VA Positions

[NeoTrion]

I live in a town in Texas with a local VA that has entry-level positions for NPs but not PAs.  It seems in order to apply to one of these positions as a PA you have to already be employed at the VA.  That doesn't make sense.  I have called HR and they are of very little help.  Apparently, they have no active HR on the premises.  When I could finally get someone on the phone from the regional HR they were of no help.  I have been told there is a head PA for the VA.  Does anyone know who that is or who I could contact?  I took a snapshot of USA jobs below.  Kind of interesting that a PA starts at a lower salary than an NP as well.  Keep in mind that in Texas we are equal in scope and abilities, although I know this is federal it still seems odd.

[SoCalPA]

That salary is crap. Wouldn't recommend

[sas5814]

There is a fair amount to unpack in your post.

VA is federal and they don't get too concerned with state rules. Theoretically they allow you to function at the level of your state licensure but that tends to vary. To work in the VA you have to be licensed in any state or territory.

There are often positions that are only open internally. There are different reasons for this. Sometimes they want people who already know the system. Sometimes the duties are unique (such as disability evaluations) and they want people who can hit the ground running. Sometimes they are "permanent" advertising for openings even when there isn't an actual opening. I don't know why this is done but I have come across a few like that. The closest I got to a cogent explanation was turnover is high and it takes time to get a job description and opening posted (typically months) so they leave the posting up all the time and actually look for candidates when they have a need.

Like out in the world many positions are advertised for NPs and not PAs in the VA. This has to do with the local hiring authority. They decide who the position will be open too. See my hundreds of previous posts as to why this happens. I won't belabor the point here.

The listed salary is the lowest possible salary. The VA went to a pay scale for PAs about 2+ years ago. For reasons I can't understand it hasn't been adopted nationally. I am maxxed out as a primary care PA and I'm at 147k plus the great federal bennies. If I wanted to seek out a leadership position I could make more. I don't.

There is a board that determines the salary offer based on education and experience. I don't think anyone gets the lowest rate. One of the vagaries of the VA system is the rate is determined last after you have spent months on your application so it is the very last thing done. It is less common now but back in the bad old days people would work on their applications and wait months and then get a garbage offer. If the local VA is using the PA pay scale then the offer should be reasonable. Again I don't know why it isn't national and some VAs are still using the old GS pay scale.

There are "head" PAs at multiple levels throughout the VA including, I assume, nationally. What they do or don't do varies wildly. Some warm a chair. Some are advocates for the profession. VAAPA advocates for us at the national level. I think they do more work than it appears because they don't communicate much.

On the actual job posting there should be, generally at the very bottom, a POC for that posting. It usually has an email and phone number. That is your best bet for more information.

PM me if you have other questions.

Edited June 1, 2023 by Hemmingway
added information

[Hope2PA]

I have made NUMEROUS calls at varying levels regarding the hiring process and job postings. Talked to individual VA Admin offices, HR, federal representatives, state representatives. Basically came down to whom ever is in the position to decide how to post the job, not HR, makes the decision, nurses are often in these positions. One VA in my region will not post positions for PAs. There are a few remaining PAs at that hospital, but they have a job and just don't seam to care to promote PAs. Another VA hires both, those some positions were typically only NP and some only PA.  That ended about a year ago when nurses complained about a position open only to PAs. It had gone as far as interviewing and then suddenly job canceled, opened later to NP and PA. They still have NP only listings, but never again PA only. The way VA works, unlike private, you cannot apply to NP position, HR will automatically Kim you out. At least that is what I was told. Best bet is be vigilant, find PAs at that location. Work with them to go to Chief Medical Officer and have a meeting about hiring practices. Don't be afraid to compare your education to PA. If you know if a particular position, send your info and a cover letter to the physician(s) in that department. Explain how you would be good for the job, how you can do as much or more than NO but position is not open to PA.Thing is PAs tend to be passive, just do best job as clinician. Nurses tend to and are taught to promote themselves at the expense of anyone in their way. They pursue managerial positions, PAs don't. Also, pay listed does not usually equate to what you get. It changes with experience, educational level and location. I doubt anyone is actually offered the base listed.

[CookiePA]

12 hours ago, Hope2PA said:

I have made NUMEROUS calls at varying levels regarding the hiring process and job postings. Talked to individual VA Admin offices, HR, federal representatives, state representatives. Basically came down to whom ever is in the position to decide how to post the job, not HR, makes the decision, nurses are often in these positions. One VA in my region will not post positions for PAs. There are a few remaining PAs at that hospital, but they have a job and just don't seam to care to promote PAs. Another VA hires both, those some positions were typically only NP and some only PA.  That ended about a year ago when nurses complained about a position open only to PAs. It had gone as far as interviewing and then suddenly job canceled, opened later to NP and PA. They still have NP only listings, but never again PA only. The way VA works, unlike private, you cannot apply to NP position, HR will automatically Kim you out. At least that is what I was told. Best bet is be vigilant, find PAs at that location. Work with them to go to Chief Medical Officer and have a meeting about hiring practices. Don't be afraid to compare your education to PA. If you know if a particular position, send your info and a cover letter to the physician(s) in that department. Explain how you would be good for the job, how you can do as much or more than NO but position is not open to PA.Thing is PAs tend to be passive, just do best job as clinician. Nurses tend to and are taught to promote themselves at the expense of anyone in their way. They pursue managerial positions, PAs don't. Also, pay listed does not usually equate to what you get. It changes with experience, educational level and location. I doubt anyone is actually offered the base listed.

Why is that allowed? How is the person posting the job have the unilateral authority to decide its only for NPs and not PAs? To me this sounds like gate keeping and childish politics (unless of course the posted job skillset is for some super niche specialties where only NPs are know to train…but still doesnt make sense) 

I am so glad you mentioned setting up a meeting with CMO and not being passive for these things. PAs need to start making noise and demand to be heard. Medical community is very small. If someone anywhere is playing these kind of games I think its best to go up in chain of command and share your concerns. (For valid points, dont spam people with tantrum emails- thats not productive)

 

 

 

 

[thinkertdm]

In the VA, NPs are autonomous independent clinicians, considered medical staff, and just hired without a whole lot of bothersome paperwork.  PAs on the other hand, need to have “collaboration”, which means nothing aside from more paperwork and more bureaucracy.  Who would you hire?  Don’t get me wrong- I believe that pas agave superior skill sets compared to np’s, but easy sells better to admins.

[CookiePA]

I hear ya and get it. If PA organizations are not going to advocate for us (and they have failed obviously to do that) than we need to be doing it for ourselves. 
Challenging hiring practices, asking for proof of studies and data that shows NP legislative independence is somehow a magic bullet to better care over PAs. Bet my money they cant provide that one ; )

[thinkertdm]

28 minutes ago, CookiePA said:

I hear ya and get it. If PA organizations are not going to advocate for us (and they have failed obviously to do that) than we need to be doing it for ourselves. 
Challenging hiring practices, asking for proof of studies and data that shows NP legislative independence is somehow a magic bullet to better care over PAs. Bet my money they cant provide that one ; )

I’m with you.  It’s precisely what np’s did provide papers and studies.  It takes a lot of work, and you’ll find you are mostly on your own.  I hate to sound defeatist, but as long as we are dependent, we will always play second fiddle.  

[cinntsp]

10 hours ago, thinkertdm said:

I’m with you.  It’s precisely what np’s did provide papers and studies.  It takes a lot of work, and you’ll find you are mostly on your own.  I hate to sound defeatist, but as long as we are dependent, we will always play second fiddle.  

But...but...docs love us.  We are the preferred providers!

[sas5814]

11 hours ago, thinkertdm said:

I’m with you.  It’s precisely what np’s did provide papers and studies.  It takes a lot of work, and you’ll find you are mostly on your own.  I hate to sound defeatist, but as long as we are dependent, we will always play second fiddle.  

There is a more nuanced history but, in essence, several years ago the VA offered to make PAs and NPs independent. NPs jumped and we dithered and pondered it until the window of opportunity passed.  I had a long discussion with someone at AAPA who was involved at the time and that is the short story. We had the chance and we missed it by a lack of action.

We have been hamstrung by the "everything is fine" and "the doctors will get mad at us" crowd for too long. Now that the bus has driven off the cliff , hit bottom, and caught fire, people are slowly catching on. (Very slowly). Whether it is too late...only time will tell.

[Hope2PA]

16 hours ago, CookiePA said:

 To me this sounds like gate keeping and childish politics (unless of course the posted job skillset is for some super niche specialties where only NPs are know to train…but still doesnt make sense) 

 

 

 

 

It is politics and, I wouldn't say childish, because it takes motivated group to basically cut out competition, it is professionally advantageous. The two I was specifically involved with was dermatology and gastroenterology with a couple surgical days. So no, not NP specific, if anything more PA specific.. 

[sas5814]

It is very much politics and a style that has worked well for the NPs while we sat around scratching our behinds and worrying about who might get mad at us. Now they are reaping the benefit of many years of aggressive politics and we are light years behind the curve and still losing ground. Don't hate the players ...hate the game. Particularly since we played it poorly.

[NeoTrion]

Scott and Hope2PA, thank you for your input.  I have followed Scott's suggestion and wrote an email to the POC at the bottom.  Getting names at the VA for people to talk to is difficult.  Hell at our VA just getting someone to answer the phone is difficult, and often they just dump you off at a voicemail you hope gets checked.  I contacted the AAPA and was told they want me to talk to the government affairs person, but I have not heard anything from that person as of it.  I plan on poking AAPA with a stick to see if I can get them to do as they offered.  Scott thank you for giving me information on the back end of things.  I am interested in the VA but I am also happy where I am.  I am just concerned that we are being left out in my part of Texas.  Please feel free to share and more pearls you may have.  I will keep working on my end.  

[sas5814]

Happy to help. There are aspects of the VA that are a PIA and , on a bad day, I'll cry and carry on but for the most part its a pretty good gig. Pay is decent. Benefits are excellent. I have no nights, call, weekends. There are all kinds of rules and a union to make sure I don't get abused.

The patient population is challenging. It will test your skills (and your patience some days). Today was "I'm non-compliant but its your fault I don't feel good" day. That can happen anywhere but it kinda piled up today. Just sent a COPD patient out by EMS who hadn't picked up his respiratory meds 11 days after I prescribed them. Lort.

[ventana]

On 6/1/2023 at 10:35 PM, thinkertdm said:

In the VA, NPs are autonomous independent clinicians, considered medical staff, and just hired without a whole lot of bothersome paperwork.  PAs on the other hand, need to have “collaboration”, which means nothing aside from more paperwork and more bureaucracy.  Who would you hire?  Don’t get me wrong- I believe that pas agave superior skill sets compared to np’s, but easy sells better to admins.

If you are licensed in Utah or one of the other states that has full OTP (independence) does it make you independent???

 

 

If so what is the BEST state to get licensed in???

[Reality Check 2]

Until the official wording is changed in ALL VA paperwork - it doesn't matter.

I have a Utah license now but am still not an LIP in the eyes of the VA. 

And the term Licensed Independent Practitioner is no longer a term.

But this will have to trickle down to ALL VAs, 170 of them, and have bylaws and SOPs changed and a whole bunch of foo.

I was told that having the license WHEN the changes go into effect is the best measure now.

Then my license can be reconsidered under my scope at that time.

99% of the time, I honestly feel no difference now - I am treated the same as the docs I work with  having the same expectations of performance and ability to do most anything I am qualified to do.

My main concern is admin/leadership jobs. 

Docs get promoted with no extra degrees etc but if a PA applies - what are you admin qualifications????

Has always been that way.

Watch for VA 1063, likely at least 18 months to adoption at this point and THEN dissemination to all sites. Went back thru my recent meeting notes. It is anticipated to give PAs somewhere between current function and full practice authority.

Edited June 27, 2023 by Reality Check 2

[Hope2PA]

1 hour ago, Reality Check 2 said:

Until the official wording is changed in ALL VA paperwork - it doesn't matter.

I have a Utah license now but am still not an LIP in the eyes of the VA. 

And the term Licensed Independent Practitioner is no longer a term.

But this will have to trickle down to ALL VAs, 170 of them, and have bylaws and SOPs changed and a whole bunch of foo.

I was told that having the license WHEN the changes go into effect is the best measure now.

Then my license can be reconsidered under my scope at that time.

99% of the time, I honestly feel no difference now - I am treated the same as the docs I work with  having the same expectations of performance and ability to do most anything I am qualified to do.

My main concern is admin/leadership jobs. 

Docs get promoted with no extra degrees etc but if a PA applies - what are you admin qualifications????

Has always been that way.

Watch for VA 1063, likely at least 18 months to adoption at this point and THEN dissemination to all sites. Went back thru my recent meeting notes. It is anticipated to give PAs somewhere between current function and full practice authority.

Is there anything no. VA employees can do to help? I do contract work with veterans. My current employer only hires NPs for veteran services, and, As I mentioned in a previous post, one of the VAs in our region only hires NP. Even in roles typically always requiring supervision, like surg, this VA and one large hospital will only hire NP because apparently no matter the position, paper work is more extensive for PA.

[Reality Check 2]

It is not the paperwork, it is Nurse EXECUTIVES and any doc who has ever had a tough PA interaction.

AND absolutely NOTHING in the govt moves with any speed. Committees, approvals, signatures, rinse, repeat, wait.

I was hired by a very pro PA Chief who is now gone and the current person is pro NP due to “perception” of fewer requirements and challenging PA who has tarnished us in the facility. 

Nurses support nurses and NPs have a Lobby like no other with tons of monetary support.

My personal belief is that once an NP - no longer an RN - if they want full practice and billing then act like providers,  not nurses,  but that will never happen nor will their education ever be as regulated as PA with broad and solid medical knowledge and skills.

PAs have to evolve or become the wooly mammoth of medicine.

Even in the VA we don’t speak up and fight hard for what we do.

I have it good right now but fear for future PAs.

Just my opinion and I don’t speak for anyone but me. 

[CookiePA]

On 6/27/2023 at 8:46 PM, Hope2PA said:

Is there anything no. VA employees can do to help? I do contract work with veterans. My current employer only hires NPs for veteran services, and, As I mentioned in a previous post, one of the VAs in our region only hires NP. Even in roles typically always requiring supervision, like surg, this VA and one large hospital will only hire NP because apparently no matter the position, paper work is more extensive for PA.

Is there a way to challenge that? 
has anyone asked them why they wont post same job posting for PAs? Did anyone contact state chapter to take up this task?

I am curious to see/know if anyone reached out and said this doesnt make any sense. If you have qualified individuals applying as PAs why still pick NPs. Cant tell me that EVERY NP they hired was much more qualified

[YourAveragePA]

There’s a lot of internal politics regarding what gets posted, but I can say, at least in my VA,  that of the 7 people in the Directors Suite, there are 4 NPs (including the hospital director).  No PAs.  That and the head of the NNU (Nursing union) has a better parking spot than the director. 
 

Being a PA at the VA is like driving a Camry…..not exciting at all, but it is reliable and will last forever.   The pay is decent and the quality of life is pretty good, but don’t count on any vertical movement beyond maybe lead department PA (which still ironically pays the same as clinic PAs). 

[sas5814]

11 hours ago, YourAveragePA said:

but don’t count on any vertical movement beyond maybe lead department PA (which still ironically pays the same as clinic PAs).

That is so timely. I have been offered the position of medical director of my outpatient primary care clinic. No raise. No bonus. Just the job. Then HR started throwing up every barrier they could cook up.

I haven't given up on the idea because it will open some doors for PAs that follow but it is going to be a lot of work to make this lumbering, clunky machine do something it doesn't want to do.

[YourAveragePA]

Just curious, what kind of barriers did HR send your way?  Also, would that position be PA4 or PA3?

In my hospital, there is only one PA4, the 'lead PA' for the hospital.  Otherwise everyone else is PA3 and since I'm step 10, I'm basically maxed for the next 20 years.  

[sas5814]

6 minutes ago, YourAveragePA said:

Just curious, what kind of barriers did HR send your way?  Also, would that position be PA4 or PA3?

In my hospital, there is only one PA4, the 'lead PA' for the hospital.  Otherwise everyone else is PA3 and since I'm step 10, I'm basically maxed for the next 20 years.  

Position is only for a physician. It will take months to get the position description changed. Can't have a bonus because he isn't leaving so retention bonus is inappropriate and we don't like doing lump sum bonuses because its hard to do. He would have to take the position and then ask to have the position made a PA4 and it would also have to be opened to competative hire, he'd have to be the acting Med Dir until the position  changes but he wouldn't have any actual authority... and on and on and on.

It was a big "too hard" email with no attempt to be helpful at all. Quite frankly it just pissed me off and made me more determined to make it happen.

Fortunately we (PAs) have some folks at the national level that know the system. I got some excellent guidance from them and the process is on the move again.

[ventana]

Many CBOC are using PA and NP as Clinic Directors in VISN..... seems to be growing