Training for VA Psychiatry?

[Philippe Pinel]

I'm one of the first class of ~50 VA HPSP recipients; am currently an MS1. I chose to participate in this program because I love the idea of working with veterans as a psychiatrist. Having said this, it sounds like the issues dealt with at the VAs across the country (poverty, homelessness, drug use, PTSD, military sexual assault, and significant environmental toxin exposures) are not always at the top of priority list for psychiatry residencies.

What characteristics/keywords should I look for when researching psychiatry residencies to prepare me for a career as a VA psychiatrist?

Additionally, if there are any graduates of the Harvard South Shore or UCLA VA psychiatry residencies, I would be curious to hear if these programs adequately prepare their graduates for VA psychiatry? (or if they have significant flaws that render their VA association moot?)

This is a pretty specific/niche post, but I am open to any insights on this process.

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[WisNeuro]

Just have your significant other or friends yell at you for ridiculous reasons throughout the day to practice. That's the prep you need to work in MH within the VA.

 

[Philippe Pinel]

Just have your significant other or friends yell at you for ridiculous reasons throughout the day to practice. That's the prep you need to work in MH within the VA.

Done. I grew up in a large family with antagonistic siblings. Next.

Edit: Appreciate the thought. Definitely found this funny... nothing quite like growing up with too many siblings, all with high IQs and too much free time. I don't think that VA MH will be an issue.

 

[psychacad]

There's a ton of SMI as well (schizophrenia, bipolar), at least at the VA I've worked in. I did enjoy my work at that VA and there weren't too many vets yelling in my face. I didn't find the experience radically different. Just a few cultural things you need to adjust to. The population I worked with was very high risk (often a mishmash of TBI, PTSD, substance use and SMI), so that's something to keep in mind.

 

[WisNeuro]

There's a ton of SMI as well (schizophrenia, bipolar), at least at the VA I've worked in. I did enjoy my work at that VA and there weren't too many vets yelling in my face. I didn't find the experience radically different. Just a few cultural things you need to adjust to. The population I worked with was very high risk (often a mishmash of TBI, PTSD, substance use and SMI), so that's something to keep in mind.

Very clinic dependent. Try initiating a conversation about tapering benzos, or telling them diplomatically that their neuropsychological eval results are FOS when they are going for SC increases

 

[PikminOC]

Just have your significant other or friends yell at you for ridiculous reasons throughout the day to practice. That's the prep you need to work in MH within the VA.

I thought you were referring to the beauracracy of the VA....

 

[Stagg737]

I'm one of the first class of ~50 VA HPSP recipients; am currently an MS1. I chose to participate in this program because I love the idea of working with veterans as a psychiatrist. Having said this, it sounds like the issues dealt with at the VAs across the country (poverty, homelessness, drug use, PTSD, military sexual assault, and significant environmental toxin exposures) are not always at the top of priority list for psychiatry residencies.

What characteristics/keywords should I look for when researching psychiatry residencies to prepare me for a career as a VA psychiatrist?

Additionally, if there are any graduates of the Harvard South Shore or UCLA VA psychiatry residencies, I would be curious to hear if these programs adequately prepare their graduates for VA psychiatry? (or if they have significant flaws that render their VA association moot?)

This is a pretty specific/niche post, but I am open to any insights on this process.

Regardless of VA, you will become well-versed in PTSD, substance disorders, and personality disorders (largely cluster B) as well as some decent TBI exposure. Beyond that is more VA dependent. When looking into residency just ask where they rotate and if they rotate through a VA how much of their time is spent there. At my program it's a fairly significant amount of time, so I'm confident in my ability to address needs of veterans and I could almost seamlessly transition to the VA's system today if necessary.

I know of one user on here who is at HSS and I'm pretty sure they have been open about it on the forums. However, I can PM you their username if you want to reach out to them for sake of privacy.

There's a ton of SMI as well (schizophrenia, bipolar), at least at the VA I've worked in. I did enjoy my work at that VA and there weren't too many vets yelling in my face. I didn't find the experience radically different. Just a few cultural things you need to adjust to. The population I worked with was very high risk (often a mishmash of TBI, PTSD, substance use and SMI), so that's something to keep in mind.

This is similar to my experience. My outpatient experience at the VA has actually been very good once some scheduling issues were taken care of. Inpatient is hit or miss but I don't think there are many more malignant patients than on our academic unit. We do get a lot more belligerently intoxicated patients at our VA though, so I'd say our VA ER tends to be much more stressful than at our academic center.

Very clinic dependent. Try initiating a conversation about tapering benzos, or telling them diplomatically that their neuropsychological eval results are FOS when they are going for SC increases

This is the beauty of working at a VA with a "no benzo" policy for years. The few patients I have on benzos have legitimate indications for them and use them appropriately. Those that I need to taper typically do it willingly once their immediate symptoms are addressed. Surprisingly, of the 3 clinics I work in the VA is by far the easiest in terms of controlled substances and I have to have harder conversations about stimulants far more often than benzos (which I don't mind).

 

[psychacad]

Oh, and their EMR is the best. You can basically free type everything and you aren't bombarded with alerts and things to fill and click. There's usually much less concern about liability.

 

[WisNeuro]

I thought you were referring to the beauracracy of the VA....

Nah, the VA bureaucracy is not belligerent in their incompetence, they are more passive and absent in my experience.

 

[theduderino]

The VA funds training at many residencies across the country. It's common to have rotations at a VA associated with an academic or community residency and thus you won't have to look hard for this experience. As far as residency goes, think about getting exposure to a diverse array of clinical experiences, particularly those that would be less commonly associated with the VA (e.g women's peripartum substance use, child/adolescent work, first episode clinic work, modes of therapy that aren't cognitively or behaviorally based, trauma work that isn't based on CPT or PE). You will have plenty of time to learn the VA way after residency and they do a good job, generally, of providing opportunities for continuing education.

 

[WisNeuro]

This is the beauty of working at a VA with a "no benzo" policy for years. The few patients I have on benzos have legitimate indications for them and use them appropriately. Those that I need to taper typically do it willingly once their immediate symptoms are addressed. Surprisingly, of the 3 clinics I work in the VA is by far the easiest in terms of controlled substances and I have to have harder conversations about stimulants far more often than benzos (which I don't mind).

Sounds like a good clinic situation to be in. Before I left, the VA seemed to be doing a much better job with benzos than other systems, but they were still right up there with opiates.

Oh, and their EMR is the best. You can basically free type everything and you aren't bombarded with alerts and things to fill and click. There's usually much less concern about liability.

Totally agree, I've used 3 systems now, and I've liked VISTA the most by far.

 

[JKinSC]

Sounds like a good clinic situation to be in. Before I left, the VA seemed to be doing a much better job with benzos than other systems, but they were still right up there with opiates.



Totally agree, I've used 3 systems now, and I've liked VISTA the most by far.

Wait, when did they lose CPRS? It was an absolute pain to re-learn on the occasions I returned to the VA, but once you got the hang of it, it was damn near magic.

 

[WisNeuro]

Wait, when did they lose CPRS? It was an absolute pain to re-learn on the occasions I returned to the VA, but once you got the hang of it, it was damn near magic.

Oops, I meant CPRS, VISTA was the imaging tool that CPRS used. Spent a lot of time looking at MRIs.

 

[Stagg737]

Totally agree, I've used 3 systems now, and I've liked VISTA the most by far.

I like Epic better just because dot phrases can save so much time with charting. I do like most of CPRS though and out of the 7-8 EMRs I've used they're probably second or third (CloudCare was also very easy). I've got to say though, the fact that CPRS hasn't been updated in nearly 20 years and is still mostly functional says a lot about it in general.

Wait, when did they lose CPRS? It was an absolute pain to re-learn on the occasions I returned to the VA, but once you got the hang of it, it was damn near magic.

They haven't yet, but Cerner did win a huge contract with the VA/DoD to develop an EMR similar to PowerCharts. They were given 10 years to do this though, so I'm sure they'll use most of that time, lol.

 

[WisNeuro]

I have never heard anything good about Cerner from other providers who have used it. Literally not one good thing.

 

[JKinSC]

I have never heard anything good about Cerner from other providers who have used it. Literally not one good thing.

We used Cerner in residency, and it wasn’t the worst thing in the world... It did motivate admin to switch to Epic, eventually.

 

[Stagg737]

I have never heard anything good about Cerner from other providers who have used it. Literally not one good thing.

I briefly used it on a rotation. Not really intuitive at all, but from what I heard once you get used to it and set up your templates it's not awful. Definitely far from the worst EMR I've used.

 

[wolfvgang22]

We are being told that Cerner will replace CPRS sometime in the next year or so. I'm not looking forward to it.

As far as training goes, just get a well rounded residency training experience. Most programs have VA rotations available. The VA offers tons of free online CME on all the veteran mental health related topics and you can sign up for their mailing lists. I get literally 50 training opportunities per week in my VA email on these topics.They are glad for residents to participate, too.

 

[kopftonmd]

We have Cerner!

It's not amazing, but it's not terrible (@ Allscripts Sunrise). It's not super intuitive, but once you get used to it and get your dot phrases and such figured out it's not incredibly slow and bumbling... just moderately slow and bumbling. It also feels like it was made a long, long time ago in a galaxy far, far away... maybe I'm such a millenial, but I feel like a more attractive interface would help me like it more.

The mobile app is a pain in the tuches, though.

 

[Fuzzy08]

Anybody know of any VA facilities that are hiring for outpatient (full or part time) in coastal areas of Florida?

 

[wolfvgang22]

Anybody know of any VA facilities that are hiring for outpatient (full or part time) in coastal areas of Florida?

Have you looked at USAJobs.gov? If not, look there first. However, sometimes jobs are available and for bureaucratic reasons they aren't posted yet. They usually have to relist open jobs every 6 months and it can be slow.
Which VA's in particular are you interested in? I might be able to dig up an email on Monday.

If it were me, after looking at USAjobs, and if I don't have their email, I would just call them. For example, here is the number for the Miami VA hospital mental health. Click on contact information. Here is the psychiatry service number: Psychiatry Service: 305-575-7000, ext. 13903
Call them and tell ask to leave a message for the chief of mental health that you are a psychiatrist looking for employment and mention whether you have been able apply for a position on USAjobs or not. Leave your contact information. If they have open positions they will call or email you back. If they don't, they either have no need or you don't want to work there, anyway. Fortune favors the bold.

 

[nexus73]

I've had some great VA patients. However, there's a subset VA population I don't tend to see in the private world that gets under my skin...a bit. There is a percentage of VA patients who are strongly narcissistic, but also extremely dependent on the VA system. It's actually striking to see someone think so much of themselves and then insist everything must be done for them as though they are not capable of taking care of themselves.

 

[WisNeuro]

I've had some great VA patients. However, there's a subset VA population I don't tend to see in the private world that gets under my skin...a bit. There is a percentage of VA patients who are strongly narcissistic, but also extremely dependent on the VA system. It's actually striking to see someone think so much of themselves and then insist everything must be done for them as though they are not capable of taking care of themselves.

I think the narcissism is there for some of these people, but the word I would use as paramount here is entitlement.

 

[robellis]

I think the narcissism is there for some of these people, but the word I would use as paramount here is entitlement.

Yeah but doesn’t entitlement stem from narcissism

 

[WisNeuro]

Yeah but doesn’t entitlement stem from narcissism

Definitely in clinical narcissism. But it's much more prevalent in the military, likely due to the training process. And then exacerbated by the discharge process and VSOs.

 

[Celexa]

I'm one of the first class of ~50 VA HPSP recipients; am currently an MS1. I chose to participate in this program because I love the idea of working with veterans as a psychiatrist. Having said this, it sounds like the issues dealt with at the VAs across the country (poverty, homelessness, drug use, PTSD, military sexual assault, and significant environmental toxin exposures) are not always at the top of priority list for psychiatry residencies.

What characteristics/keywords should I look for when researching psychiatry residencies to prepare me for a career as a VA psychiatrist?

Additionally, if there are any graduates of the Harvard South Shore or UCLA VA psychiatry residencies, I would be curious to hear if these programs adequately prepare their graduates for VA psychiatry? (or if they have significant flaws that render their VA association moot?)

This is a pretty specific/niche post, but I am open to any insights on this process.

If you're definitely going to be working at a VA I would pick a residency that includes time at the VA but also provides a broad range of other exposures. Other than that I wouldn't worry about it too much.

 

[Monocles]

I've described a "moderately positive" experience at Harvard South Shore

"Moderately positive" is like a 6/10 on a Likert scale 🤣 what are you withholding from OP?