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

[Fan_of_Meehl]

Quick vent - I don't like how the VA handles VCL calls. Like, I don't think it makes sense to reach out to EVERY SINGLE person every time they call. Sometimes people are just calling for in-the-moment support and aren't actually displaying any suicide risk. It feels very fragilizing and also potentially punishing utilizing crisis resources.

Also possibly reinforcing maladaptive behavior rather than proportionate (to the severity of the (non)crisis) self-regulatory skills practice.

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[cara susanna]

If you haven't already, check out the HBO series 'The Wire.'

Sometimes I feel we're just 'juking the stats' (as McNulty would say.

Agreed. I often feel like this meme.

 

[Fan_of_Meehl]

Agreed. I often feel like this meme.

(Insert chuckle)

Yeah...sometimes reality orientation *is* the therapy.

And it really sucks when the organization and staff iatrogenically encourage non-reality based thinking and language.

Recently a clerk interrupted my session with a direct phone call rather than Skype because of a scheduling question that obviously could have waited. I instructed him not to interrupt sessions unless it was a behavioral emergency. He replied that this was an 'emergency' and wouldn't back down from that position.

Some days I feel like a WWII paratrooper who was just dropped behind enemy lines and have to fight my way through my days in a 360 degree attack arc just to survive.

 

[summerbabe]

It means that we will have to use consults for everything, even groups and specialty services like EBPs. The idea is that the VA wants to be able to track wait times (imo, yet another example of Phoenix screwing everyone over).

There are definitely benefits to increased tracking, especially for larger MH settings where things are more likely to fall through the cracks but there will also be some major administrative redundancy.

Like if you're in a PCT on a team of 4 and you answer the PCT consult and the veteran wants PE and another PCT provider has an earlier PE opening, you'll have to fill out a new consult, rather than CPRS co-signing somebody or some other informal method.

Recently a clerk interrupted my session with a direct phone call rather than Skype because of a scheduling question that obviously could have waited. I instructed him not to interrupt sessions unless it was a behavioral emergency. He replied that this was an 'emergency' and wouldn't back down from that position.

The solution is definitely to create an SOP to define emergency.

 

[cara susanna]

There are definitely benefits to increased tracking, especially for larger MH settings where things are more likely to fall through the cracks but there will also be some major administrative redundancy.

Like if you're in a PCT on a team of 4 and you answer the PCT consult and the veteran wants PE and another PCT provider has an earlier PE opening, you'll have to fill out a new consult, rather than CPRS co-signing somebody or some other informal method.

The solution is definitely to create an SOP to define emergency.

I'm worried about how wait times for EBPs will be handled. Like, if someone wants PE and you place the consult, what happens when there is no available PE provider for several weeks?

 

[PsychPhDone]

I should have held off on posting because I have a brand new vent! Has anyone else been hearing about the changes to the MH consult process and no longer allowing intradeparmental referrals? This sounds like it's going to be a HUGE mess and another example of number-driven policy that doesn't actually align with clinical practice.

So we have a MH triage consult for new patients, and all of our individual clinics (e.g., PTSD, mood, bmed) also have their own consults. Is that what this new thing is or is it something different? I have not seen whatever email is being referenced.

 

[cara susanna]

So we have a MH triage consult for new patients, and all of our individual clinics (e.g., PTSD, mood, bmed) also have their own consults. Is that what this new thing is or is it something different? I have not seen whatever email is being referenced.

Anytime you're initiating a new treatment for the patient, it has to be done with a consult. Even if you're with the same provider (e.g., going from a monthly therapy visit to a weekly EBP).

 

[Fan_of_Meehl]

Anytime you're initiating a new treatment for the patient, it has to be done with a consult. Even if you're with the same provider (e.g., going from a monthly therapy visit to a weekly EBP).

Well that just strikes me as a bit ridiculous on its face. Not only is it inefficient and unnecessary, but there is a 'moral hazard' that whenever you create more work/steps/procedures/forms/revisions in between the decision to make an adjustment in treatment and being 'allowed' to enact that adjustment in treatment, you are, in effect, embedding a 'punishing' consequence for making THAT treatment decision/adjustment vs. just saying, "nah...let it ride. I already have 7 different documentation headaches to complete before my shift ends...I don't think I could handle completing 9 (cause you gotta revise Mental Health Suite too...at least at my facility)."

 

[Fan_of_Meehl]

Anytime you're initiating a new treatment for the patient, it has to be done with a consult. Even if you're with the same provider (e.g., going from a monthly therapy visit to a weekly EBP).

Also...am I to understand that if I wish to start a CPT protocol on a pt whom I'm already seeing...I have to enter a formal consultation request FROM myself TO myself? Hypothetically, if I change my mind the next day...could I discontinue it? Or maybe FORWARD it to myself just to up my consult stats?

This is really getting clownishly inefficient.

 

[cara susanna]

Also...am I to understand that if I wish to start a CPT protocol on a pt whom I'm already seeing...I have to enter a formal consultation request FROM myself TO myself? Hypothetically, if I change my mind the next day...could I diacontinue it? Or maybe FORWARD it to myself just to up my consult stats?

This is really getting clownishly inefficient.

That is the impression that I received, yes.

 

[Fan_of_Meehl]

That is the impression that I received, yes.

Wow.

 

[AcronymAllergy]

That is the impression that I received, yes.

That's...not very "lean."

 

[AbnormalPsych]

Also...am I to understand that if I wish to start a CPT protocol on a pt whom I'm already seeing...I have to enter a formal consultation request FROM myself TO myself? Hypothetically, if I change my mind the next day...could I discontinue it? Or maybe FORWARD it to myself just to up my consult stats?

This is really getting clownishly inefficient.

 

[summerbabe]

Also...am I to understand that if I wish to start a CPT protocol on a pt whom I'm already seeing...I have to enter a formal consultation request FROM myself TO myself? Hypothetically, if I change my mind the next day...could I discontinue it? Or maybe FORWARD it to myself just to up my consult stats?

I didn’t see the email that was referred but I got a heads up maybe a month ago during a national EBP rollout call I’m currently in and what I was told is that a consult could soon be needed whenever a provider makes a referral, but not if you’re changing gears with an existing patient.

So say PCMHI submits a med request consult to BHIP. If the med provider wants the veteran to do therapy, they would complete a consult to a therapist on their BHIP team, rather than informally assigning it via co-signing in CPRS or triaging at a huddle.

If that receiving therapist starts individual but also wants the veteran to do a group, another consult would be placed for that group referral (but not at the end of group back to the referring provider) so that one could track all of these referrals in the consult tab as if they were referred to speciality services like PCT or neuropsych.

If implemented well (lol) I am cautiously optimistic that this can be helpful especially at larger facilities where accountability is more challenging and where veterans are more likely to get lost in the shuffle. But if you’re at like a small CBOC, it might feel like playing tag with 3 people in a small closet over and over.

I’m on a small specialty team where we all split intake duties equally so it’ll be really annoying to have to fill out a consult to give a case to a colleague when we already work really well together. But I also think it will be helpful to track all of your outgoing referrals using one method.

And since it seems like there’s gonna be local variability in how this is implemented, hopefully your MH leadership won’t bungle this since adding more ways to get dinged isn’t exactly ideal.

 

[AcronymAllergy]

I didn’t see the email that was referred but I got a heads up maybe a month ago during a national EBP rollout call I’m currently in and what I was told is that a consult could soon be needed whenever a provider makes a referral, but not if you’re changing gears with an existing patient.

So say PCMHI submits a med request consult to BHIP. If the med provider wants the veteran to do therapy, they would complete a consult to a therapist on their BHIP team, rather than informally assigning it via co-signing in CPRS or triaging at a huddle.

If that receiving therapist starts individual but also wants the veteran to do a group, another consult would be placed for that group referral (but not at the end of group back to the referring provider) so that one could track all of these referrals in the consult tab as if they were referred to speciality services like PCT or neuropsych.

If implemented well (lol) I am cautiously optimistic that this can be helpful especially at larger facilities where accountability is more challenging and where veterans are more likely to get lost in the shuffle. But if you’re at like a small CBOC, it might feel like playing tag with 3 people in a small closet over and over.

I’m on a small specialty team where we all split intake duties equally so it’ll be really annoying to have to fill out a consult to give a case to a colleague when we already work really well together. But I also think it will be helpful to track all of your outgoing referrals using one method.

And since it seems like there’s gonna be local variability in how this is implemented, hopefully your MH leadership won’t bungle this since adding more ways to get dinged isn’t exactly ideal.

I would agree that necessitating consults between services, or even between providers in the same service (e.g., if a psychologist refers a patient for a medication consult, or someone in general mental health refers to the PCT), it makes sense, as it would allow VA to better track the utilization of its different services and resources. And I understand that in an organization as large as VA, you can't realistically require it at some facilities (e.g., medical center) and not others (e.g., small CBOC).

But yeah, having to submit a consult to yourself seems...odd, anywhere except in VA.

I suspect much of this just has to do with the limitations of CPRS.

 

[Fan_of_Meehl]

I really did love my red stapler...

 

[cara susanna]

I didn’t see the email that was referred but I got a heads up maybe a month ago during a national EBP rollout call I’m currently in and what I was told is that a consult could soon be needed whenever a provider makes a referral, but not if you’re changing gears with an existing patient.

So say PCMHI submits a med request consult to BHIP. If the med provider wants the veteran to do therapy, they would complete a consult to a therapist on their BHIP team, rather than informally assigning it via co-signing in CPRS or triaging at a huddle.

If that receiving therapist starts individual but also wants the veteran to do a group, another consult would be placed for that group referral (but not at the end of group back to the referring provider) so that one could track all of these referrals in the consult tab as if they were referred to speciality services like PCT or neuropsych.

If implemented well (lol) I am cautiously optimistic that this can be helpful especially at larger facilities where accountability is more challenging and where veterans are more likely to get lost in the shuffle. But if you’re at like a small CBOC, it might feel like playing tag with 3 people in a small closet over and over.

I’m on a small specialty team where we all split intake duties equally so it’ll be really annoying to have to fill out a consult to give a case to a colleague when we already work really well together. But I also think it will be helpful to track all of your outgoing referrals using one method.

And since it seems like there’s gonna be local variability in how this is implemented, hopefully your MH leadership won’t bungle this since adding more ways to get dinged isn’t exactly ideal.

Apparently you would need a consult if you're going to start an EBP with the patient, even if it's with yourself. That's what I was told yesterday.

 

[Shiori]

I wonder if consult changes will be addressed in our upcoming psychology meeting. With our leadership loving to have boxes checked, I imagine this will be eagerly over-adopted with little ability to push back.

Between reading this thread and asking my supervisors about their experiences, I have some hard decisions to make at the end of postdoc.

 

[Mercury in Taurus]

I didn’t see the email that was referred but I got a heads up maybe a month ago during a national EBP rollout call I’m currently in and what I was told is that a consult could soon be needed whenever a provider makes a referral, but not if you’re changing gears with an existing patient.

So say PCMHI submits a med request consult to BHIP. If the med provider wants the veteran to do therapy, they would complete a consult to a therapist on their BHIP team, rather than informally assigning it via co-signing in CPRS or triaging at a huddle.

If that receiving therapist starts individual but also wants the veteran to do a group, another consult would be placed for that group referral (but not at the end of group back to the referring provider) so that one could track all of these referrals in the consult tab as if they were referred to speciality services like PCT or neuropsych.

If implemented well (lol) I am cautiously optimistic that this can be helpful especially at larger facilities where accountability is more challenging and where veterans are more likely to get lost in the shuffle. But if you’re at like a small CBOC, it might feel like playing tag with 3 people in a small closet over and over.

I’m on a small specialty team where we all split intake duties equally so it’ll be really annoying to have to fill out a consult to give a case to a colleague when we already work really well together. But I also think it will be helpful to track all of your outgoing referrals using one method.

And since it seems like there’s gonna be local variability in how this is implemented, hopefully your MH leadership won’t bungle this since adding more ways to get dinged isn’t exactly ideal.

Don't know if I am allowed to share this. This is the memo we have got. If this is potentially in any violation of VA rules that I am not aware of, then I will happily remove it and you pretend that you did not see this.

 

[Mercury in Taurus]

Why our HR pretends they don't know what am I talking about until an authority figure says that it is strictly a HR matter that HR needs to address. Then HR starts acting as if I were asking them to take my coat to dry clean when what I had asked was in the scope of HR practice. Is this normal or I have unreasonable expectations? I do not want accumulated frustration ended up making me an annoying person no one wants to deal with. Meanwhile, there are benefits related matters that significantly impacting me mentally, emotionally, and financially. What else can I do other then copying my supervisor on my emails?

 

[WisNeuro]

Why our HR pretends they don't know what am I talking about until an authority figure says that it is strictly a HR matter that HR needs to address. Then HR starts acting as if I were asking them to take my coat to dry clean when what I had asked was in the scope of HR practice. Is this normal or I have unreasonable expectations? I do not want accumulated frustration ended up making me an annoying person no one wants to deal with. Meanwhile, there are benefits related matters that significantly impacting me mentally, emotionally, and financially. What else can I do other then copying my supervisor on my emails?

CC the HR head on every email. That's what eventually got my issue with HRs screwup solved.

 

[Mercury in Taurus]

CC the HR head on every email. That's what eventually got my issue with HRs screwup solved.

The highest person locally is the Chief of Human Resources. The Chief has not replied to any of my emails. Thinking about copying the VISN HR Supervisor on my follow-up email(s), but not sure if that would be considered as stepping on my supervisor's toes.

 

[WisNeuro]

The highest person locally is the Chief of Human Resources. The Chief has not replied to any of my emails. Thinking about copying the VISN HR Supervisor on my follow-up email(s), but not sure if that would be considered as stepping on my supervisor's toes.

It may sound cynical, but in dealing with HR (mostly with VA, but really any HR) you need to make it so not solving your problem causes them more grief/more work than solving your problem. In your case, I'd keep CCing the HR Chief and also including the VISN HR supervisor. Get used to stepping on toes, it's how you get things done in healthcare.

 

[Mercury in Taurus]

It may sound cynical, but in dealing with HR (mostly with VA, but really any HR) you need to make it so not solving your problem causes them more grief/more work than solving your problem. In your case, I'd keep CCing the HR Chief and also including the VISN HR supervisor. Get used to stepping on toes, it's how you get things done in healthcare.

Will do

 

[Fan_of_Meehl]

I wonder if consult changes will be addressed in our upcoming psychology meeting. With our leadership loving to have boxes checked, I imagine this will be eagerly over-adopted with little ability to push back.

Between reading this thread and asking my supervisors about their experiences, I have some hard decisions to make at the end of postdoc.

Yeah.. I'm still waiting

It may sound cynical, but in dealing with HR (mostly with VA, but really any HR) you need to make it so not solving your problem causes them more grief/more work than solving your problem. In your case, I'd keep CCing the HR Chief and also including the VISN HR supervisor. Get used to stepping on toes, it's how you get things done in healthcare.

Cynical or not, definitely a reality-based perspective.

 

[cara susanna]

Don't know if I am allowed to share this. This is the memo we have got. If this is potentially in any violation of VA rules that I am not aware of, then I will happily remove it and you pretend that you did not see this.

That is the relevant memo that I have seen, yes.

I imagine that, if people haven't had leadership discuss this yet, you will. This week I've heard a lot of discussion both in national groups I'm in as well as locally.

 

[AcronymAllergy]

There are some HR things that got moved from local to VISN, so it may also be the case that your local HR people don't actually handle it, or they themselves haven't exactly figured out who does what.

All that being said, yeah, HR is a black hole in every VA at which I've worked. Finding a responsive and helpful person there (i.e., a unicorn) makes everything so, so much easier.

 

[Fan_of_Meehl]

It may sound cynical, but in dealing with HR (mostly with VA, but really any HR) you need to make it so not solving your problem causes them more grief/more work than solving your problem. In your case, I'd keep CCing the HR Chief and also including the VISN HR supervisor. Get used to stepping on toes, it's how you get things done in healthcare.

In my experience--propaganda notwithstanding-- HR isn't there to aid or assist or to protect employees...if anything, they are solely there to protect in interests of and serve the organization. Not saying it's right (at all)...just seems to be the way it plays out in practice.

 

[AcronymAllergy]

I wonder if consult changes will be addressed in our upcoming psychology meeting. With our leadership loving to have boxes checked, I imagine this will be eagerly over-adopted with little ability to push back.

Between reading this thread and asking my supervisors about their experiences, I have some hard decisions to make at the end of postdoc.

Of the people I know who worked at VA early career, I've met few if any who regretted it.

It can definitely wear on you after a while, but there are much worse places to start out as you're getting your professional feet underneath you.

 

[Shiori]

Of the people I know who worked at VA early career, I've met few if any who regretted it.

It can definitely wear on you after a while, but there are much worse places to start out as you're getting your professional feet underneath you.

Oh, yes! There are great reasons to work in a VA. I've been geographically restricted, so I know a lot of people in our local VAs. Psychologists are fleeing and the providers who are left are having a really hard time. I'm still having the debate with myself though, especially if the right opportunity comes along. It's a tough choice.

 

[Mercury in Taurus]

Anyone has a generic PDF trifold PCMHI brochure or a link to download the brochure that you are able to share? The older version I have is BHL and that is not how we call it here. The PCMHI brochure we have here is a fuzzy looking freckled copy after copy version. I silently refuse to use it as I feel that if I hand out this embarrassing looking brochure, then I am sending the message to patients that they don't desire at least a decent looking informational brochure or we are too lazy to care. Many referrals never received behavioral health services before, and I want them to have positive experiences or at least know what is offered to them. Thanks a million!

 

[erg923]

Anyone has a generic PDF trifold PCMHI brochure or a link to download the brochure that you are able to share? The older version I have is BHL and that is not how we call it here. The PCMHI brochure we have here is a fuzzy looking freckled copy after copy version. I silently refuse to use it as I feel that if I hand out this embarrassing looking brochure, then I am sending the message to patients that they don't desire at least a decent looking informational brochure or we are too lazy to care. Many referrals never received behavioral health services before, and I want them to have positive experiences or at least know what is offered to them. Thanks a million!

Good God, who came up with "Behavioral Health Lab (BHL)." It just makes me think of psychologists in a closet with beakers and bubbling potions. Understandable if from like the 50s, but think the term is from like 2005?

 

[cara susanna]

Anyone has a generic PDF trifold PCMHI brochure or a link to download the brochure that you are able to share? The older version I have is BHL and that is not how we call it here. The PCMHI brochure we have here is a fuzzy looking freckled copy after copy version. I silently refuse to use it as I feel that if I hand out this embarrassing looking brochure, then I am sending the message to patients that they don't desire at least a decent looking informational brochure or we are too lazy to care. Many referrals never received behavioral health services before, and I want them to have positive experiences or at least know what is offered to them. Thanks a million!

Are you on the PCMHI listserv? They'd be an excellent resource for that.

 

[Mercury in Taurus]

Are you on the PCMHI listserv? They'd be an excellent resource for that.

I was on that listserv but I have not received anything since I left BHL and transferred to the current VA. I will see if I can be added again if I have been removed from the listserv.

 

[Therapist4Chnge]

Their medical team. I crafted a beautiful note being very specific about what I would and wouldn't be doing. They ignored that and said mental health would discuss meds in their own note "per mental health note" referring to my note where I clearly stated that I would NOT be discussing meds.

I hate it here.

If it makes you feel any better...I run into this a lot in private practice. In the past couple of weeks I've had patients and providers tell me I was suppose to Rx sleep & pain meds and "approve" a shoulder surgery. Oh...and of course, a request for an emotional support animal. Also, a lawyer asked me when I was going to write a report for a competency hearing...that isn't even the court case I was hired to work on. Fun times!

 

[Therapist4Chnge]

That is.... wild. Just wait until a psychologist ends up asking about a rash and a patient undresses in session to show you theirs. Nightmare waiting to happen.

Oh, I've had head injury patients just drop their pants, take off shirts, etc. in attempts to show me things. Those instances act as reminders to always orient all new patients to why they are here, what I do (and don't do), and what we will be covering in the consult.

 

[Therapist4Chnge]

I really did love my red stapler...

I special ordered a red swingline stapler back on internship....and it is still kicking! Office Space is still one of my fav. movies, and it made even more sense being in the VA (at the time)....*mumbles*

 

[Fan_of_Meehl]

I special ordered a red swingline stapler back on internship....and it is still kicking! Office Space is still one of my fav. movies, and it made even more sense being in the VA (at the time)....*mumbles*

I got one for home and one for work. They're awesome.

"Set...the building...on..........fire..."

 

[Fan_of_Meehl]

Good God, who came up with "Behavioral Health Lab (BHL)." It just makes me think of psychologists in a closet with beakers and bubbling potions. Understandable if from like the 50s, but think the term is from like 2005?

And it's not like we're talking rats in Skinner boxes and Applied Behavioral Analysis basic science work...

We're talking about slinging problematically face-valid, broad symptom checklists that are extremely vulnerable to the influence of response-bias such as the PHQ-9, GAD-7, and PCL-5...hardly 'MRI's of psychopathology' and hardly 'splitting the atom.' It just reeks of 'physics/medical envy' to use the term 'lab' at all.

 

[Mercury in Taurus]

There were some discussions about a similar topic here before, and I am still wondering what are people's thoughts are about a VA job vs. a private-sector job for an early career psychologist. Here are the relevant facts and factors:

VA job: G12 base pay + locality + federal benefits vs. private job: $130,000 annual salary + 80 OPT days + 10 holidays + private-sector benefits
VA job pros: supportive work environment, ability to consult with peers locally and/or nationally, a reasonable workload at a rural VA, transparent performance evaluation, free parking, a short commute with no traffic
Cons: ongoing difficulty with the local HR - delayed start date, delayed 1st paycheck, delaying in transferring annual and sick leave time, unresponsive to multiple requests about the EDRP application (EDRP eligibility was clearly stated in writing in the firm offer).

Private job pros: almost the double of pay, can pay off student loan out-of-pocket in 4-5 years, responsive HR, fast onboarding process, will be living close to family and friends
Cons: really not fair having to terminate with patients and caregivers who are elder and are in for long-term supportive therapy, losing annual leave time and sick time (still not transferred from last VA, not sure how my annual leave time will be paid out if not transferred and not showing on the time balance), having to relocate, and paying a big penalty for breaking the apartment lease...

Any input will be gratefully appreciated

 

[Shiori]

Thanks for posing this question! I'll be interested to see answers. I got my first non-VA response to an application I submitted, which makes me feel like I have a choice. Imposter syndrome is real.

 

[Fan_of_Meehl]

I mean, my first thought is that the degree of importance ('weightings') that an individual places on each pro/con is gonna be quite idiosyncratic (e.g., salary vs. not having to deal with insurance).

I'd just comment to say that the 'supportive work environment' is also complex. I don't think that the VA--organizationally--is a supportive work environment right now for mental health outpatient providers--at all. And it's becoming more hostile by the year (e.g., the 'blame the provider' organizational schema). However, having a service chief who is cool, a solid clinician, and who generally 'has your back' as much as they can when things come up is a huge moderating variable (and I have such a service chief right now and am very grateful for it).

I think you've done a thorough breakdown of some of the main points in a 'pros/cons' analysis, however.

 

[Sanman]

What is the private rvu/productivity requirement? Office based or facility? Is it in geriatrics? Do you want to be in geriatrics?

 

[summerbabe]

Very much second @Sanman’s question. For a $130,000 salary, you’ll definitely be expected to bring in a lot more than that in revenue which can lead to burnout if these demands aren’t a good fit for your workstyle and/or interests.

People leave the VA or change jobs within the VA all the time. Termination and interruptions in care are never easy but it is what it is.

In terms of HR, I’m much more accepting of small things but not of big things like if you can’t ever get enrolled in EDRP. I’ve also had more positive HR experiences so it wouldn’t impact any of my decision-making.

 

[Mercury in Taurus]

What is the private rvu/productivity requirement? Office based or facility? Is it in geriatrics? Do you want to be in geriatrics?

It is an office-based outpatient setting. Populations are any ages between 18 + and elder, not geriatric-focused. My preference is to be in geriatrics and have a part-time fee-for-service virtual job that is geriatric-focused to keep me on track and stay connected with geropsychology. Ideally, once my loan is paid off, I can be more focused and only need to work one job. Preferably in HBPC or CLC, if I ended up having to resign, I will be very mindful not to burn any bridges with the VA, and hope will be eligible for rehire.

 

[Mercury in Taurus]

Very much second @Sanman’s question. For a $130,000 salary, you’ll definitely be expected to bring in a lot more than that in revenue which can lead to burnout if these demands aren’t a good fit for your workstyle and/or interests.

People leave the VA or change jobs within the VA all the time. Termination and interruptions in care are never easy but it is what it is.

In terms of HR, I’m much more accepting of small things but not of big things like if you can’t ever get enrolled in EDRP. I’ve also had more positive HR experiences so it wouldn’t impact any of my decision-making.

Having been in other VAs before, I am very grateful for the current trauma-free work setting. Working with friendly co-workers who all get along with each other on my team is worth gold. It makes a huge difference in my quality of life. The unexpected difficulty of EDRP enrollment is the major factor for considering alternative employment. I believe a much higher expectation will be associated with the higher salary. Now I have some good follow-up questions for the recruiter and will make a well-informed decision. Thank you, summerbabe!

 

[Sanman]

It is an office-based outpatient setting. Populations are any ages between 18 + and elder, not geriatric-focused. My preference is to be in geriatrics and have a part-time fee-for-service virtual job that is geriatric-focused to keep me on track and stay connected with geropsychology. Ideally, once my loan is paid off, I can be more focused and only need to work one job. Preferably in HBPC or CLC, if I ended up having to resign, I will be very mindful not to burn any bridges with the VA, and hope will be eligible for rehire.

It is your choice and may be a bit of a tough one. Geriatrics has historically been one of the less competitive areas and I have never struggled to get a job. That said, I am not sure how the new geropsych boarding and more formalized post-docs will affect the market for competitive locales/jobs in CLC/HBPC. I have certainly been having similar thoughts recently, but I have a decade in geriatric practice at this point. I think it would depend on if you want to stay at this particular location or planned to move to a different locale anyway.

I would also push HR and your dept chief once more before leaving. Let them know that EDRP was important and without then fulfilling that obligation you may need to pursue other opportunities (only if that would actually make you stay).

 

[deleted106747]

It is your choice and may be a bit of a tough one. Geriatrics has historically been one of the less competitive areas and I have never struggled to get a job. That said, I am not sure how the new geropsych boarding and more formalized post-docs will affect the market for competitive locales/jobs in CLC/HBPC. I have certainly been having similar thoughts recently, but I have a decade in geriatric practice at this point. I think it would depend on if you want to stay at this particular location or planned to move to a different locale anyway.

I would also push HR and your dept chief once more before leaving. Let them know that EDRP was important and without then fulfilling that obligation you may need to pursue other opportunities (only if that would actually make you stay).

I don't like to throw this nuclear bomb unless I have to, so use it carefully and only for important things, but I got EDRP when I threatened to quit unless I got it (and I would have). I have never threatened to quit a job since then.

 

[cara susanna]

I need EFT to manage my psychological distress around the VA (Whole Health) promoting EFT.

 

[WisNeuro]

I need EFT to manage my psychological distress around the VA (Whole Health) promoting EFT.

Dealing with reimbursements too much. At first I was like "Why would you need direct deposit for that?"