Remote VA positions

[Existenz]

Looking for anyone with experience with psychology positions within the VA that are 100% remote. I have two offers and I've not found many people who do this I can ask questions to. Part of me thinks I would love doing it all remote via VVC etc but then another part of me thinks it would get old and I would feel like a prisoner in my home office. Not to mention, pivoting away from assessment.

Feel free to PM me or post here.

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[summerbabe]

I have a remote VA therapy job and have been in it for a couple of years now. There are definitely pros and cons, some of which will be institutional and some of which will be personal.

My biggest pros are avoiding the commute, having more options/freedom with my down time during the workday, and avoiding in-person annoyances (tracking down patients after they check in, getting pulled into random access things, etc). I don't get antsy at home so that's not a problem for me but I can see that happening for others.

A lot of potential cons will likely be related to specifics such as whether or not you're joining a functional team/clinic/VA with good coworkers and supervisors and the workload. You'll also get a VA cell phone that patients can call or text you from, which might feel more intrusive than your regular VA voicemail/means of being contacted.

Some places offer a workload similar to what their in-person folks are being slotted for while I've heard of other facilities that require more from their virtual folks. Some places that are offering fully virtual jobs are also really slammed with access and experiencing lots of staff departures so you could be jumping into a stressful work situation/culture. If you have any contacts at these facilities, that could be super helpful to reach out if you haven't done so already.

Good luck and feel free to posts more specific questions or PM me.

 

[erg923]

Looking for anyone with experience with psychology positions within the VA that are 100% remote. I have two offers and I've not found many people who do this I can ask questions to. Part of me thinks I would love doing it all remote via VVC etc but then another part of me thinks it would get old and I would feel like a prisoner in my home office. Not to mention, pivoting away from assessment.

Feel free to PM me or post here.

I have worked from home for years now. Not VA.

The whole idea of work-from-home is a "flexible" schedule, right?....not just doing dishes and laundry between 8 and 4.

I would NEVER take any of these VA positions unless it was for a VA Central Office role that was non-patient facing.

Otherwise, you will almost certainly be overutilized and under-resourced and have many of the same pressures as before other than the physical commute.

 

[Sanman]

I have been mostly remote for years now. The question will vary based on your personal situation and the job being offered. I am not overworked and even on site I am isolated. So, I would rather stay home and see my family more.

 

[AcronymAllergy]

I have worked from home for years now. Not VA.

The whole idea of work-from-home is a "flexible" schedule, right?....not just doing dishes and laundry between 8 and 4.

I would NEVER take any of these VA positions unless it was for a VA Central Office role that was non-patient facing.

Otherwise, you will almost certainly be overutilized and under-resourced and have many of the same pressures as before other than the physical commute.

I guess it depends on what you mean by "flexible." I know a good number of people in other occupations who have very set work-from-home hours. The flexibility comes in if they need to run down the hall for a few minutes to take care of something at home that they obviously couldn't do at the office. But if they need to leave for, say, an hour to run to a doctor's appointment, they still have to enter a PTO request as usual.

I think the idea of being able to work at home rather than in an office, even with everything else essentially the same, is appealing to a decent number of people (and not at all appealing to others).

 

[texanpsychdoc]

Don't do it.

 

[Sanman]

Don't do it.

Lol, care to expand on this?

 

[texanpsychdoc]

Lol, care to expand on this?

Sure. Don't do it...and run as far as possible away from VA.

 

[Sanman]

Sure. Don't do it...and run as far as possible away from VA.

Ah, so your objection is the VA part and not the remote part.

 

[texanpsychdoc]

Ah, so your objection is the VA part and not the remote part.

of course - my private practice is 100% remote and I love it.

 

[Sanman]

of course - my private practice is 100% remote and I love it.

I had a feeling...just wanted to clarify this for anyone else reading as I am a fan of remote work and telehealth

 

[thisisjustatest]

Is this a fully remote neuropsychology position? That must be hard to come by! Sounds like my dream job! Where did you find it?

 

[WisNeuro]

Is this a fully remote neuropsychology position? That must be hard to come by! Sounds like my dream job! Where did you find it?

If you want to do good patient care, please do not do remote neuro assessments. It has its uses, but many tests do not operate the same in this format, particularly for certain domains. You're limited in some domains on what you can actually do. And, it's an absolute nightmare for test security. It's bad practice, and bad for guild issues.

 

[AcronymAllergy]

If you want to do good patient care, please do not do remote neuro assessments. It has its uses, but many tests do not operate the same in this format, particularly for certain domains. You're limited in some domains on what you can actually do. And, it's an absolute nightmare for test security. It's bad practice, and bad for guild issues.

Agreed for 100% remote assessments into the home. I could see an argument being made for home-to-site remote assessments with the patient being at a facility and tests being administered by an (adequately trained) psychometrist there. Although even then, personally, fully-remote positions and I probably wouldn't get along.

 

[thisisjustatest]

Remote into a CBOC with a tech shouldn’t be that bad. Those positions exist in large VA in the middle of no where? Just curious

Agreed for 100% remote assessments into the home. I could see an argument being made for home-to-site remote assessments with the patient being at a facility and tests being administered by an (adequately trained) psychometrist there. Although even then, personally, fully-remote positions and I probably wouldn't get along.

 

[WisNeuro]

Remote into a CBOC with a tech shouldn’t be that bad. Those positions exist in large VA in the middle of no where? Just curious

I've seen positions where a VA neuropsych does this maybe once a week. Other then that they are on site in a VAMC.

 

[cara susanna]

We're having trouble filling our open neuropsych position BECAUSE it isn't remote

Well, that and apparently our pay sucks compared to psychologist VA positions in other locales.

 

[WisNeuro]

We're having trouble filling our open neuropsych position BECAUSE it isn't remote

Well, that and apparently our pay sucks compared to psychologist VA positions in other locales.

Do you really want to hire the type of neuropsychologist who is comfortable doing that specific job remotely?

 

[cara susanna]

Do you really want to hire the type of neuropsychologist who is comfortable doing that specific job remotely?

Oh, no, I'm not saying we should make it remote. Just complaining, lol

 

[summerbabe]

As a non-neuropsychologist and given the long wait times for assessment in VA currently, I think it would make tons of sense to hire fully remote neuropsychologists and limit their scope of practice to clinical work that shouldn't suffer from the virtual modality since there should still be neuropsychologists and possibly trainees on site to handle cases that aren't appropriate to do virtually.

 

[WisNeuro]

As a non-neuropsychologist and given the long wait times for assessment in VA currently, I think it would make tons of sense to hire fully remote neuropsychologists and limit their scope of practice to clinical work that shouldn't suffer from the virtual modality since there should still be neuropsychologists and possibly trainees on site to handle cases that aren't appropriate to do virtually.

VA wait times were always generally a fraction of wait times in the community. A better way to manage this would be to more effectively triage referrals to neuropsych. There are a lot of inappropriate referrals that make their way through that could be better handled in their original settings, or by providers who should just do their goddamn jobs even when it's uncomfortable. At the very least, a better option to doing remote evals is to hire more psychometrists. We shouldn't be lowering standards of care to deal with waitlists.

 

[texanpsychdoc]

That actually had me thinking of a nice business concept. Much like how Quest Diagnostics operates - the physician submits an order for some labs to be run. They don't necessarily do them in house, so they refer out to Quest who have technicians who do it, run it, then submit the results to the physician to then interpret and apply with the patient. I could see a scenario where there are chains of places full of psychometrists, and psychologists will submit orders like "do a WAIS, WMS, etc." and the results of tallied/scored, sent back to the psychologist who then remotely reviews/integrates the data and confers with the patient with feedback/impressions. Or maybe this is already being done and I just haven't seen them pop up at a strip mall lately.

 

[WisNeuro]

That actually had me thinking of a nice business concept. Much like how Quest Diagnostics operates - the physician submits an order for some labs to be run. They don't necessarily do them in house, so they refer out to Quest who have technicians who do it, run it, then submit the results to the physician to then interpret and apply with the patient. I could see a scenario where there are chains of places full of psychometrists, and psychologists will submit orders like "do a WAIS, WMS, etc." and the results of tallied/scored, sent back to the psychologist who then remotely reviews/integrates the data and confers with the patient with feedback/impressions. Or maybe this is already being done and I just haven't seen them pop up at a strip mall lately.

And you, as a clinician, would trust this corporatized testing from psychometrists that you have not trained and have never met? Nothwithstanding most neuropsychologists are flexible battery folks, so you'd be missing out on modifying the battery when something weird comes up. I see so, so many problems with this concept.

 

[texanpsychdoc]

And you, as a clinician, would trust this corporatized testing from psychometrists that you have not trained and have never met? Nothwithstanding most neuropsychologists are flexible battery folks, so you'd be missing out on modifying the battery when something weird comes up. I see so, so many problems with this concept.

Perhaps. I think it could be a good idea, but if I were a venture capitalist, I'd bring together psychologists, neuropsychologists, seasoned psychometrists and strategize a plan that would address these problems. Before I became a psychologist, I was a psychometrist at a AMC and then later for a private neurology practice. In either scenario, I was already given ahead of time the tests I needed to implement. The neuropsychologist would review my scoring/data, then write their report and have the feedback session. I think this is something that could be implemented on a larger scale that would allow access to testing for more people, but also allow psychologists the flexibility in working remotely if they wanted. The idea has its faults, but I think we could iron it out. No plan is perfect, not even what we have now, but I think we could offer something different with increased flexibility for all involved (including the patient).

I'd love to get back to testing/assessment and part out the actual testing portion to someone else. I do the interview, review data, write the report, etc. from the comfort of my home.

 

[Sanman]

And you, as a clinician, would trust this corporatized testing from psychometrists that you have not trained and have never met? Nothwithstanding most neuropsychologists are flexible battery folks, so you'd be missing out on modifying the battery when something weird comes up. I see so, so many problems with this concept.

The bigger question is why not just do it yourself? Psychologists are not usually physician busy. Many who won't have interest are not very well versed in assessment anyway so the data may not mean that much to them.

 

[Sanman]

VA wait times were always generally a fraction of wait times in the community. A better way to manage this would be to more effectively triage referrals to neuropsych. There are a lot of inappropriate referrals that make their way through that could be better handled in their original settings, or by providers who should just do their goddamn jobs even when it's uncomfortable. At the very least, a better option to doing remote evals is to hire more psychometrists. We shouldn't be lowering standards of care to deal with waitlists.

It is going to be an interesting few years. With psychotherapy moving online more and more, I think that assessment is going to have to do something to attract more folks in the clinical spectrum. I have not loved online assessment beyond screeners. However, I have been looking into it in a more limited capacity given my rural folks have little access and those that are limited with respect to mobility have even less. No one is willing to do a satellite clinic over an hour away from the main medical center and most patients turn down the referral when it involves that much travel and testing.

 

[cara susanna]

That's our problem: we have decent access at our main hospital, but it's 2 hrs away. Most people opt for community care even though the wait is probably twice as long.

 

[Sanman]

That's our problem: we have decent access at our main hospital, but it's 2 hrs away. Most people opt for community care even though the wait is probably twice as long.

We don't even have a community option other than neurologists that are, frankly, not the best. One of them was recently indicted for being an opioid mill pill and Medicare fraud.

 

[WisNeuro]

The bigger question is why not just do it yourself? Psychologists are not usually physician busy. Many who won't have interest are not very well versed in assessment anyway so the data may not mean that much to them.

I'm mostly forensic these days, and I wouldn't turn that over to a psychometrist. And, even for clinical stuff, I'd never have a psychometrist I did not personally train do this. As for the "testing center" idea, I have serious reservations, given the corporate nature it would have to entail, the likely low pay and high turnover that would be inherent in that system, would make me seriously doubt any of the work coming from it.

That's our problem: we have decent access at our main hospital, but it's 2 hrs away. Most people opt for community care even though the wait is probably twice as long.

Last time I asked a colleague here, the VA neuropsych dept was booking out 3 weeks. Private prac people probably 3-6 months out, non-va hospital systems 7-8+ months out currently. If you're private pay or need a favor called in, there are options for 1-2 weeks.

 

[Sanman]

I'm mostly forensic these days, and I wouldn't turn that over to a psychometrist. And, even for clinical stuff, I'd never have a psychometrist I did not personally train do this. As for the "testing center" idea, I have serious reservations, given the corporate nature it would have to entail, the likely low pay and high turnover that would be inherent in that system, would make me seriously doubt any of the work coming from it.

That's fine, but I am talking about folks sending referrals period. If I am going to be okay with referring to "corporate testing", I am also okay with opening my own testing clinic and doing it myself. For the really complex stuff, having results does nothing without the training to interpret. For a bread and butter, dementia, autism, ADHD that this plan may work for, you don't really need a boarded neuropsych. But you do need good training in that area. If that is the case why refer rather than compete yourself?

Last time I asked a colleague here, the VA neuropsych dept was booking out 3 weeks. Private prac people probably 3-6 months out, non-va hospital systems 7-8+ months out currently. If you're private pay or need a favor called in, there are options for 1-2 weeks.

It is about month by me, but that is still only the main medical center. The issue of no services outside of the metro area continues to be a problem.

 

[Pragma]

I think we are more likely to see digital tools continue to emerge rather than a laboratory-esque service.

 

[WisNeuro]

That's fine, but I am talking about folks sending referrals period. If I am going to be okay with referring to "corporate testing", I am also okay with opening my own testing clinic and doing it myself. For the really complex stuff, having results does nothing without the training to interpret. For a bread and butter, dementia, autism, ADHD that this plan may work for, you don't really need a boarded neuropsych. But you do need good training in that area. If that is the case why refer rather than compete yourself?

Couple things, even for "bread and butter" dementia cases, a skilled neuropsych is key. I've lost count the number of times someone sent me a "classic" AD, or vascular case which turned out to be PPA, FTD, LBD, or something else. You don't want a psychologist who tests to **** those patients over with a misdiagnosis. Sometimes this can be very bad (e.g., some anti psychotics in LBD). As for ADHD, most neuropsychs don't see those cases these days anyway, especially on the adult side. And, as for the pessimistic side, reimbursements for clinical testing codes have fallen more rapidly, through cuts and inflationary changes) than therapy codes have. There's a reason so many of us experienced folks devote more and more time to legal work.

 

[Sanman]

Couple things, even for "bread and butter" dementia cases, a skilled neuropsych is key. I've lost count the number of times someone sent me a "classic" AD, or vascular case which turned out to be PPA, FTD, LBD, or something else. You don't want a psychologist who tests to **** those patients over with a misdiagnosis. Sometimes this can be very bad (e.g., some anti psychotics in LBD). As for ADHD, most neuropsychs don't see those cases these days anyway, especially on the adult side. And, as for the pessimistic side, reimbursements for clinical testing codes have fallen more rapidly, through cuts and inflationary changes) than therapy codes have. There's a reason so many of us experienced folks devote more and more time to legal work.

I get it. However, I am seeing a lot of folks go without completely. That said, most real world implications for benefits (Long-term care insurance, VA benefits, etc) care more about Dementia vs not rather than sub-type. I imagine limiting it to that for brief testing may be helpful. I would prefer that to diagnosing dementia or not based on just an MMSE as I see many neurologists do.

 

[Therapist4Chnge]

And you, as a clinician, would trust this corporatized testing from psychometrists that you have not trained and have never met? Nothwithstanding most neuropsychologists are flexible battery folks, so you'd be missing out on modifying the battery when something weird comes up. I see so, so many problems with this concept.

I am way too picky to ever be okay with that model. I’d want to review the tech’s work before they ever saw one of my patients, and then I’d want to train them to make sure they do the Beh Obs how I like it, et al.

I remember when I first started using a tech in training and it felt SO WEIRD. I was so used to being able to watch how the pt would approach a task, and I could add/move/remove tests on the fly.

I’ve been fortunate to mostly work w techs who were 5-20yrs experience with solid training and great attention to detail. I can’t imagine being okay with someone I haven’t met and doesn’t know how I like things done.

 

[Sanman]

I am way too picky to ever be okay with that model. I’d want to review the tech’s work before they ever saw one of my patients, and then I’d want to train them to make sure they do the Beh Obs how I like it, et al.

I remember when I first started using a tech in training and it felt SO WEIRD. I was so used to being able to watch how the pt would approach a task, and I could add/move/remove tests on the fly.

I’ve been fortunate to mostly work w techs who were 5-20yrs experience with solid training and great attention to detail. I can’t imagine being okay with someone I haven’t met and doesn’t know how I like things done.

I was trained to utilize a lot of behavioral observations in my testing as well (and do to this day), so I imagine it would be very odd indeed to only rely on the results.

 

[WisNeuro]

I get it. However, I am seeing a lot of folks go without completely. That said, most real world implications for benefits (Long-term care insurance, VA benefits, etc) care more about Dementia vs not rather than sub-type. I imagine limiting it to that for brief testing may be helpful. I would prefer that to diagnosing dementia or not based on just an MMSE as I see many neurologists do.

The question would be, why are they going without. VA waitlists tend to be pretty short, comparatively speaking. And, for dementia, less so if there is a GRECC attached. And honestly, if you simply need a Dementia or No decision, a properly administered screener with collateral informant is pretty high, sensitivity-wise. This is why most of us don't see cases when a screener falls below a certain number.

 

[Sanman]

The question would be, why are they going without. VA waitlists tend to be pretty short, comparatively speaking. And, for dementia, less so if there is a GRECC attached. And honestly, if you simply need a Dementia or No decision, a properly administered screener with collateral informant is pretty high, sensitivity-wise. This is why most of us don't see cases when a screener falls below a certain number.

I will diagnose it if screeners fall well below threshold. Less so if they are in a grey area (though some neurologists will in my area). As I said, transportation becomes a large problem. This is especially true for our stroke patients with hemiplegia. They go to the hospital, then short term rehab, then end up at the VA for HBPC care. No dementia dx. Great, now you have folks 60+ miles from the nearest VA medical center. Medical transport will not even go to the furthest areas. Families often don't have adequate transport (cars are too low even with residual use of the weak side) Where medical transport goes, it is usually means an 7am pickup, 1-2 hr ride, get testing, wait for transport, another 1-2 hr ride. Meaning a 10-12 hour day in some cases. There is no community neuropsych in my counties. The result, you either get the community care neurologist, VVC VA neurology and neuropsych, or nothing. No testing materials at the CBOC. I used to do some testing, but it was a monumental headache. I needed to drive to the medical center and check out testing materials and then return them (I am housed in a CBOC). VVC neurospsych since the pandemic has mixed results, IMO. Keep in mind, I am the only non-virtual mental health presence of any kind in my region (CBOCs all utilize tele-health).

EDIT: That said, lost of folks are getting turned down by the caergiver support program now without a neuropsych to back the diagnosis.