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

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IloveCBT said:
Tell me about your traumatic and/or abusive VHA training experiences as an intern, postdoc, or staff member. I'm curious about other people's experiences.
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I had quite a few not so great experiences that generally fell under the umbrella of microaggressions or poor boundaries. I think the supervisors I struggled with (there were only a few) just didn't have the skills to be supervisors. They would put me in inappropriate situations with other VA staff or patients. That, or they would just say things to me that were completely not okay with even a little multicultural training. The other hard part was that leadership couldn't do much about it for a variety of reasons. My issues aren't unique in the VA, but it's where I did quite a bit of my training.
 
IloveCBT said:
Tell me about your traumatic and/or abusive VHA training experiences as an intern, postdoc, or staff member. I'm curious about other people's experiences.
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Some disorganization on internship, as well as some of what I thought was unnecessary and unhelpful "cheerleading about veterans... RA-RA" at a practicum experience.... but otherwise pretty great, actually.

Nothing crazy as a Staff Psychologist either (2012-2018) other than the fact that the Psychology Chief and I liked each other alot *personally* (kids at same school and actually lived in the same suburban subdivision/development, played golf together, etc.) but just had very different styles and beliefs about psychologist training and maybe about how some things were handled. It was simply not a role I wanted to do...long-term. Pleasure and mastery and all that Beckian stuff, right?

Also, please keep in mind that some things that might have been acceptable just 10-15 years ago are certainly NOT acceptable today. For example, the SUDs service at my local VA was definitely a "Boys Club" thru the mid 2000s and early 2010s. I won't mention the jokes and dark humor that were common and acceptable there back then. I am certainly not the most "progressive" leaning person on this board by a longshot, but even some of these comments made me wince a bit.
 
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I promise this is not an effort to start adding things to my plate as soon as I get to my job, but I wonder if there are any admin/committee duties that folks actually enjoy? The VA seems to have a lot of ways to get connected to interesting people and projects.
 
Shiori said:
I promise this is not an effort to start adding things to my plate as soon as I get to my job, but I wonder if there are any admin/committee duties that folks actually enjoy? The VA seems to have a lot of ways to get connected to interesting people and projects.
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After I got hired into a faculty position, we built out a clinic to assist with the long-term EMU. Doing some pre-testing screening when they were admitted, did some pre-post surgical evals, etc. This was kind of fun, and we had an established clinic where I did postdoc, so I had good and recent experience with such clinics.
 
Shiori said:
I promise this is not an effort to start adding things to my plate as soon as I get to my job, but I wonder if there are any admin/committee duties that folks actually enjoy? The VA seems to have a lot of ways to get connected to interesting people and projects.
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I think the pleasantness of any particular committee is 99% based on the actual people comprising it, so it's going to vary dramatically via site.
 
Shiori said:
I promise this is not an effort to start adding things to my plate as soon as I get to my job, but I wonder if there are any admin/committee duties that folks actually enjoy? The VA seems to have a lot of ways to get connected to interesting people and projects.
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I enjoyed being on the hospital Ethics Committee. It connects you with a bunch of different medical personnel and interesting cases that normally wouldn’t show up in one’s normal workday (unless you work CLC or something else inpatient/residential.
 
Shiori said:
I promise this is not an effort to start adding things to my plate as soon as I get to my job, but I wonder if there are any admin/committee duties that folks actually enjoy? The VA seems to have a lot of ways to get connected to interesting people and projects.
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I'm an MST coordinator (I've hinted at it a lot, might as well just say outright) and love it.
 
I worked on a task force committee when we were rolling out Cerner here...we were trying to figure out how we would go about re-vamping the BHIP initial eval process. I may or may not get involved with a committee again, just depends on the people.
 
Shiori said:
I promise this is not an effort to start adding things to my plate as soon as I get to my job, but I wonder if there are any admin/committee duties that folks actually enjoy? The VA seems to have a lot of ways to get connected to interesting people and projects.
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I always enjoyed being involved in training, and I spent some time on a continuing education committee that I also enjoyed.

I know folks have enjoyed ethics committee/consultation work (as was mentioned above) as well as participation on IRBs
 
cara susanna said:
From my experience, trainees are pretty protected from that.

I had a supervisor who was abusive and apparently it was years before this person was removed from supervising. Ironically, the removal happened when I was being supervised by them and then my rotation collapsed. Still was glad to not have them as my supervisor, though!
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I'm glad that was your experience. It definitely wasn't mine. I wish there was a way to warn future trainees to not apply to particular sites/beware of certain supervisors at certain VAs who need to be removed from supervisory roles but that just hasn't happened yet because their colleagues are too cowardly to do the ethical thing.
 
WisNeuro said:
Nothing traumatic or abusive. I actually loved internship and postdoc at the VA. I still contend the VA is, in general, the best training ground in psychology. Being a staff member, though, that can be tough. Arbitrary productivity measurements, team leads that are generally clueless, entitled patient population that gets way too much leeway, payscale that ceilings out quickly, etc.
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I would like to know the places people are receiving training at in the VA that aren't complete garbage experiences.
 
IloveCBT said:
I would like to know the places people are receiving training at in the VA that aren't complete garbage experiences.
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Between my experiences, and those of my friend and colleagues who trained at different VAs, it's been mostly positive things about the training experiences, particularly at the larger VAs with large and varied training. I've heard a little more hit and miss at the much smaller programs. There's been an odd not great supervisor here and there, but that was rare in the context of the overall program. I've had more trainwreck fellow trainees than bad supervisory experiences in the VA.
 
WisNeuro said:
Between my experiences, and those of my friend and colleagues who trained at different VAs, it's been mostly positive things about the training experiences, particularly at the larger VAs with large and varied training. I've heard a little more hit and miss at the much smaller programs. There's been an odd not great supervisor here and there, but that was rare in the context of the overall program. I've had more trainwreck fellow trainees than bad supervisory experiences in the VA.
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That makes a lot of sense. Maybe it's not worth it unless the facility is about 1A complexity.
 
WisNeuro said:
I've heard a little more hit and miss at the much smaller programs.
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I think there’s a lot to this. At smaller VAs, it’s more likely for a staff member who either doesn’t want to supervise and/or shouldn’t supervise be voluntold into supervising due to lack of other options.

I’ve been at 4 VAs now and at my smallest VA, some rotations (including core/required ones) may have a total supervisor pool of 1 or 2 staff psychologists (neuropsych, some speciality mental health that isn’t the PCT) while the equivalent rotation at a large facility may have 2+ people who want to supervise but aren’t accepted onto the training committee due to lack of space.

So if they declined or were not allowed to supervise, that whole rotation would drop off, which could really mess with a program’s ability to offer rotation options and maintain accreditation.

My trainee experiences were at a mid-sized and a flagship facility and both were good to solid. But I also had peers these 2 years who had negative experiences in some rotations due to supervisor-driven issues.

I currently supervise at a pretty large VA and believe our training is good to excellent. I also worked at a small facility (but did not supervise) and the training there was probably average to decent with more hit and miss variability.

Overall, it’s possible that the more competitive a VA appears, the better likelihood of getting average and above training. But from a statistical perspective, psychologists are probably just as likely as the general population to harbor less than ideal personality traits and engage in varying degrees of asocial behavior at similar rates.
 
I found that the current interns and postdocs were pretty candid during interviews, which was helpful in making my decision. I have tried to offer the same openness to applicants. I make an effort to share things that sites does well, but give frank feedback about areas of weakness. If I am asked directly about difficult supervisors, I reframe the question to discuss the kinds of trainees who might not work well with specific supervisors. They are usually good at reading between the lines.
 
IloveCBT said:
That makes a lot of sense. Maybe it's not worth it unless the facility is about 1A complexity.
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I would also caution against generalizing your experience at 1 VA to the rest of the system. There are over 100 VA internship programs, and many more VA hospitals and CBOCs without training programs that one can work. I wouldn't go back to work with the VA. Not because of the people, they were awesome, but because of the overall system in terms of what it's like to be staff there. In terms of interpersonal problems, you'll find those in any healthcare system. If anything, I've had much worse experiences inter-personally outside of the VA than within.
 
I trained at one large and one mid-size VA (the latter a part of a consortium), and had very good experiences at both. I participated in training at a smaller VA and would hold out that it also, by and large, produced good experiences and outcomes, but my perspective was not that of a trainee. The training at smaller VAs certainly has more potential to be variable, as it's more significantly impacted by changes or issues in any one rotation or supervisor.

I would say that a negative training experience is probably more likely to be due to aspects unique to a specific site more so than to any system or type of setting as a whole, unless that system or setting is just hostile to training.
 
AcronymAllergy said:
I trained at one large and one mid-size VA (the latter a part of a consortium), and had very good experiences at both. I participated in training at a smaller VA and would hold out that it also, by and large, produced good experiences and outcomes, but my perspective was not that of a trainee. The training at smaller VAs certainly has more potential to be variable, as it's more significantly impacted by changes or issues in any one rotation or supervisor.

I would say that a negative training experience is probably more likely to be due to aspects unique to a specific site more so than to any system or type of setting as a whole, unless that system or setting is just hostile to training.
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I feel like regional issues have more to do with it than than VA/Non-VA. I have found the desirable cities have a harsher training environment than the smaller cities I trained in in the south. I have generally found the places with less hustle and bustle to have more time for students and less ladder climbers. That may be personal experience and personal preference though. I seem to enjoy a more relaxed pace.
 
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Sanman said:
I feel like regional issues have more to do with it than than VA/Non-VA. I have found the desirable cities have a harsher training environment than the smaller cities I trained in in the south. I have generally found the places with less hustle and bustle to have more time for students and less ladder climbers. That may be personal experience and personal preference though. I seem to enjoy a more relaxed pace.
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Also true, good point. The "feel" of a VA is definitely going to vary based on how busy that VA is, how many other systems it may be affiliated with, etc.
 
IloveCBT said:
Tell me about your traumatic and/or abusive VHA training experiences as an intern, postdoc, or staff member. I'm curious about other people's experiences.
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Supervisors with past and current histories of CLEAR, PRESENT, AND SEVERE ‘axes 1 and 2’ pathology who are perturbedly impervious to write ups and firings for various reasons (difficulty recruiting their replacement; unconventional setting/no HR, etc) . Burden of their psychological instability is passed on to the lowest on the totem pole (interns and fellows). Makes for a fun time as an intern/fellow.
 
ohiopsychdoc said:
So so much this. We have at least one supervisor who will say all day long that they will never make you see a veteran you are not comfortable or competent to see, but then....get voluntold to see them. Or, when you do express apprehension to see that veteran, it seems like they gaslight you into seeing them by framing it in a way of "this is a good learning experience for you" only to not actually provide any fruitful/meaningful consultation, guidance, etc. I am often taking on veterans who I flat out have zero competencies in evaluating or treating, only to find myself literally thumbing through the digital DSM as I am in session with them to figure things out as I go. Then, if I express my discontent with this whole crap shoot, I am basically told "well, we can transfer them, but this is experiential avoidance; what will happen in the future?"
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“Incompetent practice is unethical practice”. I didn’t have that language in my training years, but now I do and I’m never hesitant to use it.
 
WisNeuro said:
I would also caution against generalizing your experience at 1 VA to the rest of the system. There are over 100 VA internship programs, and many more VA hospitals and CBOCs without training programs that one can work. I wouldn't go back to work with the VA. Not because of the people, they were awesome, but because of the overall system in terms of what it's like to be staff there. In terms of interpersonal problems, you'll find those in any healthcare system. If anything, I've had much worse experiences inter-personally outside of the VA than within.
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Haven't checked this thread in awhile. Interesting observation. I generally really like my colleagues at my worksite (who are overwhelmingly non-psychologists) and I mostly agree that it's the system that's stultifying and sucks.

That being said, sometimes the system does a terrible job of condoning or even outright encouraging bad behavior of psychologists (and veterans of course!) at the VA. Fortunately, I'm insulated from at least the bad-behavior-of-other-psychologists piece (given my niche at the CLC) but I see enough of it to understand why this place is so hard for so many others to work at.

In terms of the pay, for people that want to really max their possible compensation obviously there is a ceiling - but at a GS-13/9 I really am pretty satisfied.
 
How are people liking the new MHA? I like it so far, but it has gotten a wide range of emotions from others.
 
Shiori said:
How are people liking the new MHA? I like it so far, but it has gotten a wide range of emotions from others.
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It's OK, it doesn't seem like a great leap forward in functionality. Only advantage it seems to have is that it's not run via CPRS (web based instead)
 
Yup. It's about the same (user experience).
We still work for computers.
They used to work for us.
 
Fan_of_Meehl said:
I've heard/read the horror stories.

Central office should, seriously, collect baseline, pre, and post-Cerner assessments of providers filling out the PHQ-9, PCL-5, GAD-7, and CSRE's on themselves.
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This makes the assumption that central office cares about what the providers think. Not so sure about that.
 
Fan_of_Meehl said:
I've heard/read the horror stories.

Central office should, seriously, collect baseline, pre, and post-Cerner assessments of providers filling out the PHQ-9, PCL-5, GAD-7, and CSRE's on themselves.
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There are entire tests that I can no longer administer because of Cerner...the MCMI-IV is one them. I was able to do so when MHA was briefly integrated and working with Cerner, now it is not, so I can't use it.
 
ohiopsychdoc said:
There are entire tests that I can no longer administer because of Cerner...the MCMI-IV is one them. I was able to do so when MHA was briefly integrated and working with Cerner, now it is not, so I can't use it.
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You should thank them for that, that test sucks 😉
 
Sanman said:
This makes the assumption that central office cares about what the providers think. Not so sure about that.
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Exactly - at first I heard our supervisor folks praising it and really trying to "carry the team" and save face for the powers at be, but frankly, now they are like "yeah, this is a cluster f****" and have joined the rest of us in our amazement of how flawed Cerner is. Considering we had a day where it crashed on us for 3 hours...I guess that's okay?
 
WisNeuro said:
You should thank them for that, that test sucks 😉
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Hey now! I like administering it in conjunction with the MMPI-3. I typically do that for a lot of my diagnostic clarification cases, especially those where suspected SMI and personality disorders are in question.
 
ohiopsychdoc said:
Hey now! I like administering it in conjunction with the MMPI-3. I typically do that for a lot of my diagnostic clarification cases, especially those where suspected SMI and personality disorders are in question.
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Fair, I just hate that it is nearly impossible to invalidate the MCMI stuff, which makes it especially problematic in the VA
 
WisNeuro said:
Fair, I just hate that it is nearly impossible to invalidate the MCMI stuff, which makes it especially problematic in the VA
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Exactly - that's why I will use the together because on one hand, invalidating the MMPI is very telling, however, since my focus is clinical vs. forensic at the VA, then my assessment is attempting to ascertain potential treatment targets and the MCMI can really help cluster various personality factors into relevant hypothesis regarding affective and personality conditions that the MMPI can't do really. It gets even more interesting when they invalidate both 🙂 In my feedback with them, I certainly address potential inconsistencies as they relate to valid vs. invalid performances and how that is pertinent to our treatment goals.
 
ohiopsychdoc said:
Exactly - that's why I will use the together because on one hand, invalidating the MMPI is very telling, however, since my focus is clinical vs. forensic at the VA, then my assessment is attempting to ascertain potential treatment targets and the MCMI can really help cluster various personality factors into relevant hypothesis regarding affective and personality conditions that the MMPI can't do really. It gets even more interesting when they invalidate both 🙂 In my feedback with them, I certainly address potential inconsistencies as they relate to valid vs. invalid performances and how that is pertinent to our treatment goals.
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It's the VA, every assessment is potentially forensic in nature.
 
WisNeuro said:
It's the VA, every assessment is potentially forensic in nature.
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Potentially - but not in my experiences thus far. I have a clear discussion about their time with me as it relates to any potential C&P evaluations they may want in the future.
 
JeyRo said:
Haven't checked this thread in awhile. Interesting observation. I generally really like my colleagues at my worksite (who are overwhelmingly non-psychologists) and I mostly agree that it's the system that's stultifying and sucks.

That being said, sometimes the system does a terrible job of condoning or even outright encouraging bad behavior of psychologists (and veterans of course!) at the VA. Fortunately, I'm insulated from at least the bad-behavior-of-other-psychologists piece (given my niche at the CLC) but I see enough of it to understand why this place is so hard for so many others to work at.

In terms of the pay, for people that want to really max their possible compensation obviously there is a ceiling - but at a GS-13/9 I really am pretty satisfied.
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You are going to have to revisit this post after Cerner comes out. I do feel like us gero folks have an extra incentive to stay at the VA because the private equity backed PP market for our skills frankly sucks. I know that if I shift into PP, it will likely be a step back from the work I have been doing and more toward including other areas of practice.
 
ohiopsychdoc said:
Potentially - but not in my experiences thus far. I have a clear discussion about their time with me as it relates to any potential C&P evaluations they may want in the future.
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There is research out there, even in a purely research context, where they are told that the results will not be part of their clinical record, there is a significantly higher invalid performance rate compared to non-VA samples. It is unfortunately baked into the system.
 
WisNeuro said:
There is research out there, even in a purely research context, where they are told that the results will not be part of their clinical record, there is a significantly higher invalid performance rate compared to non-VA samples. It is unfortunately baked into the system.
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Absolutely - it's a challenge for sure; to balance evaluating elements to achieve diagnostic clarity for treatment guidance, and that of discerning the validity and motives of their desire to see me. I do the best I can, reference the relevant literature, consult with colleagues, and describe relevant limitations, inconsistencies as needed in an effort to pick out the salient aspects pertinent to treatment planning. From more of the forensic side of things, I would only give the MMPI-3 and if they invalidate that, that's telling in itself since my role is pretty clear as a "gate-keeper" in ways. It's one more (significant) data point to address in my review and conceptualization when I send it to the referral source.
 
ohiopsychdoc said:
Absolutely - it's a challenge for sure; to balance evaluating elements to achieve diagnostic clarity for treatment guidance, and that of discerning the validity and motives of their desire to see me. I do the best I can, reference the relevant literature, consult with colleagues, and describe relevant limitations, inconsistencies as needed in an effort to pick out the salient aspects pertinent to treatment planning. From more of the forensic side of things, I would only give the MMPI-3 and if they invalidate that, that's telling in itself since my role is pretty clear as a "gate-keeper" in ways. It's one more (significant) data point to address in my review and conceptualization when I send it to the referral source.
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How does the MMPI-3 compare to the 2RF in regard to % of validity faliures for veterans? I'm still sticking with the 2RF and will continue bc of forensic reasons, though I'm curious about the data behind the MMPI-3.
 
Why because Cerner is going to suck hard?

At this point in my life with a couple of teenage kids at home I don't have the wherewithal, much less the business sense to do PP on my own. And I certainly wouldn't do Medicare contracting - I don't care what any geropsychologist says, it's a terrible system to work with, and only continues to get worse and worse in terms of nickel-and-diming us. If I could create a private pay practice I'd do it, but that would be tricky to do.

In terms of other orgs, I don't think it would be difficult at all for me to get work elsewhere, like at Kaiser, but it would at best be a lateral move pay and benefits wise, but I'd likely lose my gero niche - and other pure geropsych jobs are going to realistically require me to take a pay cut.

So, the golden handcuffs of the VA for now

Sanman said:
You are going to have to revisit this post after Cerner comes out. I do feel like us gero folks have an extra incentive to stay at the VA because the private equity backed PP market for our skills frankly sucks. I know that if I shift into PP, it will likely be a step back from the work I have been doing and more toward including other areas of practice.
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Therapist4Chnge said:
How does the MMPI-3 compare to the 2RF in regard to % of validity faliures for veterans? I'm still sticking with the 2RF and will continue bc of forensic reasons, though I'm curious about the data behind the MMPI-3.
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This is a really good and interesting question - and one, I sadly cannot provide a good answer for at this time. I too am interested in this comparison and will be looking, so I will let you know what I find out.
 
Is it bad that I think about retiring way more than I ever did? I'm barely halfway done
 
JeyRo said:
Is it bad that I think about retiring way more than I ever did? I'm barely halfway done
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Not at all...I just got my license last December, started my VA job last August, and was already getting burnt out around January of 2021. I was contemplating alternatives to the VA, hell, and even alternatives to clinical work.
 
ohiopsychdoc said:
Not at all...I just got my license last December, started my VA job last August, and was already getting burnt out around January of 2021. I was contemplating alternatives to the VA, hell, and even alternatives to clinical work.
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Yeah I can't imagine starting right now. I got started in the early 2000s and although I've had some fits and starts, it's been mostly good.

These days though - **** - it's really starting to get to me. Gotta be honest.

Good thing I have a VA "venting" thread to get it all out tho!
 
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