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VA docs, change to hourly from salary

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  • #31
    VA has tried bringing in NPs in Primary Care setting.  We tried twice over -  most wash out within a year or two after before reaching a full panel and realizing the amount of work needed -- then flee to specialties for a more defined scope of work.

    Happening same again here in UC Setting.   Expansion of our base with NPs ongoing but more realistic using for acute settings only to narrow the scope and allow popoff to PCPs.  Independent practicing panel based NPs is going to be a rare bird IMHO.

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    • #32
      At our VA, *pharmacists* are running psychiatry clinics. Yep, people who never learned how to diagnose patients, are diagnosing and prescribing for them. It's absolutely mind boggling.

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      • #33
        I share a lot of patients with the VA who gave both military and private insurance. Most are very unhappy with the primary care but usually happy with the specialty care that is available here.
        I heard about the pharmacist thing and from what I can tell it seems very protocol driven. They seem to be most commonly used for diabetes at our VA.

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        • #34




          At our VA, *pharmacists* are running psychiatry clinics. Yep, people who never learned how to diagnose patients, are diagnosing and prescribing for them. It’s absolutely mind boggling.
          Click to expand...


          Well that sounds like a great idea..

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          • #35
            I found this with a quick online search

            https://employment.findlaw.com/wages-and-benefits/exempt-employees-vs-nonexempt-employees.html

            Looks like physicians are exempt from the requirement to pay overtime, even when considered hourly.

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            • #36
              Lordosis--I still can't quote--but I see the whole happy with specialty care but not primary care thing where I'm at too. I see many consults where the patients complain about their primary care doc but say that they like my department and the other specialty care departments. I think a large part of it is that primary care is buried in clinical reminders and other administrative burden that they have less chance to look up from the computer and so the patient feels like they don't care even though they are doing a ton of work for the patient. I really think our PCPs deserve to be paid better, even if it means a specialist like me gives up a little. I agree with StarTrekDoc that it would be very difficult for VA primary care to be taken over by NPs/PAs. Too many of the patients are just too complex. I've seen a couple PAs who are experienced and quite good in the primary care setting with their own panel but most NPs and PAs seem much more comfortable and happy manning the same day clinic or in the specialty clinics.

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              • #37
                My experience with PCPs at VAs who are lifers is that they complain about salary but essentially work half as much as in the real world.  They see way less patients, never would fit in an acute visit, and have "case managers" that essentially do all the work.  Can't always have your cake and eat it too.  When one of my patients calls and wants to be seen, I try and fit them in.  The VA PCPs would send them all to the VA ER for even ridiculous reasons.

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                • #38
                  mjohnson, some might be like that but not all. Some work really hard without much support. They get dumped on from all angles, I try not to add to it.

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                  • #39
                    I agree that PCPs (family, peds, internal) compared to other specialists are overworked and underpaid in any health care setting.  However PCPs in the VA scheduled essentially half the number of patients that private practice PCPs schedule, AND they would never add anyone even if they had cancellations and no shows.  At the time I was involved in a VA setting, they only had to see patients 3.5 to 4 days a week as well.

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                    • #40




                      I agree that PCPs (family, peds, internal) compared to other specialists are overworked and underpaid in any health care setting.  However PCPs in the VA scheduled essentially half the number of patients that private practice PCPs schedule, AND they would never add anyone even if they had cancellations and no shows.  At the time I was involved in a VA setting, they only had to see patients 3.5 to 4 days a week as well.'
                      Click to expand...


                      'Not your Daddy's VA'; just like 'not your daddy's Buick'.

                      VA volume certainly isn't Kaiser hamster wheel volume, but really isn't the same casemix either.   I see roughly the same in academic world as I did at VA with roughly the same hourly rate since I work longer hours at UC than VA but paid more.

                      Different worlds Private practice vs salaried work, which is what you're pointing out.

                       

                       

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                      • #41
                        I really like our pcps. They seem to care about the patients. I agree their caseload is smaller but patients are complex. And it takes 30 minutes to room a patient so the lack of efficiency really drags down productivity, and they don't have control over that. You aren't allowed to keep cancellation lists or patient lists of any kind so it's impossible to fill your schedule if you get a last minute cancellation. It's pretty bonkers.

                        Anne, thanks for that clarification.

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                        • #42
                          Maybe someone could clarify this.

                          The other reason a lot of my patients dislike the primary care at the VA is that they feel like they should be seen more then yearly.  I am not talking about high maintenance needy patients.  I am talking about complex DM,HTN, CAD, COPD all out of control patients who should have tighter control.

                          I do not know anything about their volumes but I know it is practically impossible for them to see primary care for anything acute in less then 3 weeks.

                          I know a lot of people just continue to use the VA for the medication benefits.

                           

                          As a medical student I spent a lot of time at different specialties at the VA and I really enjoyed it and thought they offered great care.  I wish I had the opportunity to see the primary care side of things.

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                          • #43







                            It’s going to drastically reduced the VA’s ability to hire and retain subspecialists.   As it is the VA pays about a third or less than private practice in many specialties.   In the past, however, sub specialists were often given a compressed tour so that they worked 4 longer days instead of 5 regular days.   This meant that in the past they had to use 4 days of vacation instead of 5 to take a week off.   Now that has changed, essentially cutting down the vacation and sick time.   I honestly can’t see any reason for a sub specialist to be a full-time employee of the VA.   I might consider working for them as a fee-basis contractor where they pay per patient seen.  Just to give you an idea of the discrepancy — as a contractor, paid-per-patient, the VA would may me as much in one day per week of work as I would make as a full-time employee.
                            Click to expand…


                            Yeah, I heard that was going to be an issue,  also for docs that work 12 hour shifts rather than the 8 hour shifts I work.  Essentially you cut your vacation by a third by switching to hourly.

                             

                            It just seems to me that this is a change that affects thousands of doctors and the fact that I heard nothing about it from any doctor organizations seems like a problem. Why wasn’t this a bigger deal and why weren’t we as doctors involved in making sure this change was more reasonable? Again, the issue is not about me personally,  I have a good set up. The problem is how this could negatively impact so many physicians and there was no way to lobby for an alternative. It just seems to me that once again physicians have no voice at the table with decisions that impact them. And this isn’t just about the VA either. I see this happening in all types of practices, in all kinds of issues. It feels like a real problem to me.
                            Click to expand...


                            12hour shift or 10 hour shift docs who work full time still get the regular 26days vacation per year. I checked this with HR.

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                            • #44










                              It’s going to drastically reduced the VA’s ability to hire and retain subspecialists.   As it is the VA pays about a third or less than private practice in many specialties.   In the past, however, sub specialists were often given a compressed tour so that they worked 4 longer days instead of 5 regular days.   This meant that in the past they had to use 4 days of vacation instead of 5 to take a week off.   Now that has changed, essentially cutting down the vacation and sick time.   I honestly can’t see any reason for a sub specialist to be a full-time employee of the VA.   I might consider working for them as a fee-basis contractor where they pay per patient seen.  Just to give you an idea of the discrepancy — as a contractor, paid-per-patient, the VA would may me as much in one day per week of work as I would make as a full-time employee.
                              Click to expand…


                              Yeah, I heard that was going to be an issue,  also for docs that work 12 hour shifts rather than the 8 hour shifts I work.  Essentially you cut your vacation by a third by switching to hourly.

                               

                              It just seems to me that this is a change that affects thousands of doctors and the fact that I heard nothing about it from any doctor organizations seems like a problem. Why wasn’t this a bigger deal and why weren’t we as doctors involved in making sure this change was more reasonable? Again, the issue is not about me personally,  I have a good set up. The problem is how this could negatively impact so many physicians and there was no way to lobby for an alternative. It just seems to me that once again physicians have no voice at the table with decisions that impact them. And this isn’t just about the VA either. I see this happening in all types of practices, in all kinds of issues. It feels like a real problem to me.
                              Click to expand…


                              12hour shift or 10 hour shift docs who work full time still get the regular 26days vacation per year. I checked this with HR.
                              Click to expand...


                              That is technically true but they get 26, 8 hour days. So if they work a 12 hour shift,  they use 12 hours for one day of vacation. So they end up with basically 21.5 of their work days off. Yes, it makes it equal to how many hours those with a traditional work week get,  but it's less than what they have probably been taking,  which isn't going to sit well with people. And it's going to make the VA less appealing to those folks.

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                              • #45
                                Not an attorney, but policies for “professionals “ in the Corporate world often have clauses intended to give the employer specific rights regarding duty hours, 24/7.
                                Every “supervisor “ was exempt.
                                Translation, no OT, work as many hours as your “boss demanded, find another job if you don’t like it. “At will employment means zero reason required for termination. FLSA basically was minimum wage. No help at all for anyone making more base salary of minimum wage. PTO or vacation requires “advance approval”.
                                Legally, the salary employees have a choice. Stay or leave. No rules about “equal treatment” of coworkers either. Some companies have abusive cultures, some locations, some departments and some “managers”.
                                I doubt any physician is ever asked to work 24/7.
                                What I hear is some think they have a better schedule than others. Realistically, they are different work schedules. Probably will depend on how the supervisor decides to run the show. Good luck to all.

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