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

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When you guys get thank you emails from internship applicants, do you respond? I feel so impolite not doing so, but I also don't want to set off an endless circle of thanking.
 
cara susanna said:
When you guys get thank you emails from internship applicants, do you respond? I feel so impolite not doing so, but I also don't want to set off an endless circle of thanking.
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This might be your best option:

Finger Gun Reaction GIF by MOODMAN
 
cara susanna said:
When you guys get thank you emails from internship applicants, do you respond? I feel so impolite not doing so, but I also don't want to set off an endless circle of thanking.
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Not that I get many as I am not as directly involved as others, but no, I or colleagues, don't usually respond unless there is a question or other reason to do so. You can write up a generic response to copy and paste if you would like.
 
cara susanna said:
I just got alerted to a note from MSA saying that I had failed to make minimum scheduling efforts for a patient who no showed and asking me to complete the contact attempts now. This appt was more than 6 months ago.
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Nothing like paying an MSA to tell a healthcare provider to do a job that belongs to an MSA in any other healthcare system in the world. These are the moments where you want to burn it all down.
 
cara susanna said:
I just got alerted to a note from MSA saying that I had failed to make minimum scheduling efforts for a patient who no showed and asking me to complete the contact attempts now. This appt was more than 6 months ago.
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As I have said before, the VA is RUN by secretaries and social workers. PhD/PsyD's are at the bottom of the totem pole.
 
cara susanna said:
To be fair, the MSA acknowledges that this is incredibly silly but it's VA policy. It's the policy I hate, lol
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It's not about that individual MSA, but someone made the call that providers need to do this and not MSAs. Yet, every other system decided this makes no sense. Where is DOGE when you need common sense reform? Too busy pushing community care and firing people most likely.
 
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cara susanna said:
I'm really curious for you to expand on that, lol
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I remember how much prep I got from my program. We did mock interviews. My mentor, the DCT, and other faculty looked over my materials and helped me polish things. They walked me through all of my site choices and we made sure I was a good fit and I met all the requirements.

Being on the other side, I am seeing applications where they are WAY too low on hours to be applying anywhere. Unless they live at their last practicum site, the hours don't make sense.

I don't need thoroughly tailored cover letters, but I expect they'll at least mention specific rotations they're interested in.

If they make it to the interview, it seems like they're considering a question for the very first time. We are not throwing curve balls. "Tell about a time you faced an ethical dilemma and how you resolved it?" Stuff like that.
 
Shiori said:
I remember how much prep I got from my program. We did mock interviews. My mentor, the DCT, and other faculty looked over my materials and helped me polish things. They walked me through all of my site choices and we made sure I was a good fit and I met all the requirements.
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This was my experience as well in my program (graduated about 6 years ago at this point). Even for some practicum sites this was standard.
Shiori said:
Being on the other side, I am seeing applications where they are WAY too low on hours to be applying anywhere. Unless they live at their last practicum site, the hours don't make sense.

I don't need thoroughly tailored cover letters, but I expect they'll at least mention specific rotations they're interested in.

If they make it to the interview, it seems like they're considering a question for the very first time. We are not throwing curve balls. "Tell about a time you faced an ethical dilemma and how you resolved it?" Stuff like that.
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I'm wondering , if more recently, this is due to effects of the pandemic (i.e. more virtual classes, perhaps even virtual practicum experiences and less of face to face classes, practicum groups, in person supervision and experiences.)
 
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I haven't run into that with the people I've interviewed, but my sample size is admittedly pretty small. I don't review applications so I wouldn't see the people that didn't make the cut, too.
 
I actually don't think my program offered any formal prep for internship; everything was done informally and primarily with fellow students. I honestly don't even remember if I new what internship was the first couple years in my program. They'd had consistently high placement rates, so I don't think anyone thought to do anything different. I imagine things have changed since then, though, as more programs seem to be prepping students ahead of time.
 
cara susanna said:
Hot take: all VHA patients should be required to have secure messaging enabled
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How many secure messages are you getting a day right now? You may regret that one day.

I'm out of the VA these days, but in my system this is the #1 way patients reach out. So we have to communicate in these messages between sessions, on lunch, etc. We have no additional built in time for it. Its tough. About half use it well for its administrative purpose (e.g., schedule changes, heads up about why the cancelled their visit), about half try to use it for crisis and clinical care. I would love to go back to having a barrier in place and not all my patients having a way to type whatever they want to me whenever they want and be on the clock and liable to respond with no additional build in clinical time to do so. Our physicians at least have desk medicine assistants to filter all the daily secure messages and weed out ones that don't need urgent replies triage the urgent stuff. Maybe one day us too.
 
AbnormalPsych said:
How many secure messages are you getting a day right now? You may regret that one day.

I'm out of the VA these days, but in my system this is the #1 way patients reach out. So we have to communicate in these messages between sessions, on lunch, etc. We have no additional built in time for it. Its tough. About half use it well for its administrative purpose (e.g., schedule changes, heads up about why the cancelled their visit), about half try to use it for crisis and clinical care. I would love to go back to having a barrier in place and not all my patients having a way to type whatever they want to me whenever they want and be on the clock and liable to respond with no additional build in clinical time to do so. Our physicians at least have desk medicine assistants to filter all the daily secure messages and weed out ones that don't need urgent replies triage the urgent stuff. Maybe one day us too.
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No, I mean, that's a very valid concern. But sometimes I need to send patients things that I have no real way to do that outside of snail mailing, which I also have to do myself and is time intensive. I think it's still okay to do a one-way email, but I doubt that will continue and I don't love doing that.
 
cara susanna said:
No, I mean, that's a very valid concern. But sometimes I need to send patients things that I have no real way to do that outside of snail mailing, which I also have to do myself and is time intensive. I think it's still okay to do a one-way email, but I doubt that will continue and I don't love doing that.
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Oh I see. Yeah that feature is awesome. And it is recorded when they read the message. If you have one way messaging then you guys are doing better than us with that. That sounds ideal. Ours doesn't have that feature. It is two way only and open by default to everyone.
 
Note: this is all my personal experience and likely not generalizable. As someone currently applying for internship and prepping for interviews, the amount of time the DCT and faculty help students prepare is likely directly inversely proportional to how much effort the student puts in themselves and also how aware they are of their career goals, training needs, etc. For example, I narrowed down all my sites myself, listed them based on perceived competitiveness, and began working on all my essays based on sample essays found online and through examples provided from prior students that matched in my area of interest. I only recruited faculty and mentors for assistance in reviewing my finalized cover letters and essays.
Other students in my program were basically hand held throughout the process and the DCT and their faculty advisor helped them do everything. I was surprised at genuinely how much assistance they asked for, to the extent that it felt like they weren't even the one applying. Whether this is good or not is a different discussion.
 
psy.d. 2021 said:
They are talking about privatizing USPS again. Speculating, VA will continue to be a target for that. They can't even rollout an EHR, imagine privatizing the entire system?
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They will do it piecemeal.
 
AcronymAllergy said:
Yeah, I could see privatizing (or at least trying to privatize) many specialties but maybe trying to keep some, like primary care and mental health, within VA.
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That seems to be a large part of the long term plan. I imagine pushing community care and freezing hiring will come first to force attrition.
 
AcronymAllergy said:
Yeah, I could see privatizing (or at least trying to privatize) many specialties but maybe trying to keep some, like primary care and mental health, within VA.
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I'd be curious if Vet's voting behavior would change if they got the same ****ty care that most other Americans received? I'm all aboard the VA privatization train at this point, this is what you voted for ****os!
 
Idk, that DOGE "bill" or whatever made the VA an exception from the other agencies.

But, yeah, I'd actually kind of love for people who hate the VA to see what the private healthcare world is like.
 
cara susanna said:
Idk, that DOGE "bill" or whatever made the VA an exception from the other agencies.

But, yeah, I'd actually kind of love for people who hate the VA to see what the private healthcare world is like.
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Did I miss this?
 
cara susanna said:
Idk, that DOGE "bill" or whatever made the VA an exception from the other agencies.

But, yeah, I'd actually kind of love for people who hate the VA to see what the private healthcare world is like.
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Almost every patient I had at VA who went out into the community came back to VA and said how bad it was, how much the doctors didn't understand them, etc.
 
cara susanna said:
www.fedsmith.com

DOGE Acts Introduced Targeting Federal Employees | FedSmith.com

The DOGE Acts have been formally introduced and would directly impact federal employees.
www.fedsmith.com www.fedsmith.com
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Thanks for that. I heard about the bills but had not read the most important part:

"This is a group of three bills that would cut federal spending by 1%, 2%, and 5% via spending cuts in FY 2026 and each fiscal year thereafter. They would exclude the Department of Defense, Department of Homeland Security, Department of Veterans Affairs, and National Nuclear Security Administration"

Perhaps we won't be an immediate target of DOGE then.
 
Sanman said:
Needy patients are generally a drag on billables. The VA is full of needy patients.
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Seemed to irritate some people that they could be terminated as patients, such as for threatening providers or no-showing appointments.

Also had multiple patients say they just preferred VA providers because they seemed to do a better/more thorough job.
 
AcronymAllergy said:
Seemed to irritate some people that they could be terminated as patients, such as for threatening providers or no-showing appointments.

Also had multiple patients say they just preferred VA providers because they seemed to do a better/more thorough job.
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Imagine that!
 
Our access is garbage, the consults/intakes keep rolling in, and we have a provider who just announced they're leaving (granted, it's to an internal position that's also needed, but losing a full time therapist is still the last thing we need). AND I had a second intake scheduled with me this week, when I'm only supposed to be doing one every other week.
 
psy.d. 2021 said:
Well they've already been freezing hiring and will be doing so for the foreseeable future
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They were due to the budget constraints. However, I am currently see backfill getting approved and hired at a few locations. With the budget shortfall not as bad as advertised and Trump coming there seems to be some movement now.
 
Does anyone's VA (or the VA in general) have a specific policy about writing Emotional Support Animal letters?
 
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