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

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
cara susanna said:
Yeah, mine usually go 60+, but technically the 90837 code is supposed to be up to 89 min so anything short of 90 min would fall under that.

I have started doing 60 min PE lately too, due to more flexibility with timeslots.
Click to expand...
If only my psychotherapy sessions had a working "fast forward" button (like the old style VCR's)...now that would have a LOT of utility.
Members don't see this ad.
 
Does the PE protocol still have sessions for "hot spots?"

I haven't done PE formally for almost 10 years now. But those sessions always seemed to be wasteful and/or not go according to the agenda, in my experience.
 
  • Like
Reactions: 1 user
erg923 said:
Does the PE protocol still have sessions for "hot spots?"

I haven't done PE formally for almost 10 years now. But those sessions always seemed to be wasteful and/or not go according to the agenda, in my experience.
Click to expand...

Yup, it does. I only find hot spots useful if the trauma narrative is long, and lately all of my patients have had really short ones.
 
  • Like
Reactions: 3 users
Members don't see this ad :)
Slightly off-topic question, but still pertains to the VA. I didn't complete a formal post-doc fellowship, rather, I was a GS-11 psychologist with the VA where I also received weekly supervision by a licensed psychologist, even after getting licensed 4 months into my position. Would you list this as a post-doc fellowship, or not?
 
ohiopsychdoc said:
Slightly off-topic question, but still pertains to the VA. I didn't complete a formal post-doc fellowship, rather, I was a GS-11 psychologist with the VA where I also received weekly supervision by a licensed psychologist, even after getting licensed 4 months into my position. Would you list this as a post-doc fellowship, or not?
Click to expand...
I would not.
 
  • Like
Reactions: 2 users
What exactly do suicide prevention coordinators do? I'm genuinely asking because there's a lot of confusion. There are things they ask or expect me to do that feel more like it should be their job...
 
  • Like
  • Love
Reactions: 3 users
ohiopsychdoc said:
Slightly off-topic question, but still pertains to the VA. I didn't complete a formal post-doc fellowship, rather, I was a GS-11 psychologist with the VA where I also received weekly supervision by a licensed psychologist, even after getting licensed 4 months into my position. Would you list this as a post-doc fellowship, or not?
Click to expand...

I second that I would not list it as a postdoc. It is supervised employment.
 
  • Like
Reactions: 1 user
cara susanna said:
What exactly do suicide prevention coordinators do? I'm genuinely asking because there's a lot of confusion. There are things they ask or expect me to do that feel more like it should be their job...
Click to expand...
They are the auditors to act with supervisory authority without actual clinical responsibility. Next up, full-time suicide safety plan auditor / checkers who help the suicide prevention coordinators by serving as middle bureaucratic managers between them and you--the humble clinician--who actually has to, you know, meet with the veteran and complete the actual safety plan. But, hey, at least those specialist suicide safety plan auditor / checker champions are there to ENSURE that your suicide safety plans don't EXPIRE (like a gallon of milk) after an arbitrarily-determined pre-set one size fits all span of time.
 
  • Like
  • Haha
Reactions: 2 users
ohiopsychdoc said:
Very interesting. I've asked some other contacts I have, including one who sits on an ethics board and they actually agreed it should/could be listed as a post-doc fellowship.
Click to expand...

I would wholeheartedly disagree and see it as disingenuous on an application. Supervision as a trainee and supervision from a colleague to obtain licensure hours is a very different relationship. Postdoc also carries a connotation of structured, curated training experiences and didactics.
 
  • Like
Reactions: 2 users
WisNeuro said:
I would wholeheartedly disagree and see it as disingenuous on an application. Supervision as a trainee and supervision from a colleague to obtain licensure hours is a very different relationship. Postdoc also carries a connotation of structured, curated training experiences and didactics.
Click to expand...

An example that comes to mind is someone who is training in neurpsych in a private practice who gets licensed in the beginning of their second year of their fellowship. Technically, the whole fellowship is informal, but they are receiving supervision and gaining valuable experiences the frankly would better resemble what their life would look like as a full time clinician. With all the administrative BS and all. Something that is often removed from a structured formal post-doc experience.
 
ohiopsychdoc said:
An example that comes to mind is someone who is training in neurpsych in a private practice who gets licensed in the beginning of their second year of their fellowship. Technically, the whole fellowship is informal, but they are receiving supervision and gaining valuable experiences the frankly would better resemble what their life would look like as a full time clinician. With all the administrative BS and all. Something that is often removed from a structured formal post-doc experience.
Click to expand...

Personally, I view private practice postdocs relatively unfavorably. Usually teh didactics are lacking and the training breadth is...underwhelming, to say the least, most of the time. But, even still within the PP postdoc, there is a clear delineation of trainee and preceptor/supervisor, as opposed to a collegial relationship that is often a rubber stamp in many places.
 
ohiopsychdoc said:
Slightly off-topic question, but still pertains to the VA. I didn't complete a formal post-doc fellowship, rather, I was a GS-11 psychologist with the VA where I also received weekly supervision by a licensed psychologist, even after getting licensed 4 months into my position. Would you list this as a post-doc fellowship, or not?
Click to expand...

I would think it would depend on what you were using the CV for. In general, I would just say keep it as a job (include 4 months of supervision in a line below the title if you want to). But if the details matter, for job apps early career wise, etc, you could list the first supervised 4 months as postdoctoral training (or whatever language fits). Then a new line with the job, starting date of license.
 
Members don't see this ad :)
AbnormalPsych said:
I would think it would depend on what you were using the CV for. In general, I would just say keep it as a job (include 4 months of supervision in a line below the title if you want to). But if the details matter, for job apps early career wise, etc, you could list the first supervised 4 months as postdoctoral training (or whatever language fits). Then a new line with the job, starting date of license.
Click to expand...

I ended up listing it as a post-doc, but I included an additional descriptor to the effect of "This experience was a year-long informal post-doctoral fellowship with supervised practice by two licensed psychologists."
 
ohiopsychdoc said:
I ended up listing it as a post-doc, but I included an additional descriptor to the effect of "This experience was a year-long informal post-doctoral fellowship with supervised practice by two licensed psychologists."
Click to expand...

I would still advise listing this as postdoctoral supervision, as it was not a fellowship. Honestly, if I saw this and asked about it in interview and found out what it actually was, that would be a huge red flag for me.
 
  • Like
Reactions: 3 users
I would definitely not list it as a post doc. They aren't the same thing.
 
  • Like
Reactions: 1 users
ohiopsychdoc said:
post-doctoral fellowship
Click to expand...
I also would not list in this fashion and agree with Wisneuro that this would raise red flags.

I can potentially see more blurring of distinctions between setting like in private practice but for VA, the difference between staff and fellowship positions cannot be any more clear.

Your job was found through USAJobs (or direct hire) and listed as a staff/graduate psychologist position. And I've seen some cases where postdocs transitioned into staff jobs before completing fellowship but steps were taken to formally terminate the fellowship and then onboard them again as a staff member.

I think you are getting bad advice from the people that you consulted with, even if they are serving in board-related roles.
 
  • Like
Reactions: 5 users
Sanman said:
Kind of pointless as I am remote/off-site...no one would notice.
Click to expand...

I am remote only 3 days out of the week, but for therapy, I am charging $300 for initial diagnostic interview, then $180 per 45 min. therapy sessions. I also have my own rates for psych and forensic psych testing. I am scaling the psych testing side slowly for the ones I can do remotely, like personality testing for diagnostic clarification, or ADHD evals.
 
  • Like
Reactions: 1 user
  • Like
Reactions: 2 users
There are so many "voluntary" meetings during lunch. I will be going non-stop from 9-4 with no breaks. They slap the name "brown bag" on it and call it good.
 
  • Like
Reactions: 1 users
Thanks to grid errors I have two extra patients I'm not supposed to have today, AND I had also overbooked someone (this is usually not a big deal but it is when I have two extra patients on top of it). Now my afternoon is going to be slammed. Oh, and the two extra patients are both new, which adds more stress in terms of documentation and also figuring out where to put these patients (esp when my grid is borked up so there are slots that should exist that don't, and vice versa). Arghhhh.

Shiori said:
There are so many "voluntary" meetings during lunch. I will be going non-stop from 9-4 with no breaks. They slap the name "brown bag" on it and call it good.
Click to expand...

One of the team meetings I have to attend is over lunch and I hate it so much.
 
Last edited:
  • Like
  • Care
Reactions: 1 users
cara susanna said:
Thanks to grid errors I have two extra patients I'm not supposed to have today, AND I had also overbooked someone (this is usually not a big deal but it is when I have two extra patients on top of it). Now my afternoon is going to be slammed. Oh, and the two extra patients are both new, which adds more stress in terms of documentation and also figuring out where to put these patients (esp when my grid is borked up so there are slots that should exist that don't, and vice versa). Arghhhh.



One of the team meetings I have to attend is over lunch and I hate it so much.
Click to expand...
I know it's not ideal and not the pt fault, but is there any chance they could be moved, even one of them, since it's an admin error? Or can you put scheduling on hold until your grid is fixed at least?

Sorry if you're venting and don't want problem solving but this is a recipe for burnout
 
  • Like
Reactions: 1 user
PsychPhDone said:
I know it's not ideal and not the pt fault, but is there any chance they could be moved, even one of them, since it's an admin error? Or can you put scheduling on hold until your grid is fixed at least?

Sorry if you're venting and don't want problem solving but this is a recipe for burnout
Click to expand...

Problem is I didn't discover it until this morning and I think same day cx is just not ideal. I DEFINITELY agree it's a recipe for burnout, so I'm working on getting it fixed and our MSAs are aware of the problem.
 
  • Like
  • Care
Reactions: 2 users
Shiori said:
There are so many "voluntary" meetings during lunch. I will be going non-stop from 9-4 with no breaks. They slap the name "brown bag" on it and call it good.
Click to expand...
It's 'brown' INSIDE the bag, too, at those meetings...if you know what I mean. (Brown Sandwich Lunches)
 
  • Like
Reactions: 1 user
Update: something else in my schedule freed up this afternoon so I now have an extra hour of admin time. Phew! I need to wait to see how things work out before I complain, lol

Edit: And one of the extra patients no showed anyway. :rofl:
 
Last edited:
  • Like
Reactions: 4 users
cara susanna said:
Update: something else in my schedule freed up this afternoon so I now have an extra hour of admin time. Phew! I need to wait to see how things work out before I complain, lol

Edit: And one of the extra patients no showed anyway. :rofl:
Click to expand...
"Buddha provide"

-Mr. Miyagi
The Karate Kid
 
Shiori said:
There are so many "voluntary" meetings during lunch. I will be going non-stop from 9-4 with no breaks. They slap the name "brown bag" on it and call it good.
Click to expand...

I will list the things I do not do, and am open about it with my boss and colleagues:

1. I do not attend voluntary meetings either at our VA or with the medical school I hold a joint appointment with
2. I do not do clinical reminders
3. I do not make 3 phone calls for missed appointments
4. I do not do no show calls for missed group appointments
5. I do not overbook
6. I do not not take my 1 hour lunch each day
7. Unless someone is dying, I do not pick up my phone on the first ring (I let it go to voicemail to screen out people)
8. I do not put up with MSA stupidity (recently went full Karen on an MSA because I had to repeat myself 5 times over the period of 25 minutes while dealing with another pressing matter).
9. I do not squeeze people into my schedule last minute
10. I do not bring home work
11. I do not stay past 1 minute of my tour of duty
12. I do not do TMS trainings unless I get a message from my supervisor telling me its past-due
13. I don't put up with intimidation by others, I have a "save it for Oprah" statement I usually give when people start escalating things.
14. If the patient is 10 minutes + late, it's counted as a no show.
15. If I don't hear from the patient 3 weeks after their no show, I take them off of my active case load and they are on "call in status."

I set pretty solid boundaries with folks, including patients, colleagues, and our support staff. If it causes me increased burden or stress, I typically push back pretty firmly. I work in a division where the patients we treat tend to flake out pretty quickly and are highly ambivalent towards treatment. I get it, I understand it, and I set firm boundaries. I will not work harder than the patient, and will not chase folks down. My door is open, as long as someone is not dying, then I will respond to voice messages within 48 hours.
 
Last edited:
  • Like
Reactions: 4 users
PsychPhDone said:
Ok I am very pro-care for all but where is the increased staffing to accommodate all veterans being eligible for emergency MH care even if not enrolled? They're eligible for op mh for 90 days, I read.
Click to expand...

IMO - as long as the VA keeps on operating the way it does, they will continue to have the staffing problems. They are throwing sign on bonuses and EDRP at people, but honestly, that doesn't even keep folks on board (speaking from personal experience). The way things operate, people burn out a good deal of times. All of their various SOPs and clerical/administrative burdens really adds up and gets in the way of seeing folks. At some point, people don't want to put up with it and leave. So, until we can fix the root cause issues that relate to hemorrhaging providers, they will continue to lose providers which increases the burden on existing providers.
 
Last edited:
  • Like
Reactions: 4 users
ohiopsychdoc said:
IMO - as long as the VA keeps on operating the way it does, they will continue to have the staffing problems. They are throwing sign on bonuses and EDRP at people, but honestly, that doesn't even keep folks on board (speaking from personal experience). The way things operate, people burn out a good deal of times. All of their various SOPs and clerical/administrative burdens really adds up and gets in the way of seeing folks. At some point, people don't want to put up with it and leave. So, until we can fix the root cause issues that relate to hemorrhaging providers, they will continue to lose providers which increases the burden on existing providers.
Click to expand...
This was also an issue when I was at VA, and I (unfortunately) imagine it will be for quite some time, given how complex the problem is and how many moving parts there are.
 
  • Like
Reactions: 2 users
I had 2 intakes and 3 clients. I am feeling crispy.
 
  • Like
  • Care
Reactions: 2 users
Yeah, I have a new patient today (who probably doesn't want EBP) and I'm like, where am I gonna put this person?
 
  • Like
Reactions: 1 users
cara susanna said:
Yeah, I have a new patient today (who probably doesn't want EBP) and I'm like, where am I gonna put this person?
Click to expand...
About the only thing I’ve had luck with is getting set up with peer support while scheduling sporadic apts with me (basically monthly check ins) and hope that they either change their mind on focused intervention or fizzle out of care.
 
  • Like
Reactions: 1 user
cara susanna said:
Yeah, I have a new patient today (who probably doesn't want EBP) and I'm like, where am I gonna put this person?
Click to expand...

"What goals would you like to work on"

"Oh, you don't have any."

"Here's a worksheet on setting goals. Why don't we circle back in three months so you have time to think about it."
 
  • Like
  • Haha
Reactions: 6 users
Question for previously pregnant VA psychologists. I'm a psychologist in PCMHI with 4 days on site and one day telework a week. I know this is going to be supervisor dependent but have folks had any luck requesting full-time temporary telework at the end of their pregnancy (maybe the last month or so)? I know this could be accommodated for medical reasons like bed rest or other pregnancy complications. But how about for just being huge and uncomfortable? I'm so much more comfortable the day I telework and I know it's only going to get worse from here.

Would appreciate hearing from others who have tried to negotiate this temporary telework leading up to maternity leave. Thanks!
 
  • Like
Reactions: 1 user
ac23 said:
Question for previously pregnant VA psychologists. I'm a psychologist in PCMHI with 4 days on site and one day telework a week. I know this is going to be supervisor dependent but have folks had any luck requesting full-time temporary telework at the end of their pregnancy (maybe the last month or so)? I know this could be accommodated for medical reasons like bed rest or other pregnancy complications. But how about for just being huge and uncomfortable? I'm so much more comfortable the day I telework and I know it's only going to get worse from here.

Would appreciate hearing from others who have tried to negotiate this temporary telework leading up to maternity leave. Thanks!
Click to expand...
I haven't been in this exact situation but if you could get medical documentation requesting telework I think it's very likely. ETA: less about the reason, more about doctor willingness to help you out
 
  • Like
Reactions: 3 users
Hospital systems (VA included) are largely about paperwork. If you can provide a letter from your OB/GYN requesting WFH, that probably will be helpful. It can also help your direct supervisor help you. Just my 2 cents.
 
  • Like
Reactions: 1 users
ac23 said:
Question for previously pregnant VA psychologists. I'm a psychologist in PCMHI with 4 days on site and one day telework a week. I know this is going to be supervisor dependent but have folks had any luck requesting full-time temporary telework at the end of their pregnancy (maybe the last month or so)? I know this could be accommodated for medical reasons like bed rest or other pregnancy complications. But how about for just being huge and uncomfortable? I'm so much more comfortable the day I telework and I know it's only going to get worse from here.

Would appreciate hearing from others who have tried to negotiate this temporary telework leading up to maternity leave. Thanks!
Click to expand...
Most OB/GYN‘s I know would accommodate your request and provide you with a ‘vaguely worded’ note about why you need to be on bedrest/work from home.
 
  • Like
Reactions: 2 users
ac23 said:
Thank you! And did they receive any telework flexibility prior to giving birth?
Click to expand...

I am unsure, I think they were because I vaguely remember them not coming into the office anymore in anticipation of their due date, so they either took some maternity leave or were allowed to remote work those days leading up to delivery.
 
  • Like
Reactions: 1 user
I have, like, lost all motivation to do MH treatment plans (through MHS). I wouldn't say I was great before, but it's like 0% now. I cannot summon the energy.
 
  • Like
Reactions: 1 users
We're getting a lot of pressure to do the whole intake in MHS. I think I will quit.
 
  • Wow
  • Sad
  • Like
Reactions: 3 users
You must log in or register to reply here.
Next unread thread

Similar threads

calimich
Harvard, TikTok, and mental health
Replies
10
Views
1K
Shiori
Shiori
G
  • Locked
Worsening mental health in society
2
Replies
93
Views
4K
genop
G
PsychSupreme
PhD/PsyD Just a thread to post the weirdest/whackiest/dumbest mental health-related stuff you come across in the (social) media...
2 3
Replies
118
Views
2K
R. Matey
R. Matey
abouttobeadoctor
APPIC Internship Phase II Interview & Support Thread (2024)
Replies
7
Views
2K
theSteppenwolf
theSteppenwolf
borne_before
How the cult of trauma took over mental health
2 3 4 5
Replies
216
Views
12K
PsychSupreme
PsychSupreme
Top