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I'm separating from the military in 2 months after 3 years of service as a PA in primary care and was recently extended 2 job offers; one with the VA in primary care, the other an occ med job with a non-profit organization run by Catholic Health Initiatives. As I consider what I'm looking for in my next job, factors such as work-family balance, minimal red tape and stress are more important than pay. Both offer good benefits. Can anyone offer any insight to life as a PA with the VA and how that job might compare with a position with a non-profit? Thanks!

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Hi, I work for the VA in primary care in a community-based outpatient clinic.  I love it and would be very unlikely to go back to the private sector. There are many positive aspects: good pay (better than private sector, despite all of the recent hype in the media), regular step increases, lots of time off, regular schedule, good health insurance, and excellent retirement. Most importantly, for me, is the autonomy.  We have moved from "supervision" to "collaborating."  I am responsible for my own panel of veterans, no one is looking over my shoulder.  We also are not expected to crank out patients every 10 minutes to make money for a corporation.  I get one hour with my new patient, half an hour for returns.

 

There are some annoyances, such as mandatory meetings and in-services, which are usually bullshit created by someone who has to justify their job. The other thing is that CME is inconsistent, depending on what VISN, or region, you are in.  Some are generous and pay for everything, some are stingy and will only pay for the actual program cost, no travel, etc.  On the positive side, as a federal employee, you are exempt from paying for your DEA, which is over $700 and sure to go up

 

If you have a family, you will have excellent work-home balance.  If you are really efficient, you will be out the door at 4:30 PM.  I tend to work late because I am very anal  about my work and I like the peace and quiet after the rest of the staff have left. There is no call, no rounding, etc.

 

I have worked for a free clinic in the past.  The pay was very low. Non-profit work can be shaky.  Personally, I think the VA is a better bet, but that is up to you. Veterans, for the most part, are a wonderful, appreciative patient population.

 

Do you mind telling me which VA made the offer?  Feel free to PM me if you have more questions.  Good luck with your decision!

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I currently work for the VA, and agree with gleannfia's comments.  I worked in primary care at a community based outpatient clinic, and found the pluses of working with the VA outweighed the minuses.  At present, I work in Compensation and Pension, which can be stress-free and curiously interesting on a good day, or tedious and frustrating on a bad day. 

 

In my experience, the VA will not give the selected candidate a firm salary offer until the very last minute, which can make it difficult if you're juggling multiple job offers.

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Weeziana, good to know, they seemed unwilling/unable to provide a firm number even after I expressed salary may be a deciding factor. All they could say is that they would get back to me, meanwhile I've got folks at the other position sending me their offer including salary and benefit details tomorrow.

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With experience of several years and being a graduate of an accredited program/NCCPA certified, assume you're at least a grade 12/level 6 (one of our fine contributors has messaged me, telling me that they were offered a 12/10 pay scale on two separate employment opportunities, regardless of degree level).  If you hunt around the web you'll be able to find a table showing the salary amounts for each grade/level in your area.

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I can appreciate that.  I did a brief stint at Fort Bragg and did not care for the records system or the way medicine was practiced .  I felt that we were pushed to throw ibuprofen at the soldiers and get them back out there. But that's just me.  I wasn't a good fit for military practice, there is a place for everyone.  Some people love working in prisons as well, and that is not for everyone.

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Are there going to be any major changes for PA's in the system with the whole VA debacle right now?

y2jteWY.gif<--- Opening some can of worms ... Some are eager to link the VA event to Obamacare, and more predominantly; a government-run health care. While others praise the strength of the VA holding it as an ideal of what our health care system should look like. More and likely it probably lie somewhere in the middle.  But remember the VA has always been deplorable even during the Vietnam War.

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It has been my take on the matter that the issue tends to lie primarily with the administrative personnel more so than the actual providers.  I purchased and started to read Wm. Gates non-fiction account of his time as SOD under Bush and Obama (became bogged down in it very quickly) and he himself admitted to the quagmire of the VA system, as well as the DOD as a whole, and the inability to make changes.  One of the more telling revelations was his trying to get the head of Walter Reed out of the picture when Gates himself saw the overall rundown condition of the facility.  Apparently the head of the hospital dismissed some of the concerns from the SOD.  I can only imagine how difficult making common sense modifications can be.

 

Addendum 5/29:  I did just receive a callback in follow up to my email inquiry yesterday as to the pay grade meeting that was scheduled for 5/27.  It was pushed back to tomorrow due to the head of the dept. not having been available.  Should get a call tomorrow afternoon I was told (while I will be on the road).  Guess I'll have to take my notebook with the salaries for each grade/level with me to reference.

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I can tell horror stories about Duke, Cleveland Clinic, and Johns Hopkins as well.  My general feeling, as is that of many of my colleagues, as that the VA did not prepare for all of the returning soldiers after we sent them off to war. Current veterans have survived injuries that killed those in earlier conflicts.  I am not going to get into a political dispute here, but the sequester cut 21 million from the VA budget. One huge problem is co-managed care and double-dippers.  The VA has opened up care to non service connected veterans who may or may not be combat vets.  We see many middle and upper middle class vets who want the VA to pay for their Viagra. When I was working in oncology, we saw many well-off veterans whose insurance would not pay for novel chemotherapy agents (And, yes, this was occurring well before Obama was even a Senator)

Many of us think that the VA should set up a mail-order pharmacy, much like Express Scripts, where vets who only want prescriptions and are eligible can have their scripts from outside docs mailed in and filled.  There is no need for us to see them unless they have service connected problems.

If we could limit appointments to those who are truly service-connected or who have no other resources, there would be no problem with getting vets in for their appointments in a timely manner.  Unfortunately, we are seeing people who want what they can get, even if they have good insurance/Medicare and are not service-connected. They take up appointments that should be reserved for those truly in need.

 

And yes, don't blame the providers.  Look to the administrative people, the bean counters, such as the Phoenix director.  I didn't blame Bush for Walter Reed and I don't blame Obama or Shinseki for the current situation.  It is far more entrenched than these people.

 

Still, I think this will blow over, and most vets would not choose privatization.  Instead of using this crisis for political gain, all should be working together to solve the problems and provide excellent care to our veterans.

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I can tell horror stories about Duke, Cleveland Clinic, and Johns Hopkins as well.  My general feeling, as is that of many of my colleagues, as that the VA did not prepare for all of the returning soldiers after we sent them off to war. Current veterans have survived injuries that killed those in earlier conflicts.  I am not going to get into a political dispute here, but the sequester cut 21 million from the VA budget. One huge problem is co-managed care and double-dippers.  The VA has opened up care to non service connected veterans who may or may not be combat vets.  We see many middle and upper middle class vets who want the VA to pay for their Viagra. When I was working in oncology, we saw many well-off veterans whose insurance would not pay for novel chemotherapy agents (And, yes, this was occurring well before Obama was even a Senator)

Many of us think that the VA should set up a mail-order pharmacy, much like Express Scripts, where vets who only want prescriptions and are eligible can have their scripts from outside docs mailed in and filled.  There is no need for us to see them unless they have service connected problems.

If we could limit appointments to those who are truly service-connected or who have no other resources, there would be no problem with getting vets in for their appointments in a timely manner.  Unfortunately, we are seeing people who want what they can get, even if they have good insurance/Medicare and are not service-connected. They take up appointments that should be reserved for those truly in need.

 

And yes, don't blame the providers.  Look to the administrative people, the bean counters, such as the Phoenix director.  I didn't blame Bush for Walter Reed and I don't blame Obama or Shinseki for the current situation.  It is far more entrenched than these people.

 

Still, I think this will blow over, and most vets would not choose privatization.  Instead of using this crisis for political gain, all should be working together to solve the problems and provide excellent care to our veterans.

The problem with the VA, and the rest of the federal government, isn't lack of funding.  The problem is the "blob" of bureaucracy that prevents even the best of people, like Shinsecki, from fixing things.  Watch the movie "Waiting for Superman" for an example of how the same "blob" prevents anyone from fixing the problems with our public schools.  It's not a money problem, it's a bureaucracy problem.

 

You are completely right about the problems associated with opening the VA up to non-service connected vets.  It was not, and should not be, the purpose of the VA to provide comprehensive health care to anyone who ever served a day.  However don't you see the correlation between THIS and the 50 year push for complete government-provided health care for everyone?  Our bureaucrats want to get more and more people onto gov'ment healthcare (CMS, VA, etc), yet the quality of gov'ment healthcare declines (fewer and fewer docs taking medicaid, VA waiting lists, etc).

 

 

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No offense, but most of my patients would beg to differ with you.  When is the last time your doctor spent an hour with you?  I spend an hour  (or more) with new patients, 30 minutes with returns.  That would not fly in the cha-ching of corporate health care.

That is your n=1. 

 

My n=1 with VA family practice medicine has been three visits, including two annual physicals, where my barely english speaking doc has never touched me beyond shaking my hand. 

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I can relate to the Fort Bragg experience; I worked at an Air Force Base primary care clinic, and the emphasis was on keeping everyone deployable.  The big joke was that there was a mysterious room, somewhere, with a mountain of Motrin in it!  Provider were discouraged from labeling active duty members with depression, and advised to diagnose them with adjustment disorder.  I didn't like the style of medicine practiced there; sick call brevity at best, which of course may have its place in another setting.

 

The demands on the VA system have increased, as previously noted, by the influx of veterans who have served in recent, endless conflicts.  Now, I'm not making a statement on the general quality of today's military, but a lot of these folks were, quite frankly, marginally employable prior to service, and when they get out, they either can't find a job or aren't qualified for anything.  As a provider who has worked both in primary care and compensation and pension, I have to say that there is a big rush to get on the VA bandwagon.  Between the double dippers with insurance and the unemployed/uninsured, primary care clinics are bursting at the seams.  Providers may get a big more time with patients than in the civilian world, but each patient is the proverbial "train wreck", with multiple problems/issues, who gets seen once or twice a year. 

 

There is a hue and cry about the delay in processing disability claims.  In my opinion, this is a big racket for many claimants.  Now, of course, there are so many deserving vets who are injured, broken, from their service, either physically, mentally or both, and warrant as much help as we can give them.  But then again, it is well known in VA circles that the name of the game is getting a check.  C & P is clogged with frivolous claims, generated by vet reps who comb through charts looking for potential service connections, however medically implausible.  It is not unusual to have to review years of medical records to process a claim for 15 or 20 possible conditions, so it's not like we can see 20 vets a day and take care of their claim.  VA disability payments are a source of income, and many vets keep pushing for a greater percentage of service connection.   It is sad to see stoic vets, who never complained a day in service, who come in with injuries that will plague them lifelong, struggle to get compensation without supporting evidence, while other vets spend their entire enlisted period in sick call, racking up documentation of complaints, because they know that's what they'll rely on after separation to get them a service connected disablilty. 

 

In general, vets get excellent care once they get in the system.  The system is indeed burdened with a lot of dead weight, employees that can't be gotten rid of.   Specialties have no incentive to see patients, as they get paid the same whether they see more or less, so some cherry pick their patients and find ways to decline referrals.  Primary care is an endless job, with complicated patients and endless "view alerts" to answer daily.  I have to say, though, that most people, both clerical and medical, prioritize the care of the veterans, and give them the best care possible.

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