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

[Sanman]

---

Members do not see this ad.

Just got a recruiter message offering a 1099 position to do VA compensation evals for.......$775/day.
🤣 🤣 🤣 🤣 🤣 🤣

How many evals do they want for that day? Cause I would do 1.

 

[WisNeuro]

How many evals do they want for that day? Cause I would do 1.

From what I've seen, it looks like the are expecting you to complete 4-5/day. Which is pretty much malpractice.

 

[WisNeuro]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

 

[AcronymAllergy]

From what I've seen, it looks like the are expecting you to complete 4-5/day. Which is pretty much malpractice.

Who wouldn't want to do forensic work at the rate of ~$100/hour.

Edit to add: on the surface, the idea of earning $775/day probably seems appealing at a very basic level--that works out to $186k/year for 48 weeks of work at 5 days/week.

But that quickly falls apart when you realize you're seeing 4-5 forensic cases per day, every day. And I imagine if you're doing even a semi-decent job, it's going to take you more than 1-2 hours per case, so you're putting in some serious time for that money.

If I saw just one forensic case per day, every day, for 48 weeks out of a year at a normal forensic rate: A) I'd lose my mind and probably my family, and B) I'd make a whole lot more than $186k.

 

[psy.d. 2021]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

All the liability with none of the pay. People that don't know any better maybe, people with poor boundaries perhaps. Hard to say.

 

[cara susanna]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

I've seen people take these jobs when they're desperate.

 

[Sanman]

Who wouldn't want to do forensic work at the rate of ~$100/hour.

Edit to add: on the service, the idea of earning $775/day probably seems appealing at a very basic level--that works out to $186k/year for 48 weeks of work at 5 days/week.

But that quickly falls apart when you realize you're seeing 4-5 forensic cases per day, every day. And I imagine if you're doing even a semi-decent job, it's going to take you more than 1-2 hours per case, so you're putting in some serious time for that money.

If I saw just one forensic case per day, every day, for 48 weeks out of a year at a normal forensic rate: A) I'd lose my mind and probably my family, and B) I'd make a whole lot more than $186k.

From what I've seen, it looks like the are expecting you to complete 4-5/day. Which is pretty much malpractice.

That sounds like good money on the surface, except that it is about what I would earn seeing 5 medicare patients per day for psychotherapy with less paperwork and liability.

 

[Sanman]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

Because you just paid $250k for your PsyD and the student loan repayment starts in two months.

I mean companies are still offering folks $37/patient to drive to a nursing home in 2025. Someone is taking those jobs too. Might be a midlevel now, but still...

 

[WisNeuro]

I've seen people take these jobs when they're desperate.

I can make more money just seeing Medicare dementia evals, where is the desperation?

Because you just paid $250k for your PsyD and the studnet loan repayment starts in two months.

I mean companies are still offering folks $37/patient to drive to a nursing home in 2025. Someone is taking those jobs too. Might be a midlevel now, but still...

People need to come see me, I'll exploit them less than this and I'll still make a great profit margin.

 

[R. Matey]

that works out to $186k/year for 48 weeks of work at 5 days/week.

Don't forget about taxes! On a 1099, your effective tax rate may be close to 40% (not including SALT), bringing this figure closer to an entry level W-2 job without the benefits and plenty more of the liability.

 

[Sanman]

People need to come see me, I'll exploit them less than this and I'll still make a great profit margin.

Will that be your ad?

 

[futureapppsy2]

Genuinely, I would love to chat with someone who would take a job like this. With all of the other avenues open, why do this? Especially as a 1099?

I've noticed people are allured by 1099 positions in general without realizing how much it can cost in benefits.

 

[AcronymAllergy]

Don't forget about taxes! On a 1099, your effective tax rate may be close to 40% (not including SALT), bringing this figure closer to an entry level W-2 job without the benefits and plenty more of the liability.

Yep, although I'd say that if you're paying an effective tax rate of ~40% on all of your 1099 income, you and/or your tax person are probably doing something wrong.

But even if this job somehow got you a 0% tax rate and offered great benefits, it'd still be horrible. When an entirely forensic position is offering similar or less money to what you would make seeing insurance-based clinical cases, no one should be taking it. Heck, my state's rates for SSDI evals are pretty bad, but even those might be better than this.

 

[WisNeuro]

Yep, although I'd say that if you're paying an effective tax rate of ~40% on all of your 1099 income, you and/or your tax person are probably doing something wrong.

But even if this job somehow got you a 0% tax rate and offered great benefits, it'd still be horrible. When an entirely forensic position is offering similar or less money to what you would make seeing insurance-based clinical cases, no one should be taking it. Heck, my state's rates for SSDI evals are pretty bad, but even those might be better than this.

100% agree. We are a high earning family and are well below this tax rate.

Will that be your ad?

Sure, why not?

I've noticed people are allured by 1099 positions in general without realizing how much it can cost in benefits.

There are times where it makes sense for the contractor, this one ain't it.

 

[cara susanna]

I've had a lot of no shows this week.

 

[WisNeuro]

I've had a lot of no shows this week.

Late Nov/Dec was always terrible for me in the VA with no-shows. In the private sector, it's great because everyone wants to get things in before their deductible/OOP max resets.

 

[AcronymAllergy]

I've had a lot of no shows this week.

Yeah, like WisNeuro said, this was always a bit of a dead zone for me at VA. Although I always worked multiple days the weeks of Christmas and New Year's because things were typically so light, which let me catch up on other stuff.

 

[Therapist4Chnge]

The VA are asking employees to “update” them if you have a disability. This seems extra sus with this administration.

 

[psy.d. 2021]

View attachment 412345

The VA are asking employees to “update” them if you have a disability. This seems extra sus with this administration.

Saw that...wouldn't touch that for a second

 

[WisNeuro]

View attachment 412345

The VA are asking employees to “update” them if you have a disability. This seems extra sus with this administration.

I'm sure that it's only so that everyone who identifies can get a nifty armband, with a bunch of numbers, so everyone knows who they are. And, at some future point they all get invited to a fun "summer camp" retreat...

 

[cara susanna]

View attachment 412345

The VA are asking employees to “update” them if you have a disability. This seems extra sus with this administration.

Yeah, everyone on social media is saying not to do it. Isn't it illegal to ask this?

I have FMLA for a medical condition (you all probably know what it is if you remember my past posts here, lol) and all of the relevant parties are aware of the reason behind it.

 

[Sanman]

View attachment 412345

The VA are asking employees to “update” them if you have a disability. This seems extra sus with this administration.

What was it that Ronald Reagan said are the nine most terrifying words in the English language?

 

[WisNeuro]

What was that Ronald Reagan said are the nine most terrifying words in the English language?

Was it something about if we stop taxing rich people and corporations, everyone will "win"?

 

[Sanman]

Was it something about if we stop taxing rich people and corporations, everyone will "win"?

I was thinking more along the lines of "I'm from the government and I'm here to help."

This administration just added a few more words to the sentence "...myself to your money."

 

[Therapist4Chnge]

I'm sure that it's only so that everyone who identifies can get a nifty armband, with a bunch of numbers, so everyone knows who they are. And, at some future point they all get invited to a fun "summer camp" retreat...

Them: Nifty Armband = Piece of Flair!

Us: Some people think it’s about Office Space, but the rest of us realize it’s the Spielberg sequel NO ONE WANTS. Niemand!

Them doing a dad joke: I bet you did Nazi that coming!

 

[WisNeuro]

I was thinking more along the lines of "I'm from the government and I'm here to help."

This administration just added a few more words to the sentence "...myself to your money."

Oh, I knew the exact quote you were going for, I just wanted to be facetious 🙂

 

[futureapppsy2]

How did everyone’s facilities do with the caps? We lost several open MH positions.

 

[futureapppsy2]

View attachment 412345

The VA are asking employees to “update” them if you have a disability. This seems extra sus with this administration.

FYI, all agencies do this regularly. It’s supposedly to see if they are actually hiring people with disabilities, especially the targeted (severe) disabilities. It’s voluntary.

 

[cara susanna]

How did everyone’s facilities do with the caps? We lost several open MH positions.

I didn't hear anything about it, I don't think?

 

[cara susanna]

I'm doing chart review for a testing patient. One of the notes in JLV is hand written and literally scanned in. Both the resolution and handwriting are terrible and I cannot read it.

 

[WisNeuro]

I'm doing chart review for a testing patient. One of the notes in JLV is hand written and literally scanned in. Both the resolution and handwriting are terrible and I cannot read it.

This would be an actionable violation of state record-keeping laws here. I have seen one board case for psych in the past few years where someone was sanctioned for this. Also open to state action.

 

[futureapppsy2]

I was asked to submit medical documentation that I can’t walk for an RA request. If I’ve been pretending for over 30 years, it’s been a hell of a con.

 

[WisNeuro]

I was asked to submit medical documentation that I can’t walk for an RA request. If I’ve been pretending for over 30 years, it’s been a hell of a con.

Vinny the Chin did it for decades 😉

But, I kid. Based on your other posts about this work environment, hopefully you have some good options to get out of that mess.

 

[VintageRed]

https://www.expressnews.com/news/article/san-antonio-audi-murphy-suicide-second-21225372.php

 

[Fan_of_Meehl]

...aaaaaaaand...I look forward to reading the OIG report in about a year from now.

It should be a very detailed explanation of why the VA implemented all the new life-saving 'suicide prevention' policies/procedures/rules/worksheets, etc. that they will surely have implement/add over the next several months in order to make sure 'this type of tragedy NEVER...EVER...EVER...HAPPENS AGAIN (TM).'

 

[Therapist4Chnge]

I was asked to submit medical documentation that I can’t walk for an RA request. If I’ve been pretending for over 30 years, it’s been a hell of a con.

It's like you are a method actor!

The next Daniel Day Lewis!

 

[AsOneDoes]

How did everyone’s facilities do with the caps? We lost several open MH positions.

We lost about 90 percent of open MH positions.

 

[cara susanna]

This would be an actionable violation of state record-keeping laws here. I have seen one board case for psych in the past few years where someone was sanctioned for this. Also open to state action.

This is a service treatment record, so I assume state laws don't apply, sadly.

 

[WisNeuro]

This is a service treatment record, so I assume state laws don't apply, sadly.

It gets murky. Working a federal facility does not exempt healthcare providers from state laws and regulations. But, may be more trouble than it's worth from your end.

 

[cara susanna]

There's a new thing coming out here called a phone manager, where they alert you to phone messages from patients via a website instead of CPRS (kind of like secure messaging). I'm like, oh great, another website I'll have to log into throughout the day.

 

[Sanman]

There's a new thing coming out here called a phone manager, where they alert you to phone messages from patients via a website instead of CPRS (kind of like secure messaging). I'm like, oh great, another website I'll have to log into throughout the day.

Just what we needed. They should require us to do somwthing with it within 3 days. It will make everything better. /s

 

[Fan_of_Meehl]

There's a new thing coming out here called a phone manager, where they alert you to phone messages from patients via a website instead of CPRS (kind of like secure messaging). I'm like, oh great, another website I'll have to log into throughout the day.

Who in the hell has phone messages from patients and is somehow unaware of that fact? The phone indicates it, right?

I'm so tired of being micromanaged and nannied to death by secretaries, 'champions,' 'experts without caseloads,' managers, and now all these non-human computerized automated entities.

Can't we just go back to 1995, paper charts, rotary phones (without voicemail or answering machines), a few sharpened pencils, and a few sheets of paper?

God, that sounds like absolute HEAVEN as a practice environment at this point. I'm so tired of constant messages, spam emails, Teams messages, 'reminders,' etc.

 

[Sanman]

Who in the hell has phone messages from patients and is somehow unaware of that fact? The phone indicates it, right?

I'm so tired of being micromanaged and nannied to death by secretaries, 'champions,' 'experts without caseloads,' managers, and now all these non-human computerized automated entities.

Can't we just go back to 1995, paper charts, rotary phones (without voicemail or answering machines), a few sharpened pencils, and a few sheets of paper?

God, that sounds like absolute HEAVEN as a practice environment at this point. I'm so tired of constant messages, spam emails, Teams messages, 'reminders,' etc.

You realize a good chunk of the people reading that post probably were not born or just in diapers in 1995. Heck, I was still a kid. I do miss my beeper though.

 

[cara susanna]

Who in the hell has phone messages from patients and is somehow unaware of that fact? The phone indicates it, right?

I'm so tired of being micromanaged and nannied to death by secretaries, 'champions,' 'experts without caseloads,' managers, and now all these non-human computerized automated entities.

Can't we just go back to 1995, paper charts, rotary phones (without voicemail or answering machines), a few sharpened pencils, and a few sheets of paper?

God, that sounds like absolute HEAVEN as a practice environment at this point. I'm so tired of constant messages, spam emails, Teams messages, 'reminders,' etc.

It's for if a patient calls the MSAs and leaves a message with them.

 

[Fan_of_Meehl]

It's for if a patient calls the MSAs and leaves a message with them.

Good grief.

The VA truly is the worst amalgam of the worst of government service culture combined with the worst of (pseudo)corporate culture.

 

[aim-agm]

It's for if a patient calls the MSAs and leaves a message with them.

What was the problem with just putting in a CPRS note and cosigning us?

 

[cara susanna]

What was the problem with just putting in a CPRS note and cosigning us?

The goal is to reduce the number of CPRS alerts and also have more consistency in responding to the veterans (apparently this was maybe an issue? Not sure).

 

[aim-agm]

The goal is to reduce the number of CPRS alerts and also have more consistency in responding to the veterans (apparently this was maybe an issue? Not sure).

Overarching goal: "Reduce number of alerts because of alert fatigue and to reduce time spent on alerts"
Subgoal: "Reduce number of CPRS alerts"
Solution for subgoal: "Change it from a CPRS alert to a different type of alert that will take more time to address"

 

[Sanman]

Overarching goal: "Reduce number of alerts because of alert fatigue and to reduce time spent on alerts"
Subgoal: "Reduce number of CPRS alerts"
Solution for subgoal: "Change it from a CPRS alert to a different type of alert that will take more time to address"

 

[psy.d. 2021]

What was the problem with just putting in a CPRS note and cosigning us?

Our facility MSAs don't even do that consistently. No way for clinicians to see what they're doing