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

[Shiori]

We keep neuropsychologists about a year at my current location. My last site has been looking for over a year now. I'm in the Midwest.

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[WisNeuro]

We keep neuropsychologists about a year at my current location. My last site has been looking for over a year now. I'm in the Midwest.

What are you, the Illiana system? They've been recruiting for neuropsych since I was a trainee. I swear I see that job ad every few months.

 

[Shiori]

Haha, close! I'm in the Heartland system. Weirdly, no one is feeling the Kansas and Missouri areas.

 

[WisNeuro]

Haha, close! I'm in the Heartland system. Weirdly, no one is feeling the Kansas and Missouri areas.

If I was gonna go that area, I'd shoot for Omaha, NE. Good system there with a nice starting salary and benefits package.

 

[AcronymAllergy]

As I forward yet another testing consult to community care: is anyone else's facility having trouble finding neuropsychologists? I know that my VISN is having that issue, but was wondering if it's an issue nationwide.

My facility was as well, yes; at one point there were none, although they were able to pick up a couple once they began paying consistently and with less red tape. The quality of said neuropsychologists' reports varied substantially, which is the unfortunate side-effect of paying below-market rates or taking forever to pay providers.

They were also having trouble recruiting VA neuropsychologists.

 

[WisNeuro]

My facility was as well, yes; at one point there were none, although they were able to pick up a couple once they began paying consistently and with less red tape. The quality of said neuropsychologists' reports varied substantially, which is the unfortunate side-effect of paying below-market rates or taking forever to pay providers.

They were also having trouble recruiting VA neuropsychologists.

And apparently retaining the ones they had

 

[cara susanna]

We keep neuropsychologists about a year at my current location. My last site has been looking for over a year now. I'm in the Midwest.

Also in the Midwest and our site has been looking for over a year. Maybe almost two now?

 

[WisNeuro]

Also in the Midwest and our site has been looking for over a year. Maybe almost two now?

Are you at the main hospital or a CBOC over there?

 

[psycho1391]

What are you, the Illiana system? They've been recruiting for neuropsych since I was a trainee. I swear I see that job ad every few months.

They have been recruiting for a lot of positions for months. I did my internship there and have a colleague who works there. They are now offering a special salary rate which is nice for that area.

 

[WisNeuro]

They have been recruiting for a lot of positions for months. I did my internship there and have a colleague who works there. They are now offering a special salary rate which is nice for that area.

I'm not surprised, they've had trouble recruiting for more than a decade for neuro alone.

 

[cara susanna]

Are you at the main hospital or a CBOC over there?

CBOC. Our main hospital has plenty of neuropsychologists, but they're hours away.

 

[WisNeuro]

CBOC. Our main hospital has plenty of neuropsychologists, but they're hours away.

Ah, yeah, I thought EL and KP were still at the main hospital and that they had hired a couple more in the meantime. CBOCs are always hard to get specialists.

 

[deleted1038433]

As I forward yet another testing consult to community care: is anyone else's facility having trouble finding neuropsychologists? I know that my VISN is having that issue, but was wondering if it's an issue nationwide.

Of the VAs I've worked at, the only one struggling to get neuropsychologists/any psychologists was in Ohio.

 

[texanpsychdoc]

Let's just say, part of the agreement for my accepting and subsequently joining the SDTP team at my new VA was that I would be allowed t carve out time in my grid to do psych testing. I had my team meeting today for SDTP and my director had me advertise my services, discuss why testing is helpful, what type of testing I do, etc. Well...luck would have it, that I have more red tape to get through. Evidently there is a separate (non neuro) testing clinic there in which I will need to coordinate with to iron out logistics. That was a bit defeating today. I actually interviewed for that testing clinic job and selected the SDTP role instead because I really didn't see myself working with one of the supervisors in that clinic...so now it looks like I may have to on some level.

 

[WisNeuro]

Of the VAs I've worked at, the only one struggling to get neuropsychologists/any psychologists was in Ohio.

The main hospitals generally have little problem recruiting, or at least did not when I was there. We'd get dozens of applications for spots offered. However, the CBOCs almost universally have had recruitment problems, particularly with specialty providers. I'm sure there are some pockets that do well, but I trained worked at a handful of VA hospitals and this was always the case. Heck, at one VA, we actually had to set aside a day of every week to drive out to CBOCs to do evals.

 

[Pragma]

Also in the Midwest and our site has been looking for over a year. Maybe almost two now?

I doubt I could go back after leaving, habituated to the substantially higher earnings outside of VA for neuropsychologists.

 

[PsyDWannabe]

Many of us are not in the choice program, and, around here, most practices are currently booking late spring/early summer 2023.

Huh?? Damn. I need to speed up my PP plans.

 

[PsyDWannabe]

Of the VAs I've worked at, the only one struggling to get neuropsychologists/any psychologists was in Ohio.

I wonder why. Any thoughts? From you or anyone else who can speak to the issue?

 

[PsyDWannabe]

Let's just say, part of the agreement for my accepting and subsequently joining the SDTP team at my new VA was that I would be allowed t carve out time in my grid to do psych testing. I had my team meeting today for SDTP and my director had me advertise my services, discuss why testing is helpful, what type of testing I do, etc. Well...luck would have it, that I have more red tape to get through. Evidently there is a separate (non neuro) testing clinic there in which I will need to coordinate with to iron out logistics. That was a bit defeating today. I actually interviewed for that testing clinic job and selected the SDTP role instead because I really didn't see myself working with one of the supervisors in that clinic...so now it looks like I may have to on some level.

Damn. I sympathize. That really sucks.

 

[Dr_Bee]

Any inpatient psychologists here? I am new to the role and trying to figure out billing, specifically for interactions that don't meet the time requirements for "therapy." For example, it's not uncommon for me to have a 10 minute interaction with a Veteran who is experiencing psychotic symptoms, but who cannot tolerate a full 17-37minute "therapy session." I have been documenting these under the admin clinic, so essentially not billing, but I'm wondering if I am billing correctly. The program manager (psychiatrist) and others have not been able to provide guidance. Any thoughts?

 

[texanpsychdoc]

Any inpatient psychologists here? I am new to the role and trying to figure out billing, specifically for interactions that don't meet the time requirements for "therapy." For example, it's not uncommon for me to have a 10 minute interaction with a Veteran who is experiencing psychotic symptoms, but who cannot tolerate a full 17-37minute "therapy session." I have been documenting these under the admin clinic, so essentially not billing, but I'm wondering if I am billing correctly. The program manager (psychiatrist) and others have not been able to provide guidance. Any thoughts?

You could use t1016 for case management, 90832/4/7 for those 16+ minutes.

 

[WisNeuro]

H&B codes if they apply

 

[Sanman]

Any inpatient psychologists here? I am new to the role and trying to figure out billing, specifically for interactions that don't meet the time requirements for "therapy." For example, it's not uncommon for me to have a 10 minute interaction with a Veteran who is experiencing psychotic symptoms, but who cannot tolerate a full 17-37minute "therapy session." I have been documenting these under the admin clinic, so essentially not billing, but I'm wondering if I am billing correctly. The program manager (psychiatrist) and others have not been able to provide guidance. Any thoughts?

I am not an inpatient psychologist, but It really depends on the purpose of these brief interactions and how it is documented. As mentioned above, t1016 can be used for treatment monitoring and maybe helpful if the interim goal is monitor their fitness for tolerating psychotherapy. H&B codes have changed to an initial 30 min treatment code, so the same 16 min rule really applies as it does for the 90832. If not, historical notes certainly can be used. I would suggest discussing this with any supervisor in the psychology dept that does your performance eval and asking the national listserv if there is one for inpatient.

 

[ccpsych16]

Any inpatient psychologists here? I am new to the role and trying to figure out billing, specifically for interactions that don't meet the time requirements for "therapy." For example, it's not uncommon for me to have a 10 minute interaction with a Veteran who is experiencing psychotic symptoms, but who cannot tolerate a full 17-37minute "therapy session." I have been documenting these under the admin clinic, so essentially not billing, but I'm wondering if I am billing correctly. The program manager (psychiatrist) and others have not been able to provide guidance. Any thoughts?

This doesn’t answer your main question (I am not inpatient but did an inpatient rotation on internship), but if you aren’t using the interactive complexity code, you likely could for most of your encounters. I’m not sure if there are any restrictions with what the primary code should be. But I used it on inpatient quite a bit.

 

[WisNeuro]

This doesn’t answer your main question (I am not inpatient but did an inpatient rotation on internship), but if you aren’t using the interactive complexity code, you likely could for most of your encounters. I’m not sure if there are any restrictions with what the primary code should be. But I used it on inpatient quite a bit.

Wouldn't be a problem in the VA, but in other settings, you'll for sure get an audit if you are using this a lot.

 

[stilllooking]

I got a verbal notice of selection on Friday from a VA position I applied to. I'm obviously not quitting my day job yet, of course, but does anyone know how long these take to become "real"?

 

[texanpsychdoc]

I got a verbal notice of selection on Friday from a VA position I applied to. I'm obviously not quitting my day job yet, of course, but does anyone know how long these take to become "real"?

VA onboarding usually takes 3-4 months. I just transferred from one VA to the another, and I did mine in about 3 months and was regarded as the fastest onboarding they have done in history....and they told me I practically onboarded myself. I did. I am very annoying and don't put up with B.S., I am very over control when it comes to stuff like this, so I do a lot of hand holding, pestering, emailing, calling, TEAMS messaging, etc. I make sure people are doing what they need to be doing when they tell me they are going to have it done by. Then I hold them accountable when they fail to do so.

I should add. Your verbal offer and frankly the "written" offer you will get are tentative. The actual full offer will be given to you probably 1-2 days right before you are supposed to begin new employee orientation.

 

[Dr_Bee]

I am not an inpatient psychologist, but It really depends on the purpose of these brief interactions and how it is documented. As mentioned above, t1016 can be used for treatment monitoring and maybe helpful if the interim goal is monitor their fitness for tolerating psychotherapy. H&B codes have changed to an initial 30 min treatment code, so the same 16 min rule really applies as it does for the 90832. If not, historical notes certainly can be used. I would suggest discussing this with any supervisor in the psychology dept that does your performance eval and asking the national listserv if there is one for inpatient.

T1016 may be an option. I currently don’t have a supervisory psychologist. I’m the only psychologist on the unit and I believe my program manager, who is a psychiatrist will be conducting my performance eval. I have asked a few psychologists in leadership positions and they did suggest the T1016 also but no one seems to have a definitive answer. Posting in the listserv is likely my best bet - thanks!

 

[Dr_Bee]

This doesn’t answer your main question (I am not inpatient but did an inpatient rotation on internship), but if you aren’t using the interactive complexity code, you likely could for most of your encounters. I’m not sure if there are any restrictions with what the primary code should be. But I used it on inpatient quite a bit.

I have heard some mixed views on the interactive complexity code. I was in a billing presentation last year (I know, riveting) and the presenter basically said the code is clinic specific, meaning that if you see a lot of folks who are in crisis, experiencing psychotic symptoms etc. you should only be using the code if the interaction is MORE complex than what is typical for your clinic. I admit this doesn’t sit exactly right with me, since the majority of the folks I see would likely qualify for the complexity code in MHC, but I have adopted this more conservative approach, and have yet to use the complexity code. I could be way off and would also take any feedback on views on the use of this code.

 

[Dr_Bee]

I got a verbal notice of selection on Friday from a VA position I applied to. I'm obviously not quitting my day job yet, of course, but does anyone know how long these take to become "real"?

I agree with ohiopsych 3+ months is a good estimate. VA onboarding is not great nor efficient.

 

[ccpsych16]

I have heard some mixed views on the interactive complexity code. I was in a billing presentation last year (I know, riveting) and the presenter basically said the code is clinic specific, meaning that if you see a lot of folks who are in crisis, experiencing psychotic symptoms etc. you should only be using the code if the interaction is MORE complex than what is typical for your clinic. I admit this doesn’t sit exactly right with me, since the majority of the folks I see would likely qualify for the complexity code in MHC, but I have adopted this more conservative approach, and have yet to use the complexity code. I could be way off and would also take any feedback on views on the use of this code.

Thank you for sharing. I hadn’t heard that, but their rationale makes sense. But, I lean more toward agreeing with your interpretation. It could’ve just been the group of folks I worked with, but a large majority were experiencing active psychotic symptoms but I was still expected to somehow do a “therapy” session with them. In those cases, I used the code despite that presentation being the reason they were hospitalized in the first place. Outside of inpatient, I’ve used it a handful of times, mostly in context of disruptive/aggressive behavior.

 

[Pragma]

I got a verbal notice of selection on Friday from a VA position I applied to. I'm obviously not quitting my day job yet, of course, but does anyone know how long these take to become "real"?

Took me 6 months. Total from interview to start date. Think it was 3-4 from verbal offer as others have said and I did proactively try to push credentialing.

 

[Sanman]

I have heard some mixed views on the interactive complexity code. I was in a billing presentation last year (I know, riveting) and the presenter basically said the code is clinic specific, meaning that if you see a lot of folks who are in crisis, experiencing psychotic symptoms etc. you should only be using the code if the interaction is MORE complex than what is typical for your clinic. I admit this doesn’t sit exactly right with me, since the majority of the folks I see would likely qualify for the complexity code in MHC, but I have adopted this more conservative approach, and have yet to use the complexity code. I could be way off and would also take any feedback on views on the use of this code.

I am not sure I agree with this interpretation of interactive complexity. That said, most of the criteria for use of the interactive complexity code actually is not likely to apply unless you are interacting with a guardian. The main criteria would likely be:

1. The need to manage maladaptive communication (e.g., related to high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.

The level of this is rather vague. Given that the reimbursement for the code is minimal and audit risk is increased, I imagine one can choose their level of risk based on their setting and risk tolerance.

 

[JustNoticing]

Any inpatient psychologists here? I am new to the role and trying to figure out billing, specifically for interactions that don't meet the time requirements for "therapy." For example, it's not uncommon for me to have a 10 minute interaction with a Veteran who is experiencing psychotic symptoms, but who cannot tolerate a full 17-37minute "therapy session." I have been documenting these under the admin clinic, so essentially not billing, but I'm wondering if I am billing correctly. The program manager (psychiatrist) and others have not been able to provide guidance. Any thoughts?

yep, I'm inpatient and counting my blessings, because so far they haven't made me do encounters at all, though they are threatening to change this soon. So haven't fully explored what billing/coding options are a best fit. IMO, your manager should work with you/on your behalf and not have you set up to be 100% clinical in the same way as an outpatient provider, because there are things like that that you may chart on but won't be able to bill for, "milieu therapy" and the like.

Also your understanding of interactive complexity seems incorrect, and likely would be something you'd use with some frequency in an inpatient setting. Interactive complexity doesn't mean they are complex patients, it means they are engaging in some behavior that makes it uniquely challenging to do your job, among other things. Do some research on the specifics. I'd be happy to send you some resources on coding. Be aware that the note content should justify the code use for IC.

 

[texanpsychdoc]

I've officially been in my new/transferred position for a month. Today is one of those days where I ask myself "why the hell did you agree to stay on with the VA?" Silly me for thinking it would be dramatically different than my previous position. I've come to the realization that I will not be able to do what I want to do professionally here. I am to do what they need, and that is it. I can see why folks don't stay with the VA. I have some other options, including two standing offers that are aligned with my professional interests (i.e., testing/assessment with some therapy). I'm going to try to give this position a year....then re-evaluate.

 

[AcronymAllergy]

I've officially been in my new/transferred position for a month. Today is one of those days where I ask myself "why the hell did you agree to stay on with the VA?" Silly me for thinking it would be dramatically different than my previous position. I've come to the realization that I will not be able to do what I want to do professionally here. I am to do what they need, and that is it. I can see why folks don't stay with the VA. I have some other options, including two standing offers that are aligned with my professional interests (i.e., testing/assessment with some therapy). I'm going to try to give this position a year....then re-evaluate.

Sorry to hear you're experiencing what sounds like some (unfortunately) not-uncommon VA frustration. But giving things a year sounds like a good idea. This type of situation can change markedly with changes in leadership, staffing, and/or VA's mission-of-the-moment. Heck, if you keep pushing for what you'd like to do in the ways available to you, your efforts might even benefit other psychologists for years to come.

Outside of a few specific areas (e.g., neuropsych, transplant), VA definitely does prioritize treatment/therapy over assessment. But maybe you can still work to carve out some amount of time for testing; I saw it done at the last VA where I worked.

 

[cara susanna]

How it often feels being a therapist in OPMH

 

[Sanman]

I've officially been in my new/transferred position for a month. Today is one of those days where I ask myself "why the hell did you agree to stay on with the VA?" Silly me for thinking it would be dramatically different than my previous position. I've come to the realization that I will not be able to do what I want to do professionally here. I am to do what they need, and that is it. I can see why folks don't stay with the VA. I have some other options, including two standing offers that are aligned with my professional interests (i.e., testing/assessment with some therapy). I'm going to try to give this position a year....then re-evaluate.

You have just defined the purpose of a job. I agree that giving it a year is a good thing. I would also take into consideration your life priorities in addition to your career interests. Sometimes there is no ideal job other than maybe one you create for yourself. You can choose to have a bit of patience and maybe build that in the VA system as you get the chance, go elsewhere hoping for greener pastures, or decide to give it a go working for yourself. There are many reasons not to stay at the VA. That said, I am glad there are plenty of job options here. More options is always better than less.

 

[Pragma]

You have just defined the purpose of a job. I agree that giving it a year is a good thing. I would also take into consideration your life priorities in addition to your career interests. Sometimes there is no ideal job other than maybe one you create for yourself. You can choose to have a bit of patience and maybe build that in the VA system as you get the chance, go elsewhere hoping for greener pastures, or decide to give it a go working for yourself. There are many reasons not to stay at the VA. That said, I am glad there are plenty of job options here. More options is always better than less.

Yep, pros and cons to each setting for sure. In AMCs it isn’t as if I can choose to only do the things I like to do. You just hope that you can spend most of your time doing what you like doing. A key point here is that sometimes that is built/earned and not immediately given to you.

 

[ThatPsyGuy]

Yep, pros and cons to each setting for sure. In AMCs it isn’t as if I can choose to only do the things I like to do. You just hope that you can spend most of your time doing what you like doing. A key point here is that sometimes that is built/earned and not immediately given to you.

Alright, what does AMC stand for. I keep searching for it, but I'm pretty sure it's not the American multi-cinema, mathematics completion, or maritime college.

 

[texanpsychdoc]

Alright, what does AMC stand for. I keep searching for it, but I'm pretty sure it's not the American multi-cinema, mathematics completion, or maritime college.

Academic Medical Center.

 

[erg923]

I've officially been in my new/transferred position for a month. Today is one of those days where I ask myself "why the hell did you agree to stay on with the VA?" Silly me for thinking it would be dramatically different than my previous position. I've come to the realization that I will not be able to do what I want to do professionally here. I am to do what they need, and that is it. I can see why folks don't stay with the VA. I have some other options, including two standing offers that are aligned with my professional interests (i.e., testing/assessment with some therapy). I'm going to try to give this position a year....then re-evaluate.

Sorry, have to agree with others. A "job" at a large facility is what it needs to be. You sound like you want clinical practice freedom that would come almost only from a private practice? Or at least not a primary treatment oriented/facing position?

I also think early-career psychologists can be somewhat surprised to find out that psychology's big ole tests/test batteries are not quite as valued in the fast paced, cost-conscious business of public healthcare delivery as they probably were in graduate school and internship... where such things were almost never considered or talked about.

 

[Sanman]

Sorry, have to agree with others. A "job" at a large facility is what it needs to be. You sound like you want clinical practice freedom that would come almost only from a private practice? Or at least not a primary treatment oriented/facing position?

I also think early-career psychologists can be somewhat surprised to find out that psychology's big ole tests/test batteries are not quite as valued in the fast paced, cost-conscious business of public healthcare delivery as they probably were in graduate school and internship... where such things were almost never considered or talked about.

I find that to be true of many of the skills learned in graduate school. Teaching is often poorly paid (ask any adjunct), research skills mean nothing without good grant writing skills, etc.

 

[erg923]

I find that to be true of many of the skills learned in graduate school. Teaching is often poorly paid (ask any adjunct), research skills mean nothing without good grant writing skills, etc.

The North Chicago VA had a GS-14 position posted some years ago for a TD for their internship and post-doc program. I think 10% clinical time, which let's face is it either nothing/meaningless or would have often been deferred, I would imagine. This was all pre-COVID though.

I would think that this position that could really pay-off for a talented early-career person who may be starting to get burnt? Managing alot of staff and intern/post-docs mind you, and not sure the greatness of GS-14 in the suburbs of Chicago. But still, similar opportunities may still exist out there in some VA systems?

 

[AcronymAllergy]

The North Chicago VA had a GS-14 position posted some years ago for a TD for their internship and post-doc program. I think 10% clinical time, which lets face it it either nothing/meaningless or would have often been eschewed, I would imagine. This was all pre-COVID though.

I would think that this position that could really pay-off for a talented early-career person who may starting to get burnt? Managing alot of staff and intern/post-docs mind you, and not sure how great GS-14 in the suburbs of Chicago. But still, similar opportunities may still exist out there in some VA systems?

Yep, director of training positions with limited allocated clinical time can be great finds, doubly so if they're GS-14. Last I saw, I think it was maybe a 50/50 split for DOT positions between GS-13 and GS-14, but I could be remembering that incorrectly. It's almost entirely based on local leadership, as there's no national policy (or at least there wasn't last I heard).

VA also has research positions via MIRECC and elsewhere with various research/clinical splits, although I do believe grant writing would be expected. Might not be as cut-throat as your typical AMC position, though.

 

[Pragma]

Yep, director of training positions with limited allocated clinical time can be great finds, doubly so if they're GS-14. Last I saw, I think it was maybe a 50/50 split for DOT positions between GS-13 and GS-14, but I could be remembering that incorrectly. It's almost entirely based on local leadership, as there's no national policy (or at least there wasn't last I heard).

VA also has research positions via MIRECC and elsewhere with various research/clinical splits, although I do believe grant writing would be expected. Might not be as cut-throat as your typical AMC position, though.

At my old VA the DOT got .2

 

[texanpsychdoc]

Sorry, have to agree with others. A "job" at a large facility is what it needs to be. You sound like you want clinical practice freedom that would come almost only from a private practice? Or at least not a primary treatment oriented/facing position?

I also think early-career psychologists can be somewhat surprised to find out that psychology's big ole tests/test batteries are not quite as valued in the fast paced, cost-conscious business of public healthcare delivery as they probably were in graduate school and internship... where such things were almost never considered or talked about.

It sounds like I might be better off in private practice. I really like to limit 1. the amount of administrative/bureaucratic BS, 2. the amount of people I have to answer to, 3. the amount of time I spend contemplating what the hell I am doing. I just transferred, so it would likely be pretty bad if I bailed out too early into this. I am really trying to give things/people a benefit of the doubt, but thus far, this VA has far more administrative BS than I had to deal with at my previous VA. It's like this VA is competing for the most amount of red tape one has to cut through to just be left the hell alone to practice psychology.

 

[erg923]

It sounds like I might be better off in private practice. I really like to limit 1. the amount of administrative/bureaucratic BS, 2. the amount of people I have to answer to, 3. the amount of time I spend contemplating what the hell I am doing. I just transferred, so it would likely be pretty bad if I bailed out too early into this. I am really trying to give things/people a benefit of the doubt, but thus far, this VA has far more administrative BS than I had to deal with at my previous VA. It's like this VA is competing for the most amount of red tape one has to cut through to just be left the hell alone to practice psychology.

I mean...yea. I'm not sure what have might have been "verbally promised" to you or whatever. But yea. Aren't you a Houston VA clinic/location? Its a HUGE system. And I'm sure filled with many early career folks who are either burnt, getting burnt, or have recently been promoted to somewhat nonsensical managerial roles or "champion" positions?

I started at the VA 10 years ago and left in 2018..... and I don't get the sense its even close to the same organization I was hired into? Stories I know from the 80s, 90s and early 2000s are even crazier considering current policies/practices people have told to me.

I sent a PM to you back in August or so, I think? I am happy to talk more if you would like. If you are a Ph.D. and are well rounded and have some stats competence, we might have some upcoming roles available for the right person.

 

[texanpsychdoc]

I mean...yea. I'm not sure what have might have been "verbally promised" to you or whatever. But yea. Aren't you a Houston VA clinic/location? Its a HUGE system. And I'm sure filled with many early career folks who are either burnt, getting burnt, or have recently been promoted to somewhat nonsensical managerial roles or "champion" positions?

I started at the VA 10 years ago and left in 2018..... and I don't get the sense its even close to the same organization I was hired into? Stories I know from the 80s, 90s and early 2000s are even crazier considering current policies/practices people have told to me.

I sent a PM to you back in August or so, I think? I am happy to talk more if you would like. If you are a Ph.D. and are well rounded and have some stats competence, we might have some upcoming roles available for the right person.

Yeah I am at Houston VA. Indeed - it seems like several folks have been promoted into supervisory roles, or, roles where they have reduced clinical focus. We had a meeting today and all I heard where some folks advocating "let's saddle the new guy with as many folks as possible." I was like "yeah, this won't last long." I remember they pulled this crap with me back in Columbus, and I found "creative" ways of not doing some work. At first I capitulated and I got burnt out real fast for a while. That was a dark time that I won't discuss. I don't want to get to that point again. If the fun of doing this works is gone, I don't want to do it anymore. I will find something else. So, right now, I am seeing some potential red flags, I am unsure if they are legitimate or if my brain is being biased, but I just don't know how much more I will tolerate of VAs crap. This is my third VA. Houston VA had a ton of openings recently - I was told they magically acquired some funding and were expanding, but evidently, the program I am in lost a bulk of its providers for some reason. New management came in, and now the place is getting full staffed, albeit slowly. Heck, today they voluntold me to do contingency management for an undetermined period of time since the provider doing it is stopping that. I was like "I can't emphasize enough how much I do not want to do CM, so how long will I be required to do this as VA-speak for short-term is highly variable."

Honestly, I think the only person I blame is myself. I likely rushed into this position thinking I'd be able to do a good deal of what I wanted to do (testing), but the reality is, evidently there is a supervisor for their testing clinic which is housed in the general mental health clinic, and I'd likely have to "answer" to them and will have to work within the parameters of what they will allow for me to do in terms of testing. I don't like that one bit. I didn't have that crap in Columbus. So it seems like I jumped from the pan into the fire on this one.

The good news is, I have options. On one hand I turned down an offer with a local AMC to do mostly testing with some therapy and it would be mostly inpatient with about 20% outpatient stuff. I also have a standing contract offer (just need to sign it and return) to do remote forensic evals remotely for a practice in Colorado. They quoted me $125 an hour for contract, of if I wanted salary I could do $90-100K. Alternatively, there is a law enforcement agency here in the area who was interested in me to work with them, but once they found out I took the VA offer, we put that on pause.

 

[erg923]

Yeah I am at Houston VA. Indeed - it seems like several folks have been promoted into supervisory roles, or, roles where they have reduced clinical focus. We had a meeting today and all I heard where some folks advocating "let's saddle the new guy with as many folks as possible." I was like "yeah, this won't last long." I remember they pulled this crap with me back in Columbus, and I found "creative" ways of not doing some work. At first I capitulated and I got burnt out real fast for a while. That was a dark time that I won't discuss. I don't want to get to that point again. If the fun of doing this works is gone, I don't want to do it anymore. I will find something else. So, right now, I am seeing some potential red flags, I am unsure if they are legitimate or if my brain is being biased, but I just don't know how much more I will tolerate of VAs crap. This is my third VA. Houston VA had a ton of openings recently - I was told they magically acquired some funding and were expanding, but evidently, the program I am in lost a bulk of its providers for some reason. New management came in, and now the place is getting full staffed, albeit slowly. Heck, today they voluntold me to do contingency management for an undetermined period of time since the provider doing it is stopping that. I was like "I can't emphasize enough how much I do not want to do CM, so how long will I be required to do this as VA-speak for short-term is highly variable."

Honestly, I think the only person I blame is myself. I likely rushed into this position thinking I'd be able to do a good deal of what I wanted to do (testing), but the reality is, evidently there is a supervisor for their testing clinic which is housed in the general mental health clinic, and I'd likely have to "answer" to them and will have to work within the parameters of what they will allow for me to do in terms of testing. I don't like that one bit. I didn't have that crap in Columbus. So it seems like I jumped from the pan into the fire on this one.

The good news is, I have options. On one hand I turned down an offer with a local AMC to do mostly testing with some therapy and it would be mostly inpatient with about 20% outpatient stuff. I also have a standing contract offer (just need to sign it and return) to do remote forensic evals remotely for a practice in Colorado. They quoted me $125 an hour for contract, of if I wanted salary I could do $90-100K. Alternatively, there is a law enforcement agency here in the area who was interested in me to work with them, but once they found out I took the VA offer, we put that on pause.

Ok.

Again, if you have some demonstrable skills in applying Clinical Science above and beyond individual neuropsychological testing/assessments work....we will be happy to speak with you for some leadership or pseudo-leadership positions in our company that involve help with our clinical and policy leadership. Full-time positions that are license eligible are allotted up to 8 hours per week to pursue clinical activities of their choosing,