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IMGtoPA

Has anyone worked for the Veterans Affairs (VA) Hospital system?

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My mother is a RN who has worked in the VA hospital system for the past 5 years. She's been saying I should try to get in ASAP and get the benefits, along with other perks. I have a lot of in-laws that work at the VA (non-provider roles) and they all agree.  They say it's not as organized as the private sector roles but all agree that the benefits outweigh the annoyances.

I applied for a job on a whim, not thinking anything of it and I actually got a message on their website stating I was "not selected". But an HR rep called me last week to set up an appointment for an interview, which I have... classic example of how disorganized their HR department is.

Anyone have any experience working with them that could share their thoughts?

Edited by IMGtoPA
changed a word

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I am currently employed by them, in primary care.  Is there anything in particular you want to know?

It's a shit ton of work, but for the most part, it's rewarding, intellectually.  Unlike the world, you really need to work something up before referring;  specialists don't get paid by volume so the primary care actually manages things you would rarely see anywhere else.  At xyz medicine, Inc, you see a patient with a headache, they see neuro.  Not much time to really do much else.  Kidney failure, heart failure, go to those respective specialties and you get a report.  They come back to me at the VA.

I also feel it's one of the few places where you can practice real medicine- and by that, I mean you can actually make a change in someone's life.  In all my civilian jobs, I felt that zero times.

It's not all sunshine and ponies- the pay is lower, but we get paid holidays more than other places, and when I call in sick, I don't get shit about it like I have with civilian jobs.  I don't call in sick that often (4 times in three years).  You are treated like a colleague.  The HR department may be difficult but its not run by the bosses nephew.

The the thing that drives my up the wall are these things called alerts.  All emrs have them- lab notifications, etc- in the VA, however, you get a notification for every damn action that happens with your patient.  Consult placed.  Consult accepted.  First phone call.  No answer, letter mailed.  Appointment made.  Picked up orthopedic shoes.  Saw eye clinic.  

Let me know if you have any questions!

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I stayed for six months in their Ambulatory Care Clinic.  I understand that it all depends on the facility and the setting.  I had a classmate that recently retired after 25 or so years as the senior PA at that facility.  He was NOT in the ACC.  It wasn't for me due to the commute primarily, the oversight of the residents (or lack thereof) for whom I had to cover for when they would miss things or not schedule a follow up with themselves the next time they were onsite.  First week I found a chronic leukemia that multiple residents had missed just by looking at the labs which they had ordered!  While it certainly wasn't for me, at least in that setting, I could imagine how others in the specialty clinics might enjoy it.  This particular facility did not have a good reputation at the time I came on (I only did so to get back to work after time away to take care of elderly parents) but I was willing to give it a shot since I had years of experience in numerous settings.

Regarding benefits.  I didn't find the medical to be that great compared to what I had had in other non-federal gov't. settings.  My county pension has a better return than the feds.  Days off?  "Please ask for time off SIX months in advance" in my setting.  No thanks.

Edited by GetMeOuttaThisMess

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4 hours ago, thinkertdm said:

I am currently employed by them, in primary care.  Is there anything in particular you want to know?

It's a shit ton of work, but for the most part, it's rewarding, intellectually.

That is funny because pretty much everyone I have spoken to says the workload is WAY LESS than the private sector. I guess it depends on the facility and the specialty. My mom's an OR nurse and the amount of cases are MUCH less than when she was at the private hospital down the road. VA in her city seems like it is where you go when you want to retire and slow down. All of the nurses and surgeons from her previous hospital made the move over to the VA to cash in on the better pension, slower pace, and nation-wide annual pay increases.

The position I got an interview for is for Psychiatry. They did mention that it is a position that is Mon-Fri from 8-4:30pm, with possible inpatient coverage (we will discuss more at the interview).

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18 minutes ago, IMGtoPA said:

That is funny because pretty much everyone I have spoken to says the workload is WAY LESS than the private sector. I guess it depends on the facility and the specialty. My mom's an OR nurse and the amount of cases are MUCH less than when she was at the private hospital down the road. VA in her city seems like it is where you go when you want to retire and slow down. All of the nurses and surgeons from her previous hospital made the move over to the VA to cash in on the better pension, slower pace, and nation-wide annual pay increases.

The position I got an interview for is for Psychiatry. They did mention that it is a position that is Mon-Fri from 8-4:30pm, with possible inpatient coverage (we will discuss more at the interview).

I don't know about specialties; primary care is where everything is sent back to.  Everyone seems to think it's a cushy job; in some ways it can be, especially if you drop it back to the primary.  The surgical specialties actively work on not seeing people.

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5 hours ago, GetMeOuttaThisMess said:

I stayed for six months in their Ambulatory Care Clinic.  I understand that it all depends on the facility and the setting.  I had a classmate that recently retired after 25 or so years as the senior PA at that facility.  He was NOT in the ACC.  It wasn't for me due to the commute primarily, the oversight of the residents (or lack thereof) for whom I had to cover for when they would miss things or not schedule a follow up with themselves the next time they were onsite.  First week I found a chronic leukemia that multiple residents had missed just by looking at the labs which they had ordered!  While it certainly wasn't for me, at least in that setting, I could imagine how others in the specialty clinics might enjoy it.  This particular facility did not have a good reputation at the time I came on (I only did so to get back to work after time away to take care of elderly parents) but I was willing to give it a shot since I had years of experience in numerous settings.

Regarding benefits.  I didn't find the medical to be that great compared to what I had had in other non-federal gov't. settings.  My county pension has a better return than the feds.  Days off?  "Please ask for time off SIX months in advance" in my setting.  No thanks.

I take it that you were working in primary care as well?

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Little off topic, but still about VAMC.  Does anyone working or familiar with VAMC know if there is any movement toward OTP in the system?  I recall a few years back, the PA director declined a type of full practice that was offered to NP. I had heard He/she was then sort of pushed out for not being very supportive of PAs and having conflict of interest,.  I don't work with them, had a friend who retired about that time. 

 

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I have been with the VA for a bit over a year. I wish I had gotten there many years ago. My pay is great - our director fought to get us a well needed raise that puts us equal to the NPs who have a huge nursing union. 

Primary Care uses a PACT team - Patient Aligned Care Team - Provider/RN/LPN/Clerk (MSA). You have a panel of patients. Anywhere from 900-1200 depending on location, number of patients to be served, etc.

In private practice, I had over 3000 patients, cradle to grave ---- seen in 10 minute appts like a Starbucks drive through.

VA is 30 minute to 60 minute appts. I will never see more than 14 patients a day. BUT, that is 14 high intensity internal medicine patients on poly pharmacy with mental health issues and a TON OF THINGS TO DO.

The view alerts on screen are heinous - lots of them. Some absolutely meaningless to you but you have to click through them. Lots of questions to answer, consults to place, etc. 

There is a lot of work. It is NOT a place for a new grad - My strong opinion and I am over 25 yrs out. These are intense patients and you have to know your crap. 

There is a thing called hierarchy of care and VA LAW on how to do things. If our VA doesn't have a specialty - say ENT - then by law I have to send the patient to the nearest VA that has an ENT dept. HAVE TO. Patients aren't always thrilled but it is the law. If that location cannot see the patient in 30 days then you get to send the patient out into your community - again - hoping someone worth their salt actually takes VA assignment. 

VA is 80% male and 20% female with female vets being the fastest growing number of vets to serve. I am a designated women's health provider. Some PACTs are not. 

The EMR is DOS based and older than my oldest kid - seriously. It works if you don't expect too much. I have mastered it and become friends with it to an extent. I know how to make it do what I want most of the time. A new system is rolling out in the next few years - same as active duty DoD uses now. It is 20 yrs newer - it will have its own issues as they all do.

I work my butt off but really do like it. Hard mental work, some hard core patients, lots of mental health. But I do good work - I pay attention and have the capacity to do so. Having an RN AND AN LPN is Christmas everyday. Everyone works to the limit of their license. It beats private family practice or corporate medicine hands down. 

I am treated just like the docs - not kidding. Same expectations, same patients, same responsibilities. I am "not just a midlevel" at my VA. I have some great partners and some not so awesome folks floating around but I drive my own boat. I have great support - our administration is unique, I believe, in that they are ultra supportive. Not that way at every VA.

Great benefits, lots of time off, tons of holidays. 

Not perfect, not at all - hard work, but rewarding to me and a great place for me to be. I wish I had gotten there years sooner.

Just my crusty old 2 cents

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3 minutes ago, Reality Check 2 said:

I have been with the VA for a bit over a year. I wish I had gotten there many years ago. My pay is great - our director fought to get us a well needed raise that puts us equal to the NPs who have a huge nursing union. 

Primary Care uses a PACT team - Patient Aligned Care Team - Provider/RN/LPN/Clerk (MSA). You have a panel of patients. Anywhere from 900-1200 depending on location, number of patients to be served, etc.

In private practice, I had over 3000 patients, cradle to grave ---- seen in 10 minute appts like a Starbucks drive through.

VA is 30 minute to 60 minute appts. I will never see more than 14 patients a day. BUT, that is 14 high intensity internal medicine patients on poly pharmacy with mental health issues and a TON OF THINGS TO DO.

The view alerts on screen are heinous - lots of them. Some absolutely meaningless to you but you have to click through them. Lots of questions to answer, consults to place, etc. 

There is a lot of work. It is NOT a place for a new grad - My strong opinion and I am over 25 yrs out. These are intense patients and you have to know your crap. 

There is a thing called hierarchy of care and VA LAW on how to do things. If our VA doesn't have a specialty - say ENT - then by law I have to send the patient to the nearest VA that has an ENT dept. HAVE TO. Patients aren't always thrilled but it is the law. If that location cannot see the patient in 30 days then you get to send the patient out into your community - again - hoping someone worth their salt actually takes VA assignment. 

VA is 80% male and 20% female with female vets being the fastest growing number of vets to serve. I am a designated women's health provider. Some PACTs are not. 

The EMR is DOS based and older than my oldest kid - seriously. It works if you don't expect too much. I have mastered it and become friends with it to an extent. I know how to make it do what I want most of the time. A new system is rolling out in the next few years - same as active duty DoD uses now. It is 20 yrs newer - it will have its own issues as they all do.

I work my butt off but really do like it. Hard mental work, some hard core patients, lots of mental health. But I do good work - I pay attention and have the capacity to do so. Having an RN AND AN LPN is Christmas everyday. Everyone works to the limit of their license. It beats private family practice or corporate medicine hands down. 

I am treated just like the docs - not kidding. Same expectations, same patients, same responsibilities. I am "not just a midlevel" at my VA. I have some great partners and some not so awesome folks floating around but I drive my own boat. I have great support - our administration is unique, I believe, in that they are ultra supportive. Not that way at every VA.

Great benefits, lots of time off, tons of holidays. 

Not perfect, not at all - hard work, but rewarding to me and a great place for me to be. I wish I had gotten there years sooner.

Just my crusty old 2 cents

Said it better than me.  I did hear that (rumors are great!) the new emr system may be on hold since the last secretary didn't sign the contract before he got canned.  I don't have high hopes for Wilkie; anyone who refers to patients as "customers" needs to pull their head out of their ass. 

I love it not only because some of these patients have pathology you will never see, and in various permutations, but also because I can turn away from the computer and listen to them.  The number one thing I hear is that no previous provider ever examined them before, which is sad.

But Ms. Check 2 is right on the money.

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Would you all be willing to uproot your families and move to a new location for an opportunity at the VA?

My spouse and I were talking about if this opportunity presents itself after the interview, is it worth it to sell our house and move. Just giving you background: partner is also a medical provider, we have a house and a 2 yr old in daycare. We have a local VA hospital but no response about job applications to that hospital.

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Me personally?  If I were going to do this I'd do so with a four to six month long-term stay rental and commute home on the weekends before taking that big of a dive.  It would be difficult, but less difficult, than getting there and realizing that you had made a BIG mistake if you didn't like it.  I've known one who did so (sold house, etc.) for a non-VA position and surprisingly it wasn't what he was promised.

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Another thing to consider. To get hired by the govt takes several months. 

My interview was in April. Job offer about 4 weeks later - some approval thing. Physical and drug screen in May.

Start date - August.

It just works that way. Fingerprints, FBI check, you have to account for every day of your life since birth in a history thing. Three references who have to do it a special way. Confirm they did it - confirm again. Fill out 5 more forms and wait on some licensure thing to triple check who you are. 

Day one at VA - don't get lost - don't get lost again. Find every dept on a check list - sign stuff, get an ID badge, check in with a bunch of departments who want to give you their intro and then you likely won't see a patient by yourself for about 2-3 weeks. You will likely shadow with a provider ( I do that now ) to learn how to use the system, where to find things, who to call and how to deal with stuff. 

If the VA you are considering is a ways away - stay with family if you choose the job. Don't uproot your entire family until you know.

AND, I will honestly say that you have to give it a year - a year, really.

It will take that long to figure things out, set any kind of pattern and get systems under your belt. 

Our asst chief of staff tells every new hire - ONE YEAR - please commit to one full year before deciding to leave. 

I really really like it and wish I had gotten there sooner. 

Hope all works out well for you.

 

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For myself, it was crystal clear long before a year, and it didn't hurt that I had an offer for more money and less stress (including the commute) much closer to home.  I think a lot of it has to do with your own background/experience, the specifics of the individual facility, and those whom you work with.  My "team" was slower than a tortoise and it wouldn't have worked long term.

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I am a Vietnam Veteran and get disability insurance and use the VA for many of my medical problems and have founbd my VA Medical Center in Northport, NY to be better than almost all of my private physicians who treat me as a VIP. Very little waiting and great care. I know it's not true all over the USA but my VA should be a standard.

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I worked for the VA in both primary care and compensation and pension for about 6 years.  I recently "retired" from the VA but am continuing to do locums/contract work.

As others have mentioned, although you have 30 minutes for established patient visits and 60 for new patients, you will use every minute for the tasks required.  The patients are generally complicated internal medicine patients, most of whom are requesting multiple referrals and meds.  You receive literally hundreds of "view alerts", which are electronic messages, on a daily basis.  There are also multiple "reminders", which are generally health maintenance check points, many of which can be done by nursing.  In my experience, you work non-stop all day.  It can be very intellectually rewarding.  The culture varies from location to location and administrator to administrator.  The location that I retired from was not supportive to PAs and many were leaving due to management disregard for the workforce.  Salary is lower than in the outside world, but at this point benefits are good.  As you know, this may change depending on the whims of the current administration.

 

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pay is an issue that has prevented me from working in the VA

I currently am getting almost DOUBLE (hourly) what they VA offers locally (and working only 20 hours/week)

 

Local hospital system starts new grad around 100, Va starts 75, top of scale is north of 150 at hospital, VA is under 120k.  I do not work for this hosptial, but instead the state and work 2.5 days a week for 120k

 

I have been in contact with the local med director - have forwarded  him salary data, and even the local medical director position at a neightboring VA (I have MBA so natural fit) but they say that they are not able to vary salary.  And to make matters even worse NP posting for same job is a little under 10k more, AND they lump us in with an area 60miles away (geographically we are isolated and across a state line- and this has created MUCH higher salaries locally) that pays FAR less (PA progam in that city suppresses wages.

 

So I would love to work in the local VA, but no way can I take a 50% hourly pay cut (means I would work a 40 hour week for the same pay as a 20 hour week) and be about 30-50k below what I would be in the local market...  too bad as I would love it.

 

Reality - What is your range of pay?   is it in the above range??

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