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

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ccpsych16 said:
My understanding is that firm offers can only happen after my degree is conferred, and I will confirm that too.
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You will able to verify with HR. I am hoping that you still be getting a firm offer; however, it might state something like temporary appointment contingent upon...
Once you meet the contingent conditions (e.g. degree, licensure...), then HR will work with credentialing to change your appointment to permanent
It sounds simple, but that process can take months. Your paperwork will circulate around and gets passed along the VA hierarchy for approval, signatures, verification, clarification....
The best way to track and monitor your HR files is to set up your password to access your account on the EOPF website:
https://eopf.opm.gov/va/
Things eventually work out; they just take TIME in the system.... lots of it. LOL
 
Mercury in Taurus said:
You will able to verify with HR. I am hoping that you still be getting a firm offer; however, it might state something like temporary appointment contingent upon...
Once you meet the contingent conditions (e.g. degree, licensure...), then HR will work with credentialing to change your appointment to permanent
It sounds simple, but that process can take months. Your paperwork will circulate around and gets passed along the VA hierarchy for approval, signatures, verification, clarification....
The best way to track and monitor your HR files is to set up your password to access your account on the EOPF website:
https://eopf.opm.gov/va/
Things eventually work out; they just take TIME in the system.... lots of it. LOL
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Thank you for outlining the process! I’m coming up on my second year in the VA as a trainee and I’ve heard it only gets worse when trying to onboard as staff lol. I do have an EOPF account so I will keep my eye on it.
 
I've been reading about PP as I move forward with the pre-employment process. 🎊
 
Here's my deal. I've been in the CLC with the VA for a number of years now, now in my 15th year. We're now in the 3rd year of COVID craziness. My guys are still locked down. They had some brief, marginal liberalization in the last few months (some face to face visits, albeit very time limited and with heavy PPE and policing by nursing), but still largely locked down and living a very dismal existence. And now with Omicron - we're back to being 100% locked down again and those family visits are gone again. No rec therapy outings, no *any* outings, volunteers visits are largely a memory, and paid companion services are banned. It's *dismal*.

Yeah - I get it - they are the most vulnerable. But now in year three of this I'm starting to feel increasingly hopeless about this. For sure - if we liberalized the rules too much, we are gambling with their lives due to COVID, right? Well - our guys are in their 70s and 80s and they don't have much time left. In fact, *time* is the most precious resource they have. And under these COVID lockdown rules, we - as the VA - as society - are literally gambling away whatever meaningful lives they have left. There's virtually nothing "homelike" left at the CLC. We have become a holding facility.

I'm sorry to sound so bitter but it's getting to me at this point. It ****ing sucks. It's taken a lot of joy out of my job as a VA geropsychologist.
 
FredBerfil said:
I'm all ears ser
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Look at how much you can sock away in SEP IRAs. Also consider that if you can significantly lower your tax rates by paying yourself "dividends" as an owner of a business as opposed to what you would pay on the same amount if it's salary through payroll taxes. These are two decent ones, but there are a lot of legal ways to shield money for business owners, or the ridiculous things that are deductible.
 
WisNeuro said:
Look at how much you can sock away in SEP IRAs. Also consider that if you can significantly lower your tax rates by paying yourself "dividends" as an owner of a business as opposed to what you would pay on the same amount if it's salary through payroll taxes. These are two decent ones, but there are a lot of legal ways to shield money for business owners, or the ridiculous things that are deductible.
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Damn SEP IRAs sound pretty sweet!
 
JeyRo said:
Damn SEP IRAs sound pretty sweet!
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They can be if your revenue hits a certain point, in some cases, a solo 401k may make more sense. If anyone is ever thinking about PP, it's more than worth it to get some recommendations for CPAs who work with healthcare folks and schedule a meeting to discuss what this might look like for your particular practice situations.
 
JeyRo said:
Here's my deal. I've been in the CLC with the VA for a number of years now, now in my 15th year. We're now in the 3rd year of COVID craziness. My guys are still locked down. They had some brief, marginal liberalization in the last few months (some face to face visits, albeit very time limited and with heavy PPE and policing by nursing), but still largely locked down and living a very dismal existence. And now with Omicron - we're back to being 100% locked down again and those family visits are gone again. No rec therapy outings, no *any* outings, volunteers visits are largely a memory, and paid companion services are banned. It's *dismal*.

Yeah - I get it - they are the most vulnerable. But now in year three of this I'm starting to feel increasingly hopeless about this. For sure - if we liberalized the rules too much, we are gambling with their lives due to COVID, right? Well - our guys are in their 70s and 80s and they don't have much time left. In fact, *time* is the most precious resource they have. And under these COVID lockdown rules, we - as the VA - as society - are literally gambling away whatever meaningful lives they have left. There's virtually nothing "homelike" left at the CLC. We have become a holding facility.

I'm sorry to sound so bitter but it's getting to me at this point. It ****ing sucks. It's taken a lot of joy out of my job as a VA geropsychologist.
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I left an inpatient psych position during the pandemic about the only positive about COVID precautions was most likely not having to share a room but I can’t imagine what it’s like for a CLC and how it must feel more and more like institutionalization.
 
summerbabe said:
I left an inpatient psych position during the pandemic about the only positive about COVID precautions was most likely not having to share a room but I can’t imagine what it’s like for a CLC and how it must feel more and more like institutionalization.
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Yeah it's terrible. I don't think this is right. I don't think keeping older adults alive like hermetically sealed vegetables is right, even though it may prevent COVID infection to a certain degree. My MDS nurse also says she is more than aware that veteran functioning has been declining in a variety of ways due to all of these NPI measures. I feel a lot like a dude with his fingers in a d-y-k-e as it's bursting.

Anyways, just me venting
 
JeyRo said:
Yeah it's terrible. I don't think this is right. I don't think keeping older adults alive like hermetically sealed vegetables is right, even though it may prevent COVID infection to a certain degree. My MDS nurse also says she is more than aware that veteran functioning has been declining in a variety of ways due to all of these NPI measures. I feel a lot like a dude with his fingers in a d-y-k-e as it's bursting.

Anyways, just me venting
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I read an article in something like NYT or Washington Post that was this physician asking why no one seems to care that isolation can have as many negative physical health consequences as COVID for the elderly. I think it also related to isolation policies for people sick with COVID in the hospital. I'm trying to find it, but no luck...

I have seen it with one of my patients who was in an assisted living facility that basically went on lockdown during COVID. This was someone who was already depressed and lonely, then behavioral and social engagement was reduced even further. It was awful. I can only imagine how bad your situation feels.

For my oupatients (and I recognize that this is something I have liberty to do whereas you do not), I've started to say that--I'm your mental health provider, and as such your MENTAL health is my priority. I would never tell you to do anything unsafe or against medical guidelines, and definitely listen to your primary care provider. At the same time, avoidance/behavioral disengagement/isolation/etc IS going to have a negative impact on your mental health. So we need to strike a balance somehow.
 
cara susanna said:
I read an article in something like NYT or Washington Post that was this physician asking why no one seems to care that isolation can have as many negative physical health consequences as COVID for the elderly. I think it also related to isolation policies for people sick with COVID in the hospital. I'm trying to find it, but no luck...

I have seen it with one of my patients who was in an assisted living facility that basically went on lockdown during COVID. This was someone who was already depressed and lonely, then behavioral and social engagement was reduced even further. It was awful. I can only imagine how bad your situation feels.

For my oupatients (and I recognize that this is something I have liberty to do whereas you do not), I've started to say that--I'm your mental health provider, and as such your MENTAL health is my priority. I would never tell you to do anything unsafe or against medical guidelines, and definitely listen to your primary care provider. At the same time, avoidance/behavioral disengagement/isolation/etc IS going to have a negative impact on your mental health. So we need to strike a balance somehow.
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Think this may be it?

www.nytimes.com

How Social Isolation Is Killing Us (Published 2016)

Research confirms our deepest intuition: Human connection lies at the heart of human well-being.
www.nytimes.com www.nytimes.com
 
IWillSurvive said:
So if you're booked out about 10 weeks and you are going to put in your notice...how much notice should you give? Feedback appreciated!
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Personally, I saw all of my scheduled patients. However, I knew I was leaving for a while, so my section knew a good 5 months in advance. I probably formally submitted my notice about 2 months ahead of time, but that was just a formality.
 
ela said:
OK, so week two of my new VA role and serious question. HOW ON EARTH do you all survive working with CPRS day in and day out? OH MY GÖOÖD!!!!!!

That is all. For now.
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I dunno, I found CPRS easier to navigate than EPIC for what I needed in chart reviews.
 
IWillSurvive said:
So if you're booked out about 10 weeks and you are going to put in your notice...how much notice should you give? Feedback appreciated!
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4-6 weeks would be a good pace with terminating and transferring care in MHO. Congrats on your new G14 job. Sounds like you got it 🙂
 
ela said:
OK, so week two of my new VA role and serious question. HOW ON EARTH do you all survive working with CPRS day in and day out? OH MY GÖOÖD!!!!!!

That is all. For now.
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You will get used to it. It was a monster for a while in the beginning. You probably already know that you can always save your note without signature and close the encounter if you are not ready to sign it. You can save note formats that can be easily accessed instead of retyping everything or relying on copy and paste. So many functions that can help you to be efficient 🙂
 
Mercury in Taurus said:
4-6 weeks would be a good pace with terminating and transferring care in MHO. Congrats on your new G14 job. Sounds like you got it 🙂
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Thanks for the feedback to both of you that responded... I was thinking somewhere around 6 weeks--as long as there is time to terminate and transfer care as needed. OH and I never heard back on that GS-14 which I'm assuming means I did not get it, but I'm exploring some other potential options 🙂 Thanks again!
 
ela said:
OK, so week two of my new VA role and serious question. HOW ON EARTH do you all survive working with CPRS day in and day out? OH MY GÖOÖD!!!!!!

That is all. For now.
Click to expand...
Hah, CPRS was actually one of my smallest complaints about the VA. It's dated, to be sure, but once you get used to the navigation, it's not bad. Like was mentioned above, definitely make use of the "save without signature" function as needed (e.g., to start a note during session so you can close the encounter, but wait until later to finalize and sign) and templates. I never did find a guide with a list of all the different auto-input codes you can use, but I'm sure they exist. And Mental Health Assistant is actually pretty decent for administering various measures.

The biggest complaint I had about CPRS was that it was difficult/impossible to see when patients had checked in.
 
AcronymAllergy said:
The biggest complaint I had about CPRS was that it was difficult/impossible to see when patients had checked in.
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I haven’t used it since I stopped seeing clients in person so I don’t remember the name (it’s been a year and a half), but there was some sort of link in bookmarks that showed when people checked in for their appointments. It would be nice if it was integrated into the EHR in an efficient way. Maybe on the cover page instead of saying “action required” as soon as the appointment time came up, it could say whether they checked in. And then action required could come up after the appointment hour if the person wasn’t checked out.
 
I can't sign a note because "another session has this record locked" even though that isn't the case. It seems to happen more frequently at my current VA. I will have to put in yet another LEAF request to get it fixed...again.
 
Shiori said:
I can't sign a note because "another session has this record locked" even though that isn't the case. It seems to happen more frequently at my current VA. I will have to put in yet another LEAF request to get it fixed...again.
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It is could be a tech issue. However, that may also happen when another provider is either reviewing the chart or in the middle of writing a note. I usually log out from that chart and come back later. It seemed to work or maybe I don't know something that I should have known LOL
 
ccpsych16 said:
I haven’t used it since I stopped seeing clients in person so I don’t remember the name (it’s been a year and a half), but there was some sort of link in bookmarks that showed when people checked in for their appointments. It would be nice if it was integrated into the EHR in an efficient way. Maybe on the cover page instead of saying “action required” as soon as the appointment time came up, it could say whether they checked in. And then action required could come up after the appointment hour if the person wasn’t checked out.
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Yeah, I typically used either Vista (DOS-like interface) or another program that's name I can't remember (Visual something, I think), and also had view-only access to whatever program our clerks used to schedule patients, which allowed me to see when people had checked in. So it was possible, but like you said, it would've been nice to actually have it available in CPRS.
 
Mercury in Taurus said:
It is could be a tech issue. However, that may also happen when another provider is either reviewing the chart or in the middle of writing a note. I usually log out from that chart and come back later. It seemed to work or maybe I don't know something that I should have known LOL
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Yeah, it was definitely a tech issue. I worked with IT for about an hour to get it resolved. Such a pain. All my notes from yesterday were locked and all but one magically stopped throwing a fit this morning. It happens whenever I have a temporary supervisor and they open the note before I sign it.
 
Shiori said:
Yeah, it was definitely a tech issue. I worked with IT for about an hour to get it resolved. Such a pain. All my notes from yesterday were locked and all but one magically stopped throwing a fit this morning. It happens whenever I have a temporary supervisor and they open the note before I sign it.
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Odd (and annoying). By temporary supervisor, do you mean someone temporarily assigned to go in and co-sign your notes? We would have multiple different supervisors signing trainees notes and it never seemed to be a problem, but they're also classified somewhat differently in CPRS. Maybe it's also something with what those particular supervisors are doing in the note? Hmm.

But if that's the case, maybe it means the issue will only be a problem until you're fully licensed.

Our clinic would sporadically have encounters that for some reason couldn't be closed. Which of course the clinician got "dinged" for, unless they appealed it up the chain. Happened to me once or twice and I didn't bother requesting to have it removed from my performance measures.
 
AcronymAllergy said:
Odd (and annoying). By temporary supervisor, do you mean someone temporarily assigned to go in and co-sign your notes? We would have multiple different supervisors signing trainees notes and it never seemed to be a problem, but they're also classified somewhat differently in CPRS. Maybe it's also something with what those particular supervisors are doing in the note? Hmm.

But if that's the case, maybe it means the issue will only be a problem until you're fully licensed.

Our clinic would sporadically have encounters that for some reason couldn't be closed. Which of course the clinician got "dinged" for, unless they appealed it up the chain. Happened to me once or twice and I didn't bother requesting to have it removed from my performance measures.
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Yeah, it's when a supervisor is out sick and someone else covers for them. It has only ever happened to me at this VA. I was also given more freedom to sign my notes without as much oversight previously, so maybe it didn't come up as much. I'm in the same VISN at a different hospital, but CPRS seems much more finicky here. Who knows....
 
Shiori said:
Yeah, it's when a supervisor is out sick and someone else covers for them. It has only ever happened to me at this VA. I was also given more freedom to sign my notes without as much oversight previously, so maybe it didn't come up as much. I'm in the same VISN at a different hospital, but CPRS seems much more finicky here. Who knows....
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Isn't it fun finding out just how true the saying, "if you know one VA, you know one VA" really is?
 
Shiori said:
Yeah, it's when a supervisor is out sick and someone else covers for them. It has only ever happened to me at this VA. I was also given more freedom to sign my notes without as much oversight previously, so maybe it didn't come up as much. I'm in the same VISN at a different hospital, but CPRS seems much more finicky here. Who knows....
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I can see how frustrating that must be on top of everything else we have to deal and cope with...hang in there. There is light at the end of tunnel. Sometimes, it seems like it gets darker towards the end when we feel like reaching the threshold of our tolerance
 
AcronymAllergy said:
Hah, CPRS was actually one of my smallest complaints about the VA. It's dated, to be sure, but once you get used to the navigation, it's not bad. Like was mentioned above, definitely make use of the "save without signature" function as needed (e.g., to start a note during session so you can close the encounter, but wait until later to finalize and sign) and templates. I never did find a guide with a list of all the different auto-input codes you can use, but I'm sure they exist. And Mental Health Assistant is actually pretty decent for administering various measures.

The biggest complaint I had about CPRS was that it was difficult/impossible to see when patients had checked in.
Click to expand...

O do tell!
 
ela said:
O do tell!
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Unfortunately, I don't think it's as exciting as I made it sound. Just lots of the same stuff discussed earlier in this thread--inane administrative requirements and tasks, unrealistic clinical requirements and expectations, a perpetual sense of downward pressure for never doing enough and always being to blame on frontline clinicians from upper management, an overabundance of middle management positions being filled by unqualified and/or unexperienced providers due to office politics and who had little to no understanding of the realities of clinical practice, etc. My own direct supervisors were, fortunately, always great, and I probably had the least to complain about of anyone I worked with.

There really are many great aspects of VA jobs, and I could easily see people making a career out of it (which, of course, many do). A lot of it can depend on your particular VA and its atmosphere, which can (fortunately and unfortunately) shift drastically with a few clinician and leadership changes. I'd just had my fill. Maybe I'll end up back there at some point, who knows.
 
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I don't mind CPRS but my local facility won't allow personal templates so that's been annoying. I use autohotkey scripts instead, but man I miss my personal templates.
 
cara susanna said:
I don't mind CPRS but my local facility won't allow personal templates so that's been annoying. I use autohotkey scripts instead, but man I miss my personal templates.
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Well that just seems like a beautifully horrible policy. I suppose people are just doing lots of copying and pasting from Word, then, (or using hotkeys like you), which doesn't really seem like a better/safer alternative.

I wonder if they're just trying to force utilization of the national templates, like for EBPs...?

That, or some doctor's template somehow fried CPRS for a day like 10 years ago, so now no one gets to use them.
 
cara susanna said:
I have NO idea. It upsets me greatly.
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Because you haven't filled out form OMDB-1234567. Why don't you have it completed? Stop bothering me and go talk to your dept ADPAC and come back when you have the correct forms. Next!

On a serious note, they removed anything in the system with a last name on it at my facility due to national policy. I wonder if that may have to do with the change in local policy. Everyone interprets it differently.
 
cara susanna said:
I have NO idea. It upsets me greatly.
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Its the same for me now, outside the VA.

I just use the orgs template then insert all my stuff into it. Takes an extra 10 second to bring into each note, and a couple extra min to briefly fill out what they need in bare bones way, then do it my way on top of that.

Haven't gotten any crap for it.
 
Sanman said:
Because you haven't filled out form OMDB-1234567. Why don't you have it completed? Stop bothering me and go talk to your dept ADPAC and come back when you have the correct forms. Next!

On a serious note, they removed anything in the system with a last name on it at my facility due to national policy. I wonder if that may have to do with the change in local policy. Everyone interprets it differently.
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Yes we have generic clinic names now. It's confusing to know how to place rtcs and also makes me feel like a cog/expendable. Patients can't tell their appointments apart either.
 
PsychPhDone said:
Yes we have generic clinic names now. It's confusing to know how to place rtcs and also makes me feel like a cog/expendable. Patients can't tell their appointments apart either.
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It definitely can be more confusing for us and the veterans. From a cog/expendable standpoint, I get it as I assume a new hire can just take over the clinic without new LEAF requests every time. They also removed our personal folders from the dept share drive and a few other things with names attached. I am henceforth known as "2"
 
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Sanman said:
It definitely can be more confusing for us and the veterans. From a cog/expendable standpoint, I get it as I assume a new hire can just take over the clinic without new LEAF requests every time. They also removed our personal folders from the dept share drive a few other things. I am henceforth known as "2"
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"I am not a number! I am a free man!"
 
Oh, yeah, they switched us to a number system right before I got here and people STILL are upset about it. As a VA "lifer" whose previous clinic had used the numbers system, I was already used to it. But it does suck for the patients to not know who their provider is from the appt info...
 
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