Why would any PA want to work for the VA?

[Joelseff]

 

As some of you know, I am taking a new job out of Primary Care at a private practice GI/Hep and will be starting soon...

 

During my job hunt, I cast a rather wide net including interviewing with the VA which, to me at the time, sounded like a good deal.

 

The VA clinic is up the road from my hometown and will be a rather easy commute, it's in Sleep Medicine so was thinking rather mundane, and I keep hearing about the great benefits, mainly the pension plan. All my NP friends who have worked for the VA loved it and said they pay well.

 

Fast forward 6 weeks (today) they finally called me to offer me the job. I already committed to the GI job but wanted to know more.

 

So here is where my question in the title comes in.

 

They told me they couldn't give me an actual offer but only a tentative one since they have to decide my pay via a "panel" review of my qualifications education etc. I asked for a ball park and man in all honesty, it sucked!

 

They said at starting (GS9) I would make 61k per year! [emoji15] But after several years of service, I can achieve "all the way up to GS13" or "Chief level" and would give me a salary of 136k per year...

 

I am not trying to bash PAs who work there but even looking at the AAPA salary report, how can this be justified?

 

Since the VA has been touted as a major employer of PAs I am left scratching my head.

 

I know money is not everything but it is definitely something. The GS9 starting salary is only a mere 4k more per year than my MA makes. The top Chief Salary is at least 40k less than I make.

 

I told them that this was way too low and I don't think I would be interested. The HR lady asked me to think about it and want an answer "by tomorrow" (they don't seem to try too hard to win over candidates). Which is another thing. They made me jump through all these hoops to get the interview then now they want me to jump through a couple more hoops to get the Job and they can't even tell me what level pay I would get. Plus it's going to take HELLA long to get credentialed. They told me up to 3 months because they have to confirm and examine all my transcripts, I have to pass a physical lol etc... It's ridiculous to me. Am I wrong?

 

Am I missing something guys? What's so great about the VA that many PAs jump through all these hoops to work there and in the end make not very good pay?

 

Edit: I wanted to add that I have the misfortune of living in a very high COL area and this why the pay carries some considerable weight on my decision.

 

For example, a recent news article stated that 200k household income in my area is considered middle class [emoji17] would love to leave and move to say Arizona or Texas but wife is against leaving since we both grew up here and our families are here. She's more invested in the area than I am lol.

 

 

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[Reality Check 2]

I work for the VA and really like it.

Yep, there is a salary board and on boarding takes a long time.

The admin at the hiring VA has to advocate for the applicant.

I got well over the advertised salary and the range has already been improved. My admin is amazing and wants to hire the right people and really advocate for the right applicant. 

I am a GS 13 based on years of experience. 

My benefit package is worth nearly $35K.

It is challenging work with leadership opportunities and a really reasonable schedule in Primary Care. 

It has to be right for the PA and it isn’t right for everyone.

It works for me.

[Joelseff]

I work for the VA and really like it.
Yep, there is a salary board and on boarding takes a long time.
The admin at the hiring VA has to advocate for the applicant.
I got well over the advertised salary and the range has already been improved. My admin is amazing and wants to hire the right people and really advocate for the right applicant. 
I am a GS 13 based on years of experience. 
My benefit package is worth nearly $35K.
It is challenging work with leadership opportunities and a really reasonable schedule in Primary Care. 
It has to be right for the PA and it isn’t right for everyone.
It works for me.

Thanks for replying and thanks for your work in the VA as I am a vet and get some care from my local VA.

So the salary range they gave me is not or may not be the true salary? How does the bonus structure work?

Any info would be helpful. Thanks.

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[thinkertdm]

Also gs 13 for 6 years of experience.  The pay will vary and is unfortunately less than the np's but legislation has been passed and is being implemented in some areas already to address this.

the benefits I don't think are anything special.  Every paid holiday off.  The appointments are longer than 10 minutes, and, in fact, as long as I need them to be to take care of the patient.  Several of the newer providers expressed concern that we can't just refer to specialist for something- sorry, but you'll have to actually work it up, like real medicine.  In my previous lives in the civilian world, in primary care, you spend those ten minutes deciding which specialist to refer to, but in the VA, neurology doesn't want to see an essential tremor unless you've tried something, sometimes a few somethings.  Urology is most definitely not going to see every prostate issue, and unless it can be operated on, don't try ortho.

you will also see things you will never, ever see in the real world.  I had a guy last week come in who's last va provider thought his elevated esrs were due to pmr, and started him on a years worth of prednisone. Unfortunately, the rheum labs were negative but nothing else was considered in this 150 pack year smoker.  Lung cancer.  I've had two oral cancers in the past two weeks.  A lot of b12 deficiencies.  Someone with beer  Potomania.  45 yo someone put on testosterone.  Another 45 yo someone put on morphine?! AND oxycodone for back pain.

To tell you the truth, as much as I hate the small stuff, I'd rather be in the VA than in a walk in clinic (my last job).  Because here, no press ganey.  No yelp.  My patients love that I listen to them.  And the cold is probably either a copd exacerbation or heart failure, and I have no grandmothers screaming at me to give their grand daughter antibiotics she doesn't need.  

[ventana]

beer  Potomania.

 

ahhh had one patinet with that.... Had to look it up when Endo gave the Dx (inpatient)

 

 

 

Why work in VA

 

The same reason I signed up for the Air Force - duty to serve....  too bad they are so far off on pay scale....  offered me a 50% pay cut. no thanks 

 

[Jolt2019]

My fiance has worked at the V.A. in Illinois for several years.  She worked full-time, with no breaks minus vacation, since she was certified as a CNA (got certified in high school);through RN, BSN, and now a new MSN-FNP.  She literally graduated with her FNP not 1 week ago.  She takes her boards next week, but she owes the V.A. service until this upcoming May because they paid a portion of her BSN schooling.  She knew that she would have to leave the V.A. to get fair pay, however, they approached her last week with a verbal "offer".  They offered her 72K.  She makes 70K NOW as a BSN.  She said no thanks and will look elsewhere.  People in HR told her to get experience and come back for a "fair offer"

[thinkertdm]

20 minutes ago, ventana said:

beer  Potomania.

 

ahhh had one patinet with that.... Had to look it up when Endo gave the Dx (inpatient)

 

 

 

Why work in VA

 

The same reason I signed up for the Air Force - duty to serve....  too bad they are so far off on pay scale....  offered me a 50% pay cut. no thanks 

 

True; I compared my experience of prior discussions with administrators- not seeing enough patients per day, yelp scores, patient dissatisfaction reports, yada yada yada and seeing a patient every 10 minutes? vs my schedule now, basically no patient complaints, a patient advocate that can be satisfied with basic evidence based medicine, and I'm making pretty much more than I've made before.

Also, I feel like I'm making a difference.  Daily I leave and know that at least one patient is alive because of the actions of my team.  I did not get that with any civilian place.  I was a little cog in a t-shirt factory. Now, I'm a big cog.  And we make custom t-shirts.  Still a machine.  but with custom made parts. 

[ArmyVetDude]

1 hour ago, thinkertdm said:

True; I compared my experience of prior discussions with administrators- not seeing enough patients per day, yelp scores, patient dissatisfaction reports, yada yada yada and seeing a patient every 10 minutes? vs my schedule now, basically no patient complaints, a patient advocate that can be satisfied with basic evidence based medicine, and I'm making pretty much more than I've made before.

Also, I feel like I'm making a difference.  Daily I leave and know that at least one patient is alive because of the actions of my team.  I did not get that with any civilian place.  I was a little cog in a t-shirt factory. Now, I'm a big cog.  And we make custom t-shirts.  Still a machine.  but with custom made parts. 

It is the government. Pay will suck with pretty good benefits. At least you can retire after 30 years. 

Money is important to me so unless the VA can step up and match at least local civilian hospitals, it is not worth it

[thinkertdm]

3 minutes ago, ArmyVetDude said:

It is the government. Pay will suck with pretty good benefits. At least you can retire after 30 years. 

Money is important to me so unless the VA can step up and match at least local civilian hospitals, it is not worth it

It's all what's important to you.  Maybe coming from a primary care background I am making more.  Personally, I didn't get into this for the money.  I owe a shit ton, but they can take it out on my corpse; I got into this to make the world a better place, and frankly, I wasn't doing that in the civilian world.  I'm not going to talk to a administrator again, ever, because I'd rather work at the VA than hear how some soccer mom can't sleep and needs her Xanax or ambien because her little world sucks so bad.    And the snowflakes out there?  yeah.  I couldn't handle it. 

Not arguing with you, just stating that I like money too.  I just like not kissing administrators asses more.  And those yelp scores?  When I read mine, that was the last straw. 

[ArmyVetDude]

5 minutes ago, thinkertdm said:

It's all what's important to you.  Maybe coming from a primary care background I am making more.  Personally, I didn't get into this for the money.  I owe a shit ton, but they can take it out on my corpse; I got into this to make the world a better place, and frankly, I wasn't doing that in the civilian world.  I'm not going to talk to a administrator again, ever, because I'd rather work at the VA than hear how some soccer mom can't sleep and needs her Xanax or ambien because her little world sucks so bad.    And the snowflakes out there?  yeah.  I couldn't handle it. 

Not arguing with you, just stating that I like money too.  I just like not kissing administrators asses more.  And those yelp scores?  When I read mine, that was the last straw. 

Don't get me wrong. As a combat vet who goes to VA hospital/clinic for medical care, I would like to work for the VA. Less pressure there also. unless you do blatantly foul stuff, you will probably never get fired until you retire. It would be nice if they can pay better though. They are generous with NP's.. why can't they be with  Pa's?

[thinkertdm]

Just now, ArmyVetDude said:

Don't get me wrong. As a combat vet who goes to VA hospital/clinic for medical care, I would like to work for the VA. Less pressure there also. unless you do blatantly foul stuff, you will probably never get fired until you retire. It would be nice if they can pay better though. They are generous with NP's.. why can't they be with  Pa's?

I agree.  NPs have sold themselves very well.  Some VA's are excellent with PA's, some not so good.  There has been a law- a real law- passed that equalizes the pay.  Putting it into practice is going and some VA's have it already.  The second problem is (I think) that the standards board- if you have a masters degree, with 6 years of practice under your belt, you should be a gs 13.  the actual number associated with that, however, is going to be a lot lower than the civilian folks, and the standards board should do a local review of the salaries. 

But you know how the government works.  There's the way it should, and the way it does.

Sad, I know.  Also, working here isn't all ponies and sunshine.  most days are miserable.  the emr is from the 80's, and the administration is clueless, which is odd considering a good number are ex-military, you would think it would be run efficiently.  And... there are no ponies, either.  Which is odd because there's loads of horseshit around. 

But...that's all me.  Why I work for the VA.  I imaging specialties in the civilian world are probably better than primary care, so your mileage may vary.  This is all from a primary care perspective.

[Gordon, PA-C]

3 hours ago, thinkertdm said:

And the cold is probably either a copd exacerbation or heart failure, and I have no grandmothers screaming at me to give their grand daughter antibiotics she doesn't need.  

 

What VA is this?  My VA experience was the opposite -- not only did they want antibiotics for every cold, but they wanted dilaudid for 40 year old back injuries from Vietnam or other wars they had fought in.

 

 

[Joelseff]

Great insights in the responses. Thanks. The job is in Sleep Medicine/Neuro (I only targeted non PC jobs since I'm convinced I'm out of that game now). So I think I would fall in the GS13 range but they won't tell me that or guarantee it. The HR lady was nice though she seemed to have zero control on the offer but merely the messenger.

 

I'm gonna turn it down. The pay is a huge factor but I actually prefer GI/Hep to neuro. The pension and being less than 10 miles away from home was appealing but with 2 kids about to go to college (i have Cal Vet though so this is a little bit eased) and a ridiculous Bay Area mortgage, I simply cannot ignore the pay discrepancy.

 

The funny thing is the HR lady was saying "that's what everyone tells us" when I told her the pay scale was very low. Lol.

 

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[PAMEDIC]

I have been trying to get on at my local VA since I got out of school but have been told they prefer NPs.

I think I have seen maybe one opening in the last 3 years.

[thinkertdm]

51 minutes ago, Gordon, PA-C said:

 

What VA is this?  My VA experience was the opposite -- not only did they want antibiotics for every cold, but they wanted dilaudid for 40 year old back injuries from Vietnam or other wars they had fought in.

 

 

I'm at at VA in middle of Illinois.  I think I have prescribed one "zpack" for sinusitis in the past seven months.  Luckily most of the "colds" are copd exacerbations.  We have an excellent pain management doc, and I fairly strict on opioids.  They scream at me for those, but UDS and state PMP searches weed out some (heh).

Thanks to the Tomah VA, we now have a number of other pain management options, including a pain university thing, pain psychologist, pain PT.

Don't everyone jump on me, I just like working at the VA.

[ArmyPA]

I'm waiting to hear back from the professional standards board on my salary offer for a Telehealth position in Texas. Telehealth is pretty new to the VA and working from home more than half the time sounds nice. I understand your cost of living in the Bay Area but the vast majority of the US does not have that cost of living nor those salary ranges despite what some folks on this board may say.  As far as benefits, Im retiring from the military after 20 years and have no need for health vision dental. The most important benefit to me quite frankly is time off, and most hospitals and private practices like to make money, hence, I have been underwhelmed by the PTO packages offered by the ones in Texas. Since PAs are under title 38 at the VA (not DoD or other federal agencies mind you) we are considered professional staff and thus get 26 days vacation in addition to 13 days sick leave and 10 federal holidays. Most organizations here in Texas (other than state/university jobs) are on a one pool PTO bank, and the numbers offered are less that impressive...from 20-29 days from what I've seen/been offered. So for me the extra 20 -29 days off per year I can easily make up most salary differences in the local area by doing PRN urgent care work. Also as far as retirement, Fed civilians get both a 5% TSP (401k/403b) match and a no deduction from my salary pension, albiet at only 1% per year, but you can buy back military time into this if you are not retired military. Yes I agree, working for the VA in Commifornia, Seattle, Boston, etc. you will probably take a huge pay cut, but in the other 95% of square mileage in the US, I don't think its that big of a difference. Now if they offer me less than GS 13/ 95K I will probably tell them thanks but no thanks, but beggars cant be choosers. 

[sas5814]

It really varies. I work (when we are staffed right) 3 12's a week. I have 30 days PTO, 5 days CME, some odds and ends like bereavement and jury duty (which I have used and they didn't blink) and I'm paid in the top 5-6%.

Like most jobs it can suck like a Hoover but for the most part it isn't bad.

[Joelseff]

I'm waiting to hear back from the professional standards board on my salary offer for a Telehealth position in Texas. Telehealth is pretty new to the VA and working from home more than half the time sounds nice. I understand your cost of living in the Bay Area but the vast majority of the US does not have that cost of living nor those salary ranges despite what some folks on this board may say.  As far as benefits, Im retiring from the military after 20 years and have no need for health vision dental. The most important benefit to me quite frankly is time off, and most hospitals and private practices like to make money, hence, I have been underwhelmed by the PTO packages offered by the ones in Texas. Since PAs are under title 38 at the VA (not DoD or other federal agencies mind you) we are considered professional staff and thus get 26 days vacation in addition to 13 days sick leave and 10 federal holidays. Most organizations here in Texas (other than state/university jobs) are on a one pool PTO bank, and the numbers offered are less that impressive...from 20-29 days from what I've seen/been offered. So for me the extra 20 -29 days off per year I can easily make up most salary differences in the local area by doing PRN urgent care work. Also as far as retirement, Fed civilians get both a 5% TSP (401k/403b) match and a no deduction from my salary pension, albiet at only 1% per year, but you can buy back military time into this if you are not retired military. Yes I agree, working for the VA in Commifornia, Seattle, Boston, etc. you will probably take a huge pay cut, but in the other 95% of square mileage in the US, I don't think its that big of a difference. Now if they offer me less than GS 13/ 95K I will probably tell them thanks but no thanks, but beggars cant be choosers. 

Gotcha... But I ain't beggin' lol [emoji6]

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[Reality Check 2]

There is no bonus structure at the VA. Not that I know of.

We get cost of living raises when the WH doesn't cancel them.

I see no more than 14 patients in a 10 hr day. That is enough for me - compared to my private practice nightmare.

I do make a difference. The medicine is tough - my brain hurts daily and I am in year 28 now.

I am in a leadership position in the VA and am invited to participate in many programs with great support.

You have to have an advocate in admin that wants to hire you. Otherwise - nothing works.

The salaries ARE workable but it has to go through certain steps.

I replaced not one but two new grad NPs who FLAILED with these complex patients.

New grads do not do well at the VA. It is too intense and too complex.

I am happy to serve here. I couldn't serve in the military but am a second generation Army brat raised in the Army world. This is my chance to serve and do good medicine.

I hate to hear any PA say that money is a driving factor.

Just my crusty old 2 cents

[ArmyVetDude]

3 hours ago, PAMEDIC said:

I have been trying to get on at my local VA since I got out of school but have been told they prefer NPs.

I think I have seen maybe one opening in the last 3 years.

OTP will save us all

[ArmyVetDude]

2 minutes ago, Reality Check 2 said:

 

I hate to hear any PA say that money is a driving factor.

 

We don't get paid like docs. And when you have three other people to feed in the family... it matters

[sas5814]

"I hate to hear any PA say that money is a driving factor."

 

I admire your desire to serve and many feel our profession is a calling. Bless em all.

I served a career in the Army. What I do now is a job...an exchange of money for services. Nothing more or less. Money is a driving force...

[mgriffiths]

I definitely wouldn't say that I do what I do for the money...if that was the case I definitely would have gone to medical school - or found a different job that didn't come with the stress.  But if I won the lottery would I continue doing what I do...NOPE!!  I wouldn't retire/quit on the spot as that would be harsh on my coworkers and patients, but it would be soon.  Of course you have to buy a ticket to win so it's not happening any time soon.

[sas5814]

If I won the lottery my employer would find out when they read it in the paper. I wouldn't even call. The hole would close in behind me quickly and in very short order it would be like I was never there. I have no allusions about how big a deal my departure would be.

[Joelseff]

I hate to hear any PA say that money is a driving factor.

I can respect your opinion and I am all for altruism but the reality is money IS a factor maybe not THE factor.

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