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

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I’m really struggling.. I’m a probationary employee (8 months in at this point), and I love the job. I have an offer to leave for a substantial pay increase and tenure, I don’t want to leave but I know that being a probie with less than a year of service will put me high on the chopping block in a RIF.
 
I'm obviously biased as I think you all should leave, but if you have an offer for a good pay increase and (hopefully) a great deal more stability/security, seems like the right move. Only real downside is that I can't see the grant funding situation getting any better in the near term. Personally, I'd make the move, but start putting the building blocks for private practice in place in case you need to make a quick pivot.
 
futureapppsy2 said:
I’m really struggling.. I’m a probationary employee (8 months in at this point), and I love the job. I have an offer to leave for a substantial pay increase and tenure, I don’t want to leave but I know that being a probie with less than a year of service will put me high on the chopping block in a RIF.
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Here is my question, why wouldn't you leave? Given the increased pay and security, this sounds like a better opportunity regardless of the current political climate.
 
Sanman said:
Here is my question, why wouldn't you leave? Given the increased pay and security, this sounds like a better opportunity regardless of the current political climate.
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Same question I'd be asking--why don't I want to leave, and are those reasons worth the lower pay and (currently) higher stress and uncertainty?
 
A friend told me someone (a psychologist) just started at our local VA mid-January (literally a day or 2 before all this started) and was so disgusted by everything happening, as well as management/leadership attitudes, that they formally quit yesterday. I imagine this has happened more than a few other times in recent weeks at other VAs too.

If you have something else in the bag, I cant imagine staying at the VA right now. And I cant imagine accepting a Staff Psychologist position offer at this time, starting one now, or starting one soon in the future. AT ALL. That's just nuts to me.
 
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futureapppsy2 said:
I’m really struggling.. I’m a probationary employee (8 months in at this point), and I love the job. I have an offer to leave for a substantial pay increase and tenure, I don’t want to leave but I know that being a probie with less than a year of service will put me high on the chopping block in a RIF.
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Areas that I think would experience the most cuts in a RIF would be positions like the service Administrative Officer or MSAs for specialty clinics when BHIP already has MSAs.

It would be really easy to cut the Mental Health AO and make the Nursing Service AO take on both responsibilities. Or to cut all AOs in a facility and make other people in admin absorb their duties. My guess is size of your facility would likely be relevant.

But that’s applying logic and assuming that clinical care for veterans remains a scared cow during an RIF.

If you think your offer could provide similar satisfaction with more security and increased pay, that’s hard to turn down. Perhaps there will be a VA to return to in the future lol.

Also, I would assume that productivity requirements may increase following an RIF, even if clinicians aren’t cut as there would likely be increased pressure to demonstrate value so folks sticking around may experience unpleasant changes.
 
summerbabe said:
Areas that I think would experience the most cuts in a RIF would be positions like the service Administrative Officer or MSAs for specialty clinics when BHIP already has MSAs.

It would be really easy to cut the Mental Health AO and make the Nursing Service AO take on both responsibilities. Or to cut all AOs in a facility and make other people in admin absorb their duties. My guess is size of your facility would likely be relevant.

But that’s applying logic and assuming that clinical care for veterans remains a scared cow during an RIF.

If you think your offer could provide similar satisfaction with more security and increased pay, that’s hard to turn down. Perhaps there will be a VA to return to in the future lol.

Also, I would assume that productivity requirements may increase following an RIF, even if clinicians aren’t cut as there would likely be increased pressure to demonstrate value so folks sticking around may experience unpleasant changes.
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Being put on grid and having to RTO are pretty much the same effect as a rif for me. If I am no longer a specialty psych provder and essentially BHIP with more complex patients , no reason not to move into a solo pp. But I am pretty sure that you are correct about that happening.
 
Now watch them cut clinical positions and increase 'bookable' hours to fill the entire shift to keep all the higher ups in non-caseload bearing positions.
 
Fan_of_Meehl said:
Now watch them cut clinical positions and increase 'bookable' hours to fill the entire shift to keep all the higher ups in non-caseload bearing positions.
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Considering the acuity and neediness of the population yet another reason to jump to the private sector. If you're going to see 35 patients I'd rather it not be at VA if I could help it
 
psy.d. 2021 said:
Considering the acuity and neediness of the population yet another reason to jump to the private sector. If you're going to see 35 patients I'd rather it not be at VA if I could help it
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Agreed. I'm fine with productivity requirements, assuming they're transparent and reasonable. But if VA is going to work you to the bone while providing no productivity incentive other than the paltry annual bonus psychologists sometimes get, and an ever-dwindling pension plan, you might as well get paid based on the number of people you're seeing and amount of work you're doing.

VA's costs have, from what I know, been increasing year-over-year, so I can appreciate wanting to reign some of that in. But this isn't the answer. And at the end of the day, I really don't think VA should be seen or treated as a for-profit/money-making venture. Then again, I also wouldn't be shocked if there are 80,000 "champion," middle management, and other administrative positions that could be eliminated.
 
AcronymAllergy said:
Agreed. I'm fine with productivity requirements, assuming they're transparent and reasonable. But if VA is going to work you to the bone while providing no productivity incentive other than the paltry annual bonus psychologists sometimes get, and an ever-dwindling pension plan, you might as well get paid based on the number of people you're seeing and amount of work you're doing.

VA's costs have, from what I know, been increasing year-over-year, so I can appreciate wanting to reign some of that in. But this isn't the answer. And at the end of the day, I really don't think VA should be seen or treated as a for-profit/money-making venture. Then again, I also wouldn't be shocked if there are 80,000 "champion," middle management, and other administrative positions that could be eliminated.
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This.

It is going to be a crucial empirical test of the actual wisdom (vs. cleverness) of "those in charge" to see which positions they choose to nominate to cut as part of any RIF plan: (a) positions of providers who actually see patients, full-time, and who have large caseloads for whom they also serve as their, de facto, case managers or (b) the 'expertologist/excellentologist' class who sit in meetings, write/enforce policies/procedures, and who constantly spam emails exhorting us to eat healthy, brush our teeth, pledge allegiance to mission statements, and join in all the pompom-waving antics of the PR mission. It will probably be (c): all positions (including providers who see patients all day every day) will have to 'bear the burden' of RIF 'equally' and serve up 20% of their workforce for the chopping block.

"Leadership."

Meanwhile, I have to see a veteran who is 100% service-connected for PTSD whom I must 'screen for PTSD' and document via completion of that 'clinical reminder'--5 yes/no questions [PC-PTSD-5 or something] just like I have to 'screen' all the patients diagnosed with MDD via the PHQ-2 or risk 'failing' a chart audit due to non-compliance with policy/procedure related to 'clinical reminders.' They're literally paying a licensed doctoral-level psychologist to do chart audits to play "gotcha games" to make sure I'm not failing to 'screen' for conditions that have already been diagnosed. One of the first things I'm supposed to do in an initial interview with a 100% s/c for PTSD veteran in an intake is to ask him, essentially, "Have you ever experienced a traumatic event in your lifetime, yes or no?"
 
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AcronymAllergy said:
Agreed. I'm fine with productivity requirements, assuming they're transparent and reasonable. But if VA is going to work you to the bone while providing no productivity incentive other than the paltry annual bonus psychologists sometimes get, and an ever-dwindling pension plan, you might as well get paid based on the number of people you're seeing and amount of work you're doing.

VA's costs have, from what I know, been increasing year-over-year, so I can appreciate wanting to reign some of that in. But this isn't the answer. And at the end of the day, I really don't think VA should be seen or treated as a for-profit/money-making venture. Then again, I also wouldn't be shocked if there are 80,000 "champion," middle management, and other administrative positions that could be eliminated.
Click to expand...

It is not simply about productivity, it is also about extra duties. I am fine seeing PP numbers in PP, I am not fine doing pp numbers with VA paperwork and random CSREs popping up. Do they plan on loosening up the paperwork and maybe getting me some dictation software? Doubtful given that I haven't been able to secure an RBANS for myself in nearly a decade of requests.
 
I've been planning on buying a house...and now I'm apprehensive. We are really picky, and a great house just came up. Obviously there's no way to know the future, but has anyone heard about psychologist jobs potentially being cut? I'm out of probation.
 
Sanman said:
It is not simply about productivity, it is also about extra duties. I am fine seeing PP numbers in PP, I am not fine doing pp numbers with VA paperwork and random CSREs popping up. Do they plan on loosening up the paperwork and maybe getting me some dictation software? Doubtful given that I haven't been able to secure an RBANS for myself in nearly a decade of requests.
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Meanwhile, in this week's edition of "If People Bend The Truth Sufficiently, Eventually Reality Snaps Back":

I have been encountering cases in which the veteran is facing the following dilemma:

- Been 100% service-connected for years, receiving full monthly benefits, reporting severe chronic PTSD sxs for years (PCL-5 scores >60)...but...now requesting weight loss surgery...for which they need psychological 'clearance'...psychologist does eval for bariatric surgery and notes they fail to qualify until/unless their PTSD is successfully treated with EBP's.

OMG. "What do???"

Anyone else seeing this?

Anyone else want to consider co-authoring a paper documenting the insane/instant efficacy of a single-session "cure" for chronic, debilitating PTSD in the form of "pre-bariatric surgery psych evals?" I've been amazed at the sudden collapse of PCL-5 scores--post-eval--from in the 70's to the single digits overnight.
 
Sanman said:
It is not simply about productivity, it is also about extra duties. I am fine seeing PP numbers in PP, I am not fine doing pp numbers with VA paperwork and random CSREs popping up. Do they plan on loosening up the paperwork and maybe getting me some dictation software? Doubtful given that I haven't been able to secure an RBANS for myself in nearly a decade of requests.
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Also agreed, although there's also paperwork and other in PP of course, and you generally don't get paid for that part of things (depending, and primarily on the clinical side).
 
AsOneDoes said:
I've been planning on buying a house...and now I'm apprehensive. We are really picky, and a great house just came up. Obviously there's no way to know the future, but has anyone heard about psychologist jobs potentially being cut? I'm out of probation.
Click to expand...

That is a personal decision and one that really depends on your situation (both job and otherwise). There are no specific plans to cut psychologists. However, there is no clear cut RTO plans being spelled out either. If you are outpatient and have an office at a medical center, I imagine you are relatively safe.

That said, it also depends on your finances. If you could ride out a patch of unemployment and afford a house, it may be best to buy while you have a w-2 salary right now. If RTO or a job loss may mean losing the house, I would reconsider buying at this time.
 
AcronymAllergy said:
Also agreed, although there's also paperwork and other in PP of course, and you generally don't get paid for that part of things (depending, and primarily on the clinical side).
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This is true. However, my pp notes were always concise and often had check boxes built in. Insurance paperwork was annoying, but even that is improving as EHRs were less ubiquitous when I was outside the VA.
 
AsOneDoes said:
I've been planning on buying a house...and now I'm apprehensive. We are really picky, and a great house just came up. Obviously there's no way to know the future, but has anyone heard about psychologist jobs potentially being cut? I'm out of probation.
Click to expand...
Every federal agency is supposed to submit a RIF plan to OPM by 3/13. Supposedly the goal is to cut 83k from the entire workforce. And it seems unknown if this will happen all at once of if there will be multiple rounds of RIF.

Upon OPM approval, each facility will then start to let go of people and we’ll see if any clinical staff are included.

My facility medical director said our RIF plan is going to be 100% created by our VISN network director.

Not sure if that’s 100% truthful (ie feels like the medical director would at least have some soft influence on the plan) or if this is to set up a good cop/bad cop scenario since the medical director will be in charge of implementing the layoffs and restructuring.

Are you geographically committed to this area? Including if you didn’t have this VA job? What are your employment prospects outside of VA? Do you have a partner who has a stable income or are you solo funding this home? Would you have any savings remaining following a down payment, closing costs and moving in costs?

Even if psychologists are spared from RIF, it’s possible that work conditions in the future can deteriorate to the point where one may want to get RIFed (since that comes with severance and unemployment benefits while voluntary resignation does not).
 
AsOneDoes said:
I've been planning on buying a house...and now I'm apprehensive. We are really picky, and a great house just came up. Obviously there's no way to know the future, but has anyone heard about psychologist jobs potentially being cut? I'm out of probation.
Click to expand...
i wouldn't. And i wouldn't plan on making VA a career. Its not going to get any better. Only substantially worse.
 
Sanman said:
That is a personal decision and one that really depends on your situation (both job and otherwise). There are no specific plans to cut psychologists. However, there is no clear cut RTO plans being spelled out either. If you are outpatient and have an office at a medical center, I imagine you are relatively safe.

That said, it also depends on your finances. If you could ride out a patch of unemployment and afford a house, it may be best to buy while you have a w-2 salary right now. If RTO or a job loss may mean losing the house, I would reconsider buying at this time.
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Agreed. Another wrinkle without the W-2, if you go the PP route, is that you'll probably need a good one or two years of tax returns to qualify for a mortgage.

If I had adequate savings, financial stability, and possibly a second income at home, and the house really was perfect, I might take the plunge. If not, I might stay put.
 
summerbabe said:
Every federal agency is supposed to submit a RIF plan to OPM by 3/13. Supposedly the goal is to cut 83k from the entire workforce. And it seems unknown if this will happen all at once of if there will be multiple rounds of RIF.

Upon OPM approval, each facility will then start to let go of people and we’ll see if any clinical staff are included.

My facility medical director said our RIF plan is going to be 100% created by our VISN network director.

Not sure if that’s 100% truthful (ie feels like the medical director would at least have some soft influence on the plan) or if this is to set up a good cop/bad cop scenario since the medical director will be in charge of implementing the layoffs and restructuring.

Are you geographically committed to this area? Including if you didn’t have this VA job? What are your employment prospects outside of VA? Do you have a partner who has a stable income or are you solo funding this home? Would you have any savings remaining following a down payment, closing costs and moving in costs?

Even if psychologists are spared from RIF, it’s possible that work conditions in the future can deteriorate to the point where one may want to get RIFed (since that comes with severance and unemployment benefits while voluntary resignation does not).
Click to expand...
Thank you for this info and perspective. It feels very tricky because the answer to every question is positive, with the exception of being geographically committed to the area if I didn't have this job.
 
AsOneDoes said:
with the exception of being geographically committed to the area if I didn't have this job.
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If both you and your partner were no longer employed in your current jobs, would you absolutely remain in the area? Look locally but also explore other options? Definitely or probably move?

Feels like this might be a more important question to answer than whether or not you’ll continue to work for the VA (since our employment prospects are solid) because a dream house in a not so dreamy location will probably cause some major headaches in the future. Good luck!
 
summerbabe said:
If both you and your partner were no longer employed in your current jobs, would you absolutely remain in the area? Look locally but also explore other options? Definitely or probably move?

Feels like this might be a more important question to answer than whether or not you’ll continue to work for the VA (since our employment prospects are solid) because a dream house in a not so dreamy location will probably cause some major headaches in the future. Good luck!
Click to expand...
Before all this chaos, I was expecting to live here and work for this VA for AT LEAST five more years, if not the rest of my career. My partner is a remote worker (not for the government, thankfully!).

If I lost my job, I'd definitely consider alternative locations. The location I'm in has very few houses that interest me (as an example, very few areas have sidewalks, but there's other factors that are hard to find as well that aren't worth getting into). With how picky we are, it's hard to know what may be foolish - buying a house (we have been looking for several months, and very little has interested us) or continue renting due to fear of losing my job.
 
AsOneDoes said:
Before all this chaos, I was expecting to live here and work for this VA for AT LEAST five more years, if not the rest of my career. My partner is a remote worker (not for the government, thankfully!).

If I lost my job, I'd definitely consider alternative locations. The location I'm in has very few houses that interest me (as an example, very few areas have sidewalks, but there's other factors that are hard to find as well that aren't worth getting into). With how picky we are, it's hard to know what may be foolish - buying a house (we have been looking for several months, and very little has interested us) or continue renting due to fear of losing my job.
Click to expand...

Considering stability considerations and current lending rates, I personally would recommend strongly against buying.
 
psy.d. 2021 said:
This guy is why I've heard from veterans that chaplains get a bad rap

The killer comes bearing a smile
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Is there a reputation for chaplains? I have been trying to speak to one about a patient and have gotten crickets for over a month.
 
cara susanna said:
To take a pause from all of the political stuff at the moment...

STOP CALLING IT NEUROPSYCHIATRIC TESTING
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If it makes you feel better, I commonly get that in the community as well. And of course back when I was at VA. From referrals sources I've worked with for years and who know I'm a neuropsychologist, not a psychiatrist. I think it's just a force of habit term, depending on where folks trained and what they're familiar with. Sorta kinda like how a patient might use the term X-ray or MRI to mean any type of diagnostic imaging.
 
AcronymAllergy said:
Same question I'd be asking--why don't I want to leave, and are those reasons worth the lower pay and (currently) higher stress and uncertainty?
Click to expand...

Come work for me. I can give you low pay, and random deadlines, if that's something you need.
 
PsyDr said:
Come work for me. I can give you low pay, and random deadlines, if that's something you need.
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Don't forget to also include weekly team huddles that are primarily gripe sessions, and about 12 to 15 questions, checklists, and/or templates that need to be completed at every appointment and included in all chart notes. Oh, and shared office space.

I was happy to hear last year about the raises that many/most VA psychologists were getting. Unfortunately, the new pay may no longer be worth the hassle. Although I imagine a lot can depend on how supportive local leadership is.
 
Shiori said:
Is there a reputation for chaplains? I have been trying to speak to one about a patient and have gotten crickets for over a month.
Click to expand...

I have worked with some great ones and some terrible ones. Depends on the chaplain. I am still friends with at least one, just not ones that sound like a bad used car salesman.
 
AcronymAllergy said:
Don't forget to also include weekly team huddles that are primarily gripe sessions, and about 12 to 15 questions, checklists, and/or templates that need to be completed at every appointment and included in all chart notes. Oh, and shared office space.

I was happy to hear last year about the raises that many/most VA psychologists were getting. Unfortunately, the new pay may no longer be worth the hassle. Although I imagine a lot can depend on how supportive local leadership is.
Click to expand...

Weekly huddles? Lol, they became daily huddles a couple of years ago because someone had an idea...


The raises and the telework kept a lot of people at the VA after a cluster*uck of 1.5 years that was COVID. It was the apology. At this point many that never even considered leaving are looking for new jobs.
 
I'm scanning my trash (used the Outlook rule thing to automate anything from this email) because there are some nice moments of humor embedded. Some fav subject lines include:

i like turtles
STOP ELLLONNNNN!!!!
Reply all to resign
The extended warranty on your car is about to expire
Does this count as one of my 5 accomplishments?
FYI Adrien Brody did not deserve best actor
DOGE secret intelligence and productivity test
AHHHHHHHHHHHHHHHHH
 
summerbabe said:
I'm scanning my trash (used the Outlook rule thing to automate anything from this email) because there are some nice moments of humor embedded. Some fav subject lines include:

i like turtles
STOP ELLLONNNNN!!!!
Reply all to resign
The extended warranty on your car is about to expire
Does this count as one of my 5 accomplishments?
FYI Adrien Brody did not deserve best actor
DOGE secret intelligence and productivity test
AHHHHHHHHHHHHHHHHH
Click to expand...

The Adrien Brody one was my favorite. Good thing nobody said anything about Mikey Madison or I'd have to reply! The ones about Elon and DOGE are funny too.

There was also someone offering to give out a cookie recipe.
 
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