How many clients do you have a day?

[NP112]

Hello all,
I’m sort of having a mid-grad school existential crisis. I came in thinking I’d want to do neuropsych but have since realized I’m not enjoying report writing all that much. I am considering pursuing a generalist post at a VA or a college counseling center. That being said, I am aware of my introversion and am worried about burnout eventually. How many clients do practitioners in these settings? I know that it will largely depend on the VA or CC, but wanted to get some numbers from workers in these settings for context.

TIA

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[Fan_of_Meehl]

Hello all,
I’m sort of having a mid-grad school existential crisis. I came in thinking I’d want to do neuropsych but have since realized I’m not enjoying report writing all that much. I am considering pursuing a generalist post at a VA or a college counseling center. That being said, I am aware of my introversion and am worried about burnout eventually. How many clients do practitioners in these settings? I know that it will largely depend on the VA or CC, but wanted to get some numbers from workers in these settings for context.

TIA

I think right now the standard is six hourly appointments per shift---but one of these six could be a 1.5 hr intake slot. I've heard of others having seven, which I think is too much and a recipe for burnout. At VA, there is SO much you have to do outside the sessions, especially in terms of documentation, meetings, required trainings, walking over to the hospital to replace your mouse that just crapped out on you (happened to me this morning), or otherwise operating without any real support.

For me, limiting it to 4-5 appointments per day would be really sweet, but that just ain't gonna happen.

 

[WisNeuro]

In our hospital setting, they expect therapists to have 28-32 direct therapy contact hours a week.

 

[erg923]

Between 25-32 direct hours of patient contact for full-time, therapy-focused positions is most common

 

[Childdoconeday]

I work in a community mental healthy type of setting and see between 7-9 a day! Its a lot.

 

[mypointlesspov]

Hello all,
I’m sort of having a mid-grad school existential crisis. I came in thinking I’d want to do neuropsych but have since realized I’m not enjoying report writing all that much. I am considering pursuing a generalist post at a VA or a college counseling center. That being said, I am aware of my introversion and am worried about burnout eventually. How many clients do practitioners in these settings? I know that it will largely depend on the VA or CC, but wanted to get some numbers from workers in these settings for context.

TIA

Externed for 17 hours/week at a CC and I had 11 clients and one group. The actual FT staff members typically saw 5-7 clients/day.

 

[PhDToBe]

Although likely uncommon, I have a friend who works for the VA doing home-based care and she only sees a couple of clients per day. In fact, things have been slow recently and she typically sees very few clients each week...

 

[WisNeuro]

Although likely uncommon, I have a friend who works for the VA doing home-based care and she only sees a couple of clients per day. In fact, things have been slow recently and she typically sees very few clients each week...

I did some HBPC work during training, and a good friend here was doing it in the VA for about 5 years, can confirm. In a lot of places, you get credited a good deal of productivity due to "travel time." I remember taking 2 hour lunch breaks on that rotation.

 

[AcronymAllergy]

Yeah, if you're looking for a somewhat non-traditional work setup and don't mind driving around a lot and seeing patients in their homes, HBPC is one way to go. I do wonder how it may be impacted long-term by effects from the current pandemic. They'll still need teams going into homes in-person, but I wonder if there may be fewer positions going forward for mental health due to telehealth (e.g., need fewer HBPC psychologists and social workers because more of the "regular" in-clinic staff can see more of the HBPC-enrolled patients via telehealth).

I think the main downside with HBPC is some people just seem to get bored with it eventually. It can also be a bit isolating I would imagine.

 

[WisNeuro]

I think the main downside with HBPC is some people just seem to get bored with it eventually. It can also be a bit isolating I would imagine.

I've met very few HBPC lifers. My buddy jumped off that ship as soon as an OP Gero position opened up. Person I trained with back in internship also moved to an OP job.

 

[cara susanna]

As others have said, in the VA it's generally 30 hours of client contact per week which averages to 6 appts a day. This could be fewer if you have longer appts, like intakes or 90 min therapy slots like PE.

PCMHI is another option if you're worried about seeing that many patients. Generally they want you to have open access so you aren't scheduled during that time, just be aware that theoretically you could end up--and often will--seeing patients during your open access hours because that's when you would get warm handoffs.

Also, the VA often has part-time admin roles that can lessen your clinical time. For instance, military sexual trauma coordinators are expected to have at least 8 hrs of time for that, so you get 8 hrs of extra admin time. That would make your expected clinical time 22 hrs instead of 30. There are similar admin roles with less or more admin time allocated.

 

[AcronymAllergy]

As others have said, in the VA it's generally 30 hours of client contact per week which averages to 6 appts a day. This could be fewer if you have longer appts, like intakes or 90 min therapy slots like PE.

PCMHI is another option if you're worried about seeing that many patients. Generally they want you to have open access so you aren't scheduled during that time, just be aware that theoretically you could end up--and often will--seeing patients during your open access hours because that's when you would get warm handoffs.

Also, the VA often has part-time admin roles that can lessen your clinical time. For instance, military sexual trauma coordinators are expected to have at least 8 hrs of time for that, so you get 8 hrs of extra admin time. That would make your expected clinical time 22 hrs instead of 30. There are similar admin roles with less or more admin time allocated.

To provide some additional examples of the bolded: designated educational time for participating in training (e.g., as a training faculty member or director/co-director of a training program), research (e.g., if involved with a MIRECC), supervision, and multidisciplinary treatment teams (still clinical, but won't always involve direct patient contact). Positions outside VA offer many of the same options.

 

[Sanman]

I've met very few HBPC lifers. My buddy jumped off that ship as soon as an OP Gero position opened up. Person I trained with back in internship also moved to an OP job.

Now, how are you all going to talk about HBPC without me?

As far as patients per day, it really varies based on the catchment area and the number of veterans enrolled in the program. I know some people that cover 100-150 miles and others that cover less than 30 in dense areas. Ideally, the goal is about two teams and about 150-160 patients per psych. Some places have one psych for 300+ patients, other 1 for every 80 patients. In general, more than 2-3 visits per day is unlikely unless people are very nearby due to drive time and paperwork.

It definitely can be isolating, but the travel can also make the schedule flexible and no one is looking over your shoulder.

As for need @AcronymAllergy, it is unlikely that HBPC jobs will be going anywhere unless the whole program is scrapped. Salaries for HBPC psych generally come out of GEC funding, not MH funding and the two disciplines rarely want to share nicely. If anything, I usually see MH trying to recruit less busy HBPC folks for general MH work and there being a turf war.

 

[WisNeuro]

Now, how are you all going to talk about HBPC without me?

As far as patients per day, it really varies based on the catchment area and the number of veterans enrolled in the program. I know some people that cover 100-150 miles and others that cover less than 30 in dense areas. Ideally, the goal is about two teams and about 150-160 patients per psych. Some places have one psych for 300+ patients, other 1 for every 80 patients. In general, more than 2-3 visits per day is unlikely unless people are very nearby due to drive time and paperwork.

It definitely can be isolating, but the travel can also make the schedule flexible and no one is looking over your shoulder.

As for need @AcronymAllergy, it is unlikely that HBPC jobs will be going anywhere unless the whole program is scrapped. Salaries for HBPC psych generally come out of GEC funding, not MH funding and the two disciplines rarely want to share nicely. If anything, I usually see MH trying to recruit less busy HBPC folks for general MH work and there being a turf war.

I figured you'd wander in sooner or later. Good point about the flexibility. As far as VA work went, that was by far the most flexible environment I had been in. And, as far as isolating, depends on your personality. I'm more of an introvert, so it didn't bother me all that much to have reduced interaction time with colleagues.

 

[Sanman]

I figured you'd wander in sooner or later. Good point about the flexibility. As far as VA work went, that was by far the most flexible environment I had been in. And, as far as isolating, depends on your personality. I'm more of an introvert, so it didn't bother me all that much to have reduced interaction time with colleagues.

This is true. I do miss the having colleagues (and a desk) when I worked traditional PP, but a lot of geriatrics work is isolating. I was pretty alone at my previous gig in LTC/ALF work when I was not training staff or in a meeting. Being a contractor meant you were often a little on the outside even with the facility staff (though I did make my share of friends). So, HBPC is a bit of an even trade for me. That said, you often have to want to work in rural areas to make this work long-term. There are some positions in cities or desirable suburbs, but the people in those positions generally keep them. If you want a nice house out in the country, it isn't a bad gig.

 

[erg923]

This is true. I do miss the having colleagues (and a desk) when I worked traditional PP, but a lot of geriatrics work is isolating. I was pretty alone at my previous gig in LTC/ALF work when I was not training staff or in a meeting. Being a contractor meant you were often a little on the outside even with the facility staff (though I did make my share of friends). So, HBPC is a bit of an even trade for me. That said, you often have to want to work in rural areas to make this work long-term. There are some positions in cities or desirable suburbs, but the people in those positions generally keep them. If you want a nice house out in the country, it isn't a bad gig.

Da SCABIES! Oh, Da SCABIES! Oh, the humanity ladies and gentleman! No thanks...no thanks...

 

[Sanman]

Da SCABIES! Oh, Da SCABIES! Oh, the humanity ladies and gentleman! No thanks...no thanks...

Not since COVID, unless they can travel through my computer monitor. Every time you mention scabies, I get itchy for an hour. I kinda hate you for that .

 

[Fan_of_Meehl]

As others have said, in the VA it's generally 30 hours of client contact per week which averages to 6 appts a day. This could be fewer if you have longer appts, like intakes or 90 min therapy slots like PE.

PCMHI is another option if you're worried about seeing that many patients. Generally they want you to have open access so you aren't scheduled during that time, just be aware that theoretically you could end up--and often will--seeing patients during your open access hours because that's when you would get warm handoffs.

Also, the VA often has part-time admin roles that can lessen your clinical time. For instance, military sexual trauma coordinators are expected to have at least 8 hrs of time for that, so you get 8 hrs of extra admin time. That would make your expected clinical time 22 hrs instead of 30. There are similar admin roles with less or more admin time allocated.

MST coordinators get 8 hrs PER WEEK dedicated to that function? Wow. I'm assuming this doesn't include seeing MST patients for therapy during that time.

 

[erg923]

Not since COVID, unless they can travel through my computer monitor. Every time you mention scabies, I get itchy for an hour. I kinda hate you for that .

Hashbrown: "Bed Bugs..."

 

[erg923]

Not since COVID, unless they can travel through my computer monitor. Every time you mention scabies, I get itchy for an hour. I kinda hate you for that .

I can just imagine the R41 and Hindenburg all at once explaining: "the SCABIES".....

[/QUOTE]

 

[R. Matey]

On fellowship right now, I work four tens and see about 7-8 patients a day. Very doable if you're good at time management and setting boundaries with people.

 

[NP112]

To provide some additional examples of the bolded: designated educational time for participating in training (e.g., as a training faculty member or director/co-director of a training program), research (e.g., if involved with a MIRECC), supervision, and multidisciplinary treatment teams (still clinical, but won't always involve direct patient contact). Positions outside VA offer many of the same options.

Thanks everyone! Just so I have it clear, these tasks are usually included in the job description and get recruited for from new hires, or is something that is usually attainable once someone is hired?

Also, are those admin positions separate jobs/individuals from the VA psychologists? Or you take on that admin role as well?

 

[AcronymAllergy]

Thanks everyone! Just so I have it clear, these tasks are usually included in the job description and get recruited for from new hires, or is something that is usually attainable once someone is hired?

Also, are those admin positions separate jobs/individuals from the VA psychologists? Or you take on that admin role as well?

For VA, I'd say it's a mix of both. Many people get involved in training, and eventually step is as training directors at various levels, months or years into what was originally a 100% clinical jobs. The same can happen with lead psychologist roles. But there are also positions posted recruiting specifically for training directors or lead psychologists.

I'd say it's less common for a transition to occur for research; those types of positions tend to be advertised as such from the start. Many VA psychologists are involved in research in addition to their clinical and training work, but not many of those folks end up getting time actually carved out of their schedule for it.

 

[cara susanna]

MST coordinators get 8 hrs PER WEEK dedicated to that function? Wow. I'm assuming this doesn't include seeing MST patients for therapy during that time.

Yup, it used to be just recommended but now it's mandated. And you'd be correct, although that time could involve patient outreach and advocacy.

 

[chicandtoughness]

My internship was in a UCC and I saw 6 a day + running 1 group a week. My colleagues were doing about the same. Very doable. I wish I could do UCC but my state REALLY REALLY prefers social workers and psychologists. Sigh.

For some other data points outside of VA and UCC, should you consider:

I work in an RTC/ART! I hold a caseload of 5 patients that I need to see twice a week. I run 1-2 groups a day as well. Sounds nice except we're really a 2-in-1 deal of psychotherapist and case manager, so guess who's doing allllll that fun case management work

When I was in outpatient community mental health, I saw 6-7 a day.

 

[NP112]

As others have said, in the VA it's generally 30 hours of client contact per week which averages to 6 appts a day. This could be fewer if you have longer appts, like intakes or 90 min therapy slots like PE.

PCMHI is another option if you're worried about seeing that many patients. Generally they want you to have open access so you aren't scheduled during that time, just be aware that theoretically you could end up--and often will--seeing patients during your open access hours because that's when you would get warm handoffs.

Also, the VA often has part-time admin roles that can lessen your clinical time. For instance, military sexual trauma coordinators are expected to have at least 8 hrs of time for that, so you get 8 hrs of extra admin time. That would make your expected clinical time 22 hrs instead of 30. There are similar admin roles with less or more admin time allocated.

Is the bolded pretty common? Can they only referred sexual trauma patients then? Is this tied to any kind of extra funding you are able to bring in?

 

[summerbabe]

Is the bolded pretty common?

Yes, there are many different ways to carve out 'administrative time' in a full-time schedule, a lot of which may not involve direct patient care (e.g., local recovery coordinator, serving on workgroup/committee such as high risk veterans or SAIL metrics, evidence-based psychotherapy coordinator, psychology training committee, etc). Some may only allow for an hour or two a week while others are more substantial. Availability will depend on how large your facility/service is, how much turnover a facility experiences, and how involved/uninvolved your peers want to be in admin roles.

Can they only referred sexual trauma patients then?

This may differ facility by facility, but at my site, the MST coordinator processes MST referrals (which may involve phone or in-person screenings to help coordinate care) and inter-facility outreach/education. If they also provide therapy for MST, that would likely be built into their primary clinical role.

Is this tied to any kind of extra funding you are able to bring in?

I can't speak for the entire VA but these are positions that the national VA has approved resources for each facility to have so you are applying within your facility. Some positions can be served by any LIP in mental health while others may be more restrictive by discipline.

 

[cara susanna]

Yup, MST Coordinator is administrative but many of them also provide clinical services for MST as part of their clinical role (e.g., they may work in the PTSD Clinical Team or an MST specialty clinic). The administrative role is making sure that the facility complies with national policy mandates, like screening for MST and ensuring that eligible veterans get connected to care if they so choose.

 

[Mercury in Taurus]

I think right now the standard is six hourly appointments per shift---but one of these six could be a 1.5 hr intake slot. I've heard of others having seven, which I think is too much and a recipe for burnout. At VA, there is SO much you have to do outside the sessions, especially in terms of documentation, meetings, required trainings, walking over to the hospital to replace your mouse that just crapped out on you (happened to me this morning), or otherwise operating without any real support.

For me, limiting it to 4-5 appointments per day would be really sweet, but that just ain't gonna happen.

So true Besides notes, meetings, sessions, too many emails and internal messages to respond to, and not enough time.

 

[Mercury in Taurus]

Hello all,
I’m sort of having a mid-grad school existential crisis. I came in thinking I’d want to do neuropsych but have since realized I’m not enjoying report writing all that much. I am considering pursuing a generalist post at a VA or a college counseling center. That being said, I am aware of my introversion and am worried about burnout eventually. How many clients do practitioners in these settings? I know that it will largely depend on the VA or CC, but wanted to get some numbers from workers in these settings for context.

TIA

Besides the direct contact hour expectation, consistent interruptions happen throughout the day (for example, secured messages from patients, referrals or requests from other providers, consultation requests from other team members...). Scheduling is an art. Need to schedule enough appointments in case of no-show(s) or cancellation(s); however, need to structure some flexibility to handle any emergency situations, unplanned or extended sessions.

 

[PsyDr]

Hire a scribe or an MA. Check your state laws about who you can hire. Every hour you’re in the office is billable.

 

[student9295]

Hello all,
I’m sort of having a mid-grad school existential crisis. I came in thinking I’d want to do neuropsych but have since realized I’m not enjoying report writing all that much. I am considering pursuing a generalist post at a VA or a college counseling center. That being said, I am aware of my introversion and am worried about burnout eventually. How many clients do practitioners in these settings? I know that it will largely depend on the VA or CC, but wanted to get some numbers from workers in these settings for context.

TIA

4-7 typically.

 

[NP112]

Thank

As others have said, in the VA it's generally 30 hours of client contact per week which averages to 6 appts a day. This could be fewer if you have longer appts, like intakes or 90 min therapy slots like PE.

PCMHI is another option if you're worried about seeing that many patients. Generally they want you to have open access so you aren't scheduled during that time, just be aware that theoretically you could end up--and often will--seeing patients during your open access hours because that's when you would get warm handoffs.

Also, the VA often has part-time admin roles that can lessen your clinical time. For instance, military sexual trauma coordinators are expected to have at least 8 hrs of time for that, so you get 8 hrs of extra admin time. That would make your expected clinical time 22 hrs instead of 30. There are similar admin roles with less or more admin time allocated.

What are the RVUs like for PCMHI? Does it vary by VA?

 

[cara susanna]

Thank

What are the RVUs like for PCMHI? Does it vary by VA?

I could be wrong but I don't even think they look at RVUs for PCMHI. They look instead at other metrics like Primary Care penetration rates, open access utilization, warm handoff rates, duration of appts (30 min or less is the gold standard), etc.