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?
Hello!
Great article.
I recently got selected for the VA HPSP scholarship myself!
I think the pay tables, while factually accurate, can be a little misleading from the VA’s documents. If you look at the VA job postings for physicians they’re somewhat lower than civilian ones – but not as low as the 116k or whatever. Most of the ones – even PCP – are 220+. But I suppose they could change this later if their supply was filled better.
I’m curious if you could shine some more light on some of the benefits for us. They mention 55 days of paid time off for physicians somewhere – but I don’t really understand how they get there.
Similarly, they mention credit for military service – but how does that shake out?
How do they cover VA employees that serve in the military? I saw that they offered a certain amount of paid time off for annual/weekend training or activations but I can’t really tell how much – or what happens after that number is used up.
-If, for example, the VA will “pay the difference” when you’re activated or training this could be very lucrative.
I’m considering reserve military service in combination with the VA HPSP – as stacking their offers makes for a pretty desirable income in med school and residency. Similarly, the ~20-25k a year for reserves and ~250k a year as a physician aren’t bad stacked either when you count the pension, health, and other benefits you can receive between them. (Tricare Reserve Select for example, instead of a standard health care plan).
It’s definitely hard to sort out. Typical government bureaucracy. I’m not sure how to get to $220K+ either. If they really wanted docs they’d make it a little more clear what’s going on.
Hi! Current VA family doctor here, I can’t answer a lot about the military service/reserves because I haven’t looked into it. Of note if you were active duty you can buy back your time into the VA pension system and basically use those years towards your retirement pension which is nice if you didn’t stay in long enough for a military retirement.
For the VA there is the baseline salary which is based on your GS position and then there is market compensation to make sure you aren’t being paid 120k as a board certified physician. Market compensation will vary a bit by location because of cost of living. In Arizona my base salary is like 115k for my starting GS position with step 1 and then my market compensation gets my salary up to about 235k. I also got a sign on bonus and qualify for yearly bonuses so total salary ends up closer to 250k before looking at the other benefits. Considering I only work 40 hours a week and most primary care physicians in my area are making 250-300k and working 60+ hours, I feel like I am coming out ahead but I also really value my work life balance and that was very important to me.
I will note one tricky thing with the VA is your pension is based off your BASE salary so it may not be as good as you initially think on paper. I think I am eligible to retire at 57 with 30 years and I will likely get between 40-45k in pension each year. I view it as something nice but not something I would stay at the VA for if I didn’t like my job.
For days off, the VA counts all 11 federal holidays towards that and then you get 8 hours per pay period for annual leave and 4 hours per pay period of sick leave. You also get 5 CME days to use when and how you want. I think total it adds up to 58 days off a year.
I did have one note for the article – not all my patients volunteered to serve their country. I have a good number of Vietnam veterans who are happy to let me know they were drafted and are still unhappy about it.
Good point about the draft.
Agree with most of Katrina’s comments. However, for the pension (FERS), it is based on the “basic” pay, which is “base” government scale pay + physician “market pay”, so in this example $235k. It does not include annual performance bonus (up to $15k) or other special awards.
Agree. At my location and specialty (and performance?) I don’t recall special awards or bonuses in the VA (I did as a GS Army doc- some good OICs there) but my current pension – 5 years total civil service plus 7+ years military to get required 5 years civil service, required total 10+ years govt service, gets pension not at GS-15 or GS-14 base but at the total regular salary I got including the market pay to ensure they are paying about what similar specialties can get in the area.
And sick days- 0.5 per pay period and leave 1 per pay period and holidays make 13+26+11 annually, 50 days off then add any CME. Unused sick days probably get paid to you when you retire? Not an issue for me LOL.
I don’t think the comments about the pension are totally correct. It is true that VA pensions are calculated only on the high three years of “base pay” for most employees (excluding overtime, bonuses, etc.), but for physicians base pay includes your market pay for the pension calculation so it should be based on pretty close to your full salary (excluding bonuses). In my case, my market pay is most of my salary, so it can make a big difference in pension size. This is directly from the OPM website.
https://www.opm.gov/faq/retire/is-physician-quotmarket-payquot-included-in-the-high-3-calculation-for.ashx
Came here to say exactly this. VA physician pension is calculated based on the combination of BOTH base and market pay… not just base.
Also, any unused sick leave you have accumulated upon retirement will be added to your total duration of service. This adds a small but sometimes meaningful increase in the pension (have a colleague with over a year’s worth of unused sick leave).
As a retired VA physician, I confirm that the retirement pay is based on the (base+market) sum. In my. If you serve for 30 years, that will amount to 33% of your compensation, but you also get social security and the thrift savings plan (TSP). You may well have several million there by the time you retire, and can reasonably withdraw about 4% per year without worrying about running out of money. This won’t make you rich, but if you live frugally (save money, don’t live up to your income) before retirement you can have quite a nice post-retirement lifestyle.
You also get the benefits of learning how to do your own blood draws, schedule your own x rays, take your own blood pressures, learn how to transport patients, and all other essential skills an RN can do, because buddy, that ain’t their job.
Seriously, just give the vets a no copay Medicare card and end the VA. It’s a jobs program not healthcare.
The Vets benefit from a system that understands their unique needs. PTSD, MST, and chronic pain due to combat and service related trauma are pervasive and need attention. I can absolutely guarantee you that private equity production driven medicine doesn’t give two rips about any of that. The VA, despite its many faults, at least gets that.
Agree they also have specialty clinics like an “agent orange” clinic and TBI clinic a homeless clinic. I have a hard time thinking a private place will have the volumes to create that. Also depending where you are in the country the psych services are much more comprehensive. Where I trained had groups for all diagnoses, ACT teams, inpatient care for geriatric patients, and much more comprehensive urgent care for psych which as a model doesn’t exist hardly anywhere. All while caring for the most refractory patient population I have ever encountered. They get a lot of flack, but the private market isn’t doing psych well or even on the same level by comparison. Veterans who attempted to use the choice programs to go outside the VA for psych had to come back a lot of times because they couldn’t get appointments or anywhere near the kindness services they could at the VA. They also paid LCSW’s at my facility about twice what they could make anywhere else. It was a very competitive job for a therapist.
Well, as a VA doc, hard to disagree more. Many of the veterans I treat cannot manage the coordination of care they have to engage in between their primary care doctor and specialists. The VA system does that and does it across the country and beyond. I can see someone’s labs from Puerto Rico or the Philippines in Florida and vice versa. I have access to their active duty medical records after 2000 and can easily see what they were tried on, what worked and what did not work. Can’t do that in any other system.
As noted by MT, PTSD, MST and chronic pain much better treated by the VA than outside the VA.
You did not mention the antiquated systems and the lack of motivated nursing staff at these hospitals. How can we continue to accept these conditions for our veterans? Who is in charge at these hospitals?
Thanks for sharing your experience. It’s been a very long time since I worked in a VA, but way back then the VA EMR was actually the best one available. I don’t recall the nurses being particularly better or worse than elsewhere, but I do think there were fewer of them. It’s been a long time for me though.
Base salaries are low but VA match what someone with your experience and credentials will get outside. You do get 55 days off and the nurses at the VA I work are great. Like any other job good things and not so good things. Thank you for the article.
If you are speaking of the EMRs, the antiquated systems are, in fact, a government hedge to be more fiscally responsible. Why shell out tax payer dollars for EPIC when CPRS works just fine? Shiny new toys aren’t always the best and brightest.
I work on both the outside at larger academic hospitals and at a relatively large VA hospital. I can tell you this: VA nurses care, many are fellow veterans themselves, and, in general, are damn good colleagues. I think your comments are baseless and lack a general understanding of what’s really going on.
At both military and VA facilities I have encountered civilian employees- sometimes doctors and nurses, but mostly I noted or heard about lower level front desk etc staff- who are happy to be almost unfire-able and who would definitely be fired in a private practice. (Never amongst uniformed military staff- except at the end those being booted out of/ removed from service for evilness or mental health problems.) I have also noted some personality disorders and folks quick to use the system it seemed eg claim EEO issues when actually disciplined for unprofessional behavior. It isn’t just me LOL since sometimes it was other (usually female) staff who reported issues with some women- there was a nurse manager who treated me (female doc) fine but seemed jealous and not an advocate for the nurses she managed. And as many complain, unions can make it tougher to get rid of folks, including those who oughtta go. (Disclaimer here- I love unions and have a “Friend of Labor Award” plaque behind me on the wall, was a union member all my civil service years, and received an AFL-CIO contribution for my political campaign.)
Main point is when you are understaffed some of your coworkers are with you doing their best to provide proper care, and some of them don’t give a care. And that it may never get better- which is why I resigned from my VA when we lost 50% our docs and that didn’t improve over a year. However I read somewhere, probably on Sermo rather than at WCI, that every VA is different, and you can’t generalize. This gives me hope that there are good, even excellent, VAs and jobs there. Wish that’d been the case where I worked.
IM 2nd year resident who want to do primary care outpatient. 400k med school debt. considering doing pslf and VA’s SERLP program. Do you think it’s a good deal? $40,000 per year of residency ? I will leave residency with 120k in VA loan repayment
Do you want to work for the VA? Then it’s a great deal. If you hate your job at the VA, maybe not that good of a deal.
I don’t mind working at the VA. I was curious from a loan repayment standpoint, does it seem like a good deal? For someone with 400k in debt?
At first glance, sure. You take that $400K and divide it by the number of years you’ll have to work there to get PSLF + whatever other repayment and then decide if that’s more than you were offered to work elsewhere.
If you’ve got to work there 8 more years and would have made $150K more somewhere else, then no, it’s not a good idea. If you only need to work there 4 more years and would only make $50K more a year elsewhere, then yes, it’s a good deal. But you can’t decide that in isolation. You’ve got to run the numbers. I made the mistake of doing that with my military service once and realized I came out $180K behind compared to just paying for school with student loans and taking a regular job afterward.
EDRP program was great for me, paid $40k a year with post-tax money to be reimbursed that $40k (non-taxable) all while those payments counted towards PSLF leaving with me very little money out of my pocket when they got forgiven.
Adding that I’m also benefiting from this program and there is no tax on the reimbursement. Free money to those that qualify
Hello
i was wondering what your thoughts were about remote VA physician jobs for primary care?
Any caveats I need to consider?
Thank you
Seems like it could be a great option for those looking for remote work. Might save some state licensing hassles. Can’t say much more than that.
Hello! I work in a remote primary care job for the VA. Working at the VA has been a great fit for me. I love the patient population, the work/life balance, and the noted benefits of working in the federal system. I never had any idea during training that I would be able to work from home and make $250k/year as a PCP practicing clinical medicine. I also appreciate the flexibility of being able to move to different roles within the system. I think one of the biggest downsides of remote PCP roles is losing physical exam and procedural skills, though as a VA employee, you could still have a side gig in urgent care, for example, to keep those up. The remote roles usually require travel to the site you’re serving about quarterly for a week at a time, allowing some ongoing in person care, but four weeks a year can be a lot of travel depending on your family situation. As with any remote job, it can be isolating. I do miss knowing my colleagues better and the curbsiding about patient care that happens more naturally in person. Lastly, often the remote roles are reserved for people who already have their foot in the door in the system. The federal hiring process favors already having VA experience especially for more coveted positions, which the remote ones tend to be.
As a Veteran, 22 years, Army, I absolutely hate going to the VA bc no one there has served and they are all from india or somewhere else never in service!!!!!
I’m a VA PCP for 8+ years. Never served but love the VA and grateful for the opportunity to serve those who served. While it’s hard work when I’m in the office, I don’t take work home and it’s a lot better than my colleagues in the private world. I see my work as sustainable for the long haul.
Thanks for sharing your experience.
I’m not a Vet, but my dad served in Korea and is a Cold War Veteran. I personally love our vets and it is my great honor to serve them.
Im a former career military officer. Worked at the VA. Few of us Veterans there. Civvies cement themselves and their buds into leadership roles. Rocking the boat gets you labeled as a troublemaker. They beat you with the ‘rules’ applied unequally and forcefully. Hostile work environment but they’ll lie to protect themselves. I did my required 5 yrs and bought my time in the military back to get my pension. Job was not worth the aggravation of working there. I loved most of my colleagues and Vets are great patients. They’ve all seen some shit so they understand. But it could be sooooo much better. Wish I had the patience to stay and make changes but it is military bureaucracy on steroids without UCMJ to keep things in check. Terrible leaders demonstrating the Peter principle daily.
Little tough to read this comment. Implies that only doctors and nurses who are former active duty are competent. I work in the VA and there is no difference between former active duty docs and never put on a uniform docs. The expectations for quality of care are the same.
As for where they were born, the VA trains lots of foreign medical graduates, that is the nature of training programs that the VA supports. All of the attending are US citizens.
Where I work over 50 % of our physician staff are former veterans. This is why most of us are there. Most of us also agree physicians at the VA are underpaid but we take all do our best to take great care of our veterans.
I just don’t understand the existence of separate VA(hospitals).
They don’t save any money for government, don’t provide better care than other hospitals and not easily accessible.
They don’t provide emergency care.
Only people who benefit are inefficient beurocrats who work at those hospitals.
I just started at the VA for a change of pace and it’s great. The specialist are all from my main civilian institution who just wanted a change of pace. They aren’t second rate nor are the ED docs. We just wanted something different. The nurses are top tier from our trauma center but they prefer a change of pace w better pay. Getting people timely follow up can literally happen the same day. I get a volunteer to drive them in a golf cart over to the specialty clinic and then they teams me what they discovered in the consult.
I served in the Air Force and some of the nurses and I were in the same squadron.
Lots of us are part time. You can start your pension clock, and then at some point down the line switch to full time for three years and you’ll get a healthy chunk of money in retirement. If you have prior active duty time then you can ‘buy back’ your time and get those years added to your FERS pension.
All in all I’m really happy with the different scenery and the fact that almost all of my ER patients are grateful and kind. I’m also happy that while my regular job deals with decreasing reimbursement, at risk metrics, etc at the VA I get a COLA every year. So while the civilian ER doc is slowly making less every year (or seeing more patients per hour to maintain his or her hourly income) my payer mix at the VA is the federal govt who will continue to pay me adjusted for my experience and inflation until I stop punching the clock there.
Also … CPRS is going to change to Cerner one day soon.
There is published research that contradicts almost all of your claims. VA care is less expensive, outcomes are better, many VAs have EDs.
Every VA is different. There are scandal plagued VAs that suffer from poor management but the ones with academic affiliations typically attract a lot of talent.
Almost every Veteran I speak to would rather have VA care in my region than a rushed 15 minute appointment that they waited 8 months to get with a provider who never even listened to them and is unresponsive after the visit. Have you ever been a patient yourself?
Another issue is that private docs, even in ID, just aren’t familiar with diseases of veterans like Agent Orange exposure, Leishmaniasis, and (less troublesome malaria- most docs can recognize it and most patients know they might have it) and other non US diseases. The research and care available to veterans with these almost exclusively military campaign related diseases is just not an option elsewhere.
I spent the last 10 years of my career working in the emergency department of a large VA Medical Center. Didn’t get to do near the procedures I did in the private sector, but saw some very interesting cases. We had mostly board-certified emergency physicians. Had all the latest high-tech video laryngoscopy And several ultrasound machines. It’s quite difficult to deal with the bureaucracy, but I basically had two months of paid time off per year. I retired a couple years ago and the pension is based on the base pay and market pay. I was paid an extra $35,000 to do nights and that did not figure in to the pension. I believe my pension came to about $25,000 a year, but after they take the taxes out and pay for my federal Blue Cross, I only get about $900 a month. My salary was about $300,000 a year, but pales in comparison to my private sector colleagues. There are lots of hoops to jump through in the systems. Quite a bit of unfairness and there is absolutely no incentive for anyone to work hard . Some doctors would just sit there and see two or three patients in a 12 hour shift while others would see 20. They get paid the same. So many people are unhappy. Dealing with the hospitalists was generally easy however many are miserable. One interesting thing I noticed was a pattern That at the beginning of the fiscal year when they were in the black, they would spend money, Tranfer patients that were being held in the ER and send people who want detox to these fancy expensive centers. Midway through the year, they would be in the red and we had instructions to not transfer anyone unless it was an emergency. Whoever’s in charge of the financial aspect at this hospital was not very good. And they have to spend a certain amount of money so when the time came each year, we would suddenly get a new ultrasound machine and new airway equipment even though we already had plenty of high-end Stuff. They said we have to spend the money so we’re just buying extra. Many of the nurses are not happy and leave the ER doing other jobs within the VA system until they just couldn’t stand it anymore and then quit. I think those that have big loans and want the loan forgiveness program makes sense however I think working in a private group would be much more lucrative. I will say it’s a lot less stressful than working in a super busy ER that’s understaffed and is controlled by a contract management group. On the one hand, I wish I had done it 30 years ago to get a larger pension, but on the other hand, I couldn’t wait to leave. I retired a couple years earlier than I had planned.
There is a lot wrong in this comment. Community care is far more expensive than VA based care; many VA hospitals provide high quality emergency care and a full range of subspecialty services.
How is #6 accurate? Can you clarify? Doesn’t one need to pay taxes on any forgiven loan amount? So this wouldnt be $400k “after tax” dollars. If I understand PSLF correctly, the year $400k is forgiven the individual will have a massive tax bill owed to Uncle Sam according to their tax rate. So yes, the point is valid that VA would be a public service job eligible for forgiveness, ok some benefit there, but $400k doesnt just vanish and equate to $400k in income AFTER TAX or $600k income ($120k/y) as stated here…
PSLF is tax-free, unlike most forms of forgiveness.Indeed it does JUST VANISH. Ask the thousands of docs who have gotten it so far. Why do you think medical students and their families with money are no longer paying cash for medical school even if they can?
I work at the VA for lifestyle (work 800-430), benefits (great medical, tsp match, pension as a hedge against the market), great patient population, teaching opportunities, lack of malpractice liability worries (don’t have to practice defensive/wasteful medicine). I also NEVER deal with insurance or even think about it.
One correction for the article, I can confirm that EDRP is 40,000 tax free for 5 years.
Considering all that, Im compensated very well for the volume of work I do as you alluded to. If I want more money I have plenty of time for a side hustle, or to live life instead.
Thanks for the correction. Not sure where I got the wrong info from, but as I look it up now the sources indeed say tax-free.
I actually wanted to work at the VA at one point. I love vets and think they should be treated like kings and queens though I have a lot of misgivings about the battles that our government picks (e.g., Iraq). The turnoff for me was that if you care about process improvement and seek to make things better or more efficient, the VA is not the place for you. Also, having trained at the VA at various points, there does not seem to be consistent leadership (being a political post) or a consistent focus on excellence. That would have depressed me to no end. The benefits, etc. are unparalleled, however, if that is what one seeks.
I may be biased because I choose wholeheartedly to for at VA. But, I’d like to share some other information that sways me in the VA direction:
1) Once you retire, you have healthcare for both you and your spouse for life. You continue to pay the same amount active VA employees pay for healthcare, and the VA covers the rest. Considering that healthcare is one of the highest expenses in retirement, this is huge.
2) Job stability: VA is one of the most stable positions. It is guaranteed that your salary increases and does not go down. In an unstable market (ahem Covid), this can be quite an asset and hedge risk for you. This stability can allow a VA employee pursue higher risk/higher reward potential investment strategies while mitigating some of the risk due to the VA job stability. For example, I invest in real estate and banks love VA employees, giving me an edge on obtaining mortgages with lower rates due to lower risk on the banks’ sides.
3) Mental health: In general, physician who choose VA are passionate about what they do and patients are thankful for their care. Additionally, as a specialist, I have 1 hour time slots. It is so nice to work in this type of positive environment, to tangibly see the impact of my work, and to have enough time with patients to really feel like I am providing the best care. Additionally, no insurance company bureaucracy sucks up my time and I can provide the treatment plan that I see as being best. Lastly, 26 vacation days + 11 federal holidays + 13 vacation days allows for flexibility to be away from work for fun and for caring for family if/when that is needed. I have no stress about missing family time or getting sick. All of these things add up to reduced burnout and better mental health, which is an investment in and of itself, especially from the financial perspective. The longer my health span is, the more time I have in my life to be financially productive.
I hope this helps to add to the conversation!
Great comment! I am in Pulm/CC and I work at a VA attached to a major academic center. I am full time VA but do a one half day clinic at the academic center per week to keep the affiliation and associated professorship/perks. I am early in my career and was originally in a private group, but found that being a mom to 3 very young kids and a private practice PCCM doc was taking a toll very quickly. I love my job at the VA because I have a decent salary, true work life balance, a wonderfully supportive department and plenty of time off. We actually accumulate so much time off we barely ever use it. if I am sick or a kid is sick, my colleagues are happy to cover and nice versa. I still get to teach and do everything I did in private practice in terms of clinical work, but at a slower pace and with more intention. I don’t get Sunday Scaries anymore. I also get PSLF/EDRP which for me is a financial lifesaver as I have almost half a million in student debt. It is worth considering a VA career for sure. It is true all VAs are different, but that is true of many hospitals.
Great article tricky title way to get people to read on the rather balanced pros and cons of the system.
Really the initial top reasons as a W2 vs Private practice decision tree that includes most academic institutions and most large hospital systems.
Even kaiser largely falls into the w2 grouping aside from an ownership piece for entry and exit shares.
Once past the large 30k ft issues like w2 and dollars, the real determination for/against the VA long term employment/longevity at the ground level comes down to patient population and staffing model. This is true for any job really….is it a good fit to do daily x decades.
Having the honor of taking care of our Veterans over the 14 years I worked at the VA was unmatched fulfillment and gratitude for their service to Country.
There’s some thing there that you simply cannot recieve anywhere else short of direct service yourself.
You forgot to mention that, at VA, you do not have to deal with insurance, obtain prior auth, or make any peer-to-peer calls.
There are some restrictions on expensive medications, but if legit indication, they’re usually approved. The non-formulary request to pharmacy takes about 15 seconds to complete.
I worked at the VA for 2 years after working at an AFB and undergoing a RIF. I found the VA a huge disappointment. The compensation was poor and unequal from doctor to doctor, the staff was lazy as they knew that they could not lose their job, the administrators were toxic. I saw every good doctor leave and lazy doctors who practiced poor medicine stay. Our veterans deserve better. Another example of how government can take a good idea and screw it up.
My spouse and I are both VA physicians and wouldn’t trade it for anything. Our VA takes good care of our veterans, who are a wonderful patient population to take care of. Taking into account the total benefits package, decreased liability, lack of dealing with insurance and the work life balance for our family (my schedule is so much better), I am very glad to have transitioned away from community EM several years ago. Working at the VA is so desirable now compared to the community in our area, we have many people asking for positions weekly. I can’t think of any providers making the minimum salaries noted, in fact PCPs make around $280K at our site. EM is also competitively paid when taking into account all benefits. The above combined with PLSF combined with EDRP made sense for us. My spouse’s $434K of loans were just forgiven, prior to which EDRP reimbursed almost all payments made. Don’t forget, you can work part time at the VA and get all the benefits prorated and work elsewhere to get your trauma fix, extra earning etc. This is not to say there are not frustrations, but nothing is perfect.
How does the PTO work in EM? I assume the ED is still open on the paid holidays.
Definitely open. In the SLC VA, the emergency docs are part of a private group that contracts with the VA to provide services. There’s no PTO.
been at VA for 20 months after 17 years as clinician educator at academic center. if you work a federal holiday, you get an ‘in lieu’ day on a future date of your choosing (for the most part).
A “hot take” on the VA system that I also had confirmed by quite a few others. the WW2 vets were some of the most delightful patients. Vietnam vets were basically the identical caricature that many people have of “entitled millennials.”
Rarely met WW2 vets by the time I worked there. The psychologist at my place gave me this epiphany: A 70 year old Vietnam veteran who married, had kids he raised, and a lifelong job, and is now claiming Vietnam service gave him compensable damage mentally, is FOS.* The mentally damaged Vietnam veterans died long ago from suicide or EtOH/ drug use and/or didn’t have ‘successful’ work and family lives after Vietnam. Sadly the current ongoing war’s vets are still in that stage where we hope to prevent some of the PTSD death and dysfunction not really an issue for the remaining Vietnam vets.
*A delightful but R rated movie made in my locale, Skiptracers, has a character tell his son how, for his VA evaluation, he wore old torn clothes, rolled around in dog feces, then said to the screening nurse at top of his lungs “DO YOU KNOW HOW MANY VIETCONG IT TAKES TO CHANGE A LIGHTBULB? YOU DON’T KNOW, BECAUSE YOU WEREN’T THERE!!!” to get a service related mental health dx.
There’s a reason they were called The Greatest Generation. Between growing up in the Great Depression and serving in WWII, their lives were set up on a different trajectory than the rest of ours.
This all makes sense to me except “#11 People Don’t Value the VA Population and the Ability to Care for Them”. I only worked at the VA as a medical student and resident but thought they were some of the most interesting patients I ever encountered. There was the 98 year old vet who had been part of the American Expeditionary Force in Russia, or the somewhat weak & passive appearing WWII vet who had actually twice escaped from POW camps in Nazi Germany, or the guy who came in wearing a faded and torn leather flight jacket that was from his service as one of the “Flying Tigers” in China. You can learn a lot about history by working at the VA.
Lots of people haven’t had your experience, that’s why it got on the list.
I was always tickled by the inadvertent disclosures of military operations. “Yeah I got frostbite when we were scouting in X [country we should never be in eg Iran or China or Russia]- oh yeah I forgot we never were in X, only in Y [neighboring country of X with whom we have military ties].” Yeah, our troops were NEVER in X…
I loved my experience training at the WRJ VA in Vermont. Beautiful location, amazing vets, great attendings, great training. I was one of the weirdos who liked CPRS way more than the bloated money-sucking black hole known as Epic. I don’t need my damn EMR to be “upgraded” every year. I also thought the VA did a better job of exposing me to addiction and mental health treatment than my primary residency site. I would certainly consider working at a VA in the future, though I’m not sure exactly how my specialty (addiction medicine ) fits into how the VA functions. I’ve never seen an addiction med job posted for the VA.
There are DEFINITELY addiction medicine jobs available. The USAJOBS site’s search function leaves something to be desired, so often it is best to search generally for the type of position you’re looking for rather than putting in super specific terms. For physician roles, the occupation code is 0602. Usually I’ll search with this and sort by posted date and then scan everything to catch the biggest swath of options. If you’re interested in a role within a particular VA region or clinic, I would also suggest just emailing or calling if you know or can identify someone who works there. Often there are jobs available that haven’t been posted yet due to inefficiencies in the HR system and they would be excited to skip ahead a few steps if they have a good candidate reach out. It is a bureaucracy, so bear with the HR process if you’re really interested. I think it’s worth it.
Lots of good discussion on the forum on this one: https://forum.whitecoatinvestor.com/general-welcome/442948-discuss-latest-wci-blog-post-12-reasons-doctors-don%E2%80%99t-work-at-the-va
Also a few emails to share:
# 1 I love receiving your emails and reading them as well. Quite helpful and informative.
I have been working with the Va now for 7 years other than owning your practice and doing all the work but been a federal employee isn’t bad as long as you are able to deal with the bureaucracies as written. Pay is good and benefits are awesome. I am only looking to work of another 13 years and I will retire.
Anyways thanks for all you do
# 2 I am a semi-retired 100% TDIU disabled Vietnam-era veteran. I have read many of your various posts over the years and value your experience and thoughts. I even bought one of your books a few years ago (I think through Amazon).
I found this post of particular interest. Although I get 100% free medical, dental and other care, I still have traditional Medicare and a (Wisconsin version) Plan F Medicare Supplement insurance policy. I am generally very happy with my V.A. care– having gotten into the system in 2012.
Anyway, one important correction for you– under your item 11, while service personnel and younger veterans are certainly “all volunteer”, there are still hundreds of thousands of veterans who were compelled to serve due to the draft. Myself, I was drafted on my 20th birthday and had a month to go as a draftee in the Army and end up in the no-win war of Vietnam (history of course vindicated my assessment). I wasn’t going to flee to Canada and I considered the option of enlisting for a longer term in the Army, which allegedly would allow me to pick duty other than Vietnam and maybe get assigned to Germany (at twenty drinking German beer and chasing hot frauleins was definitely appealing to me). However, I learned that they were still sending “volunteers” to Vietnam anyway. Another option was to enlist in another branch of the military– so I chose the Navy.
# 3 All good reasons however the pay scale is adjusted up to local regional competitive pay with incentives.
After 8 years active Duty Navy Doc then 20yr private practice followed by 10 years hospital based surgical practice I “retired ” to part time at the VA with a sense of duty to Veterans and continued purpose in the field of ENT. I didn’t know the VA had such a nice retirement plan and although we are FI and salary was not critical its still nice to be reimbursed. Just another way to sunset a long career and pay it forward to the next generation of trainees coming up through the system.
“100% disabled” yet you somehow graduated medical school and completed ENT training. You dishonestly gamed the system and have claimed disability for decades. Congrats.
I think you misunderstood. These are three separate emails from separate individuals. The ENT is not the same person as the disabled veteran.
Another reason some take VA jobs – many (most?) positions do not require board certification. As many academic and private hospitals, as well as insurance networks, require board certification or board eligibility, those who choose to not become certified can work for the VA. Some VA positions are under an academic institution umbrella (i.e., the academic institution contracts to cover that service for the VA); those physicians are paid by that institution, and need board certification.
I’ve been at a VA outpatient clinic for one year after working for a family medicine practice owned by a hospital system.
I do agree that you give up some of the freedoms and autonomy while working at the VA, but the atmosphere and benefits far outweigh the negatives.
Plenty of rules, but at least you know what the rules are. (There is no having to deal with the opaqueness of insurance companies or do prior authorizations to get a patient’s coverage.)
I can usually find out within a few minutes if a medication, procedure, referral will be authorized. That way I can tell the patient during the visit at their medication is authorized and will be arriving at their house in a few days.
I also enjoy having psychology, social work, mental health, counselors, podiatry, pharmacists, PT and other support all within the same building. It makes it much easier to reach out to them and coordinate a patient’s care.
I cannot speak to the specialty care at the VA, but I feel that the primary care is better run than at most hospital owned practices.
Speaking to the pay issue, I feel the pay for primary care is probably higher than most hospital systems. Base pay of 240,000 with bonus and retirement getting it up to about 260,000. All federal holidays off, five weeks vacation, plus sick leave. All with pay.
Furthermore, if you’re still Guard or Reserve you get 10 days paid leave for “annual training “.
Plus, the VA offers 12 weeks paid maternity and paternity leave. You’ll never get that in an RVU based system.
All in all, there are a lot of headaches working for the VA, but if you embrace the mission of serving veterans, and don’t let the rules overwhelm you, then I think it’s a great place to work.
Yah I think pay is comparable for most doctors employed at the VA, FM, IM, EM, Pscyh. The workload is relatively light. The patients can be a delight.
The actual hospitals vary alot in terms of quality and staffing, but one think about working for this level of bureaucracy, you can bounce from location to location, and you know what you are gonna get.
Lots of interesting comments above. I worked for the VA for 30 years, both in academic affiliated VAs. As a physician-scientist, the VA is a great career path. I was always 5/8ths, had access to the VA research grant program and great administrative support. I am a veteran and enjoyed taking care of veterans. There are limitations and hassles, but as a rheumatologist, the ability to acquire the medications for patients is much better, there are no FMLA forms or disability forms. The two VAs I worked in provided outstanding care and service. If you are pursuing a career in academic medicine, I believe the VA is a great opportunity.
Not sure I saw it mentioned, but VA employees are also eligible for 3 months of paid maternity or paternity leave. Not so bad.
As for PTO (they call it annual leave), you can cash out any left over annual leave when you retire. There is a max of what you can carry over from year to year though.
The Federal Employee Retirement System (FERS) is a poorly understood but incredible benefit for VA docs. I’m retired after 38 years and receive a pension of ~$140,000/year. This is also COLA adjusted which almost no other pension (other than social security) does. You can accept a lower payout if you have a spouse who would get the survivor benefit; I think the exact amount depends on the difference in your ages.
Note that if you consider a 4% withdrawal rate, you would need ~$3,500,000 in an investment account to get this yield!
Because of the government matching and that I contributed the maximum, I also have $2,750,000 in my IRA. (With my FERS and S.S. of $42,000, I haven’t had to touch this yet. )
; I doubt if many of my private practice colleagues have this amount of retirement income.
Not fair to compare a pension to the 4% rule. You need to compare it to a SPIA since both are guaranteed until death, then go away. Depends on age obviously, but a SPIA at 65+ may be paying 5%, 6%+ etc. depending on interest rates. Not indexed to inflation any more unfortunately which really makes it hard to compare apples to apples to properly value a pension like the VA or even SS.