By Dr. James M. Dahle, WCI Founder

The Veteran's Administration (VA) is a good option for many doctors, yet most physicians don't even consider going to work there. Why not? There are a number of reasons.

 

Why Don't Doctors Work at the VA?

Let's go through the reasons one by one.

 

#1 Not Enough Positions

Counting dentists, there are approximately 1 million doctors in the US. Only around 26,000 of them work for the Veterans Administration. Obviously, all doctors cannot go work for the VA.

 

#2 You Can't Own the VA

When I left the military and was free to choose my “big boy” job, I only looked at positions that offered ownership. I wanted to be a partner, not an employee. Many other doctors feel the same way. When you own your job, you generally have more control over your workplace and more potential for a higher income. The VA doesn't offer ownership; all of its doctors are employees. So, if you want to own your job, you wouldn't even consider the VA.

 

#3 Some People Want Nothing to Do with the Military

The VA is not part of the military but it treats veterans, people who used to be in the military. Among some people, the military has a poor reputation. They don't want anything to do with it or those who would have anything to do with it, so they don't consider VA jobs.

 

#4 The VA Is a Government Job

On the same note, some people don't like the government. The VA is part of the government. That might turn off some potential VA docs.

 

#5 The VA Is a Big Bureaucracy

Even if someone has no ethical problem working for the government, the government does have its downsides, primarily that it is a huge bureaucracy. Private businesses are ruthlessly focused on the bottom line and seek to cut waste at every opportunity. Bureaucrats almost seem to thrive on waste. Decisions are often not made at the most appropriate level for the individual doctor and patient.

 

#6 Many Doctors Don't Understand the Value of Public Service Loan Forgiveness

Public Service Loan Forgiveness (PSLF) is available to full-time VA docs. This can be a huge benefit for a highly indebted doctor. Imagine a doctor who owes $400,000 in federal student loans and needs five more years after training to obtain PSLF. That's $400,000/5 = $80,000 AFTER-TAX per year. That might be the equivalent of being paid $120,000 more per year.

 

#7 VA Positions Often Don't Pay Very Well

Like the military, the VA publishes its pay tables. You can judge for yourself whether they're competitive, especially when compared with the average salary for a physician. Here's the pay table for:

  • Endocrinology
  • Endodontics
  • General Practice – Dentistry
  • Geriatrics
  • Infectious Diseases
  • Internal Medicine
  • Primary Care
  • Family Practice
  • Palliative Care
  • Periodontics
  • Podiatry (General)
  • Podiatry (Surgery-Forefoot, Rearfoot/Ankle, Advanced Rearfoot/Ankle)
  • Preventive Medicine
  • Prosthodontics
  • Rheumatology

 

VA Physician Pay Table 1

 

I don't know about you, but I view $116,000 as a starting PA salary, not a starting physician's salary. It doesn't get all that much better for other specialties. Here's the table for:

  • Allergy and Immunology
  • Hospitalist
  • Nephrologist
  • Neurology
  • Pathology
  • Physical Medicine & Rehabilitation/Spinal Cord Injury
  • Psychiatry

 

VA Physician Pay Table 2

 

Table 3 is for:

  • Pain Management (Interventional and Non-Operating Room (OR) Anesthesiology)
  • Cardiology (Non-Invasive)
  • Emergency Medicine
  • Gynecology
  • Hematology-Oncology
  • Nuclear Medicine
  • Ophthalmology
  • Oral Surgery
  • Pulmonary

 

VA Physician Pay Table 3

 

While maximum salaries are going up, the truth is that if you look at salary surveys, you know that the average income for an emergency physician is about $375,000. That's well above the max at the VA. What if you're in a “high-paying specialty?” You use Table 4 for the following specialties:

  • Anesthesiology
  • Interventional Radiology
  • Cardiology (Invasive/Non-Interventional)
  • Neurosurgery
  • Cardio-Thoracic Surgery
  • Orthopedic Surgery
  • Critical Care
  • Otolaryngology
  • Dermatology
  • Plastic Surgery
  • MOHS Radiology (Diagnostic)
  • Gastroenterology
  • Radiation Oncology
  • General Surgery
  • Urology
  • Interventional Cardiology
  • Vascular Surgery

 

VA Physician Pay Table 4

 

That's right, it tops out at $400,000. That's a heck of a pay cut for a typical invasive cardiologist, orthopedist, or neurosurgeon—even if it is equivalent to the salary of the president of the United States (the reason why the max is set at $400,000).

 

#8 The VA Physician Compensation Package Is Confusing

Just like the military, the actual compensation package you get at the VA is confusing and difficult to figure out. Like any good bureaucracy, the VA shoots itself in the foot by making VA physician employee benefits tricky to understand.

 

The Pension

For example, there is a pension. Sure, the VA takes out 4.4% of your salary and sticks it in there, but it also puts in 8.8% of your salary as a “match.” If you're being paid $200,000, that's like another $17,600 in compensation.

 

Survivor Benefits

After 10 years of employment, there's a survivor benefit for that pension.

 

Long-Term Disability Coverage

After 18 months of employment, there's a disability insurance benefit. It's probably not near as good as what you can buy with individual disability insurance, but it beats a kick in the teeth.

 

Health Insurance

You'll use the Federal Employee Health Benefits (FEHB). There are several different choices, and the VA picks up 75% of the cost of premiums for you and your family members to age 26.

working for the va

 

Dental and Vision

The Federal Employees Dental and Vision Insurance Program (FEDVIP) covers you and your family members up to age 22.

 

No-Exam Life Insurance

If you sign up within your first 60 days, you can buy some life insurance too at a “discounted” rate via the Federal Employees Group Life Insurance (FEGLI).

 

Another Student Loan Payment Program

Completely separate from PSLF, the VA offers the Education Debt Reduction Program (EDRP) ($40,000 per year for up to five years). It's not just doctors who can qualify, but it is specialty dependent. Basically, if the VA is having trouble recruiting your specialty, it offers this program to you. Unlike PSLF, the benefit is taxable. However, this program will cover the payments (via reimbursement) on your loans while waiting for PSLF. Or it can be used for private student loans.

 

Yet Another Student Loan Payment Program

The Specialty Education Loan Repayment Program is similar, designed for relatively new attendings in certain specialties (the most recent list I saw included: family medicine, internal medicine, gastroenterology, psychiatry, emergency medicine, and geriatrics). It's good for $40,000 per year for up to four years, with each payment coming with a one-year service obligation.

 

Other Programs You May Also Qualify for

Just like the military, the VA has a Health Professions “Scholarship” (i.e. contract) Program. It pays for med school and you owe 18 months of service for each year it pays for. But there's no military match and no deployments. It's also pretty competitive with only 50ish spots in the US. There is also a “Veterans Healing Veterans” scholarship program (12ish spots per year) and a “Specialty Education Loan Repayment” program (100ish people per year) worth looking into.

Depending on your specialty and alternatives, once you add up all the benefits (particularly PSLF), you may find that your compensation package is actually higher at the VA.

 

#9 People Don't Value a Reduced Workload

As a typical salaried bureaucracy, there is little incentive to work super hard and squeeze extra patients into clinic or the OR. As a result, your pace at work may be significantly less than you might find in a private practice job. If you just compare salaries, the VA may look bad, but if you consider the pay per amount of work done, maybe it isn't too bad.

 

#10 People Don't Value Reduced Licensing and Job Change Hassle

The VA is a national organization. You can switch locations and even states while keeping the same employer. Plus, you can just get a “federal” medical license, which is much less hassle than many state licenses, especially if you need more than one of them.

 

#11 People Don't Value the VA Population and the Ability to Care For Them

The VA population consists entirely of people who volunteered to serve their country. That's a pretty special group of people. It also hedges toward the more impoverished side of society, since many veterans only qualify for VA care if their income is below a certain amount. Yet they can get the best care you can offer despite their limited circumstances. You get to care for people who really can't afford to pay you, all without reducing your own income!

 

#12 The VA May Not Offer the Practice You Are Looking for

There are lots of things the VA does not offer at all, and it certainly does not offer every service in every location. For example, if you're an emergency doc looking to practice in a busy trauma center, you're not going to like working at the VA. While the VA offers more and more obstetric and gynecologic services, most of it is outsourced to community resources. I may be wrong, but I don't think there are any labor decks at any VA center. And forget about pediatrics. The more specialized you are, the more difficult it is going to be for you to get a VA job. While there is often an opportunity to teach residents and students rotating through the VA, a VA-only job is not a classic academic job either.

 

The Bottom Line

People don't go to work for the VA for lots of reasons. However, ignorance should not be one of them. Know what opportunities are available at the VA and pursue them if they make sense for you.

What do you think? Do you work for the VA? What did I miss? What do you like about your job? Have you considered working for the VA? Why or why not? Comment below!