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  • WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    Can anybody on here make a case for a career at a VA medical center over private practice? How good are the benefits and retirement options through the VA compared to private practice? My specialty is dermatology but I am sure anyone’s experience in other specialties can be generalized.

    I have never been lost, but I will admit to being confused for several weeks. - Daniel Boone

    My sweat and my wages they don't seem to weight out
    I'm gettin' more aches than I'm gainin' in gold

    #231355 Reply
    Avatar Doc Spouse 
    Moderator
    Status: Small Business Owner, Spouse
    Posts: 217
    Joined: 10/20/2017

    It’s been discussed a few times before, but unsure how much has changed since these threads:

    https://www.whitecoatinvestor.com/forums/topic/veterans-administration-employment/

    https://www.whitecoatinvestor.com/forums/topic/di-worth-it-for-a-va-physician/

    https://www.whitecoatinvestor.com/forums/topic/va-and-non-va-retirements/

    https://www.whitecoatinvestor.com/forums/topic/question-about-leaving-the-va/– Decent discussion further down about the differences between private practice and VA

     

    Edit: Some more links.

    #231371 Reply
    Avatar wideopenspaces 
    Participant
    Status: Physician
    Posts: 1138
    Joined: 01/12/2016

    I can’t imagine it’d be worth it for derm. I’m psych and starting at the VA in a month. But I don’t plan to stay long term, the lack of flexibility is a deal killer for me. I don’t plan to work full time for very many years. But I think it’ll be a nice gig for my current stage of life.

    #231384 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018
    Earnest refinancing bonus

    There just seems to be so many issues arising with insurance nowadays in regards to requiring PAs for the simplest of medications. A colleague of mine recently had to fill out a PA for triamcinolone cream. WTF? I wouldn’t have to deal with headaches like this at the VA. But is that worth the large decrease in salary compared to being in the private world?

     

    I have never been lost, but I will admit to being confused for several weeks. - Daniel Boone

    My sweat and my wages they don't seem to weight out
    I'm gettin' more aches than I'm gainin' in gold

    #231385 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1168
    Joined: 11/07/2017

    I’m not going to try to make a case, it’s a personal decision based on what you value.  You will most likely make less at VA, and while the benefits are good I don’t think they make up for what you could make in derm private practice.  I value time and good relationships with patients, and my own personal time, much much much more than money.  So I don’t mind the pay hit.

    Full time derm at my VA generally makes low to mid 300k, although they can go up to 400k which is the current federal salary limit.  Some have side jobs and make more.   I don’t know what PP derm makes but I’m guessing it’s potentially a lot more.

    Employee pension contribution is currently 4.4% of salary, the govt contributes the rest.  I am grandfathered 0.8% contribution rate.  The govt may increase the employee contribution rate further, but so far they’ve kept employees at the rate they were hired at.  Payout is 1% x years of service x avg high 3 salary (again, there have been talks of changing it to high 5).  You need 5 years service to be vested in the pension.

    If you max out your TSP you’ll get 5% salary match.  You can take your govt healthcare with you when you retire if you’ve been enrolled in it for at least 5 years prior to retirement and stay until at least minimum retirement age.

    26 days annual leave + 10 federal holidays + 13 sick leave days.

    CME is only $1000/year (set by Congress)

    Malpractice is covered by the Federal tort claims act.

    What else…maybe just read over the links Doc Spouse provided and ask any specific questions and I’ll try to answer best I can.  Opm.gov has all the info on benefits you will ever want to read.

    Besides the money, the other downside is that some people (not the employees or patients at the VA but out in society whose only idea of the VA is what they read in the news or their limited experience in residency) look down on VA docs and will assume that because you work at the VA you are not as good a doctor because if you were you would be in PP.  I’ve been at parties where people ask me what I do and they make snarky comments.  Whatever.   I wear an invisible rubber suit and their comments bounce off me and hit them back in their smug faces 😉

    The flip side is that the patients are for the most part so great and you actually have time to spend with them.  You know that part on the WCI podcast where he says “probably nobody says thank you for all the work you do, so thank you”?  I don’t have that problem.  I saw 11 patients today and 10 said thank you.  And the one that didn’t had dementia and his daughter said thank you.  If you try to be a good doctor for them, they are truly grateful, and are just great people to work with.  A lot of the peripheral stuff at the VA (bureaucracy, management) can be really frustrating and I sometimes feel like I’m banging my head against a brick wall trying to improve the system.  But it can be a really great job if you’re able to not let that stuff get to you and just focus on the patient in front of you.

     

    Lithium Lithium 
    Participant
    Status: Physician
    Posts: 1177
    Joined: 02/15/2016

    There just seems to be so many issues arising with insurance nowadays in regards to requiring PAs for the simplest of medications. A colleague of mine recently had to fill out a PA for triamcinolone cream. WTF? I wouldn’t have to deal with headaches like this at the VA. But is that worth the large decrease in salary compared to being in the private world?

     

    Click to expand…

    This is a psychiatrist talking, but what is the worst thing that can happen if you just tell your patients to use the GoodRx app, or pay cash for “simple” medications?

    #231391 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    I appreciate the time you put in to write all that.

    The biggest reason I am considering this as a future option is because I have grown to absolutely love the veterans. After working with them for the past several years I often find myself regretting that I never entered into service for our country as they did. And for that reason I often feel that I could fill that void with offering my services to them as a dermatologist.

    I could care less about what others would think if I did become a VA doc. Physician entitlement is one of the worst characteristics of our profession, so I tend to ignore such people, anyway.

    “Full time derm at my VA generally makes low to mid 300k, although they can go up to 400k which is the current federal salary limit.”

    Any idea what one would have to do to get up to that upper 300k mark? See more patients I am guessing?

    I have never been lost, but I will admit to being confused for several weeks. - Daniel Boone

    My sweat and my wages they don't seem to weight out
    I'm gettin' more aches than I'm gainin' in gold

    #231392 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    This is a good point. I honestly don’t know the ins and outs of private practice yet so maybe there are more simple solutions than I have been exposed to as of yet. But I do hear frequently that the increase in insurance paperwork is a contributor to job dissatisfaction.

    I have never been lost, but I will admit to being confused for several weeks. - Daniel Boone

    My sweat and my wages they don't seem to weight out
    I'm gettin' more aches than I'm gainin' in gold

    #231394 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2049
    Joined: 01/15/2017

    After 1 year in the HMO scene (Henry Ford); I jumped to the VA and stayed for 14 years.   Climbed the admin ladder more because if you open your mouth, you get volunteered.   Then that becomes voluntold  to do so pretty messed up admin things and that took its toll.

    If you liked your VA experience in medical school and residency, you’ll like the VA in general.  If you didn’t gravitate toward our Veterans, then you may have an issue with the culture and mindset.  I LOVED my time in the exam room with our vets–they are second to none.  Having an opportunity to be their doc is just an added bonus for me.

    Pay isn’t great; but you won’t starve.  Per hour, it’s quite comparable and the pension is good enough too.

    FYI – PAs still find their way into the VA (Non-formulary Requests).  Cost containment is there and unless it’s a generic medication, it’s a slog to get through pharmacy hurdles — but most of the time you’ll get approval if one’s persistent and exhausted the cheap stuff.   Cutting is/freezing a lot cheaper than topicals.  IIRC, Liquid nitro was favored way over FU o — rarely saw that rx’d.

    Just don’t get into admin at the VA unless you really like politics.

     

    #231395 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    FYI – PAs still find their way into the VA (Non-formulary Requests).  Cost containment is there and unless it’s a generic medication, it’s a slog to get through pharmacy hurdles — but most of the time you’ll get approval if one’s persistent and exhausted the cheap stuff.   Cutting is/freezing a lot cheaper than topicals.  IIRC, Liquid nitro was favored way over FU o — rarely saw that rx’d.

    Just don’t get into admin at the VA unless you really like politics.

     

    Click to expand…

    Absolutely. I have had my fair share of non-formulary requests as a resident already. They certainly have their frustrations but I have had decent luck getting most stuff through.

    I have never been lost, but I will admit to being confused for several weeks. - Daniel Boone

    My sweat and my wages they don't seem to weight out
    I'm gettin' more aches than I'm gainin' in gold

    #231396 Reply
    Hank Hank 
    Moderator
    Status: Attorney
    Posts: 1401
    Joined: 03/27/2017
    You can take your govt healthcare with you when you retire if you’ve been enrolled in it for at least 5 years prior to retirement and stay until at least minimum retirement age.

    Click to expand…

    Important to note: federal employee retirement system minimum retirement age currently is 57 for those born in 1970 or later.

    #231401 Reply
    Liked by Eye3md, Anne
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1168
    Joined: 11/07/2017

    I appreciate the time you put in to write all that.

    The biggest reason I am considering this as a future option is because I have grown to absolutely love the veterans. After working with them for the past several years I often find myself regretting that I never entered into service for our country as they did. And for that reason I often feel that I could fill that void with offering my services to them as a dermatologist.

    I could care less about what others would think if I did become a VA doc. Physician entitlement is one of the worst characteristics of our profession, so I tend to ignore such people, anyway.

    “Full time derm at my VA generally makes low to mid 300k, although they can go up to 400k which is the current federal salary limit.”

    Any idea what one would have to do to get up to that upper 300k mark? See more patients I am guessing?

    Click to expand…

    I guess I should have written theoretically they can go up to 400k.  I don’t think any of ours do at this time.   The VA doesn’t do high level churn well–as derm you will see more patients than I do but will never have the pace of PP.

    We do have some that work private practice mostly and come to VA 1 day per week as contractors but they don’t get the federal benefits.  I don’t know what the pay scale for that looks like but you could just ask at the VA you are looking at–they often need derm.

    Another thing to remember is no contract and no non-compete.  So if you find you’re not happy there you can leave and work in the same city no problem.

    I’ve had zero issues with getting NF approvals.  I don’t ask for anything crazy and make sure I have justification documented but I’ve found it to be pretty easy.   The rare times I get denied I just call the reviewing pharmacist and discuss and it gets approved.  I work in a field with a lot of DME and those resources are MUCH more generous in the VA than via most insurances, even good private insurance.

    My headaches are in trying to improve the system which is not easy in any bureaucracy.  I actually feel like I have more of a voice in my VA than I probably would have in a big corporate hospital system.  I like the challenge of trying to improve things and I think I have made some improvements to our system over time (as well as had my share of blunders).

    #231406 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1168
    Joined: 11/07/2017

    You can take your govt healthcare with you when you retire if you’ve been enrolled in it for at least 5 years prior to retirement and stay until at least minimum retirement age.

    Click to expand…

    Important to note: federal employee retirement system minimum retirement age currently is 57 for those born in 1970 or later.

    Click to expand…

    Although pension calculation is also affected by years of service at that point.

    https://www.opm.gov/retirement-services/fers-information/eligibility/

    #231407 Reply
    Hank Hank 
    Moderator
    Status: Attorney
    Posts: 1401
    Joined: 03/27/2017

    WorkingtoFish, if you were considering uniformed service, you still could be a derm in the Guard or Reserves.  Reserve component military service potentially dovetails nicely with a VA job.  After all, the VA should understand the risks of discriminating against an employee who gets activated for deployment or has to fulfill annual training obligations.

    #231413 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2049
    Joined: 01/15/2017

    FYI – PAs still find their way into the VA (Non-formulary Requests).  Cost containment is there and unless it’s a generic medication, it’s a slog to get through pharmacy hurdles — but most of the time you’ll get approval if one’s persistent and exhausted the cheap stuff.   Cutting is/freezing a lot cheaper than topicals.  IIRC, Liquid nitro was favored way over FU o — rarely saw that rx’d.

    Just don’t get into admin at the VA unless you really like politics.

     

    Click to expand…

    Absolutely. I have had my fair share of non-formulary requests as a resident already. They certainly have their frustrations but I have had decent luck getting most stuff through.

    Click to expand…

    You just have to get through the hoops.  If there’s a formulary alternative, you have to get through those first before needing the nonform.   It just takes time and persistence.

    Don’t get me wrong, VA LOVES PIPs (Process Improvement Projects) and would love one to get engaged on those.  It’s when central projects/edicts get pushed out with little/no good reason or objectives or unfunded mandates come through—-those are a lot harder to get behind and garner buy-in from the troops.

    #231448 Reply

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