Starting at the Veterans Affairs (VA), NP/PA salary disparity

[Ikaruga102]

This may be in the wrong forum but I'm trying to figure out if taking a job at the VA 1 year into my career is a smart choice.

I've tentatively been offered a position for SICU at the VA. I know for a fact a NP with the same amount of experience as I do went in recently and got 105k, I spoke to someone I know who would potentially be grading me and quoted me for 75k with possible education debt repayment which actually makes sense from the VA Physician Assistant Professional Standards Board information I'm reading.

Does it make sense to anyone that there's such a disparity?
Would I be making a mistake taking this job when I can easily find something that will pay 90-100k?

How fast can I expect to move up in salary from here?

4 10s, possibly switching to 3 12s

More about the SICU

Good team of 9 midlevels, mostly day coverage since nights are taken

Floor coverage of ENT, vascular, and general surgery patients. ED consults

No first assisting, some procedure training

No call

26 day vacation

15 days sick

10 paid holidays

Pension + 401k with match

 

[PbagJones]

75k for ICU work is a joke and really any PA job for that matter, no matter where you are located. I have 2 years experience working in critical care and make about 125k working 3 12’s working MICU and SICU. There is no way you should make 50k less. Being a veteran myself I would love to work for the VA, but never with that pay disparity.

[AdamPAC]

Still a student here, but just to comment on the disparity: I understood this to both be a relic of the previously different federal pay scales for nurses versus PAs, and local decision making within the VA system. The laws changed the pay scale last year, so to me this seems like a local constraint placed by an admin that doesn’t value a PA as much. Like I said, I am still only a student, but this would be a big red flag to me unless I was able to talk with the other APPs about upward mobility and quality of life in that area. As a veteran, I would love to serve that population too, but could not place that strain on my family to do it. I hope they offer more in the end. As to the point you are at in your career, I am curious if anyone out there has insight on whether this is a good early career move or not too. 

[ventana]

VA stinks for PA

It is getting looked at

 

They offer me a 50% pay cut....  nope

 

 

NP's get to get paid based on a competitive marketplace adjustement

 

PA's paid on GS scale.

 

 

 

yup crazy 

[Ikaruga102]

12 minutes ago, ventana said:

VA stinks for PA

It is getting looked at

 

They offer me a 50% pay cut....  nope

 

 

NP's get to get paid based on a competitive marketplace adjustement

 

PA's paid on GS scale.

 

 

 

yup crazy 

Did they let you negotiate at all? How much did they adjust their original offer?

[mmiller3]

You can definitely negotiate.

I was offered $125k/year (10 years experience in Primary Care) at the Iowa/Quad Cities VA. This was the same rate as the NPs are offered. Just tell them you don't understand the disparity and don't see how you can work there at a reduced salary for the same work. If they don't work with you, hard pass (and let them know why you are passing). There is no reason for us as PAs to be paid on a different scale simply because some bureaucrat somewhere doesn't know his or her a** from a hole in the wall.

[Reality Check 2]

Nurse Practitioners at the VA are under Nursing Administration, not Medicine. They have the nursing union behind them. Their pay scale has been quite disparate for a long time.

I am at a VA in the Pacific Northwest. My pay was requested by my hiring boss at a much higher rate than advertised. She told HR and higher admin that she couldn't attract an experienced PA without normal pay. They gave it to her. 

We have already seen one local pay adjustment that pushed me up to same scale as NPs with same years experience.

There is a federal raise and adjustment pending if we haven't been torpedoed by the idiot in the White House with federal pay freezes. 

There is a ceiling - most everywhere I have been unless you work hourly and work a lot.

I am one step from that ceiling as I enter my 27th year as a PA. So are the NPs.

I cannot say enough to younger PAs - there is a ceiling. 

My frustration is that new and recent grads come out with 4x the debt I had and expect much higher pay upon graduation than the system supports. It leaves us old timers with lots and lots of experience with very little room. No offense, but a new grad is NOT going to make what I make - experience and skills count for something.

So, there is a starting salary at the VA - it isn't awesome but can be negotiated to the extent in the VA as to how hard your direct bosses want to push it. There is no one on one negotiation in the VA. 

The benefits are worth nearly $35K a year and are amazing. Federal holidays pretty much rock as well. 

The VA is INTENSE. It is Internal Medicine at its hardest. The work is hard, the computer system is old and the people are super sick. It takes a lot but is mentally rewarding to me and as a military brat - my chance to give back.  

If you want the higher salaries - you have to go to the private world where medicine has an actual payor besides the govt itself. 

Just my old 2 cents....

[mmiller3]

^^ 

Much of what Reality said it what I experienced in my negotiations with the VA. The clinic was nice but the providers looked stressed, the system they were using was archaic, and the patients were waiting forever in the lobby. The system is flawed, and ultimately I decided to go private sector instead.

 

[Reality Check 2]

The VA is a good place to work if it is the right fit for you.

The new computer program is coming. I am an up and coming super user - my kids snicker at me for that one, they think I am too old for computer skills. 

My administration is taking extraordinary measures to keep providers less stressed and onboard.  Some other locations don't sound like they have much admin support. 

It is good work with good support systems. 

I am not in this for the money. No loans here. I have kids in college and am the main breadwinner for my family. We have enough.

I work fair hours for good pay and have excellent benefits. I don't drive far. No nights, no weekends, no call, no holidays working.  My patients are tough but I enjoy the challenge and am pretty damn good at it. 

My encouragement for others is to take the system for what it is - work with it and fight the battles that can be won or improved. 

 

 

 

[ventana]

3 hours ago, Ikaruga102 said:

Did they let you negotiate at all? How much did they adjust their original offer?

 

I actually just walked away - to far out of reality to even try

 

I am likely going to circle back in a while and try to double dip with State and Federal pensions building (1/2 time at each)

 

[Ikaruga102]

Update: I asked for an estimate from HR and they said it can range from 105-130k. So I'm getting mixed messages. I won't know for sure until December. This would be a lot more fair than the 30k paycut.

[GetMeOuttaThisMess]

You should be able to go online and look this up.  I did a couple years ago.  You need to know which VISN you're in and most PA's I presume still start at GS12 or 13.  You can also find your salary adjustment based on location online as well.

[Ikaruga102]

1 hour ago, GetMeOuttaThisMess said:

You should be able to go online and look this up.  I did a couple years ago.  You need to know which VISN you're in and most PA's I presume still start at GS12 or 13.  You can also find your salary adjustment based on location online as well.

 

I would actually start out at GS11 according to this guide and someone I know on this board. I'm hoping HR is right with their estimate.

http://www.vapaa.org/resources/Documents/PSB Training VAPA Houston 2017.pptx

 

[GetMeOuttaThisMess]

1 hour ago, Ikaruga102 said:

 

I would actually start out at GS11 according to this guide and someone I know on this board. I'm hoping HR is right with their estimate.

http://www.vapaa.org/resources/Documents/PSB Training VAPA Houston 2017.pptx

 

Never saw any such information 3 years ago at VISN 17 (Dallas), but then again it WAS VISN 17.  Threats were not infrequent, staff was lazy to put it mildly, and specialty clinics didn’t give a rip about seeing appropriate referrals.  The writing was clearly on the wall after just a week.  

[mmiller3]

On 11/21/2018 at 9:24 AM, Ikaruga102 said:

Update: I asked for an estimate from HR and they said it can range from 105-130k. So I'm getting mixed messages. I won't know for sure until December. This would be a lot more fair than the 30k paycut.

Tell whomever you are in talks with what you salary requirement is, up front. If they cannot guarantee it, you should walk away. You will waste a lot of time with credentialing, etc, if they low ball you after all is said and done. I know they can do this because they did it for me, albeit in a different AO.

[CAAdmission]

On 11/20/2018 at 2:26 PM, Reality Check 2 said:

If you want the higher salaries - you have to go to the private world where medicine has an actual payor besides the govt itself. 

You should bold that sentence in red and have it blink for all the hippies that think government-sponsored, single-payer, "medicare for all" is a great idea.

[ventana]

5 hours ago, CJAdmission said:

You should bold that sentence in red and have it blink for all the hippies that think government-sponsored, single-payer, "medicare for all" is a great idea.

Govt is already paying something like 70% of all health care

 

why do our northern border docs make more then the us docs with a single payer system?

[Reality Check 2]

For the VA you will not get your final pay offer until your "packet" is processed.

Mine sat in another state on someone's desk for a month.

THEN they called me with final offer and it matched the one the hiring doc requested.

You don't get a number until about 10 people paw through your packet and all agree. Plus the FBI check, finger prints, drug screen, employment physical, etc.

It is what it is - just has to wade through it.

[Reality Check 2]

P.S. I trained at the Dallas VA.

a. In the worst part of Dallas

b. very tenure oriented back in the day - 20 yr RNs knew they would have to commit murder with witnesses to get fired - they got less active with each passing year - thus, the phone call at 3 am that your patient's IV came out at 10 pm the night before.

c. one set of elevators was haunted and stopped between floors and opened the doors or just didn't open at all.

d. the 9th floor is haunted too - stuff moves and makes noises when no one is around.

e. THE ugliest brown scrubs ever - came out of a vending machine - you get 3 pair - no return, no scrubs - everything bar coded.

f. I started rounds on the front porch everyday with all my smokers - oxygen tanks and all in tow.

g. my longest term patient had tape across his pajama shirt on the back stating "if found, return me to 5E, don't let me ride the bus"

good times, good times......

[GetMeOuttaThisMess]

Nothing like the "death march" from the light rail station through the smoke haze of all the darn smokers at the front entrance.  The medicine wasn't hard it; was dealing with the attendings and the patients who knew how to work the system.  The only "good times" I had was when I'd disappear at lunch out onto one of the decks facing Lancaster Rd. away from everyone.  Yuk.

[vb315]

15 hours ago, Reality Check 2 said:

P.S. I trained at the Dallas VA.

a. In the worst part of Dallas

b. very tenure oriented back in the day - 20 yr RNs knew they would have to commit murder with witnesses to get fired - they got less active with each passing year - thus, the phone call at 3 am that your patient's IV came out at 10 pm the night before.

c. one set of elevators was haunted and stopped between floors and opened the doors or just didn't open at all.

d. the 9th floor is haunted too - stuff moves and makes noises when no one is around.

e. THE ugliest brown scrubs ever - came out of a vending machine - you get 3 pair - no return, no scrubs - everything bar coded.

f. I started rounds on the front porch everyday with all my smokers - oxygen tanks and all in tow.

g. my longest term patient had tape across his pajama shirt on the back stating "if found, return me to 5E, don't let me ride the bus"

good times, good times......

If no one is around to hear it, does it make a sound?

[CAAdmission]

On 11/29/2018 at 9:16 AM, mcclane said:

Yeah, except the guy just got quoted a competitive salary with VA benefits on top. I am sure you have another great one liner for that, too, though. What program do you sit on for admissions?

If you think any entity - government or otherwise - having a monopoly over reimbursement is a good idea, I'm pretty sure there is nothing I would say to change your mind.

[PAMEDIC]

FWIW... I work in a clinic that sees nothing but medicaid patients and I am paid well above the national average.

[anewconvert]

On 11/30/2018 at 11:52 AM, CJAdmission said:

If you think any entity - government or otherwise - having a monopoly over reimbursement is a good idea, I'm pretty sure there is nothing I would say to change your mind.

As if an oligopoly by a middle man taking 20% off the top is better?!?

[Boatswain2PA]

An oligopoly isnt much better, but at least allows for some competition (when the oligarchs dont own the government) which could reduce costs/increase production.