Musings...
Random stuff I'm reading and thinking about. That's all, a little bit of philosophy, maybe some brain exercise. Enjoy...
Update
11/07/2009
Reveille
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November 5th 2009
"In August 2004, while on patrol with my Marine unit in Mahmudiya, Iraq, I was severely wounded by a roadside bomb. My wounds included a crushed skull and right hand, traumatic brain injury and the loss of both my eyes.
I am not alone. In the past eight years, many of the 35,000 American soldiers wounded in the wars in Iraq and Afghanistan have returned home. But many of us have also returned with deep emotional wounds, and those are harder to see"October 12th 2009
Working as a VA physician
I was eavesdropping into a conversation over the weekend and heard some interesting things. The forum I was lurking on was a private one requring all kinds of registration. I'd been given the opportunity to listen in by a friend who sent me a link.
I found it interesting that his read on all this was negative. He sent it to me in hopes that I'd make s tory of how horrible VA doctors are and maybe how we should all not care for our VA health care.
I'm printing the good, the bad and the ugly below for you. These are real doctors talking with other real doctors about work at the VA.
I won't print it all. There was just too much for that. I'll do my best to give an honest representation of what i saw there though and you can draw your own conclusions.
From my perspective it seemed that overall doctors gave VA great reviews. The criticisms were honest but could have been any hospital system. It was nice to see how many of these docs recognized our sacrifices.
The forum thread opened with a physician asking other physicians a question;
"I recently received a job offer to work in the local VA hospital. I am Board Certified in Internal Medicine, and the position is in their General Medicine Service line, with out-patient and in-patient responsibilities."
The pay is comparable to what I'm getting as a physician in a medical center. The benefits are better (insurance, TSP, etc). The scheduling is more flexible. In terms of malpractice, it seems to be a much better environment to work in.
Am I overlooking something? I've never trained or worked in a VA hospital, so any insights would be welcome!"
These are some of the responses;
"As a VA researcher I can add that you're overlooking the positive aspects of access to research data, funds, and environment, if that interests you. I'm not a medical doctor so I can't advise on things medical. Do you have direct access to VA doctors you can talk to?"
The doctor who opened the thread replies;
"Yes I have spoken to a couple of VA docs, and they are both very satisfied with their jobs. One of them had informed me about the position that I am now considering."
Another comment;
"Users of the VA health system rate their customer satisfaction higher than users of the private health care system. http://www.govexec.com/dailyfed/0206/021006nj1.htm"
And then;
"my father is a former VA physician and seemed satisfied with his working conditions. during my medical school, i think there was a perception that it was less-than-presitigious since there are many foreign-trained doctors working there, there are occasional media-hype stories of horrible medical care, and a significant number of your patient population may have significant co-morbidities. i imagine much of this perception is not entirely based in reality, but you will have to decide for yourself how such public perception plays into your career decision-making.
having said that, i have a friend who currently works for the VA is seems very satisfied with his practice and quality of life."
Another doctor chimes in;
"My wife in an internist. She worked rotations at the local VA hospital on the floors every year during her training, and she is now working for a private group. She also has friends who work at a VA, and was trying to find a job at the VA for a while but no openings. From what she tells me:
Positives:
-excellent computer system and extremely convenient since one can access any veteran's medical record across the entire country.
-excellent benefits since it's a government job.
-hours more flexible and desirable.
-once you learn the system...you're set.
Negatives:
-pay not as competitive (comparing her friend who works at the VA vs her private group pay by about 20-25%...didn't feel comfortable asking her friend the exact number even though they are good friends, but got a ballpark number)
-less flexible in terms of retaining benefits if she decides to drop her hours down once we have kids. Current job will consider her full time at 70% of current hours and allow her to keep all benefits while working less.
Can Go Either Way:
-see majority male patients: wife prefers this because no GYN stuff to worry about and she says guys are much easier going and will listens to her more (I think they like her cuz she's pretty...but I'm biased =)
-I personally want to see men, women, old, young, pregnant, everything, and anything....but then again, I'm an ER doc so I'm drawn to variety.
Conclusion:
Depends on the individual. For my wife, I think she would be happier at the VA, and she originally intended to work at a VA, but they didn't have any openings. She's currently still very happy where she is now so everything worked out. So you have to determine what you want from your job and go from there."
A reality check;
"Depends on your personality
I find the bureaucratic aspects of the VA to be maddening - formulary restrictions regardless of competancy and track record of appropriate use
I also find the clinics can be obsessed with checking off boxes for chronic care and not a focus on the management of the pt in the room
Consults can take weeks
But a number of docs who have tired of the office overhead, high volume treadmill find the VA to be a relief --
The pts are generally grateful --
The inefficiencies can drive you crazy. The employees are very much on the clock, and the worst clinical support staff tends to get promoted to supervising positions. That and the formulaic 'because that's what the policy says' attitude drove me crazy there as a resident and medical student. But that does not turn off most personalities as much as it does mine."
Someone gets in a joke;
"Gynecologist turned mechanic
A gynecologist had become so fed up with malpractice insurance and HMO paperwork and was burned out. Hoping to try another career where skillful hands would be beneficial, he decided to become a mechanic. He went to the local technical college , signed up for classes, attended diligently, and learned all he could. When the time for the practical exam approached, the gynecologist prepared carefully for weeks and completed the exam with tremendous skill.
When the results came back, he was surprised to find that he had obtained a score of 150%. Fearing an error, he called the instructor, saying, 'I don't want to appear ungrateful for such an outstanding result, but I wonder if there is an error in the grade.'
The instructor said, 'During the exam, you took the engine apart perfectly, which was worth 50% of the total mark. You put the engine back together again perfectly, which is also worth 50% of the mark."
This equaled an A. After a pause, the instructor added, 'I gave you an extra 50% because you did it all through the muffler, which I've never seen done in my entire career.'"
The thread continues;
"Thanks for posting that article. Articles like this combat the poor image of the VA system. The last paragraph is emblematic: a researcher says he wouldn't mind sending his family. I think from reading this, my impression is most lay people don't have a clue what is good medical practice. Why don't you ask a doctor who works in a university hospital across the street from a VA, which hospital he'd rather send his family member?
I used to share your view of the VA system. However, the VA system has become significantly better than when I finished training a decade ago. There is likely a spectrum of VA hospitals. As a physician, I have seen a variety of academic and private hospitals, including multiple 'prestigious' medical centers. The VA that I work as a physician has better care and equipment than the vast majority of private hospitals in the area. Many of the physician positions are sought after and competitive to obtain. Many of the new physicians that are now joining the VA are highly qualified and exact opposite of your experience. One should not generalize too much from one's own experience (limited sample size), especially if that experience was the distant past. The world changes very rapidly. The article (xvxvxvx) posted is accurate from my personal experience as a clinical physician. As a practing clincial physician, I would rather have myself or my family get care at most of the VA hospitals that I know, rather than most of the regular/private hospitals that I know of in the area.
a factual nonpolitical article reponsive to the OP (it discusses the merits and demerits of the VHA system) is available at: http://www.bloomberg.com/apps/....Ic5ABThjBk
another good source of information is: http://www.washingtonmonthly.c....ngman.html"
Another reality check (This was very long, I've cut it to the basic message);
"A lot of the problem is
efficiency.
80% of the work as a resident is either tracing down the patient's entire history. Thanks to VA computer, EVERYTHING, literally EVERY medicine prescription, stress test, consult or colonoscopy is in the same system. So instead of calling the pharmacy and getting in touch with umpteenth private attendsins, a VA admission, even for ICU patient was a joke. You'd just renew with ONE CLICK (literally) all the outpatient meds, quickly look through everything, and within 10-15 minutes know the patient as well as their primary care doc thanks to everything being accessible in the record.
You get to care for the nation's heroes! I can't tell you how many Pearl Harbor, Phillipines, Normandy, bomber, battleship whatever heroes I met.
As a child I read and was told by my grandparents about these heroic, selfless people who saved our country from certain doom. If it wasn't for these heroes, certainly we would have to wake up every morning and wave a "heil hitler" to a nazi flag.
So yes,the VA was wonderful for residency. I can be a lot of work as a resident because you have very little supervision. But that is what I most loved about it! I was a good doctor. Sure, I had my faults, but I was being judged on tasks that had NOTHING to do with being a good doctor.
The differece is this: most residents at the VA hated it. They had no appreciation for history. They didn't appreciate WHY most of these vets were so crazy that at night when covering the hospital, the hallways were full of screams, of crazies in the throes of withdrawal, of why these people were so nuts despite being on 5 psych meds. How soon our society forgets.
I still have a large number of vets. They like the "double dipping", having VA for free stuff and then seeing private doc for the boutique medicine 2nd opinion. I like that. They are some of my favorite patients.
So if you like VA, go ahead. Low pay, low work, but fabulous work environment. Can make more, do better in private practice, but from a risk/reward profile, a very "efficient" job. Take it from a veteran of that particular conflict.
Just make sure you thank your patients for what they have done. Give back.
We get to invest, to armchair talk about all this diehards baloney and have good jobs and not be slaves becaue of the vets' sacrifices. Thank a vet today, they will apreciate it."