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

[summerbabe]

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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.

I lean waaaaaay too much on the fact that it's virtually impossible for the VA to fire me while also recognizing that the primary utility of metrics like RVUs is to determine whether an ACOS might be promoted to Chief of Staff and for a Medical Center Director to go to a cushier job at the VISN and so on and so forth (none of which matters to me).

So I try my bust my ass doing good patient care with my engaged veterans which is infinitely easier when I'm ignoring some policy/the SOP of the day that has little to no clinical utility for my patients. And hope I stay under the radar.

And if I get on the radar, I recognize that all kinds of things are always going wrong so it's just a matter of time before I'm off the hot seat. And realistically, the only thing VA superiors can do is inconvenience me/make me feel kinda bad (but not really).

For example, do I input formal treatment plans? Usually. But will I ever do it in MHS? Zero chance! And sometimes I'll get lazy and just include it within my therapy notes. I try not to but hey, if it happens, I'm not going to lose sleep over it.

Plus, I have absolutely zero interest in a VA promotion. Nor do I care about the possible laugably small annual bonuses (if your facility will even give them).

 

[AcronymAllergy]

Honestly, if a person wants to provide 100% clinical services at a relatively reasonable pace, and maybe also has some interest in being involved in training, VA is one of the best gigs out there. It's also one of the most lenient employers in terms of non-competes (i.e., it basically has none), and the benefits are still solid.

 

[Fan_of_Meehl]

I lean waaaaaay too much on the fact that it's virtually impossible for the VA to fire me while also recognizing that the primary utility of metrics like RVUs is to determine whether an ACOS might be promoted to Chief of Staff and for a Medical Center Director to go to a cushier job at the VISN and so on and so forth (none of which matters to me).

So I try my bust my ass doing good patient care with my engaged veterans which is infinitely easier when I'm ignoring some policy/the SOP of the day that has little to no clinical utility for my patients. And hope I stay under the radar.

And if I get on the radar, I recognize that all kinds of things are always going wrong so it's just a matter of time before I'm off the hot seat. And realistically, the only thing VA superiors can do is inconvenience me/make me feel kinda bad (but not really).

For example, do I input formal treatment plans? Usually. But will I ever do it in MHS? Zero chance! And sometimes I'll get lazy and just include it within my therapy notes. I try not to but hey, if it happens, I'm not going to lose sleep over it.

Plus, I have absolutely zero interest in a VA promotion. Nor do I care about the possible laugably small annual bonuses (if your facility will even give them).

There is more truth in this single post than in the entirety of all of the emails I have received while being employed in the VA system for 10+ years. Bravo, you nailed it.

 

[summerbabe]

There is more truth in this single post than in the entirety of all of the emails I have received while being employed in the VA system for 10+ years. Bravo, you nailed it.

I'm 3.5 years into my full VA career (5.5 if you include internship and postdoc) and I'm now absolutely certain that the hill I want to die on is good clinical care where possible.

The people who are in charge of policy and operations and are choosing to die on that hill due to career advancement/increased pay/doing less or no clinical work/etc, I guess somebody has to do it so........good for them? But there's literally zero incentive for me to support that mission.

I still close out my encounters every day, try to get all my notes in within 24-48 hours, answer consults quickly, complete through risk assessment and fill out CSREs when I have patients who would absolutely benefit from that type of intervention, etc because I would try to hold these standards wherever I worked. But if a policy change is setting off my BS radar, I'm gonna act accordingly.

Broadly, I think this speaks to the effectiveness of negative reinforcement/militaristic pressure/social conformity that's pretty standard across the board that produces a ****load of complianance at the expense of individual well-being. Our jobs are hard enough as it with with emotional burnout and challenging patients but I really don't have the capacity (nor am I willing to try to find exta energy) to deal with that extra crap.

 

[Fan_of_Meehl]

I'm 3.5 years into my full VA career (5.5 if you include internship and postdoc) and I'm now absolutely certain that the hill I want to die on is good clinical care where possible.

The people who are in charge of policy and operations and are choosing to die on that hill due to career advancement/increased pay/doing less or no clinical work/etc, I guess somebody has to do it so........good for them? But there's literally zero incentive for me to support that mission.

I still close out my encounters every day, try to get all my notes in within 24-48 hours, answer consults quickly, complete through risk assessment and fill out CSREs when I have patients who would absolutely benefit from that type of intervention, etc because I would try to hold these standards wherever I worked. But if a policy change is setting off my BS radar, I'm gonna act accordingly.

Broadly, I think this speaks to the effectiveness of negative reinforcement/militaristic pressure/social conformity that's pretty standard across the board that produces a ****load of complianance at the expense of individual well-being. Our jobs are hard enough as it with with emotional burnout and challenging patients but I really don't have the capacity (nor am I willing to try to find exta energy) to deal with that extra crap.

This is true. And I agree with you wholeheartedly. The organization is--and always will be--very 'sick' in a certain sense and I believe that staying in a direct veteran-facing clinical role is the best way to minimize encountering that bureaucratic pathology...let alone (even worse) contributing to, perpetuating, or inflicting it upon others. That would be the worst. To quote Woody Harrelson's character in Season 1 of True Detective, 'I believe that's how people get a55 cancer." To those very few in a supervisory/administrative role who cleave to integrity rather than trying to play the Machiavellian public relations games that make a mockery of the truth...my hat's off to them...to the extent that they can actually keep that 'fight' up for the long term. I've been at VA for over a decade and I've never really seen too much of that happening (successfully) but, hey, what do they say? 'You've seen one VA, you've seen one VA.'

 

[ccpsych16]

I lean waaaaaay too much on the fact that it's virtually impossible for the VA to fire me while also recognizing that the primary utility of metrics like RVUs is to determine whether an ACOS might be promoted to Chief of Staff and for a Medical Center Director to go to a cushier job at the VISN and so on and so forth (none of which matters to me).

So I try my bust my ass doing good patient care with my engaged veterans which is infinitely easier when I'm ignoring some policy/the SOP of the day that has little to no clinical utility for my patients. And hope I stay under the radar.

And if I get on the radar, I recognize that all kinds of things are always going wrong so it's just a matter of time before I'm off the hot seat. And realistically, the only thing VA superiors can do is inconvenience me/make me feel kinda bad (but not really).

For example, do I input formal treatment plans? Usually. But will I ever do it in MHS? Zero chance! And sometimes I'll get lazy and just include it within my therapy notes. I try not to but hey, if it happens, I'm not going to lose sleep over it.

Plus, I have absolutely zero interest in a VA promotion. Nor do I care about the possible laugably small annual bonuses (if your facility will even give them).

Really appreciate this post (& others’) as someone just starting out and hoping for a long career here. This job would be even better without admin telling us how to do our jobs. At the same time, it feels like local leadership is listening to our concerns. That helps a lot.

Also, though not the main point of your post—my performance bonus was approx $2500, maybe a little higher. Is that not the norm? Is it higher or lower than typical?

 

[AcronymAllergy]

Really appreciate this post (& others’) as someone just starting out and hoping for a long career here. This job would be even better without admin telling us how to do our jobs. At the same time, it feels like local leadership is listening to our concerns. That helps a lot.

Also, though not the main point of your post—my performance bonus was approx $2500, maybe a little higher. Is that not the norm? Is it higher or lower than typical?

That's higher than any psychologist I know of at the VA where I worked. Ours were typically $1000 or less.

 

[Fan_of_Meehl]

Really appreciate this post (& others’) as someone just starting out and hoping for a long career here. This job would be even better without admin telling us how to do our jobs. At the same time, it feels like local leadership is listening to our concerns. That helps a lot.

Also, though not the main point of your post—my performance bonus was approx $2500, maybe a little higher. Is that not the norm? Is it higher or lower than typical?

That must be highly variable VA to VA. I don't even remember getting one but it could have been so low that it just didn't register.

 

[Hope4Grad]

For those that are still there. What's keeping you there?

Fear that if I go into only private practice I won’t have enough clients to be financially solvent. (Already have a private practice but I mean doing that exclusively)

 

[WisNeuro]

Fear that if I go into only private practice I won’t have enough clients to be financially solvent. (Already have a private practice but I mean doing that exclusively)

Unless you are in a super saturated area, I don't know of any insurance taking psychologists who aren't booking out a few months in advance. If you want to go full cash pay, it will take a while to build a reliable client load, but that's a different load. You could always join a practice as well if you didn't want to take care of the admin/business side of things. The vast majority of PP fears are unfounded for most jurisdictions.

 

[summerbabe]

This job would be even better without admin telling us how to do our jobs. At the same time, it feels like local leadership is listening to our concerns. That helps a lot.

My leadership, for the most part are reasonable, which is a huge draw to staying.

But they lost their minds a bit few months ago when that UAD access/clinical billable memo came out so even the best intentioned folks are not immune from these overall system pressures.

my performance bonus was approx $2500, maybe a little higher. Is that not the norm? Is it higher or lower than typical?

I have received 2. One was about $620 and another was like $880 after taxes. My COVID bonus that first year in the pandemic that everybody in our service received was like $1100.

But even on the higher end, that's not enough to change my behavior lol.

 

[Pragma]

My leadership, for the most part are reasonable, which is a huge draw to staying.

But they lost their minds a bit few months ago when that UAD access/clinical billable memo came out so even the best intentioned folks are not immune from these overall system pressures.

I have received 2. One was about $620 and another was like $880 after taxes. My COVID bonus that first year in the pandemic that everybody in our service received was like $1100.

But even on the higher end, that's not enough to change my behavior lol.

These bonus amounts sound similar to what I received and observed in the VA system. Nothing particularly motivating.

 

[WisNeuro]

These bonus amounts sound similar to what I received and observed in the VA system. Nothing particularly motivating.

Yeah, a bonus amount equal to what I get for a standard medicare dementia case would not be motivating for me to go above and beyond.

 

[Sanman]

I'm 3.5 years into my full VA career (5.5 if you include internship and postdoc) and I'm now absolutely certain that the hill I want to die on is good clinical care where possible.

The people who are in charge of policy and operations and are choosing to die on that hill due to career advancement/increased pay/doing less or no clinical work/etc, I guess somebody has to do it so........good for them? But there's literally zero incentive for me to support that mission.

I still close out my encounters every day, try to get all my notes in within 24-48 hours, answer consults quickly, complete through risk assessment and fill out CSREs when I have patients who would absolutely benefit from that type of intervention, etc because I would try to hold these standards wherever I worked. But if a policy change is setting off my BS radar, I'm gonna act accordingly.

Broadly, I think this speaks to the effectiveness of negative reinforcement/militaristic pressure/social conformity that's pretty standard across the board that produces a ****load of complianance at the expense of individual well-being. Our jobs are hard enough as it with with emotional burnout and challenging patients but I really don't have the capacity (nor am I willing to try to find exta energy) to deal with that extra crap.

Well said. IMO, this is a good perspective if you want to hang on to a career in the VA.

Personally, my reasons for staying on are threefold:

1. Geriatric patients in the VA get access to care and equipment non-VA geriatric patients only dream of being able to have. So, if makes my job easier in some ways. We are also grid exempt and excused from a lot normal problems.

2. I currently have a baby and my goal is to pretty much work as little as possible since my wife does that corporate grind and her overtime bonuses are much larger than anything in the healthcare world. The benefits are also nicer on the government side.

3. I am slowly building a private practice as my exit plan for when my wife wants to slow down and I want to really grind again.

As for performance bonuses, mine was $1000. The money you get for existing and being mediocre is much higher than anything they pay you for going above and beyond. So, I don't do that.

 

[PsyDWannabe]

Unless you are in a super saturated area, I don't know of any insurance taking psychologists who aren't booking out a few months in advance. If you want to go full cash pay, it will take a while to build a reliable client load, but that's a different load. You could always join a practice as well if you didn't want to take care of the admin/business side of things. The vast majority of PP fears are unfounded for most jurisdictions.

I was going to say just this. You will be booked so I would be more worried about developing a sense of business if you don’t have it already. But the clients are definitely there.

 

[Sanman]

Fear that if I go into only private practice I won’t have enough clients to be financially solvent. (Already have a private practice but I mean doing that exclusively)

Agreed with the others that this will never be the case. Now, the question of whether you will significantly outearn a hospital or VA job for all the extra work may be a worry. I would want a significant increase in pay (which is possible).

 

[Hope4Grad]

Unless you are in a super saturated area, I don't know of any insurance taking psychologists who aren't booking out a few months in advance. If you want to go full cash pay, it will take a while to build a reliable client load, but that's a different load. You could always join a practice as well if you didn't want to take care of the admin/business side of things. The vast majority of PP fears are unfounded for most jurisdictions.

Yeah, I am only willing to take private pay. I refuse to do insurance because I have two very young children and want to work as little as possible right now to maximize my time with them. What I could make in the NYC area with full fee private pay would allow me to work 15 hours versus 30 if I took insurance. That’s a major lifestyle difference - working 15 hours versus working 30. Right now I have 10 full fee private practice patients, but yes, it’s true that took forever to build. Years. I want to get to 15, but may not before I leave the VA (my plan is for June 1st to be my last day). I just can’t wait anymore as my kids childhood is slipping away and I’m not there. Things have changed massively at my VA post-COVID. They have taken away pretty much all remote work options. That is really bad for a parent at my stage of life as I went from being able to barely make drop offs and pick ups work to sometimes holding my infant child for 5 minutes in a day as I depart for work before they are up and come home before bed. It’s heart-breaking. They are totally inflexible and my commute is 45 to an hour each way. We are paying so much more now for gas, tolls, even had to buy a new ****box car. I have never been less physically healthy, too. Gotta get out of this lifestyle. In June I will have been at the VA for 3 years and 9 months as staff (did training there but those years don’t count towards pension). So I will miss making pension by 1 year and 3 months. Plus, I will cease to get student loan reimbursement and lose PSLF. That part sucks. But, I tell myself I can come back to the VA in a few years - although not sure I would since all the remote jobs are gone (have looked and see none on USA jobs). Not a great time of my work life. A quick note about losing out on the pension, though…I won’t lose out on much. I mean, it’s always nice to have a little extra, but working at the VA for 5 years gets you a pretty small pension. They only adjust it 2-3% per year, so not even sure that keeps up with inflation. Those pensions are great if you’ve worked there for like 15 years or more, but at 5 years you could probably put the same aside for yourself and end up in the same place.

 

[cara susanna]

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.

1. I love how the VA values evidence-based practice (well, for the most part).
2. I love having access to free trainings with experts, and resources like the NCPTSD.
3. I love having a proper 9 to 5 job with separate personal days and sick time, federal holidays off, and not having to take my work home with me. I couldn't do private practice because I do NOT want to work evenings or weekends.
4. I love how the VA allows me to have a diverse set of duties, like training and administration. I admit that I would be unhappy if I had the usual 30 hr/week clinical schedule like some of my coworkers.
5. I love team-based mental healthcare and the fact that I always have people I can consult with, even if they're across the country.
6. I feel like the VA respects my degree and profession more than some other places.
7. From what I've read, VA RVU expectations are actually on the lower side so I think I'd be very unhappy at other places.

 

[WisNeuro]

1. I love how the VA values evidence-based practice (well, for the most part).
2. I love having access to free trainings with experts, and resources like the NCPTSD.
3. I love having a proper 9 to 5 job with separate personal days and sick time, federal holidays off, and not having to take my work home with me. I couldn't do private practice because I do NOT want to work evenings or weekends.
4. I love how the VA allows me to have a diverse set of duties, like training and administration. I admit that I would be unhappy if I had the usual 30 hr/week clinical schedule like some of my coworkers.
5. I love team-based mental healthcare and the fact that I always have people I can consult with, even if they're across the country.
6. I feel like the VA respects my degree and profession more than some other places.
7. From what I've read, VA RVU expectations are actually on the lower side so I think I'd be very unhappy at other places.

Just a quick FYI, a lot of the NCPTSD stuff is widely available to non-VA providers as well, including some of the consultation stuff. We've used it in the past year.

 

[cara susanna]

Just a quick FYI, a lot of the NCPTSD stuff is widely available to non-VA providers as well, including some of the consultation stuff. We've used it in the past year.

I know, but there's more available to VA providers, especially if you're in the PTSD Mentorship program.

 

[WisNeuro]

I know, but there's more available to VA providers, especially if you're in the PTSD Mentorship program.

Fair, just want people to know things like the CAPS-5 training (and free CEs) as well as some of the consultations are still available.

 

[psycho1391]

In June I will have been at the VA for 3 years and 9 months as staff (did training there but those years don’t count towards pension

Hmm. My SF-50 counts my internship year as a year toward my pension. That is weird that yours doesn't.

 

[summerbabe]

Hmm. My SF-50 counts my internship year as a year toward my pension. That is weird that yours doesn't.

I know there is variability such as HR not willing to certify the internship year as counting towards PSFL at some systems while they freely include it all other systems.

 

[WisNeuro]

Hmm. My SF-50 counts my internship year as a year toward my pension. That is weird that yours doesn't.

As said by others, variability in HR competence. Fairly certain that it should not count towards pension/retirement. Also, you do run the risk of them eventually auditing certain accounts and having that fixed.

 

[AcronymAllergy]

Yeah, internship isn't supposed to count toward pension, as interns don't contribute to FERS (or at least they aren't supposed to). It does count toward service years in terms of leave accrual, though.

It should probably count toward PSLF, but I could see that being very HR-dependent.

 

[Pragma]

Yeah, internship isn't supposed to count toward pension, as interns don't contribute to FERS (or at least they aren't supposed to). It does count toward service years in terms of leave accrual, though.

It should probably count toward PSLF, but I could see that being very HR-dependent.

I do not see how HR would care for PSLF. It is simply verification of your dates of employment there. If you were paying your loan payments as an intern I do not see why those payments would not count if you were in something broadly categorized as public service (government, non-profit)

 

[AcronymAllergy]

I do not see how HR would care for PSLF. It is simply verification of your dates of employment there. If you were paying your loan payments as an intern I do not see why those payments would not count if you were in something broadly categorized as public service (government, non-profit)

I don't think it's so much that HR cares as it is that it just depends on what the system shows your hire date to be. If for some reason your hire date is not listed as your internship start date (e.g., as might happen if you took time between internship and later returning to the VA), it could take some convincing for HR to then certify that for you. Basically because it could require more work on their end. My hire date, for example, was always listed as my internship start date rather than the date I started my "real" job, which made things much easier all around (e.g., my leave accrual got bumped up automatically after fellowship).

That's probably a battle that's worth fighting for many people, though.

And this may be different now that some HR functions got bumped up to VISN or national levels rather than being handled locally. VA really could benefit from having a few people nationally whose primary focus is processing things like PSLF and EDRP applications.

 

[cara susanna]

It matters for grade and step, I can say that much.

 

[Pragma]

I don't think it's so much that HR cares as it is that it just depends on what the system shows your hire date to be. If for some reason your hire date is not listed as your internship start date (e.g., as might happen if you took time between internship and later returning to the VA), it could take some convincing for HR to then certify that for you. Basically because it could require more work on their end. My hire date, for example, was always listed as my internship start date rather than the date I started my "real" job, which made things much easier all around (e.g., my leave accrual got bumped up automatically after fellowship).

That's probably a battle that's worth fighting for many people, though.

And this may be different now that some HR functions got bumped up to VISN or national levels rather than being handled locally. VA really could benefit from having a few people nationally whose primary focus is processing things like PSLF and EDRP applications.

You would just use one form for the dates of employment during internship and another form for the later period - it is just whether you were employed there or not, what dates, and if it was at least a 32 hr/week position.

But yes, I can see how something so straightforward could get transformed into something confusing in the HR Incompetence Void at VA

 

[PsyDWannabe]

Yeah, I am only willing to take private pay. I refuse to do insurance because I have two very young children and want to work as little as possible right now to maximize my time with them. What I could make in the NYC area with full fee private pay would allow me to work 15 hours versus 30 if I took insurance. That’s a major lifestyle difference - working 15 hours versus working 30. Right now I have 10 full fee private practice patients, but yes, it’s true that took forever to build. Years. I want to get to 15, but may not before I leave the VA (my plan is for June 1st to be my last day). I just can’t wait anymore as my kids childhood is slipping away and I’m not there. Things have changed massively at my VA post-COVID. They have taken away pretty much all remote work options. That is really bad for a parent at my stage of life as I went from being able to barely make drop offs and pick ups work to sometimes holding my infant child for 5 minutes in a day as I depart for work before they are up and come home before bed. It’s heart-breaking. They are totally inflexible and my commute is 45 to an hour each way. We are paying so much more now for gas, tolls, even had to buy a new ****box car. I have never been less physically healthy, too. Gotta get out of this lifestyle. In June I will have been at the VA for 3 years and 9 months as staff (did training there but those years don’t count towards pension). So I will miss making pension by 1 year and 3 months. Plus, I will cease to get student loan reimbursement and lose PSLF. That part sucks. But, I tell myself I can come back to the VA in a few years - although not sure I would since all the remote jobs are gone (have looked and see none on USA jobs). Not a great time of my work life. A quick note about losing out on the pension, though…I won’t lose out on much. I mean, it’s always nice to have a little extra, but working at the VA for 5 years gets you a pretty small pension. They only adjust it 2-3% per year, so not even sure that keeps up with inflation. Those pensions are great if you’ve worked there for like 15 years or more, but at 5 years you could probably put the same aside for yourself and end up in the same place.

What is your VA/the VA’s gripe with having people work remote part/full-time? And just allowing them to show up for occasional in person things like meetings? I know this differs among VAs so I’m curious about the ones who are against remote work

 

[AcronymAllergy]

What is your VA/the VA’s gripe with having people work remote part/full-time? And just allowing them to show up for occasional in person things like meetings? I know this differs among VAs so I’m curious about the ones who are against remote work

I don't know what the issue is, but I can say my last VA had MH leadership that were very anti-telework (i.e., had a blanket policy that it was not allowed, even if a person had previously been approved for some amount of telework).

Although to be fair, that's also not unique to VA. Most frequently, the issue seems to relate to management worrying that employees will be less productive and less easily monitored.

 

[AcronymAllergy]

You would just use one form for the dates of employment during internship and another form for the later period - it is just whether you were employed there or not, what dates, and if it was at least a 32 hr/week position.

But yes, I can see how something so straightforward could get transformed into something confusing in the HR Incompetence Void at VA

Oh yeah, I'm not saying it should be a complicated process. I just have no idea whether or not it'd make heads explode.

 

[summerbabe]

What is your VA/the VA’s gripe with having people work remote part/full-time? And just allowing them to show up for occasional in person things like meetings? I know this differs among VAs so I’m curious about the ones who are against remote work

The only legitimate reason is needing LIPs on site for f2f access/crisis situations.

I have experienced some variability with tele-supervision of interns and how sites interpret COVID guidelines for supervision with some sites requiring supervisors to be on site while others are fine with tele.

But largely speaking, I think it’s a combination of misperceived difference in productivity, better monitoring/micro managing and fear that if some people have telework, everybody will want it.

 

[erg923]

What is your VA/the VA’s gripe with having people work remote part/full-time? And just allowing them to show up for occasional in person things like meetings? I know this differs among VAs so I’m curious about the ones who are against remote work

As of 2018:
Me: I have all the things of things you want me to have to do the things via CVLC. Do you want me to continue my SUD clinic or you want to cancel it...again?

Them: No, this is not seething we do here.

Me: Why?

Them: I'm sorry, this is not something we do here.

 

[cara susanna]

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.'

It's also really hard to see patients for frequent enough therapy to deliver an effective episode of care outside of EBP slots (which are only dedicated to, you know, specific EBPs). So you're seeing people monthly since that's all your access can handle, which means they don't get better and kind of just languish in your caseload, which means you have even less space to see new patients. Meanwhile, the new patients just keep on coming. And, if you are good at discharging patients, you get punished because you get more new patients (since your access is good).

 

[Sanman]

It's also really hard to see patients for frequent enough therapy to deliver an effective episode of care outside of EBP slots (which are only dedicated to, you know, specific EBPs). So you're seeing people monthly since that's all your access can handle, which means they don't get better and kind of just languish in your caseload, which means you have even less space to see new patients. Meanwhile, the new patients just keep on coming. And, if you are good at discharging patients, you get punished because you get more new patients (since your access is good).

The funny part is even when you have access, a lot folks don't want anything but supportive therapy and to never get better. So, they still end up languishing on your caseload. Can't really discharge in a PC-MHI model, so it is a revolving door.

 

[Shiori]

My supervisor told me I'm almost completely booked for over two months and I need to see more people each in the same conversation. I know they're pulled in lots of directions, but it was pretty demoralizing to be chastised for two things that contradict themselves.

It was a Telltale "Shiori will remember this" moment.

 

[Sanman]

My supervisor told me I'm almost completely booked for over two months and I need to see more people each in the same conversation. I know they're pulled in lots of directions, but it was pretty demoralizing to be chastised for two things that contradict themselves.

It was a Telltale "Shiori will remember this" moment.

Did they say you need to see more people or you need more RVUs? Not the same thing.

 

[WisNeuro]

My supervisor told me I'm almost completely booked for over two months and I need to see more people each in the same conversation. I know they're pulled in lots of directions, but it was pretty demoralizing to be chastised for two things that contradict themselves.

It was a Telltale "Shiori will remember this" moment.

Yeah, I'm going to need you to come in on Saturday...

 

[Shiori]

Did they say you need to see more people or you need more RVUs? Not the same thing.

They said I need to see more people. My average number of people is low on the low side because I'm getting no-shows and my grid was weird due to all the intake slots. It should get better because I'm just turning everything into a one hour slot instead of messing with 90 minute appointments. They're just too hard to manage in this system.

 

[Sanman]

They said I need to see more people. My average number of people is low on the low side because I'm getting no-shows and my grid was weird due to all the intake slots. It should get better because I'm just turning everything into a one hour slot instead of messing with 90 minute appointments. They're just too hard to manage in this system.

Yeah, that's just bad management then. There is lots of that.

Then you ask them "How can I be booked out for two months, have have all my slots filled, and not be seeing enough people?" and you get the blank look back.

Give me answers boss man, not problems. That is what they pay you the (not so) big bucks for...

 

[Sanman]

They said I need to see more people. My average number of people is low on the low side because I'm getting no-shows and my grid was weird due to all the intake slots. It should get better because I'm just turning everything into a one hour slot instead of messing with 90 minute appointments. They're just too hard to manage in this system.

Life advice...keep your head down, pay off your debts, live below your means....down the line they have that conversation with you, you just tell them "I could do that or just go into PP and not have this headache and make more money". Then watch the panic in their eyes. It kind of becomes fun after a while.

 

[summerbabe]

My supervisor told me I'm almost completely booked for over two months and I need to see more people each in the same conversation. I know they're pulled in lots of directions, but it was pretty demoralizing to be chastised for two things that contradict themselves.

It was a Telltale "Shiori will remember this" moment.

Sorry, that sucks!

But I'm not surprised. I've been hearing more and more emphasis on this 'unique veterans served' metric recently, which seems like a really, really, really, REALLY dumb thing to measure individuals on (versus a clinic or a system).

A small BHIP I interned at had 1 social worker who did every intake while carrying a very small follow-up caseload. So he would get kuddos under this system but every other BHIP provider would look bad compared to him because of how things were structured, which seemed to work pretty well in this setting.

Plus, some people will have periods of quick in/out discharges/loss to follow-ups and sometimes we'll have folks who we are unable to discharge at all.

I don't know where this push is coming from but it's clearly from somebody(s) who are lightyears removed from actual mental health clinical work.

 

[cara susanna]

Are any of you VA neuropsychologists or involved with neuropsychology fellows? If so, can you PM me?

 

[WisNeuro]

Are any of you VA neuropsychologists or involved with neuropsychology fellows? If so, can you PM me?

Currently, or ever? There are three of us on here who used to be in such a position, but have since vacated VA employment.

 

[Pragma]

Are any of you VA neuropsychologists or involved with neuropsychology fellows? If so, can you PM me?

 

[Fan_of_Meehl]

T

Yeah, I'm going to need you to come in on Saturday...

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I
I
I__________________ Time to 'set the building on fire' (see avatar)

 

[Fan_of_Meehl]

They said I need to see more people. My average number of people is low on the low side because I'm getting no-shows and my grid was weird due to all the intake slots. It should get better because I'm just turning everything into a one hour slot instead of messing with 90 minute appointments. They're just too hard to manage in this system.

Another thing to remind them of (if they are psychologists) if they are saying your no-show rates are "too high" is that...

NO STATISTIC IS INTERPETABLE IN THE ABSENCE OF NORMS

Last I checked the literature on no-show/cancellation rates for MH outpt appts, the range is between 20-40% of all appointments with a midpoint of around 30%. So...no...a no show rate of 20% is not 'too high.'

Unfortunately at VA, "leadership" often just pulls random round numbers out of their backsides like 'we need to get no show rates lower than 10% (arbitrary goal)'...anything above 10% is 'too high' and unacceptable. You can almost forgive social workers when they do stuff like this but doctoral-level psychologists really should know better.

 

[cara susanna]

Currently, or ever? There are three of us on here who used to be in such a position, but have since vacated VA employment.

Basically, we have an open VA neuropsych position that I am VERY motivated to fill, and was wondering if anyone would pass it along to neuropsych specific listservs or channels, especially ones that might have fellows who are looking for jobs after graduation. If anyone has access to that despite not being at the VA, too, that's fine! The caveat is I'd want to send it privately, since it would be quite identifying.

 

[WisNeuro]

Basically, we have an open VA neuropsych position that I am VERY motivated to fill, and was wondering if anyone would pass it along to neuropsych specific listservs or channels, especially ones that might have fellows who are looking for jobs after graduation. If anyone still has access to that despite not being at the VA, too, that's fine! The caveat is I'd want to send it privately, since it would be quite identifying.

I can post it to the AACN listserv if you'd like. People will post on there for people to send to their current fellows.