Perspectives on VA hiring slowdown?

[silverway]

Hi all,

I'm finishing postdoc now and am quite interested in starting my career in the VA in PCMHI, although I haven't had any practicum/internship/postdoc experiences at the VA before (I've had other solid, relevant experiences that I believe make me competitive).

I'm hoping to hear people's perspectives on the current hiring slowdown/freeze and how that might be impacting my job prospects. My current dilemma is that I'd really like to end up in a particular region (the same region I'm in now for postdoc), but openings in this region are few and far between, and quite sought-after when they occur. It's a major metropolitan area with a good handful of VA clinics and medical centers, if that matters. I've been considering taking a VA position in another area for a year or two, then transferring to my preferred location when possible, since I've heard that getting your foot in the door at the VA is the hardest part. I've also been considering finding other work in my current area and biding my time until I can get a VA position in this area. Working in a healthcare system or something.

I guess my biggest questions are:
1) How hard is it really to get a VA job these days?
2) How do you anticipate the hiring situation changing in the coming months to the next few years?
3) How easy is it to transfer to a preferred region once you have a VA job somewhere else, and how long might it take to make that move?
4) Are there any things I should prioritize to stay competitive in the VA job hunt if I take a non-VA job for a year or two?
5) For anyone who's moved for a VA job for 1-2 years then transferred, did it feel worth it to you? Moving is a lot of stress.

My main motivators for finding a VA job are access to trainings/opportunity to grow my skillset, work-life balance, and access to other psychologists for consultation/support. I'm also interested in hearing if you all have suggestions for other places I could look to find positions with similar advantages in a health psychology/primary care role.

Thanks for your time!

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[aim-agm]

1) Difficult. Essentially all vacant positions seem to have been eliminated as part of budget reduction; many positions at all stages of hiring we're also eliminated. Few new ones are being opened. At least 3 elements of my department were critically understaffed (like 20% of what they should be) for a year (years?) and I don't believe there were any new hires for them, we had to address by shifting personnel from other areas.
2) There have been many downswings and upswings, but I have been told by people who have been at the VA for a long time that this one is atypically (possibly unprecedentedly) bad. It will likely get better eventually, but you might have to find another job for the medium-term (not just the short term).
3) I know multiple people who have been looking to do so for the better part of a year that haven't been able to.
4) Dunno, sorry.
5) N/A

 

[AcronymAllergy]

1) Difficult. Essentially all vacant positions seem to have been eliminated as part of budget reduction; many positions at all stages of hiring we're also eliminated. Few new ones are being opened. At least 3 elements of my department were critically understaffed (like 20% of what they should be) for a year (years?) and I don't believe there were any new hires for them, we had to address by shifting personnel from other areas.
2) There have been many downswings and upswings, but I have been told by people who have been at the VA for a long time that this one is atypically (possibly unprecedentedly) bad. It will likely get better eventually, but you might have to find another job for the medium-term (not just the short term).
3) I know multiple people who have been looking to do so for the better part of a year that haven't been able to.
4) Dunno, sorry.
5) N/A

I wonder if the widespread approval of special rate pay contributed to this somehow...? If so, that'd be a bummer, since it'd probably just convince upper leadership to never do something similar again and/or to try to reverse the rates that were approved for future hires.

 

[PsyDuck90]

I wonder if the widespread approval of special rate pay contributed to this somehow...? If so, that'd be a bummer, since it'd probably just convince upper leadership to never do something similar again and/or to try to reverse the rates that were approved for future hires.

From my understanding, it’s mostly due to the excessive use of community care. Some VAs were more strict regarding the rules to grant community care referrals compared to others who would honor it for every veteran who asked regardless of access and availability within their local VA.

OP, I think it may be harder for you since there is such a slow down. Some VAs are still hiring, but they tend to prefer to keep their trainees if possible. I’m a current 1st year VA neuro postdoc, and all of the interns and general postdocs who wanted a position have accepted GS-11 or GS-12 positions. So while hiring has not stalled everywhere, you may have a hard time getting your foot in the door initially.

 

[coffee&CBT]

1) Difficult. Essentially all vacant positions seem to have been eliminated as part of budget reduction; many positions at all stages of hiring we're also eliminated. Few new ones are being opened. At least 3 elements of my department were critically understaffed (like 20% of what they should be) for a year (years?) and I don't believe there were any new hires for them, we had to address by shifting personnel from other areas.
2) There have been many downswings and upswings, but I have been told by people who have been at the VA for a long time that this one is atypically (possibly unprecedentedly) bad. It will likely get better eventually, but you might have to find another job for the medium-term (not just the short term).
3) I know multiple people who have been looking to do so for the better part of a year that haven't been able to.
4) Dunno, sorry.
5) N/A

To share another perspective on #1, I am finishing up post-doc right now and have a VA job lined up. This is true for 3 close friends/colleagues who are also finishing post-doc. I think it really depends on the VA (we are taking jobs across 3 different VAs in 3 different states).

 

[Sanman]

I wonder if the widespread approval of special rate pay contributed to this somehow...? If so, that'd be a bummer, since it'd probably just convince upper leadership to never do something similar again and/or to try to reverse the rates that were approved for future hires.

That is part of it along with record employee hiring in that period. However, the use of community care consults and the huge increase in VA disability benefits for veterans through the PACT Act seem to be a larger portion of the budget shortfall.

To answer the OP's question, hiring is largely frozen unless you are already a VA employee transferring to a different position. However, this may vary slightly by area and facility staffing. As the budget shortfalls have not been fixed, I don't imagine anything will get better in the next year. Lets see how the election goes after that...

 

[aim-agm]

To share another perspective on #1, I am finishing up post-doc right now and have a VA job lined up. This is true for 3 close friends/colleagues who are also finishing post-doc. I think it really depends on the VA (we are taking jobs across 3 different VAs in 3 different states).

Congratulations!

 

[Psychai]

There is variation across facilities, but at my site we have been told that hiring is almost completely frozen until fiscal year 2026. Any positions that are still hiring are only eligible for internal hires, which doesn't even include current interns or postdocs since they have a different funding source. Sharing my personal experience, I am a current VA postdoc and I was offered a staff psychologist job last year. The offer was recently terminated after a 10-month long hiring process. It's worth keeping in mind that if you do decide to apply for a VA job during this period of budget uncertainty that VA hiring processes usually take 6-12 months from interview to start date, and the site could decide they do not have the budget to fill the position at any point in that process.

 

[summerbabe]

I guess my biggest questions are:
1) How hard is it really to get a VA job these days?
2) How do you anticipate the hiring situation changing in the coming months to the next few years?
3) How easy is it to transfer to a preferred region once you have a VA job somewhere else, and how long might it take to make that move?
4) Are there any things I should prioritize to stay competitive in the VA job hunt if I take a non-VA job for a year or two?
5) For anyone who's moved for a VA job for 1-2 years then transferred, did it feel worth it to you? Moving is a lot of stress.

1. Hard but not impossible. There are still prioritized positions open for hiring at facilities across the nation. But way less than in the past & the sites that are actively moving forward with limited hiring have to get a lot more buy-in from the overall hospital leadership (essentially, they are deciding things like do we need a urologist more or a psychologist more if we can only add a single full-time FTE across all clinical services).

2. Things may slowly start to change for the better once the fiscal year turns over on 10/1/24. Budgets will be readjusted and new priorities will be identified. But again, this will be facility by facility. There are also still other expansions going on that may operate under different funding budgets. For example, many Clinical Resource Hubs still need to hire caregiver support positions since that's been nationally mandated recently (I think). Positions that were frozen this year will probably be prioritized once the lid is lifted a bit in order to get into compliance.

3. Once you're in the system, it's massively easier to apply for internal postings than as an external candidate IMO. Sites that are hiring now are stretched thin with staffing (hence getting approval to hire). But that also means supervisors don't want to take the time to train somebody new to CPRS, VA rules/regs, etc. And you'll also have a track record of meeting general expectations & at least not being formally reprimanded.

4. Honestly, not really. A better CV helps you to stand out but you're more at the mercy of VA politics & internal hires who might want to move into that position.

5. I transferred out of my first job out of VA postdoc after 1.5 years and ended up in a better fit.

Good luck!

 

[silverway]

1) Difficult. Essentially all vacant positions seem to have been eliminated as part of budget reduction; many positions at all stages of hiring we're also eliminated. Few new ones are being opened. At least 3 elements of my department were critically understaffed (like 20% of what they should be) for a year (years?) and I don't believe there were any new hires for them, we had to address by shifting personnel from other areas.
2) There have been many downswings and upswings, but I have been told by people who have been at the VA for a long time that this one is atypically (possibly unprecedentedly) bad. It will likely get better eventually, but you might have to find another job for the medium-term (not just the short term).
3) I know multiple people who have been looking to do so for the better part of a year that haven't been able to.
4) Dunno, sorry.
5) N/A

Very helpful, thank you for taking the time to respond! Especially your insight re: transferring difficulties.

 

[silverway]

There is variation across facilities, but at my site we have been told that hiring is almost completely frozen until fiscal year 2026. Any positions that are still hiring are only eligible for internal hires, which doesn't even include current interns or postdocs since they have a different funding source. Sharing my personal experience, I am a current VA postdoc and I was offered a staff psychologist job last year. The offer was recently terminated after a 10-month long hiring process. It's worth keeping in mind that if you do decide to apply for a VA job during this period of budget uncertainty that VA hiring processes usually take 6-12 months from interview to start date, and the site could decide they do not have the budget to fill the position at any point in that process.

Oh man, I'm so sorry to hear that. Hope you're successful in finding a great next position for yourself. I really appreciate the advisory. Did you get any sort of indications prior to the offer being terminated that the position was in jeopardy, or was it a total surprise?

 

[silverway]

2. Things may slowly start to change for the better once the fiscal year turns over on 10/1/24. Budgets will be readjusted and new priorities will be identified. But again, this will be facility by facility.

Someone else also told me this might be the case. I'll be very cautiously optimistic about it, I guess, especially since I really hope to have accepted an offer by then.

3. Once you're in the system, it's massively easier to apply for internal postings than as an external candidate IMO. Sites that are hiring now are stretched thin with staffing (hence getting approval to hire). But that also means supervisors don't want to take the time to train somebody new to CPRS, VA rules/regs, etc. And you'll also have a track record of meeting general expectations & at least not being formally reprimanded.

I hadn't thought about this point. Makes a lot of sense, thanks for bringing it up.

 

[summerbabe]

I'll be very cautiously optimistic about it, I guess, especially since I really hope to have accepted an offer by then.

Have you applied a bunch already? Have you gotten any interviews so far? Or are positions getting cancelled part way through the process?

If you have been successful in getting interviews, thats great and hopefully something works out. If you’ve been shut out, it could speak to these places prioritizing internal hires and/or fully licensed candidates.

I also saw that you’re hoping to end up in a specific metro.

If I had to guess (especially with recent bonuses like EDRP loan repayment expansion and special salary rates to make psychologist pay more congruent with local areas), your desired metro probably had some pretty healthy mental health expansion the last few years and thus may struggle to add new hires in the near future, even as people leave/retire.

It’s not a coincidence that some of the places actively hiring are in rural or suburban areas. I feel like I’m always seeing things for places like the Iron Mountain VA.

Hospital directors are looking at things like % of clinical capacity across literally all clinical areas so areas that are at the most critical levels of staffing (meaning more community care) will get first priority. If mental health and more specifically, PCMHI is mostly treading water or even doing fine, it may be impossible for that department to do much hiring.

It wouldn’t hurt to try to network and get connected with some people who work at your desired VA. Their take on access, how booked out they are and how PCMHI is functioning will likely give you some hints as to where mental health might fall on the priority list for future hiring. Good luck!

 

[silverway]

Have you applied a bunch already? Have you gotten any interviews so far? Or are positions getting cancelled part way through the process?

I've applied to 7 positions so far. One position has been cancelled already. I have one tentative offer for a job in a less desirable geographical area for me, and another interview coming up. So I feel like there's possibilities right now, at least. Although I'm nervous that a tentative offer could be rescinded, and the locations would be somewhat rough for me. As much as I want a VA job, I'm hesitant to uproot for a job in a new city with no social connections (again-- internship year was lonely!).

A position in my desired area is currently reviewing applications, and I'm hoping to hear back in the next few weeks if they choose to interview me. It would be a dream come true, but I'm trying not to get my hopes up too high. There were a lot more applicants for this position than the ones I've gotten interviews for.

It wouldn’t hurt to try to network and get connected with some people who work at your desired VA. Their take on access, how booked out they are and how PCMHI is functioning will likely give you some hints as to where mental health might fall on the priority list for future hiring. Good luck!

Thanks! I've talked to a couple people and get the impression there's a real need, including for PCMHI specifically in this area, but that the funding's dried up and hiring's very much being put on pause for now.

 

[Sanman]

I've applied to 7 positions so far. One position has been cancelled already. I have one tentative offer for a job in a less desirable geographical area for me, and another interview coming up. So I feel like there's possibilities right now, at least. Although I'm nervous that a tentative offer could be rescinded, and the locations would be somewhat rough for me. As much as I want a VA job, I'm hesitant to uproot for a job in a new city with no social connections (again-- internship year was lonely!).

A position in my desired area is currently reviewing applications, and I'm hoping to hear back in the next few weeks if they choose to interview me. It would be a dream come true, but I'm trying not to get my hopes up too high. There were a lot more applicants for this position than the ones I've gotten interviews for.

Thanks! I've talked to a couple people and get the impression there's a real need, including for PCMHI specifically in this area, but that the funding's dried up and hiring's very much being put on pause for now.

Honestly, it all boils down to timing and luck. If the budget issue does not improve, taking a less desirable position and transferring may be a much better way to go, but there are no guarantees that is works and you could be stuck. Depends on how much immediate wants/needs trump the long game for you.

 

[summerbabe]

I have one tentative offer for a job in a less desirable geographical area for me, and another interview coming up. So I feel like there's possibilities right now, at least. Although I'm nervous that a tentative offer could be rescinded, and the locations would be somewhat rough for me. As much as I want a VA job, I'm hesitant to uproot for a job in a new city with no social connections (again-- internship year was lonely!).

From reading the current VA tea leaves (which of course differs facility by facility), if a facility is able to make a tentative offer right now, they should be able to move forward and complete the hiring process. They wouldn’t have gotten the approval to post, recruit and have HR extend the offer.

Versus a few months ago when stuff was getting cancelled left and right at all stages.

Thanks! I've talked to a couple people and get the impression there's a real need, including for PCMHI specifically in this area, but that the funding's dried up and hiring's very much being put on pause for now.

Need is both relative and system dependent (eg the hospital may have other budgetary priorities).

For example, I know of a system that supposedly only has 40% of their overall allotted psychologist positions filled due to mass exoduses this decade & their system is absolutely dying when it comes to therapy. But they have zero openings on USAJobs.

Another, much smaller system in the same state (which is doing OK-ish from what I can tell) has a bunch of current USAJobs listings right now.

 

[Psychai]

Oh man, I'm so sorry to hear that. Hope you're successful in finding a great next position for yourself. I really appreciate the advisory. Did you get any sort of indications prior to the offer being terminated that the position was in jeopardy, or was it a total surprise?

Thanks, I was able to line up another position in the community, but this has definitely made me wary of VA hiring processes.

It was a mixed bag where there were definitely warning signs along the way, but the process continued moving forward and the hiring team was cautiously optimistic. There were several points where my hiring had to be paused to get more site and VISN approvals due to the strategic hiring processes, which I knew meant there was a risk of the offer being rescinded. However, the clinical team was fighting for the position to remain funded, and there were several points where I was told the VISN signed off on the position and hiring would move forward. Around this time I was hearing about other postdocs at my site who had been offered staff positions having their offers rescinded, but my hiring continued for months, so I remained hopeful. I completed all onboarding tasks including background checks, credentialing, employee health requirements and HR coordinated with my current supervisors about start dates. At least as far as I was told, the offer was in the final stage of waiting for local leadership to sign off on incentives when it was rescinded.

I do agree with @summerbabe that my situation is likely different than applying to VA positions now. At sites like mine it is nearly impossible for new psychologist jobs to be posted because all of these approvals have to be made beforehand and it's a much more intensive process than in the past. It is probably less likely for tentative offers to be pulled, but IMO is still a potential risk to be aware of.

 

[Therapist4Chnge]

Did they tender you an official offer? If so, did you accept it? There is employment law that could protect you if they made an official offer and you accepted it, and then they pulled it. Not a lawyer, but I've seen this happen in the corp world, and the employer had to pay significant damages because the applicant was financially harmed by their actions.

 

[Sanman]

Did they tender you an official offer? If so, did you accept it? There is employment law that could protect you if they made an official offer and you accepted it, and then they pulled it. Not a lawyer, but I've seen this happen in the corp world, and the employer had to pay significant damages because the applicant was financially harmed by their actions.

There are folks out there that got full offers pulled and I would certainly sue for that.

 

[Psychai]

Did they tender you an official offer? If so, did you accept it? There is employment law that could protect you if they made an official offer and you accepted it, and then they pulled it. Not a lawyer, but I've seen this happen in the corp world, and the employer had to pay significant damages because the applicant was financially harmed by their actions.

No, I hadn't been given an official offer yet. I felt pretty strung along since I was was told my tentative start date was two weeks out for over two months, but there was alway one more form or approval that needed to be signed before the official offer could be issued. But of course since I only had a tentative offer I wasn't supposed to make life plans based on that information.

But yes, I did see several folks on reddit saying their official/final offers were pulled around this time:

 

[Sanman]

No, I hadn't been given an official offer yet. I felt pretty strung along since I was was told my tentative start date was two weeks out for over two months, but there was alway one more form or approval that needed to be signed before the official offer could be issued. But of course since I only had a tentative offer I wasn't supposed to make life plans based on that information.

But yes, I did see several folks on reddit saying their official/final offers were pulled around this time:

Yeah, it was a garbage move by the VA to do that. I have a feeling it will cost them significantly in the long run. Then again, that it what some people want.

 

[Psychai]

Yeah, it was a garbage move by the VA to do that. I have a feeling it will cost them significantly in the long run. Then again, that it what some people want.

I agree, I definitely see this causing ripple effects in long term psychologist staffing in the VA. In addition to this further burning out existing staff, as someone who did a VA internship and postdoc and had pictured staying with VA for at least my early career, it's disappointing to have lost this much institutional trust. Realistically, I don't think I will apply for another VA job. And I know of many other VA trainees who share my experience and are similarly jaded. The goal of their training programs to retain staff that are aware of and can tolerate the VA's quirks has backfired for this cohort.

 

[cara susanna]

From my understanding, it’s mostly due to the excessive use of community care. Some VAs were more strict regarding the rules to grant community care referrals compared to others who would honor it for every veteran who asked regardless of access and availability within their local VA.

OP, I think it may be harder for you since there is such a slow down. Some VAs are still hiring, but they tend to prefer to keep their trainees if possible. I’m a current 1st year VA neuro postdoc, and all of the interns and general postdocs who wanted a position have accepted GS-11 or GS-12 positions. So while hiring has not stalled everywhere, you may have a hard time getting your foot in the door initially.

It's actually a budgeting issue. A lot of the money that we supposed to be allocated to VHA went elsewhere (VBA, from the rumors I've heard, and it may also be connected to the PACT Act). The budget shortfall isn't anything that will be fixed by hiring freezes or denying community care, it needs congressional action.

And, yes, VHA hiring is a disaster right now. We've had multiple positions cut--positions that were very needed.

 

[WisNeuro]

There are folks out there that got full offers pulled and I would certainly sue for that.

Not a lot you can accomplish here unless you can prove that the pulled offer was secondary to discrimination.

 

[Sanman]

Not a lot you can accomplish here unless you can prove that the pulled offer was secondary to discrimination.

I am no employment law expert. However, I have heard about people that quit their job and relocated following a final offer and it was reneged prior to their first day on the job. I assume there would be a breach of contract violation somewhere in there.

 

[Sanman]

It's actually a budgeting issue. A lot of the money that we supposed to be allocated to VHA went elsewhere (VBA, from the rumors I've heard, and it may also be connected to the PACT Act). The budget shortfall isn't anything that will be fixed by hiring freezes or denying community care, it needs congressional action.

And, yes, VHA hiring is a disaster right now. We've had multiple positions cut--positions that were very needed.

It does. However, community care costs more than in house care. Bleeding the budget dry and denying budget increases is a great way to shrink the level of VA services and cause staff attrition. If Trump wins, I assume this will be part of the Republican game plan.

 

[cara susanna]

It does. However, community care costs more than in house care. Bleeding the budget dry and denying budget increases is a great way to shrink the level of VA services and cause staff attrition. If Trump wins, I assume this will be part of the Republican game plan.

Oh, absolutely, but my point is that this wasn't caused by some facilities overusing community care.

 

[Sanman]

Oh, absolutely, but my point is that this wasn't caused by some facilities overusing community care.

No, if anything did it, it was the PACT Act and opening up access for additional disability claims, increasing the caregiver support program, etc. The problem there is no one is taking money out of veteran's pockets because it is political suicide

Most of the community care is no mental health anyway. It is medical specialties that the VA does not staff in most regions if you look at regional and national numbers.

 

[WisNeuro]

I am no employment law expert. However, I have heard about people that quit their job and relocated following a final offer and it was reneged prior to their first day on the job. I assume there would be a breach of contract violation somewhere in there.

Especially in cases of federal employment, best case scenario here is likely recouping moving costs. You'll spend more time and money fighting this than it's worth.

 

[psy.d. 2021]

No, if anything did it, it was the PACT Act and opening up access for additional disability claims, increasing the caregiver support program, etc. The problem there is no one is taking money out of veteran's pockets because it is political suicide

Most of the community care is no mental health anyway. It is medical specialties that the VA does not staff in most regions if you look at regional and national numbers.

And at least where I'm working, oftentimes when I do place a cc mental health consult it never gets scheduled.

 

[AcronymAllergy]

And at least where I'm working, oftentimes when I do place a cc mental health consult it never gets scheduled.

This was similar to my experience back during the first large roll-out and then expansion of community care. It was a combination of the CC schedulers dropping the ball and no community providers being available/willing to see VA patients. I also had multiple patients who I scheduled with me and referred for CC because of my lengthy wait times, and they ultimately ended up still seeing me before a community provider could get them in.

With the current setup and money being perpetually redirected to VBA, the cynical side of me sees a reality with entirely community-provided C&P evals completed by the lowest bidders and of ever-decreasing quality. Hopefully I'm wrong. At some point, it seems like someone is going to have to tighten the VBA reigns. Or just acknowledge that it's essentially open to all.

 

[cara susanna]

This was similar to my experience back during the first large roll-out and then expansion of community care. It was a combination of the CC schedulers dropping the ball and no community providers being available/willing to see VA patients. I also had multiple patients who I scheduled with me and referred for CC because of my lengthy wait times, and they ultimately ended up still seeing me before a community provider could get them in.

With the current setup and money being perpetually redirected to VBA, the cynical side of me sees a reality with entirely community-provided C&P evals completed by the lowest bidders and of ever-decreasing quality. Hopefully I'm wrong. At some point, it seems like someone is going to have to tighten the VBA reigns. Or just acknowledge that it's essentially open to all.

It's definitely the elephant in the room, but I think it'd be too politically unpopular for anyone to dare it (although Project 2025 actually talks about restricting VA disability more, but that's a whole other can of worms...)

 

[WisNeuro]

It's definitely the elephant in the room, but I think it'd be too politically unpopular for anyone to dare it (although Project 2025 actually talks about restricting VA disability more, but that's a whole other can of worms...)

At some point, someone published on rates of malingering in the VA and did some estimations on the costs of SC payouts for likely fraudulent SC decisions. The number was pretty staggering. Add on the sheer number of unnecessary appointments/procedures people get with their fraudulent claims, and that number is magnified. IMO, this is one of the GOP's biggest hypocrisies, feigning concern about budgets and inappropriate govt spending, but willfully ignoring one of the biggest sources.

 

[WisNeuro]

Found it

https://www.tandfonline.com/doi/abs/10.1080/23279095.2017.1350684

 

[PsyDr]

Found it

https://www.tandfonline.com/doi/abs/10.1080/23279095.2017.1350684

Interesting that this is almost spot on for the established base rate for malingering in compensation seeking settings.

Did they tender you an official offer? If so, did you accept it? There is employment law that could protect you if they made an official offer and you accepted it, and then they pulled it. Not a lawyer, but I've seen this happen in the corp world, and the employer had to pay significant damages because the applicant was financially harmed by their actions.

Isn't the federal government and/or VA immune from lawsuits?

 

[WisNeuro]

Interesting that this is almost spot on for the established base rate for malingering in compensation seeking settings.

Isn't the federal government and/or VA immune from lawsuits?

Yup, and that estimate is solely for mTBI, doesn't include some of the other biggies like PTSD, or the dude who had diabetes from "Agent Orange," and definitely not from his poor diet and case of beer a day drinking habit.

 

[PsyDr]

Yup, and that estimate is solely for mTBI, doesn't include some of the other biggies like PTSD, or the dude who had diabetes from "Agent Orange," and definitely not from his poor diet and case of beer a day drinking habit.

Got any references to refute the idea of progressive cognitive impairment following mTBI? Not the normal dose response curve stuff.

 

[Sanman]

Isn't the federal government and/or VA immune from lawsuits?

No, you just can't sue individual providers there. The VA gets sued all the time. OIG handles this stuff for them.

 

[WisNeuro]

Got any references to refute the idea of progressive cognitive impairment following mTBI? Not the normal dose response curve stuff.

Walker study pretty recently, and we have some references from 1 year+ post mTBI in countries with no PI litigation system reporting zero continued concerns, just to name some recent stuff. As for the other side, any compelling cites that suggest that mTBI causes more severe cognitive impairment than someone who needs 24 hour skilled nursing care, yet still manages to drive independently and work a FT job?

 

[futureapppsy2]

It's actually a budgeting issue. A lot of the money that we supposed to be allocated to VHA went elsewhere (VBA, from the rumors I've heard, and it may also be connected to the PACT Act). The budget shortfall isn't anything that will be fixed by hiring freezes or denying community care, it needs congressional action.

And, yes, VHA hiring is a disaster right now. We've had multiple positions cut--positions that were very needed.

FWIW, VBA clinical-adjacent providers (mainly rehabilitation counselors) also appears to be slammed from what I’ve heard with the PACT Act opening up eligibility for VBA services (vocational rehab, etc) to a ton more veterans.

 

[cara susanna]

Classic VA: make us see more people (access! access! access!) while also REDUCING our resources.

 

[Sanman]

Current budget shortfalls are apparently estimated at $2.9 billion deficit for remainder of 2024 and $12 billion deficit for FY2025. So, I imagine this will continue to be reality for a while.

 

[WisNeuro]

How are those lead handcuffs the VA gives out with employment contracts holding out>?

 

[Sanman]

How are those lead handcuffs the VA gives out with employment contracts holding out>?

Mine are quite comfortable, thank you. Then again, I have the keys and no one is bothering me yet other than the occasional coverage request. The folks getting the big EDRP money though, they are going to be slaves for a few years.

 

[cara susanna]

My facility, apart from cutting positions and limiting CC, is just taking this view of "eh, even if we cut hundreds of positions it won't even come close to fixing this." Basically, Congress created this and it will take an act of Congress to fix it.

 

[summerbabe]

My facility, apart from cutting positions and limiting CC, is just taking this view of "eh, even if we cut hundreds of positions it won't even come close to fixing this." Basically, Congress created this and it will take an act of Congress to fix it.

100%.

At an all staff that I attended a few months ago, a plan was laid out for how our facility was going to cut FTEs per budget deficits so they were discussing how they were trying to review redundant roles and such.

And I’m thinking ‘ummmm not all FTEs cost the same lol’.

Reading between the lines, it sounded like the facility got a (probably random) number target to hit for overall positions to eliminate but that will barely put a dent in anything but it at least shows that everybody is trying to be budget conscious.

 

[Sanman]

My facility, apart from cutting positions and limiting CC, is just taking this view of "eh, even if we cut hundreds of positions it won't even come close to fixing this." Basically, Congress created this and it will take an act of Congress to fix it.

This is actually great for providers in the system if you are willing to leverage your power, you are not in a non-clinical/management or hard to find position, and know how to negotiate. Middle managers are aware that they cannot replace you and other facilities are going to attempt to poach folks already in the system for their clinics and hospitals. I don't imagine I will get bothered much because it is easier for me to leave for a new job than it is for them to replace me. Primary care and mental health are the priority services right now anyway.

 

[summerbabe]

This is actually great for providers in the system if you are willing to leverage your power, you are not in a non-clinical/management or hard to find position, and know how to negotiate. Middle managers are aware that they cannot replace you and other facilities are going to attempt to poach folks already in the system for their clinics and hospitals. I don't imagine I will get bothered much because it is easier for me to leave for a new job than it is for them to replace me. Primary care and mental health are the priority services right now anyway.

To use a sports analogy, this is like when a team loses a good player to injury but the trade deadline has already passed so your replacement options are minimal.

One caveat: depending on how long these budgetary issues linger, those who remain will see our workload requirements increase (unless you've already been absolutely maxed out).

 

[cara susanna]

This is actually great for providers in the system if you are willing to leverage your power, you are not in a non-clinical/management or hard to find position, and know how to negotiate. Middle managers are aware that they cannot replace you and other facilities are going to attempt to poach folks already in the system for their clinics and hospitals. I don't imagine I will get bothered much because it is easier for me to leave for a new job than it is for them to replace me. Primary care and mental health are the priority services right now anyway.

Hahaha, when this was announced someone in our clinic was like "In other words, this is a great time to talk to (Our Supervisor) if you want something." And our supervisor was like "... yeah, pretty much"

 

[Sanman]

To use a sports analogy, this is like when a team loses a good player to injury but the trade deadline has already passed so your replacement options are minimal.

One caveat: depending on how long these budgetary issues linger, those who remain will see our workload requirements increase (unless you've already been absolutely maxed out).

This caveat is definitely true depending on your setting. I am the only provider in my area/setting, so it makes no difference to me (the team is one deep in my position, so to speak). If they pile on work from other areas, I leave.