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

[NEUROHERO123]

Reading this forum I agree with pretty much everything right down to the absurdity, cultural shortcomings, and sometimes even corruption described here. But I know a good deal when I see it. With Special Salary Rate tables I think we might enter another golden age of VA psychology where these jobs become highly sought after again.

Turnover has been sky high where I've worked but I saw my pay go from $130,000 to something like over $164,000 with another raise headed our way in January. With the pension benefits, teleworking, paid vacation, and a 40hr work week who can compete? OK, I'll call that no-show for you.

I do a forensic private practice on the side and I find doing both manageable. Having part of my professional identity outside the VA I think has been a critical buffer for me.

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[PsychPhDone]

Reading this forum I agree with pretty much everything right down to the absurdity, cultural shortcomings, and sometimes even corruption described here. But I know a good deal when I see it. With Special Salary Rate tables I think we might enter another golden age of VA psychology where these jobs become highly sought after again.

Turnover has been sky high where I've worked but I saw my pay go from $130,000 to something like over $164,000 with another raise headed our way in January. With the pension benefits, teleworking, paid vacation, and a 40hr work week who can compete? OK, I'll call that no-show for you.

I do a forensic private practice on the side and I find doing both manageable. Having part of my professional identity outside the VA I think has been a critical buffer for me.

I am hopeful more localities get the SSR but it's definitely highly variable. We've gotten two increases recently but I could still make twice my salary at half-time in PP where I live.

 

[Fan_of_Meehl]

Reading this forum I agree with pretty much everything right down to the absurdity, cultural shortcomings, and sometimes even corruption described here. But I know a good deal when I see it. With Special Salary Rate tables I think we might enter another golden age of VA psychology where these jobs become highly sought after again.

Turnover has been sky high where I've worked but I saw my pay go from $130,000 to something like over $164,000 with another raise headed our way in January. With the pension benefits, teleworking, paid vacation, and a 40hr work week who can compete? OK, I'll call that no-show for you.

I do a forensic private practice on the side and I find doing both manageable. Having part of my professional identity outside the VA I think has been a critical buffer for me.

Agreed.

This time around (we only got a 3% SSR 'boost')...it's highly variable.

Here's to hoping that, in the years to come, 'a rising tide lifts all boats' as they say.

If it doesn't, some 'boats' (ours included), are going to have a hard time finding people to swab their decks.

 

[AcronymAllergy]

I definitely think that higher salaries across the board at VA is good for all psychologists, as this means other organizations may need to raise their offers to compete, as opposed to VA frequently losing out on top talent because they can make a good bit more elsewhere while also not needing to wait in limbo for 6 months for the hiring approvals to come through.

Still doesn't fix how toxic leadership can quickly become with only one or two bad actors, but makes it a bit more tolerable. IMO, one of the primary downsides with VA is the leadership shuffle that commonly occurs, wherein mid- to upper-level supervisors/administrators make numerous poor decisions, but rather than being demoted or terminated, they're instead promoted, or are transferred to a different service or VA for a time until later being brought back to do the same things again. Happened multiple times at my last VA, which was...frustrating.

Although I should temper that by saying I've also worked with excellent supervisors and leadership, particularly with respect to training in VA (which is still something they do very well overall).

 

[deleted1129370]

I definitely think that higher salaries across the board at VA is good for all psychologists, as this means other organizations may need to raise their offers to compete, as opposed to VA frequently losing out on top talent because they can make a good bit more elsewhere while also not needing to wait in limbo for 6 months for the hiring approvals to come through.

Still doesn't fix how toxic leadership can quickly become with only one or two bad actors, but makes it a bit more tolerable. IMO, one of the primary downsides with VA is the leadership shuffle that commonly occurs, wherein mid- to upper-level supervisors/administrators make numerous poor decisions, but rather than being demoted or terminated, they're instead promoted, or are transferred to a different service or VA for a time until later being brought back to do the same things again. Happened multiple times at my last VA, which was...frustrating.

Although I should temper that by saying I've also worked with excellent supervisors and leadership, particularly with respect to training in VA (which is still something they do very well overall).

OMG you are speaking to exactly what myself and my colleagues in my clinic deal with. I was recently told yesterday that I will be getting placed on a PIP next week. Never in my 3 years across 3 VAs have I ever had my performance called into question, but what a coincidence, the old/new program manager who had run this clinic into the ground 3 years ago was transferred out but then back over about 3 months ago and now they are running the place just like they did prior. I should add this same PM had an EEO complaint, was named in a lawsuit, and was even scheduled for a court date, but the VA ended up shuffling them out to a CBOC. Now, our leadership allowed this same PM to come back to the very clinic the took an epic crap on to "lead it again." Talk about failing upwards. My most recent quarterly eval had me as fully successful (which has always been the case everywhere), and my most recent panel competency review showed me as meeting and exceeding expectations, but nope....out of the blue I was told yesterday for NO REASON that they are putting me on a PIP. I can't help but notice this comes only 3 weeks after I had an intense meeting with this PM who basically in no specific words told me to "get the hell out" of their office. This is the same person who in that same meeting told me "I've been doing this for 30 years, who are you to question me on this?" Not very HRO-like of them, right?

I can say that out of us 7 psychologists, 5 of us are looking to get the hell out ASAP. Our social workers are actively interviewing for jobs internally as well as elsewhere to get out of our clinic ASAP, and our peer support specialists are so over the PM, but they have little options. Needless to say, no one appreciates or likes this PM, nor respects them. It has come up several times by multiple people, that this PM is very personality disordered, and I can't help but see why. After being advised yesterday of the prospect of getting a PIP next week, this has been the final straw for me I think. I've looped in our union rep. and provided them documents, especially my OPPE and other evals to show a pattern and history of stable performance....they told me the way they've approached this is not appropriate nor is how it should be approached to implement a PIP. Several steps were skipped here. Yesterday was a rollercoaster of emotions for me. I was definitely castrophizing about how a PIP would impact my VA record as well as my abilities to get ABPP or if I desired, outside employment.

Rant over...

 

[Harry3990]

Hi all,

I’m wondering if anyone might be able to point me towards a manual or document somewhere on the VA website that outlines the differences in job duties between different depts that psychologists might work in? The descriptions on the job listings are not very detailed or helpful in my experience. For example, one I saw recently- psychologist - rehabilitation…is that physical rehab, I’m guessing? Just a little silly that many of these differentiate in the title but then say little to nothing in the description itself.

Any help greatly appreciated.

 

[PsychPhDone]

Hi all,

I’m wondering if anyone might be able to point me towards a manual or document somewhere on the VA website that outlines the differences in job duties between different depts that psychologists might work in? The descriptions on the job listings are not very detailed or helpful in my experience. For example, one I saw recently- psychologist - rehabilitation…is that physical rehab, I’m guessing? Just a little silly that many of these differentiate in the title but then say little to nothing in the description itself.

Any help greatly appreciated.

It depends on the specific hire. It's not standardized.

 

[Fan_of_Meehl]

OMG you are speaking to exactly what myself and my colleagues in my clinic deal with. I was recently told yesterday that I will be getting placed on a PIP next week. Never in my 3 years across 3 VAs have I ever had my performance called into question, but what a coincidence, the old/new program manager who had run this clinic into the ground 3 years ago was transferred out but then back over about 3 months ago and now they are running the place just like they did prior. I should add this same PM had an EEO complaint, was named in a lawsuit, and was even scheduled for a court date, but the VA ended up shuffling them out to a CBOC. Now, our leadership allowed this same PM to come back to the very clinic the took an epic crap on to "lead it again." Talk about failing upwards. My most recent quarterly eval had me as fully successful (which has always been the case everywhere), and my most recent panel competency review showed me as meeting and exceeding expectations, but nope....out of the blue I was told yesterday for NO REASON that they are putting me on a PIP. I can't help but notice this comes only 3 weeks after I had an intense meeting with this PM who basically in no specific words told me to "get the hell out" of their office. This is the same person who in that same meeting told me "I've been doing this for 30 years, who are you to question me on this?" Not very HRO-like of them, right?

I can say that out of us 7 psychologists, 5 of us are looking to get the hell out ASAP. Our social workers are actively interviewing for jobs internally as well as elsewhere to get out of our clinic ASAP, and our peer support specialists are so over the PM, but they have little options. Needless to say, no one appreciates or likes this PM, nor respects them. It has come up several times by multiple people, that this PM is very personality disordered, and I can't help but see why. After being advised yesterday of the prospect of getting a PIP next week, this has been the final straw for me I think. I've looped in our union rep. and provided them documents, especially my OPPE and other evals to show a pattern and history of stable performance....they told me the way they've approached this is not appropriate nor is how it should be approached to implement a PIP. Several steps were skipped here. Yesterday was a rollercoaster of emotions for me. I was definitely castrophizing about how a PIP would impact my VA record as well as my abilities to get ABPP or if I desired, outside employment.

Rant over...

I'd expect that this state of affairs will be increasingly common across VA MH clinics in the coming years. All of the layers and layers of paperwork / micromanagement and complexity are reaching a breaking point. It is getting to the point that even highly intelligent, highly experienced, highly motivated professionals (with doctorates) who work from the time that they get to the hospital to the end of their shift with maybe a brief break eating their lunches at their desks and cutting necessary corners are going to find it impossible to serve all the masters, complete all the paperwork, and see all the patients and do all the followup and complete all the redundant paperwork across multiple redundant charting systems. Every shift is like being an air traffic controller with 30 - 40 'planes in the air' that all have to be 'landed' by the end of your shift and your attention is constantly being divided between the person in front of you, emails from your boss (and various compliance nannies), all of the multiplicative paperwork (contingent on what happens during your shift with your patients), phone calls, Teams messages, etc. etc. etc. It's insane. The task of seeing, say, 6 patients over the course of the shift and getting all of the paperwork done by the time you leave has increased in complexity by about 200% since I came to the VA about a decade ago and there's no end in sight. And, on days, where you have to deal with 'extra' curveballs thrown at you are just a mess. Things like, people responding in true crisis (with homicidal/suicidal ideation and possibly needing to be walked over to urgent care for admission, needing to report child/elder abuse OMGASAP!, last minute projects/assignments/directives that can't wait, etc. Just brutal. I've been trying to use reminders/templates/lists to try to organize or facilitate getting everything done but I find that even bringing myself to use that system just makes me want to shut down and start signaling for 'escape' by self-injuring.

 

[AcronymAllergy]

OMG you are speaking to exactly what myself and my colleagues in my clinic deal with. I was recently told yesterday that I will be getting placed on a PIP next week. Never in my 3 years across 3 VAs have I ever had my performance called into question, but what a coincidence, the old/new program manager who had run this clinic into the ground 3 years ago was transferred out but then back over about 3 months ago and now they are running the place just like they did prior. I should add this same PM had an EEO complaint, was named in a lawsuit, and was even scheduled for a court date, but the VA ended up shuffling them out to a CBOC. Now, our leadership allowed this same PM to come back to the very clinic the took an epic crap on to "lead it again." Talk about failing upwards. My most recent quarterly eval had me as fully successful (which has always been the case everywhere), and my most recent panel competency review showed me as meeting and exceeding expectations, but nope....out of the blue I was told yesterday for NO REASON that they are putting me on a PIP. I can't help but notice this comes only 3 weeks after I had an intense meeting with this PM who basically in no specific words told me to "get the hell out" of their office. This is the same person who in that same meeting told me "I've been doing this for 30 years, who are you to question me on this?" Not very HRO-like of them, right?

I can say that out of us 7 psychologists, 5 of us are looking to get the hell out ASAP. Our social workers are actively interviewing for jobs internally as well as elsewhere to get out of our clinic ASAP, and our peer support specialists are so over the PM, but they have little options. Needless to say, no one appreciates or likes this PM, nor respects them. It has come up several times by multiple people, that this PM is very personality disordered, and I can't help but see why. After being advised yesterday of the prospect of getting a PIP next week, this has been the final straw for me I think. I've looped in our union rep. and provided them documents, especially my OPPE and other evals to show a pattern and history of stable performance....they told me the way they've approached this is not appropriate nor is how it should be approached to implement a PIP. Several steps were skipped here. Yesterday was a rollercoaster of emotions for me. I was definitely castrophizing about how a PIP would impact my VA record as well as my abilities to get ABPP or if I desired, outside employment.

Rant over...

I was going to say, my first thought was to consider speaking to your union rep. I don't always have the most positive view of them, but this certainly seems like an appropriate situation. And yes, it's not only your VA where this happens. Things that would likely get some fired pretty quickly elsewhere (and/or that would, should, or do lead to licensing board complaints) seem to commonly result in said supervisor/administrator being promoted or just moved somewhere else until eventually being brought back again (or until they retire). VA seems to really dislike hiring leadership from outside VA.

And speaking to Fan_of_Meehl's point, I agree that it seems like it has to hit critical mass eventually. It's also not just psychologists or MH. A very skilled (non-MH) physician colleague at a former VA left because despite consistently staying 2-3+ hours past his tour of duty every day, he was still falling behind on encounters and notes based on the number of patients he was pressured to see. The response from his department leadership was supposedly, "so what, stay later." That seemed to happen a lot with the PCPs as well.

 

[Fan_of_Meehl]

I was going to say, my first thought was to consider speaking to your union rep. I don't always have the most positive view of them, but this certainly seems like an appropriate situation. And yes, it's not only your VA where this happens. Things that would likely get some fired pretty quickly elsewhere (and/or that would, should, or do lead to licensing board complaints) seem to commonly result in said supervisor/administrator being promoted or just moved somewhere else until eventually being brought back again (or until they retire). VA seems to really dislike hiring leadership from outside VA.

And speaking to Fan_of_Meehl's point, I agree that it seems like it has to hit critical mass eventually. It's also not just psychologists or MH. A very skilled (non-MH) physician colleague at a former VA left because despite consistently staying 2-3+ hours past his tour of duty every day, he was still falling behind on encounters and notes based on the number of patients he was pressured to see. The response from his department leadership was supposedly, "so what, stay later." That seemed to happen a lot with the PCPs as well.

Agreed. In many ways our physician (and nurse) colleagues at VA have it even worse, considering the nature of the services they have to offer and all of the screening (in primary care contexts) and other services that fall into their lap as a nexus of care.

A general problem in the organization (but also reflected in the all the medical fields as a whole, over time) is the cumulative stripping of the providers (of care) of AUTHORITY to address things with the simultaneous increased RESPONSIBILITY to address everything as well as a seemingly never-ending expansion of the things to be addressed.

The rulership/administrative class has really turned the alchemy of separating out authority from responsibility via clever policy/procedure creation to a high art form.

 

[deleted1129370]

If I am placed on a PIP, what could I expect? My boss had submitted my paperwork for my GS-13 promotion a week ago (prior to this whole PIP stuff the PM is wanting to implement); will this mean I won't get that GS-13 promotion? Would a PIP follow me external of the VA? Would it influence my abilities to get ABPP? What if I refuse to sign a PIP?

 

[Fan_of_Meehl]

If I am placed on a PIP, what could I expect? My boss had submitted my paperwork for my GS-13 promotion a week ago (prior to this whole PIP stuff the PM is wanting to implement); will this mean I won't get that GS-13 promotion? Would a PIP follow me external of the VA? Would it influence my abilities to get ABPP? What if I refuse to sign a PIP?

I've never been involved in a PIP in the VA system or had any close colleagues who were, so I'm pretty ignorant on the specifics. I would imagine that they will focus on a few 'metrics' and pick some numbers that things have to be at across a specific time frame. Definitely get as much union involvement/help as you can with all of this is what I'd recommend.

As far as following you external to VA or ABPP...I'm not certain but I've never seen any job applications or applications for licensure ask something like, 'Have you ever been placed on a performance improvement plan at a job.' Usually they focus more on license and/or privilege suspensions/revocations as far as I can tell.

 

[Sanman]

If I am placed on a PIP, what could I expect? My boss had submitted my paperwork for my GS-13 promotion a week ago (prior to this whole PIP stuff the PM is wanting to implement); will this mean I won't get that GS-13 promotion? Would a PIP follow me external of the VA? Would it influence my abilities to get ABPP? What if I refuse to sign a PIP?

I'm a bit confused about how they can initiate a PIP prior to an annual evaluation. You usually need at least one poor eval for this. Unless the PIP is for something else (insubordination, conduct, etc). I imagine union involvement and an employment lawyer/EEOC complaint are your next steps.

 

[deleted1129370]

I'm a bit confused about how they can initiate a PIP prior to an annual evaluation. You usually need at least one poor eval for this. Unless the PIP is for something else (insubordination, conduct, etc). I imagine union involvement and an employment lawyer/EEOC complaint are your next steps.

My last eval was 04/29/2023 and I was fully successful across all domains, and my most recent competency peer review (which is done every 2 years, but during your first year as a new hire) was deemed as meeting and exceeded practice areas. The evidence does not support what is going on here. Like I said, I had an impromptu meeting with my PM about 3 weeks ago that basically involved us disagreeing on some things, and me pushing back (respectfully), but they did not like that. My thinking is this move comes as a result of that. I even told my direct boss via TEAMS just minutes after my meeting with the PM that I feared they would retaliate against me. My union rep. will be attending. They have been provided my most recent evaluations as well.

 

[AcronymAllergy]

If I am placed on a PIP, what could I expect? My boss had submitted my paperwork for my GS-13 promotion a week ago (prior to this whole PIP stuff the PM is wanting to implement); will this mean I won't get that GS-13 promotion? Would a PIP follow me external of the VA? Would it influence my abilities to get ABPP? What if I refuse to sign a PIP?

I also have little direct knowledge of the PIP process, but if the GS-13 promotion is based on the amount of time you've been independently licensed and practicing, I don't see how a PIP could affect that. Unless there's some VA technicality wherein you can't be promoted while on a PIP. Although at the same time, like you've said, the paperwork has already been completed, so the promotion was requested/approved by your boss before the PIP.

I can't really see how a PIP would follow you outside of VA unless you were to return to work at a VA. In which case your current VA would probably tell you what would happen if you left before completing it. I don't remember all the specific questions on the initial (generic) ABPP application, but I don't think this would impact that. If there are related ABPP application questions, some of it may depend on what the PIP is actually for.

If you refuse to sign, that may be grounds for termination. Unless the union rep gets involved and tells you not to sign.

 

[cara susanna]

My supervisor also told me that, if I was gonna get a negative eval, it wouldn't be sprung on me as a surprise (because I'm not a super anxious person who was always really worried about evals for no logical reason, of course)

 

[AcronymAllergy]

I would agree that generally speaking, a PIP isn't something that I'd think would come as a surprise, and certainly not after receiving relatively recent positive reviews. But I suppose there are situations where maybe that would happen, such as if the PIP related to a single incident that was viewed as crucially important.

 

[summerbabe]

My last eval was 04/29/2023 and I was fully successful across all domains, and my most recent competency peer review (which is done every 2 years, but during your first year as a new hire) was deemed as meeting and exceeded practice areas. The evidence does not support what is going on here. Like I said, I had an impromptu meeting with my PM about 3 weeks ago that basically involved us disagreeing on some things, and me pushing back (respectfully), but they did not like that. My thinking is this move comes as a result of that. I even told my direct boss via TEAMS just minutes after my meeting with the PM that I feared they would retaliate against me. My union rep. will be attending. They have been provided my most recent evaluations as well.

Like AA, I also don’t have any direct exposure to PIP. But I’m glad you have the union on board and would 1000% recommend you have representation at any future meetings or conversations related to the PIP as you're planning.

As Sanman mentioned, the PIP may have nothing to do with performance and focus on misconduct, which I would guess to be the case here based on the interpersonal interaction recently/their own stuff.

Based on this guide on OPM.gov, they ask supervisors to clarify performance versus misconduct concerns. And there is a lot more steps for performance related stuff, which includes recommendations to initially 'counsel' the employee to improve performance prior to initiating the PIP, and not much for misconduct, which is concerning.

I hope your rep knows a lot about the PIP process including how/if PIPs follow people around into future VA jobs via our personnel file depending on the outcome and differences between performance versus misconduct PIPs because if your PM has become very competent bureaucratically during their long tenure, they might be able to identify the right technocratic justification to force this through (versus having it nullified due to process errors, as your rep might be suggesting).

Good luck dealing with this crappy situation.

 

[deleted1129370]

Like AA, I also don’t have any direct exposure to PIP. But I’m glad you have the union on board and would 1000% recommend you have representation at any future meetings or conversations related to the PIP as you're planning.

As Sanman mentioned, the PIP may have nothing to do with performance and focus on misconduct, which I would guess to be the case here based on the interpersonal interaction recently/their own stuff.

Based on this guide on OPM.gov, they ask supervisors to clarify performance versus misconduct concerns. And there is a lot more steps for performance related stuff, which includes recommendations to initially 'counsel' the employee to improve performance prior to initiating the PIP, and not much for misconduct, which is concerning.

I hope your rep knows a lot about the PIP process including how/if PIPs follow people around into future VA jobs via our personnel file depending on the outcome and differences between performance versus misconduct PIPs because if your PM has become very competent bureaucratically during their long tenure, they might be able to identify the right technocratic justification to force this through (versus having it nullified due to process errors, as your rep might be suggesting).

Good luck dealing with this crappy situation.

The PM didn't like the fact that I pushed back (professionally) and provided them feedback about their own behaviors that myself and most others in our clinic are experiencing. So, it is possible this meeting will focus on that, which for me, seems like retaliation.

 

[WisNeuro]

The PM didn't like the fact that I pushed back (professionally) and provided them feedback about their own behaviors that myself and most others in our clinic are experiencing. So, it is possible this meeting will focus on that, which for me, seems like retaliation.

Are you sure it's not the not following clinic procedures and missing RVU targets? 😉

 

[deleted1129370]

Are you sure it's not the not following clinic procedures and missing RVU targets? 😉

It could very well be the case, but I know it's coming from this PM who is nitpicking and has OCPD. Like I said, I am not the only one who is experiencing problems with this PM, in fact, majority of our clinic share the same sentiments I have about this PM. This PM is wanting to mark their territory and doesn't like people standing up to them and would much prefer to run people and the clinic into the ground while quoting policies. So, I guess when they experience a second mass exodus in our clinic (2nd within the past 3 years), at least they can say "we stuck to our guns on RVUs and policies." They won't have providers to serve veterans....but I guess that aligns with their bottom line?

 

[WisNeuro]

It could very well be the case, but I know it's coming from this PM who is nitpicking and has OCPD. Like I said, I am not the only one who is experiencing problems with this PM, in fact, majority of our clinic share the same sentiments I have about this PM. This PM is wanting to mark their territory and doesn't like people standing up to them and would much prefer to run people and the clinic into the ground while quoting policies. So, I guess when they experience a second mass exodus in our clinic (2nd within the past 3 years), at least they can say "we stuck to our guns on RVUs and policies." They won't have providers to serve veterans....but I guess that aligns with their bottom line?

Generally all fair points regarding program managers. But, from some of the things that you've recently posted about your VA stuff, they definitely have enough for a PIP regarding objective documentation. Just depends on how much you want to fight it.

 

[deleted1129370]

Generally all fair points regarding program managers. But, from some of the things that you've recently posted about your VA stuff, they definitely have enough for a PIP regarding objective documentation. Just depends on how much you want to fight it.

I will be fighting it as this has been a recent revelation. Much of the stuff I discussed preceded their joining our clinic. They would need to put several of us on PIPs if that's the case as the expectations and administrative BS they are requiring of us is exceeding and most people are not adherent. I am the focus of this PM because I am more vocal, more apparent with things, and I stand my ground on stuff for which I think this PM does not really like. They want someone very submissive...and that's not me. I have evidence to also refute much of what they might allege as well.

 

[cara susanna]

Anyone else find that non-mental health providers think that all psych testing is neuropsych? I don't know why I find it so frustrating, yet I do

 

[Fan_of_Meehl]

The PM didn't like the fact that I pushed back (professionally) and provided them feedback about their own behaviors that myself and most others in our clinic are experiencing. So, it is possible this meeting will focus on that, which for me, seems like retaliation.

The chickens seem to be 'coming home to roost' all around the VA at this time with respect to outpatient MH. I am hearing rumors that a substantial number of psychologists will be either retiring, looking elsewhere for jobs and/or seeking to be promoted or laterally moved to positions that do NOT involve outpatient mental health caseloads for psychotherapy.

Tomorrow I have an intake at 8am and then five additional 1 hour therapy sessions. A solid FOUR out of those five therapy sessions are with clients who are probably 2.5 - 3 standard deviations out toward the 'tail' of a distribution of psychotherapy disengagement (multiple no-shows/cancellations without responding to followup calls and messages, passive-aggressive antics to block any kind of engagement in offered specific therapeutic interventions, etc.). One patient is actually 'working' in a protocol therapy up to the level which was common in all of my psychological practice across contexts prior to coming to the VA. Obviously, the intake is an unknown quantity at this time but only ONE out of the FIVE other therapy cases involves active patient participation in therapy that I'd consider to be representative of a patient actually BEING in therapy.

Also got an official VA email bragging about some group that had met and did some kind of mega-conference of 'leaders' (in Phoenix, AZ?) and (ostensibly) had a link in the email for one to click on to see all of their solutions (pdf publication that was, I assume, supposed to be on the VA intranet).

Of course, when I clicked on the link, it was non-functional (I was actually curious since the title had something to do with 'Providing more treatment to more veterans with less' (just great).

Tried the link several other times over the rest of the shift.

Non-functional.

I copied/pasted the title of the document into Google. What came up was a LinkedIn profile/link to what appeared to be some sort of expertologist/ excellentologist from the business/consulting/improvement community.

Welcome to the VA.

Edit: I really wish the conference of expertologists would recommend:

1) after a minimum of 5 years + at least TWO EBP protocols + at least 100 mental health appointments (offered), no more 'free' therapy for life
2) after the above, you must pay a $25 co-pay for all sessions, you must call/cancel prior to no-showing or you get hit with a $50 fee
3) improve the quality of the mental health C&P process and eliminate the multiple percentages ladder that motivate veterans to 'audition' for the next step up the s/c ladder at every appointment; do a solid assessment (structured interview, validity indices, etc.) and make it a dichotomous system (like social security disability)...just have ONE level (of '100% PTSD')
4) ensure that mental health 'case management' (vs. active psychotherapy) positions are appropriately staffed...have simple 'filtering' requirements (e.g., have to actually attend successfully a minimum of three appointments in a row prior to being referred for an EBP protocol)
5) I'm sure there are a million more ACTUAL changes that--if politically possible--would actually effectively address the 'access' issues in MH

 

[Shiori]

I recently lost my mom. I am well supported by my family and friends, and feel like I'm processing things as well as can be expected. I have several more days off, but I'm jittery about being someone's therapist right now. My mom has been such an integral part of my development as a helper and she kept me grounded on bad days. I'm going to miss her so, so much.

 

[erg923]

It could very well be the case, but I know it's coming from this PM who is nitpicking and has OCPD. Like I said, I am not the only one who is experiencing problems with this PM, in fact, majority of our clinic share the same sentiments I have about this PM. This PM is wanting to mark their territory and doesn't like people standing up to them and would much prefer to run people and the clinic into the ground while quoting policies. So, I guess when they experience a second mass exodus in our clinic (2nd within the past 3 years), at least they can say "we stuck to our guns on RVUs and policies." They won't have providers to serve veterans....but I guess that aligns with their bottom line?

The larger issue here is, even if I you did somewhat "go off" on your supervisor (I'm not saying you did), my first inclination as a leader in my own org would be to see what's going on with you in your life. And, with the org you are upset with. The appropriate move at that stage is inquiry, legitimate interest, and empathy. NOT gobment paperwork like a "Performance Improvement Plan." Seems lazy and premature.

If it's just a matter of you blatantly not doing local policy such as no-show calls (which you actually admitted you don't do) or adhering to clinic scheduling policy,...they may actually have justifiable cause for a PIP, as silly as it may seem.

Also, I hate to be blatantly ageist, but frankly, I think I am at times. You mentioned before about your clinic Program Manager being like a 30+ year veteran of the VA and ostensibly using this as some kind of badge of authority??? If so, that leadership style is ****ing ancient. Old men like this need to retire gracefully and usher in new blood. There are definitely some generational effects happening all across the country with this kind of stuff.

The pay scale bump given to psychologists at your particular VA (which seems insane compared to other VAs and rivals my own salary) should probably tell you something, Not sure what's going on down there, but it doesn't seem healthy or sustainable? What a shame.

 

[erg923]

Anyone else find that non-mental health providers think that all psych testing is neuropsych? I don't know why I find it so frustrating, yet I do

There is no reason to think that a non-mental health provider would be expected to know or care about this difference. To them (and to many psychologists) its just CPT codes. Do you know the difference between a neuroptimal exam and a optical exam and when to order one?

 

[WisNeuro]

There is no reason to think that a non-mental health provider would be expected to know or care about this difference. To them (and to many psychologists) its just CPT codes. Do you know the difference between a neuroptimal exam and a optical exam and when to order one?

Well, NeurOptimal is a purveyor of pseudoscience, so I never plan on ordering that one.

 

[PsychPhDone]

I recently lost my mom. I am well supported by my family and friends, and feel like I'm processing things as well as can be expected. I have several more days off, but I'm jittery about being someone's therapist right now. My mom has been such an integral part of my development as a helper and she kept me grounded on bad days. I'm going to miss her so, so much.

I'm so, so sorry. I think I didn't see patients for 6 weeks when my mom died, though in my situation I didn't have ongoing clients, just assessments and very short-term therapy. I hope your site will be supportive when you come back. Feel free to DM me if you want to connect for support/venting or problem solving.

 

[deleted1129370]

The larger issue here is, even if I you did somewhat "go off" on your supervisor (I'm not saying you did), my first inclination as a leader in my own org would be to see what's going on with you in your life. And, with the org you are upset with. The appropriate move at that stage is inquiry, legitimate interest, and empathy. NOT gobment paperwork like a "Performance Improvement Plan." Seems lazy and premature.

If it's just a matter of you blatantly not doing local policy such as no-show calls (which you actually admitted you don't do) or adhering to clinic scheduling policy,...they may actually have justifiable cause for a PIP, as silly as it may seem.

Also, I hate to be blatantly ageist, but frankly, I think I am at times. You mentioned before about your clinic Program Manager being like a 30+ year veteran of the VA and ostensibly using this as some kind of badge of authority??? If so, that leadership style is ****ing ancient. Old men like this need to retire gracefully and usher in new blood. There are definitely some generational effects happening all across the country with this kind of stuff.

The pay scale bump given to psychologists at your particular VA (which seems insane compared to other VAs and rivals my own salary) should probably tell you something, Not sure what's going on down there, but it doesn't seem healthy or sustainable? What a shame.

You are hitting on the right points. It could very be related to my willful and transparent position on the matter that I do not have time to chase down patients, and frankly given the clinic and population I am working with, I do not want to reinforce those sentiments that others are responsible for their well-being (like substances have more efficacy in treating their mental health ailments vs. their own intrinsic abilities through evidence-based therapy). Yeah, the pay incentives and salary itself are huge red flags here, but in general when VA started to implement recruitment/retention incentives and EDRP which gave historically been give not physicians and dentists, it represents a more pervasive issue with the system. It comes down to, how much BS am I willing to tolerate, so, I will be stepping into this meeting here in about 15 minutes to see what it is really about and what they are wanting to do. I will do my best to approach this from a place of inquiry and clarification vs. being defensive and pissed off (that will be a challenge).

 

[deleted1129370]

So I found it is due to the most trivial topic and for which my union rep. flat out told my boss that this PIP was baseless, uncalled for, and that several missteps took place here. Basically, when our new/old PM rejoined our clinic, they wanted to create a new intake template for us to use, but was not going to force people to use that template. In fact, I have it in writing from them where I overtly asked them if they would require us to use the new template for which they responded with "no, there would be no practical way for me to know or enforce it." Notwithstanding this, they also asked if all of us could do "tracers" for our re-accreditation (which is actually their job function, and they parted it out to us to complete). Either way, it was framed as something they "would like us to do" not "required to do." It was this point the union rep. stated to my boss that this was never passed through the union as there are very specific job requirements listed for providers to do, and this is not one of them, and because that was never officially deemed a required aspect of our job role, that they were in the wrong for even asking us to do this for them, which has led to understandable confusions and disagreements. The union rep. flat out told them that they will be crafting a formal grievance towards my boss and the PM outlining the several missteps and the fact that the issue they were saying was an issue was not as I had already updated my template and completed the tracer based on the time table I agreed with in my meeting with the PM about 3 weeks ago. The PM even emailed me a synopsis of our meeting where they outlined that we agreed to have the tracer and updated template completed by X date (which I did, and even told my boss that they were completed every step of the way). In the end, my boss was genuinely confused and kept reiterating that his hands were tied and that this PIP needed to be implemented by a certain day and time. He didn't even know it could be resolved in less than 90 days. The union rep. told me in private she believed someone was forcing him to do this, for which I have suspected all along based on his choice of words, and lack of knowledge in this area.

 

[Fan_of_Meehl]

So I found it is due to the most trivial topic and for which my union rep. flat out told my boss that this PIP was baseless, uncalled for, and that several missteps took place here. Basically, when our new/old PM rejoined our clinic, they wanted to create a new intake template for us to use, but was not going to force people to use that template. In fact, I have it in writing from them where I overtly asked them if they would require us to use the new template for which they responded with "no, there would be no practical way for me to know or enforce it." Notwithstanding this, they also asked if all of us could do "tracers" for our re-accreditation (which is actually their job function, and they parted it out to us to complete). Either way, it was framed as something they "would like us to do" not "required to do." It was this point the union rep. stated to my boss that this was never passed through the union as there are very specific job requirements listed for providers to do, and this is not one of them, and because that was never officially deemed a required aspect of our job role, that they were in the wrong for even asking us to do this for them, which has led to understandable confusions and disagreements. The union rep. flat out told them that they will be crafting a formal grievance towards my boss and the PM outlining the several missteps and the fact that the issue they were saying was an issue was not as I had already updated my template and completed the tracer based on the time table I agreed with in my meeting with the PM about 3 weeks ago. The PM even emailed me a synopsis of our meeting where they outlined that we agreed to have the tracer and updated template completed by X date (which I did, and even told my boss that they were completed every step of the way). In the end, my boss was genuinely confused and kept reiterating that his hands were tied and that this PIP needed to be implemented by a certain day and time. He didn't even know it could be resolved in less than 90 days. The union rep. told me in private she believed someone was forcing him to do this, for which I have suspected all along based on his choice of words, and lack of knowledge in this area.

Jesus.

Glad this round of negotiations with The Empire appears to have resolved in your favor, though. [Darth Vader voice] "No disintegrations."

If 'adding significant responsibilities to our job functions as psychologists without first getting AFGE approval' is enforceable, though...I'd like ours rolled back to circa 2012 or so, thankyouverymuch AFGE, lol.

 

[cara susanna]

Sorry, what is a tracer? I'm not familiar with that term.

 

[Fan_of_Meehl]

Sorry, what is a tracer? I'm not familiar with that term.

They were all the rage here a few years ago. Term originates with Joint Commission surveyors, I think. Basically, a self-audit of your documentation to assess compliance with certain policies/practices.

 

[cara susanna]

There is no reason to think that a non-mental health provider would be expected to know or care about this difference. To them (and to many psychologists) its just CPT codes. Do you know the difference between a neuroptimal exam and a optical exam and when to order one?

There is a separate consult for neuropsych testing vs. non-neuropsych testing here, and our facility doesn't currently offer neuropsych testing and we have to refer out or send them up to the main hospital. So, yeah, in this case I think the distinction is actually quite important.

They were all the rage here a few years ago. Term originates with Joint Commission surveyors, I think. Basically, a self-audit of your documentation to assess compliance with certain policies/practices.

Thanks for the info. That sounds absolutely awful.

 

[deleted1129370]

They were all the rage here a few years ago. Term originates with Joint Commission surveyors, I think. Basically, a self-audit of your documentation to assess compliance with certain policies/practices.

It's the PMs job, not ours. The union rep. even pointed that out as this seems to be an ad hoc task being asked without the union being involved to negotiate and ensure it's appropriate to ask staff to take on such a task. For example, the peer reviews we do quarterly, the FPPE, OPPE, competency reviews are all pre-negotiated and mutually agreed upon as something staff must do as part of maintaining their priv. at the hospital and to be fully successful for performance standards. This tracer crap is not. This PM parted out their responsibility to the rest of the clinic and created a lot of confusion as to whether it was required of us or not. There are still SEVERAL providers in the clinic who have yet to complete this tracer. I wonder if they will be put on a PIP too seeing how that was part of the rationale for implementing mine.

 

[Fan_of_Meehl]

It's the PMs job, not ours. The union rep. even pointed that out as this seems to be an ad hoc task being asked without the union being involved to negotiate and ensure it's appropriate to ask staff to take on such a task. For example, the peer reviews we do quarterly, the FPPE, OPPE, competency reviews are all pre-negotiated and mutually agreed upon as something staff must do as part of maintaining their priv. at the hospital and to be fully successful for performance standards. This tracer crap is not. This PM parted out their responsibility to the rest of the clinic and created a lot of confusion as to whether it was required of us or not. There are still SEVERAL providers in the clinic who have yet to complete this tracer. I wonder if they will be put on a PIP too seeing how that was part of the rationale for implementing mine.

When the head of our department mandated that we 'do tracers on ourselves' and send a monthly email 'attesting to the fact that we had done so and that they were at '100%' (or whatever % they actually were) I considered this particular absurd management practice to be perfectly illustrative of the pathology of leadership at VA. They should send MBA students to do 6 month field apprenticeships in VA hospitals to learn exactly what NOT to do and WHY. It would be an invaluable (and memorable) part of their education.

things NOT to do as a leader
- abdicate responsibility
- give your already overwhelmed subordinates YOUR work to do, especially if it involves monitoring/auditing
- give unethical subordinates an easy route to high marks...they'll just lie
- perpetuate worry as part of a 'gotcha' culture in your good employees with integrity

 

[cara susanna]

We had an internal (educational only) audit of our documentation and coding recently and none of us were even close to 100%.

 

[PsyDWannabe]

It's the PMs job, not ours. The union rep. even pointed that out as this seems to be an ad hoc task being asked without the union being involved to negotiate and ensure it's appropriate to ask staff to take on such a task. For example, the peer reviews we do quarterly, the FPPE, OPPE, competency reviews are all pre-negotiated and mutually agreed upon as something staff must do as part of maintaining their priv. at the hospital and to be fully successful for performance standards. This tracer crap is not. This PM parted out their responsibility to the rest of the clinic and created a lot of confusion as to whether it was required of us or not. There are still SEVERAL providers in the clinic who have yet to complete this tracer. I wonder if they will be put on a PIP too seeing how that was part of the rationale for implementing mine.

For what it’s worth, try not to co-opt other staff/faculty into your fight. I’m not saying you’re doing this, but you’ve mentioned a couple of times how they’re all doing the same thing you’re doing but not getting in trouble for it. If they wanted to fight this battle, they would. Definitely defend yourself to your fullest ability, but please be mindful of involving other folks who don’t necessarily want to fight such a battle. Again, not saying you’re doing any of that, but I feel it’s worth mentioning.

 

[Sanman]

When the head of our department mandated that we 'do tracers on ourselves' and send a monthly email 'attesting to the fact that we had done so and that they were at '100%' (or whatever % they actually were) I considered this particular absurd management practice to be perfectly illustrative of the pathology of leadership at VA. They should send MBA students to do 6 month field apprenticeships in VA hospitals to learn exactly what NOT to do and WHY. It would be an invaluable (and memorable) part of their education.

things NOT to do as a leader
- abdicate responsibility
- give your already overwhelmed subordinates YOUR work to do, especially if it involves monitoring/auditing
- give unethical subordinates an easy route to high marks...they'll just lie
- perpetuate worry as part of a 'gotcha' culture in your good employees with integrity

How do you do Tracers on yourself? Why would you not do it and just say you did?

 

[deleted1129370]

For what it’s worth, try not to co-opt other staff/faculty into your fight. I’m not saying you’re doing this, but you’ve mentioned a couple of times how they’re all doing the same thing you’re doing but not getting in trouble for it. If they wanted to fight this battle, they would. Definitely defend yourself to your fullest ability, but please be mindful of involving other folks who don’t necessarily want to fight such a battle. Again, not saying you’re doing any of that, but I feel it’s worth mentioning.

Sure - and I haven't involved others. I am an adult ya know!

On another note, things escalated to our executive director of MH Care Line and they basically advised my boss that they need to terminate the PIP should I already meet the areas they outlined in the PIP, which were already met weeks ago. Again, the basis for this PIP was non-factual and frankly, trivial in the grand scheme of things.

 

[Sanman]

We had an internal (educational only) audit of our documentation and coding recently and none of us were even close to 100%.

How can you be 100% when I am sure, no one set guidelines prior to this "educational" experience? RVU pressure leads to cheating during coding. Even those that know the codes likely cheat to game the numbers.

 

[deleted1129370]

How do you do Tracers on yourself? Why would you not do it and just say you did?

It's part of a shared excel spreadsheet on TEAMS, so they can see who has completed them or not. We have to indicate our name.

 

[Sanman]

It's part of a shared excel spreadsheet on TEAMS, so they can see who has completed them or not. We have to indicate our name.

That fine, we do peer chart reviews. However, self-review seems dumb.

 

[deleted1129370]

That fine, we do peer chart reviews. However, self-review seems dumb.

We do too....that's standard across every VA I've been at, but these tracers are not. That is not the responsibility of an LIP, it is the PM's job.

 

[AcronymAllergy]

Sure - and I haven't involved others. I am an adult ya know!

On another note, things escalated to our executive director of MH Care Line and they basically advised my boss that they need to terminate the PIP should I already meet the areas they outlined in the PIP, which were already met weeks ago. Again, the basis for this PIP was non-factual and frankly, trivial in the grand scheme of things.

Seems like, IMO, you may now be able to say you've never formally been placed on a remedial plan, as the PIP was improperly implemented and perhaps never formally approved by upper-leadership.

 

[Sanman]

We do too....that's standard across every VA I've been at, but these tracers are not. That is not the responsibility of an LIP, it is the PM's job.

All of it is the manager's job, including the peer reviews. The problems is the VA won't hire enough managers.

 

[deleted1129370]

All of it is the manager's job, including the peer reviews. The problems is the VA won't hire enough managers.

The other problem is when management assumes that delegating certain tasks to their employees is appropriate without first going through the union to ensure it abides by what the union and VA agreed upon as far scope of functions of the LIP.

 

[cara susanna]

How can you be 100% when I am sure, no one set guidelines prior to this "educational" experience? RVU pressure leads to cheating during coding. Even those that know the codes likely cheat to game the numbers.

Oh, yeah, we gave that feedback. A lot of what the audit people told us was completely new, or even inconsistent with what we'd previously learned. I tried to adjust somewhat but some of their requests were imo unreasonable and would make documentation even more of an administrative burden than it already is.