COVID-19 & Clinical Practice Changes?

[WisNeuro]

Jeez, maybe VA Land isn't so bad after all. Thanks for the perspective!

I can honestly say that every single one of my npsych friends/colleagues who have left the VA for PP have never expressed any regret for their decision.

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[Sanman]

I can honestly say that every single one of my npsych friends/colleagues who have left the VA for PP have never expressed any regret for their decision.

It really depends on the area of work. Traditional outpatient neuropsych is better setup for the insurance world than things like rehab work where insurance approvals are more time limited and you are chasing your tail with paperwork more often (the problem with low fee/ high volume work).

 

[WisNeuro]

It really depends on the area of work. Traditional outpatient neuropsych is better setup for the insurance world than things like rehab work where insurance approvals are more time limited and you are chasing your tail with paperwork more often (the problem with low fee/ high volume work).

Most definitely, my experience is also colored by base rates as most of my colleagues and friends in psych are neuro people.

 

[Sanman]

Most definitely, my experience is also colored by base rates as most of my colleagues and friends in psych are neuro people.

Absolutely, for what it is worth, there are several areas I would prefer never to work in at the VA. Anything that touches compensation schemes (Npsych, trauma, C&P), general mental health clinic (dumping ground for stuff), pain clinic (since the opioid epidemic; I really liked the work prior to that). Health psych and geriatrics seem to have a better infrastructure in the VA than outside (barring some AMC/academic positions). Suicide prevention, MST, women's clinic and a few other areas don't seem that bad either. Some people seem to like readjustment services, but that really is not interesting to me.

 

[Therapist4Chnge]

It's so funny to watch them. They like to LARP/pretend like they're some sort of 'business executive' type who are all super-duper problem-solvers, team-builders, and LEAN/six-sigma productivity and efficiency experts. Yet, all around them, problems (that don't even have to exist) run rampant, there are very few functional 'teams' to speak of....

So true. I was six sigma trained in my former career and you are 100% right. There isn't a solution out there that can't be overcomplicated with many meetings and white board talk. Dysfunction is an opportunity to improve, but often those that need to change won't....but that can only be trusted after months of meetings to prove you tried your best.

 

[Therapist4Chnge]

I can honestly say that every single one of my npsych friends/colleagues who have left the VA for PP have never expressed any regret for their decision.

100% agree. I did my intern year in a VA and had a wonderful experience....bc of the people. The VA system and red tape drove me nuts. If I had a family, wanted stability, and could just go with the flow....VA work could have been a nice fit.

In neuropsych, demand is in our favor and we have opportunities to not be reliant on insurance companies. Private practice can still be a challenge, but you are in control over most everything, so you can make improvements.

 

[Fan_of_Meehl]

So true. I was six sigma trained in my former career and you are 100% right. There isn't a solution out there that can't be overcomplicated with many meetings and white board talk. Dysfunction is an opportunity to improve, but often those that need to change won't....but that can only be trusted after months of meetings to prove you tried your best.

The latest fashionable 'craze' appears to be the 'huddle board' and the phrase 'We're all in this together'

 

[cara susanna]

Absolutely, for what it is worth, there are several areas I would prefer never to work in at the VA. Anything that touches compensation schemes (Npsych, trauma, C&P), general mental health clinic (dumping ground for stuff), pain clinic (since the opioid epidemic; I really liked the work prior to that). Health psych and geriatrics seem to have a better infrastructure in the VA than outside (barring some AMC/academic positions). Suicide prevention, MST, women's clinic and a few other areas don't seem that bad either. Some people seem to like readjustment services, but that really is not interesting to me.

MST is my specialty - it pretty much is trauma so you run into the same compensation issue, although the patients generally seem to be more motivated for treatment (this is all anecdotal).

 

[WisNeuro]

MST is my specialty - it pretty much is trauma so you run into the same compensation issue, although the patients generally seem to be more motivated for treatment (this is all anecdotal).

Having done a lot of trauma treatment in and outside of VA settings, there is definitely a HUGE divide in how much patients are motivated for treatment between those settings.

 

[Fan_of_Meehl]

The latest fashionable 'craze' appears to be the 'huddle board' and the phrase 'We're all in this together'

Edit: I still can't decide whether the 'We're all in this together' is strategic gaslighting or whether the people who say it actually believe it

 

[Therapist4Chnge]

The latest fashionable 'craze' appears to be the 'huddle board' and the phrase 'We're all in this together'

The corp jargon now makes my eye twitch. Impromptu "Scrums" are quite popular these days. Identifying "synergistic" opportunities too. I used to text a colleague of mine while sitting in meetings w admin/board member/red tape creators whenever a buzz word was used. We'd text back and forth when new buzz words would pop up. It started as a joke, but we started using them and it was an easy way to build rapport bc "we are speaking the same language." I'm so thankful I don't subject myself to those mindless meetings anymore.

 

[cara susanna]

The corp jargon now makes my eye twitch. Impromptu "Scrums" are quite popular these days. Identifying "synergistic" opportunities too. I used to text a colleague of mine while sitting in meetings w admin/board member/red tape creators whenever a buzz word was used. We'd text back and forth when new buzz words would pop up. It started as a joke, but we started using them and it was an easy way to build rapport bc "we are speaking the same language." I'm so thankful I don't subject myself to those mindless meetings anymore.

We're talking about a totally outrageous paradigm!

 

[summerbabe]

The latest fashionable 'craze' appears to be the 'huddle board' and the phrase 'We're all in this together'

Huddle board = great way to re-purpose a perfectly usable whiteboard into a completely ignored wall accessory

 

[cara susanna]

Huddle board = great way to re-purpose a perfectly usable whiteboard into a completely ignored wall accessory

My absolute favorite is having meetings to try to figure out what our yearly goals are and then never actually setting goals.

 

[Sanman]

My absolute favorite is having meetings to try to figure out what our yearly goals are and then never actually setting goals.

The concept is stupider than the meetings themselves. I can see goal setting being important for years 1-3. Beyond that, you are still doing the same job, what is left to accomplish? On the bright side, since everyone is too lazy to actually set goals with me, I can do whatever I want and seem to still get a great annual evaluation. My personal goals go something like this:

1. Continue breathing
2. Continue to collect paycheck
3. Make more time for family and lucrative side gigs

 

[foreverbull]

wa


Not true, if you are referring to the type of practice I believe you are. Once you have a physician's order in the chart, anyone can send a facesheet over. Social workers are normally utilized to do this task and aren't paid for it, so motivation is poor. Having been a manager for other clinicians in this area, troubleshooting the bolded was my full-time gig (on top of clinical work and insurance hassles). Not bad money for a few years, but not worth the headaches in the long run. VA clinician work has been life on easy mode comparatively.

Practices vary widely by facility, but yes, technically the psychologist can look up individual patients and then assign themselves to see them---but this would be a lot of admin time with some of the software or paper charts to navigate who has the appropriate insurance and would likely benefit from an initial eval, whereas some facilities have a breakdown of who has which insurance, mental illness/symptoms. Per my understanding, the colleague isn't supposed to just assign themselves to everyone just because they can, hence why social services plays a role (this client has had X problem lately and would be appropraite to see based on insurance, etc.). The psychologist doesn't have access to a census of patients, and some facilities don't even have electronic charts, as I mentioned. When said colleague was hired, they were told that social services was supposed to handle referrals.

 

[Sanman]

Practices vary widely by facility, but yes, technically the psychologist can look up individual patients and then assign themselves to see them---but this would be a lot of admin time with some of the software or paper charts to navigate who has the appropriate insurance and would likely benefit from an initial eval, whereas some facilities have a breakdown of who has which insurance, mental illness/symptoms. Per my understanding, the colleague isn't supposed to just assign themselves to everyone just because they can, hence why social services plays a role (this client has had X problem lately and would be appropraite to see based on insurance, etc.). The psychologist doesn't have access to a census of patients, and some facilities don't even have electronic charts, as I mentioned. When said colleague was hired, they were told that social services was supposed to handle referrals.

I bet they were, lol. The answer here is to complain to the manager or take on another facility if there is not enough work being generated at that one. Generally, a quick chat with the Executive Director that you will be decreasing services due to lack of referrals will light a fire. This may or may not be in your friend's purview.

Option 2, have a referral meeting weekly where you review referrals with staff and have the social worker send out paperwork in the meeting.

 

[Fan_of_Meehl]

My absolute favorite is having meetings to try to figure out what our yearly goals are and then never actually setting goals.

'The whole health synergistic inclusive veteran-centered meta-meeting regarding our proposed proto-goals is set to begin any minute now'

 

[R. Matey]

I just came to this thread to express my favorite thing about working from home (yes, we still are) is the ability to blare alt-rock during paperwork time

 

[Fan_of_Meehl]

I just came to this thread to express my favorite thing about working from home (yes, we still are) is the ability to blare alt-rock during paperwork time

You gotta FIGHT!!! For your RIGHT!!! To chaaaaaart-HEY!!!

 

[foreverbull]

I bet they were, lol. The answer here is to complain to the manager or take on another facility if there is not enough work being generated at that one. Generally, a quick chat with the Executive Director that you will be decreasing services due to lack of referrals will light a fire. This may or may not be in your friend's purview.

Option 2, have a referral meeting weekly where you review referrals with staff and have the social worker send out paperwork in the meeting.

This has been discussed with the regional manager many times, and the company has to assign new facilities and is not in a position to do so (colleague requested to drop a site that doesn't provide enough referrals and was told this wasn't in the company's best interest). This is a huge company that doesn't really care that much about fee-for-pay psychologists or their concerns--wondering if you worked in a very different setting or with a different kind of company that valued psychologists more.

 

[Sanman]

This has been discussed with the regional manager many times, and the company has to assign new facilities and is not in a position to do so (colleague requested to drop a site that doesn't provide enough referrals and was told this wasn't in the company's best interest). This is a huge company that doesn't really care that much about fee-for-pay psychologists or their concerns--wondering if you worked in a very different setting or with a different kind of company that valued psychologists more.

I worked for a couple of different companies. However, I was a regional manager at the smaller of the two companies, so I had more leverage to do what I wanted. I am curious about the details, We can talk details over PM if you want.

 

[Therapist4Chnge]

I just came to this thread to express my favorite thing about working from home (yes, we still are) is the ability to blare alt-rock during paperwork time

I was enjoying some Stone Temple Pilots last week. This week has been a chiller mix of Hootie & The Blowfish, Jimmy Buffett, and Green Day. I think I'm going to kick it up a notch to RATM this afternoon.

I go into the office 1x per week to sign off on billing and handle office/staff stuff. This work from home is likely a long-term change...with my office time being cut back to 1-2x per week.

 

[cara susanna]

I just listen to music on headphones during admin time.

 

[IWillSurvive]

The latest fashionable 'craze' appears to be the 'huddle board' and the phrase 'We're all in this together'

oh my goshhh 'the huddle board' yes!

 

[Fan_of_Meehl]

oh my goshhh 'the huddle board' yes!

It's always some new gimmick. Some new catch-phrase.

Never just fixing the problems right in front of their faces and then moving on to the next one. They have to create some elaborate ritual around the pretense that they are going to do something...at some point...maybe.

"Never confuse MOTION with ACTION"

 

[AcronymAllergy]

I think the huddle board passed us by, or I've blocked it from memory. Either way, it sounds like I should be grateful.

 

[futureapppsy2]

I think the huddle board passed us by, or I've blocked it from memory. Either way, it sounds like I should be grateful.

Out of a sense of morbid curiosity, I really want to know what it is!

 

[Fan_of_Meehl]

Out of a sense of morbid curiosity, I really want to know what it is!

It's a whiteboard. Where 'teams' put their 'goals, progress, etc.'--I forget all the particular slogans and terms employed. The reason I'm putting the words in quotes is that it's a joke. There is no implementation. We have had the same 'goals' and 'priorities' in my work area for many many months with no progress. To give but one example, we were (and still are) unable to get environmental services to actually take out trash and do janitorial duties in our areas on any regular basis. We're still there a couple of years later while having the 'goals, priorities, progress' tabs on the 'huddle board.' Also, we had on the huddle board (for 2+ years) the clear priority to improve access by replacing the third mental health provider position (refilling it with a provider) that we had lost when that social worker provider left for a promotion to be a program manager for another area. Eventually, the 'priority' of replacing the provider position was simply scrubbed for some apparent political/financial reason while--over the same 2 year time period--they continued to create/fund tons of non-clinical positions in mental health. The 'huddle board' is a joke.

As an aside, on Youtube right now they're showing the
Department of Veterans Affairs - Response to COVID-19

 

[medium rare]

For those of you in private practice, I’m curious as to what you’ve experienced over the past several weeks regarding demand for services since COVID-19.

I’ve just completed my 10th week of entirely telepsych practice and have been inundated with requests for appointments - both returning and new patients. My schedule was already full with a modest waiting list, but over the past 6 weeks, the demand has skyrocketed. I’m having a difficult time referring out as well.

What’s been especially intriguing is that I’m 100% self-pay and the demand has not diminished at all; it’s actually increased and my patient SES demographic is primarily upper-middle class.

Anyone else experiencing something similar?

 

[AcronymAllergy]

For those of you in private practice, I’m curious as to what you’ve experienced over the past several weeks regarding demand for services since COVID-19.

I’ve just completed my 10th week of entirely telepsych practice and have been inundated with requests for appointments - both returning and new patients. My schedule was already full with a modest waiting list, but over the past 6 weeks, the demand has skyrocketed. I’m having a difficult time referring out as well.

What’s been especially intriguing is that I’m 100% self-pay and the demand has not diminished at all; it’s actually increased and my patient SES demographic is primarily upper-middle class.

Anyone else experiencing something similar?

I'm not in private practice, but based on listserve posts I've seen of others who are, it's pretty similar in my area across a variety of providers.

 

[foreverbull]

For those of you in private practice, I’m curious as to what you’ve experienced over the past several weeks regarding demand for services since COVID-19.

I’ve just completed my 10th week of entirely telepsych practice and have been inundated with requests for appointments - both returning and new patients. My schedule was already full with a modest waiting list, but over the past 6 weeks, the demand has skyrocketed. I’m having a difficult time referring out as well.

What’s been especially intriguing is that I’m 100% self-pay and the demand has not diminished at all; it’s actually increased and my patient SES demographic is primarily upper-middle class.

Anyone else experiencing something similar?

I’ve experienced the exact opposite; very few potential clients reaching out these days, and for those few who do, not able to pay full fee. Same time last year my PP had a lot more emails/calls from interested folks, but I’m in a middle-class area that has been feeling the effects of the economic downturn. Some colleagues I’ve spoken to recently reported a decrease in client load and demand in my area, although I’m not sure about those who take insurance—prior to Covid, those folks reported being full constantly and having to refer out.

I haven’t spoken to my colleagues who are private pay only in a more affluent area 20 minutes away, but it’s possible that they have had a very different experience.

 

[PsyDr]

@medium rare I maintain a very limited clinical practice to back up my forensic stuff. The clinic hasn’t slowed down at all. Gonna raise rates next month.

 

[Therapist4Chnge]

My clinical/assessment work has slowed down ~30%, less than I expected. My legal work has seen an uptick, so it mostly evened out. Now I have a back log of neuro testing to squeeze into an already busy June, so I'll be busy.

I also offer follow-up counseling for my assessment cases, and my counselor has been swamped.

Videoconferencing has always been too much of a hassle, so we did the best we could w referring out....until the virus came and forced us to evolve our practices. A number of bumps along the way, but we've adjusted.

The added stress in our communities is real and harmful, especially in my injured frontline workers. I'm thankful that we could convert to videoconferencing on the fly, as it helped avoid interruption in treatment and get ppl in quicker. It also has provided a different feel in regard to treatment. I've met spouses and kids in their home environments, which rarely happened prior to the virus. It also revealed challenges w lack of high-speed access, access to a computer (at all or bc kids have school), juggling kids/caring for (covid & chronic) sick family members, etc.

One of the most frustrating things I have yet to resolve is the billing stuff. I'm just as productive as prior to the virus, but my receivables are way down. It'll pick up hopefully.

ps. To keep this in perspective, I'm thankful to have my safety and an ability it keep earning. I fully recognize my privilege has allowed me the ability to decide how & where to work, so the above definitely qualify as "first world problems."

To try and help locally, I've made larger donations to local groups, rotated food orders (personal & work) between a handful of local restaurants, commissioned art from local artists, and support new progressive candidates wanting to make real change.

 

[PsychPhDone]

So it sounds like we will be going back into the hospital to work soon. Anyone else hearing this chatter at the VA?

Not the case here. We've been encouraged to keep teleworking. There is talk of adding another couple in-person services but those are interventional things requiring psychiatry.

 

[medium rare]

I'm not in private practice, but based on listserve posts I've seen of others who are, it's pretty similar in my area across a variety of providers.

Most of my colleagues and and grad school friends have had the same experience although a few have had a decline in demand for services. One colleague in Texas reported a steep decline in the immediate weeks following the coronavirus onset but said that has leveled and demand has significantly increased in the past two weeks.

 

[cara susanna]

I was supposed to have in-person testing restart this week but the one patient scheduled cancelled. Apparently doesn't want to come in just yet (I can't say I blame them!)

 

[AcronymAllergy]

I was supposed to have in-person testing restart this week but the one patient scheduled cancelled. Apparently doesn't want to come in just yet (I can't say I blame them!)

There's been some semblance of a thought of an idea to possibly get it going here at some point. Maybe. Which means I'll probably come in tomorrow to it having started back up.

 

[AbnormalPsych]

Our facility is embracing the WFH situation given our numbers are pretty equivalent to when we were in clinic. We will probably continue WFH for the near future.

 

[iliketohelppeople]

I think we are preparing to continue delivering a considerable amount of services via telehealth for the forseeable future. I know our clinic is even fuller it seems. Not sure what will happen with WFH, but my days have been busy still (just the bathroom is closer!). Might go on until end of my fellowship. Nuts.

 

[IWillSurvive]

So...our facility has decided to re-open and we were informed that MH is #1 on the list to re-open for face-to-face appointments. I was so utterly mystified by this decision.

Edit, for context: cases are increasing, peak not yet reached for round 1, state hospitalizations increasing, social distancing measures decreasing.

 

[WisNeuro]

So...our facility has decided to re-open and we were informed that MH is #1 on the list to re-open for face-to-face appointments. I was so utterly mystified by this decision.

Edit, for context: cases are increasing, peak not yet reached for round 1, state hospitalizations increasing, social distancing measures decreasing.

The public, by and large, doesn't give a **** anymore. And likely won't until they have a few friends or family members die. We are a phenomenally selfish and stupid country as a population, and we're seeing the worst of us in these crises.

 

[cara susanna]

We opened face-to-face for urgent and emergent appts only. And testing, which obviously can't be done via telehealth.

 

[WisNeuro]

We opened face-to-face for urgent and emergent appts only. And testing, which obviously can't be done via telehealth.

Neuropsych testing? We can do it over telehealth, it just really sucks, and we can only do it well on limited patients.

 

[cara susanna]

Neuropsych testing? We can do it over telehealth, it just really sucks, and we can only do it well on limited patients.

Psychological testing. We don't really have any way of administering the measures via telehealth.

 

[WisNeuro]

Psychological testing. We don't really have any way of administering the measures via telehealth.

Pearson has a way to deliver questionnaires over telehealth via computer. though, I refuse to do it because there is next to nothing in terms of test security.

 

[thebalmofhurtminds]

Doubt the VA would allow that anyway.

 

[WisNeuro]

Doubt the VA would allow that anyway.

I hear that they've been more open to Q-global these days, though I'm a few years away from the beast at this point. @AcronymAllergy what's the update here?

 

[AcronymAllergy]

I hear that they've been more open to Q-global these days, though I'm a few years away from the beast at this point. @AcronymAllergy what's the update here?

I believe, theoretically, it is possible for VA providers to get Q-Global setup. They just have to work with their ISO to determine how to enter patient data, and with IT on actually installing it and setting it up.

 

[SportsNeuroPsych]

The public, by and large, doesn't give a **** anymore. And likely won't until they have a few friends or family members die. We are a phenomenally selfish and stupid country as a population, and we're seeing the worst of us in these crises.

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