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  • Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2040
    Joined: 01/15/2017

    Promoting incompetence is a common practice in the VA to get dead weight out of our your clinic….crazy, but true thing that happens and eventually places these in folk in lead positions that have no effective managerial skills let alone knowing HOW to do the frontline position that they were promoted out of in the first place.

    Workload –  Common rule: 20% of staff does 80% of the lift.  1/2 are routinely flotsam, or worse, create more rework .  rest do the last 20%

    #104678 Reply
    Avatar resident_1 
    Participant
    Status: Physician
    Posts: 109
    Joined: 06/26/2016

    I’m a psychiatrist in a small VA outpatient clinic for less than 1yr.  I find it a good fit so far.  The previous outpatient job with a “non-profit” hospital system was painful, particularly RVU targets, being asked to do “physician leadership” activities that were always waste of time (not for administrators who enjoy scheduling meetings just to have  a meeting). Insurance was crap.  Retirement plan matched up to 3% of salary, but it took 5yrs to fully vest, they had a pension plan but it was a private one that you couldn’t find details on even if you wanted.  Yes there is paperwork, but I had lots of it from private insurance companies anyway. Just not dealing with RVUs feels great.

    Here I get a base salary of $200k, +EDRP loan repayment (up to $120/k over 5yrs), +potential yearly bonus, +FERS, +5% of salary match (there is 3yr vesting though). Health insurance is much better (federal blue cross blue shield). But I am loving the 26days off.  I do extended hours, which means some days I’m there longer, and work 4hours each Saturday morning (and have sunday and monday off).  If its a 3 day weekend, then I have all of Saturday off and get additional 4hours of time off for future use.

    I am not liking CPRS, how inefficient it is in ordering pretty much anything.  But I do appreciate that all my patients are followed by primary care, all types of referrals are possible, I am not alone in the clinic, there is a good process for involuntarily hospitalizing patients.

    I think VA did increase its psychiatry salary, and I think it is appealing for recent graduates.

    #104765 Reply
    Avatar Dusn 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/02/2018

    If you’ve see one VA, you’ve seen one VA. The Durham VA had amazingly efficient turnover with the circulating nurse waiting outside in the hallway with the next patient and the resident barely had time to finish the discharge orders. But the eye clinic there wasn’t as well run. Asheville VA on the other hand had a very well run eye clinic and hospital in general with great ancillary staff (it seems much better than the private hospital monopoly in that area). NYC – pretty poor but I found the the ancillary and nursing staff in most NYC hospitals so poor that I saw no difference at the VA.

    My advice to anyone planning on working at the VA (or really anywhere) is to try to get some inside knowledge about where you’re planning on working.

    #104777 Reply
    Liked by StarTrekDoc, Anne
    CM CM 
    Participant
    Status: Physician
    Posts: 1168
    Joined: 01/14/2017
    Earnest refinancing bonus
    The lure of the 40 hour work week and benefits/pension has to surpass your tolerance for laziness, incompetence, and lack of institutional leadership.

    Click to expand…

    Can a VA physician count on a 40-hour work week?

    I’m an employee at a private hospital and my contract calls for a 40-hour week, but that’s ridiculous. In actual practice, 55 hours is a fairly good week.

    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried bags for Cyd Charisse (gracious). Hosted epic company parties after Friday night rehearsals.

    #234313 Reply
    SerrateAndDominate SerrateAndDominate 
    Participant
    Status: Physician
    Posts: 486
    Joined: 02/01/2018

    Having rotated through the VA as a student , resident, and now fellow, I can safely say I don’t ever see myself working in the VA system. Their path lab sends immunostains out across the country when they are available across the street. Could be a cost thing. However, my residency VA somehow struck a deal to send an immeasurable number of consults through the “fistula” (hallway connecting VA to university hospital). Basically, any challenging case would be dumped to the university folks.
    Rotating in clinics now as a fellow, I enjoy their patients a lot. Usually very grateful of your time and aware of the system’s inefficiencies. I just couldn’t deal with the slow pace

    Earn everything.

    #234326 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    Wanted to see if I could revive this thread to get some questions answered.

    Anyone on here currently working at the VA care to share their salary in one of the higher paying specialties? Did you have to do much negotiating to get this salary? Or is there any negotiating power at the VA?

    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

    #245419 Reply
    Avatar cbc 
    Participant
    Status: Physician
    Posts: 14
    Joined: 08/01/2017

    VA salaries are public at FedSmith database.

    The 10% of my time spent at the VA accounted for 90% of my professional headaches. Quitting was great for my quality of life.

    #245460 Reply
    Liked by snowcanyon
    Avatar wideopenspaces 
    Participant
    Status: Physician
    Posts: 1137
    Joined: 01/12/2016

    I don’t believe there is really any room to negotiate, as far as I know. I just started at the VA and I *am* getting some kind of sign on/retention/student loan repayment – 140k over 4 years. In my area it’s one of the higher paying places ( psychiatry).

    #245462 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    VA salaries are public at FedSmith database.

    The 10% of my time spent at the VA accounted for 90% of my professional headaches. Quitting was great for my quality of life.

    Click to expand…

    Could you elaborate on what caused the headaches? Administrative stuff?

    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

    #245548 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2040
    Joined: 01/15/2017

    I don’t believe there is really any room to negotiate, as far as I know. I just started at the VA and I *am* getting some kind of sign on/retention/student loan repayment – 140k over 4 years. In my area it’s one of the higher paying places ( psychiatry).

    Click to expand…

    EDRP ?   –  That still alive and kicking?  — That’s one program that actually worked from Day 1 and PSLF should have modelled after that.  I used it and paid off my loans —  remember have to ASK for it.  They conveniently don’t mention it.

    Most a system can do is max you out at Grade/Step, then add onto local for recruit/retention.   This latter is definitely negotiable at the Chief Of Staff level.  Same for moving/relocation expenses which can be quite generous oneoff so don’t be afraid to ask for the sun on that — like 6months rental storage of personal furniture while searching for new home is not an out of reach ask.

     

    #245553 Reply
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    StarTrekDoc – what exactly do you mean “max you at at grade/step” and add onto local for recruit/retention?

    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

    #245564 Reply
    mr_boo_jangles mr_boo_jangles 
    Participant
    Status: Physician
    Posts: 14
    Joined: 09/02/2019

    they are going to hours accrued vs days off.  so if you work a 12 hour shift, and that was considered a “day off”, it will now cost your 12 hours of accrued time.  docs i spoke with aren’t thrilled about this. so, its not really 26 days anymore for 24 hour staff.

    apparently been in the pipeline for a couple years.  going live in sept 2019 i’m told.

    ER pays $280k/yr -$315/yr depending on location…. but you do 40 hour work weeks.  so that’s about 167 hr a month, based on 40 hour work weeks, 80 hours per pay period, 26 pay periods.

    26 pay periods x80 hours per period = 2080 hours a year, 2080/12 = 167 hrs a month.  Thats a lot for an ED doctor.

    it was nice with the days off, but going to “hours accrued” vs days off when you’re banging out 12 hour shifts sucks.  that’s a lot of time lost.

     

     

    #245580 Reply
    mr_boo_jangles mr_boo_jangles 
    Participant
    Status: Physician
    Posts: 14
    Joined: 09/02/2019

    .

    #245586 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2040
    Joined: 01/15/2017

    StarTrekDoc – what exactly do you mean “max you at at grade/step” and add onto local for recruit/retention?

    Click to expand…

    GS  Grade 15 Step 10 —  that’s where almost all docs that we ever had came in on — and there’s no further way up.    That was before the days of the doc salary tiers for the pay reform was done, but essentially the same thing with ‘local’ competition sprinkled in there.

    https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2019/GS.pdf

    https://www.va.gov/OHRM/Pay/2018/PhysicianDentist/FinalAnnualPayRanges.pdf

     

    @Jangles – didn’t know yet another reform being done.  Going to hours sounds weird.  The first reform that got us off the 24/7 weekend charges was a good move though if ‘costed’ us from 30 days to 26–at least one could take a week off and not get charged 7 days.    This hourly move sounds like a jobs program.

    #245619 Reply
    Avatar faust 
    Participant
    Status: Physician
    Posts: 15
    Joined: 09/11/2017

    When I was in residency I heard about a couple of other financial perks from the attendings there (not sure if really true or just scuttlebutt) – any truth to these?

    -no need for malpractice/liability insurance. I heard that if a patient sues a VA provider they are effectively suing the federal government so the case will be taken up by government counsel – anyway that can be significant savings for some specialties.

    -nobody cares (and no financial incentive) if you’re board certified, so the attendings I had never worried about paying for recert exams/annual fees/board prep etc. It did mean some of the attendings I had had knowledge that was 30 years obsolete but oh well….

    #245631 Reply

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