Title 38 is how the VA pays its doctors, dentists, nurses, pharmacists, and other healthcare workers. It is a completely different pay system from the General Schedule. And if you are a veteran looking at VA healthcare jobs, you need to understand how it works before you apply.

I spent 1.5 years after separating from the Navy applying for federal jobs with zero callbacks. Once I cracked the code, I changed career fields six times across federal service. I have seen how confusing federal pay systems can be from both sides of the hiring desk. Title 38 is one of the most misunderstood systems out there.

This guide covers every Title 38 occupation. Not just nurses. Physicians, dentists, podiatrists, optometrists, chiropractors, pharmacists, physician assistants, and more. You will see the 2026 pay ranges, how locality pay works, and how Title 38 compares to GS pay. If you want the nurse-specific breakdown, we have a full VA nurse pay scale guide for that.

What Is Title 38 and Who Does It Cover?

Title 38 of the U.S. Code gives the VA authority to set its own pay rates for healthcare workers. The VA does not have to follow OPM General Schedule rules for these positions. Title 38 falls under excepted service, which means different hiring rules from the standard competitive service process. That means VA doctors, nurses, and other clinical staff get paid on a separate scale.

Title 38 covers three groups of VA employees:

• Full Title 38 (pure): Physicians, dentists, podiatrists, optometrists, chiropractors, and registered nurses. The VA sets their pay directly. They are not on the GS scale at all.
• Hybrid Title 38: Pharmacists, physician assistants, expanded-function dental auxiliaries, respiratory therapists, licensed practical nurses, physical therapists, occupational therapists, and others. These roles use GS grade levels but follow Title 38 qualification standards.
• Title 5 (standard GS): Administrative and support staff at VA hospitals. They follow normal GS pay scale rules.

The key difference is flexibility. Title 38 lets the VA compete with private-sector hospital pay. A VA surgeon does not make the same as a GS-15 paper-pusher. Title 38 lets the VA match market rates so it can actually recruit doctors and specialists.

How Does Title 38 Physician Pay Work in 2026?

VA physicians get the highest Title 38 pay. Their pay has two parts: base pay and market pay. Base pay comes from a table set by the VA each year. Market pay is an add-on that matches local private-sector physician salaries.

The 2026 base pay ranges for VA physicians:

But base pay is only part of the picture. Market pay adds a significant amount on top. A cardiologist in San Francisco will have much higher market pay than a family medicine doctor in rural Arkansas. The VA reviews market pay data every two years using surveys from the Association of American Medical Colleges (AAMC) and other sources.

Total compensation for VA physicians can range from $200,000 to over $400,000 depending on specialty and location. Some surgical specialties exceed $500,000 in high-cost areas. That is competitive with many private hospital systems.

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What Do VA Dentists, Podiatrists, and Optometrists Make?

These positions also fall under full Title 38. They use the same base-plus-market structure as physicians. But their pay ranges are different because the private-sector market rates are different.

Here are the 2026 base pay ranges for these roles:

Market pay adds to these base amounts. A VA dentist in New York City will make more than the same role in Fargo. The VA calculates market pay based on what private practices in that area pay for the same specialty.

How Does Hybrid Title 38 Pay Work?

Hybrid Title 38 positions use GS grade levels for pay. But they follow Title 38 qualification standards for hiring. This means you need the right clinical credentials. But your paycheck looks more like a standard federal employee.

Common hybrid Title 38 positions and their typical GS grades:

These are base pay numbers before locality. Add 15% to 45% depending on where the VA facility is located. A pharmacist in Washington, D.C. at GS-12 Step 5 takes home significantly more than the same grade in Topeka, Kansas.

For a detailed look at how VA hybrid pay plan designations work, including the specific codes you will see on job postings, check our guide on that topic.

How Does Locality Pay Affect Title 38 Salaries?

Locality pay is a percentage added to your base salary based on where you work. The Office of Personnel Management sets locality rates for GS and hybrid Title 38 employees. Full Title 38 employees (physicians, dentists) use market pay instead of locality pay.

Here are some of the highest locality pay areas for 2026:

What this means in real dollars: a hybrid Title 38 pharmacist at GS-12 Step 1 makes $86,962 base. In San Francisco, locality bumps that to about $125,350. In a rural area under "Rest of U.S.," it becomes about $102,510. Same job, same grade, big difference in take-home pay.

If you want to see how locality affects VA nurse pay by location, we break that down city by city in a separate guide.

What Are the Nurse Grade Levels Under Title 38?

VA nurses are full Title 38 employees. They do not use GS grades. They use Nurse Professional Standards Board (NPSB) grade levels. These grades determine base pay, and each grade has multiple steps.

The 2026 VA nurse pay ranges:

Locality pay adds on top of these numbers. A Nurse III in Houston takes home more than a Nurse III in rural Montana. We cover the full grade-by-grade breakdown in our VA nurse grade level guide.

How Does Title 38 Pay Compare to GS Pay?

This is where many veterans get confused. Title 38 and GS are two completely different systems. They exist side by side at the same VA facility. Here is how they compare:

The biggest practical difference is the pay ceiling. A GS-15 Step 10 in the highest locality area tops out around $212,000. A Title 38 physician can make $400,000 or more. For clinical roles, Title 38 exists because the GS system simply cannot pay enough to recruit doctors.

For non-clinical VA jobs like administrative assistants, HR specialists, or IT staff, you are on the standard GS pay scale. Title 38 only applies to designated healthcare occupations.

How Do Veterans Get Hired Into Title 38 Positions?

Getting hired into a Title 38 role is different from a standard GS application. The process has unique requirements that trip up many applicants.

Here is what you need to know:

Credentials come first. Every Title 38 position requires specific clinical licensure. You must have an active, unrestricted license in any U.S. state. For physicians, that means a current medical license. For pharmacists, a valid pharmacy license. For nurses, an active RN license. The VA will verify these before your application moves forward.

Veterans preference still applies. Title 38 positions are federal jobs. Your 5-point or 10-point veterans preference counts. But the clinical qualifications are the primary screening factor. You cannot get hired as a VA physician without a medical degree and license, regardless of your veteran status.

The resume format matters. Title 38 jobs still post on USAJOBS. Your federal resume needs to include your clinical credentials, licensure details, board certifications, and clinical experience. Keep it to 2 pages. Include hours per week and supervisor contact info like any federal resume.

Qualification standards are VA-specific. The VA has its own qualification standards for each Title 38 occupation. These are published in VA Handbook 5005. They list the education, licensure, and experience required for each grade level. Read them before you apply. They tell you exactly what the review board is looking for.

What Benefits Come With Title 38 Positions?

Title 38 employees get standard federal benefits plus some extras. The benefits package is one of the reasons many healthcare workers choose the VA over private hospitals.

Here is what Title 38 employees receive:

• Federal Employees Health Benefits (FEHB): Same health insurance options as all federal workers. The government pays about 72% of the premium.
• FERS Retirement: The Federal Employees Retirement System with a pension, TSP (401k equivalent), and Social Security.
• Thrift Savings Plan (TSP): Government matches up to 5% of your salary. This is money most private hospitals do not match at the same rate.
• Annual leave: 13 days per year to start. Jumps to 20 days after 3 years and 26 days after 15 years of service. Military time counts toward leave accrual.
• Sick leave: 13 days per year with no cap on accumulation.
• Education debt reduction: The VA offers the Education Debt Reduction Program (EDRP) for eligible Title 38 employees. Some specialties can get up to $200,000 toward student loan repayment over 5 years.
• Malpractice coverage: VA physicians and clinical staff get federal tort protection. You do not need your own malpractice insurance.

For veterans, your military service time counts toward leave accrual rate and retirement calculations. If you served 4 years on active duty, you start at the higher leave accrual rate from day one. That is a real financial benefit that many veterans overlook.

How to Read Title 38 Pay on a USAJOBS Listing

USAJOBS postings for Title 38 roles look different from standard GS listings. Here is how to decode them.

The pay plan code tells you what type of position it is:

• VM: Physician (Title 38, full)
• VN: Nurse (Title 38, full)
• GS with Title 38 note: Hybrid position. You will see a GS grade but the posting will say "Title 38" or "hybrid" in the appointment type.

When you see a USAJOBS listing that says "Salary: $100,000 to $300,000" for a physician role, that range includes base pay. Market pay will be discussed during the hiring process and varies by specialty and location.

For hybrid roles, you will see a standard GS salary range. A pharmacist posting might say "GS-12 ($86,962 to $113,047)." That is the base pay. Add your locality percentage on top of that number.

Look at the "Qualifications" section carefully. It will reference VA Handbook 5005 and list specific licensure or certification requirements. If you do not meet those requirements, your application will not move forward. This is different from standard GS jobs where specialized experience is the main qualifier.

What Should You Do Next?

If you are a veteran with clinical healthcare credentials, Title 38 positions are some of the best federal jobs available. The pay competes with private sector. The benefits are hard to beat. And your military service gives you a head start with veterans preference and leave accrual.

Here is your action plan:

1. Look up the VA Handbook 5005 qualification standard for your specific occupation. Make sure you meet the grade level requirements for the positions you want.
2. Search USAJOBS for your specialty with the location you want. Filter by "Department of Veterans Affairs" and look for Title 38 or hybrid designations.
3. Build your federal resume with your clinical credentials front and center. Include licensure state, license number, board certifications, and clinical hours. BMR's federal resume builder handles the formatting and helps you match keywords from the job posting.
4. Check the locality pay table for the VA facility where you want to work. Calculate your actual take-home pay before you decide if the position is worth it.

Title 38 pay is complicated. But once you understand the base-plus-market structure for physicians and the GS-with-locality structure for hybrid roles, the numbers make sense. The VA needs healthcare workers. Veterans with clinical backgrounds have a real edge. Use it.

If you are looking at non-clinical VA positions or other federal agencies, check out our guide to the WG vs GS pay systems to understand those options too.