In the midst of purging online accounts I no longer use I fell down the rabbit hole and landed on this post. I'd like to give my opinion as a VA RadOnc. I enjoyed my VA rotation as a resident, even though the RadOnc service at that VA was...let's say...not amazing, because the patients are awesome and we had amazing physics and dosimetry. I went to a top residency program and intended to go into academics like a good little physician scientist, but I had the issue of a 3 body problem (minus gravity wells) so I was restricted geographically. The VA option (along with a faculty position at the nearby university) was presented by one of my mentors, and I was desperate so I followed up on it.
For me, I couldn't have been happier with my decision, but I also would have had no way of knowing that it was the perfect fit. Here are some point/counterpoints in no particular order, and certainly not meant to be exhaustive.
Salary
- max is 400k, and you would command more in the community (certainly not all academic institutions as per above discussion)
- max will be lifted in the very near future as a means for talent retention, salary per patient on your census is actually quite high (census is usually lighter than at PP or pure academic), and there are means to supplement your income through your academic affiliate (see below)
Physician quality
- 10 patients on-treat between 3 physicians being the cause for chaos sounds like hyperbole
- VA sites without academic affiliates and those in remote areas may suffer from this, but plan/treatment quality is something that the VA's National RadOnc Program (NROP) has tackled aggressively to equalize the quality of care (and hopefully light a fire under some physicians' butts to perform). Incompetence is not a problem at major VA centers, and new grads are unlikely to take a job in the VA boonies.
Bureaucracy
- I can't argue with this. This is 100% a daily problem for anything being done OUTSIDE of your department. The VA is very form-focused, meaning that the form has to be filled out correctly with the appropriate signature from the right person. The middleman glut is real.
- If you can gather your street smarts and aren't socially inept, you'll be able to finagle the things (imaging, send outs, housing, etc.) you want with little to no effort other than dropping a line to your colleague. I can get same-day PETs, but this requires knowing who to ask (and also that we have a cyclotron on-site) as some of my colleagues wait months. As with anything, a little social intelligence goes a long way.
- Also if your chief is smart (as all of ours are, humble brag) then they know what needs to be done to get new equipment, machines, etc. Our equipment is honestly fancier than many of the practices around us.
9-5
- The best lesson I learned from a visiting professor in residency was to protect your time as an attending. I have no problem compartmentalizing my clinical time to allow time for being a scientist, mentor, family man, etc.
- There are relatively few people at my VA or anyone else I work with through the NROP network who isn't working later in some shape or form, doing research, mentoring residents, etc. One may certainly treat it as a 9-5, but like anything, the individual will determine their level of work output and engagement.
EMR
- I freaking love CPRS (our EMR). I was/am a superuser for Epic, and I have to say that Epic is clunky, memory-hogging garbage. The beauty of CPRS to me is how bare-bones it is. It was a home-grown application made at the VA in the 1970s (I think) that can literally fit on a USB drive. It's so easy to pull CSV files for clinical research and you can make templates and "smart phrases" or whatever.
- There is a strong, idiotic, and poorly-informed/executed attempt to change our EMR to Cerner, which I hate more than Epic.
Something that was important to me (maybe not everyone else here) are that the research opportunities are amazing as are the funding streams for said research. Additionally, the VA allows you to be 150% committed, meaning that you can keep you full-time (8/8 in VA lingo) salary from the VA and pull in whatever else at a 50% time commitment. Clear as mud? So for me this means that I pull in my academic affiliate's max allowed through grant funding obtained through said academic affiliate, which thankfully brings me closer to 550k, which is pretty good for getting paid to do what I want to do.
BIG CON
The VA is subject to oversight by Congress, and thus the trends (and some heads) at any given time change with the political vagaries of the day. Added onto this that are specific politicians that you can Google who have made it their life goal to privatize the VA and gut it into an insurance company. As much as I love sending a Gleason 3+3 in 1/12 cores of a 20 cc prostate for 40+ fractions of fake IMRT in the community due to my perceived incompetence by these politicians, many providers (not only RadOncs) have started to push back against the Koch brothers' agenda.
Long post, hopefully was worth a read. DM me if interested in VA RadOnc jobs. I'll try to check this site more than once every 2 years.
