I was going to say, you might be the only psychologist I've heard of who wants to go into C&P. And I'd be shocked if a position weren't available or someone weren't willing to trade with you in the future if you decide that's what you want to do.
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deleted1129370
I am curious why VA C&P has a bad rep. What are ya'lls thoughts?
Having done both, I will say that my VA C&P work is not similar at all to my IME work today.
Mostly rubber stamp providers, lots of red tape, extremely entitled and angry patient population. Wasn't that El Paso VA psychologist who was murdered by a Vet a C&P examiner?
At least from what I've heard, it's primarily been that not much time is given to actually perform the evaluations, not many psychologists actually like doing them and working in that context, and (as WisNeuro said), some feel frustrated depending on where they are that it all just seems like a rubber stamp--if someone is denied, they just appear until it's eventually approved.
Also, thinking on it, I do actually know a couple (non-VA) folks who enjoy doing these after having found a way to approach them efficiency (i.e., in a way to make the time/money equation attractive).
Edit: And yes, I believe the psychologist in El Paso killed by the patient was a C&P evaluator who'd seen him for a disability eval. If I'm remembering correctly, anyway.
typical clinical time at most jobs varies between 20-30 hours a week, so if you are getting 5-6 hours a day of contact time on average, you're full time after you consider lunch, paperwork/admin, etc. If that is primarily assessment, I would be doing less than 30 and turning reports fast instead. If you are seeing 5-6 clients a day for therapy and not grossing over 150k you're doing something terribly wrong.
malingering base rate issues, lack of structural support for conclusions except "yes", outsourcing for low pay, and high amounts of admin time needed that aren't supported by reimbursement/facility guidance.
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deleted1129370
I'm glad I am CCW holder.
Works in private practice, but not on VA grounds.
Legit couldnt pay me enough to do CP work. I've sat in front of and evaluated the worst of the worst and the scariest of the scariest and the most psychopathic of the most psychopathic (mostly for death penalty mitigation evals). And i would gladly sit in front of them rather than be the one sitting in front of someone who in their eyes views me as being responsible for them either getting or not getting their "deserved" benefits. Only time I've ever feared for my safety was doing SSD evals where you don't really know everything about the person walking in that office door. Stopped real quick after that, as they pay garbage and the evaluations themselves are pretty much pointless.
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deleted1129370
Did this occur on VA property?
From the news releases, it would appear so.
Yep, I believe so.
We had at least one incident of a patient attempting to bring a gun into the building. Fortunately, he didn't make it inside.
Just checked, it was in the clinic, and then the murderer went into another clinic room and killed himself rather then be held accountable for his actions.
Back in training (12+ yrs ago) I did C&P evals as part of a rotation, and they are very much an acquired taste. My mentor and me did primarily mTBI, TBI, & PTSD evals...and failure rates were like 70%+ on effort and validity measures. That was around the time when 3rd party vendors were picking up contracts to do C&P evals in bulk for cheap....well, to the contracted psychologist at least. Total scam then and I doubt much has changed.
Sanman
O.G.
Neighbor believes El Paso VA shooter suffered from PTSD
From what I am reading it happened on the 4th floor of the hospital. The guy was Chief of psychology and the vet was a desk clerk that got fired.
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deleted1129370
I already moved back to Texas in early September. I am in Houston. I read that article. Some scary stuff.
The murderer had a PTSD claim denied. Murderer was a clerk at the VA. Murderer sees Dr. F, who was the chief of psych, at a grocery store and threatens him. Dr. F files a complaint with the VA. VA does nothing. Murderer walks into Dr. F's office and shoots him, then walks to a second location and suicides. Somehow this murder is evidence that the murderer had PTSD.
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deleted1129370
I am not sure I'd jump on the PTSD bandwagon just yet. There could have been a myriad of things contributing to this behavior, especially considering if the time frame between being fired and engaging in that behavior were close in proximity. Perhaps he did have PTSD and the firing was the precipitant. Seems like a lot of info is missing here.
Sanman
O.G.
I would assume threatening other employees would lead to dismissal. The VA likely became aware of the threat through the complaint.
I don't know much about it, other than the press stuff.
Considering how aggressive/violent many of us have seen patients in the VA act and still be allowed to come in for care, I imagine this dude went pretty far to be dismissed. By far the most lenient system in this nation when it comes to patient behavior.
100% agree.
I remember when I "fired" a bunch of patients during the start of my out-pt rotation on internship. I definitely caught some blowback, but thankfully my DCT and supervisor backed me because I had a clear and empirically supported plan. Surprise surprise, the majority of those "fired" patients came back after we established behavior contracts and reviewed acceptable v unacceptable behaviors. I worked almost exclusively w Axis-II diagnoses (by choice), so it actually offered quite a bit to pull from the get-go. NPD was one of my fav diagnoses to treat back then....now.....
no thank you.
Sanman
O.G.
100% agree.
I remember when I "fired" a bunch of patients during the start of my out-pt rotation on internship. I definitely caught some blowback, but thankfully my DCT and supervisor backed me because I had a clear and empirically supported plan. Surprise surprise, the majority of those "fired" patients came back after we established behavior contracts and reviewed acceptable v unacceptable behaviors. I worked almost exclusively w Axis-II diagnoses (by choice), so it actually offered quite a bit to pull from the get-go. NPD was one of my fav diagnoses to treat back then....now.....
I generally hate treating PD. The patient rarely wants to engage in treatment and I always get push back on behavioral contracts rather than buy in. So much easier to treat mild depression and go home.
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deleted1129370
I saw a lot of "stuff" in BHIP. PDs were challenging. I was variable in my success setting and maintaining behavioral boundaries with some of them.
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deleted1129370
On a similar topic - there was a psychologist at my previous VA who is a forensic psychologist (works a lot of hours between the VA and their private practice stuff). Evidently, they were stalked and threatened by a veteran to the point where the veteran found the psychologist's address and would stay parked outside on the street.
The vast majority of my training was w. severe mental illness, significant behavioral problems (e.g. ODD, etc), and for whatever reason....a lot of personality disorders. Back then I found it interesting and I enjoyed the challenge. Now...hard pass. For any clinical referral these days I screen out all severe pathology and I don't take straight psych referrals, only cases with physical injury that includes a psych component. I still get challenging cases, but I really try to limit the level of psychiatric acuity at the front-end because out-pt is just so limited in what we can accomodate safely; that's the reality of out-pt practice.
The MD is for Maryland, I was confused as to why a medical doctor was working as a psychologist until,I reread the original post.
lol
lol
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deleted760483
Develop an in-demand specialty in your area. That's the key for career growth. I turned down an 80/20 split with profit sharing last year because it was still a pay cut for me, mainly because I'm doing things that very few people in my area know how to do.
