The Title 38 pay scale governs salaries for U.S. Department of Veterans Affairs (VA) healthcare employees. It includes physicians, dentists, nurses, and associated health professionals. The system offers locality pay, special salary rates, and performance-based incentives to attract and retain medical staff.
Introduction to Title 38 Pay Scale
Title 38 pay governs certain health care occupations within the Department of Veterans Affairs (VA) and provides compensation outside the General Schedule (GS) system.
This system is built to recruit and retain employees in clinical fields by offering higher annual pay, authorized higher rates, and more flexibility than GS pay. Title 38 applies to positions providing direct patient care in VA hospitals and other health care facilities.
The system consists of two components: base pay and market pay, with locality adjustments applied as needed.
Key Benefits:
- Market pay adjusts salaries to reflect local demand and specialty needs.
- Locality pay raises wages in high-cost areas.
- Performance-based bonuses incentivize quality patient care.
Who Qualifies for Title 38 Pay
Title 38 covers medical professionals in health care occupations who provide direct patient care.
This includes:
- Physicians
- Dentists
- Nurses
- Pharmacists
- Chiropractors
- Optometrists
- Podiatrists
- Physician assistants
Hybrid Title 38 roles include employees working under both Title 38 and Title 5 rules. Examples: respiratory therapists and social workers.
These positions are critical for delivering care across VA health care facilities and similar federal institutions like the Department of Defense and Indian Health Service.
Eligibility depends on:
- Occupation type
- Level of patient care
- Facility location
- Need for competitive compensation
Title 38 vs. General Schedule (GS) Pay Scale
Title 38 offers higher flexibility and higher rates than the General Schedule pay system for the same clinical positions.
| Feature | Title 38 | General Schedule (GS) |
|---|---|---|
| Pay Setting | Market-based + Locality | Predefined salary tables |
| Adjustments | Special salary rates, market pay | Step increases, locality pay |
| Occupations | Healthcare professionals only | All federal occupations |
| Promotion Flexibility | Merit-based + experience | Tenure and classification-based |
| Primary Purpose | Retain clinical professionals | Broad federal hiring framework |
Title 38 is competitive, offering higher annual pay and incentives based on experience and clinical demand.
How Title 38 Pay Is Determined
Title 38 pay includes two components: basic pay and market pay, with potential for special rates and bonuses.
- Basic Pay: Based on position, experience, and qualifications.
- Market Pay: Determined by national salary surveys, availability of providers, and specialty demand.
Steps to determine Title 38 pay:
- Assess market rate for the occupation
- Compare locality data from pay tables
- Evaluate experience, education, board certification
- Apply special salary rates if recruitment is difficult
The VA and HHS instruction on Title 38 allow for flexibility in setting authorized higher rates to meet workforce needs.
Hybrid Title 38 Positions
Hybrid Title 38 roles combine Title 5 and Title 38 authorities to cover clinical support positions.
These positions provide patient care or services incident to direct care but don’t qualify for full Title 38 authority. Hybrid roles allow for:
- Faster hiring
- Competitive pay setting
- Position-specific flexibilities
Common Hybrid Roles:
- Medical technologists
- Physical therapists
- Licensed practical nurses (LPNs)
- Social workers
- Occupational therapists
These employees follow Title 5 rules for appeals and grievances but receive Title 38 benefits and pay structure.
Benefits Under Title 38
Title 38 employees receive benefits designed to help recruit and retain skilled clinical staff.
Key Benefits:
- Thrift Savings Plan (TSP): Retirement savings with federal match
- Federal Employee Health Benefits (FEHB): Insurance with nationwide plans
- Paid Leave: Annual and sick leave accruals
- Bonuses: Retention, recruitment, and relocation incentives
- Premium Pay: Night, weekend, and holiday differentials
These benefits are competitive across federal and private sectors and help ensure continuity in patient care.
FAQs and Misconceptions
Below are common myths and questions about this topic.
How does Title 38 pay differ from the General Schedule (GS) for the same medical job?
Title 38 pay offers more flexibility and often higher base salaries than the GS system, especially for medical roles like physicians and nurses. It includes market-based compensation, special salary rates, and locality pay that are unavailable under GS.
Can Title 38 employees negotiate their starting salary, and what factors influence this?
Yes. VA can authorize higher initial pay for hard-to-fill positions. Influencing factors include experience, education, board certification, and specialty demand.
Are Title 38 employees eligible for overtime, premium pay, or shift differentials?
Yes, but rules differ by role. Most Title 38 staff are eligible for premium pay including overtime, night shifts, and holidays. Senior roles may be exempt.
How does locality pay work for Title 38 positions, and can it significantly affect total compensation?
Locality pay adjusts salaries based on cost of living in different geographic areas. In high-cost cities like San Francisco or New York, this can increase total pay by 20% or more.
Title 38 Pay Scale Example Table
Title 38 of the U.S. Code governs pay for certain healthcare professionals in the Department of Veterans Affairs (VA) and other federal agencies. The pay system is distinct from the General Schedule (GS) and is designed to attract and retain clinical talent. Below is a simplified example table for Title 38 pay (actual rates vary by occupation, specialty, and locality):
| Occupation | Pay Band/Grade | Entry Salary (USD) | Max Salary (USD) | Notes |
|---|---|---|---|---|
| Physician/Dentist | Tier 1–4 | $115,587 | $306,600+ | Varies by specialty and location |
| Nurse | Nurse I–III | $67,000 | $145,000 | Depends on education, experience |
| Pharmacist | GS-12/13 (T38) | $89,000 | $140,000 | Some use hybrid GS/Title 38 scales |
| Optometrist | GS-11/12 (T38) | $75,000 | $120,000 | Locality pay may apply |
| Chiropractor | GS-11/12 (T38) | $75,000 | $120,000 | Locality pay may apply |
Our Thoughts
The Title 38 pay system offers a flexible, performance-driven compensation model for federal healthcare workers. With its dual pay components, competitive edge over the general schedule pay, and focus on recruiting clinical professionals, Title 38 ensures the VA and similar agencies can continue delivering quality patient care across the country.
For healthcare professionals considering federal employment, understanding Title 38 pay components, benefits, and eligibility can provide a clear advantage during the application process. The VA pay system offers higher rates, better incentives, and job stability unmatched in many private sector roles.
