Residency Insight -- A PRESENT Podiatry eZine

Guest Editorial: For Tonight's Residency Insight, we hear from Dr. Nichol Salvo, a VA physician who will be sharing her insights into working within the VA Health System. Dr. Salvo is a a graduate of the OCPM, and she completed her residency training at the Atlanta VA. She is currently employed as a staff podiatric surgeon at the Louis Stokes DVA Medical Center in Cleveland, OH.

—Ryan Fitzgerald, DPM, PRESENT RI Associate Editor

Dr. Nichol Salvo
VA Physician

My Life in the VA

I am a young PRESENT member who has practiced podiatry both in the private sector and the VA system. I am an excellent example of the learning curve that presents with the practice of podiatry and that things don't always turn out quite like your career plan may have been written.

My Story

I completed a PMS-36 residency program at a VA facility. My three years in the VA during residency training were a good experience for me. As I was completing my third year of residency and explored my job opportunities, I considered the VA seriously for permanent employment. However, my program VA did not have any open positions to apply for and I was less than thrilled about leaving a city that I had grown quite fond of during residency. I interviewed for positions in the private sector and accepted a position at a well established practice. This seemed like a benign choice at the time, as many of my resident predecessors entered private practice and appeared to be doing well. How different from the VA could it be? For me, it turned out to be disappointingly and dauntingly different. I practiced competently, developed great relationships with my patients and staff and enjoyed my private practice. And that was it. What was wrong ? While I enjoyed the practice of podiatry, of medicine and surgery, I didn't enjoy the practice of business. I left private practice after 16 months and reentered the VA system. This was the best career decision of my life. Working for the Department of Veterans Affairs has proven entirely different from private practice and I am happy to share with you my own personal perspective.

My Days at the VA

Schedule, expectations, and responsibilities vary depending on which VA facility you work at. I have a Monday through Friday clinic with one patient scheduled every 20 minutes. I have surgery anywhere from two to four days a month. I do not take call, although I know many podiatrists in the VA that do. A benefit of working in the VA is that I treat patients all day, every day and all of the billing and reimbursement issues are eliminated. With that said, many other elements of business are eliminated as well, including ordering supplies, hiring and firing staff, marketing, etc. I can appreciate that many practitioners would dislike this lack of control and absence of practice management, but for me, it has been a blessing. I entered podiatry to practice medicine and surgery and to treat patients. The VA has afforded me the opportunity to focus my time and energy to the practice of podiatry and has eliminated the management and business components that I considered distractions.

Why Work for the VA?

I have been asked repeatedly about VA salary and compensation. The VA runs on a step and grade system, and salary (or the specific step and grade) is determined by many factors, namely post graduate training, experience, board certification, research and publications, and academic faculty appointments. There is not a bonus structure per se, but merit increases are available based on professional and/or academic accomplishments. As with many jobs, the VA provides several benefits, including health, life and disability insurance, retirement (FERS) and sick and annual leave.

Another benefit for me personally is the opportunity for student and resident instruction. The VA also supports research and my growth academically, as they know that ultimately this helps the patient and contributes to the common good of medicine. These are both opportunities that were not available to me in the private sector.

Although it may seem that I view my VA career through the proverbial rose colored glasses, I acknowledge that the VA is not for everyone. If you want specific control of the business aspect of your practice, the VA may not be suitable for you. The VA, by nature of our patient population, has a large volume of wound care, limb salvage and diabetic related complications. It has a large volume of patients with multiple co-morbid chronic conditions and many psychological issues that factor into the care I can provide. The complexity of many of our patients can be overwhelming for some. For me, the challenge adds to the already many positives of my job.