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

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Shiori said:
I probably needed another day or two at home. I'm just sitting in my office in tears. Fortunately, I almost never get emotional in session, so that shouldn't be an issue. I'll set firm boundaries about election talk. I truly just want to be left alone by the vast majority of people right now.

My stance at work has always been to fix a problem when I see one and advocate hard when I see injustices. It is a weekly, often multiple times a week, grind that I have been doing behind the scenes to make things less terrible for everyone. It's funny that I was just talking about burning out. I think I, along with a lot of Black women, are letting other people lead the charge for change. We are tired. Whatever folks need in this moment is probably in a book written by a Black woman/queer person in the 70s.
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I hear you. I just want to be alone, and am finding it hard to sit in session with patients without trying to guess in my head whether or not they voted to strip me and so many others of our fundamental rights. It is also so difficult to make room for space for both patients and those in my personal life who are struggling. Broke down in my office today between sessions for probably the first time of many.
 
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butteredtoast27 said:
I hear you. I just want to be alone, and am finding it hard to sit in session with patients without trying to guess in my head whether or not they voted to strip me and so many others of our fundamental rights. It is also so difficult to make room for space for both patients and those in my personal life who are struggling. Broke down in my office today between sessions for probably the first time of many.
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I hope you are taking the time to take care of yourself too.

I have a one-on-one with my supervisor and I'm dreading it. They are lovely, but I'm in a "burn it all down" mood. I also have a hard time keeping my mouth shut. We have already gotten the obligatory "we can never predict what will happen in the new administration" statement related to my LGBTQ+ work. I'm glad it's a work from home day because I have zero patience. None.
 
Do we have any knowledge of if the Trump admin can gut EDRP for those already approved? No reason for me to stay at VA and make less as the hiring freeze continues if they're not going to cover my student loans.
 
psy.d. 2021 said:
Do we have any knowledge of if the Trump admin can gut EDRP for those already approved? No reason for me to stay at VA and make less as the hiring freeze continues if they're not going to cover my student loans.
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I'm no legal expert, but I think it's exceedingly unlikely they'd be able to make substantive changes for existing borrowers. Other than maybe telling whoever it is that reviews the applications for forgiveness to be very strict with rules.
 
So, I am . . . so much not a fan of the Heritage Foundation, but if you read the section of the proposal on the VA, it is at odds with what you might naïvely expect.

1. They envision shifting resources from aging healthcare campuses to CBOCs and actually expanding CBOCs as the main priority for new facilities.

2. Pilot program of Saturday and extended weekday hours if excess capacity is identified and delays are past a certain standard

3. "Identify clinical services that are consistently in high demand butrequire cost-prohibitive compensation to recruit and retain talent, andexamine exceptions for higher competitive pay."

4. "Assess recruitment and retention in highly competitive medical markets to identify common limiting factors for attracting high-demand, specialized occupations."

5. "Consider expanding VA tuition assistance in exchange for reciprocal service in rural or understaffed VAMCs."

6. Examine surpluses and deficits of mental health personnel "recognizing that the department needs a blend of social workers, therapists, psychologists, and psychiatrists with a focus on attracting high-quality talent."

7. "Continue to maximize the use of new VA hiring and pay authorities providedby Congress in the RAISE Act6 and PACT Act as well as existing authorities in student loan forgiveness and the Public Service Loan Forgiveness program."

8. Accelerate time table for revising disability/service-connection standards (they are 100% trying to shrink this)

In the section covering overall proposed bureaucratic reforms the main thing that seems to be suggested for GS-13 to GS-15 is to introduce an actual system of merit pay.

It's been a long time since I did anything at a VA but this does not seem like the utter catastrophe that you might have feared.
 
clausewitz2 said:
It's been a long time since I did anything at a VA but this does not seem like the utter catastrophe that you might have feared.
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Yeah, this chapter really wasn't looking for any radical sea change. Especially compared to other sections. And, as seen in many of my comments over the years, I actually agree with reducing waste and fraud in the VA/VHA/VBA. Hard to think they'd do anything meaningful with SC, though, as it'd piss of a very vocal part of their base which is in favor of unlimited welfare as long as they are the only recipients.
 
WisNeuro said:
Yeah, this chapter really wasn't looking for any radical sea change. Especially compared to other sections. And, as seen in many of my comments over the years, I actually agree with reducing waste and fraud in the VA/VHA/VBA. Hard to think they'd do anything meaningful with SC, though, as it'd piss of a very vocal part of their base which is in favor of unlimited welfare as long as they are the only recipients.
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Like all documents like this, it's a collection of the personal wish lists of a bunch of disparate subject matter expert analysts, so plenty in there that will never be attempted.
 
clausewitz2 said:
So, I am . . . so much not a fan of the Heritage Foundation, but if you read the section of the proposal on the VA, it is at odds with what you might naïvely expect.

1. They envision shifting resources from aging healthcare campuses to CBOCs and actually expanding CBOCs as the main priority for new facilities.

2. Pilot program of Saturday and extended weekday hours if excess capacity is identified and delays are past a certain standard

3. "Identify clinical services that are consistently in high demand butrequire cost-prohibitive compensation to recruit and retain talent, andexamine exceptions for higher competitive pay."

4. "Assess recruitment and retention in highly competitive medical markets to identify common limiting factors for attracting high-demand, specialized occupations."

5. "Consider expanding VA tuition assistance in exchange for reciprocal service in rural or understaffed VAMCs."

6. Examine surpluses and deficits of mental health personnel "recognizing that the department needs a blend of social workers, therapists, psychologists, and psychiatrists with a focus on attracting high-quality talent."

7. "Continue to maximize the use of new VA hiring and pay authorities providedby Congress in the RAISE Act6 and PACT Act as well as existing authorities in student loan forgiveness and the Public Service Loan Forgiveness program."

8. Accelerate time table for revising disability/service-connection standards (they are 100% trying to shrink this)

In the section covering overall proposed bureaucratic reforms the main thing that seems to be suggested for GS-13 to GS-15 is to introduce an actual system of merit pay.

It's been a long time since I did anything at a VA but this does not seem like the utter catastrophe that you might have feared.
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I agree that this does not sound terrible. Where I am concerned is if we will get the DEI training ban again and concern for loss of LGBT groups and women’s services. The stuff I’ve seen floating around online about a loyalty oath to the administration is also highly concerning.
 
clausewitz2 said:
So, I am . . . so much not a fan of the Heritage Foundation, but if you read the section of the proposal on the VA, it is at odds with what you might naïvely expect.

1. They envision shifting resources from aging healthcare campuses to CBOCs and actually expanding CBOCs as the main priority for new facilities.
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Reading a bit more, this seems to coincide with a plan to prioritize primary care and outpatient mental health, and substance abuse while relying on private medical centers for specialty care. There was a reference to a 2018 study of VHA facilities that can be found online that breaks tecs down by VISN. It seems this includes closing a number inpatient psych units.

clausewitz2 said:
2. Pilot program of Saturday and extended weekday hours if excess capacity is identified and delays are past a certain standard
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This has been done before. Problem is that VA staff don't want to work Saturdays often. Frankly, I don't want extended week days either. One benefit of VA hours and lack of non-competes is having a part-time PP.

clausewitz2 said:
3. "Identify clinical services that are consistently in high demand butrequire cost-prohibitive compensation to recruit and retain talent, andexamine exceptions for higher competitive pay."

4. "Assess recruitment and retention in highly competitive medical markets to identify common limiting factors for attracting high-demand, specialized occupations."

5. "Consider expanding VA tuition assistance in exchange for reciprocal service in rural or understaffed VAMCs."

6. Examine surpluses and deficits of mental health personnel "recognizing that the department needs a blend of social workers, therapists, psychologists, and psychiatrists with a focus on attracting high-quality talent."
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How #6 is implemented matters greatly. I had this issue pop up a few years ago and the problem is the talking heads don't understand what specialty psych folks do.

clausewitz2 said:
7. "Continue to maximize the use of new VA hiring and pay authorities providedby Congress in the RAISE Act6 and PACT Act as well as existing authorities in student loan forgiveness and the Public Service Loan Forgiveness program."

8. Accelerate time table for revising disability/service-connection standards (they are 100% trying to shrink this)
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This is going to be aimed at vets with new sc that won't know any better. I imagine some of the caregiver support money may go as well.
clausewitz2 said:
In the section covering overall proposed bureaucratic reforms the main thing that seems to be suggested for GS-13 to GS-15 is to introduce an actual system of merit pay.

It's been a long time since I did anything at a VA but this does not seem like the utter catastrophe that you might have feared.
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The issues I am concerned about are the stances on remote work (suggesting elimination of positions or pay reductions), the push for community care that was draining the VHA budget, and a reduction in specialty areas such as MST or GEC.

I have zero interest in being a grid based outpatient therapist in an underfunded system. At that point, PP is the better option hands down. I imagine a number of more senior folks will feel the same way.
 
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Sanman said:
This has been done before. Problem is that VA staff don't want to work Saturdays often. Frankly, I don't want extended week days either. One benefit of VA hours and lack of non-competes is having a part-time PP.
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You could probably get enough staff interested in Saturdays if the incentives were good enough. However, I suspect that incentives would be minimal and it would be implemented via metric (i.e. you have to have X% of department clinical hours on Saturdays or we get mad at you). I don't think they even can meaningfully incentivize physicians to work Saturdays, since we can't get overtime, comp time, etc. It's pretty limited for psychologists to - the max OT differential you can get is ~33% at GS-11 S1, and it becomes 0% by GS12 S5 or GS13 S1.

One problem with Saturdays would also be that the cost-efficiency of care would be dramatically reduced - you probably incur practically all the expenses of having the facility open (i.e. lights, HVAC, etc.) to run it a fraction of weekday capacity.

There would be a better case for Saturdays if we were facility-limited (it would increase effective facility capacity by ~20%) we are more staffing-limited. The problem right now is much more the clinicians not having time to see their veterans than vice versa. Forcing people to work Saturdays would make that staffing issue worse rather quickly.
 
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aim-agm said:
You could probably get enough staff interested in Saturdays if the incentives were good enough. However, I suspect that incentives would be minimal and it would be implemented via metric (i.e. you have to have X% of department clinical hours on Saturdays or we get mad at you). I don't think they even can meaningfully incentivize physicians to work Saturdays, since we can't get overtime, comp time, etc.

One problem with Saturdays would also be that the cost-efficiency of care would be dramatically reduced - you probably incur practically all the expenses of having the facility open (i.e. lights, HVAC, etc.) to run it a fraction of weekday capacity.

There would be a better case for Saturdays if we were facility-limited (it would increase effective facility capacity by ~20%) we are more staffing-limited. The problem right now is much more the clinicians not having time to see their veterans than vice versa. Forcing people to work Saturdays would make that staffing issue worse rather quickly.
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The other problem that is massively contributing to 'access' issues are people using the VA mental health clinics as a means to a service-connected end. The pending re-definition of the service-connected rating scale (0-100%) criteria for mental health conditions (including PTSD) is going to lead to a massive influx of cases into MH and PTSD specialty clinics over the next couple of years when veterans are being told to go to their mental health providers to gather/document 'evidence' that they actually qualify for a higher (especially '100%') s/c rating. Since the criteria for MH conditions have always been vague and based on patient self-report, this has always been a problem (and led to the massive increase in average %age of s/c over the past several decades--driven primarily by high %age s/c for mental health conditions) but it will get MUCH worse as the specific clinical criteria (e.g., things like lack of personal hygiene, chronic/severe risks to self/others, frank psychotic symptoms, forgetting one's 'own name' at times [dementia/delirium]) will no longer apply to the 100% threshold.

I'd estimate that only about one in five cases I see on a regular basis are actually there to participate in active and effective psychotherapy.

We don't really have an 'access' problem...or, for that matter, even a problem with 'under-staffing' of competent MH therapists.

We have a systems problem that fails to properly redirect veterans who are merely seeking to audition for higher levels of s/c benefits to other destinations than MH treatment clinics.
 
Fan_of_Meehl said:
The other problem that is massively contributing to 'access' issues are people using the VA mental health clinics as a means to a service-connected end. The pending re-definition of the service-connected rating scale (0-100%) criteria for mental health conditions (including PTSD) is going to lead to a massive influx of cases into MH and PTSD specialty clinics over the next couple of years when veterans are being told to go to their mental health providers to gather/document 'evidence' that they actually qualify for a higher (especially '100%') s/c rating. Since the criteria for MH conditions have always been vague and based on patient self-report, this has always been a problem (and led to the massive increase in average %age of s/c over the past several decades--driven primarily by high %age s/c for mental health conditions) but it will get MUCH worse as the specific clinical criteria (e.g., things like lack of personal hygiene, chronic/severe risks to self/others, frank psychotic symptoms, forgetting one's 'own name' at times [dementia/delirium]) will no longer apply to the 100% threshold.

I'd estimate that only about one in five cases I see on a regular basis are actually there to participate in active and effective psychotherapy.

We don't really have an 'access' problem...or, for that matter, even a problem with 'under-staffing' of competent MH therapists.

We have a systems problem that fails to properly redirect veterans who are merely seeking to audition for higher levels of s/c benefits to other destinations than MH treatment clinics.
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I'll add to this a poorly designed grid system of employee evaluation that reinforces "forever supportive therapy" in order to make your numbers rather than engaging in proper care. Combine that with political headaches if you don't offer a veteran any care they want (Whitehouse hotline, congressional complaints) and there is no reason to engage in proper care other than wanting to make your own life a bit harder.
 
Sanman said:
I'll add to this a poorly designed grid system of employee evaluation that reinforces "forever supportive therapy" in order to make your numbers rather than engaging in proper care. Combine that with political headaches if you don't offer a veteran any care they want (Whitehouse hotline, congressional complaints) and there is no reason to engage in proper care other than wanting to make your own life a bit harder.
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Agreed. The system is utterly, utterly broken and there are absolutely NO incentives for the providers for responding any differently within the context of such a broken system. And there are plenty of very harsh disincentives to engaging in any course of action that would upset a veteran.

It would be irrational to blame providers for acting...rationally, if that makes sense.
 
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I'll do you one better: we HAD Saturday clinic for a long time at our CBOC, but ended up discontinuing it because patients never used it and it was just wasting money.

Project 2025 did talk about reducing eligibility for VA healthcare for certain groups. Now that would actually help access and f/u access issues, lol.
 
cara susanna said:
I'll do you one better: we HAD Saturday clinic for a long time at our CBOC, but ended up discontinuing it because patients never used it and it was just wasting money.

Project 2025 did talk about reducing eligibility for VA healthcare for certain groups. Now that would actually help access and f/u access issues, lol.
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Same--years ago, we had a Saturday half-day clinic that I think was limited mainly to primary care and MH, and that basically went unused. Evening hours seem like they were/are somewhat more popular, but then you have to get leadership either to approve extra compensation for the providers for working past their normal TOD (and I doubt comp time would swing it), or to approve non-traditional work schedules (e.g., 4x10, showing up later then 07:30 or 08:00), which they seem hesitant to do for some reason.
 
AcronymAllergy said:
Same--years ago, we had a Saturday half-day clinic that I think was limited mainly to primary care and MH, and that basically went unused. Evening hours seem like they were/are somewhat more popular, but then you have to get leadership either to approve extra compensation for the providers for working past their normal TOD (and I doubt comp time would swing it), or to approve non-traditional work schedules (e.g., 4x10, showing up later then 07:30 or 08:00), which they seem hesitant to do for some reason.
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I always loved the fact that leadership was so stingy with compensating providers for time spent in scheduled appointments delivering actual care (and verifiable difficult 'work') to patients but has absolutely no issue with all the 'frills' like paying people full-time FTE's to do things like send emails all day long and conduct 'drum circle' sessions or order t-shirts with slogans on them or, etc., etc., etc.

Also, with all the provider vacancies we have...where the hell is all that saved money going to? They couldn't at least pay the providers they have now for time and effort providing extra services after hours? It makes no sense.
 
Fan_of_Meehl said:
I always loved the fact that leadership was so stingy with compensating providers for time spent in scheduled appointments delivering actual care (and verifiable difficult 'work') to patients but has absolutely no issue with all the 'frills' like paying people full-time FTE's to do things like send emails all day long and conduct 'drum circle' sessions or order t-shirts with slogans on them or, etc., etc., etc.

Also, with all the provider vacancies we have...where the hell is all that saved money going to? They couldn't at least pay the providers they have now for time and effort providing extra services after hours? It makes no sense.
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You know, it strikes that in all these discussions of the VA healthcare system, there is not one where it is suggested that the VA is getting better any time soon. Certainly, the days I head about with stories of two hour lunches where clinicians played golf are gone. If all the good jobs are gone, what is the draw of the VA? I get the frustration over drum circles and other nonsense, but those are the last jobs where people are not being squeezed for the last ounce of "productivity". I have managed to have a fairly productive career helping folks without being beholden to "the grid" but I do fear those days are coming to a close. It is quite a shame that we have gotten to a point where even federal service is not considered a decent and stable job (if boring). I remember my dad (a civil servant himself) saying many years ago to go work for the government if you want work and life balance. I wonder what he would say now.
 
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Sanman said:
You know, it strikes that in all these discussions of the VA healthcare system, there is not one where it is suggested that the VA is getting better any time soon. Certainly, the days I head about with stories of two hour lunches where clinicians played golf are gone. If all the good jobs are gone, what is the draw of the VA? I get the frustration over drum circles and other nonsense, but those are the last jobs where people are not being squeezed for the last ounce of "productivity". I have managed to have a fairly productive career helping folks without being beholden to "the grid" but I do fear those days are coming to a close. It is quite a shame that we have gotten to a point where even federal service is not considered a decent and stable job (if boring). I remember my dad (a civil servant himself) saying many years ago to go work for the government if you want work and life balance. I wonder what he would say now.
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when i was on internship 12 years ago, the lunches were definitely always an hour. There was ongoing lunch ping-pong league/tournament amongst some of the psychologists in the rec room. Some psychologists went home for lunch and came back (relatively small town area). The chief locked everything up at 4:29 exactly and really everyone left at 430 on the dot. No one seemed overly stressed or overworked. Like at all. At least not there.
 
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docloufan said:
when i was on internship 12 years ago, the lunches were an definitely always an hour. There was ongoing lunch ping-pong league/tournament amongst some of the psychologists in the rec room. Some psychologists went home for lunch and came back (relatively small town area). The chief locked everything up at 4:29 exactly and really everyone left at 430 on the dot. No one seemed overly stressed or overworked. Like at all. At least not there.
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Funny you say that. My internship at the VA was nothing like that and that was about 15 yrs ago. However, it was also in NYC and I think the culture there is also different. VAs where I did my externship were also quite busy, but not as bad. One of the reasons I chose jobs in less populated areas was a slightly slower pace and the ability to take my time with patients.
 
Sanman said:
Funny you say that. My internship at the VA was nothing like that and that was about 15 yrs ago. However, it was also in NYC and I think the culture there is also different. VAs where I did my externship were also quite busy, but not as bad. One of the reasons I chose jobs in less populated areas was a slightly slower pace and the ability to take my time with patients.
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This was before the MH suite program, MH tx coordinators, CPRS checkbox overloads, and before the Shinseki scandal and really any push for "access" much less "same day access." It was a college town with a pretty old and established VA medical center with full range outpatient medical services, a CLC, A PTSD residential tx program, and an inpatient psych unit. But no inpatient medical beds, i dont think.
 
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docloufan said:
This was before the MH suite program, MH tx coordinators, CPRS checkbox overloads, and before the Shinseki scandal and really any push for access, much less same day access. It was a college town with a VA medical center with full range outpatient medical services, a CLC, A PTSD residential tx program, and an inpatient psych unit. But no inpatient medical beds, i dont think.
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To be fair, interns and even post docs are also often shielded from the issues that staff psychologists face within the VA. I know that I was!
 
cara susanna said:
To be fair, interns and even post docs are also often shielded from the issues that staff psychologists face within the VA. I know that I was!
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well, they weren't really that busy, pretty confident of that. lunches were long (no one EVER ate lunch at their desk), people went home for lunch often, and everyone left right at 430, even the service chief. I'm sure there were plenty of frustrations but it simply was not as busy or overwhelming there at that time as its seems to be at most places now.
 
There HAS to be a better system than the RFS system we use for community care where 1) I have to open up Vista Imaging to view the RFS and 2) if the consult is inappropriate, there is no one delegated to reach out to the patient so it often falls on me, when it's not actually my job 3) I have no easy way to communicate with the non-VA provider about said RFS being inappropriate
 
aim-agm said:
What did he say?
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I just saw a brief clip a friend sent. Paraphrasing, it was something like--he briefly described the SC rating system and then said veterans organizations are encouraging veterans to apply for anything and everything, and to try to take everything they can get from the government, rather than to just apply for what may be necessary based on their service, and to then go on with the next phase of their lives.
 
AcronymAllergy said:
I just saw a brief clip a friend sent. Paraphrasing, it was something like--he briefly described the SC rating system and then said veterans organizations are encouraging veterans to apply for anything and everything, and to try to take everything they can get from the government, rather than to just apply for what may be necessary based on their service, and to then go on with the next phase of their lives.
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I mean, he is not wrong. That said, I know a lot of Trump supporting veterans that are about to be really butthurt.
 
If there's one issue that actually has a good chance of kicking off the 'two-way rifle range' civil war between veterans, it's this one. There are a lot of veterans who feel the s/c disability situation has gotten way out of control...they just don't tend to be the ones that VA MH providers see that often.
 
WisNeuro said:
I thought dog eating Haitians took all of those jobs?
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I was spared because that story went stale and now something else is scary. I think we're mad at the generals right now.
 
Shiori said:
I was spared because that story went stale and now something else is scary. I think we're mad at the generals right now.
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The solution is in the problem: before we can grasp one despair-invoking absurdity, they come out with a new one, ad infinitum (or at least ad 2029)
 
cara susanna said:
I'm kind of at a stage where I'm like, just busting out the popcorn. As awful as it sounds, like, this is apparently what people wanted sooo
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I personally can't wait for tariffs to make groceries more affordable.
 
cara susanna said:
I'm kind of at a stage where I'm like, just busting out the popcorn. As awful as it sounds, like, this is apparently what people wanted sooo
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I'm not happy but I was always prepared for this possibility and planned accordingly. Unfortunately, a lot of good folks will likely face some setbacks who are not as well prepared as I am. That said, all that is left to do is to breakout the popcorn.

Who knows, maybe Trump will double my pay as a government contractor.
 
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Sanman said:
I'm not happy but I was always prepared for this possibility and planned accordingly. Unfortunately, a lot of good folks will likely face some setbacks who are not as well prepared as I am. That said, all that is left to do is to breakout the popcorn.

Who knows, maybe Trump will double my pay as a government contractor.
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So...what is the quality of work-life there now? I have been gone 7 years now. As I said before, it used to be pretty cush before mid 2014, especially at the smaller places. Now it seems more like a workhouse??? Unless in some specialty area?

Do they still do those cushy "Central Office" jobs for the Psychologists where you do some trainings and mostly work remotely and travel once a month or so?

What happened to the Org Development Office based out of the Cinci VA? They had like 10-15 psychologists on staff there at one time to address VA org dysfunction, Lean Process, and other trouble shooting. I almost applied for a post-doc doing that stuff.
 
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docloufan said:
So...what is the quality of work-life there now? I have been gone 7 years now. As I said before, it used to be pretty cush before mid 2014, especially at the smaller places. Now it seems more like a workhouse??? Unless in some specialty area?

Do they still do those cushy "Central Office" jobs for the Psychologists where you do some trainings and mostly work remotely and travel once a month or so?

What happened to the Org Development Office based out of the Cinci VA? They had like 10-15 psychologists on staff there at one time to address VA org dysfunction, Lean Process, and other trouble shooting. I almost applied for a post-doc doing that stuff.
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"10 to 15 psychologists on staff there at one time to address VA org dysfunction, Lean Process, and other troubleshooting."

I don't know why this made me laugh out loud so hard.

But it did.
 
docloufan said:
So...what is the quality of work-life there now? I have been gone 7 years now. As I said before, it used to be pretty cush before mid 2014, especially at the smaller places. Now it seems more like a workhouse??? Unless in some specialty area?

Do they still do those cushy "Central Office" jobs for the Psychologists where you do some trainings and mostly work remotely and travel once a month or so?

What happened to the Org Development Office based out of the Cinci VA? They had like 10-15 psychologists on staff there at one time to address VA org dysfunction, Lean Process, and other trouble shooting. I almost applied for a post-doc doing that stuff.
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There are still central office jobs, though they have not grown and are still filled by the same folks. Up until 2019, I would say it was all business as usual. Post-2020, there were pandemic problems that included death (had staff members die of covid that were refused telehealth accomodations pre-vaccine), followed by demands to return to the office and be normal with shortages of masks and other required equipment in 2021-22 (I was asked to reuse same N95 mask for over a year because they had no replacements). This led to many people quitting and staffing shortages. The rto caused shortages led to bonuses and increased telehealth while they begged those left to stay in 22-2023, followed by a 2024 of hiring freezes and staffing shortages where those left again have to cover in other areas.

Now, with a new administration looming, it may be more shortages, new demands to rto with no available office space, and rollback of those bonuses possible in the future, I imagine it will again be headaches and more requests for weekend and evening volunteer staff to cover shortages. I am seeing a bit of hiring now, but that may all be undone in a few months. There is currently a push to hire telehealth folks at the VISN level to fill in gaps in care for area medical centers. We will see if this trend remains or gets scrapped.

As a specialty psychologist, my job is not terrible and the workload is not crazy. Most folks in outpatient mental health clinics are in a meat grinder and honestly better off in the private practice world. The fewer folks left to do the work, the less that staying seems worth it. After all, what good are vacation days when there is no staff to cover you, so you can't take off? If you remembered to put your vacation in 45 days ahead of time in the first place. It Is death by a thousand cuts and if it had not been for the bonuses in 2023, I would have been gone. Once I have 3 years of high pay, I may still leave (if I am not fired or forced to rto to a nonexistent office first).

The truth is that Biden and McDonough have not been kind the VA employees either and incoming administration seems to want to make things worse.
 
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There are some pretty substantial rumors that the new administration is not going to allow any telework for federal employees, so I'm not sure what that would mean for those cushy VACO jobs
 
cara susanna said:
There are some pretty substantial rumors that the new administration is not going to allow any telework for federal employees, so I'm not sure what that would mean for those cushy VACO jobs
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I wonder what that would look like for all the clinics struggling with space. Even with teleworking and remote positions, space is a significant issue. I imagine addressing actual problems isn't the goal though. We're working off vibes here.
 
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