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

[WisNeuro]

So, yes and no. I screen out a lot of folks I have no desire to work with. The other component to this is, I am trying to balance it with having 50% of my caseload being cash pay with the other 50% being insurance-based. I am really trying to gather more cash pay folks so I can delegate to the two providers I hired on who don't want to take insurance. The moment I got on with 3 insurance panels, I filled up quickly to 12 patients a week in a matter of 1-3 weeks. I'm also bringing on a 3rd and possibly a 4th contractor who will take insurance, so I will have to apply for them myself. I am trying to scale this accordingly so that I eventually can see less patients and live off of the passive income I get from my contractors.

Yes, I'll concede that marketing is important for cash only, but mostly irrelevant for insurance based in most places.

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[Sanman]

Typically...because they don't want to do the hard work themselves. They are more than free to create an LLC, do their own advertising, procure referral sources, spend time paneling themselves on insurances, pay subscription fees to EHR and directories, and spend the countless hours engaging in digital and print marketing. They just need to actually put the effort into it like I am. I've spoke to a lot of psychologists in my area, and that tends to be like the #1 reason - they don't know how to create a business, market it, and be good at that. They are scared. It makes sense as I too was apprehensive in doing so, but I've always been a businessman.

Are people actually spending all that much time on this? particularly if they take insurance? Filling an insurance-based MH panel is pretty much easy mode in most jurisdictions. Make a few phone calls to potential referral bases and prepare to beat back referrals with a stick.

I think that is only part of the reason. The second (and I believe more common) reason that more psychologists do not engage in private practice is lack of personal financial stability. Personally, I wanted a certain level of net worth prior to my starting on the path to private practice. Having achieved that a few years ago, I feel much more comfortable with the instability of earnings.

 

[texanpsychdoc]

I think that is only part of the reason. The second (and I believe more common) reason that more psychologists do not engage in private practice is lack of personal financial stability. Personally, I wanted a certain level of net worth prior to my starting on the path to private practice. Having achieved that a few years ago, I feel much more comfortable with the instability of earnings.

Well sure it's only part of it....I am not listing a comprehensive list of reasons. From the folks I spoke with, the one I mentioned being at the top of their list. Either way, when you have someone else taking responsibility for the operations of the business and delegate, that tends to open them up to the idea even more so, so, when they do factor in that maybe private practice is unstable in terms of payments, it may allow them to stomach that better. Alternatively, a solution is to hire them on as a full time or part time salaried.

FYI - my response was directed to the person who asked why don't my contractors just cut out the middle man. And I explained why.

I should also add, I offer them 75% of their earnings, as well as some fringe benefits and lots of flexibility and autonomy to see as little or as many patients they want, and at whatever time is feasible for them.

 

[PsychPhDone]

How it is supposed to work or how it actually works?

Former please, I have a sense of the latter

 

[cara susanna]

Former please, I have a sense of the latter

It's supposed to be used for assigning new intakes to therapists and staffing ongoing cases. It's also SUPPOSED to be used for psychiatrists who want their patients referred for therapy to get assigned to a therapist.

 

[Sanman]

Former please, I have a sense of the latter

My understanding is that is secondary level care similar to general outpatient mental health. So veteran is seen by PCP or maybe PC-MHI and needs more than a 5-6 sessions. BHIP referral is placed and they do an intake and assign psychiatrist, psychotherapist, and case manager than work as a team to manage the patient and act as treatment coordinators. Except that is not always the case and often is no different than general outpatient care.

 

[PsychPhDone]

It's supposed to be used for assigning new intakes to therapists and staffing ongoing cases. It's also SUPPOSED to be used for psychiatrists who want their patients referred for therapy to get assigned to a therapist.

My understanding is that is secondary level care similar to general outpatient mental health. So veteran is seen by PCP or maybe PC-MHI and needs more than a 5-6 sessions. BHIP referral is placed and they do an intake and assign psychiatrist, psychotherapist, and case manager than work as a team to manage the patient and act as treatment coordinators. Except that is not always the case and often is no different than general outpatient care.

Ok so would this theoretically allow a patient to get longer term psychotherapy? Or are those still getting referred to CC?

 

[texanpsychdoc]

My understanding is that is secondary level care similar to general outpatient mental health. So veteran is seen by PCP or maybe PC-MHI and needs more than a 5-6 sessions. BHIP referral is placed and they do an intake and assign psychiatrist, psychotherapist, and case manager than work as a team to manage the patient and act as treatment coordinators. Except that is not always the case and often is no different than general outpatient care.

As a former BHIP psychologist, I can attest to this being an accurate description for the most part. At least in our BHIP teams back in Ohio, when a referral came down, we did the intake and 99.999% of the time was their therapist and MHTC and would delegate to psychiatry or other specialized areas as needed that went beyond what we could do. For example, I would receive all of the testing consults that neuro didn't want...I was also priv. for neuro testing at my previous VA, but I typically did a lot of ADHD, LD, and DDX assessments in addition to my normal therapy caseload that ranged from personality disorders, DID, psychotic disorders, eating disorders.....pretty much everything in the DSM

 

[deleted1038433]

Ok so would this theoretically allow a patient to get longer term psychotherapy? Or are those still getting referred to CC?

We still do specialty, evidence-based care in BHIP. I generally don't see anyone for more than 12-16 sessions or more than 1 year. Ideally, it is explained to veterans by every provider they interact with, that therapy is always time limited and goal focused. If they decline recommended treatment, that is their choice. We don't offer something that doesn't work just because they are whining. We don't put in a community care consult for unlimited, supportive therapy. If any of you do that, please stop. It's not helping the veterans, and it's unethical practice that undermines your colleagues.

 

[Sanman]

We still do specialty, evidence-based care in BHIP. I generally don't see anyone for more than 12-16 sessions or more than 1 year. Ideally, it is explained to veterans by every provider they interact with, that therapy is always time limited and goal focused. If they decline recommended treatment, that is their choice. We don't offer something that doesn't work just because they are whining. We don't put in a community care consult for unlimited, supportive therapy. If any of you do that, please stop. It's not helping the veterans, and it's unethical practice that undermines your colleagues.

On principle, I agree with you. In reality, some of this cannot be avoided.

 

[Therapist4Chnge]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

I’ll give them the first 1-2min of session to rant while I jot down some notes, and then I usually pivot to what they have control over (i.e. themselves and how they choose to react), and remind them the purpose of the sessions. Typically these folks are high consumers of “Grievance” Media, so they are being bombarded by negative stimuli, so I suggest reducing/removing their consumption. As the kids say today, they need to go “touch some grass” and get away from the rage propaganda.

 

[PsychPhDone]

We still do specialty, evidence-based care in BHIP. I generally don't see anyone for more than 12-16 sessions or more than 1 year. Ideally, it is explained to veterans by every provider they interact with, that therapy is always time limited and goal focused. If they decline recommended treatment, that is their choice. We don't offer something that doesn't work just because they are whining. We don't put in a community care consult for unlimited, supportive therapy. If any of you do that, please stop. It's not helping the veterans, and it's unethical practice that undermines your colleagues.

Thanks. I don't do that. I'm in specialty care, just trying to understand what will likely be a new referral source for me.

 

[deleted1038433]

On principle, I agree with you. In reality, some of this cannot be avoided.

My functional statement does not include providing anti-congressional complaint vent sessions to entitled veterans. I will stand by following ethical principles in the care I provide 100% of the time. It's okay if BHIP social workers and psychiatrists don't like me for that. I don't care too much what "specialty" mental health clinic psychologists have to say about it either because they would never provide longterm supportive counseling themselves and our productivity generally carries their positions.

 

[Fan_of_Meehl]

My functional statement does not include providing anti-congressional complaint vent sessions to entitled veterans. I will stand by following ethical principles in the care I provide 100% of the time. It's okay if BHIP social workers and psychiatrists don't like me for that. I don't care too much what "specialty" mental health clinic psychologists have to say about it either because they would never provide longterm supportive counseling themselves and our productivity generally carries their positions.

Dear Congressman Fancypants:

Differential diagnosis and treatment planning in professional psychology are not democratic exercises.

Sincerely,

Yoocan KissMyGrits, Ph.D.

 

[Sanman]

My functional statement does not include providing anti-congressional complaint vent sessions to entitled veterans. I will stand by following ethical principles in the care I provide 100% of the time. It's okay if BHIP social workers and psychiatrists don't like me for that. I don't care too much what "specialty" mental health clinic psychologists have to say about it either because they would never provide longterm supportive counseling themselves and our productivity generally carries their positions.

Which is fine for you. However, I get stuck with them on the primary level when they have a "crisis" or indicate SI every other month, but everyone else has kicked them to the curb. I can't discharge them from the primary care team.

 

[Shiori]

There are so many ways for people to cancel their appointments. I wish more of them would use them.

 

[Fan_of_Meehl]

Maybe we can develop an AI tool to predict patient cancellations before they happen with a high degree of accuracy that can pre-emptively cancel the patient (beat them to the punch) and then reschedule someone else in their place. You may think I'm joking but I'd imagine that, somewhere in the VA system there is a non-clinician working on this to 'increase access.'

 

[summerbabe]

There are so many ways for people to cancel their appointments. I wish more of them would use them.

100% agree.

Since I'm in a virtual role, I communicate with my folks on my VA issued cell phone.

I tell them that they can text me for admin things like cancel/reschedule or to find a time to check in so my no-show rate is waaaaaay lower than in my previous position. And it's usually people who have decided to drop out of treatment (but don't want to tell me).

The downside is that some people will leave concerning voicemails afterhours/weekends.

 

[Sanman]

Maybe we can develop an AI tool to predict patient cancellations before they happen with a high degree of accuracy that can pre-emptively cancel the patient (beat them to the punch) and then reschedule someone else in their place. You may think I'm joking but I'd imagine that, somewhere in the VA system there is a non-clinician working on this to 'increase access.'

Honestly, you don't need a tool to predict cancellations. I can do that. The tool you need is to figure who will show up. Let me tell you the day before/after holidays and summer time have increased cancellation just due to vacations, travel, family visits, etc. The issue is finding someone that actually wants to be seen.

 

[Fan_of_Meehl]

Honestly, you don't need a tool to predict cancellations. I can do that. The tool you need is to figure who will show up. Let me tell the day before/after holidays and summer time have increased cancellation just due to vacations, travel, family visits, etc. The issue is finding someone that actually wants to be seen.

It used to frustrate me but these days it just bemuses me...all the varied excuses, stories, rationalizations, etc. when following up with veterans around their behavioral acts of disengagement with the psychotherapy process.

I just remind myself that I'm getting paid to engage in playful banter with veterans as we co-investigate the astonishing procession of unfortunate events, wormholes, space-time anomalies, natural disasters, paper eating dogs, etc. that somehow conspired to prevent them from following up on some collaboratively-,determined exercise, worksheet, phone call, or no--showed or cancelled appointment (or 7 in a row). It is mildly entertaining.

 

[cara susanna]

Honestly, you don't need a tool to predict cancellations. I can do that. The tool you need is to figure who will show up. Let me tell the day before/after holidays and summer time have increased cancellation just due to vacations, travel, family visits, etc. The issue is finding someone that actually wants to be seen.

Also, the time and effort you put into planning a session is roughly equivalent to the likelihood that the patient will late cancel or NS.

 

[WisNeuro]

Wait. Y'all are planning out sessions beforehand?

 

[Shiori]

Also, the time and effort you put into planning a session is roughly equivalent to the likelihood that the patient will late cancel or NS.

I once made the mistakes of printing off all of my session materials and MBC. That was such a quiet day. Never again.

 

[cara susanna]

Wait. Y'all are planning out sessions beforehand?

It can be as simple as printing out things. Printing something alone brings the chance up to 50%.

 

[deleted1038433]

Which is fine for you. However, I get stuck with them on the primary level when they have a "crisis" or indicate SI every other month, but everyone else has kicked them to the curb. I can't discharge them from the primary care team.

I can undertstand your frustration. So many of the referrals I get are for veterans with occasional SI without plan or intent, but they don't actually want to do psychotherapy. I'm pretty sure those referrals are mostly about psychiatrists and primary care physicians wanting to spread the liability around.

 

[deuce22]

Maybe we can develop an AI tool to predict patient cancellations before they happen with a high degree of accuracy that can pre-emptively cancel the patient (beat them to the punch) and then reschedule someone else in their place. You may think I'm joking but I'd imagine that, somewhere in the VA system there is a non-clinician working on this to 'increase access.'

This is basically the VA version of Minority Report with Tom Cruise. All we need are some Precogs...

 

[Sanman]

I can undertstand your frustration. So many of the referrals I get are for veterans with occasional SI without plan or intent, but they don't actually want to do psychotherapy. I'm pretty sure those referrals are mostly about psychiatrists and primary care physicians wanting to spread the liability around.

Pretty much. Combine that with higher ups that only care about access and RVUs recently and it can be pointless to fight a system that encourages supportive complaining (err...I mean counseling).

 

[Fan_of_Meehl]

Pretty much. Combine that with higher ups that only care about access and RVUs recently and it can be pointless to fight a system that encourages supportive complaining (err...I mean counseling).

I had the psych nurse practitioner reach out to me with a panicked text one day (in the clinic I was relatively new to). She asked if I had any availability that shift and if I could 'see' 'client X. I asked her why would I need to see 'client X' (he wasn't in my caseload and I didn't have a consult request associated with him). She said he had expressed some passive SI without a plan...she had completed the suicide risk assessment and found he didn't need hospitalization...i.e., wasn't in crisis. I repeated my question. She seemed a bit miffed but I explained to her that if he wasn't at risk and wasn't in crisis then the appropriate thing to do (unless I was missing something) was put in a routine psychotherapy consult and I'd be glad to see him. She did, and I saw him like the next week. This is where it gets interesting.

When I did finally see him, I reviewed his chart prior to seeing him and noticed that--in addition to what the NP had said about him--she also had made a vague entry about anger and threats to others. So I asked him about that. He said that he had seen her before the election (it was a recent national election year) and that he had heard that if the Republicans took control of Congress that they were going to dismantle social security benefits and take away veterans benefits and if they did that (he was an elderly gentleman) then he would have nothing to lose and he might just 'lose it' and {insert vague hemming and hawing language quasi-threatening possible pseudo-self/other harm}. Mind you, when I saw him (it might have been two weeks later), the election had occurred and the Republicans 'lost' or whatever (basically, his 'fear' didn't come true) so he said, since they lost, he wasn't planning on doing anything. Frankly, I don't think he was serious (but of course you always have to take these things seriously and do due diligence). I asked that--even last week--when he feared the Republicans were going to take over Congress and take away everyone's Social Security and all of the Veteran's Benefits...was he thinking of any particular Congressman that he was inclined to act against or threaten or harm in any way? Did he have any particular actions he was considering taking? He shrugged it off, explaining, 'I wouldn't have done anything right away...what I'm saying is that if they had won and if they took away my benefits then as an old man I may at some point down the road get so fed up that I might do something like go off...like hurt myself or others.' I'm like...okay...and how are you feeling now? Any thoughts of wanting to hurt anyone now? Nope, they (repubs) lost. I'm like, 'crisis averted, then.' LOL. Even when he had met with the NP, he wasn't making a specific threat toward anyone, he was just venting and blowing off steam and a couple of clarifying questions and about 5 mins time (if that), it could be documented that he wasn't making any specific imminent or serious threats of physical harm toward anyone. He was also possibly trying to scare a provider into giving him what he wanted, either in the form of documenting specific things to help with increasing benefits or maybe meds he wanted, who knows.

 

[Sanman]

I had the psych nurse practitioner reach out to me with a panicked text one day (in the clinic I was relatively new to). She asked if I had any availability that shift and if I could 'see' 'client X. I asked her why would I need to see 'client X' (he wasn't in my caseload and I didn't have a consult request associated with him). She said he had expressed some passive SI without a plan...she had completed the suicide risk assessment and found he didn't need hospitalization...i.e., wasn't in crisis. I repeated my question. She seemed a bit miffed but I explained to her that if he wasn't at risk and wasn't in crisis then the appropriate thing to do (unless I was missing something) was put in a routine psychotherapy consult and I'd be glad to see him. She did, and I saw him like the next week. This is where it gets interesting.

When I did finally see him, I reviewed his chart prior to seeing him and noticed that--in addition to what the NP had said about him--she also had made a vague entry about anger and threats to others. So I asked him about that. He said that he had seen her before the election (it was a recent national election year) and that he had heard that if the Republicans took control of Congress that they were going to dismantle social security benefits and take away veterans benefits and if they did that (he was an elderly gentleman) then he would have nothing to lose and he might just 'lose it' and {insert vague hemming and hawing language quasi-threatening possible pseudo-self/other harm}. Mind you, when I saw him (it might have been two weeks later), the election had occurred and the Republicans 'lost' or whatever (basically, his 'fear' didn't come true) so he said, since they lost, he wasn't planning on doing anything. Frankly, I don't think he was serious (but of course you always have to take these things seriously and do due diligence). I asked that--even last week--when he feared the Republicans were going to take over Congress and take away everyone's Social Security and all of the Veteran's Benefits...was he thinking of any particular Congressman that he was inclined to act against or threaten or harm in any way? Did he have any particular actions he was considering taking? He shrugged it off, explaining, 'I wouldn't have done anything right away...what I'm saying is that if they had won and if they took away my benefits then as an old man I may at some point down the road get so fed up that I might do something like go off...like hurt myself or others.' I'm like...okay...and how are you feeling now? Any thoughts of wanting to hurt anyone now? Nope, they (repubs) lost. I'm like, 'crisis averted, then.' LOL. Even when he had met with the NP, he wasn't making a specific threat toward anyone, he was just venting and blowing off steam and a couple of clarifying questions and about 5 mins time (if that), it could be documented that he wasn't making any specific imminent or serious threats of physical harm toward anyone. He was also possibly trying to scare a provider into giving him what he wanted, either in the form of documenting specific things to help with increasing benefits or maybe meds he wanted, who knows.

Could he ambulate well? I had a Trumper that would have loved to be at the capitol riots, except walking to the mailbox is a triumph for him. Same guy spent a lot time talking about how the election was stolen (thanks Fox News) and Biden has dementia. It wasn't until recently that we got to talking and I find out that he has never voted in an election!

 

[Fan_of_Meehl]

Could he ambulate well? I had a Trumper that would have loved to be at the capitol riots, except walking to the mailbox is a triumph for him. Same guy spent a lot time talking about how the election was stolen (thanks Fox News) and Biden has dementia. It wasn't until recently that we got to talking and I find out that he has never voted in an election!

Yeah...he did okay for his age. Think he was in his mid-late 60's. You bring up a good point. In our state law, 'dangerousness to others' is all about people who make credible threats to inflict serious physical harm (imminently) coupled with the apparent intent AND ability to carry it out. Most of the vets I work with definitely have the ability, if only through firearms, so it's mostly about determining intent. In another job where people were developmentally disabled and in wheelchairs and had a mental age of 2 years (often), they may have the intent but not the ability.

 

[Shiori]

The other site made an offer. I am ambivalent. Both jobs have strong pros and cons. What should I ask for to stay or leave?

 

[WisNeuro]

The other site made an offer. I am ambivalent. Both jobs have strong pros and cons. What should I ask for to stay or leave?

What's the offer, and what's the expected productivity at the new job?>

 

[Shiori]

What's the offer, and what's the expected productivity at the new job?>

It's a lateral move with more admin time. Comparable teleworking options. The new job is significantly closer. I didn't get a clear answer on how I will be evaluated. It's a new position they're creating that will be very heavy on program development.

 

[summerbabe]

The other site made an offer. I am ambivalent. Both jobs have strong pros and cons. What should I ask for to stay or leave?

IMO, it’s likely going to be hard to get more than what’s already on the table since admin hands are likely tied, even if they want to. But it doesn’t hurt to formulate some ideas to inquire about.

The biggest thing that could be on the table is a tour change, if you want something different (start earlier, compressed, etc). Maybe a little bit more admin time or a new committee assignment at your current site if you decide to stay.

I would think about things like how much you’d like to discharge all your current patients and start fresh, personal factors like commute/living (esp if you will move), and which job is more aligned with your career goals/can set you up better for future opportunities.

And whether you’d rather deal with the devil you know (good, bad, ugly at your current) or take a chance on something new. Not sure if you have connections at this other VA and people who you trust to give you the truth about how things function there.

Good luck!

 

[Shiori]

I know both of these devils, fortunately. I think I might ask for assessment time to be back on the table once our clinic stabilizes. I wonder if I could get a little clinic book budget down the line too.

 

[Shiori]

Ooo! And maybe I can get not brownish-gray furniture if I'm really lucky.

 

[cara susanna]

It's a lateral move with more admin time. Comparable teleworking options. The new job is significantly closer. I didn't get a clear answer on how I will be evaluated. It's a new position they're creating that will be very heavy on program development.

I would always take a job with more admin time, personally.

 

[cara susanna]

Guys, I just found out that a paper I co-authored was featured in the Clinician's Trauma Update! I'm pretty darn pumped.

 

[eeor1006]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

 

[Fan_of_Meehl]

Guys, I just found out that a paper I co-authored was featured in the Clinician's Trauma Update! I'm pretty darn pumped.

Hell yeah!!!

 

[WisNeuro]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

It was generally pretty easy, and besides the red tape/bureaucracy, I never had too many hassles. Decent, but not stellar, benefits.

 

[PsychPhDone]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

I'm a clinician researcher and get to do "the trifecta": research, training, clinical care. Being in VA allows me to have access to VA, DoD, NIH funding.

 

[Shiori]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

I really enjoy working with the population. I also like working with folks with many of their basic needs met even if they're not affluent. Inability to alleviate extreme environmental suffering is something that burns me out really fast. I'm still working on that boundary for myself, and the VA is a good place to be while I practice that. I am able to connect my clients to resources much more easily than I can in the community. I also don't have to shoulder all the responsibility because I have a team.

I also get bored easily and the VA has all kinds of cool stuff to get into. If I have a no-show, it's easy to go down a rabbit hole on the SharePoint. I find all kinds of interesting stuff.

 

[cara susanna]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

A really strong focus on evidence-based therapies, including access to trainings in them. Especially if you like working with PTSD.

 

[Fan_of_Meehl]

A really strong focus on evidence-based therapies, including access to trainings in them. Especially if you like working with PTSD.

And a significant helping--if you're a full-time clinician in a mental health (specialty or not) clinic--of direct clinical experience with such patients to fully appreciate the significant limitations of the same.

 

[Sanman]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

1. The VA throws money at my patients and fixes things that people in the real world can only dream about (hoyer lifts, ramps, power wheelchairs, home remodels). This makes my job more pleasant as people don't just complain about things like not being able to afford medical equipment. I, in turn, feel less frustrated and demoralized.

2. My job does not exist in the real world because no one would make any money (again the government throwing large sums of money at a problem no one else would).

3. I got 3 months of paid parental leave and I have tons of sick leave plus 40+ vacation days still banked. Great for a new parent.

Most of the things I dislike about the VA, I also dislike about employment in general. Red tape (which is also job security) and the inability to get IT and HR to do anything may be the big exceptions. Also, patients using the system for a paycheck.

 

[summerbabe]

I have been very loosely following this post to kill time. Genuinely curious, what are the perks of working for VA, if any? I understand tuition loan repayment is unique benefit to federal jobs but I can't think of anything else. If you have little or no student debt, why do y'all choose VA?

In addition to what others added, you also have extreme job stability.

Like you can be utterly terrible at your job and perform at levels that would get you get easily canned in the private sector but collect a govt paycheck until you voluntarily leave/retire.

I also never have to worry about things budget shortfalls or changes in management strategies affecting my livelihood. These will create admin burdens and work headaches but I'll still be employed.

I also enjoy my job and while I work with a high intensity population that presents a bunch of challenges, my direct clinical time (especially once you factor in a ~20% no show/cancel rate) is almost certainly way better than what I could find in another institutional job.

And since I don't feel a need to be in private practice at this point in my career and get to work 100% from home, it's a pretty decent gig.

Lastly, whenever I come to feel extra burned out or want a new challenge, I can start looking for other opportunities within the system.

There's a lot of venting and complaining in this thread but I think a lot comes from the fact that things could be so much better for veterans (and by extension, us clinicians), if the system was truly focused on providing healthcare, rather than satisfying political needs.

 

[WisNeuro]

In addition to what others added, you also have extreme job stability. I never have to worry about things budget shortfalls or changes in management strategies affecting my livelihood.

Like you can be utterly terrible at your job and perform at levels that would get you get easily canned in the private sector but collect a govt paycheck until you voluntarily leave/retire.

I also enjoy my job and while I work with a high intensity population that presents a bunch of challenges, my direct clinical time (especially once you factor in a ~20% no show/cancel rate) is almost certainly way better than what I could find in another institutional job.

And since I feel a need to be in private practice at this point in my career and get to work 100% from home, it's a pretty decent gig.

Lastly, whenever I come to feel extra burned out or want a new challenge, I can start looking for other opportunities within the system.

I wouldn't necessarily count on this. Check out the projections for the Veteran population in the next 20 years. With a projected nearly 30% decline, and ever present discussions about expansion of community care eligibility, something will have to give.

 

[cara susanna]

I wouldn't necessarily count on this. Check out the projections for the Veteran population in the next 20 years. With a projected nearly 30% decline, and ever present discussions about expansion of community care eligibility, something will have to give.

I feel like a 30% decline would keep us plenty busy, still. We are slammed as it is.

 

[WisNeuro]

I feel like a 30% decline would keep us plenty busy, still. We are slammed as it is.

We shall see. But, I'd have to imagine when it comes to budget and funding at the federal legislative level, you'll get some pushback at keeping funding levels as is with that declining patient population.