VA work: let's discuss

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PsyYaYaYaYai

PsyYaYaYaYai

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I have very limited exposure to any specialty at the VA, let alone psychiatry. As there are programs with heavy VA work, I was hoping to get some input about the VA population and working at the VA from all you wonderful folks.

Pros of the VA?
Cons of the VA?
Good exposure to what (besides PTSD and TBI)?
Lack of exposure to what?
Most rewarding part?
Most frustrating part?

Thanks in advance!
 
PsyYaYaYaYai said:
I have very limited exposure to any specialty at the VA, let alone psychiatry. As there are programs with heavy VA work, I was hoping to get some input about the VA population and working at the VA from all you wonderful folks.

Pros of the VA? Good job security, excellent benefits. About a year and a half ago Congress passed legislation increasing how much psychiatrists can get paid, so I make the same or more as most of my colleagues outside of private practice. The VA also is paying off all my med school student loans over a five year period. 3 weeks vacation, and 11 federal holidays off, unless I'm on call. Since the VA is one big national system I can get records on patients from VAs around the country quickly on the computer when the patients come to me from another VA. The VA has very robust wrap around services for veterans to help with homelessness, substance abuse, and we have a ton of therapists at my VA and also offer family and couples therapy. Communication with primary care and other specialists is quick and generally responsive at my VA. Veterans get medications cheaper at the VA pharmacy, even if they aren't service connected. We have a really nice nursing home right here on campus. We even have a social worker that helps veterans quite successfully with criminal legal issues.
Cons of the VA? Though not really an issue at my VA, some times at larger inner city VAs you can see some lazy or just burned out nurses and other employees. It really varies by hospital. The patriotic posturing by politicians and media only go so far when it comes to paying for veteran care. This results in a ton of bureaucracy in doling out benefits with lots of red tape and long delays on the business side to make sure each condition is "service connected." I think it would save much frustration, time, and money in the long run to just cover all veterans 100% without all the extra paperwork. The VA is a messy bureaucracy on the business side staffed by minimally qualified clerks spread out all over and this causes patient and staff suffering.
Good exposure to what (besides PTSD and TBI)? Pretty much everything. A lot of military sexual trauma causing PTSD. Lots of TBI in younger veterans, of course. PTSD is huge. I do see a lot more alcoholism than outside the VA. I treat lots of opioid dependence with suboxone, and its nice the VA is really behind treating substance abuse.
Lack of exposure to what? There are more old men than young women, but I still see many women. Less schizophrenia and intellectual disability than you see in community mental health, but we get our share.
Most rewarding part? Helping veterans, many of which are true heroes and good men and women. Lots of institutional support.
Most frustrating part? Bureaucracy on the business side preventing veterans from getting care so the government can save money, which in fact cost more. Under staffing in primary care. Perception in the public that the VA has not improved in the last 50 years. The VA has a very bad PR problem due to some misbehaving hospitals that were under funded and over whelmed and then burned out. The expectations are very high because of patriotism, and there is the sheer numbers of patients, which can burn one out quick. My patient load is very high.

Thanks in advance!
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See my response in the quote above.
 
The VA can be one of the more rewarding, and the most frustrating medical facilities to work in. Whatever you can do to stay away from C&P/SC issues the better. No better way to get jaded than deal with a ton of red tape and/or malingering issues for a good chunk of the time.

As far as exposure, it will vary greatly depending on what specialty services that VA has and how psychiatry is embedded into it. Is your job mostly primary care, mental health outpatient, are you embedded in a specialty care service (e.g, EMU/CLC/etc)? I've worked with psychiatrists in wildly varying roles depending on where they are embedded. If you're interested in doing therapy, most VA's I have exposure to are not for you. The VA seems to want psychiatrists to stick to the med management solely.
 
st2205 said:
How is this worked out for them paying off all loans for 5 years? Is this a program?
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Maximum benefit is 120k, where you must demonstrate payment up front. It could be technically 240k as you're paying and then get a lump sum at the end of the year which is applied to the loan amount again.
 
Yesterday, I guy presented as "very distraught" at our OEF/OIF clinic (note that I think creating and naming entire clinics dedicated to one service era is idiotic and insulting) and wanted some extra clinical eyes on him. He is already enrolled in MH clinic, but isn't scheduled to see his assigned social worker therapist for the first time until mid month. They scheduled him with the psychiatrist first and then me-back to back. I asked them why they tied up both our schedules with this. They said, cause he might need meds...and we wanted him to check-in with a someone (me) cause he was so upset earlier.

Our psychiatrist just shrugged, but I can tell it bothers him.
 
That's the kind of behavior that irks me about the VA. Rather than consulting with a physician, that person has been reduced to a widget maker without anyone else really doing a proper evaluation and making decisions based on supposition.

The hierarchy and lack of respect speaks loudly.
 
st2205 said:
How is this worked out for them paying off all loans for 5 years? Is this a program?
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Like Shikima said, they pay a lump sum yearly matching your payments dollar for dollar up to $120,000 over a five year period ($24,000 a year.) It's called the Education Debt Load Reduction Program.

Also, I am learning the further I stay away from C&P exams (compensation and Pension) and Service connection issues, the less agitated patients get in my clinic. Turns out they like their doctors and therapists, it's the bureaucracy they don't tolerate, and its hard to blame them.

I do outpatient clinic and consult/liason work. I sometimes have students.

I forgot to mention that the psychiatrists get a yearly bonus of about $3K at my clinic. Not much, but it's nice. Don't forget: no malpractice expense, either. Lots of free CME available, and academic affiliations are common in the VA with med schools and residencies.

A lot of what you can do depends on the particular VA administration and department head. I can spend up to half my day doing therapy if I want, I just have to let the department know in advance, about a month out if I want to add in more therapy slots. They do prefer I do more medication management, though. I have opportunities for advancement. And there is no reason I couldn't start a practice on the side if I want to work more, I have the time.
 
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My exposure to VA settings has been more limited but in my experience, vets as a group are great to work with and are often very appreciative of the services they receive. It really is rewarding to help these folks, many of whom would not or could not access mental health care any other way. Also, the VA offers decent staff benefits, a good electronic medical record, and freedom from third party payer issues.

However, the VA is a fairly dysfunctional system made more so by its size. For instance, directives will come down from VA national and they have to be implemented (or at least you have to do a good imitation of implementation) whether they make sense in your setting or context. It's not unusual for directives or programs to be implemented in advance of the evidence, or even resources, to support them. As others have said, dealing with bureaucracy and red tape is part of the VA experience. The culture at some VAMCs magnifies these issues. VA human resources is its own special kind of hell.
 
MamaPhD said:
VA human resources is its own special kind of hell.
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VA HR is the last circle of hell. Most people think it's Satan at the center of the frozen lake in the ninth circle. They are wrong, it's an office, filled with cubicles, of the worst of the worst of VA HR employees. And you have to sit there in the waiting room, just watching their incompetence, unable to do anything.
 
I always tell people that rule #1 to remember about the VA is your experience will be VERY site and department dependent. The patient population, department leadership, clinical resources, support and HR staff, and even salary can vary greatly even between two VAs just down the road from one another.
 
WingedOx said:
I always tell people that rule #1 to remember about the VA is your experience will be VERY site and department dependent. The patient population, department leadership, clinical resources, support and HR staff, and even salary can vary greatly even between two VAs just down the road from one another.
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So very, very true.
 
WingedOx said:
I always tell people that rule #1 to remember about the VA is your experience will be VERY site and department dependent. The patient population, department leadership, clinical resources, support and HR staff, and even salary can vary greatly even between two VAs just down the road from one another.
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I'd add that loan repayment is also based on a site's unique funding. It was not available when I interviewed.

And the salary offers vary significantly by region.
 
You can ask about the pros and cons about working for the VA, but it holds about as much water as the pros and cons of working in academics or the like.

It is incredibly specific from one site to the next. The leadership, culture, opportunities, salary, and benefits are very, very different from site to site, even within a single state.

For anyone interested in VA employment, it would really behoove you to look into the reputation of the VA you're looking at. They are radically different.
 
I randomly got assigned to do my medicine sub-I at the VA. I loved it so much that I switched many of my 4th year electives to there. The caveat is that I don't really have much experience with psych patients at the VA.

-Pros of the VA? - The patients are the #1, 2, and 3 best aspects of the VA. The VA patients are a stark contrast from the typical patients you get at a city medical center. They generally value your time and respect you. You will generally respect them as well (which is a giant step above just being outwardly professional). CPRS (the EMR) seems like it should suck, but it grew on me the more I used it. It's much simpler than Epic, which is the other main EMR I'm familiar with.
-Cons of the VA? - From what I understand, VAs all tend to be different, but the one thing I hated is the lack of resources depending on what day it is. If you are a vet, it's best to not have a heart attack on the weekend. I've also had a patient stay over two weeks for an uncomplicated UTI because he couldn't get placement. The EMR is ugly as hell and looks like it was imported from the late 80s.
-Good exposure to what (besides PTSD and TBI)? - PTSD, TBI for sure. Also lots of anxiety spectrum, substance abuse (especially alcohol), depression. There's also some bread and butter psychosis, axis II stuff, and sleep disorders.
-Lack of exposure to what? - Women.
-Most rewarding part? - Helping vets. Patients appreciate you.
-Most frustrating part? - Red tape that is worse than your typical hospital.
 
Davole said:
I randomly got assigned to do my medicine sub-I at the VA. I loved it so much that I switched many of my 4th year electives to there. The caveat is that I don't really have much experience with psych patients at the VA.

-Pros of the VA? - The patients are the #1, 2, and 3 best aspects of the VA. The VA patients are a stark contrast from the typical patients you get at a city medical center. They generally value your time and respect you. You will generally respect them as well (which is a giant step above just being outwardly professional). CPRS (the EMR) seems like it should suck, but it grew on me the more I used it. It's much simpler than Epic, which is the other main EMR I'm familiar with.
-Cons of the VA? - From what I understand, VAs all tend to be different, but the one thing I hated is the lack of resources depending on what day it is. If you are a vet, it's best to not have a heart attack on the weekend. I've also had a patient stay over two weeks for an uncomplicated UTI because he couldn't get placement. The EMR is ugly as hell and looks like it was imported from the late 80s.
-Good exposure to what (besides PTSD and TBI)? - PTSD, TBI for sure. Also lots of anxiety spectrum, substance abuse (especially alcohol), depression. There's also some bread and butter psychosis, axis II stuff, and sleep disorders.
-Lack of exposure to what? - Women.
-Most rewarding part? - Helping vets. Patients appreciate you.
-Most frustrating part? - Red tape that is worse than your typical hospital.
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I don't know that patients appreciate you more at the VA. I guess the patients on medicine might -- in my experience, they were mainly older men (Vietnam and up vets) who were generally pretty agreeable although sometimes a bit inappropriate with women. However, there's a lot of frustration and entitlement with some vets toward the VA, which can really muddy your treatment with them. You'll get enough patients who are up on every wrong the VA has ever committed, including not paying that extra $10 for their gym membership indefinitely because every problem in their life is related to the military, etc., etc. ,etc.. It gets a little old. Maybe I'm burned out on the VA after spending so much time there in training and fellowship, but appreciative of care isn't really how I would describe a good deal of the patients.

VA pros: it's a closed system, so you can get records for everything. CPRS is ugly and annoying, but you've got to appreciate that it was the first EMR out there. Good substance abuse exposure. Lots of personality disorders. The ability to learn how to treat people who are also in the process of filing claims for disability for the thing you're treating them for within the same system. Some VAs have high quality physicians -- the one I worked at did. Lots of trauma, including a ton of pre-combat trauma.
VA cons: it's a huge bureaucracy, which can get annoying. See what it's like when you try to get your first PIV. Did I mention my data got lost in their breach? So that's another con. It's really inefficient, and the administrative people are friendly but kinda lazy (most of them -- some are really good, but I think it's one of those gigs where you never get fired). For example, I had to pick up some keys once. The person was supposed to be there from 8 to 5 but was really only there for about 2 hours due to smoke breaks and walking her therapy dog. That whole entitlement thing mentioned above is another con.
Good exposure: trauma, personality disorder, substance abuse
Lack of exposure: definitely fewer women, although that's changing. You'll probably see fewer people with severe/persistent mental illness although the VA has its fair share.
Rewarding parts and frustrating parts are generally covered above
 
Doctor Bagel said:
I don't know that patients appreciate you more at the VA. I guess the patients on medicine might -- in my experience, they were mainly older men (Vietnam and up vets) who were generally pretty agreeable although sometimes a bit inappropriate with women. However, there's a lot of frustration and entitlement with some vets toward the VA, which can really muddy your treatment with them. You'll get enough patients who are up on every wrong the VA has ever committed, including not paying that extra $10 for their gym membership indefinitely because every problem in their life is related to the military, etc., etc. ,etc.. It gets a little old. Maybe I'm burned out on the VA after spending so much time there in training and fellowship, but appreciative of care isn't really how I would describe a good deal of the patients.
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I would say that my experience is about 50/50 consistent with Dr. B. I imagine it varies greatly depending on what area you are in. I happen to evaluate cognition. Which includes evaluating people who have had one concussion with no LOC and are now saying that they are irreparably brain damaged. a not insignificant portion of those fail, spectacularly, validity tests. They are generally not to thrilled that now there is evidence against their C&P claim. On the other hand, I work with dementia age patients. They are generally fairly relieved to hear that they do not show evidence of dementia, or if they do, the family is generally happy for the assistance we can provide. But, from having worked in VA and non-VA places, I would have to say that I found a lot more patient appreciation from my non-VA work. I agree with the sense of entitlement getting in the way of patient health some of the time.
 
WisNeuro said:
I would say that my experience is about 50/50 consistent with Dr. B. I imagine it varies greatly depending on what area you are in. I happen to evaluate cognition. Which includes evaluating people who have had one concussion with no LOC and are now saying that they are irreparably brain damaged. a not insignificant portion of those fail, spectacularly, validity tests. They are generally not to thrilled that now there is evidence against their C&P claim. On the other hand, I work with dementia age patients. They are generally fairly relieved to hear that they do not show evidence of dementia, or if they do, the family is generally happy for the assistance we can provide. But, from having worked in VA and non-VA places, I would have to say that I found a lot more patient appreciation from my non-VA work. I agree with the sense of entitlement getting in the way of patient health some of the time.
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This is a huge problem in low SES, drug addled communities as well. Turns out vets talk and find out that other vets take a bunch of drugs, present very agitated in the ED, get hospitalized a few times, and know the right stuff to say to comp and pen. When your buddy gets 3k a month tax free to buy drugs with and a psychiatrist doesn't buy your story, the situation can get pretty ugly.
 
psyxh said:
I'd add that loan repayment is also based on a site's unique funding. It was not available when I interviewed.

And the salary offers vary significantly by region.
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I'm not sure my site has loan repayment, but we also aren't hurting for people who want to work here.
 
Merovinge said:
This is a huge problem in low SES, drug addled communities as well. Turns out vets talk and find out that other vets take a bunch of drugs, present very agitated in the ED, get hospitalized a few times, and know the right stuff to say to comp and pen. When your buddy gets 3k a month tax free to buy drugs with and a psychiatrist doesn't buy your story, the situation can get pretty ugly.
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Luckily, I have a vast array of P VT/SVT's and statistical methods to help verify the veracity of some of my data. Some of the malingering I've come across has been downright comical.
 
Low salary, endless beurocracy, and a string of patients who only respond well to Ativan? Where do I sign up?!
 
Doctor Bagel said:
I don't know that patients appreciate you more at the VA. I guess the patients on medicine might -- in my experience, they were mainly older men (Vietnam and up vets) who were generally pretty agreeable although sometimes a bit inappropriate with women. However, there's a lot of frustration and entitlement with some vets toward the VA, which can really muddy your treatment with them. You'll get enough patients who are up on every wrong the VA has ever committed, including not paying that extra $10 for their gym membership indefinitely because every problem in their life is related to the military, etc., etc. ,etc.. It gets a little old. Maybe I'm burned out on the VA after spending so much time there in training and fellowship, but appreciative of care isn't really how I would describe a good deal of the patients.
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I'm in a fully outpatient position so some of the more sociopathic malingering never actually makes it to my office, and I make it crystal clear that I'm not the person responsible for their C&P claim (though I'm less explicit about the fact that my documentation isn't going to help their case if they're FOS), so once that boundary is established I usually have fewer problems with them taking it out on me if they aren't getting their service connection. Plus, I do frequently spend time empathizing verbally about the fact that the VA can be a headache. In the time I've been at my current site, the over the top entitlement has been the exception rather than the rule, and most of the guys (and women) are happy to have their care at the VA despite some of the limitations of the system. If I'm going to be dealing with undeserved entitlement I have more tolerance from my current patients who've had it tough economically than from people in the North Shore or Lincoln Park.

Though I will say I know the VA that @Merovinge has experience with quite well, and that place is "special" even by VA standards.
 
WingedOx said:
Though I will say I know the VA that @Merovinge has experience with quite well, and that place is "special" even by VA standards.
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I also believe it to be an exception rather than the rule. The VA I trained in for medical school was really quite good. A lot of attending's I respect tremendously have been at the VA so they must be doing something right.
 
VA pros:
1) good pay and benefits generally, especially considering #2
2) very low patient load compared to pp outpt

VA cons:
1) the service connected issues. SO MANY of the patients are just playing the SC game. Ive talked to VA psychs who feel that 70% of what they do is just see people playing the ptsd sc game
2) the typical VA beaurocracy(sp?)
 
vistaril said:
VA pros:
1) good pay and benefits generally, especially considering #2
2) very low patient load compared to pp outpt

VA cons:
1) the service connected issues. SO MANY of the patients are just playing the SC game. Ive talked to VA psychs who feel that 70% of what they do is just see people playing the ptsd sc game
2) the typical VA beaurocracy(sp?)
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The low pt load, comparatively speaking is very nice. Gives me plenty of time to spend on training/supervision of interns/postdocs and research projects on the side. As far as the #1 point on your cons, I keep fairly detailed stats on my pts. Right now I'm at a 44.5% PVT/SVT failure rate.
 
WisNeuro said:
The low pt load, comparatively speaking is very nice. Gives me plenty of time to spend on training/supervision of interns/postdocs and research projects on the side. As far as the #1 point on your cons, I keep fairly detailed stats on my pts. Right now I'm at a 44.5% PVT/SVT failure rate.
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oh i think psychologists/psychiatrists at the VA is apples/oranges. Not that the situation(relative to community jobs) is neccessarily better or worse. It's just an entirely different conversation
 
WisNeuro said:
For the SC issues, or pt load?
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well im sure there are still more SC issues than the gen population.....I dont know enough about patient loads of psychologists there. I was actually speaking in a broader sense than just those few pros and cons(and about relative desirability and ease of transition between VA and pp in general for practitioners).
 
vistaril said:
well im sure there are still more SC issues than the gen population.....I dont know enough about patient loads of psychologists there. I was actually speaking in a broader sense than just those few pros and cons(and about relative desirability and ease of transition between VA and pp in general for practitioners).
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Ah, most likely true. Also, my patient load is vastly different than general psychologists considering my pt encounters range from 2-6 hours a pop. Ease of transition between the two is fairly easy (I've been in both worlds) if you can document quickly.
 
excellent posts so far, everyone--thank you so much! very helpful.

are there generally any issues getting a job outside the VA system if you train at a VA-heavy residency program?
 
PsyYaYaYaYai said:
excellent posts so far, everyone--thank you so much! very helpful.

are there generally any issues getting a job outside the VA system if you train at a VA-heavy residency program?
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Depends on what is considered "VA heavy." My program is split about 50/50 through 3 years, and that seems to be pretty typical of programs affiliated with a VA. I wouldn't want to do any more than that, however...but I would also hate not having any VA exposure.
 
PsyYaYaYaYai said:
are there generally any issues getting a job outside the VA system if you train at a VA-heavy residency program?
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There generally aren't issues getting a job outside the VA system for folks who trained pretty much anywhere.

For the more competitive jobs (including the VA jobs in highly desirable academic spots), the quality/reputation of your residency factors in quite a bit. How much VA time doesn't really factor in. There are some quality psych programs that do a fair bit of VA time.
 
Psychotic said:
Depends on what is considered "VA heavy." My program is split about 50/50 through 3 years, and that seems to be pretty typical of programs affiliated with a VA.
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I would consider that very much a "VA heavy" program.
 
notdeadyet said:
I would consider that very much a "VA heavy" program.
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I need to check my math, actually - I kind of shot from the hip there. First year was around 50/50, and in the second year it is zero VA. Third year involves some VA, I need to look at it...not sure about 4th at all, seems like that will be more up to my choices than anything else.

So 50/50 is an overstatement, but it is at least 25 percent (that would be completely accurate for the first 2 years). My uncertainty is 3rd year, which I will know more about in, umm, 6 months...
 
I never worked for the VA but did work as a forensic doctor going into lots of VAs, have a lot of friends that worked in VAs, and I worked in a state-hospital with several similarities.

The system is marred with several problems. E.g. bad physicians and don't get fired unless their problems are so over-the-line (e.g. they raped a patient). If you work in a VA get used to seeing the same people day-after-day do bad work in front of your face. It can get very annoying.

(This is NOT to say all physicians in the VA are bad. Some are very good).

You likely will get paid the same amount as the people that are terrible. This can wear on your soul. After years of this it can zombify you. E.g. you go into work not caring anymore because by caring you will get mad with the ineptitude.

A combined PRO and CON is the retirement system. The retirement benefits are incredibly good. Pro right? Well it also can force you to be in a position where you're no longer happy being there but got to stay because you're only 14 years from retirement before you get the mega-awesome pension! Does this sound over-the-top? Actually no. I know a lot of people there that don't like it but once they put in say 10 years they feel they got to stay for the entire thing. Again this "zombifies" the person.

Here's pros-I respect vets and a lot of people here I believe also do too.
The retirement system as I mentioned.
If you really want to do good by the patient money is much less of a factor. In private hospitals you keep a patient there that can't pay or their stay is no longer profitable there's a pressure to do the profitable thing, not the right thing.
Simplistic and stable. Some people don't want to worry about things such as owning their own practice, doing some accounting each month over their practice, managing employees, etc.
 
Agree Shikima unless the retiree lives several years (I'm talking at about 15+ years) after retirement, and possibly if the healthcare costs blow up in the future cause you get guaranteed healthcare.
 
whopper said:
Agree Shikima unless the retiree lives several years (I'm talking at about 15+ years) after retirement, and possibly if the healthcare costs blow up in the future cause you get guaranteed healthcare.
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I think what you do get after 5 years of being vested in the system, is access to private insurance at a reduced rate. This would be in addition to the usual public services (ie: Medicare).
 
I agree with Shikima that VA retirement benefits are way over-rated. It's not on par with comparable pension plans many county and state employers will offer and the salary offset with what you could be paid in the private arena would more than compensate. This is to say nothing with the fact that federal employment, pay, and benefits are an easy punching bag for Congress and very susceptible to cuts.

There can be a lot of great reasons for working for the VA (again, very dependent on locale): mission, patients, work environment, 4/10 scheduling, etc. There are also a lot of great opportunities for VAs that are affiliated with strong residency programs (again, very dependent on locale): tend towards teaching-focused, opportunity for specialization, great research potential. The pay can be nice starting, but you do not get the stepwise increase at the rate you see at most jobs (the VA tends to give increases to starting pay as a recruitment tool when funds are available rather than increase salary annually to existing employees). Healthcare and disability benefits are good. But retirement packages/pension is definitely not what it used to be.
 
The CSRS retirement was good. FERS retirement (the current one) isn't that good. I pay 4.4% of my salary into the pension and can't collect until age 62. Let's say you make 200k and contribute that 4.4% for 5 years, that's $8800/yr , or $44000 of after-tax money after 5 years. That sits in the pension for the next 30 years, after which you will get 1% of you final avg salary (so, $2k) for each year of work, or a total of $10k a year in benefits once you start collecting. Let's say you die at age 82. You will then have collected $200,000. If you invest $44k for 30 years and compound annually at 5% interest, you will have $190,000 (and have full access to your money in the meantime).

The pension benefit is definitely greater, but not by a ton. (correct me if my numbers are off).

The work is very difficult and resources are quite limited. At times you may feel like you're working in a 3rd world country because of this. Getting any changes made is almost impossible, even if you have a good argument for it.

In private practice (or even other hospital systems) you may still not feel like you have resources, but you can do something about it (ie: see patients longer, more frequently, provide therapy, etc).
 
keifernny2 said:
The work is very difficult and resources are quite limited. At times you may feel like you're working in a 3rd world country because of this. Getting any changes made is almost impossible, even if you have a good argument for it.
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This again may be a regional thing, but in what way do you find "resources are quite limited"?

Just curious. Out my way, I have many more options for sending vets to (therapy, groups, housing, substance, etc) than my county orients and many of my privately ensured.


Sent from my iPhone using Tapatalk
 
If I go to a program that's majority VA sites, will I be employable outside of the VA system?
 
notdeadyet said:
This again may be a regional thing, but in what way do you find "resources are quite limited"?

Just curious. Out my way, I have many more options for sending vets to (therapy, groups, housing, substance, etc) than my county orients and many of my privately ensured.


Sent from my iPhone using Tapatalk
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Each VA clinic is different, and it sounds like your patients actually make it to the referrals that you put in (meaning they are offered appointments geographically close to them in an appropriate amount of time with the correct type of provider), which is a good thing.

It doesn't work that smoothly everywhere.
 
keifernny2 said:
Each VA clinic is different, and it sounds like your patients actually make it to the referrals that you put in (meaning they are offered appointments geographically close to them in an appropriate amount of time with the correct type of provider), which is a good thing.
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Makes sense. Are you at a CBOC?

I'd imagine practicing in a truly rural environment (meaning not one with a fair size city 1 hour away) must be frustrating in any field in medicine, but particularly psychiatry.
 
Yeah, I have way more leeway in follow-up resources at the VA than I did at an AMC. Continuity of care resources are definitely better. Way too many stroke patients during my AMC days who never got rehab they needed because insurance would not cover it, or would only cover a comically low amount of time.
 
WisNeuro said:
Yeah, I have way more leeway in follow-up resources at the VA than I did at an AMC. Continuity of care resources are definitely better. Way too many stroke patients during my AMC days who never got rehab they needed because insurance would not cover it, or would only cover a comically low amount of time.
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Yeah, especially coming from someone like myself who was previously working in a medicaid-heavy clinic, the VA resources are hands down better. I don't think I'd ever be able to say the same outside of a major metro, however.

@notdeadyet I do tele to a CBOC from my primary site a couple days a week. I've been pleasantly surprised at what I've been able to do referrals for, either via tele as well or through getting a transportation consult, though my CBOC isn't terribly far away. I imagine it's a different ballgame for the sites farther out in the boonies.
 
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