Concur, Ryan Haight will never be enforced again. In terms of the CSRE, yes it's annoying. However, if you already did an intake or are otherwise familiar with the patient, it should add absolutely no more than 5 minutes to any patient encounter and possibly as little as 3 once you get familair with the intricacies of the form. Concur that mandatory Columbias triggering an inappropriate CSRE are much more of an issue on medical floor inpatient services and ED than outpatient as it's unlikely the C/L service is intimately familiar with the patient, but it does happen for the frequent flyers. In terms of supplementing income, I'm not sure what the poster above means. VA physicians generally can't earn overtime through the VA. It has to do with Title 38. A well run VA call pool with manage this through offering VA attendings in lieu of days off, but that won't help someone looking for actual income. For that, you'd have to go outside the VA and fortunately the VA has no limits on outside employment as long as it is outside your tour of duty.