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

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AbnormalPsych said:

Vets Accuse VA Therapist of Abuse Involving Sex, Astrology, Psychedelic Drugs​


www.nbcbayarea.com

Vets Accuse VA Therapist of Abuse Involving Sex, Astrology, Psychedelic Drugs

Three Bay Area military veterans struggling with serious mental health issues have filed a federal lawsuit accusing their former Veterans Affairs (VA) psychiatrist of serious ethical and legal lapses, including sexual abuse, dosing an unwitting patient with a potent psychedelic drug, and using...
www.nbcbayarea.com www.nbcbayarea.com
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VA psychiatrists ruining it for the rest of us. Apparently a grad of a Turkish med school with a residency at Tufts and training at Boston Psychoanalytic based on some google-fu.
 
When my no shows (more than one) don't return my calls
 

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PsychPhDone said:
I'd believe it. In my clinic alone, we offered earlier appts to at least 10 pts, almost all declined. What is going on
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The weather is getting nice and the pandemic is over. They don't have time for you. One of my folks recently requested to change our appt time so he could go fishing.
 
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Sanman said:
The weather is getting nice and the pandemic is over. They don't have time for you. One of my folk recently requested to change our appt time so he could go fishing.
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Y'all start fishing season early, our open water opener isn't til next month. Unless you still have ice cover in some areas.
 
WisNeuro said:
Y'all start fishing season early, our open water opener isn't til next month. Unless you still have ice cover in some areas.
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You can fish year round by me and we have had some 70 degree days recently.
 
WisNeuro said:
Y'all start fishing season early, our open water opener isn't til next month. Unless you still have ice cover in some areas.
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No closed season in MA. Ponds and lakes are pretty clear now. Rivers too high with run-off. Bass and pike will be in full gear soon. I don't hit the trout streams until May (trout fishing is pretty much stocking dependent in southern NE, and they don't throw them in until next month). Wild trout streams in Northern NE still snowed over or raging with melt run-off).

As a somewhat relevant aside, if your clinical work during the cold-dark months has resulted in your clients seeking out and enjoying pleasureable activities like fishing, then you should pat yourself on the back!
 
Alright. Here's one for you all to consider. Also I am wondering if this is normal.

Situation/Background: I was hired as a clinical research project coordinator/graduate psychologist back in August. Prior to accepting this position, I was told (in writing) that I would spend 15-20 hours coordinating the research study I was hired for and another 15-20 would be based on my career goals, including having a clinic for 4 hours a week. I was told that I would have a clinic set up by October. That came and went. Then it was November. Again, no clinic. Then I was told I would have to have a temporary permit in order to have a clinic set up. A few months passed and I was then told that having a clinic would pull me away from my coordinating duties too much. Last week, I was told that I would not be credentialed until August/September (when I have enough postdoc hours for licensure) because my supervisor didn't want to fill out the paperwork twice.

I really do not feel like a psychologist with my current duties and it has taken a toll on my mental health and marriage. I miss clinical work and have not interacted with a single patient since being hired. It just sucks.

I guess I'm looking for support, advice, and whether or not what I described above is normal.
 
psycho1391 said:
I guess I'm looking for support, advice, and whether or not what I described above is normal.
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Not sure what normal is in the VA lol but where I'm at, there are major access issues and backlogs so if there was a clinician who wanted to do more clinical work, there would be supervisors fighting over them like hungry dogs and a single steak.

What is the clinical care like at your VA? Is the issue that your current supervise doesn't want to have to co-sign all of your notes and provide supervision?

If your direct supervisor doesn't want to do that, it doesn't mean another supervisory psychologist couldn't theoretically step into that role and attach you to their clinic if you have the blessing of your admin.

Are there any other psychologists at your facility that you've come to trust? If you haven't picked their brain about inner workings and how to grease the wheels, that might be a starting point.
psycho1391 said:
I miss clinical work and have not interacted with a single patient since being hired.
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Is the option of starting a private practice once you're fully licensed an option if your facility doesn't want you to do clinic work? That would mess with work-life balance and not sure how busy your research job is but it's an option.
 
summerbabe said:
What is the clinical care like at your VA? Is the issue that your current supervise doesn't want to have to co-sign all of your notes and provide supervision?

If your direct supervisor doesn't want to do that, it doesn't mean another supervisory psychologist couldn't theoretically step into that role and attach you to their clinic if you have the blessing of your admin.
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Her excuse is the paperwork/process. The clinic I want to work in is backlogged. Theoretically, if I am able to take some clinical work of their back, maybe the other providers would have more time to participate in our studies.

summerbabe said:
Are there any other psychologists at your facility that you've come to trust? If you haven't picked their brain about inner workings and how to grease the wheels, that might be a starting point.
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I talked with one of the other clinical research psychologists previously about wanting clinical work and how to approach the supervisor. I haven't provided her with the most recent update.

Also, as far as doing private practice, I commute about 35 minutes 3x/week and 1x/week I commute 1 hour to work. Its a good suggestion though!
 
psycho1391 said:
Her excuse is the paperwork/process. The clinic I want to work in is backlogged. Theoretically, if I am able to take some clinical work of their back, maybe the other providers would have more time to participate in our studies.


I talked with one of the other clinical research psychologists previously about wanting clinical work and how to approach the supervisor. I haven't provided her with the most recent update.

Also, as far as doing private practice, I commute about 35 minutes 3x/week and 1x/week I commute 1 hour to work. Its a good suggestion though!
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How long does it take to get things through HR at your facility? How are you being paid? HR problems and turf wars are two issues that are common, IME.
 
psycho1391 said:
Her excuse is the paperwork/process. The clinic I want to work in is backlogged. Theoretically, if I am able to take some clinical work of their back, maybe the other providers would have more time to participate in our studies.


I talked with one of the other clinical research psychologists previously about wanting clinical work and how to approach the supervisor. I haven't provided her with the most recent update.

Also, as far as doing private practice, I commute about 35 minutes 3x/week and 1x/week I commute 1 hour to work. Its a good suggestion though!
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You were hired as graduate psychologist, right? So not yet licensed?
 
Sanman said:
How long does it take to get things through HR at your facility? How are you being paid? HR problems and turf wars are two issues that are common, IME.
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It depends what it is. I know it usually takes us up to 3 months to get RAs hired on.
 
Asking for a colleague who might be receiving a tentative offer soon:

Has anybody had luck getting things like being able to serve on certain committees or admin time negotiated during this stage prior to accepting an offer?

I figured it wouldn’t impact the boilerplate VA contract - more so about getting a commitment from leadership prior to onboarding. Thanks!
 
PsychPhDone said:
Then what credentialing or privileging do you even need? I was told that my hire was greatly sped up because I was not licensed at the time. (Sped up is relative term.) Is the hold up that nobody wants to co-sign your notes?
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The hire may have been sped up. However, if the OP wants to see patients and is not licensed, a supervisor would have to be identified and you would need to be approved by the dept head, the psychology services board, and the medical director. Also, it may reclassify the position. Then, when the OP is at the full performance level, it may need to be done again. The dept head may not want to do that paperwork until the OP is licensed.
 
Sanman said:
However, if the OP wants to see patients and is not licensed, a supervisor would have to be identified and you would need to be approved by the dept head, the psychology services board, and the medical director. Also, it may reclassify the position. Then, when the OP is at the full performance level, it may need to be done again. The dept head may not want to do that paperwork until the OP is licensed.
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I completely understand the logical steps. However, I just wish when I asked about clinical work and having a clinic prior to accepting the position, this would have been discussed as potential barriers.
 
psycho1391 said:
I completely understand the logical steps. However, I just wish when I asked about clinical work and having a clinic prior to accepting the position, this would have been discussed as potential barriers.
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I can't disagree with you, but that is a very VA thing to do. In the VA world, a year is like a month. The issue may get solved eventually, but do you have the patience to wait out the process? This can be in your favor or to your detriment. When negative changes happen, you can drag those out as well.
 
psycho1391 said:
Can you clarify this point please?
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Simply that when you want to get something done it takes long, but when the government wants to implement something it takes long as well. For example, the process of coming back face to face is so slow at my facility, I imagine that I will be able to enjoy work from home for the better part of this year despite the process starting last month to bring everyone back.
 
psycho1391 said:
Can you clarify this point please?
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To add on, it takes time to get things situated in one’s favor in the VA but with some luck and patience, it can happen (or not and then we move on). And once you find yourself in a favorable spot, things can be smooth for a good while due to factors like govt inertia and union protections.

Sounds like licensure is the main barrier here. My guess is that things will get smoothed out after that point but expecting this to happen now (even though it's a reasonable request) will likely only cause additional distress since short of another person in a higher level of leadership telling your supervisor to build the clinic and start to co-sign you notes ASAP, it's probably not happening.
 
Sanman said:
The hire may have been sped up. However, if the OP wants to see patients and is not licensed, a supervisor would have to be identified and you would need to be approved by the dept head, the psychology services board, and the medical director. Also, it may reclassify the position. Then, when the OP is at the full performance level, it may need to be done again. The dept head may not want to do that paperwork until the OP is licensed.
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Yikes. Wow. I hadn't realized that - I had assumed the position was set up for trainee-level clinical work from the start. It makes sense if the position was not set up that way from the beginning there could be a lot of steps ahead.
 
PsychPhDone said:
Yikes. Wow. I hadn't realized that - I had assumed the position was set up for trainee-level clinical work from the start. It makes sense if the position was not set up that way from the beginning there could be a lot of steps ahead.
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As a graduate psychologist unlicensed, this would be GS-11 and then gs-12 when licensed. If hired as a research coordinator, I could see where the clinical credentialing process was skipped to get the person started. At my facility, the clinical credentialing takes 4-6 months between HR and all the signatures. Most of the committees (psych board, medical director) only handle this stuff once a month. Miss the deadline, wait a month.
 
Sanman said:
As a graduate psychologist unlicensed, this would be GS-11 and then gs-12 when licensed. If hired as a research coordinator, I could see where the clinical credentialing process was skipped to get the person started. At my facility, the clinical credentialing takes 4-6 months between HR and all the signatures. Most of the committees (psych board, medical director) only handle this stuff once a month. Miss the deadline, wait a month.
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Near the end of my time at the VA, I was in car accident and broke my leg pretty bad. Needed surgery. Was based at a local CBOC and they, of course, didn't provide any staff coverage for my patients/clinics. Offered to do telework 6 weeks after injury. Was greenlighted by chief and medical center director for all paperwork steps until I got to the part where they said, "Oh no, sorry we don't do that here. I said..."Well, why the hell not? Its all set up already" They said, "Oh no, sorry we don't do that here." I asked why. They said, "Oh no, sorry we don't do that here."
 
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Sanman said:
As a graduate psychologist unlicensed, this would be GS-11 and then gs-12 when licensed. If hired as a research coordinator, I could see where the clinical credentialing process was skipped to get the person started. At my facility, the clinical credentialing takes 4-6 months between HR and all the signatures. Most of the committees (psych board, medical director) only handle this stuff once a month. Miss the deadline, wait a month.
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What credentialing is there when you're not licensed? I only went through it once licensed, maybe I blocked it out?
 
Sanman said:
As a graduate psychologist unlicensed, this would be GS-11 and then gs-12 when licensed. If hired as a research coordinator, I could see where the clinical credentialing process was skipped to get the person started. At my facility, the clinical credentialing takes 4-6 months between HR and all the signatures. Most of the committees (psych board, medical director) only handle this stuff once a month. Miss the deadline, wait a month.
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I started my paperwork in March/April and wasn't able to start until after August due to internship finish date and moving. I assume that would have ensured time for credentialing?

When I was hired, HR stated that it was a staff Psychologist/coordinator position. They gave me the talk about having to get licensed in 2 years or be fired.
 
PsychPhDone said:
What credentialing is there when you're not licensed? I only went through it once licensed, maybe I blocked it out?
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It is usually a few forms in Vetpro and three personal references, but there is a lot of back end work (mostly HR stuff and background checks for felonies and such). I recall submitting this stuff as an intern at the VA as well when I started. Certainly for any staff hired to do clinical work. Research not so much.
 
psycho1391 said:
I started my paperwork in March/April and wasn't able to start until after August due to internship finish date and moving. I assume that would have ensured time for credentialing?

When I was hired, HR stated that it was a staff Psychologist/coordinator position. They gave me the talk about having to get licensed in 2 years or be fired.
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So, I assume you are GS-11 then. If you are properly credentialed and job properly categorized, the only problem would be identifying someone to act as your clinical supervisor.
 
Sanman said:
So, I assume you are GS-11 then. If you are properly credentialed and job properly categorized, the only problem would be identifying someone to act as your clinical supervisor.
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Looking back through my email paperwork and I filled out a VETPRO Credentialing form. And yes, GS-11.

Thanks for all your replies. Certainly appreciate you giving some context to everything.
 
I was offered a tentative position back in April of 2021 - I went through all of the hoops, including the physical, drug testing, vaccines, then had to use VETPRO to upload information pertaining to education and work history, references, NPI #, and other fun stuff. The VA basically didn't finalize all of this until about a week prior to my starting in August of 2021, in fact, I didn't receive my final offer letter until 3 days before I was actually supposed to report for NEO. The VA will hire an unlicensed psychologist at the GS-11 level; a GS-12 would require 1 year post-doctoral experience with or without a license, however, a GS-13 is someone who would have a license plus 2 years of post-doctoral experience. I started August 1st of 2021 as a GS-11, then got licensed in December of 2021, I will have to wait until August 1st of 2022 until I bump up to GS-12. Luckily, my supervisor already filed the appropriate paperwork so that my pay bump is automatic come August 1st. Oh...and you have to go through the whole C&P process again once you get licensed....that was a pain.
 
For anyone who has done their government ethics training refresher recently. Does it seem like Sondra has a crush on her boss Bernard? She knows what his favorite type of cake is and I think she picked out that silk tie. Also, that office seems too cheery and well decorated to be at the VA. Okay, back to catching up on these TMS trainings.
 
Sanman said:
For anyone who has done their government ethics training refresher recently. Does it seem like Sondra has a crush on her boss Bernard? She knows what his favorite type of cake is and I think she picked out that silk tie. Also, that office seems too cheery and well decorated to be at the VA. Okay, back to catching up on these TMS trainings.
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Aww, now I ship them. Although I can't remember if Bernard's married.
 
Sanman said:
For anyone who has done their government ethics training refresher recently. Does it seem like Sondra has a crush on her boss Bernard? She knows what his favorite type of cake is and I think she picked out that silk tie. Also, that office seems too cheery and well decorated to be at the VA. Okay, back to catching up on these TMS trainings.
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Haha I did this training when I still worked at the VA years ago. I can’t believe they are still using it.
 
You know which one really bothers me? The one where it's that Veteran who's new to the VA and he has a mental health appt and there's this moment where he's thinking about the provider he's going to be seeing, "I bet they don't even know what an IED is!" And then the provider comes in late and she's like "sorry, group ran long! The guys can really talk, especially when we start talking about all the different types of IEDs." The line just feels so unnatural. No one talks like that. And have ANY of you ever had any groups, even supportive or process, where people started listing off types of IEDs? I know that it's to show the new patient that she knows what an IED is, but it's just bad writing!

Between NEO and that annual training, I've seen that video at least ten times.
 
cara susanna said:
You know which one really bothers me? The one where it's that Veteran who's new to the VA and he has a mental health appt and there's this moment where he's thinking about the provider he's going to be seeing, "I bet they don't even know what an IED is!" And then the provider comes in late and she's like "sorry, group ran long! The guys can really talk, especially when we start talking about all the different types of IEDs." The line just feels so unnatural. No one talks like that. And have ANY of you ever had any groups, even supportive or process, where people started listing off types of IEDs? I know that it's to show the new patient that she knows what an IED is, but it's just bad writing!

Between NEO and that annual training, I've seen that video at least ten times.
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That one always bothered me too!
 
cara susanna said:
You know which one really bothers me? The one where it's that Veteran who's new to the VA and he has a mental health appt and there's this moment where he's thinking about the provider he's going to be seeing, "I bet they don't even know what an IED is!" And then the provider comes in late and she's like "sorry, group ran long! The guys can really talk, especially when we start talking about all the different types of IEDs." The line just feels so unnatural. No one talks like that. And have ANY of you ever had any groups, even supportive or process, where people started listing off types of IEDs? I know that it's to show the new patient that she knows what an IED is, but it's just bad writing!

Between NEO and that annual training, I've seen that video at least ten times.
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I remember that one and, yes, it is silly. Which EBP is that again?
 
cara susanna said:
Either the VA needs to lessen the administrative burdens around consults, or stop requiring consults for literally everything. They cannot have both.
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I am always glad that I do not have job that requires me to manage formal consults/referrals. I look at the other mental health areas and it seems like all that is talked about.
 
Sanman said:
I am always glad that I do not have job that requires me to manage formal consults/referrals. I look at the other mental health areas and it seems like all that is talked about.
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I covered them for a colleague who was out last week and it was awful.
 
cara susanna said:
I covered them for a colleague who was out last week and it was awful.
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It was generally manageable in my niche of neuropsychology, although I only handled consults when the primary person was out or needed a break. Even then, it was still somewhat annoying to have to keep up with all the administrative aspects, especially all the extra MISSION Act/Community Care boxes to click through.

But there were horror stories from general mental health. Pretty sure they got more consults in a day than I did in 1-2 weeks (and neuropsych wasn't exactly slow).
 
AcronymAllergy said:
It was generally manageable in my niche of neuropsychology, although I only handled consults when the primary person was out or needed a break. Even then, it was still somewhat annoying to have to keep up with all the administrative aspects, especially all the extra MISSION Act/Community Care boxes to click through.

But there were horror stories from general mental health. Pretty sure they got more consults in a day than I did in 1-2 weeks (and neuropsych wasn't exactly slow).
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I have been helping out one of the virtual MH clinics and I get notified when they are closed now. There are a ton and being a team lead should get you a generous clinical offset for all the extra documentation. I never want that job...not that I would ever end up there.
 
AcronymAllergy said:
It was generally manageable in my niche of neuropsychology, although I only handled consults when the primary person was out or needed a break. Even then, it was still somewhat annoying to have to keep up with all the administrative aspects, especially all the extra MISSION Act/Community Care boxes to click through.

But there were horror stories from general mental health. Pretty sure they got more consults in a day than I did in 1-2 weeks (and neuropsych wasn't exactly slow).
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Not sure how recently you've covered them, but it's gotten even more convulated and time-consuming with the new consult toolbox.
 
cara susanna said:
Either the VA needs to lessen the administrative burdens around consults, or stop requiring consults for literally everything. They cannot have both.
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I feel this in my soul. We’ve started having to do consults within our team if the person who does the consult visit is not the person who ends up following the pt. for treatment. So some people end up having 2 “consults” with our team within a couple weeks.
 
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