VA Home Based Primary Care Thoughts?

[Sanman]

Hi all,

I just wanted to get an idea of your thoughts on this position, productivity levels, experiences, etc. I am being considered for a position, but it would mean extending my commute to 60-90 min each way. The workload would certainly be lighter than my current one, which may make up for the commute as hours may remain the same with better benefits. I just wanted to get some opinions on the general consensus regarding such a position. Is the workload too heavy for some that you have seen? Any chance it may be on the chopping block in the future with President Trump heading in? Trying to decide if it is worth a shot. Thoughts? This should be an interesting night at the dinner table for me as my wife tabled the convo last time as I was not in consideration then, just applying.

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[erg923]

Hi all,

I just wanted to get an idea of your thoughts on this position, productivity levels, experiences, etc. I am being considered for a position, but it would mean extending my commute to 60-90 min each way. The workload would certainly be lighter than my current one, which may make up for the commute as hours may remain the same with better benefits. I just wanted to get some opinions on the general consensus regarding such a position. Is the workload too heavy for some that you have seen? Any chance it may be on the chopping block in the future with President Trump heading in? Trying to decide if it is worth a shot. Thoughts? This should be an interesting night at the dinner table for me as my wife tabled the convo last time as I was not in consideration then, just applying.

Well, theres a lot of driving in HBPC positions, so tack that on to your 90 minute commute and it may make for an intolerable level of driving? Hope you have some books on tape!

I have not found the HBPC program at my VA all that useful, and they constantly kick back consults submitted for MHtx to the general mental health service...would sorta defeats the whole thing I am trying to accomplish. lol

 

[deleted343839]

HBPC has been around a while now. I don't know why it would specifically be susceptible to budget cuts. With the exception of any oil interests in Russia that you might hold, I'm not sure it makes sense to change anything you're doing based on the prospect of Trump in the Oval Office. That's just a great big ol' crap shoot.

I know someone who took a HBPC job and was quite happy. I wouldn't like driving that much, but that's just me. I think home-based work is a better fit for people who are more "go with the flow" and not too fastidious about personal boundaries. It's a valuable service when used appropriately (though as erg mentioned that could also be variable depending on your facility). Only you can decide whether it's a good fit.

 

[erg923]

I know someone who took a HBPC job and was quite happy. I wouldn't like driving that much, but that's just me. I think home-based work is a better fit for people who are more "go with the flow" and not too fastidious about personal boundaries. It's a valuable service when used appropriately (though as erg mentioned that could also be variable depending on your facility). Only you can decide whether it's a good fit.

I think that's a good point. My impression is that the HBPC psychologists here are required to have much flexibility in various aspects, and are also doing a "cognitive assessment" clinic once per week under much time pressure for report turn around. I personally enjoy having one office/one location and fairly predictable day/routine.

 

[erg923]

Any chance it may be on the chopping block in the future with President Trump heading in? Trying to decide if it is worth a shot. Thoughts? This should be an interesting night at the dinner table for me as my wife tabled the convo last time as I was not in consideration then, just applying.

Anything with the phrase "primary care" in it is probably pretty safe. The prevailing paradigm shift in the VA is that the majority of veteran's MH needs are more fitting with the model of primary care mental health (integration), than with the model of the traditional Mental Health Clinic (MHC). Specialty programs are in...and general outpatient MH positions are declining, or at least not projected to grow in the future.

 

[Therapist4Chnge]

The driving....unless you really enjoy driving, that seems like a lot of time to be in the car every day. I'd want to get paid for that extra drive time to work, which prob isn't how the VA rolls....

 

[WisNeuro]

Nope, they will not pay for the commute. However, if you use public transportation, they may subsidize part of that.

 

[Sanman]

Commute time won't get paid, but I am wondering how lenient the VA with schedule when you are driving. Seeing 5 clients/day even with driving is not a big deal to me. Seeing 7-8 may be. The other issue I am talking to my wife about is being less available for home responsibilities if I am that far away from work. Decisions..decisions.

The feeling I do have is that I may need more structure unless the workload is very light. I do fine that type of work as I do it now. However, the workload and the commute is what kills me. It is a tough decision because I know I would be good at the work, but am trying to sort out how to make more time for family and keep up with duties at home.

As for Trump, I am not making all life decisions based on him. However, when I was in the VA I knew more about what direction the money was going than I do now. If they are pushing more "medical homes"/ clinics and reducing home based care that would be good to know. Not that I would take a comp and pen job, but I have a feeling those are going to be outsourced more to meet his requirement of everyone being seen rather than more thorough in-house evals.

 

[erg923]

Commute time won't get paid, but I am wondering how lenient the VA with schedule when you are driving. Seeing 5 clients/day even with driving is not a big deal to me. Seeing 7-8 may be. The other issue I am talking to my wife about is being less available for home responsibilities if I am that far away from work. Decisions..decisions.

The feeling I do have is that I may need more structure unless the workload is very light. I do fine that type of work as I do it now. However, the workload and the commute is what kills me. It is a tough decision because I know I would be good at the work, but am trying to sort out how to make more time for family and keep up with duties at home.

As for Trump, I am not making all life decisions based on him. However, when I was in the VA I knew more about what direction the money was going than I do now. If they are pushing more "medical homes"/ clinics and reducing home based care that would be good to know. Not that I would take a comp and pen job, but I have a feeling those are going to be outsourced more to meet his requirement of everyone being seen rather than more thorough in-house evals.

You will have a quarterly RVU target, so you will have flexibility to have lite days and busy days, if that's what you are asking? My boss never cares how many patient I saw TODAY, in other words.

This sounds like an obvious "foot in the door" opportunity, no? If so, I hope you have a sense of how much people "move around" within that the particular VA. Doesn't sound like a job you would want for 5 years.

In terms of "keeping up with duties at home", you get ample PTO at the VA. Use it and don't be shy about it. I do short weeks (work 3 days off two) every couple months at least.

 

[Sanman]

Hey ERG,

I am wondering both about RVUs in terms of flexibility, but also in terms of general expectations overall. The expectation of my friends that do nursing and rehab home care (not in the VA) is no more than 4-6 appts per day and they are able to document via laptop from home. That seems doable to me. More than that seems like the expectations may be pushing more than 40 hrs when all is said and done. In addition to a 2-3 hr commute, that would be putting me in a similar situation to my current one. The PTO and benefits are a big reason for my wanting the move actually. I am really hitting a wall with the crummy benefits I currently have and do feel that the VA is more family friendly, which I need. However, reasonable structure (working reasonable hours and not being a slave to high RVU expectations) and work culture is something I need. When we have spoken before I recall you talking about doing 8 sessions a day of 90832 vs my expectations of 12-16/day (up to 18/day at a competitor I recall).

Thanks all, this is really helping me sort out my thoughts with regard to what I need from this position.

 

[erg923]

Hey ERG,

I am wondering both about RVUs in terms of flexibility, but also in terms of general expectations overall. The expectation of my friends that do nursing and rehab home care (not in the VA) is no more than 4-6 appts per day and they are able to document via laptop from home. That seems doable to me. More than that seems like the expectations may be pushing more than 40 hrs when all is said and done. In addition to a 2-3 hr commute, that would be putting me in a similar situation to my current one. The PTO and benefits are a big reason for my wanting the move actually. I am really hitting a wall with the crummy benefits I currently have and do feel that the VA is more family friendly, which I need. However, reasonable structure (working reasonable hours and not being a slave to high RVU expectations) and work culture is something I need. When we have spoken before I recall you talking about doing 8 sessions a day of 90832 vs my expectations of 12-16/day (up to 18/day at a competitor I recall).

Thanks all, this is really helping me sort out my thoughts with regard to what I need from this position.

No, I would say it very rare for me to see 8 patients in a day. 5-6 patients per day is much more standard for me, especially now that PCMHI VISN leadership are now pushing the same day access push for PCMHI psychologist-this actually urges us to schedule less patients each day and be "available" more. I manage to get away with abbreviated initial evals that can be done in 30 minutes that still hit threshold for 90791, and of course sessions sometimes need to go over 30 minutes so I have a couple 90834s each weeks as well. All that helps with my RVUs too.

The VA is kinda anal about getting here at 8 and not leaving until 430, btw.

 

[Therapist4Chnge]

The VA is kinda anal about getting here at 8 and not leaving until 430, btw.

Yeah...one of the few downsides to the VA. It's the 8am part.

 

[WisNeuro]

Yeah...one of the few downsides to the VA. It's the 8am part.

7:30-4, although sometimes it's 3:45. I'm out mfers.

 

[Sanman]

No, I would say it very rare for me to see 8 patients in a day. 5-6 patients per day is much more standard for me, especially now that PCMHI VISN leadership are now pushing the same day access push for PCMHI psychologist-this actually urges us to schedule less patients each day and be "available" more. I manage to get away with abbreviated initial evals that can be done in 30 minutes that still hit threshold for 90791, and of course sessions sometimes need to go over 30 minutes so I have a couple 90834s each weeks as well. All that helps with my RVUs too.

The VA is kinda anal about getting here at 8 and not leaving until 430, btw.

Good to know about the RVU situation. As far as 8-4:30, I remember from internship and years prior the anal nature of that. It used to annoy me as a grad student because one VA I worked at had a severe parking problem and led to me being late because I was circling the lot or worried about parking illegally in certain areas (the norm) and getting towed. I do wonder how the 4:30 part works with home based though. Do I really need to return to the VA after a home based appt that puts me nowhere near there?

 

[WisNeuro]

Do I really need to return to the VA after a home based appt that puts me nowhere near there?

Depends on whether or not you are in your own vehicle, or one of the govt ones.

 

[erg923]

Good to know about the RVU situation. As far as 8-4:30, I remember from internship and years prior the anal nature of that. It used to annoy me as a grad student because one VA I worked at had a severe parking problem and led to me being late because I was circling the lot or worried about parking illegally in certain areas (the norm) and getting towed. I do wonder how the 4:30 part works with home based though. Do I really need to return to the VA after a home based appt that puts me nowhere near there?

You wont be in your personal vehicle.

 

[WisNeuro]

You wont be in your personal vehicle.

Sometimes depends on the VA. We were allowed to sometimes just submit our mileage for our own vehicles and get reimbursed on a per mile fee. However, this for not a daily thing, so I'd imagine it'd be harder to swing from a HBPC standpoint.

 

[Sanman]

Hi all,

I just wanted to say thanks for all the replies, both here and by PM. I am being forwarded for an interview with the local team there, so hopefully it works out. I got a few answers to my questions and it seems like the hours are less strict and I have no office to report to, just appts and I can document from home. It would be by own car with mileage reimbursement. Hopefully it works out!

 

[Sanman]

Just a quick update to this thread. It looks like I will be living the GS-13 life at some point later this year. Now to navigate the on-boarding process... Having no set start date and having to inform my current employer prior to their calling them to verify employment is really a lovely perk of trying to get into government work. One of the things I will miss with private work is the ease of the hiring process.

 

[erg923]

Just a quick update to this thread. It looks like I will be living the GS-13 life at some point later this year. Now to navigate the on-boarding process... Having no set start date and having to inform my current employer prior to their calling them to verify employment is really a lovely perk of trying to get into government work. One of the things I will miss with private work is the ease of the hiring process.

This varies by VA. Mine was quick and painless.

Sounds like an interesting position. Probably not for me, as I like my office and my control over my schedule, but it would be cool to be a free range psychologist as well.

 

[Sanman]

This varies by VA. Mine was quick and painless.

Sounds like an interesting position. Probably not for me, as I like my office and my control over my schedule, but it would be cool to be a free range psychologist as well.

I'm used to the free range part at current position. I would not mind an office, but no one looking over my shoulder and the reduced rvu requirements are nice. A bit of give and take. I was told it may take a few months to start, closer to the middle of the year.