I'm still confused. The VA is not quite the monolithic organization it appears. If you were hired by the VA for a 100% telepsych job, your local VA would only be responsible for printing your ID badge, completing your onboarding physical and distributing your VA laptop and iPhone. Beyond that, your responsibility would be to the VA that hired you. As impressive as it would be, you don't start your day as a VA psychiatrist seeing a patient in Washington state and end it seeing patients in Delaware. You're seeing all patients located in a single geographic area, regardless of where you are located. So...the VA that actually hires you matters a lot, as opposed to the VA you live closest to which matters very little. Of course there are exceptions for HIGHLY specialized things, but the chance of being hired directly into one of those sort of national positions from the civilian world is unlikely. That's more something you might work up into as you get more experience with the VA and then still very rare.