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Hell, I'm not emotionally ready for Thursday (tomorrow). But I feel ya, lol
VA Mental Health Provider Venting / Problem-solving / Peer Support Thread
Started by Fan_of_Meehl
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Sanman
O.G.
I am emotionally ready for a vacation, that is about the only thing I am ready for.
Someone was saying to me that the non-supervisory VA psychologists in our locale (midsize west coast city) were on the GS-14 scale. Is this possible?
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Sanman
O.G.
Anything is possible, but it is unlikely for a medical center psychologist. Now a special salary rate that bumps you up may be possible. There are 14-15 program manager and service chief postions. I have also seen some VISN level postions at those GS levels.
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our dept is doing our salary study and some ppl were arguing that we should be comparing ourselves to GS-14, which seemed fishy to me.
Sanman
O.G.
I mean you should if you want more money. Might not hurt to include the total comp of some tech CEOs as well.
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I mean...if I have to supervise/mentor myself as a GS-13....do I get to claim the 14 salary? Hell, seems fair to me.
I'm getting SO MANY bad testing consults this week. I just can't.
On a completely unrelated note (haha), why does primary care think that we're going to conduct psych assessments if the person isn't engaged in or interested in treatment??
On a completely unrelated note (haha), why does primary care think that we're going to conduct psych assessments if the person isn't engaged in or interested in treatment??
I have been wading back into the assessment clinic waters after taking a break. It seems to be just as bad as when I left it. I think my latest consult is hoping another round of testing will turn up an elusive PTSD diagnosis.
The third...or fourth...or fifth try just might be the charm. I have found myself frequently asking (the thin air) "How many times do you have to say "no" to a PTSD diagnosis before that answer is accepted?" I am also frustrated by the reversed burden of proof issue with respect to the PTSD diagnosis in VA settings, namely, it appears to be perfectly acceptable for people to just 'slap on' a PTSD diagnosis with very little (sometimes none) evidence or analysis but, on the other hand, being able to say "no" to a self-diagnosis of PTSD often requires Herculean efforts, documentation, testing and analysis and, even then, they can just try again next year. After all, all it takes is one 'yes' to be able to say, 'I have PTSD...it's been diagnosed...I have the diagnosis.' I am getting so tired of the joke of the 'latent disease' metaphor of psychopathology these days.
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You see, the patient has feelings, and we need to get to the bottom of why they have feelings so that we can stop that or turf it to someone else. /s, but I've legit seen consult requests like this
I sometimes do PTSD evals for the workers comp system and I literally go through each criteria in my report and include objective data and dare someone to challenge it; I’m still batting 1.000 for my reports. I do it this way partially bc of my time in the VA system. Providers appreciate the thoroughness and the system appreciates the final answer.
Doing training for the new Cerner EHR
I am not emotionally prepared.Doing training for the new Cerner EHR
I wish they would just give us a dummy version of the software and let us play around with it. These videos and trainings only confuse me more.
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It will be an absolute unholy disaster...guaranteed. They will have to parachute in an entire army of disasterologists, expertologists, and excellentologists to manage the mayhem.Doing training for the new Cerner EHR
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I saw they have an AI for cerner EHR questions
That'll be super helpful...I'm sure
They can ask it for advice on how to drop their Federal retirement packets.
Sanman
O.G.
Happened to a supervisor of mine once. The guy profusely thanked him the next session and was ready to discharge. He had to ask the person what he said that worked so well.
It does happen for sure. Some folks just want me to tell them to validate what they're doing is problematic for their functioning and once they receive that validation they do something about it. Those are easy
Anyone else getting lied to more? My assessments are an interesting experience lately.
Me: You're having flashbacks?
Them: Yes.
Me: How often?
Them: Daily.
Me: ...oh. Can you tell me what they're like?
Them: <description from a movie>
Me: How long do they last?
Them: Four hours at least.
Then I wrestle with myself about how to make the rest of the process useful in any way. I have had some version of that happen several times over the last few weeks.
Me: You're having flashbacks?
Them: Yes.
Me: How often?
Them: Daily.
Me: ...oh. Can you tell me what they're like?
Them: <description from a movie>
Me: How long do they last?
Them: Four hours at least.
Then I wrestle with myself about how to make the rest of the process useful in any way. I have had some version of that happen several times over the last few weeks.
As this admin forces VBA to lower ratings for folks not in treatment and deemed to be "better" we're due to see a lot more of this. Add in the VSOs all telling vets to go to VA for an eval it's going to blow up.
You're just now noticing/encountering this? Symptom overreporting is the dark matter of the VA mental health universe...everyone knows it's there, it's everywhere exerting influence, altering landscapes...but we can't speak of its existence out in the open...that would involve...the ability to have adult (grown up) conversations.
In all seriousness, though it's always been there, I think that it's been getting progressively worse over the past few years.
It's going to take an army of forensic neuropsychologists and skilled clinical psychs to undo the damage (if the political will ever gets mustered out of sheer necessity). The over-diagnosis of PTSD/ MH conditions in veterans will someday be covered in textbooks as one of the most embarrassing chapters in our professional history.
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If you haven't discovered Nassir Ghaemi, you might find him delightfully cranky.
Thank you! I apologize for being cranky myself on this topic... feeling very old and burned out in VA mental health these days.
I am very much into collecting lists of iconoclastic authors in mental health to hear what they have to say. I will check him out!
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I am also quite cranky in general. You have given resources in the past that have helped soothe my soul. The Tyranny of Metrics has been in the back of my mind since I read it. It gave me the language to push back on nonsensical tasks.
Ghaemi goes pretty far in some of his views, but it has been nice to shake off the mental cobwebs for concepts that are worth revisiting. He also came to mind because I am doing a deep dive into different topics from a psychiatric perspective to stave off boredom during no-shows.
I watched this video yesterday:
The DSM-6 is brewing, so I am currently listening to this interview by Awais Aftab.
Lots of interesting stuff.
We've had a TON of people come in for intakes because their CVSOs want them to get a diagnosis. Guess it's nationwide and not just a local problem?
We were getting a lot of that at one point, but it slowed down. Maybe it's about to pick back up.
I am seeing TONs of veterans who are service connected for a non-PTSD MH dx (MDD, adj d/o, anxiety d/o, etc.) who appear (in my estimation) to be presenting with the goal of getting a PTSD diagnosis, possibly a "PTSD upgrade" to their s/c status. PTSD is seen as, by far, the most compensable/desirable dx to obtain for MH (and secondary) s/c purposes. Once you get the PTSD dx and it is s/c via an in service traumatic stressor/event, then you can attempt to 'hang' secondaries (migraines, OSA, you name it) onto that peg to get to 100%. PTSD is, indeed, "The Universal Nexus."
This has always been an issue but it is getting exponentially worse over time.
Veterans pushing back against me for not giving them the PTSD diagnosis (when I didn't think this was warranted) has prompted me to have (and to carefully document) very blunt and specific episodes of psychoeducation with them regarding different roles/responsibilities/authorities associated with (a) mental health patients (that would be them) vs. (b) licensed MH providers (that would be me). They, their buddies, their counselors, their psychiatrists, the guy who changes their oil, a random YouTube podcaster, a Reddit poster, their wives/girlfriends, their drill sgt, their VSO, the patient advocate, SUDS counselors, Peer Support specialists, their service dog, etc, are all free to form and express THEIR opinions about what the correct diagnosis is for the veteran. However, I retain full authority/responsibility to make MY own diagnostic determinations and I am under no obligation to agree with any of the aforementioned parties. Giving a diagnosis of PTSD isn't without potential drawbacks/risks/negative consequences down the line and I take the responsibility of doing so very seriously.
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"You are asking me to diagnose I condition I do not believe you have to further your goal of receiving service connection. Do you regularly try to engage people in conspiracies to defraud the federal government, or am I special?"
Most of the time they conceal/deny the fact that they're here to get the diagnosis...until they're ultimately not given the diagnosis. They will say they're here 'for help, for treatment.' But, then (after a multi-modal assessment process yields diagnoses other than PTSD), they immediately switch from being euthymic/flattering/obsequious to being angry/irritable/aggressive/argumentative.
Even when diagnostic impressions of OSTSRD/MDD are given along with treatment options IDENTICAL to those that would be given for PTSD/MDD are provided. Sometimes, out of frustration, they will reveal that they 'need a diagnosis' and only a diagnosis of PTSD will do. I will offer to continue with treatment planning discussions but they request to end the encounter because they 'are so upset that they don't want to discuss it with me right now'). I ask what they want to do at this point, are they still interested in tx planning with me or someone else? Yes, but not right now. Okay, I can enter an RTC for a followup with me and you can schedule at the front desk on your way out. Nah, they don't want to schedule right now, have someone give them a call. One of two things will happen now: either (a) they will prepare a 'full court press' to attempt to argue/plead/threaten with me about the non-PTSD dx at the next appt instead of focusing on tx planning or (b) [most likely] they will fail schedulung efforts and I'll never see them again.
The most interesting observation is how their disposition towards me 'turns on a dime' the INSTANT I share with them my diagnostic findings (not PTSD). Whereas, throughout the entire 3-session process (intake, testing, feedback) up to that point, they had been friendly (even obsequious) and cooperative in the extreme and eager for my 'doctorly opinions and advice' the instant I don't render the PTSD diagnosis, they become angry, hostile, belligerent, offended, demanding, demeaning, and obstinate.
I usually don't diagnose PTSD at intake. There isn't enough time to formally ensure that criteria are met and then cover all of the other things that we need information about. I give Other specified trauma with a rule-out of PTSD.
You just need to pull yourself up by the boostraps, be a little more patriotic, but some Trump scam cryptos, write an email about what you accomplished every week, and things will all make sense.
Sanman
O.G.
I mean my stock portfolio is doing great. Early retirement is looking better and better (preferably in another country, this one seems to be falling apart).
They should have a "sandbox" for folks to play around in. Ask your superuser/lead superuser.
Sanman
O.G.
t-federal-workers-38-increase-law-enforcement/415707/
Trump working hard to make sure we don't get a raise.
Trump working hard to make sure we don't get a raise.
“I have therefore decided to set at zero the pay adjustment to be made for the 2027 pay year,” Trump wrote. “This decision will maintain fiscal responsibility without harming the government’s ability to recruit and retain well qualified employees.”
But in the next paragraph, Trump said that for the second straight year, he instructed the Office of Personnel Management to issue a 3.8% increase in basic pay to federal law enforcement personnel next year, “to increase recruitment and retention” in those roles.
I appreciate Wagner.
Someone tell Trump a bunch of 13yr old girls are going to visit the White House…that’ll keep him distracted….for reasons.
So, a psychologist colleage of mine at our VA commented that they had heard through the grapevine that "at most (other?) VA's they had done away with Psychology Service Chief positions." Has anyone else heard of / experienced this? I thought that all VA psychology services had psychology service chief positions.
I don't know any VA that doesn't have one.
Sanman
O.G.
Still have one all the places that I know of. I do know there has been discussion of removing psychology service chiefs as part of the general culling of VA management positions and just having an MH chief. Not sure if this is coming or not.
Do you guys also have medical coding people that are very outspoken and tell you how to do your job? I honestly feel like I'm Michael Scott and they're Toby
Sometimes I like to hang out with the janitorial staff just to "rub elbows upward" and feel like I'm moving up in the world.
They're pretty nice and not stuck up, either. They've never just arbitrarily tried to order me around. Just about everyone else has.
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I want to clarify: I know that Michael Scott was almost always in the wrong when it came to Toby, so it's not the best comparison, but I just feel this level of antipathy that I think matches the feelings he had towards Toby
The thought occurred to me that if someone doesn't want treatment for a condition because of concern that it will reduce their SC in some sense that is dispositive of having the diagnosis because that indicates there isn't clinically significant distress or dysfunction, since the symptoms are tolerable for effectively less than minimum wage - $7.25/hour x 720 hours/month = $5220, which is greater than the maximum monthly SC payment (unless you are 100% with a dependent spouse, two dependent parents, and seven or more dependent children under 18).
Obviously it is not so simple as that (e.g. SC payment can be quite a lot less than monetary value of harm from condition, but they are dependent on that money and don't have a feasible alternative) but it is an interesting perspective.
Obviously it is not so simple as that (e.g. SC payment can be quite a lot less than monetary value of harm from condition, but they are dependent on that money and don't have a feasible alternative) but it is an interesting perspective.
Remember that the payments are tax free, though. Also, a relatively large portion of the vets I knew who were 100% SC were also working FT jobs.
I was thinking about that, although adjusted for inflation federal minimum wage should be increased by half again or more so for a gross approximation I left taxes, inflation, etc. out of it
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