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

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Psychologist1234 said:
So how safe are VA psychologists in the upcoming RIFs? New memorandum outlining more details does not seem to directly exclude VHA from a RIF.

RIF Memo
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I thought the terminations (I refuse to use the term RIF, it does not apply here) were only for non-essential employees?
 
Fan_of_Meehl said:
I mean, in the 13 yrs I've been at VA, I went from having only three supervisors above me (Psychology Service Chief --> Medical Chief of Staff --> Facility Director) to--by my count-- currently SIX (three new 'layers').
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Counterpoint: My VA has a very unique organizational structure where we have fewer leadership tiers, and it's awful
 
Fan_of_Meehl said:
I mean, in the 13 yrs I've been at VA, I went from having only three supervisors above me (Psychology Service Chief --> Medical Chief of Staff --> Facility Director) to--by my count-- currently SIX (three new 'layers').
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Curious to know if the staff have grown in size as well. I also report to a psychology service chief. However, there is also an overall MH service chief.

I can see that getting thinned out. I can also see getting actual direction being a mess if no one is in charge of just psychology who knows the ins and outs.
 
Psychologist1234 said:
So how safe are VA psychologists in the upcoming RIFs? New memorandum outlining more details does not seem to directly exclude VHA from a RIF.

RIF Memo
Click to expand...

This is near the bottom of the memo:

Finally, agencies or components that provide direct services to citizens (such as Social Security, Medicare, and veterans’ health care) shall not implement any proposed ARRPs until OMB and OPM certify that the plans will have a positive effect on the delivery of such services.
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So basically, sounds like VA healthcare providers are at least temporarily safe.
 
Sanman said:
Curious to know if the staff have grown in size as well. I also report to a psychology service chief. However, there is also an overall MH service chief.

I can see that getting thinned out. I can also see getting actual direction being a mess if no one is in charge of just psychology who knows the ins and outs.
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Having been in a system where leadership of psychology/neuropsych did not actually include such providers, it was a ****ing disaster.
 
Sanman said:
Curious to know if the staff have grown in size as well. I also report to a psychology service chief. However, there is also an overall MH service chief.

I can see that getting thinned out. I can also see getting actual direction being a mess if no one is in charge of just psychology who knows the ins and outs.
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Actually, by my estimation, client-facing and caseload-bearing staffing levels likely shrank while patient load/demand increased substantially.
 
I have some VHA patients who would like to see me in my private practice instead at my cash pay rate. This would be a bad idea, yes?
 
Behaviorismiscool said:
I have some VHA patients who would like to see me in my private practice instead at my cash pay rate. This would be a bad idea, yes?
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That would be a conflict if you are a current government employee. Are you? Did you get VA approval for your pp? If so, the agreement usually specifies conflicts that you need to exclude from your pp. Seeing vets in PP is usually an exclusion.
 
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AsOneDoes said:
To those who do telework (at least some days), are you continuing to telework until that May deadline?
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Will keep my telework days as long as possible and then request extensions for my spouse being deployed, get an adjunct agreement in place, or whatever else I can do. My job is half admin and rhat part requires no in person work.
 
Behaviorismiscool said:
I have some VHA patients who would like to see me in my private practice instead at my cash pay rate. This would be a bad idea, yes
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As long as you’re not approving a VA referral to cover their costs of seeing you in your private practice, it may be ok. Check with your…can’t remember their title. Their the person/people that hang out with privacy, compliance, government ethics and the HIPPA office folks.
 
Sanman said:
That would be a conflict if you are a current government employee. Are you? Did you get VA approval for your pp? If so, the agreement usually specifies conflicts that you need to exclude from your pp. Seeing vets in PP is usually an exclusion.
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"Back in the day" when I checked with my local risk management officer, she essentially said that the only thing I couldn't do was refer the patient to myself. I don't know that you actually have to get VA approval for your private practice, but checking with risk management probably isn't a bad idea.

If a patient, on their own, asks you if they can see you in private practice and pay for it out of pocket (or probably even use their private insurance), I don't believe there's anything actually preventing that. You just can't suggest it or try to convince them of it yourself. The problem would arrive, as was said above, if VA is paying for that care.
 
AcronymAllergy said:
"Back in the day" when I checked with my local risk management officer, she essentially said that the only thing I couldn't do was refer the patient to myself. I don't know that you actually have to get VA approval for your private practice, but checking with risk management probably isn't a bad idea.

If a patient, on their own, asks you if they can see you in private practice and pay for it out of pocket (or probably even use their private insurance), I don't believe there's anything actually preventing that. You just can't suggest it or try to convince them of it yourself. The problem would arrive, as was said above, if VA is paying for that care.
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I feel like it would be very difficult to disprove this was not a self-referral should you be accused of anything.
 
Sanman said:
I feel like it would be very difficult to disprove this was not a self-referral should you be accused of anything.
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Probably true, but that's what the risk management person told me. But all things considered, if you're seeing a veteran in private practice, it's probably safest that you haven't had any contact with them prior to them going to your practice (i.e., they show up for a session/eval, and you then find out they're a veteran).

However, the risk management person unequivocally told me that I wasn't barred from seeing veterans in private practice.
 
The gears of government are slowly starting to turn. It will be scary to watch the next several months how it all plays out.
 
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Shiori said:
The gears of government as slowly starting to turn. It will be scary to watch the next several months how it all plays out.
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One thing that ISN'T changing any time soon is the high need/demand for quality mental health services for trauma, substance abuse, and all other types of MH distress/dysfunction in veterans and even society, as a whole.
 
Fan_of_Meehl said:
One thing that ISN'T changing any time soon is the high need/demand for quality mental health services for trauma, substance abuse, and all other types of MH distress/dysfunction in veterans and even society, as a whole.
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Something, something, boostraps, suck it up snowflake!
 
futureapppsy2 said:
That “pre-decisional” email from the Secretary was so weird and ominous.
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I think it was erg or someone who described (I'll never forget it) working at VA as a psychologist to be like visiting 'Alice in Wonderland' on a daily basis.

When I saw this email at the end of a long busy shift today I thought, 'Wow...they've really upped their Wonderland game.'

And, I gotta be honest...I read a lot but I don't recall ever seeing the word/concept 'Pre-decisional' used in that kind of context or used in that way before. Hell, not sure I've ever even run across that particular adjective 'Pre-decisional' before. I guess I gotta up my neologistical 'bureaucrato-speak' game or something.

It felt too damn much like 'Pre-crime' when I watched that Tom Cruise sci-fi flick for the first time in the theater (Minority Report).
 
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Fan_of_Meehl said:
I think it was erg or someone who described (I'll never forget it) working at VA as a psychologist to be like visiting 'Alice in Wonderland' on a daily basis.

When I saw this email at the end of a long busy shift today I thought, 'Wow...they've really upped their Wonderland game.'

And, I gotta be honest...I read a lot but I don't recall ever seeing the word/concept 'Pre-decisional' used in that kind of context or used in that way before. Hell, not sure I've ever even run across that particular adjective 'Pre-decisional' before. I guess I gotta up my neologistical 'bureaucrato-speak' game or something.

It felt too damn much like 'Pre-crime' when I watched that Tom Cruise sci-fi flick for the first time in the theater (Minority Report).
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Tom Cruise is...weird. Lets not ignore the rumors... and lets not pretend he has been living or functioning in a normal society since before 1992 or so. He's ****ing weird. Ok?

Second: George Carlin would obviously be appalled...and he said as much shortly before he passed. MFer predicted the future. A few times,
over actually.

Third: There is no doubt in my my mind now that people are, essentially, idiots. And get what they deserve. What did Carlin say, exactly? This is your best American schools. This is your best American politicians. It all comes from you. This is the best we can do, folks!

What a ****ing embarrassment.
 
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I know there has been discussion regarding intern trainees not being effected by the hiring freezes (which is great for now)....but how immune do we think are current/future interns from wide-sweeping firings. It doesn't seem like Elon/DOGE dummies are putting much consideration into who gets fired, and on paper could see how temporary employees would be low hanging fruit.

While I am sure APA would get involved eventually, it could certainly make a very big mess that could potentially push back people's ability to graduate get licensed...how many interns are in the VA per year, maybe 2000?
 
tennispsycguy747 said:
I know there has been discussion regarding intern trainees not being effected by the hiring freezes (which is great for now)....but how immune do we think are current/future interns from wide-sweeping firings. It doesn't seem like Elon/DOGE dummies are putting much consideration into who gets fired, and on paper could see how temporary employees would be low hanging fruit.

While I am sure APA would get involved eventually, it could certainly make a very big mess that could potentially push back people's ability to graduate get licensed...how many interns are in the VA per year, maybe 2000?
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I'd be curious to see the number, but that seems high, that'd be well over half of all positions.
 
tennispsycguy747 said:
A smaller number would make us more vulnerable...I just want to be able to graduate in 4 months.
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I don't think current interns are likely to be effected. Coming years may struggle with reduced number of internship spots due to lack of supervisors or training staff. I can't imagine that training director positions will not be effected in the future in some way (reduced time offsets or just being eliminated due to the administrative nature of the postions)
 
We love redundancy only if done by certain people. At least it's acknowledging research is the way to solve a problem rather than vibes and conspiracy theories.
 
WisNeuro said:
"Cancel all research! Now, do some more research on an area that we have thousands of studies on throughout the past few decades!
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I think that the hypothesis that a history of combat-related concussion somehow causes debilitating, untreatable, undetectable, and irreversible neuropathological damage and mental health syndromes has officially achieved undead status at this point.
 
Fan_of_Meehl said:
I think that the hypothesis that a history of combat-related concussion somehow causes debilitating, untreatable, undetectable, and irreversible neuropathological damage and mental health syndromes has officially achieved undead status at this point.
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I mean, no one is really surprised that this is what they are touting and pushing in the news. It's popular with Vets and they can spin this. The public and Vets don't really understand that we've studied/are already studying this to death. They don't understand that other research areas will have a far greater impact on Vet health than this at the moment than this. This is a political spin move, clear and simple. This has little to nothing to do with actually improving Vet's health.
 
They could fed this thread into ChatGPT and get better recommendations for making our least our role more efficient. Given the unorthodox methods being used so far, I wouldn't be surprised if they tried it.
 
WisNeuro said:
I mean, no one is really surprised that this is what they are touting and pushing in the news. It's popular with Vets and they can spin this. The public and Vets don't really understand that we've studied/are already studying this to death. They don't understand that other research areas will have a far greater impact on Vet health than this at the moment than this. This is a political spin move, clear and simple. This has little to nothing to do with actually improving Vet's health.
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The results will also be utterly uninterpretable without some measure(s) of response bias to analyze as a factor or covariate.
 
cara susanna said:

VA Study of Brain Injuries and Mental Health Would Be Ordered Up by Senate Bill | Military.com

www.military.com www.military.com

Wow, what an interesting idea for a research study. Not like this has been done before
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Some questions like:

- did my concussion in Iraq 12 yrs ago in which I experienced a 2 min LOC and no post-traumatic amnesia so utterly and permanently damage my brain so as to cause all of my cognitive, emotional, physical, occupational, relational, spiritual, and existential problems I am experiencing today?

And

- do I have PTSD from my deployment?

are questions that can be 'asked and answered' multiple times via extensive chart review, diagnostic interviewing, objective testing, extensive write-ups complete with references to the scientific/medical literature, extensive psychoeducational feeback, etc.

But they just. won't. stop. being. asked until the answer comes back "yes."

And, unfortunatelty, it is impossible to 'prove' a negative. And all you need is one discrepant 'positive' opinion slapped down on the problem list or into the chart to argue for a service connection.

Did I mention that we have "access issues?"
 
WisNeuro said:
"Cancel all research! Now, do some more research on an area that we have thousands of studies on throughout the past few decades!
Click to expand...

It's a good thing we are getting rid of federal waste. Otherwise we might spend money on things that don't need studying just to satisfy a political agenda. Now, excuse me, while I ignore patient related responsibilities to draft my weekly Elon Musk email.
 
WisNeuro said:
I mean, no one is really surprised that this is what they are touting and pushing in the news. It's popular with Vets and they can spin this. The public and Vets don't really understand that we've studied/are already studying this to death. They don't understand that other research areas will have a far greater impact on Vet health than this at the moment than this. This is a political spin move, clear and simple. This has little to nothing to do with actually improving Vet's health.
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It’s an existing program. It’s repetitive tbi and it is biomarker driven. Might be political to announce it now. But, the current admin has nothing to do with this program.
 
neothanos said:
It’s an existing program. It’s repetitive tbi and it is biomarker driven. Might be political to announce it now. But, the current admin has nothing to do with this program.
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I need to read up on it. I will be particularly intrigued to see what they come up with to flesh out the following (from the article):

""The Precision Brain Health Research Act will help us better understand why and how blast injuries are impacting veterans' mental health and make certain VA is able to quickly incorporate these findings into care for veterans and enable them to receive an accurate diagnosis and treatment plan,"

The 'treatment plan' part will be especially interesting to see operationalized.

Also, "the why and how" refer to concepts like specific etiology/cause whereas most of the research in this area is descriptive/correlational and conclusions about causality are hard to defend or come by.
 
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neothanos said:
It’s an existing program. It’s repetitive tbi and it is biomarker driven. Might be political to announce it now. But, the current admin has nothing to do with this program.
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They are touting the revision to the original Act, but the announcements are marketing do appear to look like it's a new initiative. Which is likely intentional.
 
neothanos said:
I think the difficult thing there in the chronic space is pinning specific cause to an event in an individual. It has taken a long time to get, for example, a specific blood biomarker for Alzheimer’s. Repetitive and blast tbi are more complicated than that. A blood biomarker for cte would be cool and perhaps attainable. But, the equifinality brew of contributing causes to a bad outcome is likely more common and more challenging in assignation of causality. I do think there are threads that can be potentially pulled to modify specific processes. Meaning, there are likely broader impacts to that sort of work.
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Well, we'd probably want to actually validate a set of findings that are specific to CTE in the first place, before we go searching for diagnostic biomarkers.
 
WisNeuro said:
Well, we'd probably want to actually validate a set of findings that are specific to CTE in the first place, before we go searching for diagnostic biomarkers.
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But look how much fun unicorns can be....

Sci Fi Lol GIF by Hallmark Gold Crown
 
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