bobuddy Posted January 11, 2023 Share Posted January 11, 2023 Hi All I have been in FP/Primary Care with same practice for 20 years - small town - lots of special relationships with my patients that I consider family. Bought out by corporate - furloughed all APP's during covid for 6 months so I went to work at ER at local VA facility. Was hired on as a part time permanent with the VA but continued to work full time after PC brought us back Now the VA is offering me full time status. VA Benefits - Pros: pension, 25 days of vacation, 14 days sick, FT is 3 days a week - 12 hour shifts - work evening/days, holidays/weekends - typical ER facility - no trauma. Lower volume - see about 15 per day - they are looking to incorporate two days a month for possible telemedicine triage so work from home possible a few shifts. I know the job and the people - it would be a JOB - not what I consider my "calling" Cons: 20K less than what I make at PC facility -so I would HAVE to work at least one OT shift per pay period to make up my salary that I have now at PC. It is Federal pay scale - so no possible chance of increasing salary at this time. Also con - I would be leaving my patients that I love and have taken care of for 20 years- no CME funds. Travel time 45 min from home PCP - I have been there forever - with bonus structure making about $155 last year (again - about 20K more than regular salary at ED) . 4 - 10 hour days no weekends, no holidays, no call. 25 days of PTO a year. I love my coworkers and staff - I consider them friends ( Not true for ED staff). Travel time - 10 min from home Cons: I often work from home to keep up with the never ending onslaught of prescription refills, labs, etc. Help...... I need to make a choice soon - and depending on what day you ask me you might get a different answer. Quote Link to comment Share on other sites More sharing options...
sas5814 Posted January 11, 2023 Share Posted January 11, 2023 I think you have to look at the value of benefits (and what is most valuable to you) to decide. If money is at the top of your list chase the money. I work for the VA and it can be absolutely maddening because its a fairly stereotypical government organization BUT its hard to match the time off anywhere and they have a PENSION which, also, almost doesn't exist anywhere anymore. The pension plan is a pretty big part of my retirement planning. What is valuable to us changes over time. My currency used to be allllllll about money. Now it all about my time. I am with this insane, maddening org because I have tons of time off, when I am not at work I am not at work (no nights, weekends, call) and, if I took all my time off every year (PTO, Sick, holidays), it would be 49 work days. That's 2 months a year off. I don't think you have a bad choice. Just figure out which one offers you the most based on what you desire the most. 2 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 11, 2023 Moderator Share Posted January 11, 2023 Sounds like you love the PCP ask for a raise and stay. In pcp. 1 2 Quote Link to comment Share on other sites More sharing options...
bobuddy Posted January 11, 2023 Author Share Posted January 11, 2023 17 minutes ago, ventana said: Sounds like you love the PCP ask for a raise and stay. In pcp. Yes, I love PC - but we were told no raises - corporate "cant afford it" the VA is giving everyone a 4.5% raise this year...... Still puts me at 20K down from PC salary...... Ugh Quote Link to comment Share on other sites More sharing options...
sas5814 Posted January 11, 2023 Share Posted January 11, 2023 25 minutes ago, bobuddy said: the VA is giving everyone a 4.5% raise 4.1 and another 0.5 if you get locality pay. Quote Link to comment Share on other sites More sharing options...
kettle Posted January 11, 2023 Share Posted January 11, 2023 Do what you love, if you don't you'll perseverate over not doing it and subconsciously become spiteful. Not a whole lot of people look back and say I should have worked that one job that paid better even though I didn't like it. Peace of mind has it's price and it sounds like the job you like pays more, might not have the pension but with the extra income you could invest 1 Quote Link to comment Share on other sites More sharing options...
SedRate Posted January 11, 2023 Share Posted January 11, 2023 (edited) Stay at the PC job. You love it, close to home, no whacky schedule, mo money, CME funds, etc. Plus, time commuting is straight up time wasted. PCP commute = 80min/wk VA commute = 270min/wk Plus plus, we need more PC folks. Especially those who love their work and pts. Edited January 11, 2023 by SedRate 1 2 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 11, 2023 Moderator Share Posted January 11, 2023 Use the opportunity to shake up the PC job. mask for an RVU bonus structure above what you have ask for another week vacation ask for more CME ask for higher call pay. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 12, 2023 Share Posted January 12, 2023 As you consider your two options, do NOT take into account any things that MIGHT happen. In particular, as you look at the VA, only consider things which are in their current plans vs possible policy changes. In the same way, don't count on your new corporate owners of the primary care clinic to change anything in your favor. It's much more likely they'll make things less favorable over time: pushing for higher patient volumes, patient call-backs to improve patient satisfaction scores without any dedicated time to do it, etc. Also consider the loyalty and stability of each employer: the VA may not have any loyalty to you, but the stability is likely rock solid. You've already seen that that the corporate owners of the primary care clinic have neither loyalty nor stability. 1 1 2 Quote Link to comment Share on other sites More sharing options...
bobuddy Posted January 12, 2023 Author Share Posted January 12, 2023 18 minutes ago, ohiovolffemtp said: As you consider your two options, do NOT take into account any things that MIGHT happen. In particular, as you look at the VA, only consider things which are in their current plans vs possible policy changes. In the same way, don't count on your new corporate owners of the primary care clinic to change anything in your favor. It's much more likely they'll make things less favorable over time: pushing for higher patient volumes, patient call-backs to improve patient satisfaction scores without any dedicated time to do it, etc. Also consider the loyalty and stability of each employer: the VA may not have any loyalty to you, but the stability is likely rock solid. You've already seen that that the corporate owners of the primary care clinic have neither loyalty nor stability. You are exactly right about this - the VA is stable- not likely to change. They did not furlough anyone during covid - they actually hired. The corporate PC clinic furloughed all APP's across the board - no loyalty at all to any of us. So yes, I am still nursing that grudge. My small town patients are what keep me doing what I am doing - otherwise I would be out the door. while all of the APP;s were on furlough - we all started talking - and found that our pay scale was quite all over the place - so when they brought us back - they made pay to be consistent across the board - I actually got a 30K raise - when prior - all along they kept telling me "they could not afford it" In my head - I am thinking - do the ER job - take the time I have off and find myself a life outside of medicine. In my heart - I am not able to let go of my patient relationships. Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 12, 2023 Moderator Share Posted January 12, 2023 22 minutes ago, ohiovolffemtp said: As you consider your two options, do NOT take into account any things that MIGHT happen. In particular, as you look at the VA, only consider things which are in their current plans vs possible policy changes. In the same way, don't count on your new corporate owners of the primary care clinic to change anything in your favor. It's much more likely they'll make things less favorable over time: pushing for higher patient volumes, patient call-backs to improve patient satisfaction scores without any dedicated time to do it, etc. Also consider the loyalty and stability of each employer: the VA may not have any loyalty to you, but the stability is likely rock solid. You've already seen that that the corporate owners of the primary care clinic have neither loyalty nor stability. This. Honestly, I would probably stay where I love the staff, felt appreciated, and felt my passion. however, as had been said, the VA is rock solid employment, unlikely to be abused like you are with corporations, pension, more days off. the biggest problem is a corporation owning your place and that sucks. 1 2 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted January 12, 2023 Share Posted January 12, 2023 10 hours ago, bobuddy said: Bought out by corporate This will be your issue. Right now, you have become nothing more than a line on a spreadsheet. Life will gradually get worse. It's mainly a matter of how many years left you have to work, and how fast you might see things going downhill. If you are 10 years from retirement, you can probably ride out almost anything. If you are a youngling, it could get painful. 1 Quote Link to comment Share on other sites More sharing options...
bobuddy Posted January 12, 2023 Author Share Posted January 12, 2023 I am 56 - so about 10 years away. Every practice has gone corporate - nothing independent anymore in my state. You either belong to one hospital corporation or the other Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted January 12, 2023 Share Posted January 12, 2023 8 hours ago, bobuddy said: I am 56 - so about 10 years away. How long does it take to get fully vested in a pension at the VA? Quote Link to comment Share on other sites More sharing options...
sas5814 Posted January 12, 2023 Share Posted January 12, 2023 1 hour ago, CAAdmission said: How long does it take to get fully vested in a pension at the VA? 5 years. The amount of your pension goes up the longer you are here. The formula is something like 1.1% of your salary x the number of years employed. It might be a little more...I can't remember. But that is forever. It doesn't count as income against your social security and if you die it gets passed to a surviving spouse. It ain't nothin'.... 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted January 12, 2023 Share Posted January 12, 2023 2 hours ago, sas5814 said: 5 years. The amount of your pension goes up the longer you are here. The formula is something like 1.1% of your salary x the number of years employed... So just to use round numbers because I'm a math disaster, you work 5 years at a $100,000 salary you'd be looking at $5500 annually for life (and passed on to surviving spouse for their life). Is this right? 1 Quote Link to comment Share on other sites More sharing options...
UGoLong Posted January 12, 2023 Share Posted January 12, 2023 (edited) It sounds like you (the OP) survived working at both places so survival doesn't seem to be the long pole in the tent. You've worked in PC for 20 years and love your patients and the staff. Both can change over time but pretty much everything we do in medicine is ephemeral anyway. Peace of mind and knowing why you're there can mean a lot. Yes, things can change, but so will you. And new options will also keep opening up; such is life. The VA can be a sweet gig it sounds like (I've been in private practice for 16+ years), but job satisfaction sounds like what is really motivating you. This is your choice; satisfy your own wishes, not ours. And good luck! Edited January 12, 2023 by UGoLong 2 1 Quote Link to comment Share on other sites More sharing options...
ifeeluncomfortable Posted January 13, 2023 Share Posted January 13, 2023 9 hours ago, CAAdmission said: So just to use round numbers because I'm a math disaster, you work 5 years at a $100,000 salary you'd be looking at $5500 annually for life (and passed on to surviving spouse for their life). Is this right? The issue is they decrease your pension by 5% for every year that you retire before the age of either 57 or 62. I can’t remember which one it is. So it depends on your age. Also, you get to bring the fed employee health insurance into retirement if a part of it for the five years prior to retirement Quote Link to comment Share on other sites More sharing options...
jmj11 Posted January 13, 2023 Share Posted January 13, 2023 Maybe this was discussed above, but I didn't see it, and that's the intangible quality of life issues. I left a fantastic job once for a far lessor job, for the sake of the quality of life of my family. It was hard and I often dream I was back at that old job. But twenty years later, I know beyond a doubt that I did the right thing. I don't know if you have a family and if either job is better than the other regarding the quality of life, time with a spouse or kids, issues, but that should be part of the equation. I think money is over-rated. I met a man in a kayak on Lake Superior once. He had been a corporate lawyer in Chicago, a rat race but big $$$. He gave it all up in his late thirties to move to a podunk town in northern Wisconsin to work as a kayak guide for about $15/ hour and he told me it was the best decision of his life. 1 2 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 13, 2023 Administrator Share Posted January 13, 2023 On 1/11/2023 at 7:48 PM, bobuddy said: Every practice has gone corporate - nothing independent anymore in my state. You either belong to one hospital corporation or the other This is not a stable equilibrium. DPCs are cropping up all over the place, because people crave relationship. Figuring out how PAs fit into all that is the only challenge. 1 Quote Link to comment Share on other sites More sharing options...
bobuddy Posted January 13, 2023 Author Share Posted January 13, 2023 (edited) 8 hours ago, jmj11 said: Maybe this was discussed above, but I didn't see it, and that's the intangible quality of life issues. I left a fantastic job once for a far lessor job, for the sake of the quality of life of my family. It was hard and I often dream I was back at that old job. But twenty years later, I know beyond a doubt that I did the right thing. I don't know if you have a family and if either job is better than the other regarding the quality of life, time with a spouse or kids, issues, but that should be part of the equation. I think money is over-rated. I met a man in a kayak on Lake Superior once. He had been a corporate lawyer in Chicago, a rat race but big $$$. He gave it all up in his late thirties to move to a podunk town in northern Wisconsin to work as a kayak guide for about $15/ hour and he told me it was the best decision of his life. Yes, this - With the VA - there is no push to see more patients- the ER is steady and sometimes very busy - but if I see 4 patients or 20 patients - I get paid the same. If they are in the waiting room for 2 hours - no one is filling out reviews online saying how bad of a provider you are - In FP/PC - its always - can you see one more - emphasis on Press Ganey - I routinely see 30 a day and its exhausting - but no ability to see less patients without less RVU - which means less $$$. ER is 3 12 hour shifts for full time - but again 20K less - as long as I continue to see 30 a day in PC....... My only hesitation is leaving my patients. I started with VA in may 2020 - so I will be there 3 years already this May Edited January 13, 2023 by bobuddy Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted January 13, 2023 Share Posted January 13, 2023 1 hour ago, bobuddy said: My only hesitation is leaving my patients. I don't want to seem to prickly, but ultimately that is their problem. You need to do what is best for you and your family. So many HCPs think they need to be a martyr and stay in a job where they are treated badly by management and patients. Some false sense of loyalty to patients enables corporate to abuse us. If more people walk from bad jobs, jobs will have to get better. 2 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 13, 2023 Administrator Share Posted January 13, 2023 Just now, CAAdmission said: I don't want to seem to prickly, but ultimately that is their problem. You need to do what is best for you and your family. So many HCPs think they need to be a martyr and stay in a job where they are treated badly by management and patients. Some false sense of loyalty to patients enables corporate to abuse us. If more people walk from bad jobs, jobs will have to get better. This is true but untrue. Hippocratic medicine expects a covenant relationship between medical professional and patient. Payment and employment models that interfere with that are enemies of truly good medicine, because the most effective tool in our toolbox is the placebo effect: people believing that they're being effectively cared for get better. 1 Quote Link to comment Share on other sites More sharing options...
SedRate Posted January 13, 2023 Share Posted January 13, 2023 1 hour ago, bobuddy said: Yes, this - With the VA - there is no push to see more patients- the ER is steady and sometimes very busy - but if I see 4 patients or 20 patients - I get paid the same. If they are in the waiting room for 2 hours - no one is filling out reviews online saying how bad of a provider you are - In FP/PC - its always - can you see one more - emphasis on Press Ganey - I routinely see 30 a day and its exhausting - but no ability to see less patients without less RVU - which means less $$$. ER is 3 12 hour shifts for full time - but again 20K less - as long as I continue to see 30 a day in PC....... My only hesitation is leaving my patients. I started with VA in may 2020 - so I will be there 3 years already this May It sounds like you've figured out what's best for you. Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted January 13, 2023 Share Posted January 13, 2023 26 minutes ago, rev ronin said: Hippocratic medicine expects a covenant relationship between medical professional and patient. I don't disagree, but I don't really think anyone practices Hippocratic medicine any more. Maybe solo and small group practices have the luxury, but certainly not big corporations. Medicine has evolved into a business, and an ugly one at that. I guess I have become a mercenary - I work for a company, and if another company will treat me better I'll go there. I'd expect my lawyer, accountant, plumber and barber to do the same. I hate to say it, but I don't view my own relationship with my PCP as a covenant. He's a service provider. I go see him when I need something, and he provides it. 1 1 Quote Link to comment Share on other sites More sharing options...
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