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

[PsychPhDone]

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I agree. And virtual sending of VVC links, secure messages with group materials, no show calls, etc. all of this makes me never want to run groups again (especially while remote)

It took some creativity but my VVC group runs pretty well now. It would be challenging without trainees or at least a co-facilitator. And solid MSA support.

 

[deleted1129370]

I don't take trainees because 1. I just don't want the added responsibility of looking after someone else, 2., one more variable to control for in terms of license complaint, 2., the 1 hour I get per 8 hour rotation is not sufficient time to justify taking them on, especially when there is a high likelihood I will have to answer communications from them involving potential high risk clients, questions they might have, proofing their work, etc. in addition to my caseload and ridiculous meetings, and admin crap. Just not worth it to me in the long run. More work and responsibility for a fraction of what they "give us" for blocked time.

 

[ccpsych16]

Any word on groups? More documentation time is needed.

Where I am, 30 clinical hours/week is standard. 2.5 hours of admin time per day (including meetings and and 30 min lunch) by default. You get incrementally more admin time per group you do. I loaded up on groups because mentally I need a break from the monotony of individual therapy, group admin doesn’t actually take me that long (everything is template, only minor tweaks for VVC and MSE if something unusual happens). So I usually have some downtime at the end of my day. Helps maintain sanity. Unless I need to do CSRE or something, I’m usually not writing notes up until 4:30.

EDIT: re: a comment above about VVC links for groups, there is a way to duplicate the existing group link, so all you need to do is change the date and click create appointment 🙂

 

[Pragma]

I don't take trainees because 1. I just don't want the added responsibility of looking after someone else, 2., one more variable to control for in terms of license complaint, 2., the 1 hour I get per 8 hour rotation is not sufficient time to justify taking them on, especially when there is a high likelihood I will have to answer communications from them involving potential high risk clients, questions they might have, proofing their work, etc. in addition to my caseload and ridiculous meetings, and admin crap. Just not worth it to me in the long run. More work and responsibility for a fraction of what they "give us" for blocked time.

In an RVU model where you get full credit for a trainee’s work doing intervention, supervising for 1 hour a week seems like small potatoes relative to the benefits.

 

[WisNeuro]

In an RVU model where you get full credit for a trainee’s work doing intervention, supervising for 1 hour a week seems like small potatoes relative to the benefits.

Yeah, supervising good postdocs was gold in the VA.

 

[deleted1129370]

In an RVU model where you get full credit for a trainee’s work doing intervention, supervising for 1 hour a week seems like small potatoes relative to the benefits.

I suppose...but again, I am not all that concerned with my RVUs. For me, it means more work than I'd care to take on. Interestingly enough, our VA does not have a SUD post-doc.

 

[cara susanna]

Nice that sounds like a good set up. Are you a consultant?

Lol, no, I just am involved with some programs that have been providing information and updates about national policy changes. The bookable hours thing has been coming up a lot in the national training program that I'm a part of.

My VA experience was different, I was usually looking for something to do by the end of the week, finishing out my ToD. The last half of Friday was usually spent reading for fun or tweaking my fantasy football lineup.

Oh good, I'm not alone. I'm super fast at documentation and don't usually spend the full time in a therapy session. I also do have a good rate of cancellations/no shows due to my area of specialty (gotta love PTSD and avoidance). Sometimes I feel like a weirdo or like I should be working harder because many of my colleagues are putting in time on weekends or AWS days to catch up. As I've mentioned though, I also do have more admin time than most people in my local clinic.

 

[Pragma]

I suppose...but again, I am not all that concerned with my RVUs. For me, it means more work than I'd care to take on. Interestingly enough, our VA does not have a SUD post-doc.

I would imagine for most people it would mean less work depending how many hours the trainee is seeing patients.

 

[WisNeuro]

Lol, no, I just am involved with some programs that have been providing information and updates about national policy changes. The bookable hours thing has been coming up a lot in the national training program that I'm a part of.



Oh good, I'm not alone. I'm super fast at documentation and don't usually spend the full time in a therapy session. I also do have a good rate of cancellations/no shows due to my area of specialty (gotta love PTSD and avoidance). Sometimes I feel like a weirdo or like I should be working harder because many of my colleagues are putting in time on weekends or AWS days to catch up. As I've mentioned though, I also do have more admin time than most people in my local clinic.

I never felt bad about it because my RVU numbers were always 110-125% of target. It's hard to justify wanting to do more work simply because I had the time, when that extra work would do nothing for my salary/reimbursement.

 

[deleted1129370]

I would imagine for most people it would mean less work depending how many hours the trainee is seeing patients.

I still don't see how it's less work. One less patient I have to see so I can see my trainee for supervision. On top of that, I will likely need to consult with them when they have questions, problems, etc. while they are with their own clients and writing notes, reports, of which I will need to allocate time to proof before I co-sign. All of that time adds up in a day/week. I just don't see it as worth it. I had colleagues trying to sell me on this, and I was like "nope, one hour off my grid is not sufficient for the total time I will need to invest in ethically supervising that trainee." Our VA's policy is that a provider gets one hour off their grid per 8 hours of a rotation they supervise of a single trainee.

 

[cara susanna]

I never felt bad about it because my RVU numbers were always 110-125% of target. It's hard to justify wanting to do more work simply because I had the time, when that extra work would do nothing for my salary/reimbursement.

My RVUs are on the lower end but within the range for my FTE. I dunno. I guess I like to work smarter, not harder! The people I know who are coming in on the weekends have longer sessions and their RVUs are ridiculously high.

 

[Pragma]

I still don't see how it's less work. One less patient I have to see so I can see my trainee for supervision. On top of that, I will likely need to consult with them when they have questions, problems, etc. while they are with their own clients and writing notes, reports, of which I will need to allocate time to proof before I co-sign. All of that time adds up in a day/week. I just don't see it as worth it. I had colleagues tried selling me on this, and I was like "nope, one hour off my grid is not sufficient for the total time I will need to invest in ethically supervising that trainee." Our VA's policy is that a provider gets one hour off their grid per 8 hours of a rotation they supervise of a single trainee.

Sometimes I forget this is the VA thread. I am just talking about RVUs and yes VA RVU targets are very small.

There are people out there that spend one hour supervising while getting productivity credit for 8+ hours of patient care.

 

[WisNeuro]

Sometimes I forget this is the VA thread. I am just talking about RVUs and yes VA RVU targets are very small.

There are people out there that spend one hour supervising while getting productivity credit for 8+ hours of patient care.

Yeah, my postdoc would generally see 2 cases a week. I probably spent half an hour on pre visit supervision, and an hour or two on post visit debriefs and report review. I generally sat in on interviews and feedbacks as well, but that wasn't common across supervisors. Still banked more time than I spent.

 

[deleted1129370]

You are not counting the fact that you get workload credit for the supervisees patient visits. For interns or post-docs, this is generally a win. For externs not so much.

As mentioned earlier, I really don't focus on RVUs, so if that's the "trade off," meh...

 

[cara susanna]

My local facility (CBOC) doesn't have psychology trainees so that's not an option for me. 🙁

 

[Shiori]

My local facility (CBOC) doesn't have psychology trainees so that's not an option for me. 🙁

Based on your posts, I think you would be a great supervisor. It's a wasted opportunity. Boo!

 

[cara susanna]

Based on your posts, I think you would be a great supervisor. It's a wasted opportunity. Boo!

Aww, thank you! I do supervise our psychiatry residents on therapy cases, but I wish I could supervise psych trainees. I am exploring the possibility of remote supervision for psych trainees (I'm actually a remote member of a clinic that has interns), so maybe in the future! I also am going to have some involvement in the main hospital's psychology training program next year, though not as a supervisor.

 

[Therapist4Chnge]

It's a legit practice headed up by board members of ABPP who routinely contribute to the CONCEP/ Palo Alto series of PD courses. There's nothing about the setup that seems predatory or dishonest.

...except the reimbursement they offered you. They are *easily* getting paid $1k+ per eval, likely more. Do what you want, but $125 for an hour of your time isn't good, but then dealing with the added hassle of dealing with LEO evals....just my 2 cents.

Edit...I see this was covered, but I still think it is worth mentioning because it is very very common to get recently licensed people who don't know enough about the finances of these 3rd party setups.

 

[deleted1129370]

...except the reimbursement they offered you. They are *easily* getting paid $1k+ per eval, likely more. Do what you want, but $125 for an hour of your time isn't good, but then dealing with the added hassle of dealing with LEO evals....just my 2 cents.

Edit...I see this was covered, but I still think it is worth mentioning because it is very very common to get recently licensed people who don't know enough about the finances of these 3rd party setups.

Very true and insightful. I am very much an early career psychologist, so that makes sense about snagging the newly licensed folks to doing this work for less money. So, what do you recommend?

 

[Therapist4Chnge]

Very true and insightful. I am very much an early career psychologist, so that makes sense about snagging the newly licensed folks to doing this work for less money. So, what do you recommend?

This will sound counterintuitive bc you FEEL like an early career and you FEEL like you should take that kind of position, but they are just preying on that year's newbies. Instead, contact a few places who do what you want and inquire about their terms. At the least, you can negotiate a better rate because even disability evals pay that or more. There is PLENTY of work out there for C&P, disability, and employee screening. Each have their own nuances, but they should all have templates for how they want the info and none should required "specialized" training. This isn't the case for all side work though...child custody for instance, I wouldn't touch that w. a 10' pole because they are highly specific and magnet cases for malpractice claims. I also wouldn't recommend fitness for duty for injured/impaired officers because that has a lot more involved than a pre-employment screening.

 

[Shiori]

It seems like another part of the "Access" movement is creating an SOP for a standard episode of care. I support it in theory, but it seems like it'll turn into something very clunky in practice. Have other sites started moving in this direction? It seems new, but I'm finding out that no idea is new in the VA.

 

[cara susanna]

Our local facility is going to be adopting the active episodes of care model and I know there's been discussion of a psychotherapy SOP, but not sure how formal the latter would be.

 

[Shiori]

I've been browsing and see some places have implemented different kinds of strategies to evaluate whether a patient should be transitioned out of psychotherapy after a certain point. For example, one stated if a patient has been seen for 20 weeks, the rationale for further sessions will be discussed with a peer or team to evaluate the soundness of it. I can imagine that not being well-received.

 

[summerbabe]

I haven’t run into any new SOPs on episodes of care yet but when push comes to shove, we abhor to deny services for veterans who want to be seen/demand to be seen so if the goal is to limit over-utilizers, I’m not sure how successful this or any other strategies will be without some big philosophical changes.

 

[erg923]

I haven’t run into any new SOPs on episodes of care yet but when push comes to shove, we abhor to deny services for veterans who want to be seen/demand to be seen so if the goal is to limit over-utilizers, I’m not sure how successful this or any other strategies will be without some big philosophical changes.

I mean....at some point it needs to be known and realized that enrolling in military service is not a free-ticket to unlimited MH care with no questions asked and/or no other qualifiers. That's not really just, clinically prudent, or fiscally sustainable. It is not at all what the VA was designed for/to do, but I also realize an organization can expand over time to accomplish more lofty goals.

But care utilization has to have evidence and metrics beyond..."well, this guy/gal wants it, and we don't want them to make a bad choice because someone might blame someone else besides them for their choice." Its not like imposing certain reasonable restriction has to risk lives acutely. The VA and about a million other health care orgs and clinics have 24/7 EDs, crisis lines, or other affiliated services people can avail themselves to.

 

[Shiori]

The whole thing is making me think about how we've settled into the current system. How do providers benefit from not pushing people out of therapy sooner? It's probably things like clinical orientation, the desire for stability, keeping on consistent clients for RVU purposes, etc. With clients, it might be loneliness, dependence, and beliefs about C&P.

These approaches seem to rely on gentle peer pressure and the authority of a policy, but I'm unsure that will overcome the many reasons some people have to stay the same.

 

[PsychPhDone]

It seems like another part of the "Access" movement is creating an SOP for a standard episode of care. I support it in theory, but it seems like it'll turn into something very clunky in practice. Have other sites started moving in this direction? It seems new, but I'm finding out that no idea is new in the VA.

I haven't read all the new documentation but I think what I've been doing in my clinic is probably in alignment from what I've heard. I book patients into a certain number of weekly appointments for their episode of care. There are some upsides to this approach. What I think you want to hear is the downsides. 😉 Which is primarily what an absolute mess it becomes for my schedulers when a patient cancels their course of treatment and everyone has to be shuffled to "move up" and avoid weird gaps. It's also hard on my trainees who need hours. But it's what we've been doing for a while now.

 

[Sanman]

I've been browsing and see some places have implemented different kinds of strategies to evaluate whether a patient should be transitioned out of psychotherapy after a certain point. For example, one stated if a patient has been seen for 20 weeks, the rationale for further sessions will be discussed with a peer or team to evaluate the soundness of it. I can imagine that not being well-received.

Silly question, but what peer or team? I can agree that those in well resourced areas should be transitioned out and provided case management and other services. However, I play case manager in my rural area where I am the pretty much the only MH option for my team. If I stop seeing some of my folks, they just backslide into suicidal ideation again. Depends on what other resources are available.

 

[Sanman]

I haven't read all the new documentation but I think what I've been doing in my clinic is probably in alignment from what I've heard. I book patients into a certain number of weekly appointments for their episode of care. There are some upsides to this approach. What I think you want to hear is the downsides. 😉 Which is primarily what an absolute mess it becomes for my schedulers when a patient cancels their course of treatment and everyone has to be shuffled to "move up" and avoid weird gaps. It's also hard on my trainees who need hours. But it's what we've been doing for a while now.

This will work well for specialty clinics. However, it may become a problem for things like PCMHI if they then get shoved into a case management role because what do you do with the suicidal guy when episode of care is over and there is no case management available for follow-up or the facility is short staffed.

 

[Sanman]

I mean....at some point it needs to be known and realized that enrolling in military service is not a free-ticket to unlimited MH care with no questions asked and/or no other qualifiers. That's not really just, clinically prudent, or fiscally sustainable. It is not at all what the VA was designed for/to do, but I also realize an organization can expand over time to accomplish more lofty goals.

But care utilization has to have evidence and metrics beyond..."well, this guy/gal wants it, and we don't want them to make a bad choice because someone might blame someone else besides them for their choice." Its not like imposing certain reasonable restriction has to risk lives acutely. The VA and about a million other health care orgs and clinics have 24/7 EDs, crisis lines, or other affiliated services people can avail themselves to.

Agreed. However, the VA then needs to drop the "No veteran will commit suicide...ever" policy. They can't talk out two sides of their mouth at the same time. Either your episode of care is over and whatever will happen does not matter or no one can fall through the cracks. Pick one.

 

[Shiori]

I haven't read all the new documentation but I think what I've been doing in my clinic is probably in alignment from what I've heard. I book patients into a certain number of weekly appointments for their episode of care. There are some upsides to this approach. What I think you want to hear is the downsides. 😉 Which is primarily what an absolute mess it becomes for my schedulers when a patient cancels their course of treatment and everyone has to be shuffled to "move up" and avoid weird gaps. It's also hard on my trainees who need hours. But it's what we've been doing for a while now.

That is good to know!

I like the idea in a big picture sense and we're probably going to be asked for feedback soon. I'm early in my career, so I'm excited about everything. I'm basically a puppy right now. However, unintended consequences are always something to look out for and it's hard to undo something that is written down in VA lore. I have a lot of time right now as my credentialing stuff gets sorted out, so I might have more opportunities to give my thoughts than someone drowning in client care. If they ask my thoughts, I would like a variety of perspectives.

 

[erg923]

Either your episode of care is over and whatever will happen does not matter or no one can fall through the cracks. Pick one.

No. Of course not, that is ridiculous. But the Veterans Administration does not need to "recreate the wheel" in terms of UM and population-based health UM practices that are already impactful/effective elsewhere in the healthcare system.

 

[Sanman]

No. Of course not, that is ridiculous. But the Veterans Administration does not need to "recreate the wheel" in terms of UM and population-based health UM practices that are already impactful/effective elsewhere in the healthcare system.

I don't think they are recreating the wheel, but VA standard of care is nowhere near community standard of care. Community hospitals don't take folks in for months on end for suicidal ideation, homelessness, etc. This is why the VA often gets stuck with the cases no else wants. Half my caseload is people that community offers no support for that the VA provides free time intensive services and medical equipment.

 

[WisNeuro]

I don't think they are recreating the wheel, but VA standard of care is nowhere near community standard of care. Community hospitals don't take folks in for months on end for suicidal ideation, homelessness, etc. This is why the VA often gets stuck with the cases no else wants. Half my caseload is people that community offers no support for that the VA provides free time intensive services and medical equipment.

Definitely area dependent as you say. I still contend that the services for older adults is expansive in the VA compared to what I have in the community for my patients. I do miss warm handoffs to SW and OT for useful services after an eval. At the moment I just have hopes that referrals can go through and that they can cobble together services from the contacts I provide.

 

[Sanman]

Definitely area dependent as you say. I still contend that the services for older adults is expansive in the VA compared to what I have in the community for my patients. I do miss warm handoffs to SW and OT for useful services after an eval. At the moment I just have hopes that referrals can go through and that they can cobble together services from the contacts I provide.

They definitely are. However, these counterintuitive policies make some of it pointless. Drive around the middle of nowhere seeing very ill people in a job that it makes no fiscal sense anywhere in the real world. Great, now meet this RVU requirement because productivity important. Right...that is why this job exists nowhere else. I find my workarounds and telehealth has been a blessing, but sometimes it just gets silly. This is why I see services get eroded. It no longer makes sense to drive out to nowhere when there is a productivity requirement.

 

[WisNeuro]

They definitely are. However, these counterintuitive policies make some of it pointless. Drive around the middle of nowhere seeing very ill people in a job that it makes no fiscal sense anywhere in the real world. Great, now meet this RVU requirement because productivity important. Right...that is why this job exists nowhere else. I find my workarounds and telehealth has been a blessing, but sometimes it just gets silly. This is why I see services get eroded. It no longer makes sense to drive out to nowhere when there is a productivity requirement.

I agree, and that's why my older patients are usually waiting months to get into certain services. These services do not pay in the outside world. Heck, if I didn't make a lot of money in IME/forensic world, I would not take Medicare, or most, if any, insurance for my clinical evals.

 

[cara susanna]

I've been browsing and see some places have implemented different kinds of strategies to evaluate whether a patient should be transitioned out of psychotherapy after a certain point. For example, one stated if a patient has been seen for 20 weeks, the rationale for further sessions will be discussed with a peer or team to evaluate the soundness of it. I can imagine that not being well-received.

Yup, if patients aren't benefitting after an active episode of care their case would be staffed with the "complex care committee."

I personally think it's nice for VAs to acknowledge that, in order to have good access, we have to be able to discharge or not see people in perpetuity. I do agree that PATIENTS won't receive it well, which is why administrative support is paramount.

 

[ccpsych16]

As a new employee I’ve taken over many cases from staff who left before I came. Many were seen for YEARS on end. No progress in sight. Lots of folks angry with me when I give the spiel about therapy being most effective when goal-focused and time limited. That is my therapeutic style, except in less common cases where it’s warranted to see people longer. I haven’t gotten to the point yet of needing to have discharge conversations with people yet (too soon, no one is close to finishing an EBP course yet), but I am not looking forward to it. My biggest complaint about working in VA is how tied our hands are with this. I can tell them therapy is done, but they can walk up to the front desk or call in and get right back on my schedule again. Our leadership has talked about the episodes of care model which I think VA should’ve done a long time ago. Lots of issues to be ironed out along the way, of course. Most clients I’ve come across are deep in learned helplessness *because* they had years-long regular water cooler chats with their previous therapist. They believe that’s how therapy should be, and that they cannot function without it. An extreme disservice to them, and other Veterans who have long waits because we have little power in discharging (among other things like understaffing).

 

[PsychPhDone]

This will work well for specialty clinics. However, it may become a problem for things like PCMHI if they then get shoved into a case management role because what do you do with the suicidal guy when episode of care is over and there is no case management available for follow-up or the facility is short staffed.

Yes, agree completely. I'm in a specialty clinic. We do an initial eval and estimate number of needed sessions based on that. Very workable in our setting. Definitely more complicated for others.

 

[cara susanna]

As a new employee I’ve taken over many cases from staff who left before I came. Many were seen for YEARS on end. No progress in sight. Lots of folks angry with me when I give the spiel about therapy being most effective when goal-focused and time limited. That is my therapeutic style, except in less common cases where it’s warranted to see people longer. I haven’t gotten to the point yet of needing to have discharge conversations with people yet (too soon, no one is close to finishing an EBP course yet), but I am not looking forward to it. My biggest complaint about working in VA is how tied our hands are with this. I can tell them therapy is done, but they can walk up to the front desk or call in and get right back on my schedule again. Our leadership has talked about the episodes of care model which I think VA should’ve done a long time ago. Lots of issues to be ironed out along the way, of course. Most clients I’ve come across are deep in learned helplessness *because* they had years-long regular water cooler chats with their previous therapist. They believe that’s how therapy should be, and that they cannot function without it. An extreme disservice to them, and other Veterans who have long waits because we have little power in discharging (among other things like understaffing).

I've inherited legacy patients from other therapists and I always give the spiel that my style is very different from their previous therapist. Generally, I've found that one of two things happens. One, they actually do want to do real treatment and transition nicely to an EBP/active treatment. Or, two, they stop showing up or scheduling.

I agree that it's hard when patients can just schedule on their own. It can be really hard to enact our no show/attendance policy because the front desk doesn't have these patients flagged or anything. I alert them not to r/s the patient without the patient talking to me first, but I'm sure it's hard for them to keep track.

 

[cara susanna]

Schroedinger's Patient: When you call and leave a voicemail offering your patient an appointment but they never respond to you, so they aren't scheduled but technically could still show up for said appt.

 

[Sanman]

I've inherited legacy patients from other therapists and I always give the spiel that my style is very different from their previous therapist. Generally, I've found that one of two things happens. One, they actually do want to do real treatment and transition nicely to an EBP/active treatment. Or, two, they stop showing up or scheduling.

I agree that it's hard when patients can just schedule on their own. It can be really hard to enact our no show/attendance policy because the front desk doesn't have these patients flagged or anything. I alert them not to r/s the patient without the patient talking to me first, but I'm sure it's hard for them to keep track.

This has been an issue for me in primary care for years. I have legacy folks on our HBPC rolls that were admitted for PTSD with agoraphobia. They are unwilling to engage in trauma therapy or got kicked from trauma services. They will only engage with psychiatry and for me supportive therapy/case management. I stop seeing them, they slip into passive suicidal ideation and end up right back on my list because the PCP gets concerned. I have stopped new admissions that present similarly but will be stuck with these existing folks until I leave. HBPC discharge leads to congressional/white house hotline complaints.

 

[futureapppsy2]

I received a TJO from a VA on Wednesday, and I'm trying to negotiate for a bump up in starting Step based on experience/current (non-VA) salary. I'm a bit concerned because the email said to accept/decline the TJO within two days. I'm unsure whether I should accept now and risk being able to negotiate a Step bump or wait and risk the offer being pulled for "non-response." I've asked both HR and my VA contact about this, but haven't heard back. Thoughts?

 

[IWillSurvive]

I received a TJO from a VA on Wednesday, and I'm trying to negotiate for a bump up in starting Step based on experience/current (non-VA) salary. I'm a bit concerned because the email said to accept/decline the TJO within two days. I'm unsure whether I should accept now and risk being able to negotiate a Step bump or wait and risk the offer being pulled for "non-response." I've asked both HR and my VA contact about this, but haven't heard back. Thoughts?

Is there a third option when you go into the USAStaffing website? I think usually it says 'yes' 'no' or 'request to be contacted'... maybe selecting that third option would be best at this point.

However, I highly doubt they would revoke your offer for going beyond 2 days...it's hard enough for them to fill these positions. That just wouldn't make any sense. Also, one would assume 2 business days would be at play here since no one is in the office to process Friday-Sunday anyway...hope you have more information by now!

 

[Pragma]

I received a TJO from a VA on Wednesday, and I'm trying to negotiate for a bump up in starting Step based on experience/current (non-VA) salary. I'm a bit concerned because the email said to accept/decline the TJO within two days. I'm unsure whether I should accept now and risk being able to negotiate a Step bump or wait and risk the offer being pulled for "non-response." I've asked both HR and my VA contact about this, but haven't heard back. Thoughts?

Step is pretty much based on years of licensure, no? There’s a committee that looks at it. Not sure how negotiable it is?

 

[WisNeuro]

Step is pretty much based on years of licensure, no? There’s a committee that looks at it. Not sure how negotiable it is?

Yeah, we had a few of these and it was purely time based. I have heard that for positions that have been harder to fill they are sometimes willing to add a step or two as a recruitment incentive. But that was the exception and not the rule. Though, that was 5+ years ago when VA positions were still coveted.

 

[summerbabe]

I received a TJO from a VA on Wednesday, and I'm trying to negotiate for a bump up in starting Step based on experience/current (non-VA) salary. I'm a bit concerned because the email said to accept/decline the TJO within two days. I'm unsure whether I should accept now and risk being able to negotiate a Step bump or wait and risk the offer being pulled for "non-response." I've asked both HR and my VA contact about this, but haven't heard back. Thoughts?

VA is doing a lot of incentives such as EDRP, relocation and signing bonuses for new hires and some places are raising salaries for all staff to hire/retain staff but I haven't heard much in the way of step increases. The only thing I know that is currently active at some facilities is a 1 step bump with/after board certification.

Is your position is eligible for a recruitment incentive? If so, you might have better luck getting something like a signing bonus (since that may already have been approved for current psychologist hires) than a step increase, which would likely need to be reviewed and approved by a number of sources, including general admin outside of the mental health service line since it would be coming out of a different budgeting source.

 

[IWillSurvive]

VA is doing a lot of incentives such as EDRP, relocation and signing bonuses for new hires and some places are raising salaries for all staff to hire/retain staff but I haven't heard much in the way of step increases. The only thing I know that is currently active at some facilities is a 1 step bump with/after board certification.

Is your position is eligible for a recruitment incentive? If so, you might have better luck getting something like a signing bonus (since that may already have been approved for current psychologist hires) than a step increase, which would likely need to be reviewed and approved by a number of sources, including general admin outside of the mental health service line since it would be coming out of a different budgeting source.

I do think it is negotiable if he/she is coming from outside VA. Whether the specific facility will have an interest or precedent for that will be the question. This situation is the only other time I have ever heard of a step increase being negotiable. For transfers within VA, it is usually as you said: Board Certification or being elected by peers to a position such as President of APA Division x.

I have also heard other types of incentives recently floating around, so I would be sure to ask about any incentives available (even if remote). I

think you will be OK on your 2 day deadline. They would rather have you than stick to an arbitrary HR deadline.

 

[IWillSurvive]

I still don't see how it's less work. One less patient I have to see so I can see my trainee for supervision. On top of that, I will likely need to consult with them when they have questions, problems, etc. while they are with their own clients and writing notes, reports, of which I will need to allocate time to proof before I co-sign. All of that time adds up in a day/week. I just don't see it as worth it. I had colleagues trying to sell me on this, and I was like "nope, one hour off my grid is not sufficient for the total time I will need to invest in ethically supervising that trainee." Our VA's policy is that a provider gets one hour off their grid per 8 hours of a rotation they supervise of a single trainee.

I think it depends on the VA you are at really. For some people, when your rvu's go up as a result of supervising, you don't have to take on as many patients, which makes the other supervisory support responsibilities pay off more. However, in some larger volume systems, the referrals never stop coming and it doesn't matter where your rvu's are at, you're still taking the new patients instead of sending them into the community.

 

[PsychPhDone]

A rare rave and not a rant: FYI, VA librarians curate weekly? emails on new research articles in various topics (e.g., PTSD, women vets). I've found these to be a great resource for keeping up with the literature.