VA Psychiatry Questions

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Chianti

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I am on the verge of pursuing outpatient opportunities with the local VA. Had a few questions:

1) Would it be more efficient to contact the VA site directly or to go through their designated recruiter?

2) Does the VA system allow moonlighting at non-VA sites?
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Chianti said:
I am on the verge of pursuing outpatient opportunities with the local VA. Had a few questions:

1) Would it be more efficient to contact the VA site directly or to go through their designated recruiter?

2) Does the VA system allow moonlighting at non-VA sites?
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1) If you know people at the VA already, speak to them directly about it. They do have to do all this government job hopla but they still basically make it so you have the job.

2) That appears to vary, it was previously very common but I have heard they are trying to limit it.
 
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1. I would first contact locally directly rather than going through a recruiter, particularly if you know someone. If you later go to the recruiter, start by asking the pay they will negotiate for you.

The reason for this is that some recruiters have a mutual non-compete agreement with their client. This means that if someone initiates contact with a recruiter, they log the contact and supply it to their client so that if an applicant contacts the client about a job and they are on this list, they are either referred to the recruiter or (if the client can negotiate down well), the client hires directly and pays out the finder's fee to the recruiter.

2. There is nothing at the federal level that prohibits moonlighting (barring obvious conflict of interest stuff) but regional/hospital-specific policies will differ from one place to the next.

Generally (hard to say that with the VA), the VA doesn't much care with non-conflict moonlighting. Many people actually pursue VA jobs because many permit 4/10 scheduling that allows folks to build a practice on the side without much muss/fuss.
 
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Overall, the VA seems like a sweet gig to me. Any idea why the turnover rate seems so high? Seems like there are always people leaving, and half of the new hires don't last long.
 
JustAGuy said:
Overall, the VA seems like a sweet gig to me. Any idea why the turnover rate seems so high? Seems like there are always people leaving, and half of the new hires don't last long.
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1. Inefficiencies.
2. #1 significantly impairing your ability to get patients the care they need.
3. Service connection.
4. People utilizing resources and taking your time away from treating a lot of people because of #3.
5. An entire system that does not encourage getting better or improving.
6. See 2 again.
7. Requesting a pharmacist approve you starting an antipsychotic.
8. Review #3 again.
9. The types of personalities that you'll have in management at a VA.
10. Having unreliable colleagues who maximize all their sick days.
11. Having walk-ins.
12. Having to see someone else's patients because they're "out sick."
13. CPRS.
14. People having thousands of dollars per month dependent on their continued "impairment."
15. Having your colleague scheduled patients on the day they're not there (and won't be for months) and continuing to have to cover those patients while there are still patients scheduled >1 month out knowing their doctor won't actually be there but they're "working on it," and by "working on it" means you're working in it... when they show up next month and you have to see them "because Dr. ____ isn't here today."
16. Not being able to get your patients with legit PTSD the services they need because they're not gaming the system.
17. Getting services to people who don't need it because they're gaming the system.
18. If you're not convinced, return to top of list and repeat (because you will repeat... daily... forever.)
 
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I agree #14 can present the biggest problem.

Some patients and some employees can game a rather generous system more compared to a private or community mental health clinic. At the same time, it is nice to actually have some resources for patients and employees which I haven't seen elsewhere. A nurse here recently had to have major surgery and it was nice she could recover without having to worry about losing her job.

For me these days, the biggest downside of working at the VA is the massive amount of documentation in CPRS, which takes away from treatment time and can get quite boring.

Every job has it's good and bad. If it was all bad I wouldn't be working at the VA with all the opportunities available for psychiatrists.
 
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Oh yeah forgot:

19. At risk for wandering reminder.
20. High risk for suicide flags (who aren't really high risk but see #14 so you have to keep dealing with this nonsense when its clinically inappropriate and reaffirming maladaptive patterns for a patient).
 
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Poor and toxic leadership who care only about numbers in terms of how productive you are coupled with very low W2 wages. I'll be entering rehab for my GS employment vowing to never return.
 
Well, people might not need to worry about getting a job at the VA for a little while due to Trump's executive order mandating an indefinite hiring freeze for every government agency except the military as of January 22, 2016.

Apparently it is ok to keep producing veterans but not to care for them after their service. Business as usual.
 
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wolfvgang22 said:
Well, people might not need to worry about getting a job at the VA for a little while due to Trump's executive order mandating an indefinite hiring freeze for every government agency except the military as of January 22, 2016.

Apparently it is ok to keep producing veterans but not to care for them after their service. Business as usual.
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Pretty sure that doesn't include public health/safety people.
 
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Shikima said:
Poor and toxic leadership who care only about numbers in terms of how productive you are coupled with very low W2 wages. I'll be entering rehab for my GS employment vowing to never return.
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Pay seems pretty decent here.
 
wolfvgang22 said:
Well, people might not need to worry about getting a job at the VA for a little while due to Trump's executive order mandating an indefinite hiring freeze for every government agency except the military as of January 22, 2016.

Apparently it is ok to keep producing veterans but not to care for them after their service. Business as usual.
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To be fair, no amount of hiring is going to fix the VA as it stands right now. My local VA hospital actually uses three different EMRs with no rhyme or reason as to which floors use said EMRs. And to make things worse - only two of the EMRs communicate well with each other. I thought it was a joke when I heard about this, but nope. Blatant incompetence and beurocracy need to be ironed out so our veterans get the care they deserve. More hiring does absolutely nothing.
 
IsWhat said:
To be fair, no amount of hiring is going to fix the VA as it stands right now. My local VA hospital actually uses three different EMRs with no rhyme or reason as to which floors use said EMRs. And to make things worse - only two of the EMRs communicate well with each other. I thought it was a joke when I heard about this, but nope. Blatant incompetence and beurocracy need to be ironed out so our veterans get the care they deserve. More hiring does absolutely nothing.
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What EMRs? We use CPRS.
 
wolfvgang22 said:
The actual memo we got doesn't say anything about the VA being excepted, so right now hiring is frozen per our administrators.
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I'm pretty sure I read on multiple sites earlier today that public health people were excluded from the freeze. And now I see this on USA TODAY, which makes me think the VA will continue hiring physicians:

the VA is currently advertising to fill more than 2,000 job openings on the federal hiring website, including for hundreds of nurses and doctors. Shulkin has told USA TODAY that one of his top priorities is getting fully staffed up.

After Spicer's remarks, the VA said it planned to take advantage of the hiring freeze's allowances for public safety needs.

"The Department of Veterans Affairs intends to exempt anyone it deems necessary for public safety, including frontline caregivers," Acting VA Secretary Robert Snyder said in a statement.
 
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IsWhat said:
To be fair, no amount of hiring is going to fix the VA as it stands right now. My local VA hospital actually uses three different EMRs with no rhyme or reason as to which floors use said EMRs. And to make things worse - only two of the EMRs communicate well with each other. I thought it was a joke when I heard about this, but nope. Blatant incompetence and beurocracy need to be ironed out so our veterans get the care they deserve. More hiring does absolutely nothing.
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The va uses cprs only.
 
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wolfvgang22 said:
The actual memo we got doesn't say anything about the VA being excepted, so right now hiring is frozen per our administrators.
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Last clarification I saw was that the VA was not excluded, but that hiring managers would try to use the "public health exemption" to squeeze through hiring if front line clinicians. Although who knows what will happen in this Kafkaesque administration?
 
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JustAGuy said:
Pay seems pretty decent here.
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No, it isn't. It's below what is being offered.
Just received an offer, via word of mouth, where 250k loan repayment, all things covered including CME etc and the salary was some W2 and the rest as 1099.

Mental health is in high demand and the salaries are increasing. Not at the GS levels - lucky to get 230k with maybe EDRP.
 
Shikima said:
No, it isn't. It's below what is being offered.
Just received an offer, via word of mouth, where 250k loan repayment, all things covered including CME etc and the salary was some W2 and the rest as 1099.

Mental health is in high demand and the salaries are increasing. Not at the GS levels - lucky to get 230k with maybe EDRP.
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But the work load is typically far less than in some other higher paying jobs. A lot of people would prefer to work in a job that was less labor-intense for less. The VA may come with its own problems, but everywhere has its flaws. round my way, the VA pays 240k to begin with and I have seen some jobs in undesirable parts where they are paying 264k. VA salaries have been increasingly substantially.
 
splik said:
But the work load is typically far less than in some other higher paying jobs. A lot of people would prefer to work in a job that was less labor-intense for less. The VA may come with its own problems, but everywhere has its flaws. round my way, the VA pays 240k to begin with and I have seen some jobs in undesirable parts where they are paying 264k. VA salaries have been increasingly substantially.
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No it isn't. More often than not you are the MH treatment coordinator, the nurse, SW and have walk-in clinic. There are many alerts and other pointless documentation that you cannot delegate work to someone else to complete. And all salaries are W2 which means you lose a substantial amount to taxes. This makes student loan payments difficult. EDRP is low and must pay before you recoup anything in return. There is no CME money in many cases and often need to rationalize time off to attend a conference while not using your vacation time.
 
Shikima said:
No it isn't. More often than not you are the MH treatment coordinator, the nurse, SW and have walk-in clinic. There are many alerts and other pointless documentation that you cannot delegate work to someone else to complete. And all salaries are W2 which means you lose a substantial amount to taxes. This makes student loan payments difficult. EDRP is low and must pay before you recoup anything in return. There is no CME money in many cases and often need to rationalize time off to attend a conference while not using your vacation time.
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some of these things will be institution dependent. the VA I had been looking at before seemed open to at least 8 days of conference leave in addition to vacation, admin time, 1 day for research, working 9 hour days and getting a day off every other week for working 5 9s, providing a nurse, and were open to providing me with 2 hours for geriatric intakes. appx 220k. Sounded pretty sweet to me. unfortunately I was too foreign or something and it wasnt able to work out.
 
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Do typical VA positions involve call or inpatient coverage? And is this included in the salary?
 
splik said:
some of these things will be institution dependent. the VA I had been looking at before seemed open to at least 8 days of conference leave in addition to vacation, admin time, 1 day for research, working 9 hour days and getting a day off every other week for working 5 9s, providing a nurse, and were open to providing me with 2 hours for geriatric intakes. appx 220k. Sounded pretty sweet to me. unfortunately I was too foreign or something and it wasnt able to work out.
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I've been told similar circumstances in the past and ended up being bait and switch or flat out pathology arguing with you to do more work. Then you'll hear the nurses not doing what you've tasked them to do. Never mind others complaining about their work load and then it gets dumped on you. Remember there is no contract and can pretty much do what they want to you during working hours.

You are correct, there are others on here who have had different experiences - I suspect this is the exception, not the rule.
 
To be honest my experience is probably right in the middle between what shikima and splik are saying. My workload is always slowly increasing, mostly with paperwork bologna, but so far financially it's ok for what I do. I think if my workload goes up more I will be asking gor more $$$ or considering other opportunities. Admin here knowing this is the only reason my work load has not increased drastically.
 
Unfortunately, when workload was increased on me despite being a top producer in the department, I only heard crickets chirping when I asked for more money.

I ended up walking, but then coming back.... now walking once again to enter into rehab for GS service.
 
Shikima's VA experience seems very different than mine. VA here starts around $240, which is more than most of the places I've talked to in the city. You're working <40 hours on average per week and you get something like 2 1/2 months off a year in holidays/vacation/sick days. You get a pension, 4% tsp match. Seems hard to beat. I don't know what to say about the w2 complaints. Seems the easiest way to avoid taxes would be to reduce your tax burden through protected retirement account contributions.
 
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JustAGuy said:
Shikima's VA experience seems very different than mine. VA here starts around $240, which is more than most of the places I've talked to in the city. You're working <40 hours on average per week and you get something like 2 1/2 months off a year in holidays/vacation/sick days. You get a pension, 4% tsp match. Seems hard to beat. I don't know what to say about the w2 complaints. Seems the easiest way to avoid taxes would be to reduce your tax burden through protected retirement account contributions.
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The pension is nice, but in many of the proposed changes, significant changes to the pension plan seem to be a recurring theme, so that perk may be diminished as time goes on. Also, the TSP match should be 5%.
 
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WisNeuro said:
The pension is nice, but in many of the proposed changes, significant changes to the pension plan seem to be a recurring theme, so that perk may be diminished as time goes on. Also, the TSP match should be 5%.
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They match 100% of the first 3% and 50% for the next 2%. So you put in 5% and they match 4%.
 
JustAGuy said:
They match 100% of the first 3% and 50% for the next 2%. So you put in 5% and they match 4%.
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You're not factoring in the 1% automatic contribution.

"Agency Matching Contributions—If you’re a FERS participant, you receive Agency Matching Contributions on the first 5% of pay you contribute every pay period. The first 3% is matched dollar-for-dollar by your agency; the next 2% is matched at 50 cents on the dollar. This means that when you contribute 5% of your basic pay, your agency contributes another 4% of your basic pay to your TSP account. Together with the Agency Automatic (1%) Contribution you get, your agency puts in a total of 5%."
 
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TSP is 5%+5%. Maximizing contributions is not enough for the income bracket you're in. This then leads into a 1099 discussion. The pension is dismal - you're looking at 60-70k/yr after working 25 years (pretty pathetic for a physician) and it is taxable. PTO is standard for industry wage slave - If you're getting less than 6 weeks, you're being taken advantage of.
 
WisNeuro said:
You're not factoring in the 1% automatic contribution.

"Agency Matching Contributions—If you’re a FERS participant, you receive Agency Matching Contributions on the first 5% of pay you contribute every pay period. The first 3% is matched dollar-for-dollar by your agency; the next 2% is matched at 50 cents on the dollar. This means that when you contribute 5% of your basic pay, your agency contributes another 4% of your basic pay to your TSP account. Together with the Agency Automatic (1%) Contribution you get, your agency puts in a total of 5%."
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Oh right. Sorry, I forgot about that.
 
Shikima said:
TSP is 5%+5%. Maximizing contributions is not enough for the income bracket you're in. This then leads into a 1099 discussion. The pension is dismal - you're looking at 60-70k/yr after working 25 years (pretty pathetic for a physician) and it is taxable. PTO is standard for industry wage slave - If you're getting less than 6 weeks, you're being taken advantage of.
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You can put $18k in TSP and then there's what, a $6k catch up? Are you married? Do you and your wife have backdoor Roth IRAs? That's another $11k + catch up. You can use all your time off to run a side business and add your wife as an owner, potentially another $53k x 2 into individual 401(k)s, + catch up. You can put $2600 in FSAFEDS. So that's almost $138k right there into tax protected accounts , or $165k if you're old enough.

I don't understand what is dismal about the pension. It's a nice chunk of additional money added on to whatever you're investing yourself for retirement. What do you think the value of that income is? You can get a rough estimate of a pension value by seeing how much a similar annuity benefit would cost. I haven't checked, but I would guess $70k a year would probably be worth around $1-1.5 million. And considering VA pension has a COLA, it would be worth even more than whatever this value is.
 
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JustAGuy said:
You can put $18k in TSP and then there's what, a $6k catch up? Are you married? Do you and your wife have backdoor Roth IRAs? That's another $11k + catch up. You can use all your time off to run a side business and add your wife as an owner, potentially another $53k x 2 into individual 401(k)s, + catch up. You can put $2600 in FSAFEDS. So that's almost $138k right there into tax protected accounts , or $165k if you're old enough.

I don't understand what is dismal about the pension. It's a nice chunk of additional money added on to whatever you're investing yourself for retirement. What do you think the value of that income is? You can get a rough estimate of a pension value by seeing how much a similar annuity benefit would cost. I haven't checked, but I would guess $70k a year would probably be worth around $1-1.5 million. And considering VA pension has a COLA, it would be worth even more than whatever this value is.
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You should def. talk to a tax specialist before moving forward with this plan.

The dismal thing about the pension is that you're paying handsomely for it. You have to contribute 4.4% of your after tax pay into it , in order to get back 1% per seniority year of today's income 20-30 years from now. If you do the math you'd do almost as good sticking that money in a brokerage account and investing it yourself.

You can't run a side business on government time. This is not true with many other private jobs, where the employer really doesn't necessarily what you're doing as long as you're getting your work done. You can certainly moonlight on nights and weekends as a fed, but you have to set distinct boundaries between your practices.



You can't contribute to individual 401k and TSP at the same time beyond the maximum contribution limits.
 
wolfvgang22 said:
What EMRs? We use CPRS.
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I'm not sure what they use, I just heard the interns and residents I used to work with complain about it. Maybe it's an isolated issue here?
 
Is anyone concerned about Paul Ryan/Trump's plan to at least partially privatize the VA? Is anyone expecting this will affect physicians (not just psychiatrists but all doctors)? I've heard people say it will and others say it won't....wanted other people's opinions.
 
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Do you think the rumors about federal/VA pensions being eliminated will become a reality under the Trump administration?
 
prominence said:
Do you think the rumors about federal/VA pensions being eliminated will become a reality under the Trump administration?
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Eliminated? No. They won't risk the backlash all at once. It's more likely they would keep increasing the VA employee's share of pension payments as to make it virtually useless.
 
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keifernny2 said:
The dismal thing about the pension is that you're paying handsomely for it. You have to contribute 4.4% of your after tax pay into it , in order to get back 1% per seniority year of today's income 20-30 years from now. If you do the math you'd do almost as good sticking that money in a brokerage account and investing it yourself.
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I don't think it's that close at all. 4.4% x 20 years at 6% return comes out to around $400k or so. The pension is worth way more than that.

keifernny2 said:
You can't contribute to individual 401k and TSP at the same time beyond the maximum contribution limits.
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What does this sentence mean?
 
JustAGuy said:
I don't think it's that close at all. 4.4% x 20 years at 6% return comes out to around $400k or so. The pension is worth way more than that.



What does this sentence mean?
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Your numbers are off.
The current fed pension for new employees is 1% of your salary per year (1.1% if you stay 20 years) . so if earning 200k, the pension after 20 years is 44k annually. The amount mentioned earlier of 70k is for employees in the old system, which new employees can't get into.

Look up FERS-FRAE on the OPM.GOV website for details on the pension.

You can't put more than 18k total in contributions even if you have multiple 401k (and tsp counts like a 401k for this purpose. You can make profit sharing contributions to a solo 401k but you'd have to have a very significant side job to make it worthwhile.




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keifernny2 said:
Your numbers are off.
The current fed pension for new employees is 1% of your salary per year (1.1% if you stay 20 years) . so if earning 200k, the pension after 20 years is 44k annually. The amount mentioned earlier of 70k is for employees in the old system, which new employees can't get into.
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I was just quoting the person's scenario above me. Some of us have a lot of federal service already from before medicine. Worst case scenario would be 1.1 x 20 x 240 = $52800.

keifernny2 said:
You can't put more than 18k total in contributions even if you have multiple 401k (and tsp counts like a 401k for this purpose. You can make profit sharing contributions to a solo 401k but you'd have to have a very significant side job to make it worthwhile.
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Like I said, you can potentially contribute up to $53k x 2 into individual 401(k)s. Any tax sheltered amount would be worthwhile to me.
 
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