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

[deleted1129370]

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VA's EDRP is a solid benefit for those with loans, especially with the increases in cap amounts and the number of positions that qualify for it. I would imagine most psych folks could pay off even a relatively hefty loan in 5 years. You just have to decide whether you want to go that way in half the time (which I'd recommend, as there's less risk) or bank (literally) on PSLF in 10 years. And also, if you're paying over the minimum amount, just be sure that your loan stays out of "pay ahead" status (unless the recent PSLF waiver took care of that).

The annual bonuses were, honestly, comical, particularly relative to physicians. I believe our annual bonuses were capped at $1000, with most folks getting less than that, and were heavily dependent on your supervisor completing your paperwork on time. Meanwhile, physicians, I believe, were in the $15-20k range (and you'd better believe they would raise holy hell anytime anyone talked about policies that would make those bonuses harder to get).

Also, at my facility, during the height of COVID, nurses coming into the clinic in-person got hazard pay. Psychologists did not.

Although I should note that our service line leadership was not especially psychologist-friendly despite psychologists making up the bulk of MH staff, so it may be different elsewhere.

What's messed up is, I got COVID while working on an inpatient unit in 2020...and didn't get COVID hazard pay either. I guess we are considered "doctors" and "healthcare professionals" in spirit.

 

[WisNeuro]

Why do we as psychologists suck at advocating for ourselves? Do we fear coming off too pushy? Do we fear that we would be perceived by others as "un-psychologist-like" for asking for more money and/or better representation as a health professions field? I am very much a capitalist, so when it comes time for advocating for $$ for my hard-earned work, you better believe I will.

Psychologists are cheap and lazy, when it comes to advocacy. They do not want to put in the time for advocacy for the most part. Look at the response % we get when we blast out calls to make comments to CMS. It's downright pitiful. A very high rate for a state is like 10% of licensed psychologists. For something that literally takes 5 minutes once or twice a year. On top of that, they also do not want to pay to get advocacy done, as you can see in APA and state org membership stats. We reap what we sow.

 

[AcronymAllergy]

Psychologists are cheap and lazy, when it comes to advocacy. They do not want to put in the time for advocacy for the most part. Look at the response % we get when we blast out calls to make comments to CMS. It's downright pitiful. A very high rate for a state is like 10% of licensed psychologists. For something that literally takes 5 minutes once or twice a year. On top of that, they also do not want to pay to get advocacy done, as you can see in APA and state org membership stats. We reap what we sow.

Agree with this. Psychologists often can't seem to be bothered to even just send emails to state representatives about practice-related issues and, at least from what I've seen, have very low rates of contributing financially to support lobbying and the like. We also like to just pick at each other and criticize state and national organizations rather than supporting and pushing toward a unified goal. We also have fewer numbers than some other professions, so it would take a lot more than many currently give.

I mean, we have two dueling profession-wide national organizations (APA and APS) for crying out loud.

 

[AcronymAllergy]

What's messed up is, I got COVID while working on an inpatient unit in 2020...and didn't get COVID hazard pay either. I guess we are considered "doctors" and "healthcare professionals" in spirit.

Part of it is tied to our reimbursement for services (i.e., our services don't earn as much for the facility as, say, med management). So in that respect, physicians have more financial clout. And nurses always seem to stick together, as do social workers. I do think psychologists, by and large, have difficulty with professional assertiveness and presenting a unified front.

 

[deleted1129370]

Part of it is tied to our reimbursement for services (i.e., our services don't earn as much for the facility as, say, med management). So in that respect, physicians have more financial clout. And nurses always seem to stick together, as do social workers. I do think psychologists, by and large, have difficulty with professional assertiveness and presenting a unified front.

This makes sense.

 

[Sanman]

Agree with this. Psychologists often can't seem to be bothered to even just send emails to state representatives about practice-related issues and, at least from what I've seen, have very low rates of contributing financially to support lobbying and the like. We also like to just pick at each other and criticize state and national organizations rather than supporting and pushing toward a unified goal. We also have fewer numbers than some other professions, so it would take a lot more than many currently give.

I mean, we have two dueling profession-wide national organizations (APA and APS) for crying out loud.

Psychologists are cheap and lazy, when it comes to advocacy. They do not want to put in the time for advocacy for the most part. Look at the response % we get when we blast out calls to make comments to CMS. It's downright pitiful. A very high rate for a state is like 10% of licensed psychologists. For something that literally takes 5 minutes once or twice a year. On top of that, they also do not want to pay to get advocacy done, as you can see in APA and state org membership stats. We reap what we sow.

I don't know if we are cheap and lazy as much as poorly compensated and disorganized. A big part of this is that we are a profession with an Identity crisis. We can't decide if we are largely educators/academics, scientists, or healthcare providers. A lot of the other professions are at least agreed on the major goals even if they also have members in all three camps.

 

[WisNeuro]

I don't know if we are cheap and lazy as much as poorly compensated and disorganized. A big part of this is that we are a profession with an Identity crisis. We can't decide if we are largely educators/academics, scientists, or healthcare providers. A lot of the other professions are at least agreed on the major goals even if they also have members in all three camps.

I'm not sure I buy that. Most people can still afford their APA and state association dues. Heck, you get a steep discount for your malpractice insurance with the APA membership. This should be the bare minimum people can do. Particularly licensed psychologists, of which we have accurate numbers for.

 

[Sanman]

I'm not sure I buy that. Most people can still afford their APA and state association dues. Heck, you get a steep discount for your malpractice insurance with the APA membership. This should be the bare minimum people can do. Particularly licensed psychologists, of which we have accurate numbers for.

I agree that they can afford it. However, I feel that even these associations are target a subset of a group. My state psych association dues are significantly more than APA and the incentives largely geared toward private practice folks (reduced rate CES, job advertising, etc). When I did go to CEs pre-Covid, I was one of the only VA folks there and it was mostly to see some old colleagues in the private sector. A lot of VA folks are not a member of much other than AVAPL. I know plenty that don't even keep APA membership because they don't have malpractice and only function within the VA ecosystem. We really do like to silo into small groups. When I got more involved in psych orgs, I was actually initially discouraged from doing so because I was no longer part of the PP group being at the VA (as if I could never go back or it did not affect me as a professional).

 

[WisNeuro]

I agree that they can afford it. However, I feel that even these associations are target a subset of a group. My state psych association dues are significantly more than APA and the incentives largely geared toward private practice folks (reduced rate CES, job advertising, etc). When I did go to CEs pre-Covid, I was one of the only VA folks there and it was mostly to see some old colleagues in the private sector. A lot of VA folks are not a member of much other than AVAPL. I know plenty that don't even keep APA membership because they don't have malpractice and only function within the VA ecosystem. We really do like to silo into small groups. When I got more involved in psych orgs, I was actually initially discouraged from doing so because I was no longer part of the PP group being at the VA (as if I could never go back or it did not affect me as a professional).

You may be surprised if you talk to someone in the state psych association. In terms of the more visible stuff, the CEs and the networking are the easy things to see. But, most of the associations we work and network with spend a sizable chunk of their time and money on state advocacy efforts. Most have a state lobbyist or DPA that has contacts with state legislature reps/sens to get bills passed and let our voices be heard on other stuff. I think our state does a decent job of communicating what we're working in legislatively, but I know some other states that are doing a lot behind the scenes, but perhaps not communicating how much they are actually doing to members and prospective members.

 

[Sanman]

You may be surprised if you talk to someone in the state psych association. In terms of the more visible stuff, the CEs and the networking are the easy things to see. But, most of the associations we work and network with spend a sizable chunk of their time and money on state advocacy efforts. Most have a state lobbyist or DPA that has contacts with state legislature reps/sens to get bills passed and let our voices be heard on other stuff. I think our state does a decent job of communicating what we're working in legislatively, but I know some other states that are doing a lot behind the scenes, but perhaps not communicating how much they are actually doing to members and prospective members.

I have no doubt. APA has an advocacy arm and I contribute to that as well. State psych orgs need to do more to communicate and advertise this. I think some folks would happily pay for that portion of services without needing to fund the CEs or services they don't need.

 

[WisNeuro]

I have no doubt. APA has an advocacy arm and I contribute to that as well. State psych orgs need to do more to communicate and advertise this. I think some folks would happily pay for that portion of services without needing to fund the CEs or services they don't need.

The cost of breaking off a separate organization just for legislative advocacy (which cannot be a deductible non-profit expense) is cost prohibitive for all but the largest of state organizations. We've run the numbers ourselves. Doesn't work unless you can count on a LOT of donations that people can't deduct on taxes. The CE offerings for most states are actually money makers, or break even enterprises. In most of these associations, people aren't funding the CEs, they're funding the advocacy and other things.

 

[Sanman]

The cost of breaking off a separate organization just for legislative advocacy (which cannot be a deductible non-profit expense) is cost prohibitive for all but the largest of state organizations. We've run the numbers ourselves. Doesn't work unless you can count on a LOT of donations that people can't deduct on taxes. The CE offerings for most states are actually money makers, or break even enterprises. In most of these associations, people aren't funding the CEs, they're funding the advocacy and other things.

The more you know...

 

[cara susanna]

Does anyone else ever contemplate not doing three NS calls and just risking the possible consequences?

 

[Shiori]

Does anyone else ever contemplate not doing three NS calls and just risking the possible consequences?

It is definitely one of the more tedious parts of my work life. I wonder if any research has been done on the utility of it.

 

[WisNeuro]

Does anyone else ever contemplate not doing three NS calls and just risking the possible consequences?

Everyone knows that not making three NS calls raises the risk of completed suicide to 10000000% in the VA population. DON'T DO IT!

 

[cara susanna]

It is definitely one of the more tedious parts of my work life. I wonder if any research has been done on the utility of it.

I just have all of these patients who NS, then I call them and they r/s, then they NS again. I AM TIRED. I'm happy to see them if they actually want to engage, but I just so badly want to put the ball in their court.

 

[Shiori]

I just have all of these patients who NS, then I call them and they r/s, then they NS again. I AM TIRED. I'm happy to see them if they actually want to engage, but I just so badly want to put the ball in their court.

Yes! I have had several clients like that, and there is zero momentum. It also seems like a waste of resources. I'm about to become a very expensive scheduler as I transition from postdoc to my regular job.

 

[thebalmofhurtminds]

When I switched out of VA, it was such a relief to put the ball in the patient's court. A decent amount of times, someone who had multiple NS and was dropped from my patient list, would call back 6+ months later, be put back on my wait list, and come back motivated to complete treatment. In VA, it always seems like you're chasing them. Terrible model of care and unfair to put on providers.

 

[deleted1129370]

Does anyone else ever contemplate not doing three NS calls and just risking the possible consequences?

So...the policy at the VA I am at is a bit different than where I did my internship. Essentially, we only need "3 contacts" of which, phone calls and letters suffice this requirement. Thus, when my vet no shows...I call about 20 minutes past the hour, then when I don't hear from them, I indicate it as a no show, let our MSAs know who will then follow up with one more call and will send a letter. At my previous VA, I had to make 3 phone calls I believe.

 

[WisNeuro]

So...the policy at the VA I am at is a bit different than where I did my internship. Essentially, we only need "3 contacts" of which, phone calls and letters suffice this requirement. Thus, when my vet no shows...I call about 20 minutes past the hour, then when I don't hear from them, I indicate it as a no show, let our MSAs know who will then follow up with one more call and will send a letter. At my previous VA, I had to make 3 phone calls I believe.

Yeah, there was a lot of variability in the 3 contact rule. At the last VA job I had, we had to have 2 phone calls, and we could send a letter for the 3rd contact.

 

[cara susanna]

So...the policy at the VA I am at is a bit different than where I did my internship. Essentially, we only need "3 contacts" of which, phone calls and letters suffice this requirement. Thus, when my vet no shows...I call about 20 minutes past the hour, then when I don't hear from them, I indicate it as a no show, let our MSAs know who will then follow up with one more call and will send a letter. At my previous VA, I had to make 3 phone calls I believe.

I've only been at one VA that allowed MSAs do the last 2 NS calls (and I've been at four total).

 

[AcronymAllergy]

I always got mixed up with our contact rules after a no-show, but I think it may have been different for neuropsych as a consult service (I know the discontinue rules were different than for general MH). I think my routine was to make two calls--usually about 30-45 minutes after the scheduled start time (since neuropsych appts were ~4 hours, so I gave more room to arrive late), and then again either at the end of the day or the next day. I'd then let the MSAs know so they could send a letter as the third attempt.

For me specifically, when I did speak with the veterans (most usually would pick up when I called), I often heard that they'd never been told about the appointment to begin with. Which, to be fair, was believable most of the time.

 

[AbnormalPsych]

I looked into this research a while back. There wasn't much, but some. There is some utility in terms of length of and quantity of (# of sessions) treatment engagement (and maybe I think initial outcomes too) in having contact within 2 weeks after an appointment. So if someone no shows a follow up, I think it makes sense to try and reach out given the limited literature. BUT, with multiple contact policies, I'm not aware of any research. Nor any research related to suicide or safety.

Harassment via multiple outreach calls and not valuing your patients wishes... probably not great therapeutically.

 

[cara susanna]

I looked into this research a while back. There wasn't much, but some. There is some utility in terms of length of and quantity of (# of sessions) treatment engagement (and maybe I think initial outcomes too) in having contact within 2 weeks after an appointment. So if someone no shows a follow up, I think it makes sense to try and reach out given the limited literature. BUT, with multiple contact policies, I'm not aware of any research. Nor any research related to suicide or safety.

Harassment via multiple outreach calls and not valuing your patients wishes... probably not great therapeutically.

Absolutely, I am COMPLETELY fine with one call. But three? And to have it be a blanket policy, with no room for exceptions or clinical judgment, is ridiculous.

 

[AcronymAllergy]

I sometimes think VA could fix a lot of their policies by appending each one with, "...pending clinical judgment." Which makes it seem like they just don't trust providers to use good judgment.

Although I also understand that some providers do, unreasonably, push back and refuse to do pretty much anything new or different unless they're forced.

 

[deleted1038433]

I just have all of these patients who NS, then I call them and they r/s, then they NS again. I AM TIRED. I'm happy to see them if they actually want to engage, but I just so badly want to put the ball in their court.

Any chance clerical staff will take care of these calls and letters? That is what our SOP is at my site.

 

[WisNeuro]

Any chance clerical staff will take care of these calls and letters? That is what our SOP is at my site.

If it hasn't changed since I've been there, some sites specifically state that the provider has to do X number of these contacts.

 

[Sanman]

If it hasn't changed since I've been there, some sites specifically state that the provider has to do X number of these contacts.

I just have all of these patients who NS, then I call them and they r/s, then they NS again. I AM TIRED. I'm happy to see them if they actually want to engage, but I just so badly want to put the ball in their court.

This is why I rarely do them. I am pretty much the only MH provider available for my folks. I have to take them back if they are having difficulties, so why do the discharge paperwork unless we are trying to get them off the primary care team altogether. Makes much more sense for those folks that are traditional outpatient and need to close a consult.

 

[Therapist4Chnge]

Why do we as psychologists suck at advocating for ourselves? Do we fear coming off too pushy? Do we fear that we would be perceived by others as "un-psychologist-like" for asking for more money and/or better representation as a health professions field? I am very much a capitalist, so when it comes time for advocating for $$ for my hard-earned work, you better believe I will.

It's a long and frustrating experience to see the profession cheap out and let allied health staff lobby so much more effectively. The APA has improved in the past few years, in a few areas of advocacy, but the 15 years before that it was hard to find someone at APA who gave a damn about the average clinician (outside of a couple divisions).

 

[cara susanna]

How annoying is it that we have to redo all of the suicide prevention administrative stuff at intake, even if the patient already had it completed elsewhere? I have someone scheduled who's LITERALLY already flagged HRF and I still have to do a CSRE. How does that make sense??

 

[deleted1129370]

How annoying is it that we have to redo all of the suicide prevention administrative stuff at intake, even if the patient already had it completed elsewhere? I have someone scheduled who's LITERALLY already flagged HRF and I still have to do a CSRE. How does that make sense??

About as much sense as a screen door on a submarine. I guess it might be for liability purposes. Maybe they want to ensure that their own LIP did the evaluation so if in the event that veteran did something, lawyers couldn’t use the fact the evaluation was completed elsewhere that could have been a reason for what ever. Maybe I’m wrong…very possible lol

 

[PsychPhDone]

How annoying is it that we have to redo all of the suicide prevention administrative stuff at intake, even if the patient already had it completed elsewhere? I have someone scheduled who's LITERALLY already flagged HRF and I still have to do a CSRE. How does that make sense??

I'm on a service where everyone gets screened even if they were literally screened an hour ago at their MH appt. 👍

Edited to add: I don't mind doing the screening, I am gifted at people disclosing previously undisclosed SI to me for some reason. What I don't like is having to redo the comprehensive for people with chronic SI if it was done very recently.

 

[Sanman]

How annoying is it that we have to redo all of the suicide prevention administrative stuff at intake, even if the patient already had it completed elsewhere? I have someone scheduled who's LITERALLY already flagged HRF and I still have to do a CSRE. How does that make sense??

I'm on a service where everyone gets screened even if they were literally screened an hour ago at their MH appt. 👍

Edited to add: I don't mind doing the screening, I am gifted at people disclosing previously undisclosed SI to me for some reason. What I don't like is having to redo the comprehensive for people with chronic SI if it was done very recently.

It doesn't. EMR should have the ability to review and edit a recent CSRE and add it to your note.

 

[JustNoticing]

Does anyone else ever contemplate not doing three NS calls and just risking the possible consequences?

I rarely ever did unless the person was on the high risk list (or my own personal high risk list) tbh, though I was never explicitly told by anyone that I had to.

 

[JustNoticing]

What's messed up is, I got COVID while working on an inpatient unit in 2020...and didn't get COVID hazard pay either. I guess we are considered "doctors" and "healthcare professionals" in spirit.

A lot of inpatient folks didn't. I know you aren't a union guy, but I was glad to join AFGE's hazard pay lawsuit to try and get some, though it seems like its a longshot to win.

 

[Fan_of_Meehl]

Part of it is tied to our reimbursement for services (i.e., our services don't earn as much for the facility as, say, med management). So in that respect, physicians have more financial clout. And nurses always seem to stick together, as do social workers. I do think psychologists, by and large, have difficulty with professional assertiveness and presenting a unified front.

I also think that masochism is selected for and culturally promoted within the profession. It's odd.

 

[Fan_of_Meehl]

I just have all of these patients who NS, then I call them and they r/s, then they NS again. I AM TIRED. I'm happy to see them if they actually want to engage, but I just so badly want to put the ball in their court.

You know it's the provider's fault right? Right? LOL

I, too, feel like I spend abour 80% of my time vigorously attempting to 'sell' a 'free' service that our customer's continually refuse to "buy,"

Because of the politics involved, it will never change. One simple practical change they COULD make to address unmotivated therapy clients clogging up VA outpatient clinics would be charging a modest ($20? Or less on a sliding scale basis) co-pay once the following conditions are satisfied:

1) veteran has been provided at least two opportunities to complete an evidence-based protocol (CPT/PE)
2) veteran has been OFFERED (scheduled for) 100 or more MH treatment appointments
3) veteran has been receiving VA MH tx for at least 5 years

I mean, to any reasonable person, no veteran could credibly claim that, if given the above, the VA is greedily trying to "make money" off poor veterans without first offering help.

We are giving veterans a FREE professional service, for LIFE, that costs around $150/hr and that has wide utility. To expect them to 'restrain themselves' and not abuse this is simply irrational (especially for friggin trained/degreed behavioral scientists). If VA were offering free legal services for life, then there would be 'access issues' for those services as well.

 

[Fan_of_Meehl]

I sometimes think VA could fix a lot of their policies by appending each one with, "...pending clinical judgment." Which makes it seem like they just don't trust providers to use good judgment.

Although I also understand that some providers do, unreasonably, push back and refuse to do pretty much anything new or different unless they're forced.

They 'trust' providers plenty when it comes to loading them up with plenty of clinical RESPONSIBILITY (huge caseloads, lofty goals, complex patients, mountains of paperwork, idealistic visions/goals) while simultaneously stripping them of almost all AUTHORITY to make independent clinical judgments. Like most MH policies at VA it is quite internally inconsistent.

 

[Sanman]

I rarely ever did unless the person was on the high risk list (or my own personal high risk list) tbh, though I was never explicitly told by anyone that I had to.

I never do this, but I can't really discharge anyone anyway. So, what's the point if I have to take them when they decide to call me back?

 

[Fan_of_Meehl]

I never do this, but I can't really discharge anyone anyway. So, what's the point if I have to take them when they decide to call me back?

100% this.

In an open-access clinic with an ostensibly #BeThere mentality/mission and where I am the formally-identified 'Mental Health Treatment Coordinator (for life)' for all of my patients...what the hell would it even MEAN for me to announce that I am unilaterally 'terminating' therapy with a particular patient who routinely no shows and fails to engage? If I go through all the effort to document 'termination' and they call or come in the next day wanting to talk, guess what...they are back in my caseload. Really, they never left.

 

[cara susanna]

100% this.

In an open-access clinic with an ostensibly #BeThere mentality/mission and where I am the formally-identified 'Mental Health Treatment Coordinator (for life)' for all of my patients...what the hell would it even MEAN for me to announce that I am unilaterally 'terminating' therapy with a particular patient who routinely no shows and fails to engage? If I go through all the effort to document 'termination' and they call or come in the next day wanting to talk, guess what...they are back in my caseload. Really, they never left.

Even when I discharge them, if they want to get back into services, guess who has to call them and treatment plan? I'm like, so what's the point of a discharge note then?

 

[deleted1129370]

Even when I discharge them, if they want to get back into services, guess who has to call them and treatment plan? I'm like, so what's the point of a discharge note then?

I actually just finished up transferring/discharging 30 veterans since I am moving to a new VA. I did not put "discharge" note in most of their charts. I won't.

 

[ccpsych16]

Started my job (GS-11) recently and felt pretty confident leading up to it. But then after being introduced as Dr. Ccpsych over & over by our chief, I’ve been having mini existential crises over the fact that no, I’m not a “kid” (trainee) anymore despite accruing supervised hours. Also making a mountain out of a molehill and kicking myself anytime I refer to colleagues (to other psychologists) as Dr., which my anxiety brain tells me is a giant Vegas sign that I’m still wet behind the ears 🐣

 

[deleted1129370]

Started my job (GS-11) recently and felt pretty confident leading up to it. But then after being introduced as Dr. Ccpsych over & over by our chief, I’ve been having mini existential crises over the fact that no, I’m not a “kid” (trainee) anymore despite accruing supervised hours. Also making a mountain out of a molehill and kicking myself anytime I refer to colleagues (to other psychologists) as Dr., which my anxiety brain tells me is a giant Vegas sign that I’m still wet behind the ears 🐣

I just spent the past year as a GS-11, now a GS-12. I would say I easily had imposter syndrome for 5 months straight. Then it went away from a bit, then resurfaced a little for a couple of months. Now I'm a psychologist with at a new VA, in a completely new area (went from BHIP to SUD), and I am now an assistant professor at an AMC. I am certain I will have some more imposter syndrome pop back up soon. Alternatively, I tell myself I think this is typical and expected. Rely on your ethics to guide you - when you are in doubt or don't feel confident, consult, set boundaries, read, etc. The beautiful thing about being in the VA, is that you have a wealth of colleagues to tap into for help.

 

[AcronymAllergy]

Started my job (GS-11) recently and felt pretty confident leading up to it. But then after being introduced as Dr. Ccpsych over & over by our chief, I’ve been having mini existential crises over the fact that no, I’m not a “kid” (trainee) anymore despite accruing supervised hours. Also making a mountain out of a molehill and kicking myself anytime I refer to colleagues (to other psychologists) as Dr., which my anxiety brain tells me is a giant Vegas sign that I’m still wet behind the ears 🐣

RE: referring to colleagues as "Dr. XYZ," I did (and still do) the same, at least when meeting them initially or when talking with them in a public/professional setting, as a matter of professional courtesy. So I wouldn't kick yourself for that.

As for the imposter syndrome bit, at least in my experience, that happens with most folks (again, including me). It goes away with time, and will probably do so before you finish accruing the supervised hours.

Also, congrats on the position! As frustrating as certain parts of the VA ecosystem can be, I very much enjoyed my time there.

 

[Fan_of_Meehl]

Started my job (GS-11) recently and felt pretty confident leading up to it. But then after being introduced as Dr. Ccpsych over & over by our chief, I’ve been having mini existential crises over the fact that no, I’m not a “kid” (trainee) anymore despite accruing supervised hours. Also making a mountain out of a molehill and kicking myself anytime I refer to colleagues (to other psychologists) as Dr., which my anxiety brain tells me is a giant Vegas sign that I’m still wet behind the ears 🐣

I'd say (regarding 'imposter' syndrome)...regardless of how long you've worked in a particular area, no matter how many official certifications, book chapters, accolades or publications you may have...the only true 'imposter' in this field is the one who thinks they know everything there is to be known and that they are, essentially, infallible. Don't ever let that happen and you'll be fine. Just keep one foot in the literature, one foot in the clinic and an open mind.

 

[deleted1038433]

Started my job (GS-11) recently and felt pretty confident leading up to it. But then after being introduced as Dr. Ccpsych over & over by our chief, I’ve been having mini existential crises over the fact that no, I’m not a “kid” (trainee) anymore despite accruing supervised hours. Also making a mountain out of a molehill and kicking myself anytime I refer to colleagues (to other psychologists) as Dr., which my anxiety brain tells me is a giant Vegas sign that I’m still wet behind the ears 🐣

I still feel this way. It's been about a year or so for me. I've been a bit younger than the other new psychologists where I've worked at and that makes those feelings stronger sometimes. Some of the best advice I've gotten for dealing with it, "stop acting like you won the lottery. You didn't get here by luck. You worked really hard." I also believe it's okay to be more professional and use people's titles if that's what makes you feel comfortable. I second the comments about imposter syndrome being present to some degree throughout your career if you are truly invested in lifelong learning. I've worked with folks who don't question themselves, and those are the ones who end up violating ethics and harming others.

 

[ccpsych16]

Thank you all for the kind and wise words. I’ll certainly remind myself of them often. I’m sure none of you will be surprised to hear that my accounts have not been transferred from my previous VA, so I’ve had a lot of time during my tour to enjoy this last little bit of freedom and pump myself up. The point about not getting here my luck really hits home. I can remember in job interviews being so confident sharing my experiences and knowledge. I have to channel that person again now that I’ve achieved what I only used to dream about for years.

Something small that has helped is chatting with colleagues who’ve long been practicing but are new to the VA—despite being GS-11, I’m going on 3 years within the VA system. I have much to learn from them, but I’ve also been able to help them navigate some things, too.

 

[psycho1391]

What are everyone's thoughts about the burnout initiative?

 

[Fan_of_Meehl]

What are everyone's thoughts about the burnout initiative?

Is this the "Reducing Employee Burnout -- REBOOT" thing? Just looked it up on that VA Insider website...your post is the first I've heard of it even though they say they are "addressing key contributors to burnout by employees through direct messages, individual conversations, and focus group sessions."

As far as I'm concerned, godspeed to them and I'll reserve judgment for the time being but--if past similar 'efforts' are any guide--it will be a bunch of hot wind, buzzwords, feelgood slogans, slick graphics of models in poses, etc. while real systemic issues are, as always, minimized or completely ignored. We'll see.

Edit: having looked over their home page I'll say that I like some of their objectives including shortening meetings (making standard meeting times 25 and 50 mins), streamlining TMS training requirements, and implementing 'servant leadership' philosophies' but, again, time will tell if any of these wonderful ideas are implemented. I would love it if they were.