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

[texanpsychdoc]

I was not talking about you. I was talking about veterans.

Ah, my apologies for misunderstanding.

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[WisNeuro]

Ah, my apologies for misunderstanding.

I don't doubt that the outfit is legit, but I suspect that they are making a very decent profit off your evals. I'll be curious if they do actually take an hour between interview and documentation. Either way, once you get your feet wet, that hourly compensation needs to adjust quite a bit upwards.

 

[texanpsychdoc]

I don't doubt that the outfit is legit, but I suspect that they are making a very decent profit off your evals. I'll be curious if they do actually take an hour between interview and documentation. Either way, once you get your feet wet, that hourly compensation needs to adjust quite a bit upwards.

I agree. Since I am new to all of this, and outside of the training I did for VA police evaluations, they seem very on top of their game, so I will definitely benefit from my work with them. I am already rolling out my website for my PLLC, but I am going to take some time doing so as I am going to do some things differently compared to my previous LLC in Ohio.

 

[cara susanna]

Yeah, I've been fortunate most of my more inappropriate clients are brief encounters. VVC has also been helpful in removing some of the threat. We have a few individuals here recently who have caused us to have to lock things down because they're pretty threatening. It's something I've been thinking about more. I keep my door locked even though my preference is the friendliness of an open door.

We're also slowly, but firmly shifting to a dose-based approach, which has caused a lot of resistance here. I'm trying to be proactive about introducing therapy as it will be done in the VA. Most people only need about 12ish session to see improvement. EBPs are strongly encouraged. Groups are also encouraged. I no-show at the end of the day SO PLEASE CALL. Also, I am mandated to chase a person down if they don't tell me with words that they would like to quit therapy. I want to lay out expectations earlier with the hope that I won't agitate someone unnecessarily.

I think I'll add not calling after hours to the list. I also want to find a balance between helping someone navigate a complicated system rather than doing it for them. I don't mind case management, but it puts me behind schedule pretty fast.

So many things to think about now that I get to make more decisions!

Please don't be afraid to file DBRS in these situations. There is this issue in the VA, at least here locally, where providers don't file them because they want to keep their relationship with the patient or make explanations for their behavior. But really it shouldn't be tolerated, regardless of their behaviors being understandable. DBRS reports establish a pattern, even if the individual behavior is not enough to warrant any action. The more is added on the more actual consequences can be enforced.

 

[Pragma]

Well, I just signed the contract last week and got access to their platform, software, library, so I will begin training and getting oriented to their process. I get $125 per eval for a minimum of 8 evals a week. I can do more if wanted, and I know they are wanting a full time salary psychologist.

I would not be surprised if they are fetching at least 1-3k for these.

 

[WisNeuro]

I would not be surprised if they are fetching at least 1-3k for these.

That was my guess as well, at least 4 figures.

 

[texanpsychdoc]

I would not be surprised if they are fetching at least 1-3k for these.

Agreed. At the same time, they are doing literally everything for me outside of my interview and writing up the report. Given their considerable resources being used, I "get it." I don't necessarily see this as a permanent experience, but rather, I will be able to acquire experience doing these in an ethical manner, while also acquiring hours for ABPP in both forensic and police/public safety psychology.

 

[Shiori]

Please don't be afraid to file DBRS in these situations. There is this issue in the VA, at least here locally, where providers don't file them because they want to keep their relationship with the patient or make explanations for their behavior. But really it shouldn't be tolerated, regardless of their behaviors being understandable. DBRS reports establish a pattern, even if the individual behavior is not enough to warrant any action. The more is added on the more actual consequences can be enforced.

This is a good reminder. We have definitely had an uptick in disruptive behaviors. Between NEO and CTT, I'm thinking about safety a lot right now.

 

[texanpsychdoc]

This is a good reminder. We have definitely had an uptick in disruptive behaviors. Between NEO and CTT, I'm thinking about safety a lot right now.

I had a vet this week who was aggressive with me, flung the door open and left after threatening suicide because we wouldn't admit them to RTP for detox since they just discharged like 2 days prior. I also have in the back of my mind that article of the chief psychologist who was shot and killed in his office at the El Paso VA due to an unfavorable C&P eval...Our VA has zero metal detectors at any of the entry points and I have never seen officers patrolling our floor.

 

[Psychologist1234]

Hi Everyone,

VA psychologist here. Does anyone know if VA psychologists are also able to participate in C&P evaluations as part of their private practice? I came across a recent job posting looking to add psychologists to their network of evaluators and thought it would be a nice addition to my private practice. I'm not sure if this would be a conflict of interests, as I would (likely) occasionally be seeing current and former patients for these C&P evals.

Thank you.

 

[WisNeuro]

Hi Everyone,

VA psychologist here. Does anyone know if VA psychologists are also able to participate in C&P evaluations as part of their private practice? I came across a recent job posting looking to add psychologists to their network of evaluators and thought it would be a nice addition to my private practice. I'm not sure if this would be a conflict of interests, as I would (likely) occasionally be seeing current and former patients for these C&P evals.

Thank you.

Call your liability insurer. Personally, I would not do this, for a variety of reasons. At the very least, you may have to recuse yourself from some cases.

 

[texanpsychdoc]

Hi Everyone,

VA psychologist here. Does anyone know if VA psychologists are also able to participate in C&P evaluations as part of their private practice? I came across a recent job posting looking to add psychologists to their network of evaluators and thought it would be a nice addition to my private practice. I'm not sure if this would be a conflict of interests, as I would (likely) occasionally be seeing current and former patients for these C&P evals.

Thank you.

I've stayed away from this as the optics may not be so favorable depending who could find out. Optics are pretty big in forensic-oriented work, even if what you are doing is technically within the VAs SOP or other regulatory bodies. In fact, back in Ohio I was given a disability case to review in a local PP and declined to do it as the person was a veteran that had been seen by the VA I was working at. I am doing police evals in PP outside of my VA job, and I know a lot of VAs are contracting that out to other providers, so, if/when that comes across my table, I will also decline to do that eval.

 

[AbnormalPsych]

Even if you could, too messy. And you don't have the umbrella of VA liability protecting you as you would doing these on your regular tour (barf, the terminology sticks even though I left)

 

[AcronymAllergy]

I agree with the folks above--I don't think the reward of doing C&P evals as a part of PP while still employed by the VA is worth the potential risk.

Depending on how much they'd pay you outside VA, if there's a significant backlog, they may be able to get you approved for overtime/extra pay to perform them as a VA employee outside regular work hours and on top of your regular duties. I'm pretty sure I've seen that done, although I don't know how the pay was.

At the very least, I know overtime approval is theoretically possible, particularly when there's need. I was approved for it to provide neuropsych evals, which I did on occasion earlier on in my career.

 

[erg923]

Hi Everyone,

VA psychologist here. Does anyone know if VA psychologists are also able to participate in C&P evaluations as part of their private practice? I came across a recent job posting looking to add psychologists to their network of evaluators and thought it would be a nice addition to my private practice. I'm not sure if this would be a conflict of interests, as I would (likely) occasionally be seeing current and former patients for these C&P evals.

Thank you.

no

 

[deleted1038433]

Which VA hospitals would you absolutely steer clear from? And yes, I recognize some of you might say "all of them."

 

[texanpsychdoc]

Which VA hospitals would you absolutely steer clear from? And yes, I recognize some of you might say "all of them."

I hear Dayton is a crapshoot.

 

[WisNeuro]

Which VA hospitals would you absolutely steer clear from? And yes, I recognize some of you might say "all of them."

Those in the PNW

 

[erg923]

Which VA hospitals would you absolutely steer clear from? And yes, I recognize some of you might say "all of them."

Probably not a fair question, to be honest. Things change literally year by year based on leadership and other variables. I heard some horror stories about places 10 years ago that probably aren't valid now.

The VAMC in which I interned also seemed quite functional and "easy" 10 years ago (very much 8-4:30 and free of BS mandates/pressures) but that was before alot of what seems to have come about (or become substantially worse) in the VA system in the past 4-5 years. There is also less than 50% of that internship training faculty remaining at that particular VAMC 10 years later....so that may say something, I don't know?

 

[Sanman]

Which VA hospitals would you absolutely steer clear from? And yes, I recognize some of you might say "all of them."

This is a bit like asking which chain restaurant locations to stay away from. There is a lot of turnover that happens both in the dept staff and in hospital management.

 

[Shiori]

Yeah, the VA where I interned might have been an absolute no a few years ago, but now is lovely and enjoyable. Sometimes a few changes in leadership make a huge difference. Just as easily as it changed for the better, it can regress into a place I would flee from. Hospital work is weird.

 

[IWillSurvive]

For people in general mental health or BHIP, how many clinical hours do you have per week in your grid? Even though they're supposedly standardizing this right now, I'm hearing wide variability (28-35 clinical hours on the grid). I'm wondering what the norm is. I can't imagine doing all of the documentation the VA requires for 35 patients per week. Yuck.

 

[AcronymAllergy]

For people in general mental health or BHIP, how many clinical hours do you have per week in your grid? Even though they're supposedly standardizing this right now, I'm hearing wide variability (28-35 clinical hours on the grid). I'm wondering what the norm is. I can't imagine doing all of the documentation the VA requires for 35 patients per week. Yuck.

I'm no longer with VA, but 35 is higher than I can recall ever seeing/hearing as a requirement. At my last VA, I believe somewhere in the 30 to 32 hour range was the expectation.

 

[WisNeuro]

I'm no longer with VA, but 35 is higher than I can recall ever seeing/hearing as a requirement. At my last VA, I believe somewhere in the 30 to 32 hour range was the expectation.

Yeah, my last placement had therapists grid out 32 hours, but knowing that you'd usually get a handful of no-shows/late cancels in there.

 

[texanpsychdoc]

For people in general mental health or BHIP, how many clinical hours do you have per week in your grid? Even though they're supposedly standardizing this right now, I'm hearing wide variability (28-35 clinical hours on the grid). I'm wondering what the norm is. I can't imagine doing all of the documentation the VA requires for 35 patients per week. Yuck.

I have to allocate 32 hours, of which meetings count as .5 (I have two of those a week), but now they've changed the requirements that for the meetings to count, we must spend 30 minutes talking about a veteran, documenting it with the appropriate CPT code as well. Again...my grid is allocated for 32 hours, but actually seeing folks for 32 hours is a different story . Since I split my time in my SUD clinic with the psych testing clinic, I allocate 25 hours in SUD and the remaining in testing clinic.

 

[Pragma]

How many of those hours are covered by trainees?

 

[texanpsychdoc]

How many of those hours are covered by trainees?

I don't have trainees. I refuse to be a supervisor

 

[cara susanna]

The new guidance is going to be 30 bookable hrs per week. I have less because I have time bought out for administrative stuff and an EBP training program that I'm a part of.

 

[texanpsychdoc]

"guidance"

 

[cara susanna]

"guidance"

Unfortunately, my understanding is that it's going to be pretty heavily enforced. There are already concerns being addressed about hours not counting for trainee supervision, training, etc.

 

[texanpsychdoc]

Unfortunately, my understanding is that it's going to be pretty heavily enforced. There are already concerns being addressed about hours not counting for trainee supervision, training, etc.

And just like that I will no longer be attending meetings I actually told someone back in Columbus, if you want to bump up my client hours, that's cool, but something will be taken off my plate, and I vote meetings.

 

[Sanman]

Unfortunately, my understanding is that it's going to be pretty heavily enforced. There are already concerns being addressed about hours not counting for trainee supervision, training, etc.

They better be looking to increase salaries then. If I wasn't exempt from this, I would have already taken a virtual therapy gig with a similar client load, less headaches, and possibly more money.

 

[AcronymAllergy]

Unfortunately, my understanding is that it's going to be pretty heavily enforced. There are already concerns being addressed about hours not counting for trainee supervision, training, etc.

That's definitely unfortunate. At least as far as clinical supervision, national guidance is that it's supposed to "count" for clinical time in that you should get a 1:1 reduction in bookable hours. Unless that's changed.

Supervising can already be a time-sink (although often an enjoyable one, if it's an interest), so further punishing folks for having trainees doesn't seem consistent with one of VA's main purposes of training healthcare providers.

 

[cara susanna]

That's definitely unfortunate. At least as far as clinical supervision, national guidance is that it's supposed to "count" for clinical time in that you should get a 1:1 reduction in bookable hours. Unless that's changed.

Supervising can already be a time-sink (although often an enjoyable one, if it's an interest), so further punishing folks for having trainees doesn't seem consistent with one of VA's main purposes of training healthcare providers.

Yeah, I think that in the end it will be addressed.

 

[PsychPhDone]

The new guidance is going to be 30 bookable hrs per week. I have less because I have time bought out for administrative stuff and an EBP training program that I'm a part of.

Any word on groups? More documentation time is needed.

 

[texanpsychdoc]

Any word on groups? More documentation time is needed.

I usually carve out 90 minutes (60 for group and 30 for notes).

 

[PsychPhDone]

I usually carve out 90 minutes (60 for group and 30 for notes).

As in you leave 90 min bookable hours but only run the group for 60?

I currently run a group for 90. Thankfully between my trainees and me, we spilt up notes so it doesn't take long. But if running it myself, documentation would take me 30+ mins. If group bookable time = individual bookable time, there's no incentive to run groups. There needs to be a documentation offset or something.

 

[deleted1038433]

I have also heard to stay away from Dayton /all of VISN 10 really and the PCN

 

[WisNeuro]

Y'all need better templates.

 

[Sanman]

Y'all need better templates.

Yup, it's okay though because Cerner is coming. Got love it when they provide "guidance" for us lowly healthcare providers and they can't get their stuff straight. Way to lead by example.

 

[cara susanna]

It also really helps to keep your sessions to 40-45 min and use that extra time for documentation, when possible. I know that also hurts RVUs but I think it's worth it, perosnally.

 

[Sanman]

It also really helps to keep your sessions to 40-45 min and use that extra time for documentation, when possible. I know that also hurts RVUs but I think it's worth it, perosnally.

Depends on how many hours you are booking. I would prefer to keep all of mine to 60 min if possible and see one less a day, but I know some folks can't do that because of grid setup.

 

[texanpsychdoc]

As in you leave 90 min bookable hours but only run the group for 60?

I currently run a group for 90. Thankfully between my trainees and me, we spilt up notes so it doesn't take long. But if running it myself, documentation would take me 30+ mins. If group bookable time = individual bookable time, there's no incentive to run groups. There needs to be a documentation offset or something.

our department head told me they block out 90 minutes for groups in order to give 30 minutes to folks for documenting. I don't need 30 minutes to document, I am pretty efficient with my time. I typically end at 45 minutes, then spend 10-15 documenting. But I won't pass up more time.

Y'all need better templates.

I don't need 90 minutes...it's given to me. Like my grandpa told me, don't pass up free food, free money, and free allotted psychological note writing (he didn't say that last bit, but it's implied).

Yup, it's okay though because Cerner is coming. Got love it when they provide "guidance" for us lowly healthcare providers and they can't get their stuff straight. Way to lead by example.

Oh, Cerner was pretty straight forward after getting used to it. In fact, now at my new VA, I had to switch back to using CPRS and I actually miss some functions on Cerner.

It also really helps to keep your sessions to 40-45 min and use that extra time for documentation, when possible. I know that also hurts RVUs but I think it's worth it, perosnally.

Yup, that's what I do. And I agree, I am not really concerned about getting strongly worded emails from the powers at be if I don't hit my RVUs. My message to them will always remain the same, "you need me a hell of a lot more than I need you."

 

[WisNeuro]

our department head told me they block out 90 minutes for groups in order to give 30 minutes to folks for documenting. I don't need 30 minutes to document, I am pretty efficient with my time. I typically end at 45 minutes, then spend 10-15 documenting. But I won't pass up more time.



I don't need 90 minutes...it's given to me. Like my grandpa told me, don't pass up free food, free money, and free allotted psychological note writing (he didn't say that last bit, but it's implied).

Oh, Cerner was pretty straight forward after getting used to it. In fact, now at my new VA, I had to switch back to using CPRS and I actually miss some functions on Cerner.



Yup, that's what I do. And I agree, I am not really concerned about getting strongly worded emails from the powers at be if I don't hit my RVUs. My message to them will always remain the same, "you need me a hell of a lot more than I need you."

My VA experience was different, I was usually looking for something to do by the end of the week, finishing out my ToD. The last half of Friday was usually spent reading for fun or tweaking my fantasy football lineup.

 

[texanpsychdoc]

My VA experience was different, I was usually looking for something to do by the end of the week, finishing out my ToD. The last half of Friday was usually spent reading for fun or tweaking my fantasy football lineup.

Let's just say my spouse always makes fun of me and usually comes home and asks me "so, did you actually work today?" They would say I've got the easiest job. In SUD work, it's even more so as the no show rate here is about 30% higher than what is typically associated with general outpatient no shows.

 

[PsychPhDone]

our department head told me they block out 90 minutes for groups in order to give 30 minutes to folks for documenting. I don't need 30 minutes to document, I am pretty efficient with my time. I typically end at 45 minutes, then spend 10-15 documenting. But I won't pass up more time.



I don't need 90 minutes...it's given to me. Like my grandpa told me, don't pass up free food, free money, and free allotted psychological note writing (he didn't say that last bit, but it's implied).

Oh, Cerner was pretty straight forward after getting used to it. In fact, now at my new VA, I had to switch back to using CPRS and I actually miss some functions on Cerner.



Yup, that's what I do. And I agree, I am not really concerned about getting strongly worded emails from the powers at be if I don't hit my RVUs. My message to them will always remain the same, "you need me a hell of a lot more than I need you."

Thanks for this info!

 

[IWillSurvive]

How many of those hours are covered by trainees?

none since these are remote positions and supervision is not allowed :/ (atleast in the VA's I am familiar with)

 

[IWillSurvive]

The new guidance is going to be 30 bookable hrs per week. I have less because I have time bought out for administrative stuff and an EBP training program that I'm a part of.

Nice that sounds like a good set up. Are you a consultant?

 

[IWillSurvive]

As in you leave 90 min bookable hours but only run the group for 60?

I currently run a group for 90. Thankfully between my trainees and me, we spilt up notes so it doesn't take long. But if running it myself, documentation would take me 30+ mins. If group bookable time = individual bookable time, there's no incentive to run groups. There needs to be a documentation offset or something.

I agree. And sending VVC links, secure messages with group materials, no show calls, etc. all of this makes me never want to run groups again (especially while remote)

 

[IWillSurvive]

It also really helps to keep your sessions to 40-45 min and use that extra time for documentation, when possible. I know that also hurts RVUs but I think it's worth it, perosnally.

I wish I was this organized/not ADD That sounds like a good use of time