I've been working for the VA since graduating fellowship about 2.5 years ago. As far as benefits, when you're working with your HR specialist who drafts your offer letter, remember to ask him or her to include in the letter that you qualify for EDRP (will reimburse you $120K over 5 years for your student loans). If it is not in your letter it is difficult to get the EDRP HR specialist to do submit an application on your behalf. Once you've started working, you'll have to bug the EDRP HR specialist to sign you up. This may take several months. My paperwork went through in about 4 months. My colleague's took over 12 months. The pension is very small in the current system. You'll accrue something like 1% of your total salary (base + market) per year served. You will get up to 5% matching on 401K. You are eligible to collect social security when you retire. The old retirement system had a more generous pension but no 401K and no social security. Based on the salary and retirement plan, it is unlikely that you can semi-retire at 50 (unless you have another source of income). You will likely enter as a Tier 1 step 1 physician. Each step increase occurs at 2 year intervals and pay increase will be dependent on the current physician pay table (which is divided by specialty). The pay table offers a large range of salaries so where exactly you fall will most likely be in the same ballpark as whatever university you're associated with (assuming you're at a VA which trains residents). Tier increase occurs if you get into the management structure (e.g. Director AP = Tier 2, Service Chief = Tier 3, Chief of Staff = Tier 4) and pay increase with each tier is restricted by pay tables. As far as the work environment, I think the VA physicians I've worked with in my department and outside of it provide excellent care. There are administrative aspects which can be challenging. It takes a very long time to get anything done in the system (such as hiring someone, purchasing equipment, remodeling a room). It can be quite painful if you care deeply about efficiency. On the other hand, the bureaucracy of the VA protects it from drastic changes. So I wouldn't worry too much about our new President. Plus, he just appointed a total insider to be the new VA Secretary.
