psychresy]

So I really don't understand why people think VA benefits are so great. I am private sector offers similar if not better benefits plus more salary. Also I don't understand what the complaints about VA red tape are. I mean, private hospitals have to deal with prior auth and arguing with insurance. You don't do that in the VA. I feel like VA is really a place that makes less for less work. It's not that bad and it's not that great.

What are these private benefits?

 

[WisNeuro]

What are these private benefits?

Good question, I've never seen a non-VA or non-state position offer a pension. I will say my income potential is much higher outside of the VA for the same hourly work, but in general, the VA benefits were better than most of what I've seen offered at other institutional positions. I just value more flexibility and not having to adhere arbitrary rules in the VA system.

 

[Psychresy]

Good question, I've never seen a non-VA or non-state position offer a pension. I will say my income potential is much higher outside of the VA for the same hourly work, but in general, the VA benefits were better than most of what I've seen offered at other institutional positions. I just value more flexibility and not having to adhere arbitrary rules in the VA system.

They also offer 40k a year towards student loans. How common is it for private employers to give loan reimbursement?

 

[Attending1985]

They also offer 40k a year towards student loans. How common is it for private employers to give loan reimbursement?

Ime pretty common

 

[WisNeuro]

They also offer 40k a year towards student loans. How common is it for private employers to give loan reimbursement?

Spotty, more available in harder to fill areas., not so much in desirable metros, I didn't have any loans, so in one instance of a job offer at a place that had some loan reimbursement I just tried to use it to negotiate up other benefits.

 

[wolfvgang22]

I currently work for the VA. Student loan assistance is a max of 24K yearly for loans, dollar for dollar match for five years or until your med school loans are paid off. At least it was as of last year, I haven't looked in 2021.

I'll speak mostly to some of the positives specific to the VA off the top of my head, since the negatives are well documented already all the time. It's nice to not have to worry about carrying malpractice insurance if you work only at the VA, and having a lower risk of being sued is nice (patients generally have to sue the government first, not you directly.) However, not having to carry malpractice insurance is offset by higher non-VA salary. With the pension - if you can make more money outside the VA and invest it into your retirement, the VA is not any better just because it has the FERS pension. But if you are not great with money, the VA can be a good option. You're not going to get rich working at the VA, but it can be a long and rewarding career and it's not financially worse than public mental health or academia overall.

Not having to do a lot of prior auths or utilization review communication with insurance companies is nice, but that is offset in the VA by the large amount of aribtrary paperwork/documentation you have to do in the VA, which is honestly the worst part of being at the VA.

With the VA you can have any state license and practice at any VA, which is nice. You can move city to city and not worry about rolling over your retirement accounts. Heck, you can even prescribe using the VA hospital's DEA and not have your own if you want (I don't advise it.) The VA is more predictable as far as getting steady cost of living and tenure raises (step grade raises) so you can keep up with inflation. It's steady work for doctors who don't want to be entrepreneurs or take the peanuts academia offers and all the academic politics. And you can still teach residents and medical students as an adjunct prof.

If you like helping veterans, of course the VA is the way to go. I have seen the VA in general improve greatly over the last 15 years in pretty much every area. You always see news stories about what went wrong at some VA somewhere. Ever wonder why that is? Is it because bad things don't happen at non-VA clinics and hospitals? No, it is because by law the VA has to be transparent and give information to the media when asked. That transparency improves care.

The VA offers a lot of ancillary resources not available in other public or private mental health care settings, at minimal cost to veterans compared to non-VA care. I love that I have staff that can refer my patients to an inpatient dual-diagnosis rehab fairly easily, access to rTMS, ECT, and have an intensive case management staff. Lots of times patients don't have as nearly as good access to those things that outside the VA, that is certainly true in my state that always seems to vote against supporting any mental health care initiatives. The VA has easy to use and robust telepsychiatry opportunities and you can get paid the same as you would in person. The VA offers lots of free good quality CME all the time, the main issue is getting time away from your duties to attend, but overall that's a good problem to have.

Go to the VA and look around at the employees and note what type of people you see. The VA is a diverse place to work, not just at the MD level but in most jobs, whether you are on the coast, in the mid-west, in a city, or at a rural VA. There is a reason people of color work for the VA, and it's because federal careers provide stability and better protections against discrimination. I'm proud of that. In my experience, there is a lot more racism and discrimination in institutions outside the VA.

Finally I'll say this, as far as your individual work experience in a VA and It's the same thing my veteran patients say: "If you've seen one VA, you've seen one VA." Some of the VA's are great places to work and get care, others aren't as good. The VA is the largest hospital system in the nation. How nice it is to be at a particular VA, like anywhere else, has a lot to do with the local administration and department leadership and co-workers. If they are committed to helping and good at what they do, and generally nice people, it can be nice. I'm currently at what is considered a very good VA hospital, and we have veterans come from surrounding states and travel extra hours to come here instead of the VA in their own area because they get more personal care here and we have good staff. I will say that in the past I thought of leaving, but that is because I was overworked and we are short staffed. (Steps were taken to retain my services, so that was nice - I'm at a location that is currently good to work for.) But, again, being overworked and burned out is not specific to the VA system, I see that in public health and even academic centers.

 

[Fan_of_Meehl]

So I really don't understand why people think VA benefits are so great. I am private sector offers similar if not better benefits plus more salary. Also I don't understand what the complaints about VA red tape are. I mean, private hospitals have to deal with prior auth and arguing with insurance. You don't do that in the VA. I feel like VA is really a place that makes less for less work. It's not that bad and it's not that great.

One thing to consider are the trends in 'mental health administration/'leadership'' over the past few years as well as what is likely to happen over the next 5-10 years in the VA system. Generally, as a psychotherapist, you're dealing with cumulative increases in paperwork/ software programs (without commensurate increase in time as a resource), increasing oversight/'accountability' for successful implementation of measurement-based care (read, taking veteran self-report on symptom checklists as an unerring 'gold standard' measure of the treatment targets of interest...while completely ignoring the fact that they realize that their self-reported symptom severity is liable to directly impact their monthly income from service-connection), an absolutely mentally-******ed approach (top-down) to 'treatment planning' via mandates to use a software package/approach that doesn't comport with the way actual (master) psychotherapists do case formulation, treatment planning, and implementation, as well as (given all of the above) a top-down authoritarian management structure that has grown increasingly deaf (even hostile) toward good-faith efforts of experienced and capable clinicians to even broach the above topics and attempt to engage in an 'adult conversation' (i.e., not filled with tropes, thought-terminating cliches, mindless enthusiastic utopian pom-pom waving or drum circle pep rally speeches).

At least we have a 'union.'

 

[wolfvgang22]

One thing to consider are the trends in 'mental health administration/'leadership'' over the past few years as well as what is likely to happen over the next 5-10 years in the VA system. Generally, as a psychotherapist, you're dealing with cumulative increases in paperwork/ software programs (without commensurate increase in time as a resource), increasing oversight/'accountability' for successful implementation of measurement-based care (read, taking veteran self-report on symptom checklists as an unerring 'gold standard' measure of the treatment targets of interest...while completely ignoring the fact that they realize that their self-reported symptom severity is liable to directly impact their monthly income from service-connection), an absolutely mentally-******ed approach (top-down) to 'treatment planning' via mandates to use a software package/approach that doesn't comport with the way actual (master) psychotherapists do case formulation, treatment planning, and implementation, as well as (given all of the above) a top-down authoritarian management structure that has grown increasingly deaf (even hostile) toward good-faith efforts of experienced and capable clinicians to even broach the above topics and attempt to engage in an 'adult conversation' (i.e., not filled with tropes, thought-terminating cliches, mindless enthusiastic utopian pom-pom waving or drum circle pep rally speeches).

At least we have a 'union.'

Yeah, I feel for the therapists. I mostly do medication management and have had somewhat less to do with these issues. Also, LPCs, LMSWs, and even PhD psychologists seem like they have to take more from admin than physicians. A lot of the things said to them as requirements are more suggestions to physicians, at least around here.

Veteran entitlement is an issue at times, but I guess I'd rather have that problem compared to having more veterans who deserve benefits not get them as happened to many veterans who served prior to 9/11, but seems to happen less with the current generation of veterans (i.e.; OIF/OEF). There is sort of a undertone of "you are a bad American" if you say no to a veteran a lot of times. Patient satisfaction coupled with rah rah patriotism irks me sometimes. And I say no a lot to inappropriate benzos.

 

[comp1]

The really cool thing is...veterans CAN get therapy at the VA. It's a lot harder outside and a real benefit to the med management people.

 

[AcronymAllergy]

I currently work for the VA. Student loan assistance is a max of 24K yearly for loans, dollar for dollar match for five years or until your med school loans are paid off. At least it was as of last year, I haven't looked in 2021.

I'll speak mostly to some of the positives specific to the VA off the top of my head, since the negatives are well documented already all the time. It's nice to not have to worry about carrying malpractice insurance if you work only at the VA, and having a lower risk of being sued is nice (patients generally have to sue the government first, not you directly.) However, not having to carry malpractice insurance is offset by higher non-VA salary. With the pension - if you can make more money outside the VA and invest it into your retirement, the VA is not any better just because it has the FERS pension. But if you are not great with money, the VA can be a good option. You're not going to get rich working at the VA, but it can be a long and rewarding career and it's not financially worse than public mental health or academia overall.

Not having to do a lot of prior auths or utilization review communication with insurance companies is nice, but that is offset in the VA by the large amount of aribtrary paperwork/documentation you have to do in the VA, which is honestly the worst part of being at the VA.

With the VA you can have any state license and practice at any VA, which is nice. You can move city to city and not worry about rolling over your retirement accounts. Heck, you can even prescribe using the VA hospital's DEA and not have your own if you want (I don't advise it.) The VA is more predictable as far as getting steady cost of living and tenure raises (step grade raises) so you can keep up with inflation. It's steady work for doctors who don't want to be entrepreneurs or take the peanuts academia offers and all the academic politics. And you can still teach residents and medical students as an adjunct prof.

If you like helping veterans, of course the VA is the way to go. I have seen the VA in general improve greatly over the last 15 years in pretty much every area. You always see news stories about what went wrong at some VA somewhere. Ever wonder why that is? Is it because bad things don't happen at non-VA clinics and hospitals? No, it is because by law the VA has to be transparent and give information to the media when asked. That transparency improves care.

The VA offers a lot of ancillary resources not available in other public or private mental health care settings, at minimal cost to veterans compared to non-VA care. I love that I have staff that can refer my patients to an inpatient dual-diagnosis rehab fairly easily, access to rTMS, ECT, and have an intensive case management staff. Lots of times patients don't have as nearly as good access to those things that outside the VA, that is certainly true in my state that always seems to vote against supporting any mental health care initiatives. The VA has easy to use and robust telepsychiatry opportunities and you can get paid the same as you would in person. The VA offers lots of free good quality CME all the time, the main issue is getting time away from your duties to attend, but overall that's a good problem to have.

Go to the VA and look around at the employees and note what type of people you see. The VA is a diverse place to work, not just at the MD level but in most jobs, whether you are on the coast, in the mid-west, in a city, or at a rural VA. There is a reason people of color work for the VA, and it's because federal careers provide stability and better protections against discrimination. I'm proud of that. In my experience, there is a lot more racism and discrimination in institutions outside the VA.

Finally I'll say this, as far as your individual work experience in a VA and It's the same thing my veteran patients say: "If you've seen one VA, you've seen one VA." Some of the VA's are great places to work and get care, others aren't as good. The VA is the largest hospital system in the nation. How nice it is to be at a particular VA, like anywhere else, has a lot to do with the local administration and department leadership and co-workers. If they are committed to helping and good at what they do, and generally nice people, it can be nice. I'm currently at what is considered a very good VA hospital, and we have veterans come from surrounding states and travel extra hours to come here instead of the VA in their own area because they get more personal care here and we have good staff. I will say that in the past I thought of leaving, but that is because I was overworked and we are short staffed. (Steps were taken to retain my services, so that was nice - I'm at a location that is currently good to work for.) But, again, being overworked and burned out is not specific to the VA system, I see that in public health and even academic centers.

To add to this--I've never seen a VA with a non-compete. VA has some pretty straightforward limitations (e.g., don't refer patients eligible for VA care to your own non-VA practice for the same services you provide at VA; don't use VA resources for non-VA work), but not much beyond that.

Also, if you like training and in addition to adjunct intructorship/professorship, odds are the VA system itself will have trainees with whom you can be involved in varying capacities. And there's at least a chance you'll get some protected time for this. I'm often able to request to block a psychiatrist's schedule for an hour so they can present a seminar to psychology interns, for example.

On the downside, as others have said and as can probably be the case anywhere, VA is a somewhat top-heavy organization, and having a bad boss can be really frustrating/demoralizing.

 

[comp1]

No non-competes and no moonlighting restrictions at the VA except the straight up conflicts of interest described above.

 

[DrVan Nostrand]

I currently work for the VA. Student loan assistance is a max of 24K yearly for loans, dollar for dollar match for five years or until your med school loans are paid off. At least it was as of last year, I haven't looked in 2021.

I'll speak mostly to some of the positives specific to the VA off the top of my head, since the negatives are well documented already all the time. It's nice to not have to worry about carrying malpractice insurance if you work only at the VA, and having a lower risk of being sued is nice (patients generally have to sue the government first, not you directly.) However, not having to carry malpractice insurance is offset by higher non-VA salary. With the pension - if you can make more money outside the VA and invest it into your retirement, the VA is not any better just because it has the FERS pension. But if you are not great with money, the VA can be a good option. You're not going to get rich working at the VA, but it can be a long and rewarding career and it's not financially worse than public mental health or academia overall.

Not having to do a lot of prior auths or utilization review communication with insurance companies is nice, but that is offset in the VA by the large amount of aribtrary paperwork/documentation you have to do in the VA, which is honestly the worst part of being at the VA.

With the VA you can have any state license and practice at any VA, which is nice. You can move city to city and not worry about rolling over your retirement accounts. Heck, you can even prescribe using the VA hospital's DEA and not have your own if you want (I don't advise it.) The VA is more predictable as far as getting steady cost of living and tenure raises (step grade raises) so you can keep up with inflation. It's steady work for doctors who don't want to be entrepreneurs or take the peanuts academia offers and all the academic politics. And you can still teach residents and medical students as an adjunct prof.

If you like helping veterans, of course the VA is the way to go. I have seen the VA in general improve greatly over the last 15 years in pretty much every area. You always see news stories about what went wrong at some VA somewhere. Ever wonder why that is? Is it because bad things don't happen at non-VA clinics and hospitals? No, it is because by law the VA has to be transparent and give information to the media when asked. That transparency improves care.

The VA offers a lot of ancillary resources not available in other public or private mental health care settings, at minimal cost to veterans compared to non-VA care. I love that I have staff that can refer my patients to an inpatient dual-diagnosis rehab fairly easily, access to rTMS, ECT, and have an intensive case management staff. Lots of times patients don't have as nearly as good access to those things that outside the VA, that is certainly true in my state that always seems to vote against supporting any mental health care initiatives. The VA has easy to use and robust telepsychiatry opportunities and you can get paid the same as you would in person. The VA offers lots of free good quality CME all the time, the main issue is getting time away from your duties to attend, but overall that's a good problem to have.

Go to the VA and look around at the employees and note what type of people you see. The VA is a diverse place to work, not just at the MD level but in most jobs, whether you are on the coast, in the mid-west, in a city, or at a rural VA. There is a reason people of color work for the VA, and it's because federal careers provide stability and better protections against discrimination. I'm proud of that. In my experience, there is a lot more racism and discrimination in institutions outside the VA.

Finally I'll say this, as far as your individual work experience in a VA and It's the same thing my veteran patients say: "If you've seen one VA, you've seen one VA." Some of the VA's are great places to work and get care, others aren't as good. The VA is the largest hospital system in the nation. How nice it is to be at a particular VA, like anywhere else, has a lot to do with the local administration and department leadership and co-workers. If they are committed to helping and good at what they do, and generally nice people, it can be nice. I'm currently at what is considered a very good VA hospital, and we have veterans come from surrounding states and travel extra hours to come here instead of the VA in their own area because they get more personal care here and we have good staff. I will say that in the past I thought of leaving, but that is because I was overworked and we are short staffed. (Steps were taken to retain my services, so that was nice - I'm at a location that is currently good to work for.) But, again, being overworked and burned out is not specific to the VA system, I see that in public health and even academic centers.

if you had to estimate, what percentage of your patients are male/female ?

 

[comp1]

Female veterans are about 9.4% of the population. However, women are statistically more likely to seek help, particularly mental health help. So I'd estimate about 15% on inpatient units. It will vary a lot by what exactly you do, of course.

 

[wolfvgang22]

if you had to estimate, what percentage of your patients are male/female ?

75% male in my clinic. I occasionally see pregnant or lactating veterans. A few transgender also. Given the sheer size of my panel I see a lot of female veterans.

Regarding age, generally age 25 and up, with majority of all genders being over 60. The two main groups I see are Vietnam and Afghanistan/Iraq. Third largest group is 80s and early 90s veterans. I still have one or two Korean war combat veterans. Those guys are really neat people.

Also, regarding orientation, I reckon I see LGTBQ in about the same proportion as seen in most non -VA clinics.

 

[Stagg737]

Like you said, if you've seen one VA you've seen one VA, but some things I thought were worth addressing as I've worked in 3 VAs now:

If you like helping veterans, of course the VA is the way to go. I have seen the VA in general improve greatly over the last 15 years in pretty much every area.

I generally do agree with this. The primary VA I work at has one of the nicest/newest inpatient units in the city and the outpatient clinic has improved significantly even in the past year or two.

The VA offers a lot of ancillary resources not available in other public or private mental health care settings, at minimal cost to veterans compared to non-VA care. I love that I have staff that can refer my patients to an inpatient dual-diagnosis rehab fairly easily, access to rTMS, ECT, and have an intensive case management staff. Lots of times patients don't have as nearly as good access to those things that outside the VA

This I disagree with though. I've never seen a VA that offered TMS and ECT is highly variable (only in 1 of the 3 VAs I've worked at). All of the VA's I've worked at also only offer a maximum of 12 sessions of psychotherapy (outside of the PTSD program). If ongoing therapy is needed patients have to be referred out and it doesn't always get approved. There is an excellent residential PTSD program in our VISN though, which from what I've heard is better than any of the private options in our area. One thing I will say is that the VA does often do a good job of offering a referral to a private program if it's not available through our VA(s). The few patients I've referred out for TMS have been approved and they do often approve referrals to residential programs not available through the VA. There's also very good wrap-around support through CM and SW, which is one thing I do wish would become more common outside the VA.

Go to the VA and look around at the employees and note what type of people you see. The VA is a diverse place to work, not just at the MD level but in most jobs, whether you are on the coast, in the mid-west, in a city, or at a rural VA. There is a reason people of color work for the VA, and it's because federal careers provide stability and better protections against discrimination. I'm proud of that. In my experience, there is a lot more racism and discrimination in institutions outside the VA.

This will vary a lot as well. Other than the ancillary staff the VAs I've worked at have been much less diverse than our local private hospitals and there is a very obvious divide based on position (many Asian and black nurses, Almost exclusively white and Indian physicians). In terms of racism, it's a mix in terms of employees and not that different than outside the VA (maybe a little worse). The VA patients as a whole are much more racist than the gen pop though, this was true at all VAs I've been at in 2 different geographical regions.