I interviewed today and was offered one of six resident positions. I lost it. The panel laughed and said my reaction was the best one so far. ?
I was asked nine questions. They were along the lines of "Tell me about yourself; How will you contribute to VA care; Flexibility and describe a time when it was required; Career goals; Rate yourself 0 - 10 in the following aspects, etc.". I was sweating the whole time, but displayed a cool (I think) exterior.
It starts towards the end of September, so plenty of time for me to go over all my material from school and beef up my knowledge so I don't look like a total dunce.
I will periodically update this thread with all my trials and tribulations for those who are interested in applying for a spot in the future and want to know what the year will look like.
Yes it’s the VA. Literally the most inefficient hospital system in the county full of red tape and admin who collect w check for nothing. I dress the two months a year I have to spend there versus the private hospital systems.
Please, give me a few examples of the private hospital systems superiority. I will give you a few examples of what I've experienced so far during my VA residency and you tell me if the private sector does it better.
1. Each new patient is referred to whole health coaching. From what I've gathered, the veterans enjoy learning and applying different behavioral methods/modalities they've found useful for their life from the meetings. If needed, aromatherapy, battlefield acupuncture, aquatic therapy, music therapy, etc. may be added to enhance their care. All of this is at no extra cost to the veteran.
2. I have just about instant access to the pharmacist that works on my team. If I have a question or need advice, I can either walk down the hall to talk to them or message them. Also, each newly prescribed medication or renewal is vetted, meaning it will get kicked back if a pharmacist finds it is incorrect for whatever reason. They will deny it, tell you why, and give you recommendations and/or alternatives.
3. If I find that a veteran needs mental health (MH) intervention now rather than later, I can message the MH provider that a warm hand off is required. Once our visit has concluded, I walk the veteran to the MH provider and the veteran receives the care they need right then and there. Same goes for social work.
So far, I am impressed with the care the veterans receive at the VA. The veterans express their appreciation to me and are grateful we take such good care of them. My husband is a 100% disabled veteran and he has nothing but high praise for the VA. I haven't worked for the private sector, so please, enlighten us. I would love to attempt to address and rectify inefficiencies at the VA in order to improve patient care.
Specializes in Former NP now Internal medicine PGY-3.
No doubt some can be entitled. I never served so I give them the benefit of the doubt. But some you can tell obviously never did anything combat related and are milking the system. Those are the worst, especially when they always bring up something like "I served our country and this is what I get?”
the agent orange conversation also gets tiring quickly
That’s your opinion but not fact. All I’ve seen is providers going above and beyond for Veterans and caregivers. We have financial freedom to order labs, imaging, consults, etc. When compared to the private sector, that is way less red tape. Yes it is socialized medicine so that comes with barriers but if anything the ability to consult all specialties and disciplines (OT, PT, speech, pharm, etc) under one roof is unmatched.
Okay, look, I see this mess from the perspective of a Provider and a Veteran. There is a strict formulary. You cannot order the medications a Veteran may need because of that strict formulary. It doesn't matter if what is on the formulary currently isn't working and something else would work better. It's what you can order or nope. The Mission act is just as effective as its predecessor. Veterans are still being directly billed by the private sector because the government doesn't pay its bills. Veterans can't get appointments for the care they desperately need. Months-long waits.
Providers are leaving the VA in droves in our area. Every single time I get a new Provider, they all grandstand and refuse to refill prescriptions because "I haven't seen you yet." So you then have to grapple with trying to get an appointment that you don't actually need, which conflicts heavily with your own work schedule, just to "meet the new temporary provider." The active duty sick call system was easier to navigate. I've also stopped even trying to actually connect with Providers. They aren't there long enough and, as I've heard from so many other Veterans, these civilians have no idea what we've been through.
Just see the system for what it is. A cushy job for you, but a giant pain for most of those who have to actually use the system. It could really use a lot of fixing.
Okay, look, I see this mess from the perspective of a Provider and a Veteran. There is a strict formulary. You cannot order the medications a Veteran may need because of that strict formulary. It doesn't matter if what is on the formulary currently isn't working and something else would work better. It's what you can order or nope. The Mission act is just as effective as its predecessor. Veterans are still being directly billed by the private sector because the government doesn't pay its bills. Veterans can't get appointments for the care they desperately need. Months-long waits.
Providers are leaving the VA in droves in our area. Every single time I get a new Provider, they all grandstand and refuse to refill prescriptions because "I haven't seen you yet." So you then have to grapple with trying to get an appointment that you don't actually need, which conflicts heavily with your own work schedule, just to "meet the new temporary provider." The active duty sick call system was easier to navigate. I've also stopped even trying to actually connect with Providers. They aren't there long enough and, as I've heard from so many other Veterans, these civilians have no idea what we've been through.
Just see the system for what it is. A cushy job for you, but a giant pain for most of those who have to actually use the system. It could really use a lot of fixing.
I understand what you are saying that it is in no way perfect. I didn’t go to the VA for a “cushy” job though. I wanted to give back and I wanted to work with Veterans. My husband is 100%sc with 3 combat deployments. He’s been through hell and I’ve been by his side for 15 years. I don’t know exactly what they have gone though- you are right. But I know what their family members have. And I know a small amount from my husband but I would never claim to fully grasp what he or any other MM has been through. As corny as it sounds, I want to help. I don’t want to be one more person mindlessly thanking them for their service.
I understand what you are saying that it is in no way perfect. I didn’t go to the VA for a “cushy” job though. I wanted to give back and I wanted to work with Veterans. My husband is 100%sc with 3 combat deployments. He’s been through hell and I’ve been by his side for 15 years. I don’t know exactly what they have gone though- you are right. But I know what their family members have. And I know a small amount from my husband but I would never claim to fully grasp what he or any other MM has been through. As corny as it sounds, I want to help. I don’t want to be one more person mindlessly thanking them for their service.
You may also have seen the troubles he can experience in getting care. Or, problematic stereotypes that get applied to him erroneously just because he's a Vet patient with certain conditions. I did the vast majority of my clinicals through the VA. I still love working with the population. Same as I did as an RN on active duty. I've just given up having a PCP that understands me or is even around more than a couple of months. The VA Administration is notoriously bloated with useless Admin, wasteful spending practices, and sweeping critical issues under the rug while Vets suffer and die. There is a history of retaliation against whistleblowers. Each new scandal that breaks isn't shocking. It's just sad. This is a vulnerable population who have already given so much.
Specializes in Former NP now Internal medicine PGY-3.
This post was about working at the VA not so much the care. It seems our VA does something’s patient care wise better than the private sector but other items are completely misssing. But this isn’t the point
This post was about working at the VA not so much the care. It seems our VA does something’s patient care wise better than the private sector but other items are completely misssing. But this isn’t the point
I commented correcting an impression that an apparently new hire had from the perspective of someone who knows the system from both sides of the coin. That's all. I work private sector and I'm not delusional enough to think it isn't as broken as a one-legged chair. The working conditions at many facilities aren't roses, either, which is why many suffer revolving doors. The complete disorganization of a residency program is just one example.
Specializes in Former NP now Internal medicine PGY-3.
1 hour ago, HarleyvQuinn said:
I commented correcting an impression that an apparently new hire had from the perspective of someone who knows the system from both sides of the coin. That's all. I work private sector and I'm not delusional enough to think it isn't as broken as a one-legged chair. The working conditions at many facilities aren't roses, either, which is why many suffer revolving doors. The complete disorganization of a residency program is just one example.
Fair enough. Even med residencies have much room for improvement. The VA has a few merits but these are overshadowed by government regulations and an inability to keep up with the private sector. Coming from the perspective of a relative moderate and not someone who is antigovernment.
I started in the fall and am halfway through my second rotation. We rotate every 2 months for the first 6 months. The second 6 months we have specialty rotations (not quite sure how this is going to work honestly). Anyway at first it was a lot but I think I’ve found a rhythm. It’s as much or as little as you want to get out of it. I have really tried to do what I can an utilize all the resources that we have available. For our residency we are in lot of different clinics throughout the week. So right now I am in CLC, POSH, COACH, and Geri Pact clinic. For Geri pact we have a panel and we are the PCP. That for me has been the most work beyond that clinic appointment. Lots of f/us, consults, med refills, med changes, etc. But I feel like I have learned the most from that rotation.
Fair enough. Even med residencies have much room for improvement. The VA has a few merits but these are overshadowed by government regulations and an inability to keep up with the private sector. Coming from the perspective of a relative moderate and not someone who is antigovernment.
I wouldn't classify myself as anti-government. I just see a lot of the same wasteful practices in the VA that I saw in the military and, honestly, they should be doing far better. Trying to privatize certain aspects of the care has opened the ability for Vets to get seen, but there is still a huge amount of governmental red tape which frequently results in Vets being direct-billed because the government doesn't pay its bills. Not to mention the significant limitations on what Vets can receive when, for many, this is the only access to care they have. This includes limiting access to alternative therapies for pain, such as Chiropractors and acupuncture, which they had previously touted as their preferred over other pain management strategies. The reason for limiting these referrals and care appointments suddenly? It was costing the VA too much and the claim became "we aren't seeing any improvement in patient's pain or functionality." Not replacing it with anything, mind you, just forcing everyone who wanted to see those services or already was to see a "Physiatrist" for a no hands-on assessment of their "need" for it. What it led to is a significant number of denials for that care and chronic pain patients were left with no other modalities. I observed this and the frustration of Providers trying to get care for their patients as they discussed the policy in clinic meetings. It may be VA, but it is very much still all about the cost and not the patient.
Specializes in Former NP now Internal medicine PGY-3.
HarleyvQuinn said:
I wouldn't classify myself as anti-government. I just see a lot of the same wasteful practices in the VA that I saw in the military and, honestly, they should be doing far better. Trying to privatize certain aspects of the care has opened the ability for Vets to get seen, but there is still a huge amount of governmental red tape which frequently results in Vets being direct-billed because the government doesn't pay its bills. Not to mention the significant limitations on what Vets can receive when, for many, this is the only access to care they have. This includes limiting access to alternative therapies for pain, such as Chiropractors and acupuncture, which they had previously touted as their preferred over other pain management strategies. The reason for limiting these referrals and care appointments suddenly? It was costing the VA too much and the claim became "we aren't seeing any improvement in patient's pain or functionality." Not replacing it with anything, mind you, just forcing everyone who wanted to see those services or already was to see a "Physiatrist" for a no hands-on assessment of their "need" for it. What it led to is a significant number of denials for that care and chronic pain patients were left with no other modalities. I observed this and the frustration of Providers trying to get care for their patients as they discussed the policy in clinic meetings. It may be VA, but it is very much still all about the cost and not the patient.
Definitely did not mean to make my previous post sound as you may be anti government. Our VA seems to be a bit better in the above areas, though still it lacks in many areas that the private sector does not lack in. It has a few benefits also for patients. Probably besides the inefficiencies, I would say the VA being a haven for providers that probably should have retired a decade or two again is one of its biggest downsides. Pretty sure one of the nephrologists here has some early dementia since he called me three times on the same day to tell me the same thing, within a 15 minute time span.
momathoner09, BSN, MSN, APRN
252 Posts
Did you come here just to leave a snarky comment ?