By Dr. Jim Dahle, WCI FounderThe Veteran's Administration (VA) is a good option for many doctors, yet most physicians don't even consider going to work there. Why don't doctors want to work at the VA? There are several reasons.
#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. 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.
More information here:
What It’s Like to Be a Military Doctor — and Is It the Right Path for You?
#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:
- Allergy and Immunology
- Endocrinology
- Endodontics
- Family Medicine
- General Practice – Dentistry
- Geriatrics
- Health Informatics
- Hospitalist
- Infectious Diseases
- Internal Medicine
- Neurologist
- Nocturnist
- Palliative Care
- Periodontics
- PM&R
- Podiatry (General)
- Preventive Medicine
- Prosthodontics
- Psychiatry
- Rheumatology
- Sleep Medicine
I don't know about you, but I view $121,000 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:
- Anesthesiology
- Cardiology (Non-Invasive)
- Cardiology (Invasive/Non-Interventional)
- Cardio-Thoracic Surgery
- Critical Care
- Dermatology
- Emergency Medicine
- Gastroenterology
- General Surgery
- Gynecology
- Hematology-Oncology
- Interventional Cardiology
- Interventional Radiology
- Nephrologist
- Neurosurgery
- Nuclear Medicine
- Ophthalmology
- Oral Surgery
- Orthopedic Surgery
- Otolaryngology
- Pain Management (Interventional and Non-Operating Room (OR) Anesthesiology)
- Pathology
- Plastic Surgery
- Podiatry (Surgery — Forefoot, Rearfoot/Ankle, Advanced Rearfoot/Ankle)
- Pulmonary
- Radiology
- Radiation Oncology
- Urology
- Vascular Surgery
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 nearly 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.
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. Like PSLF, the benefit is tax-free. 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 Where You May Also Qualify
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 exploring.
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.
More information here:
How Much Do Military Physicians Make?
#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.
More information here:
How Much Money Do Doctors Make a Year? The Average Salary Is Dropping
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?
I am a physician-scientist who has practiced in the VA for almost 20 years. I come from a family with no military connections and happened to get a job in the VA out of residency because my mentor worked there. I was pleasantly surprised and have found it to be an incredibly satisfying career. What I have not seen mentioned in this article or the comments yet is what I see as one of the great benefits of working as a physician at the VA – typically having more time per patient to address complex needs. This is of course a trade off; salaries are typically lower than in the private practice sector where providers tend to see more patients per day with less time per visit. But being able to take the time to address complex patient needs and not feeling as rushed feels deeply satisfying and I think helps prevent physician burnout. And as others have mentioned, not having to deal with pre-or post-authorizations with insurance companies also helps prevent burnout probably. I have found my colleagues at the VA be incredibly dedicated and caring physicians. I also find a sense of great meaning in caring for veterans who have served our country, and especially the many who are down and out now in civilian life. As this article lays out clearly, a VA career is definitely not for everyone, but there are many advantages that I think residents are not aware of.
I am a retired Orthopedic Surgeon that worked at the VA for the last 5 years of my career. They needed someone that did joint replacements in addition to general Orthopedics. After many years in PP, I really enjoyed the more relaxed pace of work at the VA, in addition to help with the backlog of joint replacements, including reverse shoulder arthroplasties. We ended doing about 350 of them in the 3 years I was doing surgeries there, before I stopped doing surgeries. Then I did an injection pain clinic until the pandemic forced me to retire. I found the system very good. The nurses and PAs were excellent. The patients really did appreciate what we did for them. I was surprised about the amount of shoulder problems they have, maybe it is because the heavy loads they have to carry while in active duty. The salary was about $320,000 plus a bonus of $25,000. It was enough for me at that stage in my life. I had no debt; my kids were all done with college. In summary, I enjoyed serving my country very much and the veterans that sacrificed so much for all of us. It is worth trying it.
I did 20 years in private practice Internal Medicine (3 person group grew to 6). Then 3 years as the VP for Medical Affairs for a 6 hospital system in our city. The last 13 years of my career I was an ED physician at our city’s VA hospital. The salary at the VA was comparable to my experience in private practice. The benefits at the VA greatly exceeded those in private practice, vacation time and sick days being much more generous at the VA. In private practice, our pay was “pure productivity” and the overhead (roughly 50%) kept going when you took time off. So if you took a two week vacation one month you essentially got no pay that month. I took two two week vacations in 20 years, mostly just one week vacations or long weekends. In private practice you pay double Social Security (you are the employee and the employer). And malpractice insurance and health insurance some out of your pocket. As someone above noted, the Federal pension has a COLA like Social Security. The FERS pension is one percent per annum times number of years worked times average of high three salary years. The 401-k (or 403-b) has a very generous match, 5% of salary up to $10,000. You put in $10,000–the VA puts in $10,000. You can maximize your 401-k contribution above that up to around $27,000 or so. I had about $750,000 in the 401-k after 13 years, with decent investment options and unbelievably low fees in the Thrift Savings Program (TSP, the 401-k). You can get paid for unused vacation time when you leave/retire and unused sick time adds to length of service for pension calculation. VA patients are in need of medical care just like all patients, and often have no private insurance and limited means. The VA is sensitive to veterans’ specific medical/psychological needs in a way that private practice is not.
As of October 2023, the “agency“ (employer) contribution rate to the FERS pension is 16.5%, not 8.8% as quoted in the article. Employees hired since 2014 contribute 4.4%. So, in a sense, every five years there is about a full salary of principal available to pay out as pension. This coincides with the 1% of salary per year of service paid as pension . One qualifies for the pension after five years of service.
Thanks for the correction. That’s one issue with a delay between writing and publication, sometimes the article is already out of date on the day it runs.
Thank you for the article. I found it interesting that all the reasons provided and all the comments provided had one thing in common: it’s all about me. Perhaps a change in perspective might help. Or better yet, reading Stephen Ambrose’s book D-Day may offer a different outlook.
If that’s your motivation, why not be a military doc instead of a VA doc?
I’m currently working for a non-VA community health system, but previous 2 jobs in the VA as a general internist.
Re: pay, I will say that for the northeast region, where compensation is low compared to the rest of the country, VA salaries are comparable to non-VA, perhaps even slightly better (I would be making more money at my old VA than my current job).
Also while each VAMC has a lot of commonalities being part of the same system, I’m sure there is variability from center to center. My two VAs were fairly different in terms of resources and quality of personnel.
Any idea if the only physician jobs available at the VA are the ones officially posted to the VA careers website? I would definitely be interested in working at a VA at some point in pain, addiction, or emergency medicine but there seem to be few postings for these jobs especially in my geographic area (Denver) and not sure it would be of any use to use the usual methods of networking or talking with people at one’s local VA.
Like any desirable EM job, call up the department and ask the doc working who does the hiring. At our VA, it’s a private group (mine) who staffs the ED.
Thank you for the reply. In this situation do the docs in your group who staff the VA get the other advantages of being a “VA doc” like the specific government retirement benefits and on the same compensation schedule, health insurance benefits, etc? I assume they do get the benefit of the malpractice protection associated with working at the VA or federal government as a healthcare provider.
If the compensation and benefits package is not what the VA typically gives a directly employed VA doc in this case and the docs get the compensation/benefits package that your group offers, I wonder how common this set up is at VA EDs across the country?
No, they’re not VA employees. Not sure how the malpractice works, but I’m pretty sure they pay it just like I do in my division of the group. I don’t know how common it is.
Please be aware that some VA facilities will take advantage of physicians’ status as exempt employees and have no issue with requiring overtime work without either monetary or in-lieu-of hours compensation.
I worked for the VA for 17 years in Primary Care. I would not be OK right now mentally, emotionally or financially if I worked anywhere else. When I was diagnosed with RA and couldn’t work in my assigned position anymore, the VA offered me a Medical Disability Retirement. Without that I would not be able to put my sons through college or be able to pay my bills. I don’t know of any other medical system that does this for their doctors. Also, the VA pays based on location so the starting salary for Primary Care in different regions is different and is not always very different from other medical entities in the corresponding area. I really got tired of justifying why I was working for the VA and I am proud to have served some of the most deserving and incredible humans.
• Veterans Health Administration (VHA) has nearly 30K physicians on staff (the author listed 26K)
• While staff VHA physicians don’t own their jobs, they are not hamstrung by restrictive covenants or non-compete clauses (no employment contract) and can moonlight if they like
• While all governmental organizations trend towards bureaucratic, VHA achieves high marks in patient outcomes because it treats patients, not numbers on a ledger
• The average physician in VHA makes $299K. Physician pay in VA varies from specialty to specialty and locality to locality. VHA is competitive in many specialties and in instances where the pay tables limit VHA’s ability to be competitive, VA Medical Centers can lean on recruitment/relocation incentives and the new Critical Skills Incentive (CSI) (both up to 50% of total salary) to make up ground. Thanks to PACT Act legislation, VA can now exceed the former $400K aggregate pay limit using the aforementioned incentives. Additionally, VA Medical Centers can execute tier exceptions in the pay tables below to increase market competitiveness. It’s important for interested physicians to weigh VHA’s total rewards package (50-55 days paid time off, federal pension with 5 years vesting, TSP with 5% in employer contributions, insurance that can be carried into retirement, etc.) and not focus on salary. Many physicians conclude that the entire package offered in VA more than makes up ground where VHA falls short on compensation.
• While the compensation package is confusing to many, a lot of that confusion can be resolved by reviewing the VHA Total Reward$ of VHA Career brochure https://vacareers.va.gov/wp-content/uploads/sites/5/Total-Rewards-of-a-Physician-Dentist-Podiatrist-VA-Career-Brochure.pdf
• While new physicians will have 4.4% of their salary deducted, the agency now puts in 16.6% as a match (the author stated 8.8%). Given the average VA doc earns $299K, that works out to an additional $49.6K in yearly compensation
• The federal government doesn’t provide long-term disability insurance coverage as listed in the article. Federal employees are covered by the disability retirement clause in the Federal Employee Retirement System (FERS) pension which provides benefits similar to a long-term disability insurance policy after 18 months of vested service
• VHA provides up to 5% in employer contributions to the employee’s Thrift Savings Plan (TSP), or federal 401K account, and best of all, the TSP’s annual administration fees are roughly 10 times lower than industry averages (.055% for every $1K invested vs. .58% for every $1K invested). That would amount to roughly $23K in annual savings for a physician with $4.5M in their TSP.
• Not only does VHA pay roughly 75% of the health insurance premiums, but federal employees can carry that coverage into retirement and continue enjoying the premium subsidy so long as they held the insurance coverage for the 5 years preceding their retirement
I work for the VA in a large metropolitan area. The cost of living here is very high, so without my husband’s income, we probably wouldn’t be able to hack it on a VA salary. That said, I do indeed work 40 hours a week. I interviewed in private practice, and my pay would have gone up significantly, as would my responsibilities. So though I am paid lower, I
do work less relative to the private sector.
In terms of the patients, they are usually quite lovely, but there are 5% that drive me mad. A small minority come to visit simply to get service connection/ find something wrong with themselves, which is annoying, but it’s part of the job. Also, veterans sometimes request that you fill out certain forms for them– this includes a disability benefits questionnaire, and something called a Nexus letter. One patient screamed at the top of her lungs that she wanted specific wording in her Nexus letter, and reported me when I didn’t want to comply (ie she was asking me to do something unethical). So that can arise, but by and large these are very nice patients to work with. It is gratifying, but the government will be in trouble recruiting, as many of us will eventually get lured into the private sector with higher salaries.
Has anyone worked as a nocturnist or a hospitalist at VA. What was the patient census like? And how many shifts a year was required as part of the contract?
Why does the VA system exist? When I was a surgery resident in the latter 1980s, one of my favorite VA attendings said the system was envisioned to absorb the 10s of thousands of expected wounded American soldiers from a major European land war, where the older vets in the system would be transferred to civilian medical facilities. This was a very real fear in the 1950s/60s/70s. Military history is fascinating. I truly believe this is as good a reason as any. Also, world class rehab/prosthetic care and spinal cord injury care.
One of the reasons cited for doctors not choosing to work at the VA is that they would be serving only persons who volunteered to be the military. It was suggested that they may not be the ideal patient due to lower incomes, education, etc. However, many of us were drafted, not volunteers. Besides, many volunteered to avoid the draft.
Also, many of us are highly educated. We are not inferior patients.