VA employment - in small outlaying CBOC - what to expect??

[DFAAPA]

Finally coming together (I hope)

almost done with process of starting work

going to a small CBOC where I will be only provider most days

 

Medical knowledge wise I feel prepared with 20+ yrs experience

 

But my question is what this the challenge points in adapting to the VA (I am also prior military so "hurry up and wait" is fine)

 

 

What pitfalls do I need to watch for?

What special areas to focus on learning ?

What things do I avoid/steer clear of?

[sas5814]

so much to cover.....

Pitfalls? Every VISN and even CBOCs in the same VISN are different from each other. It is hard to predict pitfalls. So much of your experience will depend on your leadership. If they are really focused on patient care and shape your responsibilities accordingly things will go well. If they are only worried about metrics and appearances your life will be challenging. I'm a retired Army PA so I expected government "stuff". I have been, and continue to be, stunned by the amount of politics that goes into decision making and policy making. I have seen so many thousands of provider hours wasted trying to "manage" the political flavor of the moment is boggles the mind.

 

Special areas. This is an IM type practice with a very sick patient population. BP, diabetes, cards, chronic kidney disease with a nice over lay of mental health issues will take up the majority of your time. Beyond that it is primary care so you'll catch some of everything.

 

I don't know what to tell you to avoid. This is a socialized health care system so those type issues are prevalent here too. "Free" healthcare gets treated like it's free. Personally I won't get sucked into disability issues. There is a secondary gain for many patients who are trying to get a disability rating and the ones who really earned it and deserve it can get lost in all the noise the manipulative, dishonest patients make. I just don't get involved. I tell them I am here to take care of their health...period. Disability is a different side of the house that has nothing to do with me.

I have a particular affinity for the young people who have been broken by multiple combat deployments physically and mentally. I embrace their care with a particular passion and try to focus on that so I don't get lost in all the political foolishness. There is a lot of good to be done here for people that need it and have certainly earned it. I embrace that when the rest of it is wearing me down.

PM me if you want. Good luck and welcome aboard.

[YourAveragePA]

As a PA working in a surgical subspecialty (Ortho/Plastics) at a large VA med center, I'd offer a few points to make your job a little bit easier....

1) Don't be afraid to reach out via 'Teams' messaging to another APP in a subspecialty.  We get bogged down a lot (like PCPs do) with tons of useless view alerts and notifications.  If something is urgent or complex, the easiest way is to reach out directly to the service rather than just throw out a consult request and hope for the best.  

2) Don't be a consult machine.  It's very easy to consult every specialty for every issue, especially when you're super busy too.  But practicing medicine and not just referring makes a big difference.  I often get consults for or "generalized pain" with no exam, imaging, history, etc.  Nothing moves quickly at the VA, so sending someone to a specialist with zero work up delays their care even more.  You'd be amazed how much a little PT/OT or voltaren will help out someone's issues.  

3) Try not to get burnt out.  As stated above, the VA system is a unique one and the pathologies are challenging.  I'm in the south, and my patients tend to be very tough/stubborn about their healthcare with very high pain tolerances.  When they finally get to me, I'm amazed at how they've been living with their issues for so long.   I've seen A1cs of 18, BMIs of 70, BPs of 220/130......  The overwhelming majority of patients are very appreciative and absolutely amazing people, but like any other system, there are outliers and they will take up a lot of mental real estate.