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

[Fan_of_Meehl]

---

Members don't see this ad.

Yeah I can't imagine starting right now. I got started in the early 2000s and although I've had some fits and starts, it's been mostly good.

These days though - **** - it's really starting to get to me. Gotta be honest.

Good thing I have a VA "venting" thread to get it all out tho!

Another clinician who has been at our VA for something like 15 years was saying something similar. Everyone is frayed. Everyone is frustrated, burned out, stressed, etc. It always seems like 'just one more thing' (one more program, one more new policy/procedure, one more portal to log into and get kicked out of all day long, one more duty that we take over from non-clinical staff, and on and on and on).

Earlier today, I went up to a veteran in the waiting room who had come to his appointment with a colleague who tested positive for COVID and unexpectedly had to be out today (obviously). I informed him and said that I was here to meet with him in her stead (so we were not cancelling the appointment at the last minute). It was only a follow-up appointment to see how he was doing and for him to check in. He and his wife were upset that they were not seeing their original provider. They weren't too rude about it but the offer to see them in lieu of their regular therapist (who had to be out) caused an obvious upwelling of resentment that they broadcast in all direction in public in the waiting room by openly grumbling and complaining about the situation. I calmly provided polite customer service, offering to give him 5 mins to think about it and I could come back and check with him to see if he wanted to meet with me. I understand that if you have PTSD and have a connection with a primary therapist that being confronted with the situation of having a 'stranger' to talk to might be a bit abrupt and unsettling and said as much. The couple grumbled a couple more times and said something like, 'when can I see HER (original therapist) again?' So I said we would just routinely reschedule him for the next available appointment with her if he would like. More grumbling. I finally had to just ask him to make a decision on whether he wanted to meet with me today or not. At that point, he sort of caught himself and thanked me for offering (sincerely) but said he'd rather wait for his regular provider. I said I understood and asked the MSA to reschedule him.

Later in the day, that colleague of 15 years at the VA was running into difficulty with the new MHA-WEB thing (apparently, something was 'broken' in terms of his 'privileges' or something and he had to get IT support to try to get it addressed some time this decade). He confided that he had just had an appointment where a new veteran (I think an intake) had refused to wear a mask and, when the psychologist was politely reminding him about the policy, he became enraged, saying 'the VA doesn't even give a **** about veterans!' and eventually got up and stormed out of the intake. He was running the situation by me for a little bit of venting and peer support regarding how he handled it...obviously (being a VA provider) questioning himself.

I doubt that either of these scenarios happen very frequently in the private healthcare sector. I mean, I'm sure they happen, just not as routinely.

And, yes, I realize that by complaining about being a VA clinician it appears that I am being illogical in staying and need to be reminded of that. In several other posts I've outlined my reasons for staying (pros/cons list) and won't be recapitulating it here.

 

[deleted1129370]

Yeah I can't imagine starting right now. I got started in the early 2000s and although I've had some fits and starts, it's been mostly good.

These days though - **** - it's really starting to get to me. Gotta be honest.

Good thing I have a VA "venting" thread to get it all out tho!

You are in good company. I can only imagine what you've had to endure, and I frankly don't know what my future will look like. I feel like I am just going with the flow for now. I really don't know know what I want, well, I do want to be ABPP in clinical and possibly forensic, and I also want to get more forensic/police experiences if I can. I want to make good money, have good benefits, have a good work-life balance, and have a good retirement fund. I will say, the VA "grind" is a lot, and I am not sure how long I will last.

 

[JeyRo]

You are in good company. I can only imagine what you've had to endure, and I frankly don't know what my future will look like. I feel like I am just going with the flow for now. I really don't know know what I want, well, I do want to be ABPP in clinical and possibly forensic, and I also want to get more forensic/police experiences if I can. I want to make good money, have good benefits, have a good work-life balance, and have a good retirement fund. I will say, the VA "grind" is a lot, and I am not sure how long I will last.

I feel like if I can make it to 60 and retire (which isn't that far from now I suppose), I could write a book about how nucking futz this place is. Maybe no one would buy it - but it would be therapeutic for me at least.

 

[Sanman]

Yeah I can't imagine starting right now. I got started in the early 2000s and although I've had some fits and starts, it's been mostly good.

These days though - **** - it's really starting to get to me. Gotta be honest.

Good thing I have a VA "venting" thread to get it all out tho!

Another clinician who has been at our VA for something like 15 years was saying something similar. Everyone is frayed. Everyone is frustrated, burned out, stressed, etc. It always seems like 'just one more thing' (one more program, one more new policy/procedure, one more portal to log into and get kicked out of all day long, one more duty that we take over from non-clinical staff, and on and on and on).

Earlier today, I went up to a veteran in the waiting room who had come to his appointment with a colleague who tested positive for COVID and unexpectedly had to be out today (obviously). I informed him and said that I was here to meet with him in her stead (so we were not cancelling the appointment at the last minute). It was only a follow-up appointment to see how he was doing and for him to check in. He and his wife were upset that they were not seeing their original provider. They weren't too rude about it but the offer to see them in lieu of their regular therapist (who had to be out) caused an obvious upwelling of resentment that they broadcast in all direction in public in the waiting room by openly grumbling and complaining about the situation. I calmly provided polite customer service, offering to give him 5 mins to think about it and I could come back and check with him to see if he wanted to meet with me. I understand that if you have PTSD and have a connection with a primary therapist that being confronted with the situation of having a 'stranger' to talk to might be a bit abrupt and unsettling and said as much. The couple grumbled a couple more times and said something like, 'when can I see HER (original therapist) again?' So I said we would just routinely reschedule him for the next available appointment with her if he would like. More grumbling. I finally had to just ask him to make a decision on whether he wanted to meet with me today or not. At that point, he sort of caught himself and thanked me for offering (sincerely) but said he'd rather wait for his regular provider. I said I understood and asked the MSA to reschedule him.

Later in the day, that colleague of 15 years at the VA was running into difficulty with the new MHA-WEB thing (apparently, something was 'broken' in terms of his 'privileges' or something and he had to get IT support to try to get it addressed some time this decade). He confided that he had just had an appointment where a new veteran (I think an intake) had refused to wear a mask and, when the psychologist was politely reminding him about the policy, he became enraged, saying 'the VA doesn't even give a **** about veterans!' and eventually got up and stormed out of the intake. He was running the situation by me for a little bit of venting and peer support regarding how he handled it...obviously (being a VA provider) questioning himself.

I doubt that either of these scenarios happen very frequently in the private healthcare sector. I mean, I'm sure they happen, just not as routinely.

And, yes, I realize that by complaining about being a VA clinician it appears that I am being illogical in staying and need to be reminded of that. In several other posts I've outlined my reasons for staying (pros/cons list) and won't be recapitulating it here.

I feel like if I can make it to 60 and retire (which isn't that far from now I suppose), I could write a book about how nucking futz this place is. Maybe no one would buy it - but it would be therapeutic for me at least.

Why because Cerner is going to suck hard?

At this point in my life with a couple of teenage kids at home I don't have the wherewithal, much less the business sense to do PP on my own. And I certainly wouldn't do Medicare contracting - I don't care what any geropsychologist says, it's a terrible system to work with, and only continues to get worse and worse in terms of nickel-and-diming us. If I could create a private pay practice I'd do it, but that would be tricky to do.

In terms of other orgs, I don't think it would be difficult at all for me to get work elsewhere, like at Kaiser, but it would at best be a lateral move pay and benefits wise, but I'd likely lose my gero niche - and other pure geropsych jobs are going to realistically require me to take a pay cut.

So, the golden handcuffs of the VA for now

I have to say that I have felt really bad for my long-term care and other colleagues that had to remain face to face during the pandemic. It has been truly miserable and I have seen a lot them choose to leave as a result. I had the chance to transition mostly to WFH using VVC and it has really been a blessing. I really can't see going back to all the running around I used to do. I'll stick around at the VA as long as I can continue to mostly WFH doing VVC with the occasional home visit for assessment. If we transition back to my pre-pandemic schedule, I will likely be pulling the plug and jumping to full-time PP sooner than expected. VA infastructure (government cars, office space, etc) has gotten worse since the pandemic started. I have also had plenty of those mask arguments and I simply do not need to risk my safety. Add to that ridiculous gas prices and a growing family/ aging parents and I just don't want to be commuting that far anymore.

 

[cara susanna]

Another clinician who has been at our VA for something like 15 years was saying something similar. Everyone is frayed. Everyone is frustrated, burned out, stressed, etc. It always seems like 'just one more thing' (one more program, one more new policy/procedure, one more portal to log into and get kicked out of all day long, one more duty that we take over from non-clinical staff, and on and on and on).

Earlier today, I went up to a veteran in the waiting room who had come to his appointment with a colleague who tested positive for COVID and unexpectedly had to be out today (obviously). I informed him and said that I was here to meet with him in her stead (so we were not cancelling the appointment at the last minute). It was only a follow-up appointment to see how he was doing and for him to check in. He and his wife were upset that they were not seeing their original provider. They weren't too rude about it but the offer to see them in lieu of their regular therapist (who had to be out) caused an obvious upwelling of resentment that they broadcast in all direction in public in the waiting room by openly grumbling and complaining about the situation. I calmly provided polite customer service, offering to give him 5 mins to think about it and I could come back and check with him to see if he wanted to meet with me. I understand that if you have PTSD and have a connection with a primary therapist that being confronted with the situation of having a 'stranger' to talk to might be a bit abrupt and unsettling and said as much. The couple grumbled a couple more times and said something like, 'when can I see HER (original therapist) again?' So I said we would just routinely reschedule him for the next available appointment with her if he would like. More grumbling. I finally had to just ask him to make a decision on whether he wanted to meet with me today or not. At that point, he sort of caught himself and thanked me for offering (sincerely) but said he'd rather wait for his regular provider. I said I understood and asked the MSA to reschedule him.

Later in the day, that colleague of 15 years at the VA was running into difficulty with the new MHA-WEB thing (apparently, something was 'broken' in terms of his 'privileges' or something and he had to get IT support to try to get it addressed some time this decade). He confided that he had just had an appointment where a new veteran (I think an intake) had refused to wear a mask and, when the psychologist was politely reminding him about the policy, he became enraged, saying 'the VA doesn't even give a **** about veterans!' and eventually got up and stormed out of the intake. He was running the situation by me for a little bit of venting and peer support regarding how he handled it...obviously (being a VA provider) questioning himself.

I doubt that either of these scenarios happen very frequently in the private healthcare sector. I mean, I'm sure they happen, just not as routinely.

And, yes, I realize that by complaining about being a VA clinician it appears that I am being illogical in staying and need to be reminded of that. In several other posts I've outlined my reasons for staying (pros/cons list) and won't be recapitulating it here.

In my humble opinion, we shouldn't have to continually justify or defend our decision to stay in the VA in this thread. This thread is for venting and support - so validation, not problem solving!

 

[Sanman]

In my humble opinion, we shouldn't have to continually justify or defend our decision to stay in the VA in this thread. This thread is for venting and support - so validation, not problem solving!

I would hope no one feels the need to justify their choices. It is personal and we all need a source of income. Even the right choice has downsides.

 

[JeyRo]

I have to say that I have felt really bad for my long-term care and other colleagues that had to remain face to face during the pandemic. It has been truly miserable and I have seen a lot them choose to leave as a result. I had the chance to transition mostly to WFH using VVC and it has really been a blessing. I really can't see going back to all the running around I used to do. I'll stick around at the VA as long as I can continue to mostly WFH doing VVC with the occasional home visit for assessment. If we transition back to my pre-pandemic schedule, I will likely be pulling the plug and jumping to full-time PP sooner than expected. VA infastructure (government cars, office space, etc) has gotten worse since the pandemic started. I have also had plenty of those mask arguments and I simply do not need to risk my safety. Add to that ridiculous gas prices and a growing family/ aging parents and I just don't want to be commuting that far anymore.

Fortunately I've never had to worry about a commute (I live 15 minutes from work).

Also, never been concerned for my health or well-being working in LTC, except for maybe briefly in early 2020 when the data about risk stratification of COVID wasn't so obvious. No need to say much more than that.

I also think it's a blessing that my residents get to see me in person (albeit masked up) - and the idea of doing virtual therapy with older adults, particularly those in LTC - seems pretty absurd, so I'm glad I've never been forced to do it. On the flipside, it almost feels like abandoning my guys to even think about leaving. They've lost volunteers, paid companions, family members, and certain classes of paid staff.

I guess the thing that stresses me out more than anything else is how much less control we as providers have over the environment of care we're trying to offer our residents in LTC. It's really not "homelike" anymore. It's been a disaster for these guys in so many ways.

 

[deleted1129370]

Another clinician who has been at our VA for something like 15 years was saying something similar. Everyone is frayed. Everyone is frustrated, burned out, stressed, etc. It always seems like 'just one more thing' (one more program, one more new policy/procedure, one more portal to log into and get kicked out of all day long, one more duty that we take over from non-clinical staff, and on and on and on).

Earlier today, I went up to a veteran in the waiting room who had come to his appointment with a colleague who tested positive for COVID and unexpectedly had to be out today (obviously). I informed him and said that I was here to meet with him in her stead (so we were not cancelling the appointment at the last minute). It was only a follow-up appointment to see how he was doing and for him to check in. He and his wife were upset that they were not seeing their original provider. They weren't too rude about it but the offer to see them in lieu of their regular therapist (who had to be out) caused an obvious upwelling of resentment that they broadcast in all direction in public in the waiting room by openly grumbling and complaining about the situation. I calmly provided polite customer service, offering to give him 5 mins to think about it and I could come back and check with him to see if he wanted to meet with me. I understand that if you have PTSD and have a connection with a primary therapist that being confronted with the situation of having a 'stranger' to talk to might be a bit abrupt and unsettling and said as much. The couple grumbled a couple more times and said something like, 'when can I see HER (original therapist) again?' So I said we would just routinely reschedule him for the next available appointment with her if he would like. More grumbling. I finally had to just ask him to make a decision on whether he wanted to meet with me today or not. At that point, he sort of caught himself and thanked me for offering (sincerely) but said he'd rather wait for his regular provider. I said I understood and asked the MSA to reschedule him.

Later in the day, that colleague of 15 years at the VA was running into difficulty with the new MHA-WEB thing (apparently, something was 'broken' in terms of his 'privileges' or something and he had to get IT support to try to get it addressed some time this decade). He confided that he had just had an appointment where a new veteran (I think an intake) had refused to wear a mask and, when the psychologist was politely reminding him about the policy, he became enraged, saying 'the VA doesn't even give a **** about veterans!' and eventually got up and stormed out of the intake. He was running the situation by me for a little bit of venting and peer support regarding how he handled it...obviously (being a VA provider) questioning himself.

I doubt that either of these scenarios happen very frequently in the private healthcare sector. I mean, I'm sure they happen, just not as routinely.

And, yes, I realize that by complaining about being a VA clinician it appears that I am being illogical in staying and need to be reminded of that. In several other posts I've outlined my reasons for staying (pros/cons list) and won't be recapitulating it here.

For what it's worth (not to hash out mask vs. no mask), I as well as several others I know don't wear masks in our offices even when we have veterans. Typically, I will ask if they mind if take the, off, and if they are cool with it, then we take them off.

 

[Sanman]

For what it's worth (not to hash out mask vs. no mask), I as well as several others I know don't wear masks in our offices even when we have veterans. Typically, I will ask if they mind if take the, off, and if they are cool with it, then we take them off.

It's certainly a risk you are allowed to take if you are both willing. However, that does not make it alright for veterans to make that decision for providers. Some of us have higher risk profiles or family members with higher risk profiles. Either way, VVC means that I do not have to concern myself with that fight. I also imagine that if a veteran gets sick and reports you/sues the VA, you can kiss your job goodbye if breaking hospital policy. That matters more to some than others.

 

[WisNeuro]

Still masking in my office. My clinical patients are mostly 65+ with many high risk medical conditions. And, all of the healthcare systems still require them for appointments, so it's easy to just say that it's still a thing in healthcare offices. I've only had one person say they were not going to wear a mask, husband of a patient, but after I told him he could call me later and I could give him a referral to get the testing elsewhere, but it'd likely be a 6-12 month wait in another clinic, he relented.

 

[Sanman]

Fortunately I've never had to worry about a commute (I live 15 minutes from work).

Also, never been concerned for my health or well-being working in LTC, except for maybe briefly in early 2020 when the data about risk stratification of COVID wasn't so obvious. No need to say much more than that.

I also think it's a blessing that my residents get to see me in person (albeit masked up) - and the idea of doing virtual therapy with older adults, particularly those in LTC - seems pretty absurd, so I'm glad I've never been forced to do it. On the flipside, it almost feels like abandoning my guys to even think about leaving. They've lost volunteers, paid companions, family members, and certain classes of paid staff.

I guess the thing that stresses me out more than anything else is how much less control we as providers have over the environment of care we're trying to offer our residents in LTC. It's really not "homelike" anymore. It's been a disaster for these guys in so many ways.

Past a certain age, I think all of us are loathe to start over if we are comfortable. I said my piece regarding health and COVID in the previous post, I will say that I think the VA has done a poor job of figuring out how to consistently enforce policies throughout their programs. Home based primary care has been more difficult because there are no VA police to call if someone gets "feisty" and if you think they are opposed in a hospital setting, imagine their opinion of being forced to do so in their own home.

Certainly leaving becomes difficult after a while. I had a prior chief that considered geriatrics "god's work" as their really was very little incentive to deal with all the extra headaches. I think about that a bit, but I am used to it given it happens so abruptly in the private sector.

 

[Fan_of_Meehl]

In my humble opinion, we shouldn't have to continually justify or defend our decision to stay in the VA in this thread. This thread is for venting and support - so validation, not problem solving!

Emotion-focused coping is a valid approach to coping. Agree.

 

[JeyRo]

Past a certain age, I think all of us are loathe to start over if we are comfortable. I said my piece regarding health and COVID in the previous post, I will say that I think the VA has done a poor job of figuring out how to consistently enforce policies throughout their programs. Home based primary care has been more difficult because there are no VA police to call if someone gets "feisty" and if you think they are opposed in a hospital setting, imagine their opinion of being forced to do so in their own home.

Certainly leaving becomes difficult after a while. I had a prior chief that considered geriatrics "god's work" as their really was very little incentive to deal with all the extra headaches. I think about that a bit, but I am used to it given it happens so abruptly in the private sector.

Yeah at this point I'm stuck here for around the next 10 years.

After that I'll have a full pension with some level of inflation protection built into it. Then, I figure, I have options.

 

[deleted1038433]

Anyone ever go through a VA whistleblower disclosure? Any recommendations for the process?

 

[cara susanna]

Past a certain age, I think all of us are loathe to start over if we are comfortable. I said my piece regarding health and COVID in the previous post, I will say that I think the VA has done a poor job of figuring out how to consistently enforce policies throughout their programs. Home based primary care has been more difficult because there are no VA police to call if someone gets "feisty" and if you think they are opposed in a hospital setting, imagine their opinion of being forced to do so in their own home.

Certainly leaving becomes difficult after a while. I had a prior chief that considered geriatrics "god's work" as their really was very little incentive to deal with all the extra headaches. I think about that a bit, but I am used to it given it happens so abruptly in the private sector.

It's been a mess even outside of HBPC. Like, why did some VAs go all virtual and some didn't, even ones mere hours away? It's a NATIONAL system, we should be consistent.

 

[Sanman]

It's been a mess even outside of HBPC. Like, why did some VAs go all virtual and some didn't, even ones mere hours away? It's a NATIONAL system, we should be consistent.

Oh, it's been a mess everywhere with inconsistent policies and reversals on messaging. Those were just the first of many examples I thought about. The abrupt focus on RVUs after developing programs and asking for volunteers to help with things like EAP/employee stress reduction, additional teaching/supervision, etc which had no RVUs (there by gutting staff participation after training everyone). These are just my isolated experiences.

 

[Fan_of_Meehl]

It's been a mess even outside of HBPC. Like, why did some VAs go all virtual and some didn't, even ones mere hours away? It's a NATIONAL system, we should be consistent.

I had inferred that some VA's went (and some still are) virtual. Here we NEVER went 'work from home' even during the thick of the initial COVID panic/response. Not a single provider. I think payroll is all work from home now. Good luck getting any of those issues resolved, lol.

 

[Fan_of_Meehl]

Anyone ever go through a VA whistleblower disclosure? Any recommendations for the process?

I have not. But I admire your courage for considering it. I know that there has been widely publicized material retaliation against VA provider whistleblowers in the recent past and I have watched some of the congressional testimony from the past several years and have been amazed at the, in practice, LACK of actual whistleblower protection afforded them.

 

[deleted1129370]

Oh, it's been a mess everywhere with inconsistent policies and reversals on messaging. Those were just the first of many examples I thought about. The abrupt focus on RVUs after developing programs and asking for volunteers to help with things like EAP/employee stress reduction, additional teaching/supervision, etc which had no RVUs (there by gutting staff participation after training everyone). These are just my isolated experiences.

It's funny...I never have focused on my RVUs...just don't really care. Interestingly enough, I somehow meet or exceed my goals. There were a couple of months I was hitting 106% for my monthly.

 

[Fan_of_Meehl]

It's funny...I never have focused on my RVUs...just don't really care. Interestingly enough, I somehow meet or exceed my goals. There were a couple of months I was hitting 106% for my monthly.

I think my high was 137% for one quarter...but they don't worry about making adjustments if it's too high...only if it's 'too low'...despite the fact that there is absolutely nothing a provider can do to 'increase productivity' per the RVU's when their schedule is decided for them and they just are supposed to see all patients who show up for their appointments.

"Productivity" is such a horrid moniker for the statistic...in reality it should be referred to as the 'psychic burden ratio'

 

[deleted1129370]

I think my high was 137% for one quarter...but they don't worry about making adjustments if it's too high...only if it's 'too low'...despite the fact that there is absolutely nothing a provider can do to 'increase productivity' per the RVU's when their schedule is decided for them and they just are supposed to see all patients who show up for their appointments.

"Productivity" is such a horrid moniker for the statistic...in reality it should be referred to as the 'psychic burden ratio'

Yeah, it's more-so the case with outpatient work. Not much I do about no-shows. I will not be calling folks to remind them, just don't have the time for it.

 

[deleted106747]

In my humble opinion, we shouldn't have to continually justify or defend our decision to stay in the VA in this thread. This thread is for venting and support - so validation, not problem solving!

And I wouldn’t have queried most of the people on this thread who have responded to cogent posts with cogent posts. However, when I attempted to offer a different perspective on management, the poster in question altered what I said and then ridiculed the thing I did not say. You can go back and read it, it’s all still there. I am under no obligation to show empathy or be validating under that circumstance. As an aside, as a woman in leadership, I cannot tell you how many men have used that exact tactic to shut down my point. Then to step back and say hey, this was my safe space and you’re wrecking that (which is how the exchange went) — um, no.

I have queried no other poster on their choice to stay or go. Heck, I stayed over five years for many complex reasons, and the system frustrated the heck out of me. You can search many posts from me about that. I get the VA’s problems. I’m suggesting that seemingly crazy leadership decisions have a context that the rest of us don’t always see. That’s all.

Treat me with civility and I will return it tenfold. I had actually meant that feedback/perspective to be validating and to offer some perspective and suggest that employees are more powerful in organizational politics than they may think.

I am done posting on this thread because I have no desire to derail it further with a pointless argument, so I will not respond to anything. However, I wish to place my comments in their context, as is my right even in a forum that has learned too much from current political discourse!

 

[Sanman]

It's funny...I never have focused on my RVUs...just don't really care. Interestingly enough, I somehow meet or exceed my goals. There were a couple of months I was hitting 106% for my monthly.

I think my high was 137% for one quarter...but they don't worry about making adjustments if it's too high...only if it's 'too low'...despite the fact that there is absolutely nothing a provider can do to 'increase productivity' per the RVU's when their schedule is decided for them and they just are supposed to see all patients who show up for their appointments.

"Productivity" is such a horrid moniker for the statistic...in reality it should be referred to as the 'psychic burden ratio'

Productivity can be less of an issue in some areas. However, when you are in CLC and your unit is shut down for a COVID outbreak or you are HBPC and all your folks are hospitalized with COVID, actively dying, etc., there can be periods of no one to see. There have been periods of months where there are no admissions because a PCP is out. Not much you can do about those things.

 

[AbnormalPsych]

Anyone ever go through a VA whistleblower disclosure? Any recommendations for the process?

I have not. But I admire your courage for considering it. I know that there has been widely publicized material retaliation against VA provider whistleblowers in the recent past and I have watched some of the congressional testimony from the past several years and have been amazed at the, in practice, LACK of actual whistleblower protection afforded them.

No longer in the VA, but would actually be curious to hear about this given how much it was presented as the 'right thing to do' when I was there. I too am also amazed at your bravery for even asking the question, given the stories after stories of people getting screwed for life for this kind of ethical behavior. Maybe I am mis-remembering but I thought years ago @PsyDr had some thoughts and/or data about this outside of VA.

 

[cara susanna]

My RVUs are probably going to be below target this year. I don't think that I care anymore. I shouldn't be punished for having efficient appts. It's not like I do my own scheduling, anyway.

Oh, it's been a mess everywhere with inconsistent policies and reversals on messaging. Those were just the first of many examples I thought about. The abrupt focus on RVUs after developing programs and asking for volunteers to help with things like EAP/employee stress reduction, additional teaching/supervision, etc which had no RVUs (there by gutting staff participation after training everyone). These are just my isolated experiences.

Dude, yes. During the height of COVID, our facility set up this room where staff could go to de-stress, and asked mental health staff to rotate spending time in there to help out staff if needed. I was like, uhh, what about the mental health staff that need to de-stress?

And, yeah, our teleworking was tied to RVUs and productivity, which during a pandemic seems INCREDIBLY wrong.

And I wouldn’t have queried most of the people on this thread who have responded to cogent posts with cogent posts. However, when I attempted to offer a different perspective on management, the poster in question altered what I said and then ridiculed the thing I did not say. You can go back and read it, it’s all still there. I am under no obligation to show empathy or be validating under that circumstance. As an aside, as a woman in leadership, I cannot tell you how many men have used that exact tactic to shut down my point. Then to step back and say hey, this was my safe space and you’re wrecking that (which is how the exchange went) — um, no.

I have queried no other poster on their choice to stay or go. Heck, I stayed over five years for many complex reasons, and the system frustrated the heck out of me. You can search many posts from me about that. I get the VA’s problems. I’m suggesting that seemingly crazy leadership decisions have a context that the rest of us don’t always see. That’s all.

Treat me with civility and I will return it tenfold. I had actually meant that feedback/perspective to be validating and to offer some perspective and suggest that employees are more powerful in organizational politics than they may think.

I am done posting on this thread because I have no desire to derail it further with a pointless argument, so I will not respond to anything. However, I wish to place my comments in their context, as is my right even in a forum that has learned too much from current political discourse!

For what it's worth, I wasn't referring to you or even thinking of you when I made my post. IIRC your post was on another thread. People asking why we're still at the VA or telling us that we should leave the VA is something we get on this thread quite often, and that's what I was responding to.

 

[Pragma]

Outside of VA, that below 2k RVU expectation looks incredible - it is 150-200% of that in many other settings.

 

[Sanman]

Outside of VA, that below 2k RVU expectation looks incredible - it is 150-200% of that in many other settings.

I don't particularly have a problem with the VA productivity requirements in normal times. However, their pandemic response was so disorganized that it led to problems. For the record, I have met my annual RVU goal this year already. This isn't me becoming bitter about that. However, VA national issued requests that HBPC nationally admit sicker (bed bound, non-verbal) veterans out of nursing homes due to the pandemic crisis. Part of our CLC also ended up being used for COVID cases. They were behind the ball on helping veterans transition to VVC (I remember spending hours teaching my geriatric folks how to open emails). They then turned around in 2021 and couldn't figure out why certain folks in mental health were falling below expectations in 2020 (umm...we are transitioning care and you changed policies and took beds/spots for patients we can't see). They caused the problem and when we asked how to help because we had free time, we were told to do these non-rvu tasks. Then we got yelled at for low rvus. That is the definition of dumb. Now one can argue that national and local leadership were not on the same page, but that is not my problem.

 

[WisNeuro]

I don't particularly have a problem with the VA productivity requirements in normal times. However, there pandemic response was so disorganized that it led to problems. For the record, I have met my annual RVU goal this year already. This isn't me becoming bitter about that. However, VA national issued requests that HBPC nationally admit sicker (bed bound, non-verbal) veterans out of nursing homes due to the pandemic crisis. Part of our CLC also ended up being used for COVID cases. They were behind the ball on helping veterans transition to VVC (I remember spending hours teaching my geriatric folks how to open emails). They then turned around in 2021 and couldn't figure out why certain folks in mental health were falling below expectations in 2020 (umm...we are transitioning care and you changed policies and took beds for patients we can't see). They caused the problem and when we asked how to help because we had free time, we were told to do these non-rvu tasks. Then we got yelled at for low rvus. That is the definition of dumb.

To be fair, early in the pandemic everyone was behind the ball for telehealth stuff. I had to budget an extra hour for every eval to work out IT issues with my older patients, and ended up rescheduling 10-20% due to these issues not being able to be resolve at the time of the appt. Not fun times.

 

[Sanman]

To be fair, early in the pandemic everyone was behind the ball for telehealth stuff. I had to budget an extra hour for every eval to work out IT issues with my older patients, and ended up rescheduling 10-20% due to these issues not being able to be resolve at the time of the appt. Not fun times.

Don't disagree. Just own it and stop yelling at the providers and middle management like it was our fault.

 

[Pragma]

To be fair, early in the pandemic everyone was behind the ball for telehealth stuff. I had to budget an extra hour for every eval to work out IT issues with my older patients, and ended up rescheduling 10-20% due to these issues not being able to be resolve at the time of the appt. Not fun times.

No neuropsychs met their targets where I worked and neuro evals were halted for months. I think some therapists did fine, easier pivot.

Oh I know there is plenty to complain about at VA, but having worked in one before I can say I put in a lot less hours there because the target was way lower.

 

[WisNeuro]

Don't disagree. Just own it and stop yelling at the providers and middle management like it was our fault.

We can definitely agree on that one.

No neuropsychs met their targets where I worked and neuro evals were halted for months. I think some therapists did fine, easier pivot.

Oh I know there is plenty to complain about at VA, but having worked in one before I can say I put in a lot less hours there because the target was way lower.

Most definitely. But that also ceilings out your earning potential, and gives you little motivation do much more. It didn't matter if you went well above and beyond there, you barely even received an "attaboy!"

 

[Pragma]

We can definitely agree on that one.



Most definitely. But that also ceilings out your earning potential, and gives you little motivation do much more. It didn't matter if you went well above and beyond there, you barely even received an "attaboy!"

All of the mandates also rendered RVUs pretty obsolete at the VA I was at. Treatment providers in that PTSD clinic were annually operating at 150-200% of their targets (mostly because of trainee billing) and the bonuses were nothing to sneeze at. Hopefully it was better in some VAs!

 

[WisNeuro]

All of the mandates also rendered RVUs pretty obsolete at the VA I was at. Treatment providers in that PTSD clinic were annually operating at 150-200% of their targets (mostly because of trainee billing) and the bonuses were nothing to sneeze at. Hopefully it was better in some VAs!

At the VAs I was at, there were no bonuses, and most of us were well above our RVU targets. I think the lowest quarter we aver had in our group was 95%.

 

[Sanman]

At the VAs I was at, there were no bonuses, and most of us were well above our RVU targets. I think the lowest quarter we aver had in our group was 95%.

I can second the no bonuses. No one in my dept has ever received a productivity bonus (or any bonus really) and some areas are swamped with referrals, which leads to high turnover in those positions. Things like a shortage of MSAs and needing to do your own admin work have slowed certain providers down. We can't keep a team lead is certain clinics to save our lives.

 

[Pragma]

At the VAs I was at, there were no bonuses, and most of us were well above our RVU targets. I think the lowest quarter we aver had in our group was 95%.

The bonuses at the VA I was at were what I would call “symbolic” (all under $1000). Truly admin would split performance hairs decide if you got $500 or $700

 

[WisNeuro]

I can second the no bonuses. No one in my dept has ever received a productivity bonus (or any bonus really) and some areas are swamped with referrals, which leads to high turnover in those positions. Things like a shortage of MSAs and needing to do your own admin work have slowed certain providers down. We can't keep a team lead is certain clinics to save our lives.

Yeah, the VAs lack of being able to do anything regarding retention bonuses is a killer for psych. When I resigned my last VA position, the MH lead asked if there was anything she could so to make me stay. When I genuinely asked if there was anything materially she could do, she literally answered "No, but I had to ask."

The bonuses at the VA I was at were what I would call “symbolic” (all under $1000). Truly admin would split performance hairs decide if you got $500 or $700

I would find these more insulting than helpful at this point in my career for overachieving production goals, This isn't even a half days work.

 

[deleted1129370]

Yeah, the VAs lack of being able to do anything regarding retention bonuses is a killer for psych. When I resigned my last VA position, the MH lead asked if there was anything she could so to make me stay. When I genuinely asked if there was anything materially she could do, she literally answered "No, but I had to ask."



I would find these more insulting than helpful at this point in my career for overachieving production goals, This isn't even a half days work.

I will say this - prior to my receiving my new job offer at the VA in Texas, I was offered an inpatient job with a VA in Florida with a joint faculty appointment, and a $15K sign on bonus plus EDRP. It killed me when I had to decline their offer.

 

[WisNeuro]

I will say this - prior to my receiving my new job offer at the VA in Texas, I was offered an inpatient job with a VA in Florida with a joint faculty appointment, and a $15K sign on bonus plus EDRP. It killed me when I had to decline their offer.

I didn't have loans, but many non-VA positions will offer a sizable sign on bonus, good sized relocation package, and a higher salary than commensurate VA stuff. When I jumped VA ship, this was pretty easy to find.

 

[Sanman]

I will say this - prior to my receiving my new job offer at the VA in Texas, I was offered an inpatient job with a VA in Florida with a joint faculty appointment, and a $15K sign on bonus plus EDRP. It killed me when I had to decline their offer.

I imagine the sign on bonus came from the faculty institution and the EDRP from the VA side. EDRP is being offered quite liberally now. It is great for you youngins, but less great for those of us that have been paying for years.

 

[deleted1038433]

I have not. But I admire your courage for considering it. I know that there has been widely publicized material retaliation against VA provider whistleblowers in the recent past and I have watched some of the congressional testimony from the past several years and have been amazed at the, in practice, LACK of actual whistleblower protection afforded them.

That's kind of you to say. I am doing what I can to resolve things informally. Unsurprisingly, folks in positions of power don't seem to want to take accountability for their misconduct and abusive behavior. Fingers crossed I don't have to take it to that level.

 

[deleted1038433]

No longer in the VA, but would actually be curious to hear about this given how much it was presented as the 'right thing to do' when I was there. I too am also amazed at your bravery for even asking the question, given the stories after stories of people getting screwed for life for this kind of ethical behavior. Maybe I am mis-remembering but I thought years ago @PsyDr had some thoughts and/or data about this outside of VA.

Thank you for the support. I see it as maintaining the ethical standards of my profession and protecting the welfare of everyone. The abuse of authority has already been incredibly damaging for me, but I agree that it is important to consider additional ways one may be "screwed" here.

 

[deleted1129370]

I didn't have loans, but many non-VA positions will offer a sizable sign on bonus, good sized relocation package, and a higher salary than commensurate VA stuff. When I jumped VA ship, this was pretty easy to find.

Teach me the ways 🙂

 

[deleted1129370]

I imagine the sign on bonus came from the faculty institution and the EDRP from the VA side. EDRP is being offered quite liberally now. It is great for you youngins, but less great for those of us that have been paying for years.

Indeed - I would say 95% or more of psychologist jobs on USAJobs are advertising EDRP, and lately, many are advertising bonuses. What's sad is, the position I just got on board with a VA in Texas also has a joint faculty appointment, and I have no bonus. 🙁

 

[deleted1129370]

I didn't have loans, but many non-VA positions will offer a sizable sign on bonus, good sized relocation package, and a higher salary than commensurate VA stuff. When I jumped VA ship, this was pretty easy to find.

I have oodles of loans (pretend you can hear Hannibal's voice saying this).

 

[JustNoticing]

That's kind of you to say. I am doing what I can to resolve things informally. Unsurprisingly, folks in positions of power don't seem to want to take accountability for their misconduct and abusive behavior. Fingers crossed I don't have to take it to that level.

second shout out for being brave. Whistleblowers in the VA have definitely gotten screwed in the past, but there are more protections now, but obviously there are still risks involved even if you have protections. Consider asking your union for advice too. Whistleblowing and OIG investigations they trigger definitely can make a difference though. Thank you for doing what needs to be done!!

 

[WisNeuro]

I have oodles of loans (pretend you can hear Hannibal's voice saying this).

Loan packages are not as plentiful outside the VA, though you could pretty easily stay non-profit as there are any systems designated as such and go for PSLF.

 

[deleted1129370]

Loan packages are not as plentiful outside the VA, though you could pretty easily stay non-profit as there are any systems designated as such and go for PSLF.

At least with VA, I can do PSLF plus EDRP. Not sure if such a thing exists with other non-profit organizations.

 

[WisNeuro]

At least with VA, I can do PSLF plus EDRP. Not sure if such a thing exists with other non-profit organizations.

Not sure, i am vaguely aware of some places that offer a certain amount for loans every year, but not something I've looked into, personally. I am debt averse and would hate having that over me for the duration of PSLF. With my spouse's med school loans, we opted to spend a couple years living frugally and working extra to just pay them off outright.

 

[AcronymAllergy]

VA's EDRP is a solid benefit for those with loans, especially with the increases in cap amounts and the number of positions that qualify for it. I would imagine most psych folks could pay off even a relatively hefty loan in 5 years. You just have to decide whether you want to go that way in half the time (which I'd recommend, as there's less risk) or bank (literally) on PSLF in 10 years. And also, if you're paying over the minimum amount, just be sure that your loan stays out of "pay ahead" status (unless the recent PSLF waiver took care of that).

The annual bonuses were, honestly, comical, particularly relative to physicians. I believe our annual bonuses were capped at $1000, with most folks getting less than that, and were heavily dependent on your supervisor completing your paperwork on time. Meanwhile, physicians, I believe, were in the $15-20k range (and you'd better believe they would raise holy hell anytime anyone talked about policies that would make those bonuses harder to get).

Also, at my facility, during the height of COVID, nurses coming into the clinic in-person got hazard pay. Psychologists did not.

Although I should note that our service line leadership was not especially psychologist-friendly despite psychologists making up the bulk of MH staff, so it may be different elsewhere.

 

[deleted1129370]

VA's EDRP is a solid benefit for those with loans, especially with the increases in cap amounts and the number of positions that qualify for it. I would imagine most psych folks could pay off even a relatively hefty loan in 5 years. You just have to decide whether you want to go that way in half the time (which I'd recommend, as there's less risk) or bank (literally) on PSLF in 10 years. And also, if you're paying over the minimum amount, just be sure that your loan stays out of "pay ahead" status (unless the recent PSLF waiver took care of that).

The annual bonuses were, honestly, comical, particularly relative to physicians. I believe our annual bonuses were capped at $1000, with most folks getting less than that, and were heavily dependent on your supervisor completing your paperwork on time. Meanwhile, physicians, I believe, were in the $15-20k range (and you'd better believe they would raise holy hell anytime anyone talked about policies that would make those bonuses harder to get).

Also, at my facility, during the height of COVID, nurses coming into the clinic in-person got hazard pay. Psychologists did not.

Although I should note that our service line leadership was not especially psychologist-friendly despite psychologists making up the bulk of MH staff, so it may be different elsewhere.

Why do we as psychologists suck at advocating for ourselves? Do we fear coming off too pushy? Do we fear that we would be perceived by others as "un-psychologist-like" for asking for more money and/or better representation as a health professions field? I am very much a capitalist, so when it comes time for advocating for $$ for my hard-earned work, you better believe I will.