COVID-19 & Clinical Practice Changes?

[R. Matey]

Ok, for us federal employees...the stimulus bill has passed and agencies have encouraged maximum telework (I know VA at least should be receiving a chunk of cash, some of which to boost tele/IT capabilities). Let's do an updated survey....

What general type of agency are you working for?

Who is teleworking and who is still working from the office?

If you are in the office, are you at least only doing tele visits?

I work for a VA, continuing to go in the office, and am doing VVC and telephone only therapy appointments.

I’m on internship at a University Counseling Center. Everyone is working from home doing tele-psychology. We’re providing group and individual psychotherapy only.


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[AcronymAllergy]

I'm working for a VA. I am doing phone and VVC only in the office, but they are getting things ready for telework. Not sure if it's going to happen or if it's just a contingency plan though.

Same here. At least as of Friday.

 

[Ollie123]

AMC (but mostly research).

Exclusively telework. All studies shut down except for a handful of small-scale pilot studies we can do remotely.

Clinic is also about 99% telework. We have a handful of staff who rotate on-site to "be available for emergency in-person visits". Basically for extremely high-risk cases where hospitalization is a likely outcome. This has been in place for 2 weeks and so far I think there has only been 12- actual in-person visits and that was before they were entirely clear on how severe it needed to be to justify an in-person visit. Unclear if I will be asked to help staff unit at any point given my caseload is miniscule - they are mostly having the heavy clinical folks handle it. Which is probably good because I (fortunately) have never had to IVC someone and I don't imagine anyone voluntarily agreeing to go the hospital right now.

Inpatient is still inpatient, but even doing some things via ipads on the unit to try to minimize contact.

 

[cara susanna]

According to my friend at another VA, OPMH staff are all teleworking from home. The state is not doing well with COVID though.

 

[Fan_of_Meehl]

This makes me angry that this is still happening, esp. in a place like Florida with so many cases. I hope the same...seems like it should come down the line from national VA considering VA does have this power to enact this when local leadership is unwilling. For the moment, I think national is in the dark how various VA's are handling a lot of these things unfortunately.

Anyone higher up than a direct provider of services got there by adhering to the unholy canon of: a) kiss ass upwards at all cost; (b) maximize your authority while eliminating your actual responsibility for outcomes; and (c) never take a stand on anything that could make you or your bosses 'look bad.'

Things like professional standards of care/practice, logic/evidence, common sense, ethics, or even basic arithmetic never enter into their thinking.

In an ACTUAL crisis, you need to be willing to toss the thousands of pages of rules/policies/procedures to the side and make some tough decisions where there is no safe play from a PR perspective. VA leadership will never actually lead in this manner. They will play blame the clinician games to the bitter end.

 

[Sanman]

Anyone higher up than a direct provider of services got there by adhering to the unholy canon of: a) kiss ass upwards at all cost; (b) maximize your authority while eliminating your actual responsibility for outcomes; and (c) never take a stand on anything that could make you or your bosses 'look bad.'

Things like professional standards of care/practice, logic/evidence, common sense, ethics, or even basic arithmetic never enter into their thinking.

In an ACTUAL crisis, you need to be willing to toss the thousands of pages of rules/policies/procedures to the side and make some tough decisions where there is no safe play from a PR perspective. VA leadership will never actually lead in this manner. They will play blame the clinician games to the bitter end.

I will say that blame the provider has not been as much of an issue in my VA. That said, I am insulated from the worst of it. What (at least my VA) struggles to do is provide clear and timely guidance. Communication is also an ongoing problem. Some things are communicated 3 times and other important pieces of information never until someone asks and shares the response they got individually.

 

[thebalmofhurtminds]

I've actually been pleasantly surprised at how quickly my VA has moved in transitioning us to telehealth and working on creating/modifying grids/schedules/etc.

 

[IWillSurvive]

Anyone higher up than a direct provider of services got there by adhering to the unholy canon of: a) kiss ass upwards at all cost; (b) maximize your authority while eliminating your actual responsibility for outcomes; and (c) never take a stand on anything that could make you or your bosses 'look bad.'

Things like professional standards of care/practice, logic/evidence, common sense, ethics, or even basic arithmetic never enter into their thinking.

In an ACTUAL crisis, you need to be willing to toss the thousands of pages of rules/policies/procedures to the side and make some tough decisions where there is no safe play from a PR perspective. VA leadership will never actually lead in this manner. They will play blame the clinician games to the bitter end.

How do we persist in this environment? I am completely disillusioned with the system. My desire for justice and accountability may affect my longevity here.

 

[Fan_of_Meehl]

How do we persist in this environment? I am completely disillusioned with the system. My desire for justice and accountability may affect my longevity here.

The answer--my friend--is blowin in the wind...

My only way to cope with it is to focus on what's in front of me: my caseload, clinical work, and day-to-day responsibilities and get satisfaction from that. Honestly, I don't see ANY movement in a positive direction in the organizational climate at VA. If anything, it is gradually getting worse and worse over the years.

However, one interesting thing about the present crisis is this: do you notice how--in a time of crisis--they are starting to relax/drop certain of their many rules/policies/procedures that are there (supposedly) to ensure 'high quality' clinical services (like the telehealth restrictions/policies, HIPAA, etc.). I know that they 'don't do' logic but...if those policies/rules/procedures *actually* had ANY validity in terms of 'improving quality' of healthcare then why would they be so quickly abandoned during a time of crisis? Maybe once everyone realizes how relatively efficiently everything works without a thousand policies and procedures (and 'rule enforcers') it'll be a wake up call.

 

[cara susanna]

We aren't being judged on productivity outright, but they are saying that people with low productivity will not be picked first for telework and may also get sent to the main hospital to help out there if things get really bad. Soo...

 

[WisNeuro]

We aren't being judged on productivity outright, but they are saying that people with low productivity will not be picked first for telework and may also get sent to the main hospital to help out there if things get really bad. Soo...

Interesting way to spur productivity. Get us billables, or we throw you into the petri dish! Sounds like a good time to be looking for a new job when this is all said and done.

 

[Fan_of_Meehl]

We aren't being judged on productivity outright, but they are saying that people with low productivity will not be picked first for telework and may also get sent to the main hospital to help out there if things get really bad. Soo...

What I find maximally absurd is the notion of non-clinicians in the VA system providing parental 'oversight' of clinician 'productivity' and meting out rewards/punishment.

Firing 80% of non-provider staff at VA, hiring more providers and eliminating 90% of policies/procedures would probably net a 100% improvement in productivity, efficiency, patient satisfaction, staff resilience and safety.

 

[BuckeyeLove]

Hey in-pt nursing note that is 2 lines and takes up 2 pages because of all of the useless copy over/pass through information.

We aren't being judged on productivity outright, but they are saying that people with low productivity will not be picked first for telework and may also get sent to the main hospital to help out there if things get really bad. Soo...

How is this real life? Legit hunger games culture in a federal system.

 

[Fan_of_Meehl]

How is this real life? Legit hunger games culture in a federal system.

You should see some of the iridescent coiffed peacock-dictators roaming the halls in this place. They tend to be the one's with no caseload responsibilities and all administrative authority over clinical affairs. You know, the 'quality improvement' paladins/champions who quest for Joint Commission.

 

[Sanman]

Interesting way to spur productivity. Get us billables, or we throw you into the petri dish! Sounds like a good time to be looking for a new job when this is all said and done.

Yeah, that has been the vague threat everywhere. However, as the shutdowns get more widespread, there are fewer and fewer clinical staff in the building. Not sure if the threat really holds any water. Most of us are stuck on the phone with minimal billable procedures anyway.

In any event, if they try to do that to me...I will be spiking a low grade "fever" and complaining of flu like symptoms.

 

[Fan_of_Meehl]

Yeah, that has been the vague threat everywhere. However, as the shutdowns get more widespread, there are fewer and fewer clinical staff in the building. Not sure if the threat really holds any water. Most of us are stuck on the phone with minimal billable procedures anyway.

In any event, if they try to do that to me...I will be spiking a low grade "fever" and complaining of flu like symptoms.

Don't forget to cough on the offending bureaucrat.

 

[AcronymAllergy]

To speak to a concern raised in a different thread about students testing: I can say that none of our interns are currently performing in-person neuropsychological evaluations (none of the staff are, either). I actually don't know of any interns anywhere who are still doing in-person testing, although I admittedly and of course don't have contact with every training program in the US. And there's enough debate about telehealth assessment that I'd be surprised if many interns are performing formal assessments via telehealth/telephone.

However, I fully expect that for the upcoming training year, interns will be able to return to in-person testing (perhaps with some precautions in place or to a limited degree initially).

 

[Ollie123]

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely hate to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

 

[Sanman]

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely had to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

That sucks, I am sorry that is happening. I am in the same position as far as distance and considerations (though no positive COVID tests in my family luckily), so I have thought about the possibility. I initial urge was to go there too, but that really would not do any good. I was considering shipping a security cam to my mother in the event she is sick and home alone, so that I can log in and check on her if she is sick.

As for the work issue, I have had some days like this in my life and it is up to you if you need to take a day to deal with the news and get your head together. Self-care is an ongoing thing, monitor yourself, be honest with your boss/colleagues, and excuse yourself if you find yourself unable to adequately complete your job. As much as everyone is "powering through", the truth is that this is going to be a marathon and if a little time off helps you to cope, formulate a plan, and get your head back in the game then take the time off. As for letting the "team" down, you have to cover for others when the news hits their house and they are in the same position. No need for guilt.

 

[PsychPhDone]

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely hate to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

I'm sorry you're dealing with this, Ollie. I'll keep your parents in my thoughts.

I, personally, would be tempted to go to work to avoid the administrative burden of rescheduling and to try to stay distracted...and then I'd come to my senses and acknowledge that my head won't be in the right space and try to take the day off. I don't know about you, but the new normal has been exhausting and already draining. Taking care of yourself might help you take care of others better. Like sanman said, this is a marathon.

 

[Fan_of_Meehl]

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely hate to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

I just hope things turn out okay for you and them. Best thoughts and wishes.

 

[summerbabe]

This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage.

I'm sorry you're going through this and your parents are in my thoughts. I have also been anxious throughout this period because my mom is a nurse in a COVID-heavy region thousands of miles away and I know that thinking about her has impacted my work recently.

Reading your post, I felt like you have given this considerable thought and were pulled more towards tending to the former concern (self/family), rather than the latter concern (patients/organization). And I would be as well if I were in a similar spot.

Yes, many people are struggling but so are you and I don't think that should be minimized. Take care!

 

[IWillSurvive]

How is this real life? Legit hunger games culture in a federal system.

Well it's kind of been modeled by the President in his approach to helping states...

 

[cara susanna]

Thanks for validating

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely hate to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

I'm so sorry to hear that, Ollie. One thing I try to ask myself when I'm considering taking a sick day is: would I be an effective therapist today? Our job is a bit different from someone who's sitting in an office and, say, doing data entry or something. We need to be able to regulate our emotions and tolerate our distress. We also need to be able to focus. Obviously this is going to last more than one day, but I completely could see the rationale in taking a day off just to process and care for yourself so you're back in tip top shape (or as much as you can be) for the rest of your patients. Of course, you're the only one who can decide the answer to this.

Also, my thoughts are with you and your parents. Just remember that 102 year old man in Italy that recovered! I believe there was a woman around that age who also recovered.

 

[EmotRegulation]

What would you do? Can't promise I'll reply, but I'll read the responses.

Honestly? I'd probably work, but mostly because I find providing therapy to other people a relief from what is happening in my own mind. However, the supervisor side of me would actually question that decision, because unlike in a normal circumstance, where listening to someone else's stuff would be a distraction from my own, in this case listening to other people's stuff would TRIGGER my own worries. There would be far more intrusive thoughts than during a normal session. So as a supervisor I'd probably suggest taking the day off and processing my feelings so that I could get back to work on Monday.

 

[PsyDr]

@Ollie123 Assess hourly if your parents are acutely ill, and not just covid19 positiv.

Once they begin to mention getting ill,throw some supplies in your car, start driving, and get your ass to them.

Screw the rest.

 

[Ollie123]

Thanks all. I'm forging ahead for now and checking in regularly with the parents (who continue to be OK and at least my father appears to be recovering quickly). I alerted my lead and chief, in case a rapid departure is necessary.

unlike in a normal circumstance, where listening to someone else's stuff would be a distraction from my own, in this case listening to other people's stuff would TRIGGER my own worries.

This hit the nail on the head. I'm normally much like you and separate pretty easily and even find it helpful. In the span of 24 hours I feel like I suddenly became the (acutely) wounded healer and am having to readjust. This is new territory.

 

[deleted106747]

Thanks all. I'm forging ahead for now and checking in regularly with the parents (who continue to be OK and at least my father appears to be recovering quickly). I alerted my lead and chief, in case a rapid departure is necessary.



This hit the nail on the head. I'm normally much like you and separate pretty easily and even find it helpful. In the span of 24 hours I feel like I suddenly became the (acutely) wounded healer and am having to readjust. This is new territory.

This is a beast. I'm sorry you're having to go through this. The new territory thing is something that throws me on a regular basis. We have no template for this. I'm sending my best to you & your parents.

 

[futureapppsy2]

I absolutely cannot stand ABA people who are insisting on still providing in-person services "because ABA is healthcare and healthcare is essential!" If imminent harm to self or others is an issue, sure, you can argue that in-person crisis ABA services might be justified. Otherwise, use telehealth and don’t perpetuate a pandemic so that you can make a child touch blue five times. And now is not the time to teach "touch nose."

 

[futureapppsy2]

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely hate to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

Sending the good and healing thoughts, Ollie. Please email me if there's anything I can do.

 

[deleted343839]

I absolutely cannot stand ABA people who are insisting on still providing in-person services "because ABA is healthcare and healthcare is essential!"

Seriously. That is some high-horse nonsense. Plenty of physicians who provide "essential" services are doing it by phone or videoconferencing for now.

 

[mypointlesspov]

Seriously. That is some high-horse nonsense. Plenty of physicians who provide "essential" services are doing it by phone or videoconferencing for now.

This reminds me of someone from my program (who is on internship as well) who posted something on social media saying "I can't stay home, I'm a healthcare worker."

Sweetie, you are a psychology intern. It's not that serious.

 

[cara susanna]

Is anyone else finding it REALLY disheartening to have like a 45-50 min session and then only be able to bill for 30 min? lol

 

[Fan_of_Meehl]

Is anyone else finding it REALLY disheartening to have like a 45-50 min session and then only be able to bill for 30 min? lol

Yup. And I have been busier than ever. Full clinical schedule and since I'm calling veterans directly (while they are following stay-at-home orders) there are very few no shows and cancellations.

 

[cara susanna]

Yup. And I have been busier than ever. Full clinical schedule and since I'm calling veterans directly (while they are following stay-at-home orders) there are very few no shows and cancellations.

I'm less busy overall. I've even had a few phone no shows (yes, apparently that is a thing!) But, even so, the phone billing thing is just demoralizing.

 

[iliketohelppeople]

I'm less busy overall. I've even had a few phone no shows (yes, apparently that is a thing!) But, even so, the phone billing thing is just demoralizing.

I have had quite a few no shows as well which is curious. What is truely demoralizing is the VA network capabilities. Have been sent home, but I have to log on extra early to grab a spot and then it is super slow. Not the worst, but definitely demoralizing!

 

[Sanman]

Is anyone else finding it REALLY disheartening to have like a 45-50 min session and then only be able to bill for 30 min? lol

Truthfully, I don't care much. It's all semantics since we are salaried. I have transitioned a few people to VVC or other approved tele-health apps. WIth the exception of one or two people who lack the equipment and need the therapy, I have capped all of my telephone sessions at 30 min. This has helped to motivate some people to try tele-health. Otherwise, given the choice most seem to opt for phone due to it being easier on them.

 

[cara susanna]

Truthfully, I don't care much. It's all semantics since we are salaried. I have transitioned a few people to VVC or other approved tele-health apps. WIth the exception of one or two people who lack the equipment and need the therapy, I have capped all of my telephone sessions at 30 min. This has helped to motivate some people to try tele-health. Otherwise, given the choice most seem to opt for phone due to it being easier on them.

VVC is really unstable right now so I'm doing mostly phone. Even some of my VVC appts have turned into phone because it hasn't been working.

 

[AcronymAllergy]

VVC is really unstable right now so I'm doing mostly phone. Even some of my VVC appts have turned into phone because it hasn't been working.

This has been my experience as well. I've switched to almost entirely using telephone for now, productivity/wRVUs be damned.

 

[Sanman]

VVC is really unstable right now so I'm doing mostly phone. Even some of my VVC appts have turned into phone because it hasn't been working.

Ours was initially as well, but national has been stress testing in different VISNs and our has been getting smoother as the weeks go by. I always have my phone available as back-up. Had failure with a zoom session and facetime as well today due to general bandwidth availability in my area. Keep in mind that my patient volume is significantly lower than average for MH and I am still mostly phone call.

The reason I am pushing for tele-health is not for current use anyway. With the lack of effective treatment or a vaccine for COVID-19, I can't see outpatient healthcare returning to normal for a long time even if other measures are relaxed. I want my veterans to be prepared for use of VVC for those physician and specialty visits they may need in coming months. Those clinics will not be as patient as I am in testing this out with them.

 

[WisNeuro]

This has been my experience as well. I've switched to almost entirely using telephone for now, productivity/wRVUs be damned.

Between new codes/RVUs in 2019 and COVID this year, projections for neuropsychology productivity is going to be all over the place for the next couple years.

 

[AcronymAllergy]

Between new codes/RVUs in 2019 and COVID this year, projections for neuropsychology productivity is going to be all over the place for the next couple years.

I'm ballparking my wRVU expectation for 2021, if it's based on 2020, to be 50 +/- 3000.

 

[ClinicalABA]

I absolutely cannot stand ABA people who are insisting on still providing in-person services "because ABA is healthcare and healthcare is essential!" If imminent harm to self or others is an issue, sure, you can argue that in-person crisis ABA services might be justified. Otherwise, use telehealth and don’t perpetuate a pandemic so that you can make a child touch blue five times. And now is not the time to teach "touch nose."

I know- not worth risk to clients or staff. We moved to telehealth ABA services before state mandates. About 50-60% of sessions still occurring. Some DTT programs being run by family (yay! generalization), some skills being montored in absence of treatment (yay! maintenance probes), and a lot of parent consultation and training. Goal is to maintain contact with vulnerable population while still providing necessary and effective services. It’s definitely been a hit for many staff especially non-licensed behavior therapists (who are FFS with benefits). We have a conscientious owner/president, and strong management who are reviewing productivity and billable daily, and have lowered productivity requirements based on projections for what is need to “keep the lights on.” Agency higher ups (who are also presidents/board members of state ABA and Neurospych orgs), in conjunction with our lobbyists and contacts at the state house, have worked with DPH, public- and private insurers, etc., to make sure we get auths and payment for telehealth, as well as to identify other services we can provide at this difficult time (such as on call behavioral crisis consult to keep families from bringing kids to ERs for behavioral problems). Staff who can’t do telehealth for whatever reason have been offered furloughs. It not ideal, but it’s been generally working, and I’m proud of how my company has responded.

 

[Fan_of_Meehl]

Bu

I know- not worth risk to clients or staff. We moved to telehealth ABA services before state mandates. About 50-60% of sessions still occurring. Some DTT programs being run by family (yay! generalization), some skills being montored in absence of treatment (yay! maintenance probes), and a lot of parent consultation and training. Goal is to maintain contact with vulnerable population while still providing necessary and effective services. It’s definitely been a hit for many staff especially non-licensed behavior therapists (who are FFS with benefits). We have a conscientious owner/president, and strong management who are reviewing productivity and billable daily, and have lowered productivity requirements based on projections for what is need to “keep the lights on.” Agency higher ups (who are also presidents/board members of state ABA and Neurospych orgs), in conjunction with our lobbyists and contacts at the state house, have worked with DPH, public- and private insurers, etc., to make sure we get auths and payment for telehealth, as well as to identify other services we can provide at this difficult time (such as on call behavioral crisis consult to keep families from bringing kids to ERs for behavioral problems). Staff who can’t do telehealth for whatever reason have been offered furloughs. It not ideal, but it’s been generally working, and I’m proud of how my company has responded.

Meanwhile, in the VA system, I must have received about 20 or so emails today from non-clinician well-wishers, pompom wavers, sloganeers, and other sundry non-essential experts imploring me to stay safe, practice mindfulness, worship whole health, reduce stress, wash my hands, not french kiss water fountains, keep a stiff upper lip, etc. God, sometimes I wish someone would take an axe to some of the useless positions in this organization instead of continuing to cut clinical positions while expanding clinical services and hiring more non-clinician well-wishers, pompom-wavers, etc., etc.

 

[ClinicalABA]

Bu
Meanwhile, in the VA system, I must have received about 20 or so emails today from non-clinician well-wishers, pompom wavers, sloganeers, and other sundry non-essential experts imploring me to stay safe, practice mindfulness, worship whole health, reduce stress, wash my hands, not french kiss water fountains, keep a stiff upper lip, etc. God, sometimes I wish someone would take an axe to some of the useless positions in this organization instead of continuing to cut clinical positions while expanding clinical services and hiring more non-clinician well-wishers, pompom-wavers, etc., etc.

I’m sincerely sorry you’re having that experience. Smaller (though we still have ~400+ employees) and more streamlined systems can just respond quicker and change faster. I was texting with a former colleague who does what I do at the local big-system AMC in the area, and they have stopped doing all assessments as they explore options for how to implement telehealth. Almost a month later and they’re still working on it!

 

[Doctor Eliza]

Hoping to tap the collective wisdom of the board on this one. This is not a request for medical/psychological advice, so please keep the focus on the work decision itself and not psychological advice/coping as I would genuinely hate to see this thread locked. Trust that I've got that piece down as best circumstances allow and am doing what I can.

Just found out a few hours ago my parents both have COVID. They are - so far - doing OKish (at least able to speak on phone) and not yet hospitalized, though it remains possible. They are in their late 60's with some health problems (diabetes, cancer survivor, high bp, etc.) so needless to say I am nonetheless very concerned what path this will go down in the coming days. Probably amplified by the fact that I am across the country with no reasonable prospects of being able to get to them (and they would probably bar the doors if they saw me coming anyways).

I am scheduled in clinic tomorrow and right now my entire caseload basically consists of treating people for "OMG we're all gonna die from COVID" anxiety. I am generally pretty good at drawing emotional boundaries when it comes to clinical care. I am much less certain about my ability to be present for them tomorrow, or the toll it will take on my own mental health from trying to be. Like everyone, I've certainly had some off-days where I am somewhat more distracted for whatever reason and not 100%, but I expect tomorrow to be distinctly different. I've certainly had days where a handful of cases hit a little closer to home. I've had days where I had some challenges and still made it work without difficulty. This is the first time in my career I'm seriously questioning whether I am grounded enough to make it through tomorrow. At the same time, they are my patients and our department is SLAMMED right now so there is no hope of coverage. Although a big part of me wants to cancel, seeing our medical staff power through has me feeling like a bit of a wuss. At the same time (and obviously not to disparage our field), my patients are not particularly high acuity and I am about as certain as I can be my clinic tomorrow will not be the difference between life and death for anyone.

What would you do? Can't promise I'll reply, but I'll read the responses.

Putting my situation aside, for those who weren't yet thinking about things like this....might be time. I sincerely hope no one else ends up in this position, but my parents are not in a hotspot and were being extraordinarily careful. So while the thought had occurred to me something like this might happen I was not yet really prepared for it. I sincerely hope no one else ends up in this position in the coming weeks, but I'm increasingly confident many of us will.

How’s it going? Thinking of you!

 

[IWillSurvive]

Bu
Meanwhile, in the VA system, I must have received about 20 or so emails today from non-clinician well-wishers, pompom wavers, sloganeers, and other sundry non-essential experts imploring me to stay safe, practice mindfulness, worship whole health, reduce stress, wash my hands, not french kiss water fountains, keep a stiff upper lip, etc. God, sometimes I wish someone would take an axe to some of the useless positions in this organization instead of continuing to cut clinical positions while expanding clinical services and hiring more non-clinician well-wishers, pompom-wavers, etc., etc.

Wow, I kind of wish my VA was giving me more of this in exchange for the constant stalking on remote desktop to make sure that skype light is green. And being assigned administrative work to fill in the gaps so they can make sure I'm not actually enjoying having a bit of free time in my schedule. I am in 100% agreement re: cutting the administrative positions. At my site, they are completely clueless on actual administrative and clinical work. I find it interesting that none of them knew the term 'VVC' until about a month ago and now they use it on the regular. I shudder at the thought of the 100s of thousands of dollars wasted on these admin positions, that in the long run drive good providers away from the VA, hurt actual veteran care, and amount to a series of meetings designed to give the appearance of work. Dilbert principle, anyone?

Side note: It is nice to be prioritized as a clinician over admin for once with the rollout of telework, considering we're doing all the heavy-lifting anyway.

 

[Ollie123]

How’s it going? Thinking of you!

So far so good. Recovery is agonizingly slow, but moving in the correct direction. Thanks.

 

[beginner2011]

Is anyone else finding it REALLY disheartening to have like a 45-50 min session and then only be able to bill for 30 min? lol

I believe you can mark the encounter with multiple 21-30m -- e.g., 60m appt = 2 21-30m codes in the encounter.

I have to say, I've been really impressed with how quickly the transition to tele has happened where I'm interning. There was some initial pushback, but now that the cat is out of the bag things seem to be running really smoothly. I've also found my F2F hours have increased and my extra time to put toward side-projects has also increased. Probably in part confounded by increased competence as the intern year goes on, but I think everything being done from one office via tele makes things quite a bit more simple and efficient, as well.

 

[cara susanna]

I believe you can mark the encounter with multiple 21-30m -- e.g., 60m appt = 2 21-30m codes in the encounter.

I have to say, I've been really impressed with how quickly the transition to tele has happened where I'm interning. There was some initial pushback, but now that the cat is out of the bag things seem to be running really smoothly. I've also found my F2F hours have increased and my extra time to put toward side-projects has also increased. Probably in part confounded by increased competence as the intern year goes on, but I think everything being done from one office via tele makes things quite a bit more simple and efficient, as well.

I have been told by numerous people that you cannot bill multiple codes for phone sessions, sadly.