It is no secret that multiple challenges face the US healthcare system in 2024. For emergency medicine physicians, issues involving boarding, for-profit private equity groups, regulatory requirements, and complicated electronic health records have led to significant increases in burnout and an increase in physicians who have left clinical practice or are considering to do so. Anecdotally from conversations I have had with many of my peers across the country, there is a feeling that practicing emergency medicine today is not the same as it was only a decade ago.
As an active-duty emergency physician with the US Navy, I was reminded of the hidden benefits of working in the military health system (MHS) during every ED shift. I could order the tests I wanted, prescribe the medications needed, schedule the follow up required, and leverage a Primary Care Manager to assist with care coordination. There were no insurance companies to deal with, boarding was an infrequent issue, and staffing levels were driven by clinical requirements, not profit margins. Burnout is hard to find when you have the privilege of caring for the soldiers, sailors, marines, airmen, guardians, and coast guardsmen who keep us safe and free and you feel your time and efforts are appreciated and making a positive impact.
With that as a background, I had some apprehension about pursuing a full-time clinical emergency medicine career after deciding to separate from the Navy. I had moonlighted enough to know that, despite the various shortcomings of the MHS, the grass is not always greener on the other side. So, when I separated in 2023, I ended up completing an interservice transfer to the US Public Health Service and remained on active duty. I took my first assignment with the Department of Veterans Affairs (VA) and have come to discover an organization that champions much of the same culture as the Navy and the Department of Defense.
The Veteran’s Health Administration’s (VHA) primary mission is to “honor America’s veterans by providing exceptional health care that improves their health and well being.” My fellow employees – many of them veterans themselves – embrace this commitment to service, something that will be familiar to any prior military servicemember. In this article and in future Epic newsletters, I want to highlight the opportunities of working in the VHA, healthcare innovations, interagency collaborations, and VA-research advancing the practice of emergency medicine. For this first publication, I specifically want to call out the benefits of practicing emergency medicine in the VA and why military physicians should consider working at the VA upon separating from active duty. Many of these topics are also well articulated in an invited commentary by Drs. Neil Patel and Chad Kessler in a 2023 publication in Academic Emergency Medicine.
The VHA is the largest integrated healthcare network in the United States, encompassing over 1,300 facilities in all 50 states as well as some US territories such as Guam and Puerto Rico. Once credentialed and employed in the VA, EM physicians have opportunities to work in rural or urban environments, tertiary care medical centers, teaching hospitals, and everything in between. Many VA sites have partnerships with world class civilian medical schools, such as Stanford University and UCSF, and 60 of the VA’s 111 emergency departments have received Geriatric ED Accreditation (GEDA) from the American College of Emergency Physicians, a testament to the VA’s commitment to providing the best care to its veterans. The breadth and scale of the VA system means that employment opportunities are not limited by geographic considerations, and one has the flexibility to move across the country, continue their career progression, and retain their healthcare and retirement benefits.
As an integrated healthcare system, the VA also enjoys the benefit of a unified medical record, where a veteran’s health information can be obtained from any VA site, regardless of where the veteran may have previously been cared for. Continuing innovation in digital health technology and health information interoperability pledges from some of the largest civilian healthcare networks such as Intermountain Health and Kaiser Permanente means VA EM physicians have the information they need in order to make the best clinical decisions for the veterans they are caring for. For veterans requiring outpatient follow up after their ED visit, their Patient Aligned Care Team (PACT) is an invaluable resource to complete in-person or virtual follow ups and care coordination. Rather than worrying about productivity and regulatory metrics, insurance approvals, and primary care access, I get to focus on meeting the needs of the veteran in front of me. It is empowering to provide your patients the right care, in the right setting, at the right time, and make what you and your patient believes are the right clinical decisions.
A rewarding work environment is only part of the appeal of an emergency medicine career in the VA. The VA also offers competitive compensation packages for its employees, starting at around $300 - $310,000 per year on average. When factoring in leave – 13 to 26 annual leave days, 13 sick days, 11 federal holidays, and 12 weeks of parental leave – access to the TSP with an employer match, contributions to the Federal Employee Retirement System (FERS, which provides a monthly pension in retirement), and medical malpractice coverage, the total annual compensation value tops $410,000 per year. Initiatives such as the expansion of a national Tele Emergency Care program also mean that VA EM physicians have opportunities to perform tele-work, which can reduce commuting requirements, time away from home, and provide a break from the busy pace of clinical emergency medicine. This type of robust compensation package and flexible work schedule is becoming increasingly hard to find, but is available in the VA.
Perhaps my biggest apprehension when I separated from the Navy was that I would miss being a part of an organization whose mission I continue to believe in and had been committed to since being a ROTC midshipmen over 20 years ago. When I was offered an opportunity to work with the VA, I was not sure what to expect, but I was intrigued by the idea that I could continue to care for those who had served in the Armed Forces with me. It felt like a natural next-step and a way to stay connected to the culture and people my family and I committed so much of our lives to. I have since come to discover that I now have the pleasure of working alongside some of the federal government’s finest public servants, who work every day to deliver the best healthcare possible to our nation’s veterans. I continue to find meaning and purpose in my clinical work and other duties every single day, much as I did in the US Navy. I cannot overstate how important this is, when many physicians in clinical medicine today find themselves increasingly overworked, undervalued, and questioning their commitment to their profession. I would highly encourage anyone in the military or other federal service to seriously consider a career in emergency medicine with the VA, should the opportunity arise.