VA psychiatry a complete buzzkill: poor work ethic, nice pay

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I admire the VA mission when it comes to psychiatry, but I also feel like it wastes a significant amount of taxpayer money. It rewards poor work ethic with nice pay.

Here's why:

I have worked at the VA on the outpatient side over the past year and the no-show rate is greater than 50%. If this is universal to all VAs, it appears to me that VA is hiring psychiatrists with a full-time salary to sit around and surf the internet (with poor bandwidth and blocked websites). I speculate that this volume of work in the private sector would not generate more than $50k per year in physician take home pay with medicare or even private insurance rates (including overhead and malpractice).

To my dismay, I've found that this system attracts a significant number of lazy psychiatrists (the 1/3rd of Whopper's rule). However, with the 20 year retirement package and attractive benefits it seems to also appeal to some of the brightest and highly educated psychiatrists. I find this quite disappointing and frankly just thinking about it gives me a complete buzzkill.

Wondering if this is location-dependent? Certain VAs seem to be more academic than others. I am thinking about the VA in Durham or in West Haven, Ct. Others like the ones in the Bronx or East Orange, NJ seem a league behind. My experience is pretty limited to one of a medical student. Some things do seem universal. Things pretty much shut down after 4-430pm on weekdays. On my interview trails, some residents have mentioned that they preferred VA as their outpt sites as their days are shorter than those whose clinics are located on the main hospital sites.

I would say it's location dependent. While the VA bureaucracy does tend to breed a culture where things happen more slowly than in the private sector I would say my VA is pretty good. Our no show rate is much lower than 50% and we have some bright, conscientious docs working there.

I agree with the others. It's extremely location dependent. Even within one state you can find radically different VA programs and cultures.

This is probably true for all specialties, but I especially notice it in psychiatry. Some VA's are essentially a collection of high no-show outpatient appointments, others are centers of excellence for all sorts of mental health issues, which attract some great minds, motivated staff, and good research…

Defintely agree that it's location dependent - my experience with the VA here isn't like what you describe at all.

Most of the VA system, or beneficiary systems in general, attract a certain percentage of lazy people even with a noble stated aim. But is it that noble? That you're being hired to take care of young/old soldiers who the Armed Forces recruited (or drafted) from the lowest socioeconomic strata with the highest rates of premorbidity for psych disorders to begin with . . . and then exposed them to trauma?

Rant over. My VA training facility is filled with dedicated shrinks. Yes, there are a few burnouts or note-signers, but there is overall an intense commitment to taking care of the patients. And my psych primary clinic has a 10% no show rate, averaged over a month. Try to be happy with your training in a system that actually lets you...say...keep a first-breaker for long enough to stabilize his medications before a corporate hierarchy is breathing down your neck to discharge. There are benefits.

I'm not a fan of working at the VA, but I've got to say our VA attendings are for the most part pretty good. Here, the VA seems to do a better job attracting people because of I think better work schedules, more support and actually more money for research types of stuff. Now, I haven't done outpatient VA work yet (but it's coming in a big way next year), so I have no idea about the no show rates and whatnot.

What I hate about the VA is the bureaucracy (filling out various endless forms for every admission that maybe have some benefit, but I don't know) and the patient population. My current census is about 90% social trainwrecks and 10% acute psychiatric concerns. So, no, I don't think I'd ever work there, but they get some good people here.

The problem with the VA system is the disconnect between entitlement and responsibility. Surely, vets should feel entitled to psychiatric care, especially those traumatized while on the front line. However, with the entitlement should come the responsibility to show for your appointments and adhere to the treatment plan. There is no negative consequences for missed appointments in the VA outside of a nurse or social worker calling you to make sure that you aren't lethal.

The no-shows are a sea change from the way things used to be - with the WWII and Korea guys, if they had an appt at 2pm on Thursday, they were there 2pm Thursday. Why, they can't tell you, but they're there "because that was the order".

I totally agree that this the show-rate depends on location. My med school was tagged to a VA, and they had very good rate of patients who showed up for their appointments. I would guess ( just from memory) that it was more like 20% no- show than 50%.

I had a similar problem working for the state. There were doctors literally only writing one progress note a month, if even that, and it was a darned poor one at that. E.g.

Mr. X is psychotic.

(That's it!)

I had one guy transferred to my unit from another doctor (an Ivy league grad who attended Exeter Academy) and this guy had hepatic encephalopathy for a month that the other doctor did nothing about.

While it's very frustrating, I basically had to accept it and simply not let myself do such poor work. I got worked up several times over it and knew the administration simply kept these people working there because they could not get better doctors to replace the existing bad ones.

I ultimately did enjoy my state job. Every job has pros and cons. The thing I liked about it was I was able to take patients off of meds that I thought was malingering and have no worry that an insurance company would then stop paying for the treatment because the state was paying for it, and I was able to nail about 20% of the patients on my unit as not mentally ill at all in an Axis I non-abuse/dependence sense. Most of them were just antisocials that some shmuck diagnosed with bipolar disorder.

Another thing I liked was I could spend several hours on one patient either doing extensive interviewing or going through their old notes with a fine toothed comb.

Originally Posted by whopper

Another thing I liked was I could spend several hours on one patient either doing extensive interviewing or going through their old notes with a fine toothed comb.

I do like this about the VA!

Originally Posted by Apollyon

The no-shows are a sea change from the way things used to be - with the WWII and Korea guys, if they had an appt at 2pm on Thursday, they were there 2pm Thursday. Why, they can't tell you, but they're there "because that was the order".

Yea those guys are solid.

Originally Posted by whopper

....

I was able to nail about 20% of the patients on my unit as not mentally ill at all in an Axis I non-abuse/dependence sense. Most of them were just antisocials that some shmuck diagnosed with bipolar disorder.

:thum bup:

The interesting next step result was imagine a guy, misdiagnosed as bipolar disordered, having received disability payments for it for years, being in a psychiatric forensic hospital for committing a crime and trying to get a not guilty by reason of insanity defense.

Now the guy won't be able to get that NGRI. Fine by me. His disability is now cut off. Fine by me, the guy wasn't mentally ill to begin with.

The problem becomes now this guy, who was institutionalized since his teens (people in this demographic often-times only had oppositional defiant disorder but but misdiagnosed intentionally by well-meaning but misguided mental health providers on the hope that a bipolar disorder diagnosis would get the kid more services), is then discharged from the hospital with no education, no meaningful training, used to getting free money, and no skills to get a job.

Such individuals often times end up going to prison.

My point is not that I did anything wrong. To further lie and give a bull$hit diagnosis of bipolar disorder would've just furthered the problem. I found it quite shocking to see how many doctors were willing to continue a diagnosis on record they didn't even believe in. Some did it because it was simply easier to further the lie than to confront it, and in doing so that would require a psychiatrist to write lengthy reports and do psychological testing to show that the prior dx was BS.

The point is IMHO, well meaning health care providers, encouraging doctors (or the doctors themselves) to put a false diagnosis of bipolar disorder in reality are creating a type of demographic that misguides children into thinking they are not responsible for their own behavior, and hurt the child's ability to make a turn in their behavior while there's still more of a chance for this to happen. There's already a study showing that more than 50% of people diagnosed with bipolar disorder don't have it.

http://www.ncbi.nlm.nih.gov/pubmed/18466044

METHOD:
Seven hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed a self-administered questionnaire, which asked the patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history information was obtained from the patient regarding first-degree relatives. Diagnoses were blind to the results of the self-administered scale. The study was conducted from May 2001 to March 2005.
RESULTS:
Fewer than half the patients who reported that they had been previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on the SCID. Patients with SCID-diagnosed bipolar disorder had a significantly higher morbid risk of bipolar disorder than patients who self-reported a previous diagnosis of bipolar disorder that was not confirmed by the SCID (p < .02). Patients who self-reported a previous diagnosis of bipolar disorder that was not confirmed by the SCID did not have a significantly higher morbid risk for bipolar disorder than the patients who were negative for bipolar disorder by self-report and the SCID.

It's funny when someone finally does a study showing what we've seen upfront and knew what was going on for years. Refreshing actually because now there's some actual empirical proof vs. just our anecdotal experiences.

I've had plenty of young men who had a completely BS dx of bipolar disorder, who thanks to my work got that dx taken off, and now got booted from the hospital, and within months just committed a crime because were so institutionalized, in part by the BS diagnosis. This is a problem where you have to connect the dots to see it exists with the person promoting the misdiagnosis probably doesn't realize the harm they are causing.

Bridging this back to the original post, I've seen several doctors state-wide, continue a completely BS diagnosis. I had one case of a guy hospitalized 7x and each time got off thanks to his diagnosis. I went through all the records, and none of the actual hospitalizations documented he actually had any real symptoms of bipolar disorder, (he'd bully other patients, that's it. Some docs even wrote down "psychosis evidenced by bullying other patients and taking their food.") One actual doctor wrote something to the effect of "I question if this patient is actually mentally ill in an Axis I sense, but given that several doctors previously diagnosed him with bipolar disorder, I am hesitant to remove the diagnosis."

When I got the patient, I took him off of meds, and he never showed any symptoms of an Axis I disorder though he was antisocial to an extreme.

Originally Posted by Apollyon

The no-shows are a sea change from the way things used to be - with the WWII and Korea guys, if they had an appt at 2pm on Thursday, they were there 2pm Thursday. Why, they can't tell you, but they're there "because that was the order".

These were, by far, my favorite Veterans to see. I saw guys in their late 80s and early/mid-90s that were often mildly to moderately demented, but damn if they didn't make a point to get there EARLY and be ready from the get-go. Admittedly many got up at 4am-5am, so a 9am appt was practically lunch. It was quite the contrast to many of the younger guys I evaluated who often had a much different approach to the evaluations (typically C&Ps). The system doesn't do them any favors, but it was very frustrating at times.

Originally Posted by whopper

The point is IMHO, well meaning health care providers, encouraging doctors (or the doctors themselves) to put a false diagnosis of bipolar disorder in reality are creating a type of demographic that misguides children into thinking they are not responsible for their own behavior, and hurt the child's ability to make a turn in their behavior while there's still more of a chance for this to happen. There's already a study showing that more than 50% of people diagnosed with bipolar disorder don't have it.

I think this is the biggest problem in the VA system. I saw SO MANY Veterans who not only were misdiagnosed, but they were conditioned to use/abuse the system. Some VAs will take exception with the use of effort measures, which really makes it difficult to 'connect the dots'. God forbid you hint at secondary gain issues and/or straight up malingering. There are many fine Veterans I was able to work with during my time in the VA system, and they deserve everything they get and probably more....but there is also an undercurrent of Veterans that are blatantly using the system. 100% service connection for PTSD & TBI....but they can still get out and play a round of golf and go out with friends.

Another reason not to work for the VA -- it's a complete administrative nightmare. My remote access for CPRS isn't working currently, and I just got off the phone with tech support, which was about the most worthless conversation I've ever had. I had the exact same experience on nightfloat when I was stationed at the university hospital but also had to cover the VA through remote access. It's kind of critical that these things work and yet I'm the jerk for calling and complaining about something not working.

And the PIV badges. Mandated by the government in like 2005, and they just got rolled out here this year. I filled out a form a year ago to get my badge, heard nothing (and even followed up because I'm a little anal about these things) and then all of sudden got notice that I had to get my badge like yesterday. The PGY3s and 4s have to actually submit a whole new background check and get re-fingerprinted to get their new badges.

CPRS is also pretty lame. I'm sure it was awesome in its day, but I'd much rather use epic. Access to records is good, but it's also a lesson in how sometimes you can have years of records and still not really have much data about a patient.

I agree that the old vets are awesome, though. And the young vets may be entitled, but they're pretty effed up from a situation that our government created. Maybe they were effed up before, too, but throwing someone with not so hot pre-war functioning into Afghanistan wasn't really a great idea.

Originally Posted by Doctor Bagel

I agree that the old vets are awesome, though.

How often do they hit on you? I don't think I've ever seen a female doc at a VA - even the most bellicose, obese, and/or unattractive - not have an old vet, usually very politely and very slick, offer a proposition.

Originally Posted by Doctor Bagel

Another reason not to work for the VA -- it's a complete administrative nightmare. My remote access for CPRS isn't working currently, and I just got off the phone with tech support, which was about the most worthless conversation I've ever had. I had the exact same experience on nightfloat when I was stationed at the university hospital but also had to cover the VA through remote access. It's kind of critical that these things work and yet I'm the jerk for calling and complaining about something not working.

Yeah, again, this is regional. Tech support at one VA I worked at was rough. Tech support at my current one is way better than my university tech support. I dial a four digit number and someone answers the phone. Much better than the tree that leads inevitably to a voice mail for the university system. It varies.

I think CPRS gets a bit of a bad rap. It's not the prettiest presentation of data, and looks older than hell, but it's thorough. It lacks a better search mechanism, but I think that's a complaint of most EMRs. I'm glad the VA had the foresight (it went with an EMR before a lot of academic medical centers did) to do what they did when they did, because I can't imagine them building one now.

Originally Posted by Doctor Bagel

I agree that the old vets are awesome, though. And the young vets may be entitled, but they're pretty effed up from a situation that our government created. Maybe they were effed up before, too, but throwing someone with not so hot pre-war functioning into Afghanistan wasn't really a great idea.

I think this all has a lot more to do with the generation of vets than the wars they fought in.

The WWII guys are solid and professional because they came from a generation that was solid and professional in the way they carried themselves in public. The Vietnam generation was less so and it shows a bit in how they interact with the VA. And entitlement is a bit of a theme among the latest generation, so I have a hunch that it's going to be a pretty challenging generation to work with in the VA system in the years to come. I'd expect a lot of entitlement for shrinking dollars combined with a culture where malingering is much more socially acceptable than it used to be. Interesting days ahead...

I saw SO MANY Veterans who not only were misdiagnosed, but they were conditioned to use/abuse the system.

My fellowship PD, Doug Mossman wrote a paper on this that was mentioned in another thread.

http://www.nationalaffairs.com/publi...ays-to-be-sick

During my court-gig where I evaluated patients on a weekly schedule for the court, almost every single vet I interviewed at the VA had PTSD. When I interviewed them and asked them if they had PTSD symptoms, hardly any of them had it.

It seemed that some of the doctors at this particular VA basically just spot-diagnosed all the patients in the psych unit with that disorder.

Originally Posted by whopper

During my court-gig where I evaluated patients on a weekly schedule for the court, almost every single vet I interviewed at the VA had PTSD. When I interviewed them and asked them if they had PTSD symptoms, hardly any of them had it.

Reminds me of a patient at the VA yelling "I HAVE P-T-S-D!!!". I'm pretty sure it was just a personality disorder.

Look at the flipside.

If so many doctors blow at the VA, if you actually do a good job you'll shine. I figure you actually care, and you should hold onto that and not let it go.

Happened to me at the state hospital I worked at. I don't claim to be the world's greatest doctor but I do claim to give a damn, try to diagnose based on actual DSM criteria, write progress notes based on a standard given by the textbooks (e.g. explain why I chose the med they are on and keep a record of what med did what to each patient), and give meds based on evidenced-based standards. While that IMHO should be the standard of care, I've noticed it's actually way above the norm.

Now if you do a good job, you will stand out, and that could lead to several benefits aside from the personal satisfaction that should come with being a good doctor. You could get promoted within the system, it could open doors to bigger and better jobs, staff members and fellow doctors will respect you.

But, and heed my advice, I've noticed if you're in a state funded hospital, even bad doctors get away with doing poor work. A hospital could try to dump the worse work onto you because you're a good doctor. If you do a good enough job, you could earn enough political capital to start picking and choosing the better jobs in the hospital. When I say better, I don't mean easier.

What I did in my state job was position myself into being on the best unit (out of 10 units) in terms of having the best psychologist, social worker, nurse manager, and nurses. I always have wanted tough cases, but not at a rate I can't handle (e.g. on my 21 patient case-load in the hospital, I always wanted at least 1-3 of the hospital's toughest patients, but no more than that to keep the unit atmosphere stable), and with my treatment team, I had tremendous job satisfaction getting patients better that were literally sick for months to years without improvement under another doctor in the hospital, but get better with the treatment team I was with.

On VA IT awesomeness (I'm a little perseverative here), I discovered that there is no actual tech support for remote access issues over the weekends or at night. You can call the help line (outsourced somewhere) and make a complaint, which will be dealt with during normal working hours. The complete ludicrousness of this amazes me. You use remote access on off hours more than during regular work hours, so why no support for it.

Of course I'm currently attempting to do a VA call from home. Remote access is working today, but I'm going to be so freaking angry if I have to go into the hospital to order some prn docusate. I hate the VA!

Originally Posted by Doctor Bagel

You use remote access on off hours more than during regular work hours, so why no support for it.

Classic

Originally Posted by Doctor Bagel

I hate the VA!

"And that's The Word." -Stephen Colbert

...

http://www.nytimes.com/2012/04/15/op...&smid=fb-share

This article makes me want to work at a VA. I was a yoga teacher before medical school. Mindfulness based meditations have made it into some VA's, and I could also teach those techniques to vets. It makes me think about my days as a lifeguard- you were considered a better guard if you never had to go into the water (due to prevention). It's the patients that we can help to get better over time that keep the suicide numbers lower. Whatever helps, despite the bureaucracy, would in the end be worth it.

Originally Posted by Doctor Bagel

Another reason not to work for the VA -- it's a complete administrative nightmare. My remote access for CPRS isn't working currently, and I just got off the phone with tech support, which was about the most worthless conversation I've ever had. I had the exact same experience on nightfloat when I was stationed at the university hospital but also had to cover the VA through remote access. It's kind of critical that these things work and yet I'm the jerk for calling and complaining about something not working.

At least you have the hope of logging on. My VA locked a bunch of residents out of the system because we didn't complete some asinine online HIPAA training thing that got announced at the last minute--while some of us were out of town attending VA related conferences!!! Now I can't get ahold of the coordinator who is supposed to tell me how to restore my access. I've also been told that after I finish the training, it has to go through 14 LEVELS of bureaucratic approval before my access is restored. So much for seeing patients when I can't get to my template let alone patients' charts.

And never mind the PIV badge. I've given up on that. Next thing I know they'll just prevent me from walking through the hospital doors. Fine with me!

That article about suicides among veterans is interesting. Every single thing I see the VA do in response to the suicide problem just looks ridiculous if you ask me. This is true whether it's the "flagged" charts or the endless "suicide risk assessment" check box forms that NEVER influence clinical decision making, or the triplicate phone calls to no shows, or the "treatment plans" that just copy what's in the H&P. Seriously all that paperwork has probably just resulted in VA staff starting to feel suicidal themselves. Not to mention it slows down seeing patients.

Originally Posted by nancysinatra

At least you have the hope of logging on. My VA locked a bunch of residents out of the system because we didn't complete some asinine online HIPAA training thing that got announced at the last minute--while some of us were out of town attending VA related conferences!!! Now I can't get ahold of the coordinator who is supposed to tell me how to restore my access. I've also been told that after I finish the training, it has to go through 14 LEVELS of bureaucratic approval before my access is restored. So much for seeing patients when I can't get to my template let alone patients' charts.

Classic scenario. The best is when CPRS crashes and continues to keep you logged in and you're SOL for 20-30 minutes until idle kicks in.

Originally Posted by nancysinatra

At least you have the hope of logging on. My VA locked a bunch of residents out of the system because we didn't complete some asinine online HIPAA training thing that got announced at the last minute--while some of us were out of town attending VA related conferences!!! Now I can't get ahold of the coordinator who is supposed to tell me how to restore my access. I've also been told that after I finish the training, it has to go through 14 LEVELS of bureaucratic approval before my access is restored. So much for seeing patients when I can't get to my template let alone patients' charts.

And never mind the PIV badge. I've given up on that. Next thing I know they'll just prevent me from walking through the hospital doors. Fine with me!

That article about suicides among veterans is interesting. Every single thing I see the VA do in response to the suicide problem just looks ridiculous if you ask me. This is true whether it's the "flagged" charts or the endless "suicide risk assessment" check box forms that NEVER influence clinical decision making, or the triplicate phone calls to no shows, or the "treatment plans" that just copy what's in the H&P. Seriously all that paperwork has probably just resulted in VA staff starting to feel suicidal themselves. Not to mention it slows down seeing patients.

I so love this post. About the lockout thing -- I lucked out, but it happened to several nurses here, all the med students, a few residents and social workers. So basically no one got to do any work you know helping vets because of VA bureaucratic BS.

The last paragraph, so freaking true. My work on the unit consists of endless suicide risk assessments, notifying some suicide prevention coordinator, making sure suicide safety plans get done ... But none of this stuff actually helps patients as far as I can tell. Does anyone look as a suicide risk assessment? I don't.

Originally Posted by Doctor Bagel

Does anyone look as a suicide risk assessment? I don't.

I think only lawyers look at it. A forensic specialist may know the definite answer to this question. It might be the single most important piece of documentation for legal protection in a psychiatric assessment. ie. patient's family sues you, their lawyer says to you "there is no suicide risk assessment". Which then automatically means you didn't think about it. I moonlight at a place where social workers do the suicide risk assessment. It's nice.

A forensic specialist may know the definite answer to this question

This issue's kind of a sore spot because it's so grey. There are psychiatric textbooks citing that there is really no standard of care when it comes to predicting suicide because it is such a grey area. If that is the case (and I got that textbook saved in case I ever need it to save by butt), then one could never be successfully sued for malpractice if a patient commits suicide because malpractice requires there be a violation in the standard of care. I can't believe there is no standard whatsoever. Perhaps those texts meant there is no way to be able to predict suicide in a manner that could be clearly defined. Certainly a standard IMHO would consist of a psychiatrist taking the typical steps that any reasonable person would do in addition to doing a standard initial interview.

As with any risk assessment when it comes to something where free-will is involved (e.g. predicting future violence), there are static risk factors and dynamic ones. Static factors cannot be changed. E.g. one's sex, race, age, etc. Dynamic ones could be changed. For example, the last occurrence where someone attempted suicide, the person's recent behavior, or a contract for safety are some examples.

A problem with any risk assessment that uses a checklist and score is that clinical judgment is needed. Further, to simply judge a situation based on static factors (or even dynamic ones) without looking at the situation as a whole (this requires clinical judgment), is that you're literally just profiling if only judging by specific factors in a mechanical manner.

For example if I were to do a 72 hour (edit-forgot to write "hold") on every single person that lit up on a typical suicide risk assessment, then every single older white male with a gun is going to be held against their will no matter what they did, and I'd be discharging every single African-American female who believes in God no matter what they did.

Checking out the risk assessment forms in any situation will help cover your butt, but they are not the end-all-be-all. I certainly would advise it because having one and at least factoring into your decision will give you an added layer of protection in this specific area that is so grey--and as a result could make you feel uncomfortable.

Originally Posted by whopper

A problem with any risk assessment that uses a checklist and score is that clinical judgment is needed.

This just encapsulates everything that's wrong at the VA in general. If you ask me, "judgment" of any kind long since left the VA and mostly all that is left is the bureaucratic shell of an overgrown government institution that breeds dependency at every level nowadays.

The one thing I would have liked to experience during my time at the VA would have been to meet a WWI vet. That would have been cool. However the last one died recently. The WWII and Korean War vets are interesting to meet too.

However as far as those older vets seeming more professional, I gotta say, the American economy is not in the favor of the returning vets nowadays, nor has it been for many years. When those WWII vets returned, they could count on the GI bill giving them some serious upward mobility, which isn't exactly the case nowadays.

http://www.nytimes.com/2012/04/19/us...r=1&ref=health

Veterans Department to Increase Mental Health Staffing

The Department of Veterans Affairs will announce on Thursday that it plans to hire about 1,600 additional psychiatrists, psychologists, social workers and other mental health clinicians in an effort to reduce long wait times for services at many veterans medical centers.

The hiring, which would be augmented by the addition of 300 clerical workers, would increase the department’s mental health staff by nearly 10 percent at a time when the veterans health system is being overwhelmed not just by veterans returning from Iraq and Afghanistan, but also by aging veterans from the Vietnam era.


“History shows that the costs of war will continue to grow for a decade or more after the operational missions in Iraq and Afghanistan have ended,” Eric K. Shinseki, the secretary of veterans affairs, said in a statement to be released Thursday. “As more veterans return home, we must ensure that all veterans have access to quality mental health care.”
The announcement comes as the department is facing intensified criticism for delays in providing psychological services to veterans at some of its major medical centers.
The department’s own inspector general is expected to release a report as soon as next week asserting that wait times for mental health services are significantly longer than the department has been willing to acknowledge.
Senator Patty Murray, a Washington Democrat who is chairwoman of the Senate Veterans’ Affairs Committee, has also scheduled hearings next week about the delays.
And last year, the United States Court of Appeals for the Ninth Circuit, based in San Francisco, issued a scathing ruling saying that the department had failed to provide adequate mental health services to veterans.
“No more veterans should be compelled to agonize or perish while the government fails to perform its obligation,” Judge Stephen Reinhardt wrote for the majority. The Obama administration has appealed the ruling.
The veterans department says that it has worked hard to keep pace with the tide of new veterans needing psychological care, increasing its mental health care budget by 39 percent since 2009 and hiring more than 3,500 mental health professionals.
The department says it has also established a policy to do mental health evaluations of all veterans not in crisis within 14 days, a goal it says it meets 95 percent of the time.
However, the inspector general’s report is expected to question the validity of that claim.
One issue confronting the department has been finding enough mental health clinicians to fill job openings, particularly in rural areas. The director of veterans health care in Montana recently was reassigned, for instance, amid complaints that she had been unable to hire psychiatrists to staff a new psychiatric unit.
But department officials said they were confident that they would be able to find qualified mental health clinicians in most regions. Funds for the new jobs will be allocated out of the current department budget, the officials said, and clinicians will be added to all 21 of the department’s service networks.
The vast majority of the new hires, about 1,400, will be patient care providers. But the department also plans to hire more than 100 people for a crisis hot line as well as 100 examiners to review disability compensation and pension claims.
That disability compensation system is struggling with a growing backlog, with nearly 900,000 veterans currently waiting for decisions on their claims.

Originally Posted by nancysinatra

That article about suicides among veterans is interesting. Every single thing I see the VA do in response to the suicide problem just looks ridiculous if you ask me. This is true whether it's the "flagged" charts or the endless "suicide risk assessment" check box forms that NEVER influence clinical decision making, or the triplicate phone calls to no shows, or the "treatment plans" that just copy what's in the H&P. Seriously all that paperwork has probably just resulted in VA staff starting to feel suicidal themselves. Not to mention it slows down seeing patients.

Totally agree with this. One of the main reasons I turned down the VA jobs offered to me.

The paperwork and bureaucracy are some of the reasons I cannot wait to leave the VA. Half of my time in residency was spent at a VA. There were times when I did not feel like a physician at all. For instance, in order to order a non-formulary medication it has to first be approved by a Pharm.d who has no clue of the pt's background. Do they not think I considered those medications when making my decision? Its just so frustrating dealing with the staff who all think they know more than the doctors. Everyone walks around in long white coats. Pts were getting so confused about who their physician was that they started complaining. We now wear these large bright red badges stating Resident Dr with attendings wearing large black badges stating Attending Dr.

Well in ever changing tides and currents in my life the state hospital I left a few months ago to join the university as a professor offered me the #3 highest doctor's position as the director of forensic psychiatry. I know it's not the VA but there's a heck of a lot of parallels, and it's basically a yellow brick road to the #1 doctor's position at that hospital so long as I continue to do good work.

Nuts. I'm getting a headache because each time I turn down some of the job offers I get, I truly regret it. I'm deciding for now to avoid the position because I'd be knee deep in bureaucracy plus I know plenty of bad doctors at that hospital that I'd likely have to beg to stay there because I couldn't replace them--besides, I'm still getting my ego stroked being able to work side by side with some of the top doctors in the country and I am learning things from them I wouldn't have if not in this position.

At least as a clinical doctor in a state hospital I was like Capt. Kirk...I could do what I wanted and be in charge of something I believed in. I think going into administration would make me like Admiral Kirk, hating the higher position and wishing I were back in the trenches.