VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

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ccpsych16 said:
My colleagues and I have been talking about quitting together and opening a group practice for over a year now. It’s looking more appealing.



I’ve got some friends at other VAs where they’ve shut down all “DEI” seminars and Veteran groups. Somehow it has only affected LGBTQ and racial/ethnic minority resources. Women’s resources have gone untouched. Almost like saying the quiet part out loud.
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I think that's a fair point. Women are definitely a statistical minority with respect to the veteran population but so are the other groups.
 
IMG_2648.png

Hard to explain how much this enrages me.
 
I love how it's not so subtly shading you all in the public sector for being "lower productivity" employees as opposed to us out here in the private sector. I mean, technically I do have higher productivity than I did in the VA, but I also get paid multiples of that salary, and deliver far less actual healthcare. So, not sure how that helps Murica in general. I also shield A LOT more in taxes, also not helpful to the general public.
 
ccpsych16 said:
I’ve got some friends at other VAs where they’ve shut down all “DEI” seminars and Veteran groups. Somehow it has only affected LGBTQ and racial/ethnic minority resources. Women’s resources have gone untouched. Almost like saying the quiet part out loud.
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I'm not sure if you'll feel better or worse, but we seem to be leaving women's resources alone only if they don't point out any disadvantages women have compared to men.
 
That email makes me furious. I just got an offer to join a private practice where I could work fully remote and do fewer clinical hours/week. But, yes, please tell me how much more productive the private sector is.

Also, the private sector couldn't freaking function without government services. NOTHING could.

I know the goal is to make us feel so despised and miserable that we quit. I wish my local leadership would acknowledge it. We had an all-employee meeting yesterday and they were making all this sound so normal that I was just so frustrated. And so many people trust OPM still.
 
The message is definitely playing on the stereotype of government employees being lazy, subpar, and just wanting to ride out an easy job to a sweet retirement. In my experience, there are SOME government employees who definitely fall into that camp, but the psychologists are some of the best I've met, in aggregate. And the referral access (for patients and providers) to multiple specialties/services is almost unmatched.

But these people obviously aren't much interested in truth.
 
cara susanna said:
That email makes me furious. I just got an offer to join a private practice where I could work fully remote and do fewer clinical hours/week. But, yes, please tell me how much more productive the private sector is.

Also, the private sector couldn't freaking function without government services. NOTHING could.

I know the goal is to make us feel so despised and miserable that we quit. I wish my local leadership would acknowledge it. We had an all-employee meeting yesterday and they were making all this sound so normal that I was just so frustrated. And so many people trust OPM still.
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The thing about government that the Musks of the world cannot process is that there are things is world that need to be done without regard to profit. The reason I work at the VA is that the type of people I see would be a net loss in a profit focused environment (poor old people that often have family members/caregivers that take up your time unreimbursed and live in rural areas).

This is true of many veterans, from the suicidal folks on poor paying insurance to the old folks on Medicare. The thing that patients don't understand is that if I leave, them being unable to access care is not my problem. I will see rich, higher functioning people that can afford to pay me better or have good insurance.
 
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Sanman said:
The thing about government that the Musks of the world cannot process is that there are things is world that need to be done without regard to profit. The reason I work at the VA is that the type of people I see would be a net loss in a profit focused environment (poor old people that often have family members/caregivers that take up your time unreimbursed amd live in rural areas).

This is true of many veterans, from a the suicidal folks on poor paying insurance to the old folks on Medicare. The thing that patients don't understand is that if I leave, them being unable to access care is not my problem. I will see rich, better functioning people that can afford to pay me better or have good insurance.
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When people think of gov't employees, they don't think of people like us, either. I mean in the real world when I tell people my job, they always just look so impressed and sometimes thank me. Lol
 
cara susanna said:
When people think of gov't employees, they don't think of people like us, either. I mean in the real world when I tell people my job, they always just look so impressed and sometimes thank me. Lol
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People think of this:

Office Space Milton GIF by 20th Century Fox Home Entertainment


That is part of the problem. Then when planes crash into helicopters, everyone wants to know where that guy is too.
 
AcronymAllergy said:
The message is definitely playing on the stereotype of government employees being lazy, subpar, and just wanting to ride out an easy job to a sweet retirement. In my experience, there are SOME government employees who definitely fall into that camp, but the psychologists are some of the best I've met, in aggregate. And the referral access (for patients and providers) to multiple specialties/services is almost unmatched.

But these people obviously aren't much interested in truth.
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I always tell people/my patients, if I had the choice where to receive my care, I'd pick the VA. I just don't want to work for them at this point in my career.
 
WisNeuro said:
I love how it's not so subtly shading you all in the public sector for being "lower productivity" employees as opposed to us out here in the private sector. I mean, technically I do have higher productivity than I did in the VA, but I also get paid multiples of that salary, and deliver far less actual healthcare. So, not sure how that helps Murica in general. I also shield A LOT more in taxes, also not helpful to the general public.
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They actually emailed these FAQ responses to everyone too. Shade thrown in your face, don’t have to dig.
 
Fan_of_Meehl said:
But THAT's not ALL!

You too can get a free car wash and 6 months free credit monitoring with Equifax if you ACT NOW to take advantage of our special offer!
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Of course that comes as a result of another data breach of a Corp that didn’t safe guard your data. Sure, you got your identity stolen in the name of cutting corners to pad profits, but A FREE SIX MONTHS of credit monitoring…
 
Therapist4Chnge said:
Of course that comes as a result of another data breach of a Corp that didn’t safe guard your data. Sure, you got your identity stolen in the name of cutting corners to pad profits, but A FREE SIX MONTHS of credit monitoring…
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And then, ostensibly, can be billed monthly FOR THE REST OF YOUR LIFE--a new lifelong paying customer, yay!!! If you don't think I've suspected some sort of conspiracy there (or at least intentional incompetence with respect to all these damn data breaches (includung at OPM)), then you don't know Milton from Office Space very well, lol.
 
Psychologist1234 said:
But why? In what scenario would that be helpful for us?
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In the scenario where DOGE starts deleting/changing your records or an unsecured server they have at OPM gets hacked and a mess is created. Do you have proof of your telework contract if this goes to court? How about of your position and compensation? What happens down the line if you have FERS money and the records are a mess? At the very least, save a copy of your SF-50s. That is always good practice anyway.
 
cara susanna said:
I just read that the VA deactivated the whistle blower (NO FEAR) training
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The only positive of firing the Inspector generals. At least there is less work to be done on the road to fascism.

Hope we don't get a FEAR training now.
 
Sanman said:
The only positive of firing the Inspector generals. At least there is less work to be done on the road to fascism.

Hope we don't get a FEAR training now.
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That and some training to properly execute the "my heart goes out to you" salute that will be mandatory on a daily basis.
 
Sanman said:
https://www.npr.org/2025/02/04/nx-s1-5286238/federal-employees-fork-musk-trump-deferred-resignation
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Color me not surprised.

So a rapidly-conceived, poorly-thought out offer, primarily designed by someone who really has no direct experience with any form of government employment (or government in general), and with the thinly-veiled primary goal of trying to pressure federal employees to leave their jobs by any means necessary, has unforeseen (and foreseen) problems? Who could've anticipated that...
 
AcronymAllergy said:
Color me not surprised.

So a rapidly-conceived, poorly-thought out offer, primarily designed by someone who really has no direct experience with any form of government employment (or government in general), and with the thinly-veiled primary goal of trying to pressure federal employees to leave their jobs by any means necessary, has unforeseen (and foreseen) problems? Who could've anticipated that...
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The important bit:

The sample contract agreement also asks employees to waive their right to "pursue through any judicial, administrative, or other process, any action against [AGENCY] that is based on, arising from, or related to Employee's employment at [AGENCY] or the deferred resignation offer" – and to similarly waive any claim that might be brought on their behalf by a labor union or other entity.
 
Fan_of_Meehl said:
I can sometimes (rarely) find them in JLV if they were done in other VA locations. However, these days, it's getting rarer and rarer.
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Contracted C&P’s are at best, shallow and at worse, negligent. I’ve been able to find a few on JLV, I’m rarely satisfied. I remember one guy that blew multiple SVTs, embedded and stand alone for PTSD, said some very unusual/gamey things… then followed up with a contracted psychiatrist who gave him the diagnosis without so much as a PCL-5, let alone a thorough history of symptoms,PSSI5 or CAPS5.
 
DoubtfulDoc said:
Contracted C&P’s are at best, shallow and at worse, negligent. I’ve been able to find a few on JLV, I’m rarely satisfied. I remember one guy that blew multiple SVTs, embedded and stand alone for PTSD, said some very unusual/gamey things… then followed up with a contracted psychiatrist who gave him the diagnosis without so much as a PCL-5, let alone a thorough history of symptoms,PSSI5 or CAPS5.
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The over- and mis-diagnosis of PTSD over the past 15 years is a GARGANTUAN epidemic that future generations will look back on and shake their heads about. At some point, the majority of psychologists will also HAVE to admit that the clinical and scientific PTSD database is near worthless, as well, due to this. But it may take a good 20 or 30 years from now. If it happens earlier, I predict that the reason(s) will be largely financial (e.g., all the service-connected (for life) cases or cases on SSDI for life--though these seem to be more rarely PTSD and more often other mental disorders). If the VA were interested in the truth, they'd hire an army of forensic neuropsychologists, turn them loose, and let them find what they find.
 
Fan_of_Meehl said:
The over- and mis-diagnosis of PTSD over the past 15 years is a GARGANTUAN epidemic that future generations will look back on and shake their heads about. At some point, the majority of psychologists will also HAVE to admit that the clinical and scientific PTSD database is near worthless, as well, due to this. But it may take a good 20 or 30 years from now. If it happens earlier, I predict that the reason(s) will be largely financial (e.g., all the service-connected (for life) cases or cases on SSDI for life--though these seem to be more rarely PTSD and more often other mental disorders). If the VA were interested in the truth, they'd hire an army of forensic neuropsychologists, turn them loose, and let them find what they find.
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At this point, I don't even consider the conclusions of studies that don't use the CAPS.
 
WisNeuro said:
More importantly, that do not use SVTs.
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In support of this, the CAPS involves detailed (generally open-ended) structured interviewing around specific symptoms. However, in my opinion (and not inconsiderable clinical experience) it is VERY susceptible to a relatively sophisticated malingerer/'misattributor'/overreporter feigning PTSD successfully.

Is anyone aware of ANY recent studies in which the CAPS-5 and SVT indicators (via MMPI-2-RF, PAI, MENT, SIRS, et.) were co-administered to the same patients? I think there was an older (2008?) study demonstrating high levels of clear symptom exaggeration (50+%) via SIRS crtiteria/cutoffs and total SIRS scores being positively correlated with CAPS symptom severity scores, but nothing more recent.

It would be VERY interesting to have a large representative sample of veterans presenting to VA PCT's who had been given the MMPI-2-RF and CAPS-5...which is exactly the reason it never has been (and never will be) done.

I don't care what anyone says, the CAPS is only (arguably) the 'gold standard' for PTSD diagnosis after extreme overreporting of psychopathology has been ruled out.
 
Therapist4Chnge said:
I read elsewhere that the majority of ppl accepting were retiring anyway. I believe 1% have accepted, though Elon & Co-Conspirators were hoping for 5-10%.
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I mean, if you had already hit your retirement numbers and were gonna retire in the next 1-3 years anyway, why not?
 
Therapist4Chnge said:
I read elsewhere that the majority of ppl accepting were retiring anyway. I believe 1% have accepted, though Elon & Co-Conspirators were hoping for 5-10%.
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Yeah retirees, probationary folks, and those that secured other jobs already seem to be the bulk.
 
WisNeuro said:
More importantly, that do not use SVTs.
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I had to explain to a psychologist I know what an SVT was. They had gotten a request for testing for accommodations and it stated it required an SVT with the scores and results . They said they never heard of SVTs and thought it just meant making sure the symptoms were valid in their professional opinion 😳 I recommended they decline that request since obviously they would have done it without the SVT , and sent them some lists of SVTs and how to use them.
 
Fan_of_Meehl said:
In support of this, the CAPS involves detailed (generally open-ended) structured interviewing around specific symptoms. However, in my opinion (and not inconsiderable clinical experience) it is VERY susceptible to a relatively sophisticated malingerer/'misattributor'/overreporter feigning PTSD successfully.

Is anyone aware of ANY recent studies in which the CAPS-5 and SVT indicators (via MMPI-2-RF, PAI, MENT, SIRS, et.) were co-administered to the same patients? I think there was an older (2008?) study demonstrating high levels of clear symptom exaggeration (50+%) via SIRS crtiteria/cutoffs and total SIRS scores being positively correlated with CAPS symptom severity scores, but nothing more recent.

It would be VERY interesting to have a large representative sample of veterans presenting to VA PCT's who had been given the MMPI-2-RF and CAPS-5...which is exactly the reason it never has been (and never will be) done.

I don't care what anyone says, the CAPS is only (arguably) the 'gold standard' for PTSD diagnosis after extreme overreporting of psychopathology has been ruled out.
Click to expand...
Schroeder RW, Bieu RK. Exploration of PCL-5 symptom validity indices for detection of exaggerated and feigned PTSD. J Clin Exp Neuropsychol. 2024 Mar;46(2):152-161. doi: 10.1080/13803395.2024.2314728.

And Shura’s 2023 article that initially developed the indices studied are god reads. A CAPS or PSSI5 would be ideal but sometimes the best I get when doing an assessment involving reviewing others work is a single or a few PCL-5s. I’m glad they’re exploring this.
 
Fan_of_Meehl said:
In support of this, the CAPS involves detailed (generally open-ended) structured interviewing around specific symptoms. However, in my opinion (and not inconsiderable clinical experience) it is VERY susceptible to a relatively sophisticated malingerer/'misattributor'/overreporter feigning PTSD successfully.

Is anyone aware of ANY recent studies in which the CAPS-5 and SVT indicators (via MMPI-2-RF, PAI, MENT, SIRS, et.) were co-administered to the same patients? I think there was an older (2008?) study demonstrating high levels of clear symptom exaggeration (50+%) via SIRS crtiteria/cutoffs and total SIRS scores being positively correlated with CAPS symptom severity scores, but nothing more recent.

It would be VERY interesting to have a large representative sample of veterans presenting to VA PCT's who had been given the MMPI-2-RF and CAPS-5...which is exactly the reason it never has been (and never will be) done.

I don't care what anyone says, the CAPS is only (arguably) the 'gold standard' for PTSD diagnosis after extreme overreporting of psychopathology has been ruled out.
Click to expand...
In my experience, it doesn't even take a sophisticated dissimulator to "game" the CAPS, given its format/structure. But it's better than the PCL and, for many providers (particularly those unfamiliar with PTSD), better than just their standard clinical interview. It helps to get at the concept that just because a person may be experiencing symptoms of a condition doesn't actually mean they have a mental health disorder. The measure itself also gives the evaluator an opportunity to rate the overall response validity, which I've always taken to mean as based on whatever information you have available.

But yeah, I take much extant PTSD research with a grain of salt, especially if the diagnosis is based on self-report rating scale(s), brief telephone or internet survey, and/or chart review. It's one of the few MH conditions from a compensability standpoint that has a (theoretically) straightforward link to a causal event (although that's not as much of an issue in the SC world), meaning involvement of secondary gain may play a role in a higher proportion of cases.
 
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