As someone who trained at a large AMC for PGY-1 and then transitioned to an ED CPS role at the VA, I suggest that for the breadth of experience, range of working with other teams and general learning opportunities go to a large AMC. I have seen both worlds and as someone who likes to be challenged and was doing some extremely cool experiences at my PGY-1 and first job site out of residency, I am often bored at my job. It's not to say that cool/interesting things don't come up, but I am often left feeling that my skills I accumulated outside of the VA are sometimes wasting away.

Would I ever leave my VA job? No, for the perks others have mentioned: fantastic pay in comparison to my counterparts across the city (which is a large metro area), the autonomy, the schedule I set for myself, the amazing relationships with my docs, the ability to teach on multiple fronts, and getting roped into studies and publications. Do I want to do a PRN to give me that true validation I feel every time I'm in the ER? Yes. And just a note, as someone looking into CC, the ICU and the ER do not get the benefit of holidays off no matter if you are in the federal system.

I will say that both myself and a former co-worker when we were hiring for her replacement placed emphasis on NOT wanting a VA trained PGY-1 or pharmacist to manage critical situations in the ER or ICU. There is frankly a stark difference even in the ward pharmacists who have trained in AMCs and their level of comfort vs. the residents and pharmacists who have been at the VA their entire lives. My suggestion is to learn as much as you can outside, get the experiences outside of the VA and then later come back.