Working at the VA?

[bananapeppers]

There doesn't seem to be much posts about the VA but wanted to start a thread and get some input. After 10 years of EM, I'm fed up with our constant schedule changes, working out from the lobby, short-staffed from our group. We are constantly being measured on metrics and customer service due to the No Surprise Act, which has been detrimental to the ED business. I don't anticipate it getting any better which lead me to start looking at different positions.

I saw a listing at my VA and had applied for it, received an interview invite, and interviewed with them yesterday. They seemed to be impressed and got the feeling that they would extend an offer as I spoke to the chief that I would not consider taking the position unless I received a similar salary which he stated they "should" be able to match. (~135k). The highest pay for PAs from the pay scale is ~134k. It would also be a very easy job and the chief said I would see about ~12 patients a day.

While it appears that the VA has gotten better about their salary, the benefits are hard to beat as I don't even get PTO with my current employer. However, I was a bit turned off when the chief stated that they would want me to go to a satellite hospital about an hour away, once a week, to be in their clinic. This was not even mentioned in the posting online, so I was surprised when he mentioned that I would need to travel once a week. While it doesn't sound terrible, long term it would be cumbersome as 1/4th of the weather in the Midwest is snow. 

How easy is it to negotiate with the VA in terms of schedule? If I did make the drive once a week, then I would like to either have an admin day or day where I can work from home but I am not really sure how likely they would even budge on that. This is also a new clinical position - pain management - where I'll be closely working the pharmacist to come up with pain regime for veterans. Otherwise, how is job satisfaction with the VA? 

[sas5814]

This may not be the morning for me to answer the question but I'll try.

Every job has some suck factor. With the VA it is the absurd admin burden because we are like the military in many ways but we have politicians answering to politicians instead of leaders. Just this week we got another "alert" we have to do with every patient. Alerts are click boxes about things someone somewhere who has no idea what actually happens at the point of service. For a new patient (primary care) there are 29 alerts that have to be answered at the first visit. Its a 60 minute visit so by the time you get all the boxes checked and forms complete there is zero time to actually provide care. For an established patient it is a 30 minute visit. I usually have about 10 minutes left by the time all the boxes are checked and clicked. These metrics drive everything. In the 2 years I have been here this list has only gotten longer and every time its "it will only take a minute." Again idea propagated by people who really don't know what happens at ground level.

Our patient population is very challenging. The vast majority of our folks are really sick and need a lot of care. There aren't enough resources to get it all done and that gets very frustrating for the patient and the providers. Right now we (and by we I mean leadership) is trying to make our metrics line up with national averages. We are doing that by denying services and supplies under the false flag of "medical necessity."

There is more than average mental health problems to deal with. Just yesterday I had a patient call me a "fucking faggot" because I asked him questions about his abdominal pain. I have had patients physically attack me once or twice.

When I speak to people about changes or try to organize some folks to institute changes...even small ones that would give more provider time with the patient...I get a deluge of emails and messages telling me it is pointless. There are a lot of tired, burned out people who feel hopeless.

Can you negotiate your schedule? Sure! It will last until your feet hit the ground. I was hired to see walk in patients at a primary care clinic. The word "float" was never mentioned. I have been here 26 months and spent 22 of them running a full physician panel for 40% of what the VA pays the physicians....and I am maxxed out on PA pay. I had to do that because 1) a physician retired and the VA won't allow a position to be advertised until someone who has announced their departure is physically gone. If there was another physician waiting for the position the hiring process takes about 6 months if things go smoothly which they rarely do and 2) the new physician couldn't keep up with the administrative work despite me doing half her work every day and eventually quit and 3) her replacement has been here for 9 months and I just finished running her panel for 6 weeks , again, because she got so far behind on her admin work. She just took her panel back 4 days ago and she is already sinking. When she leaves I'll be given her panel to fix and manage until the next one comes along.

When I challenged this every "leader" I spoke to said they thought it was perfectly reasonable that I do the exact same job as a physician (in a position that is advertised for and can only be filled by a physician) for less than half the pay. The chief of staff basically told me that's because I am a PA and can only really do half the job a physician would do despite the fact my patients and panel size were exactly the same and I have been a PA for 33 years.

So the short answer is no... you cannot negotiate a schedule that the VA will follow. Even if your current chief holds to it they won't be there long and the next one will do as they please.

Ok...upside? The pay is not terrible. You can negotiate up to the top of your pay grade but, at the end of the day, it is decided by a board who looks at your education and experience and sets your pay grade. Your chief pushing can help it go more your way and if you get an offer you don't like you can ask to be reconsidered.. Also if you are in a high COL area you may receive locality pay to make things a little better. However, in true VA fashion, they will make you do EVERYTHING needed pre-hire, which will take 6 months or so, before they tell you what your salary offer is. The benefits are excellent. If you can do the time you will retire with a pension...a real live forever pension. That almost doesn't exist any more.

Staffing is generally good. Hours are hours. They don't like to pay OT so generally there isn't any (and there have been and still are lawsuits about unpaid OT). Generally no call and no weekends. Of course that may be different when you are working the ER.

Today I am really tired because of sleep deprivation (unrelated to work) so I am particularly cranky. I am also still PO'd about another alert that just got added that "only takes 3 to 5 minutes." 30 minute established patient appointments. My 8 year old granddaughter could do this math but "leadership" can't or won't.

Every VISN (hospital system) is different and my colleagues tell me there good ones out there and this one is quite possibly the worst in the country. I don't know because I have never been in another one but I have now heard this from several people. My advice is talk to PAs where you are considering working. Don't just talk to the people they want you to talk to...drill down a couple of tiers. If possible talk to whoever had the job before you. They left for a reason. What was it?

I wanted to add an interesting aside. I follow a couple of Reddit threads for physicians. One in Fam Med and one ER. Without exception they are filled with people who are tired of corporate medicine, short staffing, excessive call, and medical decision making being driven by corporate greed. Without exception someone(s) will say "look into the VA" and then will go on to describe many ways the VA is better than working for a big corporate institution. So my microcosm may not be representative of the VA experience and certainly doesn't reflect ER or specialty care. 

Good luck. PM if you want to discuss further....maybe after I get some sleep.

 

 

Edited April 27, 2023 by Hemmingway

[Reality Check 2]

PM me if you would like to discuss. VA Primary Care Provider.

[thinkertdm]

18 hours ago, bananapeppers said:

There doesn't seem to be much posts about the VA but wanted to start a thread and get some input. After 10 years of EM, I'm fed up with our constant schedule changes, working out from the lobby, short-staffed from our group. We are constantly being measured on metrics and customer service due to the No Surprise Act, which has been detrimental to the ED business. I don't anticipate it getting any better which lead me to start looking at different positions.

I saw a listing at my VA and had applied for it, received an interview invite, and interviewed with them yesterday. They seemed to be impressed and got the feeling that they would extend an offer as I spoke to the chief that I would not consider taking the position unless I received a similar salary which he stated they "should" be able to match. (~135k). The highest pay for PAs from the pay scale is ~134k. It would also be a very easy job and the chief said I would see about ~12 patients a day.

While it appears that the VA has gotten better about their salary, the benefits are hard to beat as I don't even get PTO with my current employer. However, I was a bit turned off when the chief stated that they would want me to go to a satellite hospital about an hour away, once a week, to be in their clinic. This was not even mentioned in the posting online, so I was surprised when he mentioned that I would need to travel once a week. While it doesn't sound terrible, long term it would be cumbersome as 1/4th of the weather in the Midwest is snow. 

How easy is it to negotiate with the VA in terms of schedule? If I did make the drive once a week, then I would like to either have an admin day or day where I can work from home but I am not really sure how likely they would even budge on that. This is also a new clinical position - pain management - where I'll be closely working the pharmacist to come up with pain regime for veterans. Otherwise, how is job satisfaction with the VA? 

I’ve been with the va a total of 8 years I think.  I personally love it more than any civilian job.  I’m also in pain in the Midwest…is Illinois the Midwest?  Anywho, I’ve been in urgent care, pact, and now pain at various facilities all over.  Send me one of those message things if you are curious…

[ventana]

7 hours ago, Hemmingway said:

This may not b

I wanted to add an interesting aside. I follow a couple of Reddit threads for physicians. One in Fam Med and one ER. Without exception they are filled with people who are tired of corporate medicine, short staffing, excessive call, and medical decision making being driven by corporate greed. Without exception someone(s) will say "look into the VA" and then will go on to describe many ways the VA is better than working for a big corporate institution. So my microcosm may not be representative of the VA experience and certainly doesn't reflect ER or specialty care. 

Good luck. PM if you want to discuss further....maybe after I get some sleep.

 

 

 

Been there (although not in the VA)

Corp med is AWFULLLLLLLL

 

Do what I did, start your own clinic..... be your own boss.

Now I am trying like mad to not pay a doc 15k a year for the privilege of being in business.... man this industry sucks

[sas5814]

I had my own clinic briefly but life intervened. I need to finish 5 years here, combine it with my military time, and retire. Then...who knows.

My screen saver is a countdown timer to retirement. 1038 days, 8 hours, and 35 minutes.

[ventana]

Scott - -  just got a call for a position at the local VA.... still trying but this is the last time....

[sas5814]

15 hours ago, ventana said:

Scott - -  just got a call for a position at the local VA.... still trying but this is the last time....

Hang in there. I read posts from people who apply 100x before they stick the landing. Keep us posted.

[benyonce]

On 6/27/2023 at 4:10 PM, ventana said:

Scott - -  just got a call for a position at the local VA.... still trying but this is the last time....

I work at a VA and will say the PAs I work with are happy in their positions. It's at a much different pace than the private sector and has a great work-life balance (the ER-PAs work 4/10-hour shifts per week). The benefits are great, and if you have more than 3 years of experience then you can get a significantly higher pay grade! (I have the file of the PA salary scale saved on my computer - so if you'd like to see it let me know!!)

I will say the hiring process took me about 8 months in total, and even post-hire it takes at least a month or two to get your ID... but, the wait is worth it if you have the opportunity imo.

I'm currently in my third cycle of applying to PA school, and the VA will pay both my tuition and salary for two years if I sign a 3-year service commitment. They may even have some loan forgiveness for staff, but I'd have to check. Best of luck to you!

[PAMalignantHeme]

Max salary at the VA is 135k?  How can they keep or attract people?   What am I missing?

New grad salaries are in the 120's.

[sas5814]

15 hours ago, PAMalignantHeme said:

Max salary at the VA is 135k?  How can they keep or attract people?   What am I missing?

New grad salaries are in the 120's.

I think you have to look at a lot more than salary alone and think longer term to see a lot of the bigger benefits.

Max salary varies a little by region. I am maxxed out in my grade in a LCOL area and make 147k. If I get into a leadership position and get promoted that will jump to 159k. If you are in a HCOL area there is regional pay to make up for it. It can be pretty substantial. They just recently got the ceiling on locality pay raised a great deal but I don't know the numbers off the top of my head.

The benefits and work/life balance add a lot. 26 days PTO, 13 days sick, 10 paid holidays. In primary care there's no nights, call, weekends. Insurance is good and reasonably priced.

There is a real live pension. That almost doesn't exist anymore. That is a big contributor to my retirement planning. That is in addition to a 5% match on your retirement fund.

If you are here long enough you can retire and take your health insurance with you at the same price you paid when you were an employee. Private insurance at a subsidized rate.

I'm not going to get rich but my pay and comp is pretty good. I am at a point in my life where work/life balance is really important so it suits me.

[Nitchnotch]

Hi, new grad currently onboarding at my local VA. I’m curious about how moving up grades (not steps) works. Can you move up in grade or will I be stuck in whatever grade I’m initially started in? I’m assuming I’d be placed in grade 1 step 1 since I am a new grad.