PhD/PsyD Here is the letter to congress to address VA concerns!

[CogNeuroGuy]

Fair enough, I will concede the first point, I have been conflating the two posters. For that I do apologize.

As to the second. I'm not here to hold hands. We are in the business of science and empiricism. I'll argue for that and for the profession for the entirety of my career. For that I make no apologies.

I understand this, and I know many people who are like this. It fits you, but realize that there are others who may not share that same perspective as professionals. I can think of many psychologists who don't take that approach when dealing with people, so I know it can be done and I know there is not "one way/ best way" in dealing with people. I am a pretty relaxed person, so I typically see the value in many things rather than just a couple of things when I discuss something. If that makes me a terrible psychologist, then so be it, but I personally feel that characteristic is not a detriment.

Other than that, I've said what I have needed to say, I have some meetings and a hair cut to get to (not in that order).

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[WisNeuro]

Fair enough. We need all kinds in psychology. But we've held an "everyone's viewpoint is equally valid" kind of reasoning in the profession for too long. It's led to a loosening of standards and foundations in the field. I am not ok with that and I am willing to argue against it. We all wear different hats, and that is my advocacy hat. It is a different style and hat than my therapy, assessment, or administrative hats.

 

[nessa34]

I think it's useful to know that a leader in the field who is pushing for a stance seemingly incongruous to the health of the profession has a vested interest- namely, that he went to one of the schools that stands to benefit. I am assuming that this is what cogneuroguy is trying to say.

I also think cogneuro guy has a point- there is a difference between calling out posts that are misleading or unhelpful as such (which may require one's advocacy hat), and dismissing posts without trying to understand the motivation or meaning behind the post (which is not in the spirit of a board intended for *students*). I have started to see more and more of the latter on here. For me personally, I no longer post much here for fear it will be misconstrued and I will be piled on. Perhaps cogneuroguy and I are alone in this, but it's concerning for me. This forum has been a very valuable resource for me in the past and I don't want it to stray from that.

 

[WisNeuro]

To be fair, I did apologize for conflating his posts with OneNeurodoc, who was making misleading statements. There will always be contentious issues around the profession, especially when some see some things as a direct threat to the profession's well-being (e.g., FSPS's). That being said, I don't think I've ever seen any one "piled on" when they've provided a cogent argument backed up with empirical support. We get on people who throw out irrelevant anecdotes and the like, presenting them as proven fact. This is what we are in the business of. We are a profession backed by science, and you need to be able to defend your assertions. It is this way in the clinical world. I need to use appropriate neuropsychological instruments that are backed by empirical data and appropriate, well-validated norms. If I deliver treatment, it has to have met certain standards of efficacy from an empirical point. I understand wanting to avoid confrontation, but confrontation on this board is nothing compared to confrontation in the real world. If people can't take a dose of it here, it's going to be a long, hard, road ahead in the profession.

 

[nessa34]

I appreciate the reply, WisNeuro, but none of it addresses my concerns.

There will always be contentious issues around the profession, especially when some see some things as a direct threat to the profession's well-being (e.g., FSPS's).

We get on people who throw out irrelevant anecdotes and the like, presenting them as proven fact.

What I am talking about goes beyond discussions of FSPSs or irrelevant anecdotes presented as fact. This is the problem, actually- any disagreement is lumped together.

That being said, I don't think I've ever seen any one "piled on" when they've provided a cogent argument backed up with empirical support.

What is empirical support on an internet forum? If we are talking citations and the like (which is my definition), then yes, you will not see any piling on in response to such posts because virtually no posts meet this criteria.

This is what we are in the business of. We are a profession backed by science, and you need to be able to defend your assertions. It is this way in the clinical world. I need to use appropriate neuropsychological instruments that are backed by empirical data and appropriate, well-validated norms. If I deliver treatment, it has to have met certain standards of efficacy from an empirical point.

Again, how does this apply to forum discussions? How is this anything but a red herring?

I understand wanting to avoid confrontation, but confrontation on this board is nothing compared to confrontation in the real world. If people can't take a dose of it here, it's going to be a long, hard, road ahead in the profession.

And confrontation without thought here is just as dangerous, and just as likely to lead to an echo chamber with no real discussion, as IRL.

 

[MCParent]

Most of that information you just stated came from OneNeuroDoctor, not me, I did not add those value-laden terms. Review my prior posts.

You said the base fact, and appeared confused about why people reacted to it. I was trying to illustrate that people reacted to it b/c it can't be used to form a good argument on either side; it would be used either as OND did (to say he's wealthy or old or whatever) or to dismiss the argument because of a personal fact about him.

I continue to fail to understand the tone issue. It baffles me. This is an anonymous forum, how could it possibly affect anything in the world to be disagreed with? (This comes up on listserves occasionally, which are generally not anonymous, and it still confuses me.) e.g., "For me personally, I no longer post much here for fear it will be misconstrued and I will be piled on." I don't understand. This is an internet forum, so you can't actually be shouted at or interrupted. If multiple people disagree with you, so what? If something was misconstrued, you write a correction (e.g., I made a post a while back that was poorly worded about bisexual people, and seemed to suggest something that I didn't mean. Two people pointed this out, and I accepted my wording error and clarified. This did not cause psychic trauma). The only interpretation I can make is that this concern would stem from a fear of being shown to be incorrect about something.

 

[nessa34]

I continue to fail to understand the tone issue. It baffles me. ... The only interpretation I can make is that this concern would stem from a fear of being shown to be incorrect about something.

or that people are more (and, admittedly, perhaps overly) sensitive to criticism compared to you? perhaps people respect the more senior people on this board and are hesitant to disagree with them? or perhaps people don't want to be psychoanalyzed for making a point? really, I expected better from you.

 

[WisNeuro]

Nessa, we post data here all the time. People are constantly citing research or actual figures in some of our dealings. Whether it be the RxP thread, or APPIC match rates, treatment efficacy, etc. We're fine with disagreement, just back it up with something. As for confrontation without thought does happen, I like to think I put a lot of thought into my confontational comments. If people can't take it, as I said, I'm not optimistic about their chances in the real world.

 

[AcronymAllergy]

Hey all, let's see if we can return to the original topic (i.e., the letter to Congress); if further discussion of the other issues is desired, it can of course be continued via PM or perhaps in a new thread. Thank ya.

 

[CogNeuroGuy]

Yeah, there really isn't much I can say without it being psychoanalyzed or essentially "intellectualized" as to why people constantly feel the need to use verbiage that is condescending. There is no excuse for it, simply saying "everyone else does it in the field and you should buck up" is not a reason. It perpetuates the idea that it is acceptable. I don't care if you have 3 Ph.D.'s, treat people with respect, whether that be how you phrase things or tone (internet or verbal). You can be 100% right about a theory you may have, how you present it will determine how people might take to your character. I know really smart people that I work with, but they are dinguses and they think because they are a scientist it gives them the right to intellectualize why they can treat people the way they do. These people I often avoid, I would opt to not work with in projects, manuscripts, etc. Being collaborative and not condescending is key. It's interesting that this part of psychology, people are cherry picking out of their life. This is one golden rule I have been learning as a graduate student and one I continue to use as a constant. Life is way too short to essentially work with dinguses. They may be out there and will always be out there, but you have the ability to not work with them and hopefully that might be a testament to them to want to change their behavior. If not, they will quickly realize they are missing out on some great people they could have worked with, been friends with, etc.

I worked the Sports Neuropsychological Society conference and had the pleasure of meeting a lot of people at the check in booth. However, I did get to meet some really neurotic and rude people, which for the life of me I can't fathom. Those are the people that I would put on a fake smile, still was polite and tried everything I could to ease them down, but ultimately, I redirected them to get the seated in their lecture to get off my back. Professionally, these are people who will isolate themselves from different populations of people, many will be attracted to this type of personality, many will also be repulsed. I like to strike a good balance between the two. I may not agree with working with Christian conservatives, but I will always respect them, engage them in good productive conversations about it and make them feel proud about who they are as opposed to needing to feel defensive about their religious convictions. This is an example of something I have a strong stance on, but a great example of how diversity of perspective can be dealt with professionally, cordially and even productively.

And sorry for not using some pie chart or regression analysis in my forum post, I didn't have a scholarly article open at the time I was writing this to back my opinion on the matter.

 

[CogNeuroGuy]

Nessa, we post data here all the time. People are constantly citing research or actual figures in some of our dealings. Whether it be the RxP thread, or APPIC match rates, treatment efficacy, etc. We're fine with disagreement, just back it up with something. As for confrontation without thought does happen, I like to think I put a lot of thought into my confontational comments. If people can't take it, as I said, I'm not optimistic about their chances in the real world.

This doesn't work out too well, blaming the victim so to speak. I may not be approaching adversity as you do, I personally feel it is cold and insensitive, not something I prefer and hardly believe this is the standard model of operation for training psychologists. It's your approach, your opinion, not the rule. I firmly believe that this has gotten way out of control, way too much thought has been placed on such a trivial topic that has spiraled out of control, and it doesn't help that I rebuttal to yours and others posts, for that I see my fault.

 

[WisNeuro]

Blaming the victim, or constructing a victim where there is none in the first place? This forum isn't a training program, these are not my supervisees or patients. I do not treat them the same way. When someone asks advice, I provide it, I have very good feedback and plenty of PM's from people seeking such advice. When someone wants to debate a controversial topic, they should be prepared to back up their assertions. Context matters a lot, both in and out of this forum.

Feel free to PM me if you want o discuss it further. Otherwise, we can get back to the VA letter.

 

[smalltownpsych]

I just wanted to chime in on this. I am glad that the VA upholds the standard of APA internships and also that states are beginning to implement that as a requirement. We cannot afford to allow standards to slip. I work in a underserved area and i get paid well because I am a licensed psychologist in a state with some of the highest standards and the people in this community see the value that I bring and are willing to pay me for that. The choice is simple: either lower the standards or increase the pay. That is it. Law of supply and demand and the good ole bell curve. Not everyone can nor should be a doctor and this limits the supply which drives the demand and increases our pay. Economics 101 (well maybe, I never really took an econ course)

 

[OneNeuroDoctor]

Is anybody watching the news about what is happening with the VA? The ole saying is turning out to be true and so far we are just seeing "The Tip of the Ice Berg." Hopefully this mess get figured out! For Federally funded hospitals using tax money, how can they justify such large bonuses? One of the VA administrators today said they have to have large bonuses to retain staff. Certainly Doctors are not working at the VA just for the money when they can make more money in the private sector.

Initially the problems were isolated incidents but today on the news they are reporting inflated evaluations so administrators could get extremely large bonuses. Some of these administrators are resigning under pressure and paying back bonuses they did not deserve.

Thank goodness this is not happening in the psychology divisions of the VA.


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[WisNeuro]

Yeah, our wait list currently is maybe 2-3 weeks out at our VA. I've worked in one neuropsych clinic and one AMC npsych clinic in earlier years. Waiting lists, 4-6 months for each.

 

[erg923]

Beefin the numbers is wrong, obviously. Having a cetralized admin that passes down policies without proper utilization and resource analysis in also stupid (I have no idea what the rationale is for the "8 in 14", can someone explain this idoiatic things to me?)

Otherwise, the VA does very well in terms of care, care outcomes, and providing care timelines that are not much different from the private sector. But, that doesnt sell papers, does it?

I agree, bonuses are pretty standard aspect of many jobs even in healthcare. I get a bonus at my job for various things. Seems appopriate. And it helps make this an appealing place to work.

 

[WisNeuro]

Well, usually when a private hospital does something wrong, you never hear about as it's taken care of internally. Or, if you do, no one remembers after a couple of months. As erg says, media outlets need to sell stories, and people love to **** on the VA because it's a government agency and an easy target, even if it's outcomes exceed the national averages in relation to other hospitals.

Bottom line, can things improve at the VA ,of course, and we hope it does. But, we generally deliver care that exceeds most hospitals in this country. At least our hospital administrators don't get bonuses for turfing uninsured patients to county hospitals. So, I guess we're doing at least one thing right.

 

[Therapist4Chnge]

Yeah, our wait list currently is maybe 2-3 weeks out at our VA. I've worked in one neuropsych clinic and one AMC npsych clinic in earlier years. Waiting lists, 4-6 months for each.

For reference, those wait times are in line with what I've seen at multiple AMCs and the VA clinic I trained at for internship.

 

[erg923]

Well, usually when a private hospital does something wrong, you never hear about as it's taken care of internally. Or, if you do, no one remembers after a couple of months. As erg says, media outlets need to sell stories, and people love to **** on the VA because it's a government agency and an easy target, even if it's outcomes exceed the national averages in relation to other hospitals.

Bottom line, can things improve at the VA ,of course, and we hope it does. But, we generally deliver care that exceeds most hospitals in this country. At least our hospital administrators don't get bonuses for turfing uninsured patients to county hospitals. So, I guess we're doing at least one thing right.

Its ironic to me that, given the light shining on the VA, anyone would even suggest hiring MH staff who have anything less than gold standard qualifications/training.

How does this headline look:
"VA hires unaccredited psychologists to provide care for our nations heros!" Yea, that will make us look good...

 

[WisNeuro]

Well, we do unfortunately allow EMDR as a treatment for PTSD,.....so maybe we're not that far off.

 

[smalltownpsych]

I think the main problem with the bonuses at the VA is that they were able to be earned by cooking the books. Any compensation package that allows for you to earn more by self-report is going to lead to something like this. When I worked in sales, an employer came out with a bonus plan that was tied to the number of cold-calls made per hour. We burned through those calls so fast that the number skyrocketed, of course, sales plummeted and they had to quickly change the compensation package. It sounds like the VA administration was trying to fix the problem of wait list and didn't take this human factor into account. Obviously, a bad move. It doesn't even have to be intentional deception as we all know. Hence, the double blind in research.

I also wanted to add that I am glad that the VA continues to hold the line on the need for accredited internships. We don't need lower standards for licensure and in my experience the VA is doing a great job in providing psychological services to our vets. Keep up the great work!

 

[WisNeuro]

Well, to be fair, we need to look at executive bonuses and clinician bonuses through a separate lens. Our bonuses are a result of many factors (clinical work, training, research, etc). They're not blank bonuses for us, and we actually have to have products to show for it.

 

[AcronymAllergy]

I agree--initially the focus was on the executive-level folks whose bonuses may have been earned via fraudulent practices, but some of the recent stuff I've seen coming out seems to be broadening things and saying essentially, "look at ALL these people across the whole VA who got bonuses! Who gets bonuses? I sure don't, so that must mean they're bad!"

And I also agree with JS that this recent number indicating that 1,000+ veterans may have died due to extended appointment times has little to no substantiation at the moment; it's probably only received attention because A) it's about the VA, and B) it was a legislator-physician's office that put it out. I know that, for example, negotiated appointments that were set past the scheduling guideline windows ended up counting against facilities, so there's a chance these were factored into the 1,000+ figure.

 

[smalltownpsych]

Well, to be fair, we need to look at executive bonuses and clinician bonuses through a separate lens. Our bonuses are a result of many factors (clinical work, training, research, etc). They're not blank bonuses for us, and we actually have to have products to show for it.

I don't think anyone has criticized provider's bonuses at the VA or at least I haven't heard that in the media. It is tough to criticize a bonus structure if it is closely tied to verifiable data. I am not surprised that the execs made the structure very solid and difficult to earn for providers of care and much less rigorous for themselves. More of that human nature stuff.

 

[WisNeuro]

I don't think anyone has criticized provider's bonuses at the VA or at least I haven't heard that in the media. It is tough to criticize a bonus structure if it is closely tied to verifiable data. I am not surprised that the execs made the structure very solid and difficult to earn for providers of care and much less rigorous for themselves. More of that human nature stuff.

It's more that they discuss bonuses at the VA as a singular concept. I assure you that people now believe that bonuses in general in the VA are bad all around and I have heard rumblings of freezes in such at all levels. Remember, we don't have much say about this at the local level, if a politician in DC wants to make a theatrical show of support for Veterans and pass a resolution against bonuses, it can definitely happen. Just look at the pay freeze that just expired, that thing lasted a long time >5 years I believe. It's all about perception in the public, and right now the media is fueling only the negative hype.

 

[erg923]

It's more that they discuss bonuses at the VA as a singular concept. I assure you that people now believe that bonuses in general in the VA are bad all around and I have heard rumblings of freezes in such at all levels. Remember, we don't have much say about this at the local level, if a politician in DC wants to make a theatrical show of support for Veterans and pass a resolution against bonuses, it can definitely happen. Just look at the pay freeze that just expired, that thing lasted a long time >5 years I believe. It's all about perception in the public, and right now the media is fueling only the negative hype.

Which is why, of all times, this is the dumbest possible time to push this unaccredited programs and internships issue. It looks bad. It reflect bad on the profession and it would reflect bad on the VA.

Someone always asks, "Well, do you have empirical evidence of that those that went to APA programs and/or internships are better psychologists? Well, no, how the **** would you design a controlled study for that! We use known metrics of quality, and those metrics then help create checks and balances to increase confidence in quality of training. Its no different than board cert for physicians or going to a residencey that was accredited. How come these folks never challenge the notion that VA physcians need to have gone to an accredited medical school or an accredited residecy, etc.?

 

[NHPilot]

It's more that they discuss bonuses at the VA as a singular concept. I assure you that people now believe that bonuses in general in the VA are bad all around and I have heard rumblings of freezes in such at all levels. Remember, we don't have much say about this at the local level, if a politician in DC wants to make a theatrical show of support for Veterans and pass a resolution against bonuses, it can definitely happen. Just look at the pay freeze that just expired, that thing lasted a long time >5 years I believe. It's all about perception in the public, and right now the media is fueling only the negative hype.

Doesn't look good and it is a terrible blow to VA providers....

"The U.S. House unanimously passed a bill Tuesday that would ban bonuses for all Veterans Affairs Department employees through 2016, but the Phoenix VA Health Care System refuses to disclose how many of its employees received bonuses despite one official's acknowledgment that the information is readily available."

"VA investigators have confirmed that agency officials across the country were "gaming the system" of tracking appointments in order to get financial rewards. Acting VA Secretary Sloan Gibson, Shinseki's replacement, last week said he ordered a stop to all bonuses for VA executives and had suspended extra performance pay to other employees."

"On Tuesday, the House in a 426-0 vote went even further by seeking to ban all bonuses for the next few years, which would save the VA $400 million annually, according to House Veterans' Affairs Committee Chairman Jeff Miller, R-Fla., the bill's author. Miller said that money could be used for expanded care for veterans."


http://www.azcentral.com/story/news.../2014/06/10/va-bonuses-phoenix-over/10310313/

 

[WisNeuro]

And that's the thing I was talking about smalltown.

 

[NHPilot]

Interesting read.....proposes increases of base pay, loan repayment and increased pay for rural and under served areas as opposed to bonuses for VA providers:

U.S. Rep. Ann Kirkpatrick, D-Ariz., a member of the House Veterans' Affairs Committee, issued the following statement about today's hearing, "Review of Awarding Bonuses to Senior Executives at the Departent of Veterans Affairs," and submitted 10 questions for the record:

http://kirkpatrick.house.gov/media-...and-questions-for-veterans-affairs-hearing-on

 

[OneNeuroDoctor]

Wow that happened quickly! I was reading on a website that this investigation actually began back in 2005. Seems odd that it is just being reported now in 2014. Sounds like to avoid criminal fraud charges some of these folks are resigning and paying back bonus money. My guess is due to the severe shortage of doctors they will find good jobs or will this be an ethic violations resulting in losing their medical license?


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[smalltownpsych]

Doesn't look good and it is a terrible blow to VA providers....

"The U.S. House unanimously passed a bill Tuesday that would ban bonuses for all Veterans Affairs Department employees through 2016, but the Phoenix VA Health Care System refuses to disclose how many of its employees received bonuses despite one official's acknowledgment that the information is readily available."

"VA investigators have confirmed that agency officials across the country were "gaming the system" of tracking appointments in order to get financial rewards. Acting VA Secretary Sloan Gibson, Shinseki's replacement, last week said he ordered a stop to all bonuses for VA executives and had suspended extra performance pay to other employees."

"On Tuesday, the House in a 426-0 vote went even further by seeking to ban all bonuses for the next few years, which would save the VA $400 million annually, according to House Veterans' Affairs Committee Chairman Jeff Miller, R-Fla., the bill's author. Miller said that money could be used for expanded care for veterans."


http://www.azcentral.com/story/news.../2014/06/10/va-bonuses-phoenix-over/10310313/

Unfriggin' believable! Typical political garbage. Punish the people who are actually doing the work after the people that have screwed the system have already gotten paid. I guess I should have seen that coming.

 

[AcronymAllergy]

The medical license board is a different animal. I'm guessing (don't know) that a lot of this is a politically manufactured issue and that the individuals involved were probably hamstrung by various rules from the congressional level and that, "wrong doing" was likely pretty limited. I doubt they will lose their licenses.

I'd imagine this is probably largely true. Were there some folks who likely "gamed the system" for bonuses? Sure, but does that mean every executive did so? Of course not. But let's not have paltry things like "the truth" prevent Congress from swooping in to try and act like bandwagoneering heroes.

 

[cara susanna]

Hilarious that Congress is taking away bonuses from employees that they feel were corrupt and didn't do enough. *cough*

 

[OneNeuroDoctor]

Hilarious that Congress is taking away bonuses from employees that they feel were corrupt and didn't do enough. *cough*

If I am reading this right, all bonuses are on hold until after 2016. Rather than punish the offenders all staff will be punished.

Seems that some administrator were getting insanely high bonuses of 10,000 bucks per year. I doubt that the staff positions were that high as clinical psychologists were more in line between 100-500 dollars per year. No wonder they were having budget issues if administrators were receiving high bonuses.

It seems that administrator were receiving bonuses based on keeping cost down or being cost efficient and eliminating waste of money. Seems that they were violating sound management principals and rather than using money to provide quality services they were padding their own wallets. No telling how long this practice would have continued without whistle blowers risking their jobs by revealing this corruption.

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[NHPilot]

Seems that some administrator were getting insanely high bonuses of 10,000 bucks per year. I doubt that the staff positions were that high as clinical psychologists were more in line between 100-500 dollars per year. No wonder they were having budget issues if administrators were receiving high bonuses.

It would be nice it it were only 10 grand....

"Panel chairman Jeff Miller, a Florida Republican, cited numerous examples of what he characterized as unwarranted bonuses to VA officials overseeing a department with such problems in recent years:

• The medical center director in Dayton, Ohio, receiving a bonus exceeding $10,000 despite an investigation of veterans getting exposed to hepatitis B and C at the facility;

• The former director of the VA regional office in Waco, Texas, getting more than $53,000 in bonuses when the average processing time for disability claims increased to what Miller called "inexcusable levels."

• The director of the Pittsburgh health care system getting a top performance review and a regional director getting a $63,000 bonus despite a legionella outbreak in the Pittsburgh VA health care system that led to six patient deaths.

"To the average American, $63,000 is considered to be a competitive annual salary, not a bonus," Miller said."

http://www.cnn.com/2014/06/20/politics/va-scandal-bonuses/

 

[OneNeuroDoctor]

It would be nice it it were only 10 grand....

"Panel chairman Jeff Miller, a Florida Republican, cited numerous examples of what he characterized as unwarranted bonuses to VA officials overseeing a department with such problems in recent years:

• The medical center director in Dayton, Ohio, receiving a bonus exceeding $10,000 despite an investigation of veterans getting exposed to hepatitis B and C at the facility;

• The former director of the VA regional office in Waco, Texas, getting more than $53,000 in bonuses when the average processing time for disability claims increased to what Miller called "inexcusable levels."

• The director of the Pittsburgh health care system getting a top performance review and a regional director getting a $63,000 bonus despite a legionella outbreak in the Pittsburgh VA health care system that led to six patient deaths.

"To the average American, $63,000 is considered to be a competitive annual salary, not a bonus," Miller said."

http://www.cnn.com/2014/06/20/politics/va-scandal-bonuses/

Whoever approved these insanely high bonuses was really out of line. A performance bonus should never be this high. Corruption... Sound like the Superintendent for Dallas School District who was paying consultant $100,000 a year for two weeks consultant schedule per year but he had telephone contact this rest of the year. They then discovered that he bought a $60,000 sailboat with school district credit card as well as other administrative staff embezzling money for personal interest.





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[AcronymAllergy]

I agree with what JS has posted--while the media and Congress have painted the bonuses to look egregious, we really don't know any details pertaining to how/why they were earned. It's possible that they were the result of some type of foul play, but it's also possible that they were awarded for legitimate reasons.