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

[Shiori]

A rare rave and not a rant: FYI, VA librarians curate weekly? emails on new research articles in various topics (e.g., PTSD, women vets). I've found these to be a great resource for keeping up with the literature.

That sounds great! What is it called?

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[AcronymAllergy]

A rare rave and not a rant: FYI, VA librarians curate weekly? emails on new research articles in various topics (e.g., PTSD, women vets). I've found these to be a great resource for keeping up with the literature.

Wow, I don't think I ever knew about that. I will say that of all the employment-related gripes we levy at VA, their library services (and particularly their librarians, media specialists, etc.) have, in my experience, been pretty consistently great. They'll go to some great lengths to track down articles you need, borrow materials from other VAs, etc.

 

[cara susanna]

A rare rave and not a rant: FYI, VA librarians curate weekly? emails on new research articles in various topics (e.g., PTSD, women vets). I've found these to be a great resource for keeping up with the literature.

Me too! I subscribe to those emails.

 

[Shiori]

It only took close to two months to have a fully functional PIV card!

 

[cara susanna]

It only took close to two months to have a fully functional PIV card!

When I was an intern my PIV card randomly stopped working like 2-3 times. I even had to get my fingerprints redone at one point. I was like, is the VA trying to tell me something??

 

[Shiori]

They love to get my fingerprints. I was told I needed new prints because of all of the covid handwashing.

 

[AcronymAllergy]

I had my card randomly stop working while I was with VA at one point. I don't think the police ever figured out why.

 

[cara susanna]

You know that Joe Tiger "I'm never gonna financially recover from this" meme? I need a version of that about RVUs. Had one PE patient cancel and another no show!

 

[texanpsychdoc]

You know that Joe Tiger "I'm never gonna financially recover from this" meme? I need a version of that about RVUs. Had one PE patient cancel and another no show!

It's been no show central with me all this week.

 

[Shiori]

I'm spending my free time reading through all the bookability questions and answers in their database. I'm up to question 435 and it seems like a lot of people only have a vague idea of what bookability even means. Good or bad, I am worried about its implementation. Building a system based on exemptions seems especially challenging.

 

[medium rare]

It's been no show central with me all this week.

It’s too bad the VA won’t let you charge for no-shows.

 

[Shiori]

One of the local hospitals makes people who no-show twice go through psychotherapy orientation. I liked that system. People were pretty motivated not to have to sit through it as it was a little tedious.

 

[AbnormalPsych]

Remember when China and perhaps Russia, breached VA computers and HR systems last decade and took the the unencrypted records and bio data (including finger prints I think) for millions of vets and employees? What a perk of federal service.

 

[cara susanna]

Remember when China and perhaps Russia, breached VA computers and HR systems last decade and took the the unencrypted records and bio data (including finger prints I think) for millions of vets and employees? What a perk of federal service.

Yeah, whenever I'm worried about data breaches I'm like "eh, China has all of my info anyway."

 

[ccpsych16]

Remember when China and perhaps Russia, breached VA computers and HR systems last decade and took the the unencrypted records and bio data (including finger prints I think) for millions of vets and employees? What a perk of federal service.

I hadn’t heard about this. Certainly doesn’t help my case with reality testing client delusions about technology & being under attack.

 

[WisNeuro]

I hadn’t heard about this. Certainly doesn’t help my case with reality testing client delusions about technology & being under attack.

I mean, one of the most popular social media apps is likely heavily influenced by a certain government. These days they don't have to hack information, people will freely share it.

 

[texanpsychdoc]

I mean, one of the most popular social media apps is likely heavily influenced by a certain government. These days they don't have to hack information, people will freely share it.

Tik Tok right?

 

[Therapist4Chnge]

Wow, I don't think I ever knew about that. I will say that of all the employment-related gripes we levy at VA, their library services (and particularly their librarians, media specialists, etc.) have, in my experience, been pretty consistently great. They'll go to some great lengths to track down articles you need, borrow materials from other VAs, etc.

I loved the library staff at my former VA. They tracked down all sorts of articles for us, and I'd sometimes go there to decompress and read articles.

 

[cara susanna]

Someone here mentioned that you have a group patients have to attend if they no show, like a therapy orientation group. Whoever you are, can you please reach out to me privately? I can't find the post no matter how hard I search (so it's also possible this is a false memory). We're thinking of implementing something like that in our clinic and would love to see further info, especially materials.

Thanks!

 

[WisNeuro]

Someone here mentioned that you have a group patients have to attend if they no show, like a therapy orientation group. Whoever you are, can you please reach out to me privately? I can't find the post no matter how hard I search (so it's also possible this is a false memory). We're thinking of implementing something like that in our clinic and would love to see further info, especially materials.

Thanks!

Seattle/American Lake used to have something like this, but that was 5+years ago, so I have no idea if it's still a thing

 

[PsychPhDone]

Someone here mentioned that you have a group patients have to attend if they no show, like a therapy orientation group. Whoever you are, can you please reach out to me privately? I can't find the post no matter how hard I search (so it's also possible this is a false memory). We're thinking of implementing something like that in our clinic and would love to see further info, especially materials.

Thanks!

It was @Shiori but not their hospital

 

[unclefather]

Sharing my experience from the other side of the "bookability" hammer. I'm at a new VA. They have implemented the new guidance for maximum use of clinical time, which now means I have zero control over my schedule. If I have an open slot, it gets filled with a new intake patient. I'm seeing a billion new patients a week and then needing to set-up on-going weekly appointments with those people 2-3 months down the line, as every available slot is taken by new pts and pts I saw for intake 2 months ago. Even then, we've been instructed not to put special instructions in our orders (like a request for weekly therapy at a certain time). My MSA and I are going rogue and doing it anyway. I honestly don't understand how I would see pts more than once every 2 months if I couldn't put in special instructions. It's just crazy. This is so different from my former VA and I am slammed, seeing so many new people, writing up all those intake reports and feeling like I'm not really doing any actual therapy. For example, this week I saw 30 patients and 18 of them were intakes. Admin is completely inflexible. From their end, they are "reaching" way more Veterans. I am trying to stick it out here (at one of the historically dysfunctional VAs), but I feel like this is not normal and other VAs are at least slightly less dysfunctional? Is anyone else experiencing this? How do you manage it? Any advice on addressing this with supervisors?

 

[Sanman]

Sharing my experience from the other side of the "bookability" hammer. I'm at a new VA. They have implemented the new guidance for maximum use of clinical time, which now means I have zero control over my schedule. If I have an open slot, it gets filled with a new intake patient. I'm seeing a billion new patients a week and then needing to set-up on-going weekly appointments with those people 2-3 months down the line, as every available slot is taken by new pts and pts I saw for intake 2 months ago. Even then, we've been instructed not to put special instructions in our orders (like a request for weekly therapy at a certain time). My MSA and I are going rogue and doing it anyway. I honestly don't understand how I would see pts more than once every 2 months if I couldn't put in special instructions. It's just crazy. This is so different from my former VA and I am slammed, seeing so many new people, writing up all those intake reports and feeling like I'm not really doing any actual therapy. For example, this week I saw 30 patients and 18 of them were intakes. Admin is completely inflexible. From their end, they are "reaching" way more Veterans. I am trying to stick it out here (at one of the historically dysfunctional VAs), but I feel like this is not normal and other VAs are at least slightly less dysfunctional? Is anyone else experiencing this? How do you manage it? Any advice on addressing this with supervisors?

This is one of those things that middle/hospital management do because they are focusing on a certain stat. In this case, the only thing that seems to matter is time between consult and intake. I assume that they are asking you not to put specific orders in because then they can't just shove that person into a group or have them seen in whatever way they see fit. What you can do really depends on the local politics and what your boss/bosses notice and condone. The bigger question is whether you want to continue to deal with this and for how long. This is an issue that arises out of chronic understaffing that goes unaddressed. The VA is very specific about the information they need to hire more providers and it is a bit of a cart and horse situation. Rather than spending too much time banging your head against a wall, your time would likely be better spent on Usajobs/Indeed looking for a better position.

 

[Fan_of_Meehl]

Sharing my experience from the other side of the "bookability" hammer. I'm at a new VA. They have implemented the new guidance for maximum use of clinical time, which now means I have zero control over my schedule. If I have an open slot, it gets filled with a new intake patient. I'm seeing a billion new patients a week and then needing to set-up on-going weekly appointments with those people 2-3 months down the line, as every available slot is taken by new pts and pts I saw for intake 2 months ago. Even then, we've been instructed not to put special instructions in our orders (like a request for weekly therapy at a certain time). My MSA and I are going rogue and doing it anyway. I honestly don't understand how I would see pts more than once every 2 months if I couldn't put in special instructions. It's just crazy. This is so different from my former VA and I am slammed, seeing so many new people, writing up all those intake reports and feeling like I'm not really doing any actual therapy. For example, this week I saw 30 patients and 18 of them were intakes. Admin is completely inflexible. From their end, they are "reaching" way more Veterans. I am trying to stick it out here (at one of the historically dysfunctional VAs), but I feel like this is not normal and other VAs are at least slightly less dysfunctional? Is anyone else experiencing this? How do you manage it? Any advice on addressing this with supervisors?

I mean...I could argue that it falls beneath standard of care in professional psychology to make you do an intake with a patient, diagnose the patient with a serious psychological condition (e.g. MDD, PTSD), and then promptly delay all care for 2-3 months before even being able to initiate treatment.

However, I've never found it productive to reference such arcane concepts as 'standards of care' or 'standards of practice' in VA mental health settings. Apparently, they've never heard of these concepts or terms. If you really want their foreheads to crinkle, mention 'spontaneous remission rates '

Oh look, TMS says I'm late for my 'Holy Federal Angelic Ethics Competency Training Modules.' Gotta attend to muh 'ethics.' Ethics, ethics, ethics. We're ALL ABOUT the 'ethics' at Team VA. Yessireee....That and 'Whole Health... and...ummm.... patient care....

 

[Shiori]

My VA has intake slots and they are good about not scheduling folks outside of those times even though I'm new. We're decently staffed at the moment and our numbers have been solid lately.

 

[summerbabe]

This is so different from my former VA and I am slammed, seeing so many new people, writing up all those intake reports and feeling like I'm not really doing any actual therapy. For example, this week I saw 30 patients and 18 of them were intakes. Admin is completely inflexible. From their end, they are "reaching" way more Veterans. I am trying to stick it out here (at one of the historically dysfunctional VAs), but I feel like this is not normal and other VAs are at least slightly less dysfunctional? Is anyone else experiencing this? How do you manage it? Any advice on addressing this with supervisors?

Sorry to hear this. This is 100% not normal. Intake slots and follow-up slots should be differentiated, even if they are both 60 min apts. Or all intakes should be booked in an intake clinic where multiple providers see patients.

Are you freshly onboarded and thus have openings relative to long-standing staff who are super booked out? Or are other staff in this clinic also scheduled an absurd amount of intakes? Even if they aren't, if one of those psychologists gets a cancellation, would that slot get filled by an intake or somebody already on their panel? Do they have dedicated intake versus follow-up slots but you don't?

If this is isolated to you/new staff, I wonder if you are being used to see as many veterans as possible until your panel gets full enough that you can't do that anymore in order to help metrics and/or avoid further hits to the community care budget, both of which can be major management priorities.

Are any of your peers helpful? There are clear and obvious solutions (if management wants to implement them) but the current staff likely know what typically happens and what might be possible.

And check out USAJobs if you want to stay in VA or look elsewhere if not. If relocation isn't possible, there seem to be more and more remote jobs popping up and many offer perks like EDRP.

 

[unclefather]

Sorry to hear this. This is 100% not normal. Intake slots and follow-up slots should be differentiated, even if they are both 60 min apts. Or all intakes should be booked in an intake clinic where multiple providers see patients.

Are you freshly onboarded and thus have openings relative to long-standing staff who are super booked out? Or are other staff in this clinic also scheduled an absurd amount of intakes? Even if they aren't, if one of those psychologists gets a cancellation, would that slot get filled by an intake or somebody already on their panel? Do they have dedicated intake versus follow-up slots but you don't?

If this is isolated to you/new staff, I wonder if you are being used to see as many veterans as possible until your panel gets full enough that you can't do that anymore in order to help metrics and/or avoid further hits to the community care budget, both of which can be major management priorities.

Are any of your peers helpful? There are clear and obvious solutions (if management wants to implement them) but the current staff likely know what typically happens and what might be possible.

And check out USAJobs if you want to stay in VA or look elsewhere if not. If relocation isn't possible, there seem to be more and more remote jobs popping up and many offer perks like EDRP.

Everyone is experiencing this. I may have slightly more intakes than the average because I came on ~6 months ago but at this point I am about caught up with everyone. They have done away with intake/follow up slots. It's just a free for all. I know I am not the only one dealing with this. If a cancellation occurs, a new patient gets put in there. As someone above mentioned, the "stats" they are looking at are time between consult and intake (even if initiation of care takes 2+ months) and number of new Veterans who are seen in the clinic. I'm sure these stats look great. We absolutely hemorrhaged providers last year (and continue to) due to poor management, so those that have remained are all swamped. We have every incentive in the book right now, which is keeping me on at the moment. But this feels completely unsustainable. Peers are supportive as they can be but obviously extremely overworked themselves. Management is completely unhelpful and had me thinking this is how it is in every VA (which is why I found myself here), as these are national directives. My direct supervisor is kind but seems powerless.

To the person above who mentioned standard of care...I feel this is a huge liability and absolutely a road to something bad happening. They have also cut all training/supervision hours to one hour a week. Thanks all. Continue to tell me how this isn't normal so I can push back to the best of my ability.

 

[Fan_of_Meehl]

Everyone is experiencing this. I may have slightly more intakes than the average because I came on ~6 months ago but at this point I am about caught up with everyone. They have done away with intake/follow up slots. It's just a free for all. I know I am not the only one dealing with this. If a cancellation occurs, a new patient gets put in there. As someone above mentioned, the "stats" they are looking at are time between consult and intake (even if initiation of care takes 2+ months) and number of new Veterans who are seen in the clinic. I'm sure these stats look great. We absolutely hemorrhaged providers last year (and continue to) due to poor management, so those that have remained are all swamped. We have every incentive in the book right now, which is keeping me on at the moment. But this feels completely unsustainable. Peers are supportive as they can be but obviously extremely overworked themselves. Management is completely unhelpful and had me thinking this is how it is in every VA (which is why I found myself here), as these are national directives. My direct supervisor is kind but seems powerless.

To the person above who mentioned standard of care...I feel this is a huge liability and absolutely a road to something bad happening. They have also cut all training/supervision hours to one hour a week. Thanks all. Continue to tell me how this isn't normal so I can push back to the best of my ability.

It isn't normal. Not here. Though I will say the CBOCs have it rough in terms of this and some of them will delay initiation of care for 4+ months after intake which I think is absolutely insane. Four months in between intake and session 1 of psychotherapy. Oh...but we just had to get them in to 'see someone' stat! Get them in to see someone and then wait for four months to initiate a course of psychotherapy. Which means--even best case scenario (since psychotherapy is delivered in courses over time rather than in a single session (and, you're not even 'doing [much] psychotherapy/treatment' in the intake session) they might be expected to begin to meaningfully respond during the course of delayed psychotherapy approximately, say, five or more months after the intake session that they just had to have immediately.

Another thing that is absolutely insane is that, if they could somehow pull off charging veterans even a modest co-pay for appointments (at some point, say, after receiving at least 2 years of 'free' care), all of these issues (access, not enough providers, 'lifers' in therapy) would disappear. Overnight.

 

[WisNeuro]

It isn't normal. Not here. Though I will say the CBOCs have it rough in terms of this and some of them will delay initiation of care for 4+ months which I think is absolutely insane.

Another thing that is absolutely insane is that, if they could somehow pull off charging veterans even a modest co-pay for appointments (at some point, say, after receiving at least 2 years of 'free' care), all of these issues (access, not enough providers, 'lifers' in therapy) would disappear. Overnight.

Why do you hate freedom?

 

[Fan_of_Meehl]

Why do you hate freedom?

I just love that in the name of 'access' and 'best care anywhere' for our veterans...we make therapy 'free' and limitless...

And thereby end up delaying initiation of care by 2-4 MONTHS.

 

[WisNeuro]

I just love that in the name of 'access' and 'best care anywhere' for our veterans...we make therapy 'free' and limitless...

And thereby end up delaying initiation of care by 2-4 MONTHS.

As they say, freedom ain't free. Every now and then the Tree of Liberty must be refreshed with the tears of frustrated providers and patients.

 

[Sanman]

I just love that in the name of 'access' and 'best care anywhere' for our veterans...we make therapy 'free' and limitless...

And thereby end up delaying initiation of care by 2-4 MONTHS.

True. On the flip some folks would not have jobs without all that unnecessary volume.

 

[texanpsychdoc]

I've basically implemented a pretty radical version of boundaries at my VA and clinic. When I get social work asking me to squeeze in a veteran for a last minute intake to SDTP, I say "you need to speak with my MSA to see my next available intake slot." If a veteran misses their appointment, I tell them they need to get with my MSA to get scheduled into my next available intake slot. If I have a veteran who no shows me 3 times in a row, they go into call in status and I do not hunt them down. For folks who no show, I simply call once and document and that's it. I do not expend more energy than that. Right now, my SDTP clinic has me doing 4 EBA intakes a week. I also do various groups, including contingency management. I do not hunt people down when they no show. I take an hour for lunch every day. I tell veterans upfront in our intake, that if they are not interested in individual or IOP treatment, then this will be our only meeting if/until they change their minds and pursue our offered therapies. I see informed consent as ongoing, not just a one and done thing you do in the initial visit. When I see folks for therapy, I have a different informed consent discussion that outlines the expectations going forward. If they are amendable to it, then we go forward, if not, see ya...

 

[AcronymAllergy]

Everyone is experiencing this. I may have slightly more intakes than the average because I came on ~6 months ago but at this point I am about caught up with everyone. They have done away with intake/follow up slots. It's just a free for all. I know I am not the only one dealing with this. If a cancellation occurs, a new patient gets put in there. As someone above mentioned, the "stats" they are looking at are time between consult and intake (even if initiation of care takes 2+ months) and number of new Veterans who are seen in the clinic. I'm sure these stats look great. We absolutely hemorrhaged providers last year (and continue to) due to poor management, so those that have remained are all swamped. We have every incentive in the book right now, which is keeping me on at the moment. But this feels completely unsustainable. Peers are supportive as they can be but obviously extremely overworked themselves. Management is completely unhelpful and had me thinking this is how it is in every VA (which is why I found myself here), as these are national directives. My direct supervisor is kind but seems powerless.

To the person above who mentioned standard of care...I feel this is a huge liability and absolutely a road to something bad happening. They have also cut all training/supervision hours to one hour a week. Thanks all. Continue to tell me how this isn't normal so I can push back to the best of my ability.

As others have said, it's not normal, at least based on my VA experience. Our providers had clearly-differentiated intake/new patient vs. follow-up appointment/clinics. Heck, even in neuropsych, I had differentiation between new appointments and follow-ups. Anytime there was a mix-up and I or another provider saw someone scheduled incorrectly, we messaged the MSAs to tell them what the problem was. There were also specific MSAs assigned to groups of providers so that they would be familiar with each provider's scheduling setup.

But yes, there's a perpetual crunch on seeing new intakes as quickly as possible; I felt it in neuropsych and had to adjust my clinic setup and schedule accordingly, and they definitely felt it in GMH. GMH tried various options, including group-based, multi-provider intake appointment days. But even then, they were sending a lot of patients out for Community Care. At the end of the day, it's typically a supply-side problem (i.e., not enough providers). You can only do what you can do. But it may take all of mental health banding together and having a discussion with your service line, facility, or VISN-level leadership.

 

[Fan_of_Meehl]

True. On the flip some folks would not have jobs without all that unnecessary volume.

Very true.

I gotta admit that it would probably drop the demand for therapy so significantly that at least 75% of positions would be no more.

 

[PsychPhDone]

Sharing my experience from the other side of the "bookability" hammer. I'm at a new VA. They have implemented the new guidance for maximum use of clinical time, which now means I have zero control over my schedule. If I have an open slot, it gets filled with a new intake patient. I'm seeing a billion new patients a week and then needing to set-up on-going weekly appointments with those people 2-3 months down the line, as every available slot is taken by new pts and pts I saw for intake 2 months ago. Even then, we've been instructed not to put special instructions in our orders (like a request for weekly therapy at a certain time). My MSA and I are going rogue and doing it anyway. I honestly don't understand how I would see pts more than once every 2 months if I couldn't put in special instructions. It's just crazy. This is so different from my former VA and I am slammed, seeing so many new people, writing up all those intake reports and feeling like I'm not really doing any actual therapy. For example, this week I saw 30 patients and 18 of them were intakes. Admin is completely inflexible. From their end, they are "reaching" way more Veterans. I am trying to stick it out here (at one of the historically dysfunctional VAs), but I feel like this is not normal and other VAs are at least slightly less dysfunctional? Is anyone else experiencing this? How do you manage it? Any advice on addressing this with supervisors?

For now, I have separate intake and treatment slots. This means that patients are generally seen quickly from consult time but there is a wait for treatment if they want (or need) individual care. For the most common concerns we do offer group, and unless they are unlucky and come into the clinic just after a group starts, we can offer group within 6 weeks.

A lot of the wait in care in this model is driven by patient cxls and no shows, as others have noted. We're doing our best to offer patients options to decline care or engage in self guided care if they want (since we do get a fair number of presenting complaints of "my doctor sent me") but when it's time to work a significant number of our patients aren't ready.

 

[cara susanna]

Sharing my experience from the other side of the "bookability" hammer. I'm at a new VA. They have implemented the new guidance for maximum use of clinical time, which now means I have zero control over my schedule. If I have an open slot, it gets filled with a new intake patient. I'm seeing a billion new patients a week and then needing to set-up on-going weekly appointments with those people 2-3 months down the line, as every available slot is taken by new pts and pts I saw for intake 2 months ago. Even then, we've been instructed not to put special instructions in our orders (like a request for weekly therapy at a certain time). My MSA and I are going rogue and doing it anyway. I honestly don't understand how I would see pts more than once every 2 months if I couldn't put in special instructions. It's just crazy. This is so different from my former VA and I am slammed, seeing so many new people, writing up all those intake reports and feeling like I'm not really doing any actual therapy. For example, this week I saw 30 patients and 18 of them were intakes. Admin is completely inflexible. From their end, they are "reaching" way more Veterans. I am trying to stick it out here (at one of the historically dysfunctional VAs), but I feel like this is not normal and other VAs are at least slightly less dysfunctional? Is anyone else experiencing this? How do you manage it? Any advice on addressing this with supervisors?

Holy cow, that is awful! As others have mentioned, this is not normal and there should be a separate intake grid. I hate when there is so much focus on consults and initial appts, and nothing on f/u access. When it comes to this issue, I always think of this meme from The Simpsons (top is initial access, bottom is f/u access).

I've been in a similar position, although I admit not nearly as bad as that, and here is what I recommend. First, remind yourself that you are one person and you are limited in what you can do. Don't overbook or extend yourself trying to make up for a problem that you didn't cause. Until admin starts to care about f/u access or you can get a new job (whichever comes first), have a discussion at that intake appt with these new patients telling them that you can't provide more frequent f/u and offer community care or Vet Center. If they say, no, it's fine then document that. Either way, document that you are having this discussion. Another is to encourage patients to file patient advocate complaints or call the White House hotline if they are upset that they can't get seen more for f/u frequently--as the veterans in our system, they have the most power to make system changes. For instance, our clinic went YEARS without provider name plates on our doors. My patient talked to the patient advocate about it and we had name plates, like, the following week.

 

[texanpsychdoc]

I think I need an out with the VA system. I need to plan for my future that doesn't involve the VA. Honestly, I am pretty sure I want to avoid going to any large hospital or organization as they will likely have significant productivity standards that will be a whole issue in itself, especially with work/life balance. What are people's thoughts on alternatives here? I think 3 years with the VA is about as much as I will stomach.

 

[texanpsychdoc]

This is me

 

[erg923]

I want to avoid going to any large hospital or organization as they will likely have significant productivity standards that will be a whole issue in itself, especially with work/life balance. What are people's thoughts on alternatives here? I think 3 years with the VA is about as much as I will stomach.

You want to work at a place that pays you see people for psychological services, but doesn't keep track of said services.... or how it helps these people or the organization's mission?

 

[texanpsychdoc]

You want to work at a place that pays you see people for psychological services, but doesn't keep track of said services.... or how it helps these people or the organization's mission?

Maybe? Does such a thing exist?

 

[erg923]

Maybe? Does such a thing exist?

I will entertain if you can answer: How such a place remains fiscally solvent and responsible to its owners?

 

[texanpsychdoc]

I will entertain if you can answer: How such a place remains fiscally solvent and responsible to its owners?

Idealism and unlimited cash flow?

So what I hear you say is....ride out the VA for as long as I can.

 

[erg923]

Idealism and unlimited cash flow?

So what I hear you say is....ride out the VA for as long as I can.

Son... it's a free county. Do as you wish. But if you want an employed position with no responsibility or ultimate oversight for your work, this is not going to happen.

In a private practice financial landscape, you are still going to be ultimately responsible for demonstrating the value of your services. Your training in clinical psychological science should tell you that this is measurable and that you should obviously attempt to measure it (if for no other reason in that to attract more business.)

 

[Sanman]

Idealism and unlimited cash flow?

So what I hear you say is....ride out the VA for as long as I can.

You don't need to ride it out at the VA if you don't want to. However, VA productivity standards are pretty much the lowest around. If that is too much for you, then you need to do PP and pretty much be working part-time.

 

[texanpsychdoc]

It's a free county, son. Do as you wish. But if you want an employed position with no responsibility or ultimate oversight for your work, this is not going to happen.

In a PP financial landscape, you are still going to be ultimately responsible for demonstrating the value of your services. Your training in clinical psychological science should tell you that this is measurable and that you should obviously attempt to measure it (if for no other reason in that to attract more business.)

So is every employment environment for psychologists exactly the same? This isn't my first rodeo - I used to work in corporate America for a while, so I am used to the BS often observed in organizations. But I am curious about what other employment environments would look like compared to the VA.

 

[texanpsychdoc]

You don't need to ride it out at the VA if you don't want to. However, VA productivity standards are pretty much the lowest around. If that is too much for you. Then you need to do PP and pretty much be working part-time.

I will echo what "Meh" said in a previous post, that a significant amount of my time at work is often dealing with red tape and organizational BS other than my actual job duties of seeing patients. That tends to be a significant source of stress for me. Being in a specialty clinic has its advantages compared to general mental health (which I've done at a previous VA). It's more-so the ancillary organizational bureaucratic BS that just gets to be too much.

 

[erg923]

So is every employment environment for psychologists exactly the same? This isn't my first rodeo - I used to work in corporate America for a while, so I am used to the BS often observed in organizations. But I am curious about what other employment environments would look like compared to the VA.

No

 

[texanpsychdoc]

No

That's my point.

 

[erg923]

That's my point.

Did you ask the question or not, son?