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

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The consult process is painful. It also seems like a way to annoy other clinics when they're frustrated with each other. It's always interesting to have multiple rotations because I get to see between clinic battles. As the consults become more burdensome, there has been more desire to punt them to other clinics which leads to more hostility. It is uncomfortable to watch.
 
I get particularly annoyed when I discover that 5 consults for different psychotherapies were sent to different clinics by the same provider and their rationale is "whatever gets scheduled first 👍👍" usually discover after colleague and/or I reviewed the chart in depth for 20 minutes
 
summerbabe said:
It just shows that the geniuses at national OMHSP are so far removed from day to day MH treatment, especially in systems that are taxed with access and provider turnover issues.
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Pretty much. This is how a lot of policies go in VA. I just consulted with a colleague that has a difficult patient who doesn't really want any EBP treatment for his MH or medications and mostly wants to complain. However, it is easy/consistent RVUS and that seems to be all that matters this year, so he gets "treatment". Way to incentivize good treatment VA.
 
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Sanman said:
If you think no one cares about veterans now...
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I've started receiving referrals from our local VA since their pain psychologist left. It has been such a relief to be able to actually set boundaries, no-show limits, normal clinic policies, etc. If they're mad about it, they can't really complain the way they do at VA. It's great.
 
summerbabe said:
This seems like truly one of the worst VA staff psychologist positions that's readily available.
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I did a lot of training in pain management back when everyone what getting all the opioids they wanted and pain was the fifth vital sign. Thought about being a VA pain psychologist if I didn't opt for neuropsych. Obviously did not do that and I am glad I dodged that bullet. Too much drug seeking now.
 
Shiori said:
I can't imagine how anyone thinks the private sector could (or would want to) absorb that influx of veterans. Community care is hanging on by a thread in so many places.
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Yeah, our wait lists are so insane for all types of MH providers/clinics at our AMC that most of them have a 1 year ban if you no-show your intake. Would not go well.
 
cara susanna said:
Wow, as a VA provider I cannot even IMAGINE that!
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Not at all! I feel like I am required to practically harass clients who have made it clear they're not interested in services. I'm all about making sure people don't fall through the cracks, but 2-3 calls, a letter, and finding some other alternative mode of communication to reach out as well is excessive.
 
Shiori said:
Not at all! I feel like I am required to practically harass clients who have made it clear they're not interested in services. I'm all about making sure people don't fall through the cracks, but 2-3 calls, a letter, and finding some other alternative mode of communication to reach out as well is excessive.
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Yes, I also feel like I'm harassing people. I remember at our MH meetings our chief would ask if people had any concerns and someone would always bring up the NS calls policy. And the chief would be like "yeah, I hear you, but there isn't anything I can do about it."
 
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 was watching the ICARE video this morning and cracking up thinking about this thread.
 
Shiori said:
I've been reading through VA policies, and they're giving me palpitations. The description for "minimal effort" in the no-show policy is painful.
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Is minimal effort just three calls and a letter or is there EVEN more to it?
 
cara susanna said:
Is minimal effort just three calls and a letter or is there EVEN more to it?
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It's just that, thank goodness! It is left up to the discretion of the individual sites and clinics to add addition contact requirements.
 
Shiori said:
It's just that, thank goodness! It is left up to the discretion of the individual sites and clinics to add addition contact requirements.
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I couldn't imagine actually requiring more than 3 calls and a letter. That is a service I would not want to work in.
 
Shiori said:
It's just that, thank goodness! It is left up to the discretion of the individual sites and clinics to add addition contact requirements.
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AcronymAllergy said:
I couldn't imagine actually requiring more than 3 calls and a letter. That is a service I would not want to work in.
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The new push seems to be requiring two different methods of contact. (phone, secure message/text, then letter)
 
WisNeuro said:
Is that new? We had to do that 5+ years ago when I was at the VA.
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Might just be new locally. It has always been phone calls and letter here. Last dept meeting they state the policy is now to use two differerent methods of contact before the letter if possible.
 
Yes, we have recently gotten feedback to try to switch up the method with the second attempt at contact. Of course, there are significant barriers to that because several of our folks have difficulty with texts and secure messaging. I could try telepathy.
 
Shiori said:
Yes, we have recently gotten feedback to try to switch up the method with the second attempt at contact. Of course, there are significant barriers to that because several of our folks have difficulty with texts and secure messaging. I could try telepathy.
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Yeah, a lot my folks don't believe in using the magic boxes.
 
AbnormalPsych said:
I'm frankly surprised there aren't more instances of harassment complaints of pts with repeated outreach attempts when both parties know its not the best step.
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Especially if they have ever acknowledged any history of suicidal ideation. So much contact.
 
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Shiori said:
Especially if they have ever acknowledged any history of suicidal ideation. So much contact.
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In what may be the most VA experience ever, I had a bed-bound quadriplegic patient that voiced suicidal ideation in the hospital and ended up with a flag in his chart. The fact that he was physically unable to pick up a phone (or carry out his stated plan to kill himself) did not stop suicide prevention from calling him (daily even) once he was discharged. Man was he pissed...
 
PsyDuck90 said:
As a trainee, this thread is both enlightening and a little scary. I am currently doing a practicum at a research clinic in a VAMC, and I'm loving it and thinking about it as a full time option down the road. Other than the hiccups with getting my PIV card, I've been really enjoying the environment.
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Give it a little time. Your eyes will be opened
 
PsyDuck90 said:
As a trainee, this thread is both enlightening and a little scary. I am currently doing a practicum at a research clinic in a VAMC, and I'm loving it and thinking about it as a full time option down the road. Other than the hiccups with getting my PIV card, I've been really enjoying the environment.
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Research as a full-time option? If you wanted to talk about being a research psychologist in the VHA I can provide you insight. It isn't as fun as you think.
 
Psycycle said:
I left the VA about six months ago. Mostly I was frustrated with the lack of career growth; I felt like I hadn't done all the work I did to just be in a clinical rut. My new job is amazing on a lot of levels and I get to branch out and grow. There's things I miss about the VA, but my life has improved a lot not being there.
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I am in a 100% research position (supposed to be 75% research/25% clinical). I'm in a spot where I didn't do this much work to push paper and be someone's lackey. Hoping for more balance in a different position.
 
psycho1391 said:
I am in a 100% research position (supposed to be 75% research/25% clinical). I'm in a spot where I didn't do this much work to push paper and be someone's lackey. Hoping for more balance in a different position.
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Good for you! Get out if/when you can. I have never found it to be a mistake when I left something for the right reasons for my personal wellness or growth.
 
Psycycle said:
Good for you! Get out if/when you can. I have never found it to be a mistake when I left something for the right reasons for my personal wellness or growth.
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Got a tentative offer and they are working on a relocation incentive package. Coming home almost every night crying was NOT it. Had to apply for another position.
 
psycho1391 said:
Got a tentative offer and they are working on a relocation incentive package. Coming home almost every night crying was NOT it. Had to apply for another position.
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Congratulations! and totally - we do too much work for this freaking profession to be miserable!
 
psycho1391 said:
Research as a full-time option? If you wanted to talk about being a research psychologist in the VHA I can provide you insight. It isn't as fun as you think.
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No, the practicum just happened to be research focused, but I would like my primary responsibilities to be clinical. I matched to a flagship VA for internship, so I think I'll get more exposure in the coming months.
 
PsyDuck90 said:
No, the practicum just happened to be research focused, but I would like my primary responsibilities to be clinical. I matched to a flagship VA for internship, so I think I'll get more exposure in the coming months.
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VA can work for you but it takes being proactive + some degree of luck + some degree of willingness to bend the system/rules when following the rules would be rather nonsensical yet where bending them usually won’t draw undue attention that can then trigger all kinds of unpleasantness (in my experience).

I’m in my second VA staff psychologist position and I am not looking to leave anytime soon. This gig is way better than my first one coming out of a VA postdoc and internship. I started actively looking for another position less than a year into my non-trainee career even though it was decent.

And having now been in 4 different systems, it’s so true how things can be wildly different between facilities in terms of culture, expectations, what types of rules/bureaucracy are emphasized or deemphasized, access/provider demand issues, etc. Good luck during internship!
 
psycho1391 said:
Research as a full-time option? If you wanted to talk about being a research psychologist in the VHA I can provide you insight. It isn't as fun as you think.
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Agreed - I started out wanting a VA research career, did a VA research fellowship, and almost submitted a CDA. I eventually applied for clinical jobs after learning more about VA research careers.
 
Uh oh, I'd love to hear thoughts on research in the VA and the unique ways it's challenging.
 
cara susanna said:
Agreed - I started out wanting a VA research career, did a VA research fellowship, and almost submitted a CDA. I eventually applied for clinical jobs after learning more about VA research careers.
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I took a project coordinator role that gives me the chance to learn about that path without the didactics. Four months in, I decided I did NOT want anywhere near a CDA. Happy to be a co-i or sub-i, but no way in hell do I want to be a PI.
 
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psycho1391 said:
I took a project coordinator role that gives me the chance to learn about that path without he didactics. Four months in, I decided I did NOT want anywhere near a CDA. Happy to be a co-i or sub-i, but no way in hell do I want to be a PI.
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I am a PI on a CDA and am happy to PM anyone who has questions. I'm mostly happy tbh.
 
Shiori said:
Uh oh, I'd love to hear thoughts on research in the VA and the unique ways it's challenging.
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For me, it was hearing about the endless pursuit of funding. Every stage of research you had to think ahead to future funding. When you get your CDA, you need to start thinking about your R1 or Merit Grant. Etc etc. At the time I was growing tired of lack of stabillity and moving constantly. And then I knew VA research psychologists who had their time eaten up by full-time clinical more and more as the years progressed because they weren't getting enough funding, who were very bitter. One told me you'd be better off in academia and having access to VA research datasets.
 
cara susanna said:
For me, it was hearing about the endless pursuit of funding. Every stage of research you had to think ahead to future funding. When you get your CDA, you need to start thinking about your R1 or Merit Grant. Etc etc. At the time I was growing tired of lack of stabillity and moving constantly. And then I knew VA research psychologists who had their time eaten up by full-time clinical more and more as the years progressed because they weren't getting enough funding, who were very bitter. One told me you'd be better off in academia and having access to VA research datasets.
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All of this. Plus the pandering and pivoting your research to "fit" what is getting funded so that you can continue to do research. It isn't for me. However, that doesn't mean its not for someone else.

I do think a lot of my unhappiness is related to the project coordinator role and the team I work with.
 
That is helpful to consider. I go back and forth on whether I want to do research at all. Academia has so many opportunities, but also so many headaches. I'm also still early enough in my training where I'm pulling apart my actual career interests from what I'm just good at doing. I also avoid hard feelings by throwing myself into my work and racking up achievements, so it seems like it'll be a recipe for disaster.
 
Hello All. I am a current intern wrapping up an internship at a VA this Fall. I applied to several positions (6) at the VA I am at currently and received a tentative job offer in a clinic I enjoyed working in (completed a rotation there this year). However, I heard from providers in this clinic they are expecting the psychologist onboarded to take on the team lead role. These expectations were not described in the job announcement and I have no interest in a team lead position right out of school. I have yet to complete interviews for 4 of the positions I applied to, I am curious if it is typical for leadership expectations to not be listed in the job announcement? I appreciate your thoughts.
 
relationalpsych said:
Hello All. I am a current intern wrapping up an internship at a VA this Fall. I applied to several positions (6) at the VA I am at currently and received a tentative job offer in a clinic I enjoyed working in (completed a rotation there this year). However, I heard from providers in this clinic they are expecting the psychologist onboarded to take on the team lead role. These expectations were not described in the job announcement and I have no interest in a team lead position right out of school. I have yet to complete interviews for 4 of the positions I applied to, I am curious if it is typical for leadership expectations to not be listed in the job announcement? I appreciate your thoughts.
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A team lead is usually an informal role and not one that gets you any official bump in pay. If you want it, go for it. If not, then no one can really force you to take it. Colleagues can expect whatever they want, but they are not your boss. You can clarify with your future boss expectations before accepting the position. Don't be afraid to take the job and say 'No' to team lead responsibilities.
 
relationalpsych said:
Hello All. I am a current intern wrapping up an internship at a VA this Fall. I applied to several positions (6) at the VA I am at currently and received a tentative job offer in a clinic I enjoyed working in (completed a rotation there this year). However, I heard from providers in this clinic they are expecting the psychologist onboarded to take on the team lead role. These expectations were not described in the job announcement and I have no interest in a team lead position right out of school. I have yet to complete interviews for 4 of the positions I applied to, I am curious if it is typical for leadership expectations to not be listed in the job announcement? I appreciate your thoughts.
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Since you've worked in this clinic before, do you have any knowledge about what the team lead role looks like? In some clinics, it's a lot of extra work and in others, it's something they try to toss on anyone they can as a non-role role.
 
Yeah, is it like a BHIP team lead where it really doesn't require that much work, or like an actual administrative position?
 
thebalmofhurtminds said:
Since you've worked in this clinic before, do you have any knowledge about what the team lead role looks like? In some clinics, it's a lot of extra work and in others, it's something they try to toss on anyone they can as a non-role role.
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It would be like a BHIP team lead position. I would be in charge of consults, monthly meetings with hospital admin, and in charge of reviewing the clinic intake process for improvement as well as delineation of therapy cases from med provider intakes. My supervisor on that rotation was the temporary team lead and seemed to have difficulty with those tasks on top of having a full-time caseload. That's my primary concern. However, they did not shift her clinic grid to account for the extra administrative duties.
 
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