Interesting Ethical Dilemma

[Sanman]

Yet another 'damned if you do, damned if you don't' provider trap built into the system with the end result of increasing stress and burnout.

Don't worry in a few years the system will push the "write your notes in session" model of practice to maximize RVUs.

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[Fan_of_Meehl]

...and require you to submit your notes to the patient for their pre-approval and corrections prior to finalizing your notes.

 

[Fan_of_Meehl]

Or keeping the patient the full 60 min, which then puts you behind on notes and admin time.

I've empirically determined--and have the data to prove it--that a single hard-working outpatient psychotherapy provider at VA can successfully absorb new patients into his caseload at a rate of about 7 to 8 new cases per month and maintain 'equilibrium' and still have enough availability to schedule all new patients in weekly courses of psychotherapy. Thats a rate of about 84 to 96 unique patient cases 'put to bed' per year, per full time provider.

If every outpatient therapist were putting cases to bed at this rate, there would be no access issue.

But, because psychologists left and right are abandoning ship, all their cases (and extra cases from other clinics) will soon make it impossible for me to continue to see people weekly and clear them out. The leadership have no interest in actually addressing the access problem. Their only motivation is to play a bizarre game of political "failure oneupsmanship" by claiming that their clinics/providers boast the most backed up psychotherapy clinics and that, therefore, those with the least backed up clinics are 'lazy' and need to be drowned in extra patient loads (destroying their ability to function). By working hard and being productive, I have "embarrassed" my supervisors and earned their scorn and resentment. This is what utter lack of competition yields...insistence that everyone fail.

 

[cara susanna]

Yes, we can't hire psychologists and now we're even struggling to get LCSWs. They need to increase that special salary rate for things to get better.

 

[Shiori]

I just had my yearly eval and my supervisor gave me "exceeds expectations" even though my RVUs are on the lower side because they think I'm doing great clinical work and the numbers aren't the best measure of the actual work I'm doing. That was so refreshing!

This was my experience too! It was encouraging. This is the most balanced and content I have been in a while.