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  • Avatar Eye3md 
    Participant
    Status: Physician
    Posts: 72
    Joined: 12/01/2017

    StarTrekDoc, I believe you are 100% accurate.  The VA employed cataract docs were doing 5-6 cases per day (from what i was told).  In private practice, even the slowest cataract surgeon around here can do 10-12 in a day.  The fastest ones could do 24+, if needed.  A lot more efficient than the VA (or most any hospital system, considering these private practice cataracts are being done in ASCs).

    #103645 Reply
    Avatar Kamban 
    Participant
    Status: Physician
    Posts: 2487
    Joined: 08/01/2016

    No government employee can be paid more than the president, so $400K will be the cap.

    Click to expand…

    So prior to 2001 when George W. Bush salary went up from $200K to $400K no physician in VA system could have earned more than $200K per year. If that was the case how would they have found radiologists and ortho and neurosurgeons willing to work for $199,999.99 per year or less. Even I earned more than that per year in 2000, and I am not in a high paying specialty.

    #103647 Reply
    childay childay 
    Participant
    Status: Physician
    Posts: 1013
    Joined: 01/09/2016

    No government employee can be paid more than the president, so $400K will be the cap.

    Click to expand…

    So prior to 2001 when George W. Bush salary went up from $200K to $400K no physician in VA system could have earned more than $200K per year. If that was the case how would they have found radiologists and ortho and neurosurgeons willing to work for $199,999.99 per year or less. Even I earned more than that per year in 2000, and I am not in a high paying specialty.

    Click to expand…

    See below, seems to be accurate.  I assume the VA had no neurosurgeons and sent them to other hospitals?

    https://www.federalregister.gov/documents/2016/09/01/2016-20910/annual-pay-ranges-for-physicians-and-dentists-of-the-veterans-health-administration-vha

    #103666 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1174
    Joined: 11/07/2017

    No government employee can be paid more than the president, so $400K will be the cap.

    Click to expand…

    So prior to 2001 when George W. Bush salary went up from $200K to $400K no physician in VA system could have earned more than $200K per year. If that was the case how would they have found radiologists and ortho and neurosurgeons willing to work for $199,999.99 per year or less. Even I earned more than that per year in 2000, and I am not in a high paying specialty.

    Click to expand…

    See below, seems to be accurate.  I assume the VA had no neurosurgeons and sent them to other hospitals?

    https://www.federalregister.gov/documents/2016/09/01/2016-20910/annual-pay-ranges-for-physicians-and-dentists-of-the-veterans-health-administration-vha

    Click to expand…

    There are a few doctors at VA who make just over 400k, but barely.  Most neurosurgeons at VA are attached to academic centers and are dual salaried–i.e. they pull the (close to 400K) salary from VA, and then pull a similar or higher salary from the academic hospital to bring them to an acceptable pay rate.

    #103682 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1174
    Joined: 11/07/2017

    Yeah, I would take a HUGE pay cut but I would not consider working at the VA until I was FI. And because I’d be FI, I would consider the work at the VA to be an opportunity to provide care to the vets (without much concern for the big pay cut)

    Click to expand…

    I became FI (if you believe the 4% rule) at age 40 while working at the VA…so it is possible.  But I am DINK (happily childfree), and we are not big spenders by nature.  I’m not a huge fan of the 4% rule, and enjoy my job most of the time, so I have no plans of adding the RE part anytime soon…unless things change and we move more to assembly line medicine.   I enjoy having complex patients that I have time to sit down with, really figure out their problems, and develop a plan to help them.  I have a fair amount of autonomy within my specialty and have become pretty good at navigating the VA system.  It is correct that the VA is not good at high volume churn, and could definitely be more efficient.  I have worried in the past that I would never be able to reenter a job where I am seeing 20-30 patients a day, but then again, I’m FI at this point so in the worst case scenario I still won’t have too.  Seeing that many patients is overwhelming to my introverted nature–I am much better suited to spending more time with a complex patient and really delving into their issues than spending a few minutes each with simple issues (or worse, a few minutes with complex issues and just kicking the can down the road).

    If someone really wants to work for the VA, I would recommend applying when a job opens up and not assuming that a job will be easy to get in the future.  The main way they can decrease the workforce in the VA is to stop new hires, and that is always a possibility.  I get several phone calls a year from doctors who are worn out from corporate medicine or private practice and want to join my dept–we have a small dept and all of our doctors are happy, so unless we get funding to expand (seems unlikely in the current political climate), someone quits or retires (which doesn’t seem likely in the near future) we have no openings.

    #103685 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Wow,  I’ve never lived in an area where there wasn’t a oversupply of cataract surgeons and I’m not even near a big city.  Our VA does about 7-8 cataracts per day but an attending is generally supervising and training a resident.  But there aren’t that many visually significant cataracts with worse than 20/40 vision anyway.

    The real demand is for glaucoma and medical retina.  The demand for intravitreal injections at most eye clinics I’ve seen is overwhelming.  And with lucentis and eylea costing about half as much for the VA and opposed to private practice (the VA negotiates the cost of their meds) keeping retinal injections in-house is the most cost effective measure they can have.

    I’d agree with the above statement that every VA is very different.

    #103847 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2055
    Joined: 01/15/2017

    @anne – spot on.  14 years in Internal Medicine there without moonlighting and able to squirrel away quite a lot.  If my post office mother-in-law can put her daughter through med school on her salary, we can do the unimaginable with a six figure salary.

    VA is the rare place where the complexity of care is constant and challenging.  Even now in the UC system across the street you don’t get the ‘I drove 150 miles to see you doc for a bit of back pain’ and turns out to be a dissecting aneurysm, or an untreated sleep apnea with AHI scores in the 80s and still functional.

    The cautionary advice to burnout for career folk —  stay away from the admin side of things and have ability to withstand nonsense edicts coming out of Central Office to ‘improve care’ (read politically charged mandate).   I probably would still be at the VA if didn’t take on an active role to believe that I could do good and move that ball forward.   And mind this — it’s one of the better admin VAs.   🙁

     

    #103864 Reply
    Liked by Anne
    Avatar Eye3md 
    Participant
    Status: Physician
    Posts: 72
    Joined: 12/01/2017

    Dusn, I am suspecting you are an eye doc based on the name…..clever.

     

    On the east coast and midwest, there are a ton of ophthalmology jobs.  I’d say most candidates coming out of residency and/or fellowship have their pick of where they’d like to go.  Retina and glaucoma are even better and the job scene is even more wide open.

     

     

    #103880 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    Haha.  Yes. Finding a little parasitic worm wiggling around the retina and trying to shoot it with a laser as it tries to hide is the coolest treatment in medicine IMO.  And DUSN is a pretty cool name for the condition.

    That’s great to hear that the ophthalmology job market has opened up!  It wasn’t that way a few years ago….  I like my current job but maybe I should keep my eyes open for one closer to family…. And maybe I should stop telling my residents who want jobs on the east and west coasts that they need to specialize in retina or glaucoma for the job market.

    #103923 Reply
    RJ RJ 
    Participant
    Status: Physician
    Posts: 124
    Joined: 01/09/2016

    I am an ophthalmologist practicing on the west coast, 8 years in practice. I am happy (sarcasm) to report that job market on this coast is as bad as it has ever been. So please keep telling your residents to specialize if they want to practice on the west coast. Glaucoma would be my suggestion. There is tons of retina on the west coast already.

    #103950 Reply
    Avatar Ghetto 
    Participant
    Status: Physician
    Posts: 126
    Joined: 08/13/2017

    I worked at a VA for three years in my residency and the worst part was the ancillary staff.

    I would have five OR procedures scheduled (by the previous resident) that were to finish before noon and I’d have to be over at the University clinic at 1pm. I’d do the first case and the time it took to turn the room over was ridiculous. The employees would move at molasses like speed and I’d be frustrated and start mopping the floors and doing their jobs to get the room ready for the next case. Nothing like watching unaccountable low level employees take a break while you do their jobs. Needless to say I was always late to University clinic and my attendings wouldn’t be happy.

    I’m assuming this was primarily because a resident had little or no recourse? Any current VA docs run into similar issues?

    #104397 Reply
    Avatar BladeRunner 
    Participant
    Status: Physician
    Posts: 46
    Joined: 07/03/2017

    Hah!

    I remember a surgical tech called the floor and had the nursing staff feed our next patient, thus getting him cancelled because the case might go past 3 pm.

    One attending would turn around and drive back home if he couldn’t find a parking space close to the hospital in the morning.

    Got called by a nurse in the middle of the night to start an IV on a patient, who then mentioned by the way, that the patient’s roommate “wasn’t breathing so well” last time she checked.

    Roomate was dead, of course.

    Ahh, the VA.

    #104530 Reply
    Liked by Tim, MPMD, Ghetto
    Avatar Ghetto 
    Participant
    Status: Physician
    Posts: 126
    Joined: 08/13/2017

    Hah!

    I remember a surgical tech called the floor and had the nursing staff feed our next patient, thus getting him cancelled because the case might go past 3 pm.

    One attending would turn around and drive back home if he couldn’t find a parking space close to the hospital in the morning.

    Got called by a nurse in the middle of the night to start an IV on a patient, who then mentioned by the way, that the patient’s roommate “wasn’t breathing so well” last time she checked.

    Roomate was dead, of course.

    Ahh, the VA.

    Click to expand…

    That surgical tech should have been fired but I’m sure there were zero consequences.

    That kind of stuff is why I will never again work for the VA.

    #104541 Reply
    Avatar ellenb 
    Participant
    Status: Physician
    Posts: 23
    Joined: 12/21/2017

    This is the dilemma that I’ve seen – many good doctors are so frustrated by the subpar ancillary/support staff (clinical, administrative/HR, etc) and upper management neglect in addressing problems that these factors negate any VA positives.

    The lure of the 40 hour work week and benefits/pension has to surpass your tolerance for laziness, incompetence, and lack of institutional leadership. Maybe this perspective improves with age, and doctors in their 60s may not be bothered by all the VA deficiencies.

    #104649 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1174
    Joined: 11/07/2017

    Yes, incompetent and lazy ancillary staff can be a problem (heck, incompetent and lazy doctors can be a problem).   I have found that this has improved quite a bit at my VA over the past 5-6 years, although there are still lazy people.  There are also some really great people though too who really care about the VA’s mission.  I have found which support staff I can rely on and which to avoid.  Unfortunately, this means if you are a good worker you will get more to do.  I try my best to help these people get promoted whenever possible.   While it is possible to remove an incompetent govt employee, doing so is a lot of work and hassle.  I think historically there have been a lot of older, burned out doctors who have taken “leadership” roles in VA and then do not do the work to improve it and just take the easy way out of letting these incompetent employees slide.   What has helped my VA improve is the influx of younger, competent doctors in leadership roles who are willing to do that work, as well as a director who actually gives a crap.

    I think a few things are helpful to being happy at the VA as a doctor:  1.  Being in a specialty that does not rely too much on ancillary staff, and being willing to do some of your scut work yourself.  It is annoying/inefficient, yes, but at least things get done correctly.  And I know that if I ever want to transition to a low overhead model private practice, I will be able to do so.  2.  Having a personal tie to the VA’s mission.  I was in the military and have many veterans in my family, including my dad and both grandfathers, and really care about making sure my patients are well cared for.  3.  Having clinical interests that are in line with what you see at the VA–e.g. Combat PTSD, amputee care, certain environmental exposures, etc.  If you have only 1 or none of these things, and your VA is one of those that is not competently run, it will probably drive you crazy.  But if you are working for a VA that is run at least decently well, it can be very rewarding.  And if you find it’s not for you, at least there’s no non-compete

    #104661 Reply

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