Training at the VA?

[iqureshi7]

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I'm considering a psych program that does a lot of their training at a VA (particularly outpatient). What are your opinions on training at the VA (assuming they have dedicated faculty)? My main concern is: will training at a VA adequately equip you to treat "non-va" patients? I do not have intention to practice in a VA in the future.

Thanks for your help in advance!

 

[fielight]

it really depends on what you want to see... VA hospitals tend to see a lot of substance abuse (cocaine, alcohol, etc.), homelessness, PTSD (obviously - in fact, some would say that is one of its advantages), schizophrenia is pretty common as well. now, all of these things i mentioned would be similar to what you'd see in a major urban-setting hospital (like NYC) anyway. VA's are not known for the affluent population and you probably won't see much of the truly rare diagnoses (though to be fair, i think it's tough to see rare pathology unless you're in one of the major psych centers in the country where they get referrals). the CPRS computer system is amazing; it's the prototype of what an EMR should be, and a big perk if you're not into handwriting notes/orders. the pace of VA's is also slower, which may or may not be a good thing, and generally it's a more relaxed atmosphere with easier hours. of course, this all depends on which VA as they will certainly differ with location, but most people would agree that the above is true.

 

[Solideliquid]

I'm considering a VA career when I graduate (that is, if I don't go into child).

You should also be aware the generally (remember, general statement here) most VA's I have been to have poor staff and nursing personnel compared to your garden variety hospital/academic center.

 

[Lauraaa]

I think VA training is nice too in that if you do not get exposure, say to a county facility or other location in residency where you see patients who are not very affluent, that VAs can give experience working with a population that might not be as advantaged as other populations. Could be helpful if you are interested in community psychiatry, perhaps. Also, b/c the EMR is so great and well-organized, and some VAs have a slower pace of work I've known people to get involved w/ some small research projects during that time, having all this data that they could use and a bit of extra time as well.

 

[189213]

I believe that having the opportunity to work at a VA during part of a residency would be extremely valuable, for a couple of reasons. First, as others have mentioned, it is a very interesting population that has some psychopathologies you might not encounter elsewhere. Second, I think it's personally very gratifying serving those who have served the country honorably. Third, I think it is a great opportunity to practice medicine in an environment where making money/being profitable isn't a factor lurking in the background. These reasons appeal to me; obviously I think it's totally valid if others feel like they'd be happy without a VA experience -- and I think they'd end up being just as good a psychiatrist.

 

[masterofnone]

I have a similar concern. My two top picks are b/w a program that does 1/2 of the in & outpatient rotations at the VA- the other program has no VA time. I love the VA and working with the Vets. My concerns with the VA centered program are (provided that I choose not to work at the VA):

1. Limited exposure to female patients
2. Fewer personality disorders (at least from what I've seen...)
3. High malingering rates (I like the challenge but I don't want to become jaded)
4. The outpatient seems to be entirely med checks with psychologists doing therapy so residents have less chance to practice

Since roughly 1/2 of my time would still be at traditional in & outpatient facilities (not to mention my electives), should the above points be a concern if I end up not working for the VA?

Thanks!

 

[Solideliquid]

I have a similar concern. My two top picks are b/w a program that does 1/2 of the in & outpatient rotations at the VA- the other program has no VA time. I love the VA and working with the Vets. My concerns with the VA centered program are (provided that I choose not to work at the VA):

1. Limited exposure to female patients
2. Fewer personality disorders (at least from what I've seen...)
3. High malingering rates (I like the challenge but I don't want to become jaded)
4. The outpatient seems to be entirely med checks with psychologists doing therapy so residents have less chance to practice

Since roughly 1/2 of my time would still be at traditional in & outpatient facilities (not to mention my electives), should the above points be a concern if I end up not working for the VA?

Thanks!

1. Sure yes the majority are male, but as more and more Iraqi Freedom Fighters return from Iraq you will see more female VA patients.

2. Well, a lot of them DO have personality issues. And remember some of them had axis II issues BEFORE going into the military.

3. This is certainly a problem in our field, especially as the VA has recently mandated that all substance abusing veterans be offered substance treatment. Of course the population in my area have realized that they can get a bed for 21 days to 90 days and believe me they ask for it!

4. Well, in my program anyway we don't do therapy until PGY III what's your hurry? 🙂

 

[sunlioness]

I think you can get good training at the VA, but it takes a certain kind of person to like it there. I am not that kind of person so I don't really know what attributes those are. *laugh* I spend one day a week there currently seeing outpatients and am looking forward to graduating so I don't have to do it anymore. YMMV, of course.