another VA question

[Igor4sugry]

Anyone have perspective of working at Phoenix VA? They have multiple job openings, but what is the reason for this (more positions added or increased turnover)? The news have been hammering away at care in that system. Are psychiatrists under the magnifying glass there? Here is a story about suicidal patients eloping from the ED. http://dailycaller.com/2016/03/22/e...-phoenix-facility-va-tries-to-dodge-findings/
Feel free to PM me, it would be helpful.

---

Members don't see this ad.

 

[wolfvgang22]

Well, you have to keep in mind that Phoenix was ground zero for long waits in their ER a couple of years ago. There was a big shortage of doctors and unrealistic expectations for insufficient staff to be able to see a huge number of patients in the ER and in primary care.

Rather than listen to the doctors and hire more staff, the administration there in Phoenix created a hostile environment where staff would keep an unofficial off the books wait list of patients needing care to avoid getting written up for not seeing all the patients quick enough. The line of patients waiting to be seen in the ER would stretch out to the street every day. I saw this in person a couple of years before the poo hit the fan. The initial whistle blowers for all this mess were an ER doc (who was run off by admin in Phoenix) and another retired Phoenix VA doc. There was an investigation. It was found that somehow, no deaths were directly due to the long waits. What eventually resulted was the director of the entire national VA lost his job (it wasn't his fault, he had been making reforms for some time nationally) and then the director of the Phoenix VA lost her job (it was at least partly her fault). The entire VA then went through a shake up to make sure this kind of thing isn't happening anywhere anymore. Every single VA department in every clinic and hospital got audited for wait times.

However, the VA still has a huge problem attracting and keeping good physicians, and no matter how many rules they make that a veteran must be seen within X number of days, hours, or minutes, without a clinician available those rules are nearly useless and just causes burn out among the staff they do have. Which then makes it harder to recruit new staff, because word gets around.

The psychiatry department in Phoenix has the misfortune of being near the ER.

There are many folks in the media who know that writing any negative articles about the Phoenix VA in particular is a very easy way to get clicks online and sell more advertising, over two years after the initial scandal. Some are particularly anti-VA and have an agenda to privatize the VA. USA Today in particular will re-hash old stories criticizing the VA on slower news days rather than actually looking for news. Everything the VA does is public record. It's easy compared to trying to criticize a private entity. What these writers don't tell you is the fact that most veterans who use the VA, especially those with mental illness, have no insurance outside the VA, so privatization won't help those men and women. The VA is fantastic in a lot of ways for these low income patients, with very inexpensive and competent care they would never get without a government run VA and if they had to rely on private health care.
It is very obvious this is true, because the VA can't get private health care providers to accept the CHOICE card that the VA has made available to veterans who can't see a VA clinician within a month throughout many regions of the U.S., because it isn't profitable for private providers to accept the low amount of money the VA has available to pay for veteran care.

Congress needs to put its money where its mouth is when they tout how much they care about veterans in my opinion. There doesn't seem to be a dollar limit on war fighting over the last several years, but there sure is a limit on what they will spend for veterans health care.

One final note. One veteran once told me it is the sacred right of the soldier to complain, in a half joking manner. These veterans are often hurting, and the government promises them the best care in the world, more than private healthcare or even medicare or medicaid would ever offer, and then doesn't deliver. So veterans complain loudly. Some complaints very valid, some not. at all valid. The VA often can't explain or defend itself against any invalid complaints (like the guy who no showed 15 appointments last year and says nobody helps him) due to HIPPA privacy rules. So the VAs necessary silence looks like an admission of guilt of all complaints to the public.

 

[lymphocyte]

It is very obvious this is true, because the VA can't get private health care providers to accept the CHOICE card that the VA has made available to veterans who can't see a VA clinician within a month throughout many regions of the U.S., because it isn't profitable for private providers to accept the low amount of money the VA has available to pay for veteran care.
Congress needs to put its money where its mouth is when they tout how much they care about veterans in my opinion. There doesn't seem to be a dollar limit on war fighting over the last several years, but there sure is a limit on what they will spend for veterans health care.

Thank you for saying this so eloquently. QFT.

 

[AcronymAllergy]

Thank you for saying this so eloquently. QFT.

+1. There are now efforts to require walk-in, non-emergent MH pts be seen by MH the same day. My current clinic has been down 4 psychiatrists and I have no clue how many psychologists and NPs for ~1 year. Every time efforts are made to hire, things get bogged in red tape. But that doesn't stop more mandates from coming down from Congress, accompanied by their criticisms of "VA isn't doing its job, why should we give them more money?"

I enjoy the setting as a whole, and VA does many things very well, but there are definitely some frustrations. Mostly administrative. The providers I work with are great.

 

[wolfvgang22]

Yeah, same here, we have 6 psychiatrist openings - well, now only 4 because they have given up and are just now trying to hire NPs and PAs as a stop gap measure. I like my job here in this VA a lot, so I'm not going anywhere, though. I care more about my veterans than I probably should, I don't know.
I'm not happy at all with this push for non emergent walk ins. If they block off an hour or so a day for me to do that, maybe it's ok, but I'm very concerned it will result in a chaotic ER type situation. I'm pretty sure many veterans will just no show their scheduled appointments, and then just walk in whenever they deteriorate from medication non adherence. Personally, I have a lot of emergency psychiatry experience, and if I wanted to be doing that I'd work in a psychiatric ER working 4 twelve hour shifts a week with no call.
I agree with you, the main reason I stick around is I like my colleagues and the resources we have for patients a lot.

 

[WingedOx]

What eventually resulted was the director of the entire national VA lost his job (it wasn't his fault, he had been making reforms for some time nationally)

The GOP was REALLY not fond of Shinseki even before he took over the VA. He was a rather vocal critic of the GWB administration, and when scandal started brewing, they pounced. Shame too because McDonald seems in way over his head, particularly in the "stop saying really stupid things to the media" side of the job.

Yeah, same here, we have 6 psychiatrist openings - well, now only 4 because they have given up and are just now trying to hire NPs and PAs as a stop gap measure. I like my job here in this VA a lot, so I'm not going anywhere, though. I care more about my veterans than I probably should, I don't know.
I'm not happy at all with this push for non emergent walk ins. If they block off an hour or so a day for me to do that, maybe it's ok, but I'm very concerned it will result in a chaotic ER type situation. I'm pretty sure many veterans will just no show their scheduled appointments, and then just walk in whenever they deteriorate from medication non adherence. Personally, I have a lot of emergency psychiatry experience, and if I wanted to be doing that I'd work in a psychiatric ER working 4 twelve hour shifts a week with no call.
I agree with you, the main reason I stick around is I like my colleagues and the resources we have for patients a lot.

My job and site are similar. We're down a few docs, but not doing too badly. The inpatient and intake docs are feeling a lot more pressure to meet up with various mandates than I am. My general outpatient clinic has been rather low key. My department leadership is also doing a decent job of pushing back against walk-in appointments. The vast majority of patients I have who are trying to get walk-ins are perpetual no-showers or drug seekers, and for now I have the ability to tell them no. We'll see how long that lasts. There's talk of having a scheduled walk-in time, but honestly the patients who are complaining to our senators that they "The VA is refusing to give me care" won't show up during scheduled hours anyway even if we do that.

 

[vistaril]

Anyone have perspective of working at Phoenix VA? They have multiple job openings, but what is the reason for this (more positions added or increased turnover)? The news have been hammering away at care in that system. Are psychiatrists under the magnifying glass there? Here is a story about suicidal patients eloping from the ED. http://dailycaller.com/2016/03/22/e...-phoenix-facility-va-tries-to-dodge-findings/
Feel free to PM me, it would be helpful.

if you can get a VA job(input or outpt) in the area you live, run not walk to start there. It's impossible to overstate just how much better these jobs are(from a financial and benefits and workflow standpoint) than most jobs in pp. I once calculated the average per pt reimbursement for VA outpt positions after benefits and incentives and no shows and everything was accounted for and it came to something absurd like 204 dollars per outpt. Keep in mind the vast majority of those are going to be easy f/us. So 204 dollars per outpt checkin vs the private sector or community system? Not even close. Even in some fantasy world where you would make 200+ dollars for a routine PTSD med mgt f/u(yeah right), you still have to consider overhead, malpractice, etc...........

Saying the VA is the best game in town is like saying the sun is hot.

 

[st2205]

if you can get a VA job(input or outpt) in the area you live, run not walk to start there. It's impossible to overstate just how much better these jobs are(from a financial and benefits and workflow standpoint) than most jobs in pp. I once calculated the average per pt reimbursement for VA outpt positions after benefits and incentives and no shows and everything was accounted for and it came to something absurd like 204 dollars per outpt. Keep in mind the vast majority of those are going to be easy f/us. So 204 dollars per outpt checkin vs the private sector or community system? Not even close. Even in some fantasy world where you would make 200+ dollars for a routine PTSD med mgt f/u(yeah right), you still have to consider overhead, malpractice, etc...........

Saying the VA is the best game in town is like saying the sun is hot.

Have you ever worked VA outpatient? My original plan was to stay for a year at the VA here because they pay $235k and has a lot of time off. Having now just spent a year in that clinic, I wouldn't touch that job for less than $300k.

 

[notdeadyet]

Saying the VA is the best game in town is like saying the sun is hot.

You described the small handful of options you have available to you. Pretty much everyone chimed in that those options were pretty dismal and very unusual. You are limited to an extent that nobody else I've seen on these boards describe.

It's the best game in town because the town, as you've described it yourself, sucks.

 

[WisNeuro]

The VA is a very ambivalent place. My patients receive far better care than anything I had access to in AMC/PP settings, but providers have more frustrations and lack of incentives compared to those settings.

 

[vistaril]

You described the small handful of options you have available to you. Pretty much everyone chimed in that those options were pretty dismal and very unusual. You are limited to an extent that nobody else I've seen on these boards describe.

It's the best game in town because the town, as you've described yourself, sucks.

no, I've also worked extensively and looked for jobs in 3 other places separated by a few hundred miles. The VA workflow situation just can't be beat. Lets look at inpatient for example....VA inpatient docs typically cover 10-11 or so beds, and of those 10-11 4 are typically going to be just waiting forever and ever and basically take 2 mins a day. What a VA inpatient psych does in a whole day would be a quick pop-in before their real work starts in the morning for many people......

You have to look at ppc(per patient compensation). With the way their followups and intakes are structured and the no show rate and the 'non-clinical' time they PAY you for, it's the best game in town everywhere I've ever been by far.

 

[vistaril]

Have you ever worked VA outpatient? My original plan was to stay for a year at the VA here because they pay $235k and has a lot of time off. Having now just spent a year in that clinic, I wouldn't touch that job for less than $300k.

curious....why not? They do protected time and 30 minute followups right? What in the world is there to complain about that?

 

[Shikima]

curious....why not? They do protected time and 30 minute followups right? What in the world is there to complain about that?

You're sorely illiterate when it comes to the VA. The appointments may be that long, but you have a lot, I mean a lot, of things to cover in that appointment. That is if you have a nurse. In addition, you have people persistently in crisis which you must contact them. In some cases, you have to do your own follow-ups on no shows and document all of this. Plus the refills and lab follow-ups. It is not uncommon to have people squeezed into your clinic because another physician calls in sick and you are left to see them and those on your own panel, and the walk-ins, and anything else that literally anyone can schedule into your clinic without your permission. And you may have to cover the ER and other crisis as it comes up.

Sure, not all VA centers are going to be this way but I'm willing to bet a lot are and all VAs are significantly understaffed as cited by the psychologists on this board who are working at those centers.

 

[vistaril]

You're sorely illiterate when it comes to the VA. The appointments may be that long, but you have a lot, I mean a lot, of things to cover in that appointment. That is if you have a nurse. In addition, you have people persistently in crisis which you must contact them. In some cases, you have to do your own follow-ups on no shows and document all of this. Plus the refills and lab follow-ups. It is not uncommon to have people squeezed into your clinic because another physician calls in sick and you are left to see them and those on your own panel, and the walk-ins, and anything else that literally anyone can schedule into your clinic without your permission. And you may have to cover the ER and other crisis as it comes up.

Sure, not all VA centers are going to be this way but I'm willing to bet a lot are and all VAs are significantly understaffed as cited by the psychologists on this board who are working at those centers.

lmao....no you appear to be sorely illiterate when it comes to practicing everywhere else.

1) you have a lot of things to cover in an appt? Well just what in the hell do you think us in pp are doing during our apps(which are much shorter btw)? Playing checkers? We have a lot of **** to cover too.

2) if you have a nurse? wtf? The delusional level of this comment speaks for itself......

3) people in crisis? oh no!! All my patients in the community are always completely stable and loving life...thats why they come and see me.

4) the refills? oh no!!! the horror! I've never had to deal with a refill request in pp.

you would ****ing drown in a day if you were dropped in the real world....I can tell this from the way you talk. So definitely stay at the VA

 

[notdeadyet]

You have to look at ppc(per patient compensation). With the way their followups and intakes are structured and the no show rate and the 'non-clinical' time they PAY you for, it's the best game in town everywhere I've ever been by far.

The fact that you're comparing how great jobs are by the per patient compensation is telling.

You don't GET per patient compensation in the VA. Or many to most non-private jobs that are salaried. PPC has no bearing here.

Now if you're using that as some kind of substitute for the fact that you see less patients at the VA, this is true (for the most part). But the amount of non-patient care duties at the VA and administrivia is not to be underestimated. Yes you are paid for it, but it eats up the hours.

The VA tends to be slower pace than others but not as slow as you think. Also, the amount of work increases dramatically when you are at a major medical center or academically affiliated VA as opposed to CBOCs which can have long waits and an increased amount of patients to be seen.


Sent from my iPhone using Tapatalk

 

[vistaril]

The fact that you're comparing how great jobs are by the per patient compensation is telling.

You don't GET per patient compensation in the VA. Or many to most non-private jobs that are salaried. PPC has no bearing here.

of course it has bearing.....thats one way to rate compensation. if I have a choice between seeing 9 pts on average per day for 230k or 27 opts on average per day for 265k.....well the first job is better by a mile.

 

[notdeadyet]

of course it has bearing.....thats one way to rate compensation. if I have a choice between seeing 9 pts on average per day for 230k or 27 opts on average per day for 265k.....well the first job is better by a mile.

Like I thought. You're not looking at rate compensation, you're looking at the number of patients seen.

And it's not much of a particularly helpful metric unless you have an allergy to patients. How long are you seeing the patients? What acuity? What is the documentation burden? How much time do you have taken up by meetings, online training requirements, mandatory committees, etc.

 

[Shikima]

lmao....no you appear to be sorely illiterate when it comes to practicing everywhere else.

1) you have a lot of things to cover in an appt? Well just what in the hell do you think us in pp are doing during our apps(which are much shorter btw)? Playing checkers? We have a lot of **** to cover too.

2) if you have a nurse? wtf? The delusional level of this comment speaks for itself......

3) people in crisis? oh no!! All my patients in the community are always completely stable and loving life...thats why they come and see me.

4) the refills? oh no!!! the horror! I've never had to deal with a refill request in pp.

you would ****ing drown in a day if you were dropped in the real world....I can tell this from the way you talk. So definitely stay at the VA

le sigh.

I am in PP. I also work at the VA, along with other places.

I don't drown because I don't allow unessential work to be completed by me and I delegate. That is, until I get to the VA -- then I cannot delegate.

Btw, your hysteria is showing.

 

[Shikima]

The fact that you're comparing how great jobs are by the per patient compensation is telling.

You don't GET per patient compensation in the VA. Or many to most non-private jobs that are salaried. PPC has no bearing here.

Now if you're using that as some kind of substitute for the fact that you see less patients at the VA, this is true (for the most part). But the amount of non-patient care duties at the VA and administrivia is not to be underestimated. Yes you are paid for it, but it eats up the hours.

The VA tends to be slower pace than others but not as slow as you think. Also, the amount of work increases dramatically when you are at a major medical center or academically affiliated VA as opposed to CBOCs which can have long waits and an increased amount of patients to be seen.


Sent from my iPhone using Tapatalk

I've heard and seen many physicians and other practitioners needing to stay late or come in on weekends to be caught up on work.

 

[notdeadyet]

1) you have a lot of things to cover in an appt? Well just what in the hell do you think us in pp are doing during our apps(which are much shorter btw)? Playing checkers? We have a lot of **** to cover too.

What Shikima is likely referring to is the administrivia, which I'd wager the VA has more of than almost anywhere else. CPRS requires all sorts of surveys and the like to be filled out at each appointment. Many of them redundant. No one I know in private practice has to devote much time to this (and why would they?).

3) people in crisis? oh no!! All my patients in the community are always completely stable and loving life...thats why they come and see me.

The benefit of private practice is that you can select your patients. This is not the case at the VA. You don't get to not accept them. This is a benefit of private practice.

you would ****ing drown in a day if you were dropped in the real world....I can tell this from the way you talk. So definitely stay at the VA

The "real world" tends to mean whatever job you're working at the moment. Only half of psychiatrists work in private practice. If you are talking about "private practice," just call it such. The "real world" is actually made up of more ways of practicing psychiatry than the one you're in.

 

[notdeadyet]

I've heard and seen many physicians and other practitioners needing to stay late or come in on weekends to be caught up on work.

No doubt. I'm done feeding the troll.

I always get the impression that maybe by providing information and/or alternative viewpoints, he'll take it all in and broaden his perspective. But he just doubles down. Sigh...

 

[vistaril]

le sigh.

I am in PP. I also work at the VA, along with other places.
.

which is my goal too....to have a full time VA job with all the bennies and then supplement my income with side work(not necessarily pp). I could do that because(due to the laid back nature of the VA) I see plenty of other people do the same thing....work a full time job at the VA and then cherry pick side work. I'd make 340k or so(with both gigs combined) and work far less than I would in my current job now and make far far more.

 

[vistaril]

The "real world" tends to mean whatever job you're working at the moment. Only half of psychiatrists work in private practice. If you are talking about "private practice," just call it such. The "real world" is actually made up of more ways of practicing psychiatry than the one you're in.

I've explained what I mean by real world a number of times. It's much broader than pure private practice.

 

[clausewitz2]

which is my goal too....to have a full time VA job with all the bennies and then supplement my income with side work(not necessarily pp). I could do that because(due to the laid back nature of the VA) I see plenty of other people do the same thing....work a full time job at the VA and then cherry pick side work. I'd make 340k or so(with both gigs combined) and work far less than I would in my current job now and make far far more.

Then your goal requires you to move somewhere less desolate job-wise, almost literally anywhere else. Nothing else for it, based on your posts.

Or, you know, you could pursue your true, grousing-related goal. Pretty sure you got that covered.

 

[nexus73]

The VA is not my cup of tea. At least not the VA at my residency program. Too much administrative work, too many lazy support/clerical staff, to many entitled patients (though many patients were great). At least at the CMHC the patients don't think they're owed everything. The VA seemed to attract patients with a mix of narcissistic dependency, which is annoying to deal with.

 

[wolfvgang22]

Some VA patients can come across as entitled for a reason. Veterans are promised the best care in the world, above and beyond anything available to non rich people in the rest of the United States by politicians, and by extension the VA administration beholden to the politicians. Since 9/11 veterans are placed on a pedestal (one veteran I know said "verbally fellated") and idolized in the media and by politicians ("thank you for your service") and literally told they are entitled to free care, and whatever else they want or need because they are all heroes. When these promises prove to be half truths at best, many veterans understandably get angry. If we did this to CMHC patients, they would behave the same way. I'm often amazed how gracious many veterans are in this situation.

 

[keifernny2]

Some VA patients can come across as entitled for a reason. Veterans are promised the best care in the world, above and beyond anything available to non rich people in the rest of the United States by politicians, and by extension the VA administration beholden to the politicians. Since 9/11 veterans are placed on a pedestal (one veteran I know said "verbally fellated") and idolized in the media and by politicians ("thank you for your service") and literally told they are entitled to free care, and whatever else they want or need because they are all heroes. When these promises prove to be half truths at best, many veterans understandably get angry. If we did this to CMHC patients, they would behave the same way. I'm often amazed how gracious many veterans are in this situation.

They are not just promised health care, they are promised massive amounts of disability money. Many "disabled" veterans I work with receive more tax free disability money each month than I net as a physician after paying my taxes, health insurance, student loans, and retirement contrib. (Things that they will never have to pay for).

The demand for disability money drives the Demand for health care to justify how disabled they are.


Sent from my iPad using Tapatalk

 

[Armadillos]

Yeah the VA disability situation is terrible, literally the only thing preventing every single veteran from getting 1000s a month for 100% service connected PTSD is the time it takes to get and their own morals (or in very rare cases ignorance of the buzzwords they need).

Puts people in a tough spot, there is free money out there, you can reasonably feel you earned the right to it and all you have to do is exaggerate a little. At worst maybe tolerate a crappy week beefing up your application on an inpatient unit.

 

[wolfvgang22]

A way to solve the problem is to just grant all veterans free healthcare and forget the opaque service connection mumbo jumbo. Stop the patriotic rhetoric and subsequent non delivery of care.

Even more practical to my mind would be a universal healthcare single payor system in the U.S. But, that may not happen in my life time and is controversial for some people.

Anyhow, I regret this topic has gone far afield. The original poster is asking if anybody who actually works or has some other connection to the Phoenix VA has any insight to the working conditions there, or why they have so many openings that might be due to job conditions at that particular VA.

 

[notdeadyet]

A way to solve the problem is to just grant all veterans free healthcare and forget the opaque service connection mumbo jumbo.

All veterans free healthcare would be prohibitively expensive.

The disability thing by the VA is weird. Particularly since the military has their own disability system. I work with active duty soldiers who are 100% device connected at the VA and performing fine in the Army. Many don't push for a military medical board because they know that the military actually does a thorough examination/evaluation prior to giving disability for life.


Sent from my iPhone using Tapatalk

 

[wolfvgang22]

All veterans free healthcare would be prohibitively expensive.

If only somebody had thought of this cost before creating the need for it. Alas.

 

[notdeadyet]

I don't think I understand the bit about creating the need for it?

The majority of veterans do not serve during time of war or have any exposure to it. The idea of providing 60 years of free healthcare totaling millions of dollars because someone did a two-year army hitch in Oklahoma in their late teens is just plain silly. And cost prohibitive.


Sent from my iPhone using Tapatalk

 

[rikudo]

They are not just promised health care, they are promised massive amounts of disability money. Many "disabled" veterans I work with receive more tax free disability money each month than I net as a physician after paying my taxes, health insurance, student loans, and retirement contrib. (Things that they will never have to pay for).

The demand for disability money drives the Demand for health care to justify how disabled they are.


Sent from my iPad using Tapatalk

The resentment and lack of compassion here is palpable. I'm a disabled vet and I'd give up all VA benefits on the spot in exchange for a semblance of a normal life. The $407/mo check I receive by no means make my disabilities "worth it". Despite their "luxurious" disability pensions and "having it made" benefits, you'd be hard pressed to find a vet that wouldn't trade financial landscapes with you in a second, let alone the sequelae of lifelong disabilities and trauma.

 

[Doctor Bagel]

I don't think I understand the bit about creating the need for it?

The majority of veterans do not serve during time of war or have any exposure to it. The idea of providing 60 years of free healthcare totaling millions of dollars because someone did a two-year army hitch in Oklahoma in their late teens is just plain silly. And cost prohibitive.


Sent from my iPhone using Tapatalk

Presumably a reference to starting wars, leading to disabled vets. Didn't the VA use to be limited to combat veterans? Depending on service connection and income, veterans do have to pay for some care -- I think it's still pretty limited for who actually qualifies for totally free care.

 

[Doctor Bagel]

The resentment and lack of compassion here is palpable. I'm a disabled vet and I'd give up all VA benefits on the spot in exchange for a semblance of a normal life. The $407/mo check I receive by no means make my disabilities "worth it". Despite their "luxurious" disability pensions and "having it made" benefits, you'd be hard pressed to find a vet that wouldn't trade financial landscapes with you in a second, let alone the sequelae of lifelong disabilities and trauma.

When I was at the VA, I certainly saw people who were really hurt by their military experience and deserved a lot of care and disability benefits. I also saw people who somehow convinced someone along the way that they were 100% disabled when they were actually entirely capable of working. Lots of these people weren't combat veterans, btw, and weren't veterans who had clear cases of combat related PTSD or whatever. Sadly, a lot of my truly disabled patients struggled to get a high enough level of service connection I guess because they didn't know how to play the game.

 

[rikudo]

When I was at the VA, I certainly saw people who were really hurt by their military experience and deserved a lot of care and disability benefits. I also saw people who somehow convinced someone along the way that they were 100% disabled when they were actually entirely capable of working. Lots of these people weren't combat veterans, btw, and weren't veterans who had clear cases of combat related PTSD or whatever. Sadly, a lot of my truly disabled patients struggled to get a high enough level of service connection I guess because they didn't know how to play the game.

People do abuse the VA system, as people abuse all health systems, but that doesn't justify generalizations that sweep in the legitimately disabled and injured. I'm saddened to see providers routinely assume patients are faking their conditions, it's poor outlook to have as a physician.

Whether an injury is combat acquired acquired shouldn't be a point of concern. Modern military units do a lot more training than fighting. Non battle fatalities routinely exceed combat fatalities year after year.

 

[Armadillos]

Don't extrapolate anything you read in this thread to think we are universally skeptical of veterans or don't think those injured during their service deserve to have pensions/etc. What pisses us off is that dealing with the malingerers demands severely impacts the quality of care we can provide to those who genuinely need it.

 

[rikudo]

Don't extrapolate anything you read in this thread to think we are universally skeptical of veterans or don't think those injured during their service deserve to have pensions/etc. What pisses us off is that dealing with the malingerers demands severely impacts the quality of care we can provide to those who genuinely need it.

I agree with your point about malingerers. It was the multiple mentions of skepticism for non-combat injuries (which make up a majority of military injuries) and stating disability benefits as a better deal than an Attending's salary that was poor form.

 

[lymphocyte]

I agree with your point about malingerers. It was the multiple mentions of skepticism for non-combat injuries (which make up a majority of military injuries) and stating disability benefits as a better deal than an Attending's salary that was poor form.

I think everybody has compassion for disabled veterans. They're just burnt out from dealing with "disabled" veterans. And I would imagine it's more common to malinger for "non-combat" injuries than "combat" injuries--if only because fewer have served in combat--so that's where the skepticism is most directed.

I think we should expand health care generally in the US and detach it from social services (the two are becoming increasingly enmeshed). This may solve some of the problems with "disability" (note the quotes). But, in the meantime, veterans have been promised the Moon, adulated by all the politicians, sent off to fight and sometimes die, and are getting shafted when the bill comes due. We gotta do better than that, and part of the solution might be doing less for "disabled" veterans.

 

[hamstergang]

stating disability benefits as a better deal than an Attending's salary that was poor form.

He put the word disabled in quotes, leading me to believe he was talking about those not actually disabled.

 

[keifernny2]

I didn't say that it was a "better deal," I stated that it was more money. Disability checks are not intended to be payment for time spent in the military, that's a pension. They are payment for lost earning potential due to inability to work because of medical conditions. What you earn in disability is supposed to make up for what you couldn't earn because of your disability.

When those that are receiving a disability check have an income greater than physicians, lawyers, engineers, and teachers, the system is broken.

There are massive numbers of disabled veterans who are collecting 80% VA disability on top of working a full time GS federal job. Clearly they are not 80% disabled, as they go to work each day and get promoted frequently, however the VA calculator allows them to claim that they are. The system is broken.

In addition, those on VA disability are often earning more in total compensation (counting taxes) than active duty soldiers (who are actually at risk of getting shot), and at this point active duty soldiers are fairly well compensated (if you count equivalent income of BAH and different bonuses) . These are facts, whether you choose to politicize it or try to personalize it to your situation or not.

We all care for veterans, however making honest comments on the state of the system is seen as unfriendly by those that try to politicize things. You're acting no differently than when the Social Security deficits are pointed out and everyone starts scream that you're "anti senior" for saying so.




Sent from my iPad using Tapatalk

 

[erg923]

Presumably a reference to starting wars, leading to disabled vets. Didn't the VA use to be limited to combat veterans?

I would actually bet this is most people's belief about the VA. Most people have never served and dont think a thing about the VA or what is really does or doesnt do.

I also think most people would be appalled at the how this "service connection" thing is actually defined and doled out. Its sounds completely insane to pretty much anybody I have ever met (who isn't getting it or seeking it). Go figure.

 

[prominence]

The VA currently exists to serve the medical needs of veterans. Veterans were brave enough to enlist in the military and potentially be selected for deployment to a combat zone. While I feel we should be looking at providing more efficient and less expensive medical care at all sites in the nation, not just within the VA system, I believe veterans should qualify for free medical care for life since that's what they were promised. It is a privilege to work as a psychiatrist and treat those who have served our nation.

In terms of disability, the VA does not place the clinician in the dilemma of treating the pt and also determining if they qualify for a service connected disability and at what percentage. In mental health, a disability reviewer who is either a psychiatrist or a psychologist and who has no clinical role to the pt does a disability evaluation. That report gets sent to a compensation and pension panel, which consists of different types of people, including non-physicians. This board of people determines if the veteran qualifies for service-connection disability, and if so, at what percentage.

If a psychiatrist is treating a pt who wants disability, the pt is simply provided the contact phone number of who to speak to get the application process started. The psychiatrist can clearly state that their progress notes are accessible to the disability reviewer as the reviewer can choose to examine any part of the electronic medical record that they wish to. The psychiatrist can clearly and honestly state to the pt that he or she has no role in determining disability.

It takes a specific personality and temperament to work as a psychiatrist within the VA system as it is not for everyone.

 

[notdeadyet]

Presumably a reference to starting wars, leading to disabled vets. Didn't the VA use to be limited to combat veterans? Depending on service connection and income, veterans do have to pay for some care -- I think it's still pretty limited for who actually qualifies for totally free care.

Wolfgang22 was talking about free healthcare for ALL veterans to avoid the disability rating boondoggle (which would be a huge increase in coverage vs current policy of free healthcare for service connected veterans). I was pointing out that it would be prohibitively expensive as the majority of veterans have no wartime disabilities.

 

[notdeadyet]

The VA currently exists to serve the medical needs of veterans. Veterans were brave enough to enlist in the military and potentially be selected for deployment to a combat zone. While I feel we should be looking at providing more efficient and less expensive medical care at all sites in the nation, not just within the VA system, I believe veterans should qualify for free medical care for life since that's what they were promised.

No, they were not. They were not promised this. This is a myth that is propagated in the community and at the VA (by presumably misguided but well-meaning folks).

No one who joined the military (including myself) were told that this meant free healthcare for life. We were told that if we were injured as part of our service that we would have these injuries treated for life.

Nowhere in enlistment or commissioning papers is there a clause for "free healthcare for life." This myth grates on me, because it allows the public to feel good about themselves for caring for veterans when they haven't really taken on that role. If folks want to tell themselves they are providing free healthcare for life to all veterans, they'd better be willing to vote for an increase of 5% or so in federal income taxes. But of course that will never happen.

So let's please collectively stop recycling this myth: veterans do not get free healthcare for life. They were never promised it and they do not receive it. When we recycle it, we are patting the backs on a public that does not deserve it and we are discrediting the veteran population by assuming they have more resources than they do.

Apologies for the rant, but I have folks who I have served with who are homeless and ill who are ineligible for VA healthcare services. The amount of folks who assume they are "covered" and being supported by a grateful nation is incredibly irritating.

It takes a specific personality and temperament to work as a psychiatrist within the VA system as it is not for everyone.

Agreed. Working for large healthcare systems requires a certain acceptance and patience that is proportional to their size/level of bureaucracy.

That said, these systems also can also attract "lifers" since it is nearly impossible to get fired from the federal government once hired. Large bureaucracies are also a refuge of folks who are looking for the comfort of just shrugging and saying "what can you do?" when presented with problems.

I enjoy working for the VA and tolerate much for the sake of the mission. But I don't feel that it is above criticism and that said criticism implies a "bad fit." We need to have some folks willing to rock the boat; there's already plenty of ballast.

 

[notdeadyet]

The resentment and lack of compassion here is palpable. I'm a disabled vet and I'd give up all VA benefits on the spot in exchange for a semblance of a normal life. The $407/mo check I receive by no means make my disabilities "worth it". Despite their "luxurious" disability pensions and "having it made" benefits, you'd be hard pressed to find a vet that wouldn't trade financial landscapes with you in a second, let alone the sequelae of lifelong disabilities and trauma.

You are pointing out one of the challenges that SDN experiences: it is meant to be a collaborative forum of professionals but it is open to the public.

Medicine is an incredibly frustrating field. It is frustrating because of the illnesses we try (not always successfully) to treat. It is also frustrating because of our patients.

We get frustrated with our county patients. We get frustrated with our private insurance patients. And yes, we get frustrated with our VA patients. Anyone I'm leaving out is unintentional: doctors get frustrated with ALL their patients at one point or another.

When we have that frustration, we essentially have two choices: we can bottle it or we can share it with peers. When we bottle frustration, it can lead to burn out. It can cause us to develop negative feelings about our jobs and the people we treat. Lots of bad juju. Alternately, we can share it with peers. That acts as a valve that bleeds off pressure that lets us get back to providing compassionate care.

SDN is a great place for (amongst other things) sharing frustration. Because the forum is meant for fellow professionals, we don't input a lot of qualifying information and caveats. We are not communicating with patients here.

What you are seeing as resentment and lack of compassion is frustrated doctors supporting each other letting off steam. It serves a purpose and allows us to pony up and take on the next patient with care, compassion, and empathy. It's NOT being able to vent that actually leads to the resentments and coldness.

 

[Doctor Bagel]

In terms of disability, the VA does not place the clinician in the dilemma of treating the pt and also determining if they qualify for a service connected disability and at what percentage. In mental health, a disability reviewer who is either a psychiatrist or a psychologist and who has no clinical role to the pt does a disability evaluation. That report gets sent to a compensation and pension panel, which consists of different types of people, including non-physicians. This board of people determines if the veteran qualifies for service-connection disability, and if so, at what percentage.

Don't the comp and pen people also review your notes, meaning you're somehow involved in the process? At least when I was rotating at theVA, I remember working with attending who didn't specifically comment on improvement related issues out of worries that it would reduce a patient's service connection if it were reviewed again. It would seem a bit ridiculous to have a disability process where the medical provider's documentation is not reviewed.

 

[notdeadyet]

Don't the comp and pen people also review your notes, meaning you're somehow involved in the process?

How much C&P evaluates CPRS records is going to be extremely evaluator dependent.

At least when I was rotating at theVA, I remember working with attending who didn't specifically comment on improvement related issues out of worries that it would reduce a patient's service connection if it were reviewed again.

^^^ This is the crux of my frustration with the VA being both a care providing organization and a disability providing organization.

One of the big hurdles for evidence-based treatment of veteran's mental health issues is that the research suggests that no one gets better. PTSD tends to get better on its own without any treatment at all. But if you went by chart review of VA records, it would appear that PTSD is one of the least responsive diseases to any intervention at all. This is due to the linkage between treatment and disability pay out.

And the attending you're referring to is part of the problem, Doctor Bagel. We should not alter what we chart out of fear of how it will affect disability ratings. Actions like that contribute to why we can't provide better care to our veterans. When it looks like nothing works, we may as well do very little care, too much care, or completely random care.

Incidentally, very few folks get their SC rating decreased. Re-evaluation most often occurs when veterans push for more ratings. Sometimes, this can back-fire if a particularly generous C&P determination is re-evaluated and then diminished.

 

[erg923]

People who believe the "separation" of VHA and VBA someone how eliminates problems inherent to the way in which the VAs disability system is set up need some courses in social psychology...and probably to pay better attention.

 

[prominence]

No one who joined the military (including myself) were told that this meant free healthcare for life. We were told that if we were injured as part of our service that we would have these injuries treated for life.

Nowhere in enlistment or commissioning papers is there a clause for "free healthcare for life." This myth grates on me, because it allows the public to feel good about themselves for caring for veterans when they haven't really taken on that role. If folks want to tell themselves they are providing free healthcare for life to all veterans, they'd better be willing to vote for an increase of 5% or so in federal income taxes. But of course that will never happen.

So let's please collectively stop recycling this myth: veterans do not get free healthcare for life. They were never promised it and they do not receive it. When we recycle it, we are patting the backs on a public that does not deserve it and we are discrediting the veteran population by assuming they have more resources than they do.

I never said the military was responsible for the promise of free health care for life to veterans.

It is our entrusted politicians who make this promise regularly on their political platforms.