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

[cara susanna]

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I'm definitely looking for PCL-5 alternatives (to include in a multi-method psychological assessment/evaluation process for purposes of case formulation, differential diagnosis, and treatment planning). I'd like something that has some embedded validity scales (I'm aware of some of the cool initial work some folks have done trying to explore this space [embedded validity scales] for the PCL-5, but I don't think that stuff is 'ready for prime time' yet and everyone gets PCL-5's thrown at them constantly already). I frequently use the MMPI-2-RF in these assessments so I have broadband psychopathology (under the HiTOP model) covered in those cases as well as embedded validity scales for that measure) but I'd like to have a 'measure' / checklist for PTSD that isn't so face-valid (people who just circle 3's and 4's) and also something that may be a bit more 'supplemental' to the ocean of PCL-5's/PHQ-9's that most of these patients have been swimming in. So, alternatives such as the DAPS and TSI-2 have piqued my interest along with alternatives to the PHQ/GAD approach to 'operationalizing' the DSM-5 criterion sets where people just circle high numbers. Alternatives/ additions to the PHQ/GAD in the form of the MASQ or IDAS-II to measure depression/anxiety presentations would also be nice. I'm really interested in the new Inventory of Problems (IOP-29) measure but since it is a dedicated/ standalone measure of response bias it would be a 'non-starter' in VA clinical practice, though I have suspicions that in the coming years the VA may be forced to admit that symptom overreporing is a HUGE issue compromising the validity/integrity of both its MH research programs/publications and its clinical operations (under 'measurement-based care' failures). It would be nice to be able to selectively utilize the SIRS or SIMS in cases where there is compelling preliminary evidence of likely symptom overreporting--for example, people who invalidate the MMPI-2-RF protocol due to overreporting psychopathological/cognitive/somatic problems, the folks who regularly produce PCL's in the 75+ range and PHQ-9's in the 25+ range despite observational and chart review and collateral (work performance) data clearly discrepant with that and/or reporting all sorts of bizarre/rare standalone 'pseudo-psychotic' symptoms, etc. But that's a whole 'nother topic for another time.

I used to be in a clinic that gave the TSI-2 to all new patients (it was part of a research study) and, honestly, I didn't find it that useful clinically.

 

[WisNeuro]

Just got a recruiter message offering a 1099 position to do VA compensation evals for.......$775/day.
🤣 🤣 🤣 🤣 🤣 🤣

 

[Therapist4Chnge]

Oh yeah, I get weekly emails/LinkedIn Msgs/Texts from recruiters about those, IMEs, and then the rando neuropsych jobs in states I refuse to work in (TX, FL, MO, AL, LA, etc).

 

[Sanman]

Just got a recruiter message offering a 1099 position to do VA compensation evals for.......$775/day.
🤣 🤣 🤣 🤣 🤣 🤣

How many evals do they want for that day? Cause I would do 1.

 

[WisNeuro]

How many evals do they want for that day? Cause I would do 1.

From what I've seen, it looks like the are expecting you to complete 4-5/day. Which is pretty much malpractice.

 

[WisNeuro]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

 

[AcronymAllergy]

From what I've seen, it looks like the are expecting you to complete 4-5/day. Which is pretty much malpractice.

Who wouldn't want to do forensic work at the rate of ~$100/hour.

Edit to add: on the surface, the idea of earning $775/day probably seems appealing at a very basic level--that works out to $186k/year for 48 weeks of work at 5 days/week.

But that quickly falls apart when you realize you're seeing 4-5 forensic cases per day, every day. And I imagine if you're doing even a semi-decent job, it's going to take you more than 1-2 hours per case, so you're putting in some serious time for that money.

If I saw just one forensic case per day, every day, for 48 weeks out of a year at a normal forensic rate: A) I'd lose my mind and probably my family, and B) I'd make a whole lot more than $186k.

 

[psy.d. 2021]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

All the liability with none of the pay. People that don't know any better maybe, people with poor boundaries perhaps. Hard to say.

 

[cara susanna]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

I've seen people take these jobs when they're desperate.

 

[Sanman]

Who wouldn't want to do forensic work at the rate of ~$100/hour.

Edit to add: on the service, the idea of earning $775/day probably seems appealing at a very basic level--that works out to $186k/year for 48 weeks of work at 5 days/week.

But that quickly falls apart when you realize you're seeing 4-5 forensic cases per day, every day. And I imagine if you're doing even a semi-decent job, it's going to take you more than 1-2 hours per case, so you're putting in some serious time for that money.

If I saw just one forensic case per day, every day, for 48 weeks out of a year at a normal forensic rate: A) I'd lose my mind and probably my family, and B) I'd make a whole lot more than $186k.

From what I've seen, it looks like the are expecting you to complete 4-5/day. Which is pretty much malpractice.

That sounds like good money on the surface, except that it is about what I would earn seeing 5 medicare patients per day for psychotherapy with less paperwork and liability.

 

[Sanman]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

Because you just paid $250k for your PsyD and the student loan repayment starts in two months.

I mean companies are still offering folks $37/patient to drive to a nursing home in 2025. Someone is taking those jobs too. Might be a midlevel now, but still...

 

[WisNeuro]

I've seen people take these jobs when they're desperate.

I can make more money just seeing Medicare dementia evals, where is the desperation?

Because you just paid $250k for your PsyD and the studnet loan repayment starts in two months.

I mean companies are still offering folks $37/patient to drive to a nursing home in 2025. Someone is taking those jobs too. Might be a midlevel now, but still...

People need to come see me, I'll exploit them less than this and I'll still make a great profit margin.

 

[R. Matey]

that works out to $186k/year for 48 weeks of work at 5 days/week.

Don't forget about taxes! On a 1099, your effective tax rate may be close to 40% (not including SALT), bringing this figure closer to an entry level W-2 job without the benefits and plenty more of the liability.

 

[Sanman]

People need to come see me, I'll exploit them less than this and I'll still make a great profit margin.

Will that be your ad?

 

[futureapppsy2]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

I've noticed people are allured by 1099 positions in general without realizing how much it can cost in benefits.

 

[AcronymAllergy]

Don't forget about taxes! On a 1099, your effective tax rate may be close to 40% (not including SALT), bringing this figure closer to an entry level W-2 job without the benefits and plenty more of the liability.

Yep, although I'd say that if you're paying an effective tax rate of ~40% on all of your 1099 income, you and/or your tax person are probably doing something wrong.

But even if this job somehow got you a 0% tax rate and offered great benefits, it'd still be horrible. When an entirely forensic position is offering similar or less money to what you would make seeing insurance-based clinical cases, no one should be taking it. Heck, my state's rates for SSDI evals are pretty bad, but even those might be better than this.

 

[WisNeuro]

Yep, although I'd say that if you're paying an effective tax rate of ~40% on all of your 1099 income, you and/or your tax person are probably doing something wrong.

But even if this job somehow got you a 0% tax rate and offered great benefits, it'd still be horrible. When an entirely forensic position is offering similar or less money to what you would make seeing insurance-based clinical cases, no one should be taking it. Heck, my state's rates for SSDI evals are pretty bad, but even those might be better than this.

100% agree. We are a high earning family and are well below this tax rate.

Will that be your ad?

Sure, why not?

I've noticed people are allured by 1099 positions in general without realizing how much it can cost in benefits.

There are times where it makes sense for the contractor, this one ain't it.

 

[cara susanna]

I've had a lot of no shows this week.

 

[WisNeuro]

I've had a lot of no shows this week.

Late Nov/Dec was always terrible for me in the VA with no-shows. In the private sector, it's great because everyone wants to get things in before their deductible/OOP max resets.

 

[AcronymAllergy]

I've had a lot of no shows this week.

Yeah, like WisNeuro said, this was always a bit of a dead zone for me at VA. Although I always worked multiple days the weeks of Christmas and New Year's because things were typically so light, which let me catch up on other stuff.