VA rotations

[MidWestLass]

I am interested in a career with the VA and recently matched with one in the midwest - woo hoo, I can keep my name!

For internship, I can choose 4 rotations. I have my 2 main areas of interest picked out but am still deciding on the remaining ones. Frankly, I want to do them all!

I consider myself a generalist and want to round out my experiences so that my application is more appealing to future employers in the VA system (as well as VA postdocs). I was wondering if the folks familiar with the VA's hiring trends had any recommendations on what types of experiences are most attractive to employers or if there are any types of positions the VA has difficulty filling. For example, I imagine that finding people with PTSD experience isn't very challenging, but SMI/Pain experience could be less common. Please let me know if I am completely wrong on these assumptions.

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[AcronymAllergy]

Experience with pain, behavioral medicine (potentially also including inpatient medical), and primary care MH could all be very useful. Same goes for treating sleep disorders. These will be relevant at pretty much every VA.

SMI experience, as you've said, is generally less common (which can make it more or less valuable, depending on the VAs and specific positions you're eyeing).

Substance misuse is also relatively common, although whether psychologists are primarily involved in treating it can vary from one VA to the next; still, experience there won't hurt.

 

[Sanman]

Agreed with everything AA said. Something to think about is whether you want to try and develop a specialty area or prefer being a generalist. Behavioral medicine, pain management, etc positions are being filled more with specialty post-docs in those areas (as well as neuropsych). PTSD, Primary Care MH, MST, Suicide prevention, SMI, possibly substance abuse tend to be filled more by those with VA experience during internship and post-doc. Home-based primary care experience can help as many times people take those positions to get their foot in the door.

 

[MidWestLass]

Agreed with everything AA said. Something to think about is whether you want to try and develop a specialty area or prefer being a generalist. Behavioral medicine, pain management, etc positions are being filled more with specialty post-docs in those areas (as well as neuropsych). PTSD, Primary Care MH, MST, Suicide prevention, SMI, possibly substance abuse tend to be filled more by those with VA experience during internship and post-doc. Home-based primary care experience can help as many times people take those positions to get their foot in the door.

Thanks to you and AcronymAllergy for your quick responses and excellent advice!

I think my major strengths are in delivering cognitive behavioral and third wave treatments to people with a wide range of presenting problems (this is what I did during my VA practicum). As such, I want to apply to VA postdoc positions that would appreciate someone with that kind of experience (mental health outpatient clinics, etc.). Regarding more specialization, I worry that doing a 3 month Pain rotation (as an example) will not be enough to make me a competitive applicant for Pain postdocs. It feels pretty risky to me. However, I would still love to have that experience, considering most veterans struggle with pain, and expect that I would do that during the second half of internship (when postdoc apps have already gone out).

Also, I think that I will likely apply to a few BHIP postdocs. D you think that completing a PCMHI rotation would make me more competitive for BHIP postdocs? I am having a difficult time understanding the difference between the 2. Are there other experiences, in addition to my generalist training, that would make me more competitive for BHIP rotations?

EDIT: I can't stop with all the parentheticals. Sorry!

 

[Sanman]

PCMHI is integrated into the PACT or primary clinic. If the PCP notes depression or if short intervention is needed, they refer to PC-MHI. The PC-MHI psychologist will refer to general mental health if it needs secondary care (BHIP the model used for mental health outpatient treatment at the secondary level). I agree with the your assessment regarding pain rotation. It is good to have, but PC-MHI training may be more helpful when seeking generalist jobs if you can only choose one of the two. That said, I have used my pain management and insomnia training many times in my career without being a specialist.

 

[AbnormalPsych]

VA is hiring and will likely be for the foreseeable future in primary care MH integration. Anything in there plus behavioral med/health psychology would be a good rotation to have under your belt. Could round out with gero which will also be a big need very soon. Others that wouldn't hurt - PTSD or sub use. Avoid inpatient.

 

[Justanothergrad]

Another big +1 for what AA said. Jobs will be open in the PCMHI realm in coming years so even if that isn't where you want to end up long term, this is a great way to get your foot in the door. It's also a trend in the field, so I'd be watching for those training opportunities.

Beyond the VA, I am a firm believer that a good psych training will give you a basis for (1) SMI, (2) SUD, (3) some type of residential or inpatient training [type matters less imho- but you should know first hand what strengths and weaknesses these programs have], (4) exposure to neuropsych or gero [even if you aren't neuro], and (5) Primary Care/Integrative care models. I would make sure you have done all of those at some point during your training, in addition to any specialty you want. If you aren't trained in those areas, you will likely find yourself struggling to understand some aspect of care or service models.

 

[AcronymAllergy]

To add to the excellent responses about RE: PC-MHI, one very important set of benefits trainees tend to pick up in those rotations is the ability to conduct a thorough yet timely diagnostic interview, quickly arrive at an informed diagnostic conclusion, and use said conclusion to develop and deliver an evidence-based and time-limited intervention (or know how/when to refer if it's beyond your setting's scope).

Very often, I'll see or hear of trainees going into PC-MHI being used to conducting their interviews across 3-4 (or more) sessions before arriving at a diagnosis/conceptualization. And then sometimes another 2-3 sessions to broach the topics of therapy and orient the patient before beginning. PC-MHI rotations can then come as a bit of a shock, but can be great for helping to increase the efficiency of this process.

 

[MidWestLass]

You all are so wonderful. Thank you for this awesome advice. I will definitely do a PCMHI rotation. It sounds like an excellent way to round out my experience.

And if you were to choose between Pain and Substance Use...? It sounds like both of these would be extremely useful. I do have experience working with vets with substance use, but mostly in coordinating care and motivational interviewing. I’ve never delivered any treatments for substance use.

 

[Justanothergrad]

You all are so wonderful. Thank you for this awesome advice. I will definitely do a PCMHI rotation. It sounds like an excellent way to round out my experience.

And if you were to choose between Pain and Substance Use...? It sounds like both of these would be extremely useful. I do have experience working with vets with substance use, but mostly in coordinating care and motivational interviewing. I’ve never delivered any treatments for substance use.

It depends on which way you want your career to go and there will be a lot of cross-over between the two as well within the umbrella of addiction. It just comes down to which is more closely matched to the type of setting you want to be in (If you want to be in a primary MH role then I'd do SUD, if you are trying to track into a more medically focused setting I'd do pain).

 

[AcronymAllergy]

Agreed, there's plenty of demand for both. For VA specifically and its various opiate initiatives, for the near future, if you mention that you have training and interest in treating pain, that could very readily get your application serious consideration. It could also shoehorn you into an entirely or almost-entirely pain management role. Substance use, depending on the VA, has multiple other provider types involved (e.g., peer support, substance abuse counselors); pain, less so.

 

[cara susanna]

As someone who completed internship and postdoctoral training in the VA, and is now a staff psychologist, I suggest the following experiences would be helpful in terms of working with patients.
- Substance use
- Sleep issues/insomnia
- Primary Care Mental Health Integration
- Chronic pain
- PTSD or trauma - if not a specific rotation in a PTSD clinic, then definitely knowledge of assessment and treatment considerations

In terms of competitiveness, being trained in specific EBTs is definitely considered. Being VA certified--at some VAs you can get this during training--is even better. You'll also want experience working with complex patients.

 

[Justanothergrad]

You'll also want experience working with complex patients.

Making sure I got that was never a problem at a VA lol