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

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Sanman said:
Private world runs the gamut. Some you would never hear about until you go to reschedule and owe a fee. Others send the obligatory email and text spams as reminders. Very rarely do I receive a reminder call from a staff member. What no one in the private world has ever done is have the doctor call me personally unless I am dying.
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I have to call them three times if they miss an appointment. FML
 
futureapppsy2 said:
On the clinical side of VBA, we have a system that allows us to send and receive texts to and from veterans from our computers within the system. It's a nice system that lets us communicate with them via text without the pressure to provide access to us after working hours. Our VOIP phone system is completely useless, though--like, it might as well not even exist.
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Sorry if I missed this before, but what is your role at VBA? I don’t think I’ve met a psychologist in VBA.
 
Does anyone else still feel awful when they get a provider change request due to reported low rapport? Does it ever get better?
 
cara susanna said:
Does anyone else still feel awful when they get a provider change request due to reported low rapport? Does it ever get better?
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Definitely have felt worse in the past. It can still hit hard for a bit, especially depending on who is making the request.

But mostly, I now default to the ‘it’s one less patient on my caseload temporarily’ mentality and hope they can engage better/differently with somebody else.
 
cara susanna said:
Does anyone else still feel awful when they get a provider change request due to reported low rapport? Does it ever get better?
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I haven't gotten a formal request. Though there was one patient who requested someone who was older -_-. That made me feel crappy.
 
cara susanna said:
Does anyone else still feel awful when they get a provider change request due to reported low rapport? Does it ever get better?
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I haven't had it happen with a person I felt a good connection with. I think that would definitely sting more. I give a pretty aggressive "please switch providers if it's not working" speech regularly because that sting is usually less painful than therapy with a person who isn't a good fit. I have a few on my caseload who would be perfect for a different provider, but feel committed to sticking it out with me. Please break up with me. We're terrible together.

Sending all the good vibes your way.
 
Shiori said:
I haven't had it happen with a person I felt a good connection with. I think that would definitely sting more. I give a pretty aggressive "please switch providers if it's not working" speech regularly because that sting is usually less painful than therapy with a person who isn't a good fit. I have a few on my caseload who would be perfect for a different provider, but feel committed to sticking it out with me. Please break up with me. We're terrible together.

Sending all the good vibes your way.
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Thank you, this one I really didn't see coming and I thought the appt went well (we met once).
 
cara susanna said:
Does anyone else still feel awful when they get a provider change request due to reported low rapport? Does it ever get better?
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I never take it personally, though it is a bit different for me because you are heading to mental health clinic and the whole setting is different from HBPC or telehealth. In the past, the few times it happened I was relieved, because it was usually accompanied by an ethnic slur and I had no interest in seeing them anyway.
 
psycho1391 said:
I'm the ONLY pain psychologist, so its hard for them to switch.
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Yep, same here. And pain patients tend to be an, er, disagreeable bunch. My supervisor is lovely and told me it's understandable if my clinic grid is a little less full, due to needing to space patients out a bit more since the work can be taxing.
 
Outpatient psychotherapy isn't an assembly-line process. It sounds like your supervisor understands this concept, which wasn't a rare thing when I began my career, though its becoming increasingly rare to have a supervisor like that in this age of 'corporatism' in healthcare. When I was in training, the common joke was that psychologists had 'physics envy' and that was why we tried so hard to make a science out of psychotherapy. These days, it's more like organizations (and supervisors/administrators) have 'corporate envy' and they are trying way too hard to act like they're CEO's, squeezing every ounce of 'productivity' (even though counting RVU's isn't a valid measure of 'productivity' as a therapist) and 'efficiency' out of their 'human resource' workforce all while wearing a fake smile and reciting the latest thought-terminating cliches that are supposed to be 'motivational.'
 
Fan_of_Meehl said:
Outpatient psychotherapy isn't an assembly-line process. It sounds like your supervisor understands this concept, which wasn't a rare thing when I began my career, though its becoming increasingly rare to have a supervisor like that in this age of 'corporatism' in healthcare. When I was in training, the common joke was that psychologists had 'physics envy' and that was why we tried so hard to make a science out of psychotherapy. These days, it's more like organizations (and supervisors/administrators) have 'corporate envy' and they are trying way too hard to act like they're CEO's, squeezing every ounce of 'productivity' (even though counting RVU's isn't a valid measure of 'productivity' as a therapist) and 'efficiency' out of their 'human resource' workforce all while wearing a fake smile and reciting the latest thought-terminating cliches that are supposed to be 'motivational.'
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Ironically, our HRO/ lean white belt trainings were born from the assembly line quite literally. It helps Toyota make a great car and the ideas may translate to something like surgery an pre-surgical prep. However, it has nothing to do with how I practice.
 
butteredtoast27 said:
Yep, same here. And pain patients tend to be an, er, disagreeable bunch. My supervisor is lovely and told me it's understandable if my clinic grid is a little less full, due to needing to space patients out a bit more since the work can be taxing.
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Knock on wood. I've only had one request a different provider.
 
Sanman said:
Ironically, our HRO/ lean white belt trainings were born from the assembly line quite literally. It helps Toyota make a great car and the ideas may translate to something like surgery an pre-surgical prep. However, it has nothing to do with how I practice.
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And if you read the recent miraculous tx literature on "massed (accelerated)" PE/CPT protocols for PTSD, the condition can be just as effectively treated/eliminated in 4-5 days of treatment. Truly miraculous times we're living in.

Some veterans devoted to the idea that their condition is 100%, Total and Permanent are going to be mighty shocked to learn that, au contraire, Sammy Joe, Ph.D. is likely to be able to cure that in a mere 5 days when it took The Almighty a full six days to create the Heavens & Earth.
 
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psycho1391 said:
I haven't gotten a formal request. Though there was one patient who requested someone who was older -_-. That made me feel crappy.
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Probably because I am overworked as are we all, but the age thing doesn’t bother me at all and I am happy to have one less person (provided they are safe/OK and something terrible didn’t happen to them). It’s only peeved me when someone was being rude and insulting. Even though I said it’s fine, no need to explain. But there still needs to be respect and talking down to me is not going to be tolerated. Interestingly I have only had older women be condescending when expressing an issue with my age.
 
ccpsych16 said:
Probably because I am overworked as are we all, but the age thing doesn’t bother me at all and I am happy to have one less person (provided they are safe/OK and something terrible didn’t happen to them). It’s only peeved me when someone was being rude and insulting. Even though I said it’s fine, no need to explain. But there still needs to be respect and talking down to me is not going to be tolerated. Interestingly I have only had older women be condescending when expressing an issue with my age.
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Honestly, If you are overworked at the VA, set better boundaries. Respect would be nice, but I don't expect it working at the VA.
 
Sanman said:
Honestly, If you are overworked at the VA, set better boundaries. Respect would be nice, but I don't expect it working at the VA.
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To your point, I'm having a very hard time identifying ANY action having been taken on the part of administration, VISN, central office, or the VA in general in recent years that could be fairly characterized as demonstrating actual 'respect' for its mental health practitioners. To the contrary, it seems like many changes express the exact opposite sentiment--e.g., requiring use of mental health suite software, requiring 45-day advance notice to take annual leave, making sure we're referred to as 'providers' (rather than practitioners or doctors), all the oversight by unqualified expertogists/excellentologists and their checklist of policy/procedure 'thou shalt' audits and nastygrams, etc., etc.

And, no...flowery emails stating how much we are (supposedly) 'appreciated' don't count. Talk is cheap.
 
Fan_of_Meehl said:
To your point, I'm having a very hard time identifying ANY action having been taken on the part of administration, VISN, central office, or the VA in general in recent years that could be fairly characterized as demonstrating actual 'respect' for its mental health practitioners. To the contrary, it seems like many changes express the exact opposite sentiment--e.g., requiring use of mental health suite software, requiring 45-day advance notice to take annual leave, making sure we're referred to as 'providers' (rather than practitioners or doctors), all the oversight by unqualified expertogists/excellentologists and their checklist of policy/procedure 'thou shalt' audits and nastygrams, etc., etc.

And, no...flowery emails stating how much we are (supposedly) 'appreciated' don't count. Talk is cheap.
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Beyond that, the general state of VA offices and lack equipment to do the job are not great. The lack of funding for organizational structure (if you have a large dept, why are there not more manager and associate chief roles? no money) The treatment during the pandemic gave me whiplash (treat providers like garbage and then throw money and perks at them when the market has spoken). Having sat on hiring committees and in meetings with local leadership, the sentiment is often "if you have a better deal take it". Central office folks I know have always been very outspoken about common sense and proper implementation of procedures. However, they are also not in the real world and have no say over what these folks do. It is the reason for the ongoing midcareer brain drain in many places.
 
Sanman said:
Honestly, If you are overworked at the VA, set better boundaries. Respect would be nice, but I don't expect it working at the VA.
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I have excellent boundaries in professional and personal life. But no one can say “32 patients a week is too much, do not give me that many grid slots”. Can’t stop admin from directing MSAs to schedule intakes in our follow up clinics because intake clinic is booked through December. Can’t stop taking new patients even though we do not have the space to see our caseload on a weekly/biweekly basis. Etc etc. At a certain point we work within a system, and if we want to do things “my way” we would just go into private practice. Which many former VA employees (and employees of other health orgs) end up doing. Or wait to be put on a PIP as we’ve seen in this very thread.

I find “set better boundaries” more applicable to my colleague who regularly stays in the clinic until 7pm doing notes, without comp time which is illegal, because they stopped granting it unless you handled a hospitalization that day.
 
ccpsych16 said:
But no one can say “32 patients a week is too much, do not give me that many grid slots”. Can’t stop admin from directing MSAs to schedule intakes in our follow up clinics because intake clinic is booked through December. Can’t stop taking new patients even though we do not have the space to see our caseload on a weekly/biweekly basis
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Maybe a potential solution is looking at your own GUI schedule and booking your EBP follow-ups 4 sessions ahead? That's what our BHIP clinic has been directed it do. Honestly, it's what I've been doing to make sure my clinics reflect what I'm doing. Intakes get put off.
 
ccpsych16 said:
I have excellent boundaries in professional and personal life. But no one can say “32 patients a week is too much, do not give me that many grid slots”. Can’t stop admin from directing MSAs to schedule intakes in our follow up clinics because intake clinic is booked through December. Can’t stop taking new patients even though we do not have the space to see our caseload on a weekly/biweekly basis. Etc etc. At a certain point we work within a system, and if we want to do things “my way” we would just go into private practice. Which many former VA employees (and employees of other health orgs) end up doing. Or wait to be put on a PIP as we’ve seen in this very thread.

I find “set better boundaries” more applicable to my colleague who regularly stays in the clinic until 7pm doing notes, without comp time which is illegal, because they stopped granting it unless you handled a hospitalization that day.
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Glad to hear that you are setting healthy boundaries. Certainly should not be doing notes until 7pm. @psycho1391 provided a good suggestion. My thoughts on the matter:

1. 32 slots is not that much. I used to see between 9-11 per day as a younger (and poorer) guy.

2. Figure out the best way to speed up notes (templates, dictation software, etc.)

3. Make friends with your msa and discuss how you like scheduling done and when to insert those intakes in your schedule so you have time. Book up the slots you don't want used well ahead of time.

4. Start discussing groups and places to divert people with no place to go. This is a leadership issue as well.

5. There are places in the VA where "my way" is more acceptable than others. There is a reason I like working rural CBOCs.

6. If leadership is not effective and responsive to your issues, USAjobs is a click away. The hiring freeze means transfers are the only source for filling positions right now.
 
Also, I hardly use the full hour in my sessions or intakes. I have found that by introducing the session as "ok, so we have an hour to do this intake ,I may interrupt you to make sure we have everything covered. This will allow us to get a running start on the actual treatment. "

This intro often stops tangents and life story sort of answers.
 
psycho1391 said:
Maybe a potential solution is looking at your own GUI schedule and booking your EBP follow-ups 4 sessions ahead? That's what our BHIP clinic has been directed it do. Honestly, it's what I've been doing to make sure my clinics reflect what I'm doing. Intakes get put off.
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I do this, actually I go over 4 and no one has stopped me yet. And I am trying to get more EBP and less follow up slots. But then we get told by leadership it’s taking people too long to get in. I can imagine one day they’ll force EBPs to be used for intakes. Anytime I think they can’t make a worse decision…

psycho1391 said:
Also, I hardly use the full hour in my sessions or intakes. I have found that by introducing the session as "ok, so we have an hour to do this intake ,I may interrupt you to make sure we have everything covered. This will allow us to get a running start on the actual treatment. "

This intro often stops tangents and life story sort of answers.
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I do this as well and I seem to be the only one in my clinic. There may be 1-2 people I routinely have a hard time corralling, but I tell people we have about 45 minutes. I usually have no notes to do during my last couple hours of admin time. A full day of back to back individual sessions just isn’t in the cards for me long term. My favorite days are broken up by groups and extra admin release time. On days where I have none of that, I tend to have no time for notes earlier in the day. But I do much better than my coworkers at that.

Sanman said:
Glad to hear that you are setting healthy boundaries. Certainly should not be doing notes until 7pm. @psycho1391 provided a good suggestion. My thoughts on the matter:

1. 32 slots is not that much. I used to see between 9-11 per day as a younger (and poorer) guy.

2. Figure out the best way to speed up notes (templates, dictation software, etc.)

3. Make friends with your msa and discuss how you like scheduling done and when to insert those intakes in your schedule so you have time. Book up the slots you don't want used well ahead of time.

4. Start discussing groups and places to divert people with no place to go. This is a leadership issue as well.

5. There are places in the VA where "my way" is more acceptable than others. There is a reason I like working rural CBOCs.

6. If leadership is not effective and responsive to your issues, USAjobs is a click away. The hiring freeze means transfers are the only source for filling positions right now.
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We will just differ in that regard, I think 32 is too much. I’ve done more before and 32 being less doesn’t make it good (for me). During one of the national meetings a year or two ago, several people brought up in the chat that there has been research done on max contact hours taking into account therapist satisfaction, quality of care, flow, etc. It was 26.

I use self-created templates and the EBP templates for all my notes, so usually done in 5 min.

I am in top of 3&4 as well, being someone who assists with triage and referrals. And as a clinic we are trying to get all therapists on board with being more confident in offering clinical recommendations and holding clients to that. For example, I and a couple other colleagues do not take “I just want coping skills” cases. We say “That’s what group/class is for. You can choose to decline it, but those are your options.” That’s always been my style but others are more passive or averse to people being mad at them. Our prescribers seem to do this well given how often clients fire or threaten them for not doing what they demand.

I’ve been at more CBOCs than main hospitals and love it. Not rural but I DO have a lot of leeway and less oversight. That is changing since they have taken away duties from local MSAs. Now main campus MSAs are scheduling and they don’t always follow my instructions. There is also this MH Connect thing which, from what I’m told, will eventually take over and remove more autonomy from clinic staff.

As for 6, I am on it daily! Actually was a finalist for a cool job but wasn’t selected—told I was too early career and they wanted more experience. Like many I am limited in that I can’t pick up my family and go wherever I want to, which adds another layer. Everyone wants remote! While I’m still ECP I’ve even thought of pivoting back to research and/or teaching. I do not want to be “on” for 90% of my day, every day.
 
psycho1391 said:
Also, I hardly use the full hour in my sessions or intakes. I have found that by introducing the session as "ok, so we have an hour to do this intake ,I may interrupt you to make sure we have everything covered. This will allow us to get a running start on the actual treatment. "

This intro often stops tangents and life story sort of answers.
Click to expand...

Same, I do an hour intake and if we don't get to everything I say "Unable to assess" for the stuff we didn't get to. Therapy I keep to 45 minutes, and if it's a full protocol like PE or WET I keep it to 60 (maybe 70 for PE) maximum since we can no longer bill for extended session length past that.
 
I listen to music on YouTube when I'm doing admin stuff and they keep playing political ads. If I get a Hatch Act violation, it's on them (I usually use headphones, but sometimes I forget they aren't plugged in)
 
cara susanna said:
I listen to music on YouTube when I'm doing admin stuff and they keep playing political ads. If I get a Hatch Act violation, it's on them (I usually use headphones, but sometimes I forget they aren't plugged in)
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Haha you’re good. Your VA probably has TVs in waiting areas that show commercials with political ads and maybe even cable news.

There was a couple month period when I volunteered for a campaign and had to be very aware of the Hatch Act such as being careful about when/how I was engaging with personal emails that were campaign related (like going for a walk on my lunch break and only using my personal phone).
 
cara susanna said:
I listen to music on YouTube when I'm doing admin stuff and they keep playing political ads. If I get a Hatch Act violation, it's on them (I usually use headphones, but sometimes I forget they aren't plugged in)
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Youtube premium FTW (it's sincerely the only "streaming" subscription where I know I get my money's worth every month, ngl).

On another note, I'm beginning to be surprised when a patient hasn't been divorced at least once, and it reminded me of this old satire article: Marine Scout Sniper sets record for most confirmed divorces
 
Just got news that we are doing away with intake clinics early next year and no more EBP DNS….
 
psycho1391 said:
what does this mean for you?
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We have a grid specifically for EBP patients. No one can just be scheduled there. We were in talks to increase EBP slots and decrease regular follow up slots so we can protect more time for people who are actually engaging in therapy. Now we will just have F2F and VVC grids. So MSAs will schedule people wherever, and we will have more intakes per week than we are supposed to (3).
cara susanna said:
All of our CBOC PCMHI therapists are leaving. Please pray for us, lol.
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We have operated without PCMHI for *so long*. And we are doing better than another. CBOC that has no PCMHI and no GMH therapists. Absolutely none. For a long time!
 
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