Should I get a Psy.D to enable me to do IMEs for Veterans?

[hemipepsis5p]

Hi all,

I have my BA in Psychology and I'm trying to decide if I should get an LMHC or a Psy.D. In terms of how I want to practice, the only benefit a Psy.D confers is the ability to do IMEs for Veterans (and it adds a little more credibility if I want to write a book or make an informative Youtube channel). I've read the posts here on psychology IMEs but they don't have much specific information on doing them for Veterans. My questions are:

1. If I get my Psy.D, is it possible to have a part time/full time practice doing IMEs for Veterans, in private practice (telepsych largely), without having to work through some big mega corporation that pays very little and doesn't give me the time to do it correctly?

2. Will a neuropsych specialization likely be required at some point in the future to do psychology IMEs? I ask because although I'm moderately interested in assessments, I don't want to specialize in neuropsych, and I wouldn't want to go after a Psy.D planning on spending 50% of my time doing IMEs for Veterans for 20-30 years, only to have laws passed that require me to be a neuropsychologist at year 10.

3. Generally speaking I'm on the side of Veterans, but I'm not willing to misrepresent what is actually going on with the Veteran in order to get them a higher disability rating. Would this deadline my ability to do IMEs for Vets (basically because lawyers won't hire me?) Am I able to take a quick look through a possible client's medical history, either for free or a small fee, and then let them/their VA disability attorney know, "I can write you an opinion, but it probably won't get you any/more benefits?" I have a suspicion there could be ethical problems with "prescreening" their medical records.

4. Is the job market for writing IMEs for Veterans really small and competitive and there's no way I can do it for 20-30 years?

5. What are the odds of me testifying in court when doing IMEs for Veterans? I only ask because if I'm going to do telepsych with clients from, say, both inside and outside a 3 hour drive from me, living in eg: New York and having to show up to a Veteran's Benefits Court in Nevada would be a big problem.

6. Are there any good locations for me to get information on performing IMEs for Vets? I've done a lot of googling but it seems to be super niche and most information is aimed at informing clients about the psych IME process.

Warm regards/happy holidays.

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[AcronymAllergy]

I'm guessing what you're talking about are C&P evaluations. Most of those are managed through third-party companies that take a portion of an already limited reimbursement (compared to other IME work), but there is sometimes the option to work directly with/for VA. No third-party company should be telling you how to practice (e.g., dictating how much time you can spend on an eval) unless you're their employee. What they, and the VA itself, can determine is how much they're going to pay. I believe VA pays for C&P evals on a per-evaluation (rather than per hour) basis. So whether you spend 2 hours or 10 hours, you get paid the same. I personally would not want to build a practice primarily around C&P evaluations. I know folks who make them a decent add-on/side gig, but the only people I know of who focus on them as a major part of their practice are what could kindly be described as shills. That's not to say it's impossible, I've just not seen it.

As for some of the other questions:

2. I don't have the numbers, but I imagine most C&P evals are non-neuropsych in nature (e.g., for PTSD as opposed to TBI). You would not need neuropsych expertise to conduct these. But if, as a non-neuropsychologist, you attempt to perform a TBI-based C&P, expect that you'll receive scrutiny. VA policy may now explicitly forbid this after a few situations that arose, but I'm not sure. The stipulation is also usually not based on law; it's based on professional competency (and whatever VA decides). For example, there's usually nothing to stop a psychologist with little or no neuropsych training from conducting a "regular" (i.e., not C&P) neuropsych IME if they (erroneously) determine they're qualified to perform it, but the odds of them getting shredded at depo/trial, and possibly having their report and opinions excluded, are pretty high.

3. In performing an IME, you shouldn't be on the side of anyone other than objectivity, regardless of who's paying you. C&P evals are different than other IMEs in that VA approaches them in terms of "the tie goes to the runner" (i.e., if it's 50/50, the veteran gets the decision), whereas typically in an IME, you make decisions on a more likely than not basis. I imagine many people who perform C&P evals do so either directly with VA or via a third-party IME company rather than working directly with lawyers. The lawyers you work with, if you choose to do so, are very likely to be representing veterans who are appealing prior denials. So yes, they're going to want you to arrive at a favorable decision for them. They will exert varying amounts of pressure (from none/minimal to a lot) on you. If your eval is not favorable for their client, they may not hire you again, and the less scrupulous among them may try to get you to change your opinion. That's the nature of legal work. You should never be conducting evals worrying about how it's going to affect future business; that's a legitimate (and very human) concern to have, but it's not something that should affect your decision making. As for pre-screening, folks will not-uncommonly talk with attorneys ahead of time about cases. It's not unusual for an attorney to ask you not to write a report for an evaluation that is not favorable to their client. Not sure how that factors into C&P cases; if it's through VA, they are your client and you send them your report regarding. If it's via an attorney, I would imagine they have the potential to shop around for a report that's favorable. But don't ever do anything for free, and always get paid in advance when working directly with attorneys. And realize that if they get your opinion on a case, and particularly if they've paid you for your time, you're now conflicted out on that case for the opposing side (i.e., even if you never actually perform the evaluation, you can no longer work with opposing council on the case should they come to you for an evaluation/opinion).

4. There's no shortage, at present, of these evals. There does seem to be an unfortunate shortage of competent providers willing to perform them due to the compensation.

5. From my understanding, there's minimal to no chance you'll be deposed or called to trial. But if you're using telehealth for IME evals, be prepared to be able to defend that practice (it's viable, but you'd better be able to justify it).

6. You'd want to try to get some experience with these evals, or at least with VA clinical care in general, while in grad school. And then potentially get some peer supervision on at least a few cases after graduating. The worst C&P evals I've reviewed have typically come from providers who had no formal training in a VA setting and have little to no familiarity with the VA system and veterans. VA may also have some trainings they require you to complete before conducting the evals, if you're working directly with them.

 

[PsyDr]

1) it is my understanding that veterans do not get IMEs. They get C&Ps. These are separate practices, but many incompetent psychologists fail to understand the difference.

2) It is also my understanding that the VA requires C&Ps to be performed by doctoral level psychologists who have completed some form of BS training, comprised of watching some PowerPoint or something.

3). If you look at the VA thread, people consider the C&Ps to be the third level of hell. People are incentivized to act aggressively, or try to fake something that you have a decade of education in.

4) A practice of just assessment, especially for compensation, takes a long term toll on a person. One of the rewards of the profession is seeing people slowly get better. That doesn’t happen in assessment only. “How are you?” “Bad”. Repeat for 40 hrs per week.

 

[summerbabe]

Based on anecdotes that I've heard from my VA patients about their C&Ps, you'll be working in a dingy strip mall office on the outskirts of town (maybe virtually or partially virtually now?), spend like 20 minutes with each veteran, and then try to bang out your full C&P report so you can move onto your next eval at the top of the next hour. That sounds hella depressing.

I've had recruiters try to tempt me with these and the compensation seemed in line with what I could make doing insurance based therapy (and probably less ultimately since I'm not an efficient report writer), less than an established cash based practice and likely similar or worse to what I make currently as a VA staff psychologist when factoring in benefits.

And I'm sure the company that contracts with the VA to do these evals is making many times over whatever you get. Seems like a pretty bad deal in addition to what PsyDr mentioned about doing this kind of work day in, day out.

You can try to find a VA staff C&P position but those are quickly being phased out to put all providers towards treatment.

 

[WisNeuro]

1) it is my understanding that veterans do not get IMEs. They get C&Ps. These are separate practices, but many incompetent psychologists fail to understand the difference.

2) It is also my understanding that the VA requires C&Ps to be performed by doctoral level psychologists who have completed some form of BS training, comprised of watching some PowerPoint or something.

3). If you look at the VA thread, people consider the C&Ps to be the third level of hell. People are incentivized to act aggressively, or try to fake something that you have a decade of education in.

4) A practice of just assessment, especially for compensation, takes a long term toll on a person. One of the rewards of the profession is seeing people slowly get better. That doesn’t happen in assessment only. “How are you?” “Bad”. Repeat for 40 hrs per week.

Yeah, one of the several reasons that maintain a certain level of clinical work. While lucrative, the legal/IME/forensic side of things can make one fairly cynical, or more cynical than they already are.

But, to mirror others, these contracted C&Ps are usually pretty bottom barrel reimbursement. I've run across some people who do this as most of their work, and these are people I wouldn't trust to dress and feed themselves adequately, less so to provide competent doctoral level clinical work. On the plus side, I've never laughed so much reading some of these providers' reports, so I guess there is that.

 

[cara susanna]

Yup, contract C&P jobs are like psychologist meat grinders. You get paid per eval so there is a ton of pressure to do them quickly, not well. A former colleague took such a job a while back and it sounds like they're now looking to get back into our VA clinic.

I did C&P exams back when the VA used to have their own psychologists do them and absolutely haaated doing them. The MST ones were the worst imo.

 

[JustNoticing]

largely uncompetitive work that seems to have been the victim of the worst things associated with privatization. There are still some VA gigs doing this that I assume would be better (pay, benefits, union, a culture of trying to understand veterans and not just see them as a source of money), but sadly letting this work get outsourced seems like it has been both bad for patients and providers alike. There are some solo practitioners that can get contracts directly with the VA for this work (though not sure how), but a lot of business seems to go through a few of the big corps.

 

[hemipepsis5p]

Sorry, I should have clarified. I am in fact referring to IMEs, Veterans who are unhappy with the results of their C&P exam and are filing an appeal usually get an IME done to fight the C&P exam. I have no interest in conducting C&P exams, only in providing IMEs. Question 1 was basically aimed at determining if the IME sector is as bad as the C&P sector, which I was able to learn through research is not great.

 

[WisNeuro]

Sorry, I should have clarified. I am in fact referring to IMEs, Veterans who are unhappy with the results of their C&P exam and are filing an appeal usually get an IME done to fight the C&P exam. I have no interest in conducting C&P exams, only in providing IMEs. Question 1 was basically aimed at determining if the IME sector is as bad as the C&P sector, which I was able to learn through research is not great.

Unfortunately, the only way to really make these types of IMEs a significant portion of your work is to become a plaintiff *****. Plaintiff law firms don't actually want an expert who will do an independent evaluation, they want an expert who will find PTSD no matter the facts of the case. So, in most cases, you can do good work, and have trouble finding work in this area, or you can sell your integrity and write what the lawyers want to keep the work coming in. I have yet to see someone working in this area whom I would consider ethical and competent.

 

[PsyDr]

Sorry, I should have clarified. I am in fact referring to IMEs, Veterans who are unhappy with the results of their C&P exam and are filing an appeal usually get an IME done to fight the C&P exam. I have no interest in conducting C&P exams, only in providing IMEs. Question 1 was basically aimed at determining if the IME sector is as bad as the C&P sector, which I was able to learn through research is not great.

Those are not IMEs. IMEs have specific definitions and standards. The incompetent people who do those fake C&P think they are IMEs.

 

[WisNeuro]

Those are not IMEs. IMEs have specific definitions and standards. The incompetent people who do those fake C&P think they are IMEs.

The "I" in IME would be the big issue absent in these types of evals. Though I could say the same for a lot of "experts" who do PI work as well.

 

[PsyDr]

The "I" in IME would be the big issue absent in these types of evals. Though I could say the same for a lot of "experts" who do PI work as well.

Uhhhh... both state and federal law define who can perform IMEs, and what constitutes an IME.

It takes a lot of gall to just do something, without finding out if it is legal. "Oh hi officer, I didn't know I couldn't drive a tank down 5th ave."

 

[WisNeuro]

Uhhhh... both state and federal law define who can perform IMEs, and what constitutes an IME.

It takes a lot of gall to just do something, without finding out if it is legal. "Oh hi officer, I didn't know I couldn't drive a tank down 5th ave."

While true, it's a pretty low bar to clear for most doctoral providers.

 

[Therapist4Chnge]

Uhhhh... both state and federal law define who can perform IMEs, and what constitutes an IME.

It takes a lot of gall to just do something, without finding out if it is legal. "Oh hi officer, I didn't know I couldn't drive a tank down 5th ave."

To be fair, some of the current SUVs are as big as some smaller tanks. The Cybertruck is like a tank too….ugly, overpriced, and woefully behind schedule for production.

 

[hemipepsis5p]

Unfortunately, the only way to really make these types of IMEs a significant portion of your work is to become a plaintiff *****. Plaintiff law firms don't actually want an expert who will do an independent evaluation, they want an expert who will find PTSD no matter the facts of the case. So, in most cases, you can do good work, and have trouble finding work in this area, or you can sell your integrity and write what the lawyers want to keep the work coming in. I have yet to see someone working in this area whom I would consider ethical and competent.

I see. Very unfortunate. Thanks for the info.