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

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Shiori said:
For the people who post regularly, I think we're all well aware of the pros and cons of the VA. We get "nudged" to leave regularly.

Any new people stumbling upon this thread for the first time will literally see 128 pages of ranting about the VA.

I already have complaints about my little private practice. It's fun. I love it. It's still work, and it has its own issues.

The VA pays more than the local hospitals. The local hospitals have been in person for a couple of years already. Please trust that people know what they're doing.
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Oh, if experience has shown us anything, it's that this is far from true. It's why some of us in the medicolegal world make such good money 😉
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Members don't see this ad :)
Fan_of_Meehl said:
Remember the 'Air Commission' report?

"This website provides information regarding the Department of Veterans Affairs' (VA) recommendations to the Asset and Infrastructure Review (AIR) Commission to modernize and realign the VA health care system."

www.va.gov

VA.gov | Veterans Affairs

Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.
www.va.gov www.va.gov

Name your clinic 'The Veterans F-AIRs Clinic'

Emphasis on the "*F*"
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Lol!

Can't forget about the AIR Commission. After all, Project 2025 adopted all of its recs for VHA.
 
Shiori said:
For the people who post regularly, I think we're all well aware of the pros and cons of the VA. We get "nudged" to leave regularly.

Any new people stumbling upon this thread for the first time will literally see 128 pages of ranting about the VA.

I already have complaints about my little private practice. It's fun. I love it. It's still work, and it has its own issues.

The VA pays more than the local hospitals. The local hospitals have been in person for a couple of years already. Please trust that people know what they're doing.
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Plus, the VA has set/stable hours and pays regardless of no-shows, which is nice.
 
futureapppsy2 said:
Plus, the VA has set/stable hours and pays regardless of no-shows, which is nice.
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Thanks for this info. I always wondered about that. I'm thinking, 'Yeah...there's no way that private providers are just going to 'eat' all these no-shows and last minute cancellations.' Now it all makes more sense.
 
Pragma said:
And good but not great benefits. Why do people think they are great?
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They're better or comparable to a lot of the local places and with better pay. I also have a spouse in corporate America and his benefits package significantly makes up for anything lacking from the VA. I also get 12 weeks of maternity leave, which has become relevant recently.
 
Fan_of_Meehl said:
Thanks for this info. I always wondered about that. I'm thinking, 'Yeah...there's no way that private providers are just going to 'eat' all these no-shows and last minute cancellations.' Now it all makes more sense.
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There is usually a no show policy stating a fee if you no show with less than 24 hrs notice. A lot providers give one free warning and then charge.

That said, no show rates are nowhere near the VA. Snow days were an issue up north. With telehealth now, not a problem.
 
Fan_of_Meehl said:
Thanks for this info. I always wondered about that. I'm thinking, 'Yeah...there's no way that private providers are just going to 'eat' all these no-shows and last minute cancellations.' Now it all makes more sense.
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The nice thing is, we generally don't eat these. On the clinical side, my no show rate is exceedingly small. On the cash pay and IME side, they pay for the time regardless of whether or not they show up. I actually love my medicolegal no-shows. I get paid, and then I just do other medicolegal work that I need to get finished up, it's like double dipping.
 
Yeah, private practice can be a great option, but let's not act like hospitals and universities don't have their own issues. My current university is following full RTO as well. It's all ridiculous.
 
thebalmofhurtminds said:
Yeah, private practice can be a great option, but let's not act like hospitals and universities don't have their own issues. My current university is following full RTO as well. It's all ridiculous.
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I don't see anyone calling non-VA hospitals a panacea in this thread.
 
WisNeuro said:
I won't be as forceful as some, but in the many people I know who have left the VA, myself included, I have never heard anyone regret that decision. And that was before all of this recent nonsense with the Trump admin.
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I know people who regretted it. They've tried to come back and they can't because they burned bridges here.

Remember that not all of us live in large metro areas, too. Options outside of the VA may be more limited. And you can't tell me that private practice won't be impacted by this administration in terms of insurance reimbursement rates and economic conditions that may make people less likely to prioritize therapy.
 
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cara susanna said:
I know people who regretted it. They've tried to come back and they can't because they burned bridges here.

Remember that not all of us live in large metro areas, too. Options outside of the VA may be more limited.
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In some areas, but if anything, I make my best money (out of town/travel fees) to leave the metro to do work in more rural areas. They can't find anyone in their catchment area to do the work, so they'll pay me to go out there. I travel to your state quite a bit these days. As for the clinical side, with intervention/therapy work, one could easily fill a schedule with mostly local patients, and supplement with virtual patients through PSYPACT rules if needed.
 
I will do all of that only if I get to also do tarot readings for my clients and charge them extra for the experience.
 
Shiori said:
I will do all of that only if I get to also do tarot readings for my clients and charge them extra for the experience.
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Just become a Witch/Life Coach and you can do whatever the hell you want. In some states you can also become an ND with minimal training and throw some meds/supplements at them.
 
WisNeuro said:
Just become a Witch/Life Coach and you can do whatever the hell you want. In some states you can also become an ND with minimal training and throw some meds/supplements at them.
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Eh, I have to do something with this doctorate. I will keep on plugging along and making mischief.
 
WisNeuro said:
I don't see anyone calling non-VA hospitals a panacea in this thread.
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Was referring to this quote: "Do you have any idea how common it is for Ph.Ds to have scheduling flexibility and work from home days outside the VA? It's 2025, folks. It's the norm! Live in the now!"
 
thebalmofhurtminds said:
Was referring to this quote: "Do you have any idea how common it is for Ph.Ds to have scheduling flexibility and work from home days outside the VA? It's 2025, folks. It's the norm! Live in the now!"
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Sure, one person, but I'd say the vast majority is either pushing private practice, or simply stating that while non-VA hospitals have their own issues, they pale in comparison to the VA. Having worked a variety of settings, I'd choose a non-VA system any day at this point if for some unknown reason I moved out of private practice.
 
WisNeuro said:
Sure, one person, but I'd say the vast majority is either pushing private practice, or simply stating that while non-VA hospitals have their own issues, they pale in comparison to the VA. Having worked a variety of settings, I'd choose a non-VA system any day at this point if for some unknown reason I moved out of private practice.
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With exactly zero psychologists employed at my local medical center and only a few specialty positions at the largest medical centers in the metro, there are not a lot of choices there and plenty of competition with the VA emptying out.
 
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Shiori said:
There are like...10 people who post here regularly. "Vast" is doing a lot of work.
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Po-tay-toh, Po-tah-to...

Sanman said:
With exactly zero psychologists employed at my local medical center and only a few specialty positions at the largest medical centers in the metro, there are not a lot of choices there and plenty of competition with the VA emptying out.
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Come to the dark side/PP..it's all warm and inviting.
 
Personally, I never thought VA was a bad gig (until the current administration). I just got burned out due to a variety of factors. For a W-2 position, telework was never a big deal for me, and even during COVID, I went into the office every day. VA is probably one of the best places to work if you enjoy training, and particularly if you want to get paid to be involved in training.

If the SC system could somehow be made entirely separate from VHA, I have a feeling it would make so, so many clinicians' professional lives more tolerable.
 
AcronymAllergy said:
Personally, I never thought VA was a bad gig (until the current administration). I just got burned out due to a variety of factors. For a W-2 position, telework was never a big deal for me, and even during COVID, I went into the office every day. VA is probably one of the best places to work if you enjoy training, and particularly if you want to get paid to be involved in training.

If the SC system could somehow be made entirely separate from VHA, I have a feeling it would make so, so many clinicians' professional lives more tolerable.
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Yes. For me, the two main issues that contribute to burnout as a MH clinician are:

1) the multifarious woes caused by the s/c and disabled lifestyle aspects of clinical practice and

2) the massive increase in policy/procedure/nitpicking/gotcha-checking and paperwork in MH practice at VA over the past 10-15 years. Relatedly, the hordes of extra bosses, pseudo-bosses, and empowered excellentologists and expertologist positions that have proliferated that now almost outnumber practicing providers with MH caseloads.

Eliminate #1 and roll back the clock 10-15 years, it wouldn't be as bad a practice environment.
 
Non-VA hospitals generally go with social workers because it's cheaper and the bundled reimbursement is the same. Psychologists generally get hired for specialty positions doing evals.

A good deal of group practices are offering crappy splits for not a ton in return. Still 1099 usually so forget even good benefits....how about no benefits.

The techbro VC companies take most of your fee and are 1099. Not worth anyone's time honestly.

Your best bet is PP...a market that seems to be saturating and doesn't guarantee you get paid.

Combined with the fact that I'm in EDRP right now...it's hard for me to find something that works. I'm not going to leave VA to go to something that doesn't work for me.
 
Fan_of_Meehl said:
Yes. For me, the two main issues that contribute to burnout as a MH clinician are:

1) the multifarious woes caused by the s/c and disabled lifestyle aspects of clinical practice and

2) the massive increase in policy/procedure/nitpicking/gotcha-checking and paperwork in MH practice at VA over the past 10-15 years. Relatedly, the hordes of extra bosses, pseudo-bosses, and empowered excellentologists and expertologist positions that have proliferated that now almost outnumber practicing providers with MH caseloads.

Eliminate #1 and roll back the clock 10-15 years, it wouldn't be as bad a practice environment.
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So, you're saying, if it didn't suck so bad, then it wouldn't suck so bad there? 🙂
 
WisNeuro said:
I won't be as forceful as some, but in the many people I know who have left the VA, myself included, I have never heard anyone regret that decision. And that was before all of this recent nonsense with the Trump admin.
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I am maybe rare bird that left the VA for private sector hospital and actually miss the VA enough to be returning. It does seem like folks that leave for private practice seem pleased with their decisions though. Grass isn't always greener, and hospital closures and layoffs happen outside the VA too, though with much less chaos than what is happening at the moment.
 
JustNoticing said:
I am maybe rare bird that left the VA for private sector hospital and actually miss the VA enough to be returning. It does seem like folks that leave for private practice seem pleased with their decisions though. Grass isn't always greener, and hospital closures and layoffs happen outside the VA too, though with much less chaos than what is happening at the moment.
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Hospital is hospital to me. Not much of a difference honestly whether VA or private. They try to be competitive. Your own PP is a whole different ball game.
 
Sanman said:
Hospital is hospital to me. Not much of a difference honestly whether VA or private. They try to be competitive. Your own PP is a whole different ball game.
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For many things, definitely. I did, however, have much more flexibility and freedom when I worked in a non-VA hospital. No one gave a **** where I did my work as long as it got done, patients were seen, and I attended the meetings I needed to.
 
WisNeuro said:
For many things, definitely. I did, however, have much more flexibility and freedom when I worked in a non-VA hospital. No one gave a **** where I did my work as long as it got done, patients were seen, and I attended the meetings I needed to.
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Honestly, it's been pretty much the same for me at the VA until recently. Now, a lot folks are dealing with very rigid rules.
 
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Shiori said:
They're better or comparable to a lot of the local places and with better pay. I also have a spouse in corporate America and his benefits package significantly makes up for anything lacking from the VA. I also get 12 weeks of maternity leave, which has become relevant recently.
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I dunno, I’ve got some years in both types. The pension is really modest. I’ve had better hc coverage elsewhere. It’s the “lavish benefits” for federal workers talk that confuses me. Maybe I’ve just been lucky. Some state universities have killer benefits.
 
Pragma said:
I dunno, I’ve got some years in both types. The pension is really modest. I’ve had better hc coverage elsewhere. It’s the “lavish benefits” for federal workers talk that confuses me. Maybe I’ve just been lucky. Some state universities have killer benefits.
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Agreed that a narrative that federal workers are lazy and taking advantage of "lavish" benefits ranges from exaggerated to outright incorrect.

Now, you want to talk about some great benefits, let's look at some state benefits for police forces. The military's ain't too bad, either. You just have to deal with that job for about 20 years first.
 
Pragma said:
I dunno, I’ve got some years in both types. The pension is really modest. I’ve had better hc coverage elsewhere. It’s the “lavish benefits” for federal workers talk that confuses me. Maybe I’ve just been lucky. Some state universities have killer benefits.
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I am being specific to my location. I have applied to different jobs and looked at the benefits packages. I have friends who have applied and we've discussed the pros and cons including the benefits package. When we did the special pay rate process for several VAs in the area, they gathered information about the differences. Here, the VA has the better offer, for me, overall.

When we considered moving to Dallas, that was not the case. I almost certainly wouldn't have ended up at the VA. On average, the benefits are not better. Here, where I live and work, they are.
 
Pragma said:
I dunno, I’ve got some years in both types. The pension is really modest. I’ve had better hc coverage elsewhere. It’s the “lavish benefits” for federal workers talk that confuses me. Maybe I’ve just been lucky. Some state universities have killer benefits.
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Yeah, but most people are comparing government to corporate benefits. My HC coverage is better than most of the corporate plans my wife has been offered. Her bonuses and stock options though blow government out of the water.
 
Pragma said:
I dunno, I’ve got some years in both types. The pension is really modest. I’ve had better hc coverage elsewhere. It’s the “lavish benefits” for federal workers talk that confuses me. Maybe I’ve just been lucky. Some state universities have killer benefits.
Click to expand...

Likewise. They're good, but usually far from the best available. Especially compared to PP when you can guide your own benefits, and the deductions that come with that.
 
Sanman said:
While I have never enjoyed the pizza party ( no loss there), the great thing about being housed at a cboc was those meetings were always remote and it let me catch up on busy work.
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I don't think I can recall a single interesting/meaningful conversation or topic being raised or discussed in any of the departmental or medical staff meetings for at least the past 8-10 years or so. Certainly no meaningful inter-professional discussion/debate. I mean, it's not like there aren't meaningful topics to be discussed. People are just too terrified to speak up. Whoever is chairing the meeting, at the end, cordially 'invites' anyone to bring up 'anything' for open discussion. Again, it's been about 8+ years (at least) since anyone did...at any meeting. It's that blindly ideological and authoritarian as a work culture at this point. It's never been a tolerant atmosphere for that sort of discussion but I seem to remember at least 10+ years ago there was some--albeit occasional--meaningful discussion/debate or topics or information shared. Nowadays it is nothing more than an ideological 'circe-jerk' with announced long lists of 'kudos' of people for being a good person, or doing you a favor, or 'just being you,' or some other combination of empty affirmations. It's soul-numbing.
 
psy.d. 2021 said:
Non-VA hospitals generally go with social workers because it's cheaper and the bundled reimbursement is the same. Psychologists generally get hired for specialty positions doing evals.

A good deal of group practices are offering crappy splits for not a ton in return. Still 1099 usually so forget even good benefits....how about no benefits.

The techbro VC companies take most of your fee and are 1099. Not worth anyone's time honestly.

Your best bet is PP...a market that seems to be saturating and doesn't guarantee you get paid.

Combined with the fact that I'm in EDRP right now...it's hard for me to find something that works. I'm not going to leave VA to go to something that doesn't work for me.
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I know a psychologist who does testing for a non-VA hospital, one of the biggest in this area, and is supervised by a social worker who has zero understanding of how testing works. They keep overbooking this person so they'll be more "productive."
 
cara susanna said:
I know a psychologist who does testing for a non-VA hospital, one of the biggest in this area, and is supervised by a social worker who has zero understanding of how testing works. They keep overbooking this person so they'll be more "productive."
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Yeah, even at VA, I occasionally had upper-level leadership who didn't understand why I couldn't personally just do 4-5+ outpatient neuropsych evals per day. Although to be fair, neuropsych is a pretty unique setup.
 
Fan_of_Meehl said:
I don't think I can recall a single interesting/meaningful conversation or topic being raised or discussed in any of the departmental or medical staff meetings for at least the past 8-10 years or so. Certainly no meaningful inter-professional discussion/debate. I mean, it's not like there aren't meaningful topics to be discussed. People are just too terrified to speak up. Whoever is chairing the meeting, at the end, cordially 'invites' anyone to bring up 'anything' for open discussion. Again, it's been about 8+ years (at least) since anyone did...at any meeting. It's that blindly ideological and authoritarian as a work culture at this point. It's never been a tolerant atmosphere for that sort of discussion but I seem to remember at least 10+ years ago there was some--albeit occasional--meaningful discussion/debate or topics or information shared. Nowadays it is nothing more than an ideological 'circe-jerk' with announced long lists of 'kudos' of people for being a good person, or doing you a favor, or 'just being you,' or some other combination of empty affirmations. It's soul-numbing.
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Thanks for putting into better words what I hate about the stupid "kudos" lists. They feel completely empty and it's more likely to make me angry than feel appreciated.
 
Fan_of_Meehl said:
I don't think I can recall a single interesting/meaningful conversation or topic being raised or discussed in any of the departmental or medical staff meetings for at least the past 8-10 years or so. Certainly no meaningful inter-professional discussion/debate. I mean, it's not like there aren't meaningful topics to be discussed. People are just too terrified to speak up. Whoever is chairing the meeting, at the end, cordially 'invites' anyone to bring up 'anything' for open discussion. Again, it's been about 8+ years (at least) since anyone did...at any meeting. It's that blindly ideological and authoritarian as a work culture at this point. It's never been a tolerant atmosphere for that sort of discussion but I seem to remember at least 10+ years ago there was some--albeit occasional--meaningful discussion/debate or topics or information shared. Nowadays it is nothing more than an ideological 'circe-jerk' with announced long lists of 'kudos' of people for being a good person, or doing you a favor, or 'just being you,' or some other combination of empty affirmations. It's soul-numbing.
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We have had several meaningful topics raised. Almost always by front line clinicians who had already resigned or were about to resign and felt fine calling everyone out.
 
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