At the beginning of fellowship, my wife (also a General Surgeon) and I began looking for jobs near my family in rural Montana. There were many potential benefits: good salary, 3-year guarantee, no non-compete… this, of course, was in exchange for a 1:4 ‘home’ call schedule that typically required in-house consultations and overnight cases. I had also joined the Army Reserves during fellowship (a lifelong goal of mine) and asked about potential time-off for deployments or drill. I could take all the time I needed as vacation but would be responsible for ‘making up’ the missed call to make sure that everyone had roughly the same number of call days per year. At the time, the deployment schedule was roughly q24 months for general surgeons. That meant that every 2 years I would be mobilized and deployed for roughly 4 months – not an impossible schedule but definitely a challenge as not only would I have to make-up the call I missed; but also my wife’s call increases (she would be in the same call pool). Lastly, after the first 3-years, our salary would become RVU-based and likely take a significant cut during deployments.
We then received a call from the Chief of Surgery at the VA where we had done our residency. Up until then, we had not considered working at the VA and didn’t know much about being a government employee. As the discussions began, we quickly began to wonder – is this deal too good to be true?
To begin with – in the past, VA physician salaries have been considered “low.” However, in Denver (and many competitive localities where a lot of surgeons compete over few spots which drives down salaries), the VA can easily achieve the MDMA average. On top of that, the benefits are where the value of being a federal employee exceeds nearly all other academic (and most community) positions – 1) Thrift Savings Plan (401(k) equivalent) matches contributions up to 5% of salary with the lowest administrative fees of any investment portfolio; 2) Pension/Retirement – the VA offers one of the few remaining ‘pensions’ on top of your TSP contributions; 3) Health Insurance – the VA pays, on average, up to 70% of health care premiums with a wide range of options from high deductible plans through Blue Cross Blue Shield, Aetna, etc. to Kaiser and so on. (https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/)
There are also significant benefits to those who are in – or were in – the military. There is annual military leave up to 15 days on top of your 26 days of annual (vacation) leave. You can also ‘buy back’ your active duty military time to count towards a VA retirement – allowing you to retire earlier and still receive a full pension.
Beyond the salary and benefits, we were lucky to join a team of like-minded individuals. This, I think is the single most important piece of advice I would give those looking for their first (or second… or 3rd) job. Your daily satisfaction and burn-out will be directly related to who you work with. If your potential partners are ornery, don’t offer to help each other out and have dissimilar goals – then you’ll likely stay at the job for a couple years and rapidly move in. But if you can find a group of people who work well with each other, are willing to help each other out and “put the team in front of the individual” then it could end up being your first… and only job. So take extra time to get to know your potential colleagues as best you can before making that decision.
The last topic regarding the VA is the concern regarding productivity: there is a persistent myth that everything shuts down by 2-3pm; no cases happen on the weekend and there are long wait lines for everything. While this may be true elsewhere, ‘your’ VA can be whatever you make it. In Denver, for Gen Surg, we commonly see patients and get them to the OR within 2-3 weeks of presentation – very nice continuity of care for our rotating residents and students and significantly faster than the wait times in the community and nearby academic centers. We also run our ORs to 5PM and operate on the weekends. This was driven by our Chief of Surgery who recruited likeminded individuals (such as my wife and I) who slowly changed the paradigm over the course of 5 years.
In sum – the VA offers a competitive salary and numerous benefits, especially to those who are current or former military members. But more important than finding a VA is finding partners who have similar interests and work ethic so that your first job could be your last job.
Edward Jones, MD, MS, FACS