For folks considering VA vs. Academic medical center as future career track primarily for clinical/supervision work, what are pros and cons?

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From what I heard, VA seems to value psychologists (e.g., protection from malpractice, etc.) across the board. AMC can be a bit of context-specific.

I'd love to hear your observations and information on prestige, pay (throughout career 10-20 year track, including initial pay), work-life balance, future career track opportunities, etc. between VA and AMC.

A bit more context - I'm trying to decide where to go for internship between VA and AMC. Most of my sites I interviewed are in big cities, so I am excited about networking further.

Thank you!

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From what I heard, VA seems to value psychologists (e.g., protection from malpractice, etc.) across the board. AMC can be a bit of context-specific.

I'd love to hear your observations and information on prestige, pay (throughout career 10-20 year track, including initial pay), work-life balance, future career track opportunities, etc. between VA and AMC.

A bit more context - I'm trying to decide where to go for internship between VA and AMC. Most of my sites I interviewed are in big cities, so I am excited about networking further.

Thank you!

I would give up on any aspirations of prestige working in healthcare as a psychologist if I were you.
 
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Oh, please say more?

I'm just not sure what you are looking for exactly, but it isn't exactly the status symbol it used to be 50+years ago. VA is a little better, but in most places you are not considered part of the medical staff and have very little say in how things go. Your area lead/manager is usually a social worker with an MBA. It's still a good job in some places, but you're not exactly looked up to, for the most part. The respect you get from other staff will be very much individually based, with very little to do with your degree and credentials.
 
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I'm just not sure what you are looking for exactly, but it isn't exactly the status symbol it used to be 50+years ago. VA is a little better, but in most places you are not considered part of the medical staff and have very little say in how things go. Your area lead/manager is usually a social worker with an MBA. It's still a good job in some places, but you're not exactly looked up to, for the most part. The respect you get from other staff will be very much individually based, with very little to do with your degree and credentials.
This is very different description of what I have been informed about AMC positions. I have not heard of licensed psychologists with Ph.D. being managed by social workers. I'm curious to hear others' experiences and thoughts.
 
Just a head's up, I ranked all AMCs first in my internship applications, but ended up matching at a VA anyway, and now I'm a VA "lifer." So the decision may be made for you in the end, lol.
 
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Just a head's up, I ranked all AMCs first in my internship applications, but ended up matching at a VA anyway, and now I'm a VA "lifer." So the decision may be made for you in the end, lol.

We'll convince you of the merits of private practice yet. Lots of demand for PTSD folks in clinical practice and IMEs. :)
 
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This is very different description of what I have been informed about AMC positions. I have not heard of licensed psychologists with Ph.D. being managed by social workers. I'm curious to hear others' experiences and thoughts.
I'm not even being hyperbolic when I say that--depending on the particular people in your 'line' of supervision--you may even be treated (in fact) as beneath the MSA's (a.k.a., the 'secretaries'). I'm not even kidding. If you don't want to sell your integrity to the Devil, you can be a front line provider and benefit from job stability, decent retirement, less malpractice liability exposure, etc. But--for the love of God--don't have any misconceptions that you are going to get any 'prestige' by being a VA psychologist.

We are run by social workers. I've even joked (no joke) about going back to get my LCSW if I ever wanted to 'advance' in the hierarchy (of course, I have zero desire to 'advance' in the power hierarchy for numerous reasons).
 
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I'm not even being hyperbolic when I say that--depending on the particular people in your 'line' of supervision--you may even be treated (in fact) as beneath the MSA's (a.k.a., the 'secretaries'). I'm not even kidding. If you don't want to sell your integrity to the Devil, you can be a front line provider and benefit from job stability, decent retirement, less malpractice liability exposure, etc. But--for the love of God--don't have any misconceptions that you are going to get any 'prestige' by being a VA psychologist.

We are run by social workers. I've even joked (no joke) about going back to get my LCSW if I ever wanted to 'advance' in the hierarchy (of course, I have zero desire to 'advance' in the power hierarchy for numerous reasons).

No better in most of the larger non-VA healthcare systems here. I only knew one psychologist in a leadership position (mid-level management) in the entire system. Even then, that person was a meat shield who was primarily there to soak up criticism from providers, as they had no decision making power.
 
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I was going to post part of this in the other VA vs. AMC thread, but I can add it here. I'll start with the caveat that my AMC experience is pretty much universally second-hand, heard mainly through former supervisors and/or seen as a trainee in those settings.

For work-life balance, VA will probably win out most of the time. For compensation, VA may edge out AMCs early-career, but will likely be outpaced by mid- and late-career. Flexibility, I imagine AMCs win out most of the time. Prestige is so variable and both site- and individual-specific, I don't know that generalizations could be made. But I certainly would recommend trying to find sites where psychologists are on the medical staff, and where there aren't issues with psychologists referring to themselves as "doctor."

RE: where to go for training, in the grand scheme of things over the course of an entire career, it may not matter much. Especially if you're also considering doing a postdoc. That being said, if you have little to no VA training experience thus far and you're considering VA as an early-career option, I'd probably recommend picking a VA for internship, as it may help you with the hiring committee. Not sure if the same holds true for AMCs.
 
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We'll convince you of the merits of private practice yet. Lots of demand for PTSD folks in clinical practice and IMEs. :)

Dis u?

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We'll convince you of the merits of private practice yet. Lots of demand for PTSD folks in clinical practice and IMEs. :)

I dunno, I reaaally like the VA work/life balance and involvement in training
 
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I have a social worker as my manager in a VA setting, and it is totally fine. They respect me, the work I do, and the expertise I bring to the table. I also believe I have a fair amount of occupational prestige, within the hospital and in the community. Certainly not as much as many other professions, and there's clearly a lot of folks on this board who are constantly disappointed to not be treated like MDs, which may make sense in some specialties. VA work life balance is pretty solid, though more vacation days (particularly early career) would be nice.
 
I'm just not sure what you are looking for exactly, but it isn't exactly the status symbol it used to be 50+years ago. VA is a little better, but in most places you are not considered part of the medical staff and have very little say in how things go. Your area lead/manager is usually a social worker with an MBA. It's still a good job in some places, but you're not exactly looked up to, for the most part. The respect you get from other staff will be very much individually based, with very little to do with your degree and credentials.
This has not been the case at any of the AMCs I've worked at. Leaders are all MDs/PhDs.
 
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From what I heard, VA seems to value psychologists (e.g., protection from malpractice, etc.) across the board. AMC can be a bit of context-specific.

I'd love to hear your observations and information on prestige, pay (throughout career 10-20 year track, including initial pay), work-life balance, future career track opportunities, etc. between VA and AMC.

A bit more context - I'm trying to decide where to go for internship between VA and AMC. Most of my sites I interviewed are in big cities, so I am excited about networking further.

Thank you!
I am definitely biased because I love being at an AMC, though I'm not sure I'd want to be at an AMC solely to perform clinical work/supervision. More $$ in PP. Prestige at AMCs in my opinion is about research funding and has very little to do with clinical service or education. That being said I do know a lot of people in PP join our faculty (there is a separate faculty standing they can have in exchange for a certain amount of service...they don't receive any pay) in part because being affiliated with a major AMC makes them more attractive to private patients and PP can get boring.
 
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I would give up on any aspirations of prestige working in healthcare as a psychologist if I were you.
Indeed. I am at my third VA, one in which I have a joint faculty position with a well-respected medical school. Even with the pay, benefits, and faculty appointment, I am so over the VA system.

I'm just not sure what you are looking for exactly, but it isn't exactly the status symbol it used to be 50+years ago. VA is a little better, but in most places you are not considered part of the medical staff and have very little say in how things go. Your area lead/manager is usually a social worker with an MBA. It's still a good job in some places, but you're not exactly looked up to, for the most part. The respect you get from other staff will be very much individually based, with very little to do with your degree and credentials.
Yup - in my former position as a BHIP psychologist at a VA in Ohio, they were actively looking for a BHIP supervisor that could have been a psychologist, LCSW, or RN.

We'll convince you of the merits of private practice yet. Lots of demand for PTSD folks in clinical practice and IMEs. :)
I have learned the ways. It's in part what drove me to establish a LLC private practice back in Ohio when I started my first VA psychologist job. I wanted something I could build on the side, and I saw it as a goal to work towards for a more permanent solution. Before I moved to Texas, I did 3 things bout 2 months prior to my move: I dissolved my Ohio LLC, I applied for my Texas license, and a established my Texas PLLC. Knowing that this would take time, everything fell into place about 2 months after I moved. Now, I have been slowly ramping up marketing and attempting to get clinical and forensic work going. I am giving myself until this September to get everything in order so I can hopefully transition to full time private practice by then.
 
We are run by social workers. I've even joked (no joke) about going back to get my LCSW if I ever wanted to 'advance' in the hierarchy (of course, I have zero desire to 'advance' in the power hierarchy for numerous reasons).

Posts like these and those on the venting thread do a great job of keeping me out of the VA. I'm still super early career, but I have yet to be convinced that it's any better than a gold plated version the CMHCs I worked in when I was master's level clinician.

This has not been the case at any of the AMCs I've worked at. Leaders are all MDs/PhDs.

This is because mid-levels can't get faculty appointments, right? That's how it worked at the AMCs I'm familiar with.
 
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I'm not even being hyperbolic when I say that--depending on the particular people in your 'line' of supervision--you may even be treated (in fact) as beneath the MSA's (a.k.a., the 'secretaries'). I'm not even kidding. If you don't want to sell your integrity to the Devil, you can be a front line provider and benefit from job stability, decent retirement, less malpractice liability exposure, etc. But--for the love of God--don't have any misconceptions that you are going to get any 'prestige' by being a VA psychologist.

We are run by social workers. I've even joked (no joke) about going back to get my LCSW if I ever wanted to 'advance' in the hierarchy (of course, I have zero desire to 'advance' in the power hierarchy for numerous reasons).


Never been supervised by an LCSW and never plan to be. I have supervised LCSW therapists though.

MSAs secretly run the VA, there is no one above them.
 
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I've never heard of a master's-level person supervising psychologists at an AMC. They're involved and sometimes did have the potential to make your life difficult (e.g., our intake team was all master's level folks and they did case assignments), but that was quite a bit different than supervising you. The research front was different though, as they are the ones with the power to shut down your research program if one of your staff initialed the paper "wrong" or similar nonsense the research world prioritizes nowadays.

I think both are good early career options. I've never fully understood why people stay in clinical roles at AMCs long-term unless it is for the benefits or because they want a very niche practice that is just not sustainable in another setting. The research side I get since you simply <can't> do many types of work outside an AMC.

I'm a researcher, but if I was clinically-focused with fairly bread & butter practice interests (depression, anxiety, etc.) I would probably spend a few years in a clinical role at a local VA or AMC to build my reputation, then open a cash practice as long as there weren't any non-competes preventing me from doing so.
 
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Never been supervised by an LCSW and never plan to be. I have supervised LCSW therapists though.

MSAs secretly run the VA, there is no one above them.
"Scheduling Mafia" confirmed
 
This is because mid-levels can't get faculty appointments, right? That's how it worked at the AMCs I'm familiar with.
99% of the time I believe this is true. Maybe a random faculty here or there in an MSW program, but I haven't seen those directly connected to AMCs.

"Prestige" is a funny thing. I've already worked at 2 of the top 5-6 R1 programs for what I do and was recruited by 2-3 of the other ones, but they all have most of the same pros/cons. I'd still have to deal with the bean counters and be on multiple useless committees. I miss some of the collaborative opportunities and being able to drop in on grand rounds and lecturers, but the money difference is enough to give that stuff up.

Prestige is largely an illusion, especially these days of AMCs acting like for-profit hospitals. It used to be (15-20+ yrs ago) that you could live in the ivory tower, teach/mentor/research, and a large part of the draw was the independence combined with a pretty cushy existence you could carve out with some research $'s. Now research $'s are harder to attain, productivity metrics have metastasized across most/all settings, and as a result the bean counters have more of an impact on day-to-day work.

The VA seems good for 0-5 years, basically beginning of early career because they generally have a better work/life balance and good benefits for people wanting to start/grow families. The problem w. VAs (at least for psychs that work in speciality areas like Beh. Health, Rehab, Neuro) is that salary-wise, you cap out pretty quickly, and then PP will easily pay more than a salaried VA position. AMCs can still provide a solid total package, but you need to bring in research dollars to get the cushy positions and endowed positions, as clinicians don't bring in enough comparatively.
 
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99% of the time I believe this is true. Maybe a random faculty here or there in an MSW program, but I haven't seen those directly connected to AMCs.

"Prestige" is a funny thing. I've already worked at 2 of the top 5-6 R1 programs for what I do and was recruited by 2-3 of the other ones, but they all have most of the same pros/cons. I'd still have to deal with the bean counters and be on multiple useless committees. I miss some of the collaborative opportunities and being able to drop in on grand rounds and lecturers, but the money difference is enough to give that stuff up.

Prestige is largely an illusion, especially these days of AMCs acting like for-profit hospitals. It used to be (15-20+ yrs ago) that you could live in the ivory tower, teach/mentor/research, and a large part of the draw was the independence combined with a pretty cushy existence you could carve out with some research $'s. Now research $'s are harder to attain, productivity metrics have metastasized across most/all settings, and as a result the bean counters have more of an impact on day-to-day work.

The VA seems good for 0-5 years, basically beginning of early career because they generally have a better work/life balance and good benefits for people wanting to start/grow families. The problem w. VAs (at least for psychs that work in speciality areas like Beh. Health, Rehab, Neuro) is that salary-wise, you cap out pretty quickly, and then PP will easily pay more than a salaried VA position. AMCs can still provide a solid total package, but you need to bring in research dollars to get the cushy positions and endowed positions, as clinicians don't bring in enough comparatively.


Pretty much agree on both points. Regarding the VA issue, I agree. The hard part for me is whether leaving VA (or similarly AMC) may also mean leaving exclusive specialty practice. There are more lucrative areas that are just less headache in PP, but I do enjoy my area of work. Depending on specialty, this can be hard to replicate in PP.
 
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I personally feel quite respected as a psychologist at the VA.
 
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I personally feel quite respected as a psychologist at the VA.
Just to add my own anecdotal experience, I also felt respected at my VA as a psychologist, although my VA had a long history of psychology being well-represented in mid- to upper-leadership. Psychologists were also on the medical staff. My direct and upper-level leadership rotated between social work, psychology, and psychiatry during my time.

And pretty much anywhere you are, it helps to do good work. I'd actually say that's the single biggest factor contributing to respect, combined with familiarity. I had other providers at times refer patients to me specifically (although that wasn't really possible in VA) because they were familiar with what I did and how I wrote my reports. Even if psychologists as a whole are not automatically held in high regard at a site, you can still be respected as an individual for providing high-level care, and that can then sometimes result in more respect being given to your colleagues.
 
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Just to add my own anecdotal experience, I also felt respected at my VA as a psychologist, although my VA had a long history of psychology being well-represented in mid- to upper-leadership. Psychologists were also on the medical staff.

And pretty much anywhere you are, it helps to do good work. I'd actually say that's the single biggest factor contributing to respect, combined with familiarity. I had other providers at times refer patients to me specifically (although that wasn't really possible in VA) because they were familiar with what I did and how I wrote my reports. Even if psychologists as a whole are not automatically held in high regard at a site, you can still be respected as an individual for providing high-level care, and that can then sometimes result in more respect being given to your colleagues.

This sums it up well, I guess I separate respect vs. prestige. I do not think there is much prestige in the profession, in general. However, like you said, you can definitely earn respect through your work. If you produce good product and have good impressions with patients/families, you'll have no problems with referrals.
 
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This sums it up well, I guess I separate respect vs. prestige. I do not think there is much prestige in the profession, in general. However, like you said, you can definitely earn respect through your work. If you produce good product and have good impressions with patients/families, you'll have no problems with referrals.

Among the general public there is some prestige. In an actual healthcare setting, the prestige has been declining overall. The corporatization of healthcare has meant even physicians are seen as worker drones and nothing more in many settings. You want to see nice suits and fancy coffee machines, walk to the business office...even at the VA.

The one thing we have going for us, imo, is the ease of setting up PP and having that stuff for ourselves.
 
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I personally feel quite respected as a psychologist at the VA.

By the many patients and my colleagues? Yes, I feel quite respected. However, one trip to HR or to renew my PIV card and man do you feel like a number. Same when speaking to the front office about things like office space.
 
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By the many patients and my colleagues? Yes, I feel quite respected. However, one trip to HR or to renew my PIV card and man do you feel like a number. Same when speaking to the front office about things like office space.

Oh, yeah. MSAs too, from my experience.
 
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This sums it up well, I guess I separate respect vs. prestige. I do not think there is much prestige in the profession, in general. However, like you said, you can definitely earn respect through your work. If you produce good product and have good impressions with patients/families, you'll have no problems with referrals.
Ah yes, good point. I went off on a respect tangent rather than speaking specifically to prestige. I would agree that I wouldn't go into psychology (or pretty much anywhere in direct care provision in healthcare at this point) hoping for prestige.
 
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I think for me, it depends. At my previous two VAs, I felt psychologists were respected. At my current VA within my clinic, I do not feel that way. Perhaps it varies by clinic and VA.

It definitely varied by facility, leadership, and previous experience. That said, psychology is one of those odd careers where you can fail into money.

Your trajectory could literally be, I was turned down for tenure making $60k at an r2, so I took a VA job making double that. Couldn't deal with the VA duties and ended up in PP doubling my VA salary. Congrats, you have no prestige and quadruple the salary.
 
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It definitely varied by facility, leadership, and previous experience. That said, psychology is one of those odd careers where you can fail into money.

Your trajectory could literally be, I was turned down for tenure making $60k at an r2, so I took a VA job making double that. Couldn't deal with the VA duties and ended up in PP doubling my VA salary. Congrats, you have no prestige and quadruple the salary.

True. To be honest, I think the whole prestige aspect of being a psychologist for a large VA and an assistant professor at an AMC has lost its luster for me. I had been considering leaving the VA since April of 2022 when I was at my previous VA, so this is by no means an abrupt revelation, it's been a long-standing sentiment. For me, I think a re-evaluation of professional and personal goals and values has been coming up for me lately. I don't need to be a professor or working for the federal government. I am not looking for approval or admiration from others. I want more $$$, I want to have the time off for vacations, etc., I want to not to have to submit time off requests 45 days in advance, I want to work with people that like each other who are professional and respectful, I want to engage in clinical/forensic activities that matter to me, I want to work with a patient population that values my services/doesn't abuse them. I'd also prefer to work remotely more if I can.
 
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I'm not even being hyperbolic when I say that--depending on the particular people in your 'line' of supervision--you may even be treated (in fact) as beneath the MSA's (a.k.a., the 'secretaries'). I'm not even kidding. If you don't want to sell your integrity to the Devil, you can be a front line provider and benefit from job stability, decent retirement, less malpractice liability exposure, etc. But--for the love of God--don't have any misconceptions that you are going to get any 'prestige' by being a VA psychologist.

We are run by social workers. I've even joked (no joke) about going back to get my LCSW if I ever wanted to 'advance' in the hierarchy (of course, I have zero desire to 'advance' in the power hierarchy for numerous reasons).

Every time the "I don't like research, want to solely provide therapy, and end up in private practice, so should I get a counseling or psychology degree?" question come up, I tell people MSW to LCSW route. I work in a AMC and our departments are managed by SW or Psychiatrist's. The psychologist earn more than our SW manager's, but nonetheless, they're the ones getting the administrative/manager roles. Even when these roles are posted, the qualification is SW with 5+ years of experience, they wouldn't even consider psychologists for these roles for some reason.
 
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Every time the "I don't like research, want to solely provide therapy, and end up in private practice, so should I get a counseling or psychology degree?" question come up, I tell people MSW to LCSW route. I work in a AMC and our departments are managed by SW or Psychiatrist's. The psychologist earn more than our SW manager's, but nonetheless, they're the ones getting the administrative/manager roles. Even when these roles are posted, the qualification is SW with 5+ years of experience, they wouldn't even consider psychologists for these roles for some reason.

That's ridiculous. What a shame.
 
That's ridiculous. What a shame.

This was pretty much the case in our old hospital system. Most midlevel leadership was SW, and upper level leadership was all MDs. I suspect that midlevel leadership goes to SWs because they can pay them less. Even if they are clueless and losing the unit money. At one point I found a simple billing problem they were having that was losing thousands a week that they were just writing off because they didn't know what to do.
 
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This was pretty much the case in our old hospital system. Most midlevel leadership was SW, and upper level leadership was all MDs. I suspect that midlevel leadership goes to SWs because they can pay them less. Even if they are clueless and losing the unit money. At one point I found a simple billing problem they were having that was losing thousands a week that they were just writing off because they didn't know what to do.
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This was pretty much the case in our old hospital system. Most midlevel leadership was SW, and upper level leadership was all MDs. I suspect that midlevel leadership goes to SWs because they can pay them less. Even if they are clueless and losing the unit money. At one point I found a simple billing problem they were having that was losing thousands a week that they were just writing off because they didn't know what to do.

It is pretty much this from what I have seen. Though, even the psychology leadership positions pay less than working a side hustle.
 
Some social work programs are much more administrative, so some of those skills can be pitched as "management material." I think it's mostly BS, but most leadership in hospitals love to make decisions based on the bottom line and don't need a ton of convincing when there is a clear lowest cost option. This isn't a slight on MSWs, but moreso a critique of the penny wise, pound foolish approach by most hospital systems towards staffing decisions.
 
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This was pretty much the case in our old hospital system. Most midlevel leadership was SW, and upper level leadership was all MDs. I suspect that midlevel leadership goes to SWs because they can pay them less. Even if they are clueless and losing the unit money. At one point I found a simple billing problem they were having that was losing thousands a week that they were just writing off because they didn't know what to do.

Same for me at the large healthcare system where I did my residency hours. My supervisors were psychologists, but the area "manager" was a social worker who had some authority over the psychologists and psychiatrists (they all loved it, I assure you). That person was smart enough to know what they didn't know and was all too happy to cede authority on most clinical decisions so they were really not much more than an administrator. So, that's fortunate, but also easy to see how a petty tyrant could ruin that dynamic quickly.
 
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