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

[WisNeuro]

Sanman's questions are good ones. I also considered applying for a PM position, but ultimately decided I'd probably have been pretty miserable and the extra work wasn't worth the pay bump. There was also an insufficient time offset for administrative duties, IMO; I think it was maybe 50%, with the remaining being continued clinical work.

I think being in both positions (i.e., supervisory psychologist and PM) would be tough, but I know folks who've done it and enjoyed it. They definitely had to learn how to pick their battles, though. But they were, at times, able to help psychologists out.

Ive known a couple of handfuls of people in these types of positions in the VA over the years. More people disliked it than liked it. Nearly all indicated that the extra work was nowhere near compensation enough for the extra pay. But, in the VA, at least psychologists are getting these leadership roles, unless most non-academic hospital systems.

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[hthpsych]

Is this a GS-14 position?

If so, how many students and staff are you responsible for managing in the program?

How many additional staff will you be required to supervise outside of the program (complete eperformance evaluations and such)?

What clinical load, if any, will you be required to maintain?

Management positions are tricky, imo. Some are worth it and some are not.

Yes! Great questions! It's a GS-14 position. I don't have answers to the other questions you asked, but knowing those answers will definitely be important! Thanks so much.

 

[hthpsych]

Sanman's questions are good ones. I also considered applying for a PM position, but ultimately decided I'd probably have been pretty miserable and the extra work wasn't worth the pay bump. There was also an insufficient time offset for administrative duties, IMO; I think it was maybe 50%, with the remaining being continued clinical work.

I think being in both positions (i.e., supervisory psychologist and PM) would be tough, but I know folks who've done it and enjoyed it. They definitely had to learn how to pick their battles, though. But they were, at times, able to help psychologists out.

Agreed. I am leaning toward not applying - I don't think the pay bump will offset the extra work and the less-than-appealing nature of some of the work (managing others) for me either. Thanks for sharing your experience! It's helpful.

 

[texanpsychdoc]

Only thing that I saw, that was replicated in adequate studies was a very small effect with sleep onset in like lavender or something. I'm always skeptical of MD lit reviews, they're the reason people think donepezil has en effect

Like at most, it might "add" two weeks onto someone's life with AD last time I reviewed it.

 

[WisNeuro]

Like at most, it might "add" two weeks onto someone's life with AD last time I reviewed it.

Most of those studies were based off faulty modeling and the misuse of LOCF methods. Some of the bigger real world studies showed no differences in time to institutionalization or to severe disability.

 

[texanpsychdoc]

Most of those studies were based off faulty modeling and the misuse of LOCF methods. Some of the bigger real world studies showed no differences in time to institutionalization or to severe disability.

Interesting. I will certainly be re-visiting what sounds like to be more updated info. Do you recommend a particular meta study that has examined up-to-date studies as compared to prior ones?

 

[WisNeuro]

Interesting. I will certainly be re-visiting what sounds like to be more updated info. Do you recommend a particular meta study that has examined up-to-date studies as compared to prior ones?

No one is really doing meta-analyses on it anymore, for the most part. The Cochrane study was a decently sized one, but the authors never even looked in to the GIGO problem. Grab the highest weighted studies of that meta and look at them. Absolutely terrible. A bunch of pharma funded work that used/misused analyses to portray their data in the most favorable light, and even that light was not good. As for real world stuff, look at the AD2000 project and some of its papers.

 

[hthpsych]

This is especially important IMO. I’ve seen/heard of positions that run anywhere from 30% to 70% (small PTSD clinic + RRTP) and one case of 0% (only supervisor for all of BHIP at a smaller VA).

Setting seems important. If this is a speciality service where you already have a good idea of what’s going on and the clinical load seems reasonable and you’re interested in admin, it could be a good fit.

But if this is BHIP at a VA with access issues, you’ll be eyeballs deep triaging cases everyday and providers will be unhappy when you keep assigning patients when they are already booked out for months and upper leadership will be unhappy when you refer too many to the community (even though they are responsible for backfilling positions and advocating for larger budgets).

But BHIP for CBOCs in the same system might be fine if those sites aren’t battling with access and provider turnover.

Me personally, the only GS-14 promotions that I would consider is training because that’s something I’m passionate about and it’s more removed from hospital functions.

You sound like exactly what VA should have for GS-14 roles and thus potentially destined to be unhappy in that role due to constant pressure to improve the SAIL metric/priority of the month, dealing with personnel issues, etc.

However, if your facility/mental health service line has a good workplace culture and your coworkers are largely pleasant and competent people, you might have a fighting chance of achieving some desired clinical goals.

You sound like exactly what VA should have for GS-14 roles and thus potentially destined to be unhappy in that role due to constant pressure to improve the SAIL metric/priority of the month, dealing with personnel issues, etc.

^^^This part! This is my primary concern. Those things definitely don't appeal to me :/ I have a "mission over metrics" mindset that has allowed me to continue loving (for the most part!) my GS-13 role (though I'm meeting all the metrics), and that probably won't translate well to meeting expectations in a GS-14 role. And I have zero interest in dealing with various personnel issues - particularly "implementing disciplinary measures" (which is included in the job announcement). I didn't become a psychologist with the hopes of disciplining anybody!

 

[hthpsych]

I'd avoid it

Probably a good idea!

 

[hthpsych]

Ive known a couple of handfuls of people in these types of positions in the VA over the years. More people disliked it than liked it. Nearly all indicated that the extra work was nowhere near compensation enough for the extra pay. But, in the VA, at least psychologists are getting these leadership roles, unless most non-academic hospital systems.

That's helpful. Thank you!!

 

[Therapist4Chnge]

I hear reading tea leaves will be making a come back soon.

Rorschach does what?

 

[Therapist4Chnge]

I guess a couple of other things that steam my clams are the following:

1. When I first started, people decided to take it upon themselves to address me by my first name, rather than "Dr.", yet, they will say "Dr." for our psychiatrists.

I’d pull them aside and professionally but firmly tell them that in professional settings (i.e. at work) professional titles will be used. If they do it again, file a formal complaint w their direct supervisor for them being unprofessional. It was almost always the social worker, who seemed to have more casual (read: loose) boundaries already.

I’ve had this happen back when I had fellows (mostly female) and I’d wait for rounds and pop in and call the attending by their first name, sometimes multiple times in a row, which usually took care of the issue quickly if it was an MD doing it. If it was an MSW (which seemed to happen most frequently), i’d do the first approach.

After both of these, it didn’t happen again. I may not have been everyone’s friend, but they *did* address my fellows correctly and that was what was most important to me.

For full transparency, I’ve also corrected family members and patients who called the residents by their first names (& treated like med students) and one time when the patient REFUSED to address the managing physician bc she was female and Indian, and the patient was a racist misogynist. There was a serious brain injury involved too, which complicated things.

 

[texanpsychdoc]

I’d pull them aside and professionally but firmly tell them that in professional settings (i.e. at work) professional titles will be used. If they do it again, file a formal complaint w their direct supervisor for them being unprofessional. It was almost always the social worker, who seemed to have more casual (read: loose) boundaries already.

I’ve had this happen back when I had fellows (mostly female) and I’d wait for rounds and pop in and call the attending by their first name, sometimes multiple times in a row, which usually took care of the issue quickly if it was an MD doing it. If it was an MSW (which seemed to happen most frequently), i’d do the first approach.

After both of these, it didn’t happen again. I may not have been everyone’s friend, but they *did* address my fellows correctly and that was what was most important to me.

For full transparency, I’ve also corrected family members and patients who called the residents by their first names (& treated like med students) and one time when the patient REFUSED to address the managing physician bc she was female and Indian, and the patient was a racist misogynist. There was a serious brain injury involved too, which complicated things.

A very good point you've made. I set pretty firm boundaries with my colleagues, clerical staff, and even my supervisor, but this is something I have not done much about because there is a backstory. Evidently, about two years ago, my department was struggling with "challenging" personalities and behaviors amongst the clinicians, peer support folks, and clerical staff, which escalated on several levels that ultimately led to most of the staff leaving and the supervisor being removed (or left on their own, I forget). Ether way, the few that remained were pretty bitter and jaded and they do not not want to feel like they are being condescended to, etc. by new clinicians, thus, they would prefer to be very relaxed in their professional demeanor with everybody, including our supervisor who is M.D./Ph.D. From what I was told by one of my colleagues, is that our supervisor initially introduced me by my first name to our clinic as to preemptively quell any potential bitterness/jadedness that may be evoked by the existing staff members - basically, to ensure they don't get "triggered" by my onboarding. In fact, I remember one of our peer support folks telling me "listen, you deal with veterans up there, and we deal with veterans on their level; you have to earn our respect."

I told my colleague I understand the "why," but I do not agree with it. I told my colleague that pandering to the rest of the group to appease them at my expense will only maintain their disdain towards others in "higher positions" (aka: doctors), and it makes me feel invalidated as a provider - someone who has literally earned the right and privilege to use the title "doctor." I don't go around treating people like crap, and I am very respectful and kind to my colleagues. I think that can be something we can do while also respecting professional titles and boundaries. By default, I will address my colleagues as "doctor" unless told otherwise, and I I will introduce my colleagues to patients and other staff members either by "doctor" or by "Mr./Ms." unless told otherwise.

IMO - we live in an era now where we are more vigilant about being mis-gendered and making sure others use our self-identified pronouns, but yet we can't address people as "doctor." It's frustrating.

So now, I basically acquiesce and give into their behaviors and all the while I stew in frustration. Not very healthy, but it is what it is for now.

 

[Sanman]

A very good point you've made. I set pretty firm boundaries with my colleagues, clerical staff, and even my supervisor, but this is something I have not done much about because there is a backstory. Evidently, about two years ago, my department was struggling with "challenging" personalities and behaviors amongst the clinicians, peer support folks, and clerical staff, which escalated on several levels that ultimately led to most of the staff leaving and the supervisor being removed (or left on their own, I forget). Ether way, the few that remained were pretty bitter and jaded and they do not not want to feel like they are being condescended to, etc. by new clinicians, thus, they would prefer to be very relaxed in their professional demeanor with everybody, including our supervisor who is M.D./Ph.D. From what I was told by one of my colleagues, is that our supervisor initially introduced me by my first name to our clinic as to preemptively quell any potential bitterness/jadedness that may be evoked by the existing staff members - basically, to ensure they don't get "triggered" by my onboarding. In fact, I remember one of our peer support folks telling me "listen, you deal with veterans up there, and we deal with veterans on their level; you have to earn our respect."

I told my colleague I understand the "why," but I do not agree with it. I told my colleague that pandering to the rest of the group to appease them at my expense will only maintain their disdain towards others in "higher positions" (aka: doctors), and it makes me feel invalidated as a provider - someone who has literally earned the right and privilege to use the title "doctor." I don't go around treating people like crap, and I am very respectful and kind to my colleagues. I think that can be something we can do while also respecting professional titles and boundaries. By default, I will address my colleagues as "doctor" unless told otherwise, and I I will introduce my colleagues to patients and other staff members either by "doctor" or by "Mr./Ms." unless told otherwise.

IMO - we live in an era now where we are more vigilant about being mis-gendered and making sure others use our self-identified pronouns, but yet we can't address people as "doctor." It's frustrating.

So now, I basically acquiesce and give into their behaviors and all the while I stew in frustration. Not very healthy, but it is what it is for now.

Maybe make your preferred pronoun "doctor" and see what happens.

 

[texanpsychdoc]

Maybe make your preferred pronoun "doctor" and see what happens.

Gawd I can see a lot of folks there getting offended. Just my luck the field I work in. But in another environment, I'd totally stir that pot

 

[Shiori]

There are days when the grief and PTSD work get to be a lot.

 

[texanpsychdoc]

There are days when the grief and PTSD work get to be a lot.

Indeed. The veterans I've treated for PTSD ....my goodness the stories I've heard they haven't even made movies off of.

 

[cara susanna]

[redacted because I am paranoid, lol]

 

[Shiori]

I want to go play outside instead of working.

 

[Psychchick09]

I want to go play outside instead of working.

 

[Shiori]

Is there a way to get old TMS trainings removed? I'm almost 1,000 days late on one of them.

Edited: Have I asked the question before? My life is a spiral.

 

[AcronymAllergy]

Is there a way to get old TMS trainings removed? I'm almost 1,000 days late on one of them.

Edited: Have I asked the question before? My life is a spiral.

You may have to talk to whoever's in charge of setting the TMS reqs for providers. I know back during the early days of COVID, for example, there was a training all providers were normally required to complete, but it was in-person, so no one could. We all got an email that basically said, "yeah, just keeping ignoring this till we figure out what to do."

 

[Sanman]

Is there a way to get old TMS trainings removed? I'm almost 1,000 days late on one of them.

Edited: Have I asked the question before? My life is a spiral.

Since AA gave the correct answer above, I will give you the other options:

1. Ignore it
2. Complete it
3. Quit

 

[Shiori]

LEAF requests get an F-

 

[PsychPhDone]

LEAF requests get an F-

100%. Building a new clinic later today, why can't I just say "copy paste x clinic, give new name, thx"

 

[cara susanna]

100%. Building a new clinic later today, why can't I just say "copy paste x clinic, give new name, thx"

And why can't you just say "cancel ALL clinics"? I can't tell you the number of times I didn't have all my clinics cancelled and someone got scheduled in one of the clinics that was still open.

 

[WisNeuro]

This thread is a constant reminder that I made the right choice.

 

[Sanman]

LEAF requests get an F-

100%. Building a new clinic later today, why can't I just say "copy paste x clinic, give new name, thx"

And why can't you just say "cancel ALL clinics"? I can't tell you the number of times I didn't have all my clinics cancelled and someone got scheduled in one of the clinics that was still open.

The answer to all of this is that there is not enough staff to build and manage these clinics. My expertise is in mental health. Why do I need to learn how to build a LEAF clinic. Should this not be the job of an MSA/staff member that manages this stuff.

 

[Sanman]

This thread is a constant reminder that I made the right choice.

In purchasing shares of a brewery? Absolutely, it makes me want to drink too.

 

[WisNeuro]

In purchasing shares of a brewery? Absolutely, it makes me want to drink too.

That decision has already paid itself back in multiples of the initial investment

 

[Sanman]

That decision has already paid itself back in multiples of the initial investment

 

[cara susanna]

I wish BHL Touch had a way to dismiss all pending survey administrations that timed out.

 

[Shiori]

It feels like every question I have requires the entirety of my research training to answer.

Who are our chaplains? 30 minutes of searching. I found the answer in a request for supplies.

Can I get local data on a diagnostic code? It's a mystery. I have had the "right" person 3 times so far and I still don't have the actual person.

 

[R. Matey]

Who are our chaplains? 30 minutes of searching. I found the answer in a request for supplies.

Interesting. So is your VA chaplain is an upside mop with large googly eyes?

 

[Shiori]

I bet that would have been easier to find.

 

[Sanman]

It feels like every question I have requires the entirety of my research training to answer.

Who are our chaplains? 30 minutes of searching. I found the answer in a request for supplies.

Can I get local data on a diagnostic code? It's a mystery. I have had the "right" person 3 times so far and I still don't have the actual person.

Because once you find them, you want them to do work. That why our hospital IT folks are in a locked, unmarked office in a dark corner of the hospital that that you can only identify once they email you with the room number. Their email addresses are sometimes oddball too.

Our HR is behind a locked door too. Probably too many threats on them.

 

[SikeThatsTheWrongNumber]

It feels like every question I have requires the entirety of my research training to answer.

Who are our chaplains? 30 minutes of searching. I found the answer in a request for supplies.

Can I get local data on a diagnostic code? It's a mystery. I have had the "right" person 3 times so far and I still don't have the actual person.

I highly recommend conducting an advanced search in your Outlook address book. “Location: [your VA]. Title: chaplain.” It should return a list of all the chaplains in your VA. Might have to play around with wording or search more broadly for departments, but still might be 0.5 seconds faster.

 

[Shiori]

I appreciate the suggestion! For some reason, a lot of our people don't have the location set in outlook. I had to make a special request to IT to fix mine.

 

[psy.d. 2021]

Question for folks working as psychologists in a outpatient BHIP setting - what is considered a "normal" panel size for someone who is a graduate psychologist (taking 2 hours out/week for supervision) and otherwise is in a purely clinical role (e.g, no time allocated for research). I feel like mine is getting quite high and want to know if it's acceptable to push back or if my panel is standard.

 

[summerbabe]

Question for folks working as psychologists in a outpatient BHIP setting - what is considered a "normal" panel size for someone who is a graduate psychologist (taking 2 hours out/week for supervision) and otherwise is in a purely clinical role (e.g, no time allocated for research). I feel like mine is getting quite high and want to know if it's acceptable to push back or if my panel is standard.

IMO, normal is totally dependent on the size of your VA, # of veterans enrolled in care, # of new veterans enrolling in care vs leaving VA, and current access to timely MH apts.

Off the top of my head, it wouldn’t be unheard of for BHIP psychologists at the biggest VAs that are struggling most with access to see 250+ unique patients in a calendar year (meeting once to a handful of times with 75% of those) while others working in CBOCs with stable veteran populations or at small VAs where demand for MH is low to see less than 100 unique veterans across that same year (and likely having more appointments with each veteran).

There are some dashboards like Power BI (or named something like that) where anybody with the link while on VA intranet can look up provider stats such as RVUs, notes written, encounters completed, and next availability and can compare your stats to coworkers.

 

[Shiori]

Have I expressed how much I don't like the LEAF system? I am going to have to become obsessive about my schedule and who is on it.

 

[WisNeuro]

Ya'll need to LEAF the VA system...

 

[cara susanna]

Have I expressed how much I don't like the LEAF system? I am going to have to become obsessive about my schedule and who is on it.

And you can't even edit or cancel requests after they've been submitted (but before supervisor approval). What the heck is up with that?

 

[Shiori]

It is a really strange approach.

 

[deleted1038433]

What keeps you all going in VA employment? I like helping veterans and providing therapy, but I feel chronically discontent with the organization and how therapists are treated.

 

[Fan_of_Meehl]

IMO, normal is totally dependent on the size of your VA, # of veterans enrolled in care, # of new veterans enrolling in care vs leaving VA, and current access to timely MH apts.

Off the top of my head, it wouldn’t be unheard of for BHIP psychologists at the biggest VAs that are struggling most with access to see 250+ unique patients in a calendar year (meeting once to a handful of times with 75% of those) while others working in CBOCs with stable veteran populations or at small VAs where demand for MH is low to see less than 100 unique veterans across that same year (and likely having more appointments with each veteran).

There are some dashboards like Power BI (or named something like that) where anybody with the link while on VA intranet can look up provider stats such as RVUs, notes written, encounters completed, and next availability and can compare your stats to coworkers.

What I love is the airtight logic that they employ to ENSURE that they can always play 'blame the provider' successfully.

If your schedule has openings in it, then you're 'lazy' (your RVU's are too low)...even though I don't have any way to control this (other than doing what they say I'm supposed to do, namely, 'getting people in efficiently, treating them efficiently, and getting them out efficiently.' If I'm too efficient in treating people with evidence-based treatment protocols and terminating with them, then I have openings in my schedule and, therefore, I am a 'bad' provider.

On the other hand, if I am slammed with more intakes than anyone else I know and my current caseload climbs to 120+ patients and my schedule is so jammed packed as a result that I don't have any availability to reschedule any of those 120+ patients into a slot until two months down the road...I am also a 'bad' provider for 'not handling my caseload' effectively.

You can't win. You can't even 'win' even when you work your ass off and 'win' (by working hard to get people in, and get people out)...you will be accused of being 'lazy' or 'underworked' for having availability in your schedule to see new patients or to reschedule established patients. Then, if your schedule fills up to the point where it is hard to schedule new patients, you will have somehow committed the sin of 'lacking access.'

 

[Fan_of_Meehl]

Because once you find them, you want them to do work. That why our hospital IT folks are in a locked, unmarked office in a dark corner of the hospital that that you can only identify once they email you with the room number. Their email addresses are sometimes oddball too.

Our HR is behind a locked door too. Probably too many threats on them.

I have always joked about having to literally 'lay siege' to certain departments/people who are notoriously hard to track down. They don't answer their phones, or respond to emails, or return phone calls. A couple of times I have literally had to go hunt them down physically once I managed to find out where their offices are and spend time there running around knocking on doors and interrogating people until I finally am able to meet them face to face and essentially demand they help me.

 

[Fan_of_Meehl]

Is there a way to get old TMS trainings removed? I'm almost 1,000 days late on one of them.

Edited: Have I asked the question before? My life is a spiral.

Have you tried literally 'laying siege' to whoever the Grand Swami of Education & Training (or your local equivalent) is by physically tracking down the location of their closed/locked heavy iron door and made a burnt offering of fatted calf while blowing the rising smoke with a hand bellows into the HVAC system to reach his approving nostrils and perhaps respond to your cries of 'Holy, holy, holy, O Great Poobah of the Education and the Training, Master of Past and Present, Commodore of Sedge and Bee, and Lord Protector of the Realm, hear my cries, O Lord...'

I CAN'T be the only one who has done this.

 

[Fan_of_Meehl]

There are days when the grief and PTSD work get to be a lot.

Especially back-to-back-to-back-to-back-to-back like they sometimes are. I hate those shifts. You are completely emotionally drained after a full hour of one person and then put on the 'Mask of Freshness' for the next patient then repeat repeatedly until you can go home and collapse, lol

 

[Fan_of_Meehl]

Is there anything more nerve wracking than that 15 min wait to NS an appt?

You should really recite the 'Provider's No Show Prayer' to pass the time...
Say it with me:

"Our patient, who art in traffic,
'Absent' be thy Name;
Please do not come, our work be done
In CPRS, MH Suite, and MHA-WEB;
Give us this day, our daily pause;
And forgive us our Action Required's,
As we forgive the double-bookings.
Lead us not into temptation
To skimp on our Safety Plans,
But deliver us from audits.

Amen."