Stay in private practice medical or take VA job offer?

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Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Fri Jan 11, 2019 12:27 pm

Hello! I am considering a change in employment, but could use some advice. Seeking financial advice from anyone in "the know" as well as physicians, NP/PA, or other medical professionals that have gone from private practice to federal or vice versa.

I am a 45 yo working in an outpatient specialty medical practice. I've been in my career 15 years and with my current company 8 years. My primary reason for considering a change in employment is my commute. I have a 40-50 min commute and have been doing this for 3 years. My wife and I and our 4 and 6 yo kids are pretty rooted in our home and neighborhood, and I don't foresee being willing to move in the near future. While the commute is doable, it's a grind. The job offer I am considering is with the VA and it's a 10 min drive. I could even bike if I want.

I am reasonably happy at my current position. I enjoy my patients and coworkers and my employer allows flexibility in my schedule such as having a shorter clinic day two days a week to pick up my kids. I just can't see myself doing the drive 5 years from now.

Current private practice job:

$228,000 pretax 2018; My income varies year to year based on productivity. I predict it would stay above $200 K due to grown of the practice. Prior year: $183,000 pretax 2017
4 days per week 8:30-4:30
15 days vacation
4 days continuing medical education (CME); $2000 per year for CME.
10 days sick time
8 observed holidays
401 K: I max out 401 K each year, 4% employer match
Malpractice, Medical and dental. I pay for disability and life insurance on my own.

VA position:
$132,500 pretax, GS 13, step 7
4 days per week 8-4:30ish. I may actually work a few more hours per week in this job.
26 days vacation
CME?
13 days sick time
10 federal holidays
TSP with 5% matching
Pension if I retire there, approx $25,000 per year (assuming I did the calculation right) if I retire at age 62.
Malpractice, disability and life insurance.
Healthcare insurance for myself and spouse once I retire is a bonus.

So...I either take a hefty paycut to obtain a longterm plan with stability and federal perks with the hope that I will get better balance and less time on the road OR I stay in private practice. We have planned well for our retirement thus far, so we could afford a paycut. BUT, if it seems crazy to take a 58% reduction in income, I'd keep doing the drive. Thank you for your feedback!

Jeff P
Posts: 147
Joined: Tue Aug 11, 2015 10:07 am

Re: Stay in private practice medical or take VA job offer?

Post by Jeff P » Fri Jan 11, 2019 6:42 pm

I wouldn’t do that. $100k is a big hit not just to your wallet but to your lifestyle and probably self worth.

I’d also imagine switching from private practice to a VA job is going to be frustrating in ways you dont understand yet. I just took a job with a city and the red tape is crazy. Plus there is litte opportunity to move up or make more money. Its not dependent on you at all.

Additionally, wouldnt you be off work without pay due to the shut down right now?

Keep your job and find a better closer job or move would be my advice. Until then, so something worthwhile with your commute. Get Pimsleur and learn a new language in the car.

staythecourse
Posts: 6340
Joined: Mon Jan 03, 2011 9:40 am

Re: Stay in private practice medical or take VA job offer?

Post by staythecourse » Fri Jan 11, 2019 6:58 pm

Jeff P wrote:
Fri Jan 11, 2019 6:42 pm
I’d also imagine switching from private practice to a VA job is going to be frustrating in ways you dont understand yet.
If there is one thing I have learned life it is ALL about tradeoffs. Everyone seems to be tunnel vision on just one aspect of a decision (in this case commute) and puts blinders on for every other issue.

The above is a BIG reason I wouldn't do it. So the commute difference is 30 minutes (40-10 minutes). In exchange you are getting into a situation you have admin. incompetence to the upteenth level in the government with EVERYONE not caring about the patient or the care they are giving every minute of each work day for the whole work week for the whole year.

So in the end you shave 30 minutes to spend more time unhappy each minute you are at work. I wouldn't do it. Then, of course, my commute is 30-40 minutes and I LOVE It. With a wife and 2 toddlers at home it is the ONLY time in my life I have some peace and quiet. For me commute is not a negative, but a positive.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

jayk238
Posts: 488
Joined: Tue Jan 31, 2017 1:02 pm

Re: Stay in private practice medical or take VA job offer?

Post by jayk238 » Fri Jan 11, 2019 7:14 pm

Headaboveh2o wrote:
Fri Jan 11, 2019 12:27 pm
Hello! I am considering a change in employment, but could use some advice. Seeking financial advice from anyone in "the know" as well as physicians, NP/PA, or other medical professionals that have gone from private practice to federal or vice versa.

I am a 45 yo working in an outpatient specialty medical practice. I've been in my career 15 years and with my current company 8 years. My primary reason for considering a change in employment is my commute. I have a 40-50 min commute and have been doing this for 3 years. My wife and I and our 4 and 6 yo kids are pretty rooted in our home and neighborhood, and I don't foresee being willing to move in the near future. While the commute is doable, it's a grind. The job offer I am considering is with the VA and it's a 10 min drive. I could even bike if I want.

I am reasonably happy at my current position. I enjoy my patients and coworkers and my employer allows flexibility in my schedule such as having a shorter clinic day two days a week to pick up my kids. I just can't see myself doing the drive 5 years from now.

Current private practice job:

$228,000 pretax 2018; My income varies year to year based on productivity. I predict it would stay above $200 K due to grown of the practice. Prior year: $183,000 pretax 2017
4 days per week 8:30-4:30
15 days vacation
4 days continuing medical education (CME); $2000 per year for CME.
10 days sick time
8 observed holidays
401 K: I max out 401 K each year, 4% employer match
Malpractice, Medical and dental. I pay for disability and life insurance on my own.

VA position:
$132,500 pretax, GS 13, step 7
4 days per week 8-4:30ish. I may actually work a few more hours per week in this job.
26 days vacation
CME?
13 days sick time
10 federal holidays
TSP with 5% matching
Pension if I retire there, approx $25,000 per year (assuming I did the calculation right) if I retire at age 62.
Malpractice, disability and life insurance.
Healthcare insurance for myself and spouse once I retire is a bonus.

So...I either take a hefty paycut to obtain a longterm plan with stability and federal perks with the hope that I will get better balance and less time on the road OR I stay in private practice. We have planned well for our retirement thus far, so we could afford a paycut. BUT, if it seems crazy to take a 58% reduction in income, I'd keep doing the drive. Thank you for your feedback!
How can anyone possibly give advice without knowing your employment? What do you do? Its very simple thing to inform us.

Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Fri Jan 11, 2019 7:21 pm

Pimsleur, huh? I’ll have to check that out. I could definitely be doing more productive things with my commute. No, I believe the VA is considered essential employees, so it’s not affected by the shutdown. Thank you both for the feedback. Also, I do value some downtime before getting home to the wild ones.

il0kin
Posts: 157
Joined: Mon Feb 26, 2018 8:19 pm

Re: Stay in private practice medical or take VA job offer?

Post by il0kin » Fri Jan 11, 2019 7:23 pm

I did a 1 hour commute for quite a bit less money until my work location changed. Podcasts are a game changer. They make the time fly by!

I would not leave your current job. It would be one thing if it was for 5-10k, but no way for 100k. I am in the medical field although not a provider (I do IT work but frequently work with clinical people) and everyone I run across who has worked there says the VA is soul sucking and awful to work for.

crankyoldguy34
Posts: 4
Joined: Wed Feb 08, 2017 8:26 am

Re: Stay in private practice medical or take VA job offer?

Post by crankyoldguy34 » Fri Jan 11, 2019 7:39 pm

In 1987 I went from private practice (in pathology) to a medicine residency to 4 years in the USAF to 21 years with the VA. I took a pay cut to do this, not as large as yours, but a cut. My motivation was to move from a rust-belt community in the frozen northern wastelands (/s) to a position somewhere in the sun belt. There were no jobs advertised in pathology so I had to retrain before the move.

I was happy working for the VA. It takes a certain mind-set to adjust to that (and spending 4 years in the USAF just before was a pretty good predictor of what it is like to work for the VA). If you don't mind being a small cog in a very large machine, if you are happy with the salary and other benefits, the VA can be a great place to work. You will likely be in charge of nothing. Many (most, all) important decisions will be made at the "central office" or at least far enough above your pay grade that you will have no input. If you can adjust your workstyle to match what the VA values, if you can accept their targets and practice monitors and do your level best to meet their expectations, you may be happy. The annual leave (26 days, can roll over forever and get paid for it when you retire if unused) and sick leave (13 days, I believe currently same policy when retiring) is adequate. You should get 10 days for CME also, but that may be up to your local facility. My hospital did not give any cash for paying for CME costs, but we did get the time off with pay. All in all, I was very happy working for the VA and felt they treated me fairly and professionally. (YMMV!). I had no call, no weekend or holiday duty, a very predictable schedule, which allowed a 'normal' home life.

Happiness is hard to quantify and predict. If a 45m commute is the 'only' factor that is driving your decision, could you not move closer to your current job? You say your are not willing, but do the math -- how much would the salary differential invested in a S&P500 mutual fund grow to when you retire at age 62? That would be a hard (well, estimated) number you could compare with the cost and inconvenience of moving closer to your current job. A move is a one-time event, a new job will last till age 62.

One other thing - the VA changes! When I began working there, primary care docs had no panels of patients, we saw mostly ER walk-in patients seeking care for non-service connected conditions and telling them 'sorry, we can't help you', and maybe 30% of our time seeing established eligible patients and caring for their service-connected conditions ("here is some motrin for your service-connected knee disorder, but I'm sorry we can't help your diabetes or asthma or coronary disease"). In 1996/7 that changed radically and now eligible patients get care for all medical conditions, service-connected or not. There are now panels and teams, and performance monitoring is heavily used. My point - the VA which hired me was totally different from the VA from which I retired -- different policies, different values, really a totally different job. Nobody can predict the future!! When you are a government bureaucrat, be willing to go with the flow and adjust to political winds blowing in different directions.

Nthomas
Posts: 130
Joined: Fri Jul 15, 2016 8:46 am

Re: Stay in private practice medical or take VA job offer?

Post by Nthomas » Fri Jan 11, 2019 7:41 pm

Headaboveh2o wrote:
Fri Jan 11, 2019 7:21 pm
Pimsleur, huh? I’ll have to check that out. I could definitely be doing more productive things with my commute. No, I believe the VA is considered essential employees, so it’s not affected by the shutdown. Thank you both for the feedback. Also, I do value some downtime before getting home to the wild ones.
I'm pretty sure "essential employee" just means you still have to work, you just aren't getting paid. This year is different, at least with the military/DoD, as that budget fortunately was already passed.

I echo the sentiments above about the culture of some VA's. I have friends at VA's and military clinics/hospitals and for the most part they put up with the headaches in exchange for healthcare and a promised pension. The government is always trying to increase the employee contribution for the pension as well and it's already at 4.4% (the proposal this year was ~7%), borderline not worth it IMHO. The rare case is the happy and satisfied physician (however there is one on BH's who has posted before). Private practice will give you way more freedom than the VA. Also, be sure you truly understand what a lifestyle difference that 100K less would be. It's hard to believe the pension would compensate for that loss.

There are some pros, other than pension and subsidized healthcare. The pressure to produce RVUs is significantly less. However, in exchange for an easier workload, you get staff who are often apathetic and admin and nurses who couldn't care less about your degree or the respect you believe you deserve. And it's near impossible to fire anyone or have a say in who is hired, even if they are bad for patient care. From what I have been told and from my limited experience, it's night and day compared with private practice.

One final thought, there is currently a big push in the military as well as the VA to move to private civilian sector healthcare. Jobs may not be as stable as they once were.

Calli114
Posts: 86
Joined: Tue May 16, 2017 12:54 am

Re: Stay in private practice medical or take VA job offer?

Post by Calli114 » Fri Jan 11, 2019 7:46 pm

il0kin wrote:
Fri Jan 11, 2019 7:23 pm
I did a 1 hour commute for quite a bit less money until my work location changed. Podcasts are a game changer. They make the time fly by!

I would not leave your current job. It would be one thing if it was for 5-10k, but no way for 100k. I am in the medical field although not a provider (I do IT work but frequently work with clinical people) and everyone I run across who has worked there says the VA is soul sucking and awful to work for.
+1 to this. I'm retired from a healthcare entity considered locally to fall into the "soul-sucking employer" category (not the VA). Your real beef seems to be with the length of commute, which perhaps can be addressed by improving the quality of it as others have suggested. It might be different if you weren't confident in your retirement planning; I do know one person who is switching to the VA to secure a pension.

TheMadEph
Posts: 9
Joined: Thu May 24, 2018 11:25 pm

Re: Stay in private practice medical or take VA job offer?

Post by TheMadEph » Fri Jan 11, 2019 7:47 pm

I'll take the contrary view - it is almost impossible to be fired from the VA, and the VA job is not going to get any harder or worse than it would be when you start. Private practice can change at any moment. Biking to work is amazing for your health - and you will save significant money reducing use of car (especially over long term). A pension is an amazing thing to have, as is the health insurance forever going forward. You have more days off too right now. Better matching in the TSP - probably better than your 401K (better matching too). Plus, VA pay will likely always go up - I understand you think the private practice will be more lucrative now, but that is NOT guaranteed.
My wife works in private practice but picks up shifts at the VA Emergency Room - everyone works much, much less hard at the VA. So your stress may go down in two ways: (i) lose commute and (ii) easier work. I disagree with the poster who suggests that may be a big hit to your self worth - but i guess that is up for you to decide. Obviously the bureaucracy is worse at the VA, but it is not like the medical field generally is immune from bureaucracy and crazy shit (looking at you health insurance cos.) so.....
Also, if you want/need extra money, can you simply moonlight a couple days a month somewhere for extra cash?
I think VA sounds very, very tempting. I wouldn't characterize it as a $100,000 pay cut in any event - i suspect you start adding up everything (including NPV of pension and health insurance in perpetuity) and Imma gonna guess its only a $50K/40K pay cut. That seems pretty reasonable. I think the key decision for me would be whether you would like to retire early, or think you like working enough that you would likely continue until 62 anyway...

FYI My wife and I are also considering this and her pay cut would be a lot more like $150,000 - and she would have more work days...
But still tempting for various reasons, we are holding off on doing so because we may simply be in a "FIRE" situation so much earlier than 62 that the pension starts to seem like a worse deal.....

go_mets
Posts: 361
Joined: Wed Oct 21, 2015 11:49 am

Re: Stay in private practice medical or take VA job offer?

Post by go_mets » Fri Jan 11, 2019 7:51 pm

4 days a week where the schedule is 7:30 am - 5:30 pm including your commute?
And 2 of the 4 days you get to leave early?
I think most people would sign up for that!
I know I would.

I was a lowly engineer at a megacorps where it is 5 days a week at 7:30 am - 6:00 pm including 30 minutes unpaid lunch and the commute.

I would not be jumping!
Last edited by go_mets on Fri Jan 11, 2019 7:52 pm, edited 1 time in total.

DavidRoseMountain
Posts: 152
Joined: Sun Nov 30, 2014 3:27 pm

Re: Stay in private practice medical or take VA job offer?

Post by DavidRoseMountain » Fri Jan 11, 2019 7:51 pm

A friend of mine worked as a primary care physician in 2 different VA medical settings, one was in a hospital and the other was an outpatient medical setting. In both cases my friend said the experience with the VA was very negative. The physicians are overloaded with patients, physicians are constantly leaving the VA system, there's huge turnover in staff due to both burnout from being overloaded, as well as poor administrative management. The wait times for patients to see physicians is inaccurately portrayed on the VA website. VA physicians will often overlook treatment, preventive care, nor carefully review a patient's history because of being overburdened.
I'd also like to add that the hours that you are working were not correct, you end up doing a lot more hours to keep up with the administrative work.

Nthomas
Posts: 130
Joined: Fri Jul 15, 2016 8:46 am

Re: Stay in private practice medical or take VA job offer?

Post by Nthomas » Fri Jan 11, 2019 7:53 pm

TheMadEph wrote:
Fri Jan 11, 2019 7:47 pm
...Better matching in the TSP - probably better than your 401K (better matching too).....
Good point. Did not include this in my post but the TSP match is very good, basically makes the pension contribution a wash.

TheDoorMan19
Posts: 13
Joined: Sun Dec 16, 2018 10:07 am

Re: Stay in private practice medical or take VA job offer?

Post by TheDoorMan19 » Fri Jan 11, 2019 8:02 pm

I know someone who is a physician for VA in a large city. He makes something like 200. I think his title is hospitalist, not sure exactly.

He wouldn’t leave the VA if he was offered double the pay
in private practice. He knows exactly what his schedule will be a long time in advance, never gets called after work and the days he is working he doesn’t really have to do too much and can take time to go to gym or whatever. He also likes talking to the vets.

I’m not a doctor but I would be willing to take a big paycut to get a job that is that relaxed and predictable.

Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Fri Jan 11, 2019 8:20 pm

TheMadEph wrote:
Fri Jan 11, 2019 7:47 pm
I'll take the contrary view - it is almost impossible to be fired from the VA, and the VA job is not going to get any harder or worse than it would be when you start. Private practice can change at any moment. Biking to work is amazing for your health - and you will save significant money reducing use of car (especially over long term). A pension is an amazing thing to have, as is the health insurance forever going forward. You have more days off too right now. Better matching in the TSP - probably better than your 401K (better matching too). Plus, VA pay will likely always go up - I understand you think the private practice will be more lucrative now, but that is NOT guaranteed.
My wife works in private practice but picks up shifts at the VA Emergency Room - everyone works much, much less hard at the VA. So your stress may go down in two ways: (i) lose commute and (ii) easier work. I disagree with the poster who suggests that may be a big hit to your self worth - but i guess that is up for you to decide. Obviously the bureaucracy is worse at the VA, but it is not like the medical field generally is immune from bureaucracy and crazy shit (looking at you health insurance cos.) so.....
Also, if you want/need extra money, can you simply moonlight a couple days a month somewhere for extra cash?
I think VA sounds very, very tempting. I wouldn't characterize it as a $100,000 pay cut in any event - i suspect you start adding up everything (including NPV of pension and health insurance in perpetuity) and Imma gonna guess its only a $50K/40K pay cut. That seems pretty reasonable. I think the key decision for me would be whether you would like to retire early, or think you like working enough that you would likely continue until 62 anyway...

FYI My wife and I are also considering this and her pay cut would be a lot more like $150,000 - and she would have more work days...
But still tempting for various reasons, we are holding off on doing so because we may simply be in a "FIRE" situation so much earlier than 62 that the pension starts to seem like a worse deal.....
Thank you for that. I think I would work until 62 whether in private practice or federal. We're always getting squeezed in medicine with insurance requirements, pressure to be more productive, online reviews, etc. I was thinking possibly the VA would shelter one from some of that. I guess the tradeoff would be bureaucracy.

orangejelloh
Posts: 17
Joined: Fri Nov 11, 2016 11:02 am

Re: Stay in private practice medical or take VA job offer?

Post by orangejelloh » Fri Jan 11, 2019 8:38 pm

A couple thoughts:

1) Working at different VAs can be very different. The kind of environment one finds in a large VA hospital affiliated with a major academic university is different from a rural community clinic. The workload/burden varies based on the region: certain regions are trying to manage a significant influx of veterans (e.g. southwest, southeast from what I have heard) versus others where there is a net negative migration. You will probably get the most helpful answers about what your work environment would be like by talking to future colleagues at the site you are thinking about working at.
2) The concern about bureaucracy may be overhyped above. In private practice, you have to deal with insurance companies (getting prior authorizations for medications approved, various documentation requests by insurance). At the VA, you may find comparably fewer headaches as the regulations are clearly outlined and evidence-based.
3) Study after study has shown that care at VAs is generally superior to that in the private sector. Here is an example of a recent study:
https://tdi.dartmouth.edu/news-events/v ... re-markets http://annals.org/aim/article-abstract/ ... -hospitals
"The researchers found that VA hospitals were likely to provide the best care in a local health care market and rarely provided the worst care in local markets."

brad.clarkston
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Location: Kansas City, MO

Re: Stay in private practice medical or take VA job offer?

Post by brad.clarkston » Fri Jan 11, 2019 8:59 pm

Nthomas wrote:
Fri Jan 11, 2019 7:41 pm
I'm pretty sure "essential employee" just means you still have to work, you just aren't getting paid. This year is different, at least with the military/DoD, as that budget fortunately was already passed.
No that's not how it works my wife has been a federal employee 15 years and has went through multiple shutdowns under different administrations.

1.) Essential employee's work as normal and get paid just like every other day.

2.) Non-Essential employee's are sent home during the duration or called back if they are deemed essential after a long period. While they don't get paid during the shutdown they get back payed once the shutdown ends. The House can say no to back paying those employee's but they have haven't done that since the 1920's it's a good way to not be in office next election as everyone knows who voted it down.

3.) This shutdown is not like the last administration's (or the last 3 for that matter) this is a partial so many agency's are working more than just the essential staff this go around.

Nthomas
Posts: 130
Joined: Fri Jul 15, 2016 8:46 am

Re: Stay in private practice medical or take VA job offer?

Post by Nthomas » Fri Jan 11, 2019 9:26 pm

brad.clarkston wrote:
Fri Jan 11, 2019 8:59 pm
Nthomas wrote:
Fri Jan 11, 2019 7:41 pm
I'm pretty sure "essential employee" just means you still have to work, you just aren't getting paid. This year is different, at least with the military/DoD, as that budget fortunately was already passed.
No that's not how it works my wife has been a federal employee 15 years and has went through multiple shutdowns under different administrations.

1.) Essential employee's work as normal and get paid just like every other day.

2.) Non-Essential employee's are sent home during the duration or called back if they are deemed essential after a long period. While they don't get paid during the shutdown they get back payed once the shutdown ends. The House can say no to back paying those employee's but they have haven't done that since the 1920's it's a good way to not be in office next election as everyone knows who voted it down.

3.) This shutdown is not like the last administration's (or the last 3 for that matter) this is a partial so many agency's are working more than just the essential staff this go around.
Interesting. That was not my impression, as per this article.

"AFGE filed the suit in the U.S. Court of Federal Claims alleging that the government is violating the Fair Labor Standards Act by forcing employees deemed essential to work without pay."

https://www.countable.us/articles/18482 ... y-shutdown

Nthomas
Posts: 130
Joined: Fri Jul 15, 2016 8:46 am

Re: Stay in private practice medical or take VA job offer?

Post by Nthomas » Fri Jan 11, 2019 9:32 pm

"Even a partial government shutdown could impact hundreds of thousands of federal employees – with workers facing furloughs and unpaid labor – depending on how much of the bureaucracy Congress agrees to fund in the next nine days.

For example, the U.S. Secret Service agents protecting Trump and his family would not be paid during a shutdown. Transportation Security Agency personnel working at airports through the holiday season would also stay on the job during a shutdown, but they’d also have to wait to get paid."

https://abcnews.go.com/Politics/federal ... d=59863103

Also
https://www.theatlantic.com/politics/ar ... ke/579793/

https://www.narfe.org/index.cfm?fa=view ... le&id=3571
Last edited by Nthomas on Fri Jan 11, 2019 9:43 pm, edited 1 time in total.

Globalviewer58
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Re: Stay in private practice medical or take VA job offer?

Post by Globalviewer58 » Fri Jan 11, 2019 9:37 pm

What would it cost to have a car service pick you up at home for the drive and return you after work? Even if you did this 2 of the 4 work days it may make the commute less of a drag. I am going to guess that you could schedule a regular drive for $100 per day round trip. 100 of these is $10,000. Not so painful as the $100,000 pay cut you are considering. A quick way to check actual price is to open the Uber or Lyft app on your phone and see what they charge.

Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 12:49 am

orangejelloh wrote:
Fri Jan 11, 2019 8:38 pm
A couple thoughts:

1) Working at different VAs can be very different. The kind of environment one finds in a large VA hospital affiliated with a major academic university is different from a rural community clinic. The workload/burden varies based on the region: certain regions are trying to manage a significant influx of veterans (e.g. southwest, southeast from what I have heard) versus others where there is a net negative migration. You will probably get the most helpful answers about what your work environment would be like by talking to future colleagues at the site you are thinking about working at.
2) The concern about bureaucracy may be overhyped above. In private practice, you have to deal with insurance companies (getting prior authorizations for medications approved, various documentation requests by insurance). At the VA, you may find comparably fewer headaches as the regulations are clearly outlined and evidence-based.
3) Study after study has shown that care at VAs is generally superior to that in the private sector. Here is an example of a recent study:
https://tdi.dartmouth.edu/news-events/v ... re-markets http://annals.org/aim/article-abstract/ ... -hospitals
"The researchers found that VA hospitals were likely to provide the best care in a local health care market and rarely provided the worst care in local markets."
Thank you! This is a large VA hospital associated with an academic center. The limited feedback I have had is that folks are happy there. My neighbor is an anesthesiologist who left private practice for the VA and he is happy with his choice. I have a couple colleagues who are happy there.

Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 12:55 am

Globalviewer58 wrote:
Fri Jan 11, 2019 9:37 pm
What would it cost to have a car service pick you up at home for the drive and return you after work? Even if you did this 2 of the 4 work days it may make the commute less of a drag. I am going to guess that you could schedule a regular drive for $100 per day round trip. 100 of these is $10,000. Not so painful as the $100,000 pay cut you are considering. A quick way to check actual price is to open the Uber or Lyft app on your phone and see what they charge.
That’s brilliant, although I might rethink my level of annoyance with my commute for $100/day. I think I would sooner start listening to podcasts or something to make my commute more interesting. If I only had a self driving car. Your idea does make me want to think outside of the box though. Thanks!

Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 12:59 am

go_mets wrote:
Fri Jan 11, 2019 7:51 pm
4 days a week where the schedule is 7:30 am - 5:30 pm including your commute?
And 2 of the 4 days you get to leave early?
I think most people would sign up for that!
I know I would.

I was a lowly engineer at a megacorps where it is 5 days a week at 7:30 am - 6:00 pm including 30 minutes unpaid lunch and the commute.

I would not be jumping!
It always helps to get perspective. Poor me. I know, I don’t have it so bad. Thank you.

Topic Author
Headaboveh2o
Posts: 11
Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 1:19 am

crankyoldguy34 wrote:
Fri Jan 11, 2019 7:39 pm
In 1987 I went from private practice (in pathology) to a medicine residency to 4 years in the USAF to 21 years with the VA. I took a pay cut to do this, not as large as yours, but a cut. My motivation was to move from a rust-belt community in the frozen northern wastelands (/s) to a position somewhere in the sun belt. There were no jobs advertised in pathology so I had to retrain before the move.

I was happy working for the VA. It takes a certain mind-set to adjust to that (and spending 4 years in the USAF just before was a pretty good predictor of what it is like to work for the VA). If you don't mind being a small cog in a very large machine, if you are happy with the salary and other benefits, the VA can be a great place to work. You will likely be in charge of nothing. Many (most, all) important decisions will be made at the "central office" or at least far enough above your pay grade that you will have no input. If you can adjust your workstyle to match what the VA values, if you can accept their targets and practice monitors and do your level best to meet their expectations, you may be happy. The annual leave (26 days, can roll over forever and get paid for it when you retire if unused) and sick leave (13 days, I believe currently same policy when retiring) is adequate. You should get 10 days for CME also, but that may be up to your local facility. My hospital did not give any cash for paying for CME costs, but we did get the time off with pay. All in all, I was very happy working for the VA and felt they treated me fairly and professionally. (YMMV!). I had no call, no weekend or holiday duty, a very predictable schedule, which allowed a 'normal' home life.

Happiness is hard to quantify and predict. If a 45m commute is the 'only' factor that is driving your decision, could you not move closer to your current job? You say your are not willing, but do the math -- how much would the salary differential invested in a S&P500 mutual fund grow to when you retire at age 62? That would be a hard (well, estimated) number you could compare with the cost and inconvenience of moving closer to your current job. A move is a one-time event, a new job will last till age 62.

One other thing - the VA changes! When I began working there, primary care docs had no panels of patients, we saw mostly ER walk-in patients seeking care for non-service connected conditions and telling them 'sorry, we can't help you', and maybe 30% of our time seeing established eligible patients and caring for their service-connected conditions ("here is some motrin for your service-connected knee disorder, but I'm sorry we can't help your diabetes or asthma or coronary disease"). In 1996/7 that changed radically and now eligible patients get care for all medical conditions, service-connected or not. There are now panels and teams, and performance monitoring is heavily used. My point - the VA which hired me was totally different from the VA from which I retired -- different policies, different values, really a totally different job. Nobody can predict the future!! When you are a government bureaucrat, be willing to go with the flow and adjust to political winds blowing in different directions.
Thank you for your wisdom and insight. Well, the commute is the main detractor but like with any job not the only factor. I will ask my financial planner to calculate the salary differential if I were to invest that. Happiness is not defined by the length of commute or $$$. That’s why this decision has been tough for me.

fru-gal
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Re: Stay in private practice medical or take VA job offer?

Post by fru-gal » Sat Jan 12, 2019 7:08 am

brad.clarkston wrote:
Fri Jan 11, 2019 8:59 pm

No that's not how it works my wife has been a federal employee 15 years and has went through multiple shutdowns under different administrations.

1.) Essential employee's work as normal and get paid just like every other day.

2.) Non-Essential employee's are sent home during the duration or called back if they are deemed essential after a long period. While they don't get paid during the shutdown they get back payed once the shutdown ends. The House can say no to back paying those employee's but they have haven't done that since the 1920's it's a good way to not be in office next election as everyone knows who voted it down.
I read that some employees are not able to come into work and will not get back pay.

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Watty
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Re: Stay in private practice medical or take VA job offer?

Post by Watty » Sat Jan 12, 2019 8:28 am

A couple of things;

1) Look at the reduction in your disposable income. In purely made up numbers if your after tax after expense home pay goes from $170K to $100K and your fixed expenses are $70 then your disposable income went from $100K to $30k.

2) The dollar numbers are important but they are sort of abstract. Try to look at it in terms of opportunity cost meaning what will change in your life with the different options. For example would you have to work ten more years if you changed jobs?

3) At many public libraries you can download audio books for free. I used that for years before I retired.

4) Someone mentioned hiring a driver. I doubt that would work well because they will occasionally be delayed in traffic and you would not have any flexibility if you needed to leave late or had an errand you needed to do. In bad weather they might not even show up.

5) You only work four days a week and you also get a lot of days off. I did not do the math but it looks like that you only work about 180 days a year so you would only save something like 250 hours a year in commute time. You can do the math giving up $100K is a lot to save that many hours.

6) You can sort of buy back some of the hours by hiring people to do some of the work you do around the house. For example if you spend an hour a week cutting the grass then you can buy back an hour of free time each week by hiring a lawn service to cut your grass.

All that said I think that the right answer is "None of the above." I would keep looking for better job that has a shorter commute.
Last edited by Watty on Sat Jan 12, 2019 9:02 am, edited 1 time in total.

sambb
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Re: Stay in private practice medical or take VA job offer?

Post by sambb » Sat Jan 12, 2019 8:49 am

stick it out for 2-5 years. you can always get a lower paying job, but compounding by saving more now is worth the hassles

Nowizard
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Re: Stay in private practice medical or take VA job offer?

Post by Nowizard » Sat Jan 12, 2019 8:50 am

Your comment about not uprooting family suggests that a balanced life is important to you. If that is the case, then maximization of income may not be as significant for you as for many others since your training assures a solid income. Working for the VA is likely to provide job stability, though you are probably aware of some of the issues it has administratively and politically. The patients are broad-based in terms of their health but may be somewhat older on average than you would see in private practice, though your area of focus may influence that as well. Some VA's are very well rated, and it is important to obtain information on rankings in terms of its "stars" and comparison with other VA's, particularly in your area of practice. Another issue is whether you feel you would adapt well to what is generally an appeal-to-authority administrative structure since the patients are military based. Obviously, the most financially prudent decision would be to earn heavily now, invest well, etc., but that does affect your life in other ways.

Tim

Cruise
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Re: Stay in private practice medical or take VA job offer?

Post by Cruise » Sat Jan 12, 2019 1:57 pm

OP:

Good luck with your decision. One thing that I did not see discussed is the effective daily wage you will earn in each venue:

Simply said, You will earn $492 more each day you work at your current job. Do you value your commute time so highly? Of Course, you may have a higher value on the added days off through vacation and holidays, and the time saving of a commute.

Data:

Current Job

Days worked a year = 208

Vacation, Holidays, CME = 27

Effective Days worked per year = 181

Effective Daily Wage = 228.000/181 = $1,259

VA Opportunity

Days worked a year = 208

Vacation, Holidays, CME = 36 (May be more with CME--an unknown--added in)

Effective Days worked per year = 172

Effective Daily Wage = 132,000/172 = $767

Daily Cost of taking New Job = $492 (Will change with CME credits added to divisor)

A note about commute time:

181 days worked x 30 minutes effective more commute time per trip x 2 trips per day = 181 hours yearly commute time

Your hourly wage= $228,000/181 days = $1,259/8 hr day= $157/hr
Application of hourly wage to commute:: 181 hour of extra commuting x $157 = $28,500 (Value of commute to you). It would seem that, as others have said, you could maintain your current job and hire a good reliable driver for way less than that amount. Or, just better deal with it. Use the time to dream of early FI)

mrc
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Re: Stay in private practice medical or take VA job offer?

Post by mrc » Sat Jan 12, 2019 2:04 pm

Going the other way, if someone offered me and extra $8K a month to commute an additional 60-80 minutes a day 4 days a week, I'd jump at it. Podcasts. Books on tape.
If it’s not long term it’s small talk

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Re: Stay in private practice medical or take VA job offer?

Post by brad.clarkston » Sat Jan 12, 2019 2:45 pm

fru-gal wrote:
Sat Jan 12, 2019 7:08 am
brad.clarkston wrote:
Fri Jan 11, 2019 8:59 pm

No that's not how it works my wife has been a federal employee 15 years and has went through multiple shutdowns under different administrations.

1.) Essential employee's work as normal and get paid just like every other day.

2.) Non-Essential employee's are sent home during the duration or called back if they are deemed essential after a long period. While they don't get paid during the shutdown they get back payed once the shutdown ends. The House can say no to back paying those employee's but they have haven't done that since the 1920's it's a good way to not be in office next election as everyone knows who voted it down.
I read that some employees are not able to come into work and will not get back pay.
[OT comment removed by admin LadyGeek] I'm more than willing to bet all furloughed employees will be back payed because it's in the best interest of the government. Keep in mind I'm talking about the real bureaucracy (Federal Employee's) not the debutante SAS'ers in DC that are not accountable to anyone but the congress critter they work for. Most people get the two confused they are not Fed Employee's.

My wife is currently not classified as an "Essential Job Function" but she's still working normally and getting paid.

1.) Because the Core has been funded.
2.) Even it if wasn't funded it's inside of the Partial Shutdown guidelines as the administration wanted civil eng to still function.

Topic Author
Headaboveh2o
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Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 8:11 pm

Watty wrote:
Sat Jan 12, 2019 8:28 am
A couple of things;

1) Look at the reduction in your disposable income. In purely made up numbers if your after tax after expense home pay goes from $170K to $100K and your fixed expenses are $70 then your disposable income went from $100K to $30k.

2) The dollar numbers are important but they are sort of abstract. Try to look at it in terms of opportunity cost meaning what will change in your life with the different options. For example would you have to work ten more years if you changed jobs?

3) At many public libraries you can download audio books for free. I used that for years before I retired.

4) Someone mentioned hiring a driver. I doubt that would work well because they will occasionally be delayed in traffic and you would not have any flexibility if you needed to leave late or had an errand you needed to do. In bad weather they might not even show up.

5) You only work four days a week and you also get a lot of days off. I did not do the math but it looks like that you only work about 180 days a year so you would only save something like 250 hours a year in commute time. You can do the math giving up $100K is a lot to save that many hours.

6) You can sort of buy back some of the hours by hiring people to do some of the work you do around the house. For example if you spend an hour a week cutting the grass then you can buy back an hour of free time each week by hiring a lawn service to cut your grass.

All that said I think that the right answer is "None of the above." I would keep looking for better job that has a shorter commute.
That is very helpful. Thank you for taking the time out of your day to give me advice!

Topic Author
Headaboveh2o
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Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 8:20 pm

Nowizard wrote:
Sat Jan 12, 2019 8:50 am
Your comment about not uprooting family suggests that a balanced life is important to you. If that is the case, then maximization of income may not be as significant for you as for many others since your training assures a solid income. Working for the VA is likely to provide job stability, though you are probably aware of some of the issues it has administratively and politically. The patients are broad-based in terms of their health but may be somewhat older on average than you would see in private practice, though your area of focus may influence that as well. Some VA's are very well rated, and it is important to obtain information on rankings in terms of its "stars" and comparison with other VA's, particularly in your area of practice. Another issue is whether you feel you would adapt well to what is generally an appeal-to-authority administrative structure since the patients are military based. Obviously, the most financially prudent decision would be to earn heavily now, invest well, etc., but that does affect your life in other ways.

Tim

Thank you Tim. This VA is rated 3 stars for 2018, up from 2 stars the year before. I’m leaning toward taking the most financially prudent decision (not bc of the rating).

Topic Author
Headaboveh2o
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Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sat Jan 12, 2019 8:25 pm

Cruise wrote:
Sat Jan 12, 2019 1:57 pm
OP:

Good luck with your decision. One thing that I did not see discussed is the effective daily wage you will earn in each venue:

Simply said, You will earn $492 more each day you work at your current job. Do you value your commute time so highly? Of Course, you may have a higher value on the added days off through vacation and holidays, and the time saving of a commute.

Data:

Current Job

Days worked a year = 208

Vacation, Holidays, CME = 27

Effective Days worked per year = 181

Effective Daily Wage = 228.000/181 = $1,259

VA Opportunity

Days worked a year = 208

Vacation, Holidays, CME = 36 (May be more with CME--an unknown--added in)

Effective Days worked per year = 172

Effective Daily Wage = 132,000/172 = $767

Daily Cost of taking New Job = $492 (Will change with CME credits added to divisor)

A note about commute time:

181 days worked x 30 minutes effective more commute time per trip x 2 trips per day = 181 hours yearly commute time

Your hourly wage= $228,000/181 days = $1,259/8 hr day= $157/hr
Application of hourly wage to commute:: 181 hour of extra commuting x $157 = $28,500 (Value of commute to you). It would seem that, as others have said, you could maintain your current job and hire a good reliable driver for way less than that amount. Or, just better deal with it. Use the time to dream of early FI)
Thank you for taking the time and breaking it down like that. Suddenly, I’m liking my commute more and more.

gold99xx
Posts: 31
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Re: Stay in private practice medical or take VA job offer?

Post by gold99xx » Sat Jan 12, 2019 9:05 pm

Do you even enjoy being an MD? This thread and responses make me believe you would be better suited for another line of employment.

Afty
Posts: 870
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Re: Stay in private practice medical or take VA job offer?

Post by Afty » Sat Jan 12, 2019 11:48 pm

My mom made this move when she was around 50. I don’t get the impression she was very happy at the VA. She complained a lot about the politics, and eventually become the department chief, and then was demoted from department chief when she didn't play the political game well enough. Her workload seemed pretty manageable compared to private practice.

The pension and health insurance after retirement were great though.

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Nestegg_User
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Re: Stay in private practice medical or take VA job offer?

Post by Nestegg_User » Sun Jan 13, 2019 1:32 am

brad.clarkston wrote:
Sat Jan 12, 2019 2:45 pm
fru-gal wrote:
Sat Jan 12, 2019 7:08 am
brad.clarkston wrote:
Fri Jan 11, 2019 8:59 pm

No that's not how it works my wife has been a federal employee 15 years and has went through multiple shutdowns under different administrations.

1.) Essential employee's work as normal and get paid just like every other day.

2.) Non-Essential employee's are sent home during the duration or called back if they are deemed essential after a long period. While they don't get paid during the shutdown they get back payed once the shutdown ends. The House can say no to back paying those employee's but they have haven't done that since the 1920's it's a good way to not be in office next election as everyone knows who voted it down.
I read that some employees are not able to come into work and will not get back pay.
That's called FUD and it's in the big network news/Facebook/Google's best interest to spread it as they are currently anti-administration. I'm more than willing to bet all furloughed employees will be back payed because it's in the best interest of the government. Keep in mind I'm talking about the real bureaucracy (Federal Employee's) not the debutante SAS'ers in DC that are not accountable to anyone but the congress critter they work for. Most people get the two confused they are not Fed Employee's.

My wife is currently not classified as an "Essential Job Function" but she's still working normally and getting paid.

1.) Because the Core has been funded.
2.) Even it if wasn't funded it's inside of the Partial Shutdown guidelines as the administration wanted civil eng to still function.


having gone through it (too many times) before retirement, as both "essential" and "non", NEITHER get paid until there is an appropriation for that department: those deemed "essential" (in their parlance) will get backpay for the hours worked, the others need a specific legislation to give them pay (remember, that they still had to remain available at any time to return to work; many agencies (those that I worked at) required specific approval to work any other job during non-work hours). [BTW, the notion of "essential" isn't quite what you might think.... supervisors are deemed "nonessential" in areas where the rank-and-file are deemed "essential"... and areas like the CDC and FDA are deemed "nonessential" ( with a few commissioned corp** left to hold down the fort)]

{ ** commissioned corp of the public health service is a "uniformed service" , one of the seven (NOAA also has one for their fleet) ... the others are those commonly known: navy, army, marines, AF, CG}

{to my knowledge, in the past a bill did eventually get passed in all prior shutdowns resulting in backpay for all workers.... the individual furloughs, like that for DOD civilians a few years ago, did not have them getting reimbursed, nor have individuals gotten interest paid for the late payment nor any measures made for lapses of payments due to the late payout of salaries. This last area is likely to be of most concern since a single late credit card payment could immediately result in large increases in rates and it's also been noted that a few mortgage companies have been very quick to send to collections any delinquent payments. }

Carl53
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Re: Stay in private practice medical or take VA job offer?

Post by Carl53 » Sun Jan 13, 2019 6:47 am

Headaboveh2o wrote:
Sat Jan 12, 2019 8:25 pm
Cruise wrote:
Sat Jan 12, 2019 1:57 pm
OP:

Good luck with your decision. One thing that I did not see discussed is the effective daily wage you will earn in each venue:

Simply said, You will earn $492 more each day you work at your current job. Do you value your commute time so highly? Of Course, you may have a higher value on the added days off through vacation and holidays, and the time saving of a commute.

Data:

Current Job

Days worked a year = 208

Vacation, Holidays, CME = 27

Effective Days worked per year = 181

Effective Daily Wage = 228.000/181 = $1,259

VA Opportunity

Days worked a year = 208

Vacation, Holidays, CME = 36 (May be more with CME--an unknown--added in)

Effective Days worked per year = 172

Effective Daily Wage = 132,000/172 = $767

Daily Cost of taking New Job = $492 (Will change with CME credits added to divisor)

A note about commute time:

181 days worked x 30 minutes effective more commute time per trip x 2 trips per day = 181 hours yearly commute time

Your hourly wage= $228,000/181 days = $1,259/8 hr day= $157/hr
Application of hourly wage to commute:: 181 hour of extra commuting x $157 = $28,500 (Value of commute to you). It would seem that, as others have said, you could maintain your current job and hire a good reliable driver for way less than that amount. Or, just better deal with it. Use the time to dream of early FI)
Thank you for taking the time and breaking it down like that. Suddenly, I’m liking my commute more and more.
You also have 1/2 hour per day less worktime, wipes out half of the extra time saved on the VA commute. Not clear whether you leaving early two days a week is less hours worked or made up on other days since you mention schedule flexibility. If you are not required to make it up and leave 1 hour early on two days that would wipe out the other 30 minutes saved on the VA commute.

Lots of folks commute because their family likes their home location. I originally went from a 20 minute commute to an hour commute so that my spouse could work nearly an hour in the other direction. We stayed in that community when they were no longer commuting. I did it for another 25 years with half of time driving alone and other times in a carpool (added perhaps another 30 minutes a day).

I would think twice before giving up the pay and flexibility you have. There have been several suggestions about hiring uber/lyft that might prove useful. I'd not recommend a carpool as your flexible schedule is more valuable. A few years when our kids were into school sports, I did not have a carpool and was allowed a somewhat flexible schedule, actually often allowed to not make up office time since they knew I often did stuff at home. That was very appreciated.

Maverick3320
Posts: 510
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Re: Stay in private practice medical or take VA job offer?

Post by Maverick3320 » Sun Jan 13, 2019 9:44 am

fru-gal wrote:
Sat Jan 12, 2019 7:08 am
brad.clarkston wrote:
Fri Jan 11, 2019 8:59 pm

No that's not how it works my wife has been a federal employee 15 years and has went through multiple shutdowns under different administrations.

1.) Essential employee's work as normal and get paid just like every other day.

2.) Non-Essential employee's are sent home during the duration or called back if they are deemed essential after a long period. While they don't get paid during the shutdown they get back payed once the shutdown ends. The House can say no to back paying those employee's but they have haven't done that since the 1920's it's a good way to not be in office next election as everyone knows who voted it down.
I read that some employees are not able to come into work and will not get back pay.
During every furlough or shut down in recent history, government workers have been given backpay. The House just agreed to do the same this time around.

https://thehill.com/homenews/house/4249 ... y-shutdown

Topic Author
Headaboveh2o
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Joined: Thu Jan 10, 2019 8:47 pm

Re: Stay in private practice medical or take VA job offer?

Post by Headaboveh2o » Sun Jan 13, 2019 10:20 am

Carl53 wrote:
Sun Jan 13, 2019 6:47 am
Headaboveh2o wrote:
Sat Jan 12, 2019 8:25 pm
Cruise wrote:
Sat Jan 12, 2019 1:57 pm
OP:

Good luck with your decision. One thing that I did not see discussed is the effective daily wage you will earn in each venue:

Simply said, You will earn $492 more each day you work at your current job. Do you value your commute time so highly? Of Course, you may have a higher value on the added days off through vacation and holidays, and the time saving of a commute.

Data:

Current Job

Days worked a year = 208

Vacation, Holidays, CME = 27

Effective Days worked per year = 181

Effective Daily Wage = 228.000/181 = $1,259

VA Opportunity

Days worked a year = 208

Vacation, Holidays, CME = 36 (May be more with CME--an unknown--added in)

Effective Days worked per year = 172

Effective Daily Wage = 132,000/172 = $767

Daily Cost of taking New Job = $492 (Will change with CME credits added to divisor)

A note about commute time:

181 days worked x 30 minutes effective more commute time per trip x 2 trips per day = 181 hours yearly commute time

Your hourly wage= $228,000/181 days = $1,259/8 hr day= $157/hr
Application of hourly wage to commute:: 181 hour of extra commuting x $157 = $28,500 (Value of commute to you). It would seem that, as others have said, you could maintain your current job and hire a good reliable driver for way less than that amount. Or, just better deal with it. Use the time to dream of early FI)
Thank you for taking the time and breaking it down like that. Suddenly, I’m liking my commute more and more.
You also have 1/2 hour per day less worktime, wipes out half of the extra time saved on the VA commute. Not clear whether you leaving early two days a week is less hours worked or made up on other days since you mention schedule flexibility. If you are not required to make it up and leave 1 hour early on two days that would wipe out the other 30 minutes saved on the VA commute.

Lots of folks commute because their family likes their home location. I originally went from a 20 minute commute to an hour commute so that my spouse could work nearly an hour in the other direction. We stayed in that community when they were no longer commuting. I did it for another 25 years with half of time driving alone and other times in a carpool (added perhaps another 30 minutes a day).

I would think twice before giving up the pay and flexibility you have. There have been several suggestions about hiring uber/lyft that might prove useful. I'd not recommend a carpool as your flexible schedule is more valuable. A few years when our kids were into school sports, I did not have a carpool and was allowed a somewhat flexible schedule, actually often allowed to not make up office time since they knew I often did stuff at home. That was very appreciated.
Thank you for your advice! No, I don’t have to make up the time where I get out 30 min earlier two days a week so I can pick up my kids.

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AAA
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Re: Stay in private practice medical or take VA job offer?

Post by AAA » Sun Jan 13, 2019 10:24 am

staythecourse wrote:
Fri Jan 11, 2019 6:58 pm
In exchange you are getting into a situation you have admin. incompetence to the upteenth level in the government
Having spent a career dealing with management incompetence in a mega corp, I always find such generalizations to be somewhat of an exaggeration.

staythecourse
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Re: Stay in private practice medical or take VA job offer?

Post by staythecourse » Sun Jan 13, 2019 2:42 pm

AAA wrote:
Sun Jan 13, 2019 10:24 am
staythecourse wrote:
Fri Jan 11, 2019 6:58 pm
In exchange you are getting into a situation you have admin. incompetence to the upteenth level in the government
Having spent a career dealing with management incompetence in a mega corp, I always find such generalizations to be somewhat of an exaggeration.
Not if you are comparing a private medical practice of 1-10 docs vs. VA. It is NOT a knock on management. It is a truth that the more levels of folks in between your ideas of how to streamline a practice and actually doing it the longer and harder it is to get done. Especially since the folks who are in between CAN NOT understand why you are doing it since they aren't even in the same field of your expertise (medicine vs. business folks).

No large organization can be more efficient then a smaller organization.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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AAA
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Re: Stay in private practice medical or take VA job offer?

Post by AAA » Sun Jan 13, 2019 5:24 pm

staythecourse wrote:
Sun Jan 13, 2019 2:42 pm
Especially since the folks who are in between CAN NOT understand why you are doing it since they aren't even in the same field of your expertise (medicine vs. business folks).

No large organization can be more efficient then a smaller organization.
I agree and have had managers in megacorp who had no familiarity with the work of the group I was in. It's not limited to government agencies.

rjbraun
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Re: Stay in private practice medical or take VA job offer?

Post by rjbraun » Sun Jan 13, 2019 9:08 pm

sambb wrote:
Sat Jan 12, 2019 8:49 am
stick it out for 2-5 years. you can always get a lower paying job, but compounding by saving more now is worth the hassles
Maybe. It's conceivable that the terms of the VA job (or something comparable) may be inferior to what's currently on offer. Put another way, I worked in the private sector but transitioned to the public sector serval years ago. I make a fraction of my prior compensation, but had I transitioned in, say, 2006, prior to the "Great Recession" my pension and vesting terms would have been far superior to what I got. In both cases, the salary would be the same but the benefits (at least some of them) differ, and were reduced for subsequent hires (e.g., 10-year vesting vs. 5-year vesting earlier, higher employee contribution now than earlier, which actually went to 0% after 10 years, etc.).

tulsuduke
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Re: Stay in private practice medical or take VA job offer?

Post by tulsuduke » Sun Jan 13, 2019 9:43 pm

I think much of the administrative issues people have brought up on this thread (most seemingly from second hand experience) are more of a problem with those who are in administration. I have been primarily clinical and really don't get bogged down with any of that stuff. I come in at 8am, do my work, and leave at 4:30p. It's been great for my family life.

staythecourse
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Re: Stay in private practice medical or take VA job offer?

Post by staythecourse » Sun Jan 13, 2019 9:59 pm

tulsuduke wrote:
Sun Jan 13, 2019 9:43 pm
I think much of the administrative issues people have brought up on this thread (most seemingly from second hand experience) are more of a problem with those who are in administration. I have been primarily clinical and really don't get bogged down with any of that stuff. I come in at 8am, do my work, and leave at 4:30p. It's been great for my family life.
No it is real. I would say your attitude is perfect for corporate medicine or VA or even academic medicine. My wife has the same attitude. She likes to check in and out and doesn't really care about anything else. Doesn't mean there aren't issues, but she doesn't really care as she gets her paycheck and comes home to the kids and me.

If you have this outlook on your work life then these positions are GREAT. You have security, good benefits, great hours, etc... If you are one who sees the cracks in the armor of a process and wants to improve it then it is a difficult situation to be in as you can't do what I do in my own practice, "Hey tomorrow we are changing X and if you aren't on board guess you have to find a new place to work".

Nothing wrong with either work situation, but you have to align your personality with the job situation is all I am stressing. It often is hard for those who have not been "institutionalized" coming from the private sector. That is all I was saying. Not that one is better then another. Just something for the OP to keep in mind.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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