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

[erg923]

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True.

I made them take my 'additional signer' status off the note/plan. They didn't follow through on actually changing the plan in the medical record. They changed it in Mental Health Suite but did not re-publish to CPRS. It still lists me as the sole 'team member' with the sole treatment objective and me as the responsible person for implementing it with the patient. Their names (supervisor and intern) by their signatures makes it clear that they authored the plan (not me). I have let the psychologist and my/our supervisor know, in writing, that I object to this plan being written 'for me' without consulting me and for a patient whom I have never evaluated. I have made it clear that it is not--at this point--in any way, shape, or form 'my' plan. I have made it clear that I will answer the consult that has been entered for me to evaluate the patient for suitability for a particular protocol treatment that I do (although from reviewing his chart, he already appears to be a poor candidate, but I will complete the consultation in good faith).

Do you think this is related to your particular facility's midlevel leadership model, which frankly seems quite bizarre to me based on what you've previously posted/made us aware of? Where are the psychiatrist leaders in the MH service line? This treatment plan issue was one issue I never saw at all, but then again, I have been out for over 5 years now.

"We engage in a 'team based' model of intervention here"

Yea. So this seems like what one might expect, to some degree, in a residential/DOM or inpatient SUDs program. Not really in OP/BHIP. Seems very weird. Where is all this (unnecessary) pressure coming from, exactly?

 

[Fan_of_Meehl]

Do you think this is related to your particular facility's midlevel leadership model, which frankly seems quite bizarre to me based on what you've previously posted/made us aware of? Where are the psychiatrist leaders in the MH service line? This treatment plan issue was one issue I never saw at all, but then again, I have been out for over 5 years now.

"We engage in a 'team based' model of intervention here"

Yea. So this seems like what one might expect to some degree in a residential/DOM or inpatient SUDs program. Not really in OP/BHIP. Seems weird.

Social workers. Run. Everything.

In all seriousness, I wonder if standing my ground and politely requesting that we send the conflict/issue up to the VISN level or something would be a way to go. To me, the act of one LIP authoring a treatment plan 'on behalf' of another LIP who--in no uncertain terms--refutes the 'plan' and objects to a 'plan' being entered on his behalf when he hasn't even evaluated/assessed the patient is sheer madness and wildly clinically irresponsible and will only lead to pandemonium if it becomes common practice. They cannot be so inept/corrupt at the VISN level as to not acknowledge that this is stupid and wreckless to just let providers fire off plans 'for' other providers and refuse to remove them from the record when the referenced provider objects to having such a plan written 'for' him. But, who knows.

 

[erg923]

Social workers. Run. Everything.

Where is all this (unnecessary) pressure coming from, exactly? This is some national VA thing? Or some weird variant based on the mid-level leadership you have?

Are you saying a MSW has clinical and admin leadership over the whole service line???

 

[erg923]

The only pressure is to conform to the 'rule' that a 'treatment plan' must be 'completed' at session 3. In our clinic, session 1 is an intake, session 2 is a group psychoeducational 'orientation' (menu of choices) to the clinic and session 3 is supposed to be a 'treatment planning' session. So the person will claim that he 'had' to 'finalize' the plan at session 3 and the treatment that the veteran expressed a preference for is a treatment that I provide but only if certain criteria are met and only if it is indicated (thus the need to complete a consultation/evaluation prior to me committing to do this protocol with this patient). The nuances of the requirement for me to evaluate prior to committing to implementing the protocol is way above the head of the people in charge and is going to be politically spun as me being 'lazy' or 'uncooperative' or 'unresponsive' to veteran's needs/preferences, I'm sure. This entire organization is so corrupt, inept, and political that socialized sociopaths thrive here and can pretty much just do as they wish if they have no shame and decide to cynically use concepts/ideas such as 'we're a team,' 'veteran-centered care,' 'evidence-based treatment' (generally invoked more often as a chant or an incantation), etc., etc.

Yea. I don't get it. Not that I'm meant to though, lol.

So let me get this straight? 3 different people in 3 consecutive sessions? Seems unwelcoming already. And then there needs to be a SMART treatment plan made despite the fact they they have never actually met with the actual treating/episode of care provider???

 

[Fan_of_Meehl]

Yea. I don't get it. Not that I'm meant to though, lol.

So let me get this straight? 3 different people in 3 consecutive sessions? Seems unwelcoming already. And then there needs to be a SMART treatment plan made for them despite that fact they they have never meet with their actual treating/ongoing episode of care provider???

My position is that some arbitrary 'rule of 3' (seems eerily religious to me and arbitrary) should not dictate my clinical practice. So, I have had veterans present with multiple 'rule outs,' complex histories, unresponsive/uncooperative presentations, late attendance to sessions, etc. that have meant that, in order to do a competent job with diagnosis and treatment planning, it is going to take me more that 2 or 3 sessions. The way our specialty clinic is set up, you basically have to 'finalize' the treatment plan at session 1. Let me explain. You do the intake (first contact). Then you send them to 'orientation group' which is done psychoeducationally by another provider. Then you meet for your first session (after intake) to 'finalize' the treatment plan. Obviously, to do a competent job, with some patients it is going to take more time than that. I am shameless about (and haven't gotten any backlash so far on it) just putting in an 'objective' to 'finalize differential diagnosis and treatment planning efforts due to complex presentation' or something like that and give myself up to two months or whatever and just revise the 'treatment objective' when I can do so responsibly.

What I do not do (but certain other providers have started doing this) is use the 'must finalize plan at session 3' rule as an excuse to kick the case to another provider.

 

[AcronymAllergy]

Where is all this (unnecessary) pressure coming from, exactly? This is some national VA thing? Or some weird variant based on the mid-level leadership you have?

Are you saying a MSW has clinical and admin leadership over the whole service line???

Just to reply to the bolded portion: my last VA cycled through leadership, which did at times include MSWs in clinic-level (i.e., midlevel) leadership roles as well as ACOS-level leadership roles. The facility generally offered all leadership roles to all provider types.

 

[summerbabe]

Where is all this (unnecessary) pressure coming from, exactly? This is some national VA thing?

99% sure it's coming from the VACO/VISN/national levels and which then amplifies local cultures of blame.

I've been in the system since 2017 and every year, it seems like there is more and more pressure to conform to the metric of the day and to do it quickly.

A directive gets issued rom the top (like connect more suicidal veterans to services) so then every level below jumps to respond, including creating processes that don't improve actual care, are often short-sighted to improve a specific metric that probably doesn't even capture genuine outcomes, or is even detrimental to the general provision of healthcare services (like diverting already scarce resources).

I've even seen things like the annual All Employee Survey cause local leaders to freak out if they don't get enough of a response rate or if certain employee satisfaction metrics are below desired levels since they will then flack about it and potentially have it be a stumbling block in their career advancement, likely much more so than in days past in the VA.

 

[Sanman]

My position is that some arbitrary 'rule of 3' (seems eerily religious to me and arbitrary) should not dictate my clinical practice. So, I have had veterans present with multiple 'rule outs,' complex histories, unresponsive/uncooperative presentations, late attendance to sessions, etc. that have meant that, in order to do a competent job with diagnosis and treatment planning, it is going to take me more that 2 or 3 sessions. The way our specialty clinic is set up, you basically have to 'finalize' the treatment plan at session 1. Let me explain. You do the intake (first contact). Then you send them to 'orientation group' which is done psychoeducationally by another provider. Then you meet for your first session (after intake) to 'finalize' the treatment plan. Obviously, to do a competent job, with some patients it is going to take more time than that. I am shameless about (and haven't gotten any backlash so far on it) just putting in an 'objective' to 'finalize differential diagnosis and treatment planning efforts due to complex presentation' or something like that and give myself up to two months or whatever and just revise the 'treatment objective' when I can do so responsibly.

What I do not do (but certain other providers have started doing this) is use the 'must finalize plan at session 3' rule as an excuse to kick the case to another provider.

Here is the thing, this rule is interpreted differently at different places. When I treatment plan in these cases it can be as simple as:

Veteran agrees to be assessed by @Fan_of_Meehl to see if he is appropriate for X therapy and participate if accepted. If he is deemed to be inappropriate he agrees to referral to Y therapy (ptsd group, OPMH, etc) for treatment.

Look, I wrote a treatment plan without being unethical or an idiot.

 

[Fan_of_Meehl]

Here is the thing, this rule is interpreted differently at different places. When I treatment plan in these cases it can be as simple as:

Veteran agrees to be assessed by @Fan_of_Meehl to see if he is appropriate for X therapy and participate if accepted. If he is deemed to be inappropriate he agrees to referral to Y therapy (ptsd group, OPMH, etc) for treatment.

Look, I wrote a treatment plan without being unethical or an idiot.

100% this.

 

[deleted1038433]

They cannot be so inept/corrupt at the VISN level

I actually think the incompetence and unethical behavior is worse at higher levels in VA. I don't see that level of leadership standing up for individual providers.

 

[Fan_of_Meehl]

I actually think the incompetence and unethical behavior is worse at higher levels in VA. I don't see that level of leadership standing up for individual providers.

I have a direct supervisor right now whom I respect. She does exhibit integrity and actually sees far more clients than she has to in addition to multiple demanding admin and supervising roles. But she is run ragged as a result and has very little to no authority to make changes, but she legitimately tries. She is a rarity. She is also a living example of the reality of a corrupt organization in that it punishes virtue and rewards sociopathy. What I mean is that it leans heavily on the competent hard working people so that all you get for competence and diligence is more work and responsibility rather than more authority. The socialized psychopaths in the organization know exactly how to maximize their authority in the system while simultaneously somehow minimizing their level of responsibility. So they run around with a fake grin all shift long, glad handing and chatting up everyone without a care in the world.

 

[cara susanna]

VA National is OBSESSED with numbers, even if the numbers don't measure what they're supposed to be measuring.

 

[Fan_of_Meehl]

99% sure it's coming from the VACO/VISN/national levels and which then amplifies local cultures of blame.

I've been in the system since 2017 and every year, it seems like there is more and more pressure to conform to the metric of the day and to do it quickly.

A directive gets issued rom the top (like connect more suicidal veterans to services) so then every level below jumps to respond, including creating processes that don't improve actual care, are often short-sighted to improve a specific metric that probably doesn't even capture genuine outcomes, or is even detrimental to the general provision of healthcare services (like diverting already scarce resources).

I've even seen things like the annual All Employee Survey cause local leaders to freak out if they don't get enough of a response rate or if certain employee satisfaction metrics are below desired levels since they will then flack about it and potentially have it be a stumbling block in their career advancement, likely much more so than in days past in the VA.

This is so spot on. I use the 'piano falling through palm leaves' analogy. It's like a piano (new inflexible directive from on high) is dropped from a 12 story building and on it's way down to crash at terminal velocity with the ground (non-supervisory clinical staff) it travels straight through multiple layers of palm leaves, overlapping one another at multiple levels (administrative/'leadership' staff) slamming into the ground and shattering to pieces after encountering essentially zero resistance on its way down. Meanwhile, the palm fronds just flex right back into place and take to lazily swaying in the breeze...

Edit: I know I just sang the praises of my immediate supervisor a post ago and I meant it. But she is 'low to the ground,' so to speak, in the organization. To amend the above analogy just slightly...the act of nailing a single 20ft long 2 x 4 plank between 2 palms to their trunks, 2 feet off the ground really wouldn't alter the fate of the piano (or the ground it impacts), would it? Ah...but a network of multiple intersecting, strategically-placed, and jointly reinforcing sturdy 2 x 4's just might.

 

[cara susanna]

99% sure it's coming from the VACO/VISN/national levels and which then amplifies local cultures of blame.

I've been in the system since 2017 and every year, it seems like there is more and more pressure to conform to the metric of the day and to do it quickly.

A directive gets issued rom the top (like connect more suicidal veterans to services) so then every level below jumps to respond, including creating processes that don't improve actual care, are often short-sighted to improve a specific metric that probably doesn't even capture genuine outcomes, or is even detrimental to the general provision of healthcare services (like diverting already scarce resources).

I've even seen things like the annual All Employee Survey cause local leaders to freak out if they don't get enough of a response rate or if certain employee satisfaction metrics are below desired levels since they will then flack about it and potentially have it be a stumbling block in their career advancement, likely much more so than in days past in the VA.

Yup, I've learned it's tied to their bonuses.

 

[Sanman]

Yup, I've learned it's tied to their bonuses.

Which makes the VA the same as any large corporation, except you can't be easily downsized.

 

[PsyDWannabe]

True.

I made them take my 'additional signer' status off the note/plan. They didn't follow through on actually changing the plan in the medical record. They changed it in Mental Health Suite but did not re-publish to CPRS. It still lists me as the sole 'team member' with the sole treatment objective and me as the responsible person for implementing it with the patient. Their names (supervisor and intern) by their signatures makes it clear that they authored the plan (not me). I have let the psychologist and my/our supervisor know, in writing, that I object to this plan being written 'for me' without consulting me and for a patient whom I have never evaluated. I have made it clear that it is not--at this point--in any way, shape, or form 'my' plan. I have made it clear that I will answer the consult that has been entered for me to evaluate the patient for suitability for a particular protocol treatment that I do (although from reviewing his chart, he already appears to be a poor candidate, but I will complete the consultation in good faith).

I applaud you for persisting and standing up for yourself. This is so crazy.

 

[PsyDWannabe]

Do you think this is related to your particular facility's midlevel leadership model, which frankly seems quite bizarre to me based on what you've previously posted/made us aware of? Where are the psychiatrist leaders in the MH service line? This treatment plan issue was one issue I never saw at all, but then again, I have been out for over 5 years now.

"We engage in a 'team based' model of intervention here"

Yea. So this seems like what one might expect, to some degree, in a residential/DOM or inpatient SUDs program. Not really in OP/BHIP. Seems very weird. Where is all this (unnecessary) pressure coming from, exactly?

I think it has evolved to a battle of egos at this point because nothing else makes sense.

 

[Fan_of_Meehl]

I applaud you for persisting and standing up for yourself. This is so crazy.

Today I entered a chart note to clarify my role vis-a-vis the patient's care. I clarified that I was in receipt of a consult to evaluate the patient's potential suitability for Protocol X. I also described (in case anyone reading the note needed the edification) the standards of care/practice pertaining to professional psychological evaluation/assessment, informed consent, treatment planning, and treatment implementation and highlighted how critical it was that the steps proceed in that order. I also noted that I did not currently have an active treatment plan with respect to the patient as I have yet to evaluate him and that the referring psychologist remained his provider of record.

Strictly speaking, I believe that the 'treatment plan' (naming me as the (current) sole 'team member,' with only my objective (with me named as the 'responsible person')) that was authored by and signed by the intern (whom I do not supervise) and his supervising psychologist (neither of whose names appear on the document save as signatures...I believe that strictly speaking this chart note is fraudulent or, at least, clearly inaccurate. This plan was created for me and entered into the record without my consent, involvement, or permission and against my repeated verbal and written objections. It clearly implies that it is 'my' treatment plan, that the issue pertinent to the requested consult will be answered in the affirmative (how can the authors presume that?) and that I somehow authored or approved of the plan as it lists me as the 'responsible person.' 'Leadership' appears loathe to clarify that such conduct isn't appropriate but if it happens again, I may need to step up my objections. It's fraudulent documentation.

 

[Fan_of_Meehl]

I think it has evolved to a battle of egos at this point because nothing else makes sense.

Sure. It has become that. But I am puzzled how it makes any sense to accept another LIP having the audacity to presume to write your plans for you and refuse to correct the error in the medical chart. What this is illustrating is the corrupt/political nature of my present circumstances. There is no way that this would 'fly' if you were to simply change the involved participants. I know multiple psychologists in the same system who have gone completely apoplectic over another supervisor even daring to question their diagnoses, let alone instruct an intern to write their plans for them without their input/permission and over their strenuous objections.

 

[deleted1129370]

If you get a board complaint, the VA will spend more time and resources exonerating themselves than exonerating you. I would never leave the fate of my professional license, my literal livelihood, up to whatever institution I was working for. No matter how “we are a family/team” they claim to be. In fact, whenever folks say stuff like that, it’s basically permission to overstep all of your boundaries.

Exactly...that was told to me by supervisors I've had across 3 VAs - if push came to shove, the VA would throw me under the bus to save face.

 

[cara susanna]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

 

[WisNeuro]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

Usually poker face and let them rant for a minute. Then I'd redirect to the issue we were currently dealing with in therapy. I was pretty goal focused in my therapy approach in the VA. I also heavily prefaced that in the initial session that I was very goal focused in therapy and did not do supportive therapy. We could address issues that came up in life and do mini-crisis counseling stuff if need be, but we would not have random rant/supportive sessions.

 

[Fan_of_Meehl]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

(1) Remind them that the patient role in professional psychotherapy is clearly on SELF analysis and SELF change (of thinking/belief patterns and/or behavioral patterns) including learning coping skills; if YOU'RE broke, and need fixing, then you've come to the right place; if the NATION (or half of its inhabitants) are broke and need fixing then that is well beyond my scope of practice...bye
(2) Remind them the question "Was I RIGHT to say/think X?" isn't generally a helpful approach in therapy; far more helpful is the question, "Is what I'm doing WORKING or getting me the results I want or making me healthier?"; focus on functional rather than moral evaluations of 'right and wrong'
(3) explore, Socratically and non-judgmentally and in a 'downward arrow' fashion the personal relevance/meaning of their particular "hot button" political stances on issues they are passionate about. Therefore, "pro 2nd amendment" positions may translate to "I want my family to be safe (value).' Of course, 'sensible gun control' is 'pointed' in the same direction (same value). Explore this Socratically with them. Are their actions in service to that identified value? How else (under their control) could they take action in service to their identified values? Fix yourself before fixing America (or the entire planet).
(4) conceptualize it as avoidance behavior and intervene accordingly; consider setting limits (no more than 5 mins)?
(5) ask them why they watch the news or follow politics on social media; to stay informed? Really? Track how much time you are spending on that stuff? How is it affecting you emotionally? Would it really be 'dangerous' to go cold turkey on news/politics for a month? How did the great Thomas Jefferson or George Washington (whom you so admire) ever make it without consulting the University of Facebook, Twitter and Instagram? When was the last time you read The Federalist and Anti-Federalist Papers? James Madison's Federalist #10 is a work of frickin' intellectual beauty. You want to be politically astute/informed??? Can we do a behavioral experiment? Can we at least reduce it by 25% and evaluate? How much time do you spend on social media per day? 1 to 2 hours? Just for ONE month let's try having you read The Federalist Papers and Anti-Federalist Papers instead. How do you feel now? More or less agitated? More or less politically astute and informed? What did we learn? At least some more vocabulary words (I know *I* did).

 

[Shiori]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

I try to examine the process taking place rather than the content. I am worse at this when I'm tired or annoyed, so I am okay sitting on it until I'm in the right frame of mind to tackle it. I ask questions in my mind like why is this person coming to me, in general? Why is this person coming to me and telling me this specific content out of ALL the content they could be bringing up? Why is this person repeatedly bringing up this content? Are they looking for validation? Do they want to test the relationship for safety? Do they have no one else to bounce these ideas off of because they're isolated or their family finds it unpalatable? If I can get at the why, it makes it easier to deconstruct in the room. Sometimes I have to ask directly, but usually it's part of a bigger pattern and I can use a less provocative example to discuss it. Depending on different factors, I might later loop in the example of what's happening in the room with me.

 

[erg923]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

I probably wouldn't let them do this at all. Seems like there are many, many, many more pressing things for them to talk about/work on if they are there in the first place, no? You are one of their doctors. I'm sure their PCP doesn't let them drone on about that garbage if it takes up any substantial appt time? Would gently remind them of that each time.

 

[cara susanna]

See, I do that (redirect, remind them that therapy isn't for discussing politics, discuss limiting news or finding more productive ways to channel political frustrations, etc) but sometimes people STILL keep going back to it and bringing it up over and over again. I'm not sure what to do in those situations.

 

[Shiori]

I probably wouldn't let them do this at all. Seems like there are many, many, many more pressing things for them to talk about/work on if they are there in the first place, no? You are their doctor and/or therapist. I'm sure their PCP doesn't let them drone on about that garbage if it takes up any substantial appt time? Would gently remind them of that each time.

I had a PCP refer their patient to me because they wanted to talk about political concerns. I was not pleased.

 

[erg923]

I had a PCP refer their patient to me because they wanted to talk about political concerns. I was not pleased.

That's pretty disrespectful at multiple levels (personal, professional, financial/ VA care access issues). Would immediately kick that to the Peer Support Program. Hope you talked with the PCP about this?

 

[erg923]

See, I do that (redirect, remind them that therapy isn't for discussing politics, discuss limiting news or finding more productive ways to channel political frustrations, etc) but sometimes people STILL keep going back to it and bringing it up over and over again. I'm not sure what to do in those situations.

If you are running any kind of EBT protocol for their symptoms/problems that we know of...they don't seem ready. Talk with them about externalization in a gentle way.

If you are in some kind of supportive BHIP/in-between land....same thing actually! 🙂 No one's tombstone epitaph improves/changes by bitching about Joe Biden. They are obviously already there for other reasons. Just tell them that.

 

[Shiori]

That's pretty disrespectful at multiple levels (personal, professional, financial/ VA care access issues). Would immediately kick that to the Peer Support Program. Hope you talked with the PCP about this?

I have in the past. In this case, the patient was quite offended by the referral so it worked itself out.

 

[erg923]

See, I do that (redirect, remind them that therapy isn't for discussing politics, discuss limiting news or finding more productive ways to channel political frustrations, etc) but sometimes people STILL keep going back to it and bringing it up over and over again. I'm not sure what to do in those situations.

Seriously....I would tell them (if you have an established relationship with them that is) that you don't give a flying **** about politics or what they think about politics/culture wars/insert US president here. This isn't Born on the 4th of July. We cannot fight "the man" here. We are fighting YOUR mind/brain at this time. This is a professional mental health service clinic in a hospital. You are here for a reason. I/we will work tirelessly to help you if that is what you truly want?

I would do this speech several times. I actually did that speech several times when I was working at the VA.

 

[Sanman]

I know this comes up a lot, but the struggle is real: how do you guys handle patients ranting about politics in session? Especially if you find their views particularly awful?

"We are not here to discuss politics. However, it seems like the news/Facebook triggers some negative emotional responses for you. Have you thought about how to manage those triggers so that you are not so upset/angry/depressed? Remember, you can't control the world. You can only control your own personal emotions and behaviors."

 

[deleted1129370]

I think I'm ready to leave full time clinical care. Especially with the VA. I want to continue to build my private group practice so that I can earn passive income and do some clinical work myself, but I am looking at other options where it's not as hectic and the balance of work is much better compared to clinical care. Any thoughts?

 

[Fan_of_Meehl]

I think I'm ready to leave full time clinical care. Especially with the VA. I want to continue to build my private group practice so that I can earn passive income and do some clinical work myself, but I am looking at other options where it's not as hectic and the balance of work is much better compared to clinical care. Any thoughts?

Other than full-throated agreement? LOL

 

[PsychPhDone]

If you are running any kind of EBT protocol for their symptoms/problems that we know of...they don't seem ready. Talk with them about externalization in a gentle way.

If you are in some kind of supportive BHIP/in-between land....same thing actually! 🙂 No one's tombstone epitaph improves/changes by bitching about Joe Biden. They are obviously already there for other reasons. Just tell them that.

Can someone please explain BHIP to me?

 

[PsychPhDone]

I think I'm ready to leave full time clinical care. Especially with the VA. I want to continue to build my private group practice so that I can earn passive income and do some clinical work myself, but I am looking at other options where it's not as hectic and the balance of work is much better compared to clinical care. Any thoughts?

I predict 34 seconds until wisneuro appears for ya

 

[erg923]

Can someone please explain BHIP to me?

Whatever you think is probably right.

 

[deleted1129370]

Other than full-throated agreement? LOL

I predict 34 seconds until wisneuro appears for ya

Right now, I have 12 patients I see in private practice, I just hired 2 psychologists who are cash pay, and I have a third psychologist I am interviewing this week who will join on insurances with me. I also just got group contract approved with one new insurance company. My plan is to hire 8 more folks...I take 30%, and that's a pretty decent passive income if I can get them to see 14-20 patients a week. Ideally, my plan has been to switch to part time with the VA in September, but who knows, every day is an act of congress just to adult.

 

[SikeThatsTheWrongNumber]

Right now, I have 12 patients I see in private practice, I just hired 2 psychologists who are cash pay, and I have a third psychologist I am interviewing this week who will join on insurances with me. I also just got group contract approved with one new insurance company. My plan is to hire 8 more folks...I take 30%, and that's a pretty decent passive income if I can get them to see 14-20 patients a week. Ideally, my plan has been to switch to part time with the VA in September, but who knows, every day is an act of congress just to adult.

Curious. What’s keeping your psychologists from cutting the middle man?

 

[WisNeuro]

I predict 34 seconds until wisneuro appears for ya

My timing is off, this is a travel week for work, different timezone and all 🙂

 

[summerbabe]

Can someone please explain BHIP to me?

To take a page for Plato, a combination of bureaucrats and their ‘scientifically informed’ advisors/handlers created a model for integrated care (BHIP as Form).

But implementing it is basically wandering around Plato’s Cave in darkness.

 

[smalltownpsych]

If the patient starts to talk politics, change the subject to complaining about the VA, all the vets love that. Seriously though, I let a certain amount of venting happen for most of my patients. We all like to share our frustrations and be validated. I can usually validate most political perspectives in a general way, but I am noticing that there seems to be more and more of a paranoid and persecutory flair to those in more recent times and I feel the pull to try and moderate or challenge the rationality of some of those fears.

 

[Fan_of_Meehl]

To take a page for Plato, a combination of bureaucrats and their ‘scientifically informed’ advisors/handlers created a model for integrated care (BHIP as Form).

But implementing it is basically wandering around Plato’s Cave in darkness.

nice. LOL. I like the cut of your jib.

 

[Sanman]

If you are running any kind of EBT protocol for their symptoms/problems that we know of...they don't seem ready. Talk with them about externalization in a gentle way.

If you are in some kind of supportive BHIP/in-between land....same thing actually! 🙂 No one's tombstone epitaph improves/changes by bitching about Joe Biden. They are obviously already there for other reasons. Just tell them that.

Unless you happen to be a Republican presidential candidate. Then the title on your tombstone may change depending on how well you are able to bitch about Biden.

 

[Sanman]

Can someone please explain BHIP to me?

How it is supposed to work or how it actually works?

 

[WisNeuro]

How it is supposed to work or how it actually works?

Step1: Come up with an acronym
Step 2: ??????
Step 3: Profit!

 

[cara susanna]

BHIP is awesome... when implemented correctly. When not, oof.

 

[deleted1129370]

Curious. What’s keeping your psychologists from cutting the middle man?

Typically...because they don't want to do the hard work themselves. They are more than free to create an LLC, do their own advertising, procure referral sources, spend time paneling themselves on insurances, pay subscription fees to EHR and directories, and spend the countless hours engaging in digital and print marketing. They just need to actually put the effort into it like I am. I've spoke to a lot of psychologists in my area, and that tends to be like the #1 reason - they don't know how to create a business, market it, and be good at that. They are scared. It makes sense as I too was apprehensive in doing so, but I've always been a businessman.

 

[WisNeuro]

Typically...because they don't want to do the hard work themselves. They are more than free to create an LLC, do their own advertising, procure referral sources, spend time paneling themselves on insurances, pay subscription fees to EHR and directories, and spend the countless hours engaging in digital and print marketing. They just need to actually put the effort into it like I am. I've spoke to a lot of psychologists in my area, and that tends to be like the #1 reason - they don't know how to create a business, market it, and be good at that. They are scared. It makes sense as I too was apprehensive in doing so, but I've always been a businessman.

Are people actually spending all that much time on this? particularly if they take insurance? Filling an insurance-based MH panel is pretty much easy mode in most jurisdictions. Make a few phone calls to potential referral bases and prepare to beat back referrals with a stick.

 

[deleted1129370]

Are people actually spending all that much time on this? particularly if they take insurance? Filling an insurance-based MH panel is pretty much easy mode in most jurisdictions. Make a few phone calls to potential referral bases and prepare to beat back referrals with a stick.

So, yes and no. I screen out a lot of folks I have no desire to work with. The other component to this is, I am trying to balance it with having 50% of my caseload being cash pay with the other 50% being insurance-based. I am really trying to gather more cash pay folks so I can delegate to the two providers I hired on who don't want to take insurance. The moment I got on with 3 insurance panels, I filled up quickly to 12 patients a week in a matter of 1-3 weeks. I'm also bringing on a 3rd and possibly a 4th contractor who will take insurance, so I will have to apply for them myself. I am trying to scale this accordingly so that I eventually can see less patients and live off of the passive income I get from my contractors.