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

[WisNeuro]

My f/u access is garbage, as is everyone else's, and the new patients. just. keep. coming. Or people coming back. They're offered community care but they always decline. It's really burning me out.

I hear there's a pretty big demand for PTSD evaluators in the forensic realm these days....

---

Members don't see this ad.

 

[cara susanna]

I hear there's a pretty big demand for PTSD evaluators in the forensic realm these days....

I admit that I'm kind of curious about that would entail and what it would pay.

 

[Fan_of_Meehl]

My f/u access is garbage, as is everyone else's, and the new patients. just. keep. coming. Or people coming back. They're offered community care but they always decline. It's really burning me out.

Take some solace in the fact that if, for some reason, you were able (lucky) enough to have some availability/gaps in your schedule, you'd get b1tched at because of that, too.

Meanwhile,

veterans have access to limitless lifetime free doctoral-level therapy sessions ($150 - $180 per in PP) without co-pay or without any consequences for no showing or last minute cancellations and can audition endlessly for increased s/c benefits and fail to do homework or set goals til the cows come home

Is there any wonder that clinics are clogged? It's almost as if behavior is a function of its consequences and MH leadership are (some of them) experts in behavior modification. Almost.

The naked elephant in the room has, is, and always will be sporting shiny new invisible clothes.

 

[cara susanna]

Take some solace in the fact that if, for some reason, you were able (lucky) enough to have some availability/gaps in your schedule, you'd get b1tched at because of that, too.

Meanwhile,

veterans have access to limitless lifetime free doctoral-level therapy sessions ($150 - $180 per in PP) without co-pay or without any consequences for no showing or last minute cancellations and can audition endlessly for increased s/c benefits and fail to do homework or set goals til the cows come home

Is there any wonder that clinics are clogged? It's almost as if behavior is a function of its consequences and MH leadership are (some of them) experts in behavior modification. Almost.

The naked elephant in the room has, is, and always will be sporting shiny new invisible clothes.

One of my previous VAs ended up temporarily closing new OPMH referrals (automatically referred for community care) and I don't know why we can't do that here. We're drowning.

 

[Fan_of_Meehl]

One of my previous VAs ended up temporarily closing new OPMH referrals (automatically referred for community care) and I don't know why we can't do that here. We're drowning.

As I type this I just had two back to back appointments (an 0930 and a 1030) remotely/electronically cancelled by veterans last-minute (one 2 mins before the f2f session, the other 15 mins before the VVC session). Now, these were two very specialized MH appointments (one was for session 1 of CPT, the other was a within-specialy-team to consult on possible CBT-N (CBT for nightmare protocol, basically, ERRT tx) for traumatic nightmares. There will be no consequences. The clerks will call and r/s.

I get a bit irritated at all the news articles constantly bemoaning veterans' "lack of access" to mental health care in the VA system. Of course, there is variability esp in urban areas but... at most VA's the access is limitless, free, lifetime access to doctoral-level state of the art EBP treatment that is rarely available to citizens or in the community (esp if the VA is rural) and appointments are frequently no showed or canceled at the last minute.

 

[Fan_of_Meehl]

One of my previous VAs ended up temporarily closing new OPMH referrals (automatically referred for community care) and I don't know why we can't do that here. We're drowning.

You can't do that there because to admit that providers were not to blame for the situation would be literally against the religion of VA management.

For the life of me, I don't understand why supervisors are not responsible for calculating a ratio of #intake slots/wk divided by #therapy slots/wk on someone's grid. Some providers/clinics have 4 intake slots per week and others have 2 and people act like these are equivalent scenarios.

I have been told, in the past, when the rate of intakes into my clinic (relative to clinic slots) was double what it is now, that I needed to 'manage my caseload' better...it was "my responsibility" to "manage my caseload" b/c I had >120 active patients and was booked solid 2 months out.

In a different position, I have worked my backside off clinically to offer EBP, be flexible but firm in redirecting clients to set goals, commit to some level of HW between sessions, etc. (Basically, refused to lapse into supportive nontherapy)...and because I have some openings in my schedule, am shamed/blamed that I am not working hard enough even though I never call in (and often cover for those who do), I have had at least as many intakes as others in the clinic and have even handled several problematic 'hot potato's clients that others were tired of dealing with and sent my way. Eff it...it's supportive motivational interviewing and friggin Jungian dream analysis and archetype speculation horsesh1it from here on out so I can 'fill up' my schedule and not look 'lazy.'

I guess I vented/said all that just to say that in....

Scenario/clinic #1: 3x intake slots/wk but only 4/5 day per week to see patients (5th day was TBI clinic /internship). Got overwhelmed with that degree of 'inflow' of new pts and my grid couldn't handle it to the point that I was booked 2 months out. Got b1tched at for "not managing my caseload."

Scenario/ clinic #2: only 2 formal set aside intake slots per week (but frequent 'dumping' of pts into my caseload outside of that, which I handle), 100% clinical grid of 40 hrs/wk. 80-90% booked (but, OMFG! Not 100%!!!!!l because I am still building caseload in the new clinic. Get b1tched at / shamed for having too much availability and NOT being booked out 2 months in advance like everyone else.

You know what DID change between scenarios 1 and 2? Rate of weekly intakes / number of weekly clinic slots to see them.

You know what didn't change? My overall approach to responsible clinical practice. My approach has been consistent.

You know what ELSE didn't change? Getting b1tched at.

You know what DID? The rationale for b1tching me out flipped 180 degrees.

I can only hope that some absolutely ingenious supervisor at some future point in time possessing the arithmetical abilities of an 11-year-old, the problem-solving / logical abilities of a god, and the motivation to win some sort of Nobel prize for mental health innovative practice will have a friggin' Goldilocks Moment and realize that 4 intakes/wk is too many while 2 intakes/wk is too few and we may want to assign between 4 and 35 VA GS-14's to form a special committee to discover an integer lying somewhere between them.

 

[summerbabe]

Some providers/clinics have 4 intake slots per week and others have 2 and people act like these are equivalent scenarios.

That is a major frustration of mine. There are some long-term employees whose VA experiences seem very different than other people in the same exact role because when they were hired, clinical expectations and mapping just so happened to be different and reasonable adjustments haven’t been made since.

Plus, as they have accrued tenure, they have (smartly) picked up random things that knock a clinical hour off here, an hour off there but then new employees (or new transfers to a clinic) can be treated with very different expectations.

I get that there will always be variability with grids and some people are doing valuable things outside of direct patient care but it’s still frustrating to experience (and I think plays a role in people leaving the system who might otherwise stay longer).

 

[Sanman]

You can't do that there because to admit that providers were not to blame for the situation would be literally against the religion of VA management.

For the life of me, I don't understand why supervisors are not responsible for calculating a ratio of #intake slots/wk divided by #therapy slots/wk on someone's grid. Some providers/clinics have 4 intake slots per week and others have 2 and people act like these are equivalent scenarios.

I have been told, in the past, when the rate of intakes into my clinic was double what it is now, that I needed to 'manage my caseload' better...it was "my responsibility" to "manage my caseload" b/c I had >120 active patients and was booked solid 2 months out.

In a different position, I have worked my backside off clinically to offer EBP, ve flexible but firm in redirecting clients to set goals, commit to some level of HW between sessions, etc. (Basically, refused to lapse into supportive nontherapy)...and because I have some openings in my schedule, am shamed/blamed that I am not working hard enough even though I never call in (and often cover for those who do), I have had at least as many intakes as others in the clinic and have even handled several problematic 'hot potato's clients that others were tired of dealing with and sent my way. Eff it...it's supportive motivational interviewing and friggin Jungian dream analysis and archetype speculation horsesh1it from here on out so I can 'fill up' my schedule and not look 'lazy.'

I guess I vented/said all that just to say that in....

Scenario/clinic #1: 3x intake slots/wk but only 4/5 day per week to see patients (5th day was TBI clinic /internship). Got overwhelmed with that degree of 'inflow' of new pts and my grid couldn't handle it to the point that I was booked 2 months out. Got b1tched at for "not managing my caseload."

Scenario/ clinic #2: only 2 formal set aside intake slots per week (but frequent 'dumping' of pts into my caseload outside of that, which I handle), 100% clinical grid of 40 hrs/wk. 80-90% booked (but, OMFG! Not 100%!!!!!l because I am still building caseload in the new clinic. Get b1tched at / shamed for having too much availability and NOT being booked out 2 months in advance like everyone else.

You know what DID change between scenarios 1 and 2? Rate of weekly intakes / number of weekly clinic slots to see them.

You know what didn't change? My overall approach to responsible clinical practice. My approach has been consistent.

You know what ELSE didn't change? Getting b1tched at.

You know what DID? The rationale for b1tching me out flipped 180 degrees.

You're a better man than me. I have 'regulars' who are 100%sc for PTSD, refuse EBP tx and will forever be on my caseload for nontherapy. I try to sneak in goals where I can but their lives are chaotic and their follow through non existent. They will stay on my caseload because RVUs and they will not see anyone else. Besides, the minute they mention SI, everyone will come running to me again anyway. I long ago lapsed into acceptance and 'I need a PP' stage of life.

However, I don't see a long term future for me at the VA anyway. The pandemic and VVC adoption kept me in it a few extra years.

 

[Fan_of_Meehl]

You're a better man than me. I have 'regulars' who are 100%sc for PTSD, refuse EBP tx and will forever be on my caseload for nontherapy. I try to sneak in goals where I can but their lives are chaotic and their follow through non existent. They will stay on my caseload because RVUs and they will not see anyone else. Besides, the minute they mention SI, everyone will come running to me again anyway. I long ago lapsed into acceptance and 'I need a PP' stage of life.

However, I don't see a long term future for me at the VA anyway. The pandemic and VVC adoption kept me in it a few extra years.

I have a 'mini-caseload' [10-20%?] composed of the same clients..they 'outlasted' my efforts to wrangle them into active psychotherapy or run them off.

Edit: the better term for those 10-20% would be my 'sub-caseload' of Axis II Special Forces Commando Pre-Contemplators...

And, come to think of it, I should probably buy them all t-shirts with the 'Cheers' (80s TV show) logo on em...

"Sometimes you wanna go...where everybody knows your naaaaaa ha hame!"

 

[Shiori]

I had 7 intakes last week and no where to put them. It doesn't feel good. I also had a day of "regulars" today. One no-showed and another canceled 2 hours before their appointment. Now I won't look sufficiently busy even though I am drowning.

 

[PsyDr]

I had 7 intakes last week and no where to put them. It doesn't feel good. I also had a day of "regulars" today. One no-showed and another canceled 2 hours before their appointment. Now I won't look sufficiently busy even though I am drowning.

wait, do "no shows" affect your RVU metrics?

 

[Sanman]

wait, do "no shows" affect your RVU metrics?

No billable service provided, no rvu. It is all based on the billing codes.

 

[Fan_of_Meehl]

wait, do "no shows" affect your RVU metrics?

Absolutely, as do cancellations.

But, the thing is, even if you're at '100% productivity' (which is based on some median # of annual RVUs (1926, if I remember correctly) per full time psychologist, the corporate culture of the VA is such that you get brainwashed into feeling 'lazy' if you have a cancellation or no-show during your shift.

 

[Sanman]

I had 7 intakes last week and no where to put them. It doesn't feel good. I also had a day of "regulars" today. One no-showed and another canceled 2 hours before their appointment. Now I won't look sufficiently busy even though I am drowning.

With that many intakes, how are you not making numbers? You should be able to make it with 6ish/day psychothetapy codes.

 

[Sanman]

Absolutely, as do cancellations.

But, the thing is, even if you're at '100% productivity' (which is based on some median # of annual RVUs (1926, if I remember correctly) per full time psychologist, the corporate culture of the VA is such that you get brainwashed into feeling 'lazy' if you have a cancellation or no-show during your shift.

My philosophy is different. I try not do more than required of a productivity bonus. That has meant cutting back on some non-clinical duties because teaching 5 seminars gets me no more credit than teaching 1. Same with committees. Got on the easiest committee and stayed there.

 

[AcronymAllergy]

wait, do "no shows" affect your RVU metrics?

Yep, my experience was the same as what others mentioned--you got "dinged" for no-shows in that you of course didn't earn any RVUs and your target was not adjusted downward.

They theoretically were supposed to adjust the target downward if a person were not 100% clinical. I don't know if that ever actually happened.

Although I also don't know that anything ever came of providers not hitting their target. I suppose someone could've been put on a performance plan as a result, but I never heard of that happening. I also never heard of any kind of benefit associated with hitting or going above your RVU target.

Some (but not all) folks in management were also very protective of RVU data, not wanting providers to have access even though there were links available that provided the data.

 

[Sanman]

Yep, my experience was the same as what others mentioned--you got "dinged" for no-shows in that you of course didn't earn any RVUs and your target was not adjusted downward.

They theoretically were supposed to adjust the target downward if a person were not 100% clinical. I don't know if that ever actually happened.

Although I also don't know that anything ever came of providers not hitting their target. I suppose someone could've been put on a performance plan as a result, but I never heard of that happening. I also never heard of any kind of benefit associated with hitting or going above your RVU target.

Some (but not all) folks in management were also very protective of RVU data, not wanting providers to have access even though there were links available that provided the data.

Performance expectations are supposed to be tailored at the local level, but gs14 supervisors have no time for that so it never happens. I had 1 year with tailored productivity expectations in the last 7 years. Then it fell apart when that supervisor left.

 

[summerbabe]

One no-showed and another canceled 2 hours before their appointment. Now I won't look sufficiently busy even though I am drowning.

Make Having No Shows Great Again!

But seriously, as salaried employees with incredibly high levels of job security, we should strive do whatever we can to savor those brief moments of relief and not think twice about it.

 

[cara susanna]

As I type this I just had two back to back appointments (an 0930 and a 1030) remotely/electronically cancelled by veterans last-minute (one 2 mins before the f2f session, the other 15 mins before the VVC session). Now, these were two very specialized MH appointments (one was for session 1 of CPT, the other was a within-specialy-team to consult on possible CBT-N (CBT for nightmare protocol, basically, ERRT tx) for traumatic nightmares. There will be no consequences. The clerks will call and r/s.

I get a bit irritated at all the news articles constantly bemoaning veterans' "lack of access" to mental health care in the VA system. Of course, there is variability esp in urban areas but... at most VA's the access is limitless, free, lifetime access to doctoral-level state of the art EBP treatment that is rarely available to citizens or in the community (esp if the VA is rural) and appointments are frequently no showed or canceled at the last minute.

Seriously. I was told the current wait for therapy in one private healthcare system is 8 months. Why is the VA held to such a different standard? I get that we're the only healthcare these guys have access to, but you can't get blood out of a rock. You can't put people in appt slots that don't exist.

And it's easy to say, just schedule them out and offer community care if they don't, but unfortunately I do believe that the VA offers superior mental healthcare and patients usually elect to stay with us. ALSO, our upper leadership is now questioning why mental health at our CBOC is using community care so often. Like, do you realize we are a CBOC and can't offer everything? And, if you ask me, the main hospital should probably be using community care MORE.

 

[Pragma]

Just out of curiosity, is there a place where you DON'T get dinged for no shows? That has been ubiquitous anywhere I have practiced.

 

[summerbabe]

wait, do "no shows" affect your RVU metrics?

No shows do not impact your clinic utilization numbers (the % of your available slots that are booked) but the VA is on an RVU kick nationally so unfortunately, your clinic can be nearly 100% utilized but you can still get flack if your RVUs are low for reasons beyond your control.

Maybe Dennis McDonaugh (who is neither a healthcare provider nor had previous healthcare admin experience) got indoctrinated on RVUs upon swearing in so he’s gone all in on that metric as indicative of performance.

 

[AcronymAllergy]

Performance expectations are supposed to be tailored at the local level, but gs14 supervisors have no time for that so it never happens. I had 1 year with tailored productivity expectations in the last 7 years. Then it fell apart when that supervisor left.

Yep, same. We always hard, for example, that neuropsychology expectations (particularly regarding face-to-face time) should be addressed at the individual level. I never heard of RVUs being individually-tailored, but I also never got any pushback regarding face-to-face time, so I couldn't complain.

 

[Pragma]

No shows do not impact your clinic utilization numbers (the % of your available slots that are booked) but the VA is on an RVU kick nationally so unfortunately, your clinic can be nearly 100% utilized but you can still get flack if your RVUs are low for reasons beyond your control.

Maybe Dennis McDonaugh (who is neither a healthcare provider nor had previous healthcare admin experience) got indoctrinated on RVUs upon swearing in so he’s gone all in on that metric as indicative of performance.

Well in that case, the VA is ahead of some AMCs because there are places where no shows will ding you on RVUs as well as utilization numbers.

 

[cara susanna]

No shows do not impact your clinic utilization numbers (the % of your available slots that are booked) but the VA is on an RVU kick nationally so unfortunately, your clinic can be nearly 100% utilized but you can still get flack if your RVUs are low for reasons beyond your control.

Maybe Dennis McDonaugh (who is neither a healthcare provider nor had previous healthcare admin experience) got indoctrinated on RVUs upon swearing in so he’s gone all in on that metric as indicative of performance.

I was told they can't even calculate utilization right now, at least at our local level.

Lol, I just had 2 cancellations for tomorrow. So yeah, no room to put people but then all this free time...

 

[Shiori]

With that many intakes, how are you not making numbers? You should be able to make it with 6ish/day psychothetapy codes.

I'm also looking at the "average number of patients a day" metric. I was told by my supervisor to strive for 4 a day. I had 5 scheduled and two won't be coming in.

 

[Sanman]

I'm also looking at the "average number of patients a day" metric. I was told by my supervisor to strive for 4 a day. I had 5 scheduled and two won't be coming in.

Yeah, that doesn't matter as much if you have a lot of intakes some days. VA rvus are based on something like 5 90834s/day. More 90837s and 90791s are like an extra rvu each (2.25 vs 3.1 or 3.3). 3-4 intakes is the same as 5-6 90834s.

 

[Fan_of_Meehl]

I'm also looking at the "average number of patients a day" metric. I was told by my supervisor to strive for 4 a day. I had 5 scheduled and two won't be coming in.

4 a day is very do-able. I tend to get stressed and fall behind on paperwork with six slots (including one 90 min intake) and everyone attending.

 

[cara susanna]

I'm also looking at the "average number of patients a day" metric. I was told by my supervisor to strive for 4 a day. I had 5 scheduled and two won't be coming in.

That's such a dumb metric. You have very little control, especially if you don't even do your own scheduling.

6 is my max limit. I had an intake and 4 therapy pts yesterday (should have been 5 but had a cancellation, thank goodness) and I was exhausted by the end.

 

[Sanman]

4 a day is very do-able. I tend to get stressed and fall behind on paperwork with six slots (including one 90 min intake) and everyone attending.

I used to do 5-6 intakes/day at my old job. They were quicker than VA, but background took longer because paper records. I think my record was 30 intakes in week (I was wiped out by Friday).

 

[Shiori]

I am more than happy to see the four people. I just have no control over whether they show up.

That's such a dumb metric. You have very little control, especially if you don't even do your own scheduling.

6 is my max limit. I had an intake and 4 therapy pts yesterday (should have been 5 but had a cancellation, thank goodness) and I was exhausted by the end.

Yeah, my typical day is scheduled with 5-6 people. There will be a random mix of intakes scattered throughout the week. I get pretty worn out with more than one intake in a day. Last week, I had 2 intakes in one day day plus 4 regular clients twice. I have a lot of higher acuity people right now too, which isn't helping. It's just frustrating to feel like I'm being evaluated on something I have almost no control over.

 

[PsyDr]

Just out of curiosity, is there a place where you DON'T get dinged for no shows? That has been ubiquitous anywhere I have practiced.

1) Any employee position where you are paid as a percentage of collections. It is unusual to have an employee position with that arrangement, but it can be done.

2) Any contractor gig. Contractors must have control of their schedule, and how they do their work. But most contractor gigs in psychology would fail IRS tests.

 

[Sanman]

1) Any employee position where you are paid as a percentage of collections. It is unusual to have an employee position with that arrangement, but it can be done.

2) Any contractor gig. Contractors must have control of their schedule, and how they do their work. But most contractor gigs in psychology would fail IRS tests.

You still lose money when there is a no show unless you collect a no-show fee. You won't get yelled at, but really I don't care about that part.

 

[cara susanna]

Does anyone else's facility email the entire clinic when a secure message is about to escalate and tell them to check their messages? Would it kill them to tell us the specific provider who was assigned to that message?

 

[Fan_of_Meehl]

Ours does the public shaming in the town square as well. I'm sure there's a facile excuse but I'm also sure that the ritual is entirely consistent with the sacred practices of the Holy Church of Making Providers Eat Crap All Day Long Every Single Day From Everyone From The Janitors to the Secretaries to the Imperial Legate of Secure Messaging.

 

[Sanman]

Does anyone else's facility email the entire clinic when a secure message is about to escalate and tell them to check their messages? Would it kill them to tell us the specific provider who was assigned to that message?

Ours does that as well. I think the idea is to get someone to do it if that person is out.

 

[Shiori]

Taking my first vacation since starting! It was a process, but all my clinics are closed, my leave was approved, and I'm crafting my away message to post this afternoon. I should change my voicemail message, but I'm already mentally on vacation.

 

[WisNeuro]

Taking my first vacation since starting! It was a process, but all my clinics are closed, my leave was approved, and I'm crafting my away message to post this afternoon. I should change my voicemail message, but I'm already mentally on vacation.

Have I mentioned lately how great private practice is?

 

[Shiori]

Have I mentioned lately how great private practice is?

I have been toying with names for a LLC.

 

[Fan_of_Meehl]

Taking my first vacation since starting! It was a process, but all my clinics are closed, my leave was approved, and I'm crafting my away message to post this afternoon. I should change my voicemail message, but I'm already mentally on vacation.

Why does it feel like parole? LOL

 

[cara susanna]

Anyone else feel like accessing MyPay without PIV sign in is like trying to get into Fort Knox?

 

[Shiori]

I'm back from my vacation, and I'm ready to go on another one already. I think I will use all my no-show time to find a nice beach.

 

[deleted1038433]

Anyone at a VA hospital that has special pay for psychologists as a retention incentive? How much is your special pay rate, and does it make it more worth it for you?

 

[summerbabe]

Anyone at a VA hospital that has special pay for psychologists as a retention incentive? How much is your special pay rate, and does it make it more worth it for you?

I’m at the regular rate but I have heard it can be as much as 20% above the standard package, which is a hell of a lot more incentivizing than annual bonuses (if your facility even has that and you meet criteria).

And it seems like more and more facilities are requesting this so while I don’t know the ins and outs that would go into this, it feels like an across the board raise somewhere down the line should be on the table given the continued issues with retention and recruitment.

 

[Shiori]

Does anyone use Adaptive Disclosure? I usually end up tweaking CPT and PE to get at moral injury stuck points more thoroughly, but I wonder if AD would be useful to get into. I keep reading the first couple of chapters of one of the book and lose the drive to read more.

 

[Sanman]

I’m at the regular rate but I have heard it can be as much as 20% above the standard package, which is a hell of a lot more incentivizing than annual bonuses (if your facility even has that and you meet criteria).

And it seems like more and more facilities are requesting this so while I don’t know the ins and outs that would go into this, it feels like an across the board raise somewhere down the line should be on the table given the continued issues with retention and recruitment.

I know of some depts that got more than 20%. Whether it is worth it really depends on your position.

 

[Fan_of_Meehl]

Anyone at a VA hospital that has special pay for psychologists as a retention incentive? How much is your special pay rate, and does it make it more worth it for you?

I am completely unfamiliar with this. Is this a deal for certain subspecialties (e.g., neuropsych, pain psychology) that are in high demand but are particularly difficult to recruit/retain in VA settings? It's not for rank-and-file outpatient clinicians is it?

 

[Psychchick09]

I am completely unfamiliar with this. Is this a deal for certain subspecialties (e.g., neuropsych, pain psychology) that are in high demand but are particularly difficult to recruit/retain in VA settings? It's not for rank-and-file outpatient clinicians is it?

All the psychologists at my VA got one, but we are more rural so I don’t know if that factored in!

 

[Sanman]

I am completely unfamiliar with this. Is this a deal for certain subspecialties (e.g., neuropsych, pain psychology) that are in high demand but are particularly difficult to recruit/retain in VA settings? It's not for rank-and-file outpatient clinicians is it?

From my understanding, it is applied at the dept level for all clinicians in locations struggling with retention and recruitment. The dept chief has to apply and get approval.

 

[Fan_of_Meehl]

From my understanding, it is applied at the dept level for all clinicians in locations struggling with retention and recruitment. The dept chief has to apply and get approval.

Thanks for the info. We've definitely struggled with this.

 

[summerbabe]

Thanks for the info. We've definitely struggled with this.

To add on, these are requests that each facility makes to their VISN/VACO/OMHSP so the chief goes to the ACOS who goes to the hospital leadership and so on up the food chain. So it’s operating differently than recruitment incentives for a specific position like neuropsych but not BHIP.

From what I’ve gathered, data to support the following can lead to approval:
- areas that can show they have always struggled with recruitment (e.g., rural areas that are always at a suggested staffing FTE deficit) even though tenure may be decent or even above average
- significant loss of staff post-COVID without adequate replacement (e.g., how many recent postings went without a hire, posting without a qualified candidate even applying, times when a selected candidate backed out, etc)
- local market rates at other hospitals/institutions are significantly higher than the VA even after locality adjustment

While I’ve never heard any ‘VA leaders’ talk about raises for psychologists (or other mental health staff) across the board, many facilities are going in one or more of these directions currently. It’s just that the facilities that have gotten this approval already are usually facilities with competent leadership who are trying to stay ahead of the game. Maybe trickle down VA economics works better than in the real world.

Either that or we’ll get replaced by mid-levels every time somebody leaves and rather than reposting as a PhD/PsyD position, these get more seemlessly transitioned into PhD and MSW/LPC/MFT eligible gigs, which is currently a major hassle to reclassify due to bureaucratic inertia, which then plays an oversized role in keeping PhD/PsyD positions at current levels.