Working at a VA Hospital

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PsychBoxe

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Does anyone have any input about working/interning at a VA? At this point I am looking into doing my practicum at a VA, and would like to know the positives and negatives of this work environment. I have already done my own research on this topic, but would like to hear the opinions and experiences of others going into the field, or from those who are currently working at a VA. Thanks!
 
I did a practicum at a VA. I wasn't there full time, but this was my impression of what it would be like to work there.

Positives: respect for psychology as a discipline, good benefits/salary, the veterans are very interesting and rewarding to work with, good training opportunities in evidence-based PTSD treatments, flexibility in the modality of tx (e.g. you may work with couples, families, groups, and individuals).

Negatives: there is a culture of sexism (often benevolent sexism) that you have to negotiate, the VA still considers EMDR as a valid treatment option, working for the government means a lot of red tape, secondary trauma can take a toll if you aren't someone who deals well with that, long waiting-lists for tx, lots of anger management issues.

Hope that helps. Overall, I'm glad I worked there for a year and got the experience.
 
My VA appearerd to have a huge skizm between primarily research clinical psychs and the practicing clinical psychs. That was prob just my VA though. I agree with massive redtape. Didn't notice any sexism at my VA (alot of the top dog researchers were women). Great training and attentive supervision. Good benefits as an employee.

My biggest complaint was actually with the system as a whole, which appears to encourage and foster disability seeking and often looks the other way even when it was patently obvious. People who were born and raised in Canada seem to get this (and note the massive difference), many others don't seem to for some reason
 
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Upside: Good pay, very good benefits, and it's hard to beat the value of a VA position on your CV, particularly for early career psychologists.

Downside: Politics, administrative red tape, bureaucracy.

The way psychology is treated as a discipline generally, and the way psychologists are treated individually varies widely by VISN, system, and facility.

Example: one psychologist I know of got hired as a director of a prestigious clinic at one of our other facilities. She got paired with an administrative assistant that was supposed to work for her, but she had no formal authority over, and worse, this admin person was personality disordered as well - but no one could figure out how to get rid of her. To make a long story short, this psychologist friend of mine quit her prestigious job basically because this administrative assistant was literally making her crazy. She works somewhere else now in an equally prestigious position, but likely makes less money.

Another example: I know of a psychologist who has the exact same position I do at a neighboring VISN. Unlike me, she has to record her time in three different ways (an excel spreadsheet, an "event capture" program, and through the electronic charting program we use), and she has to do her own MDS careplanning. Not only that, unlike where I work, her boss is a psychiatrist and doesn't seem to respect psychology as a discipline.

So, as you can see, not all VAs are the same.
 
Dr Gero, could you elaborate on how a being a staff psychologist at the V.A. helps enhance your vita? I have never heard that before

Thanks
 
You may want to do a search because I believe this has been asked, so there should be some good info out there.

I'll post my experience when I have more time, but overall my time in the VA system was very well spent.
 
Didn't notice any sexism at my VA (alot of the top dog researchers were women).

I didn't mean any sexism on the part of the institution in terms of hiring practices or anything. I was talking more about sexist remarks from the veterans as females go about their business. "Why can't you smile honey?" "Someone so pretty shouldn't look so stern." "Let me get that box for you, I can't believe other men let you carry that." "Ladies can't tolerate swearing, so I'll have to watch my tongue." Sure, it's not meant to be rude (quite the opposite), but it still rubbed me the wrong way. It was much more prevalent in the VA than in any other system I've encountered.
 
Dr Gero, could you elaborate on how a being a staff psychologist at the V.A. helps enhance your vita? I have never heard that before

Thanks

I just meant that a VA position generally is something held in high regard, it's relatively prestigious. Just my sense of things.
 
I have prepared myself for many of the negatives mentioned, and it is a bit reassuring to see a trend in the replies for this post. Personally, it seems that the focus on evidence based theories used in treatment, the myriad of issues surrounding the clients, and the benefits (salary and government assistance with student loans) are the things that I have focused on as positive.
 
While working for the VA, is the employee offered any loan repayment assistance? Is it still valid that after a certain number of years, loans can be forgiven, or greatly reduced?
 
I didn't mean any sexism on the part of the institution in terms of hiring practices or anything. I was talking more about sexist remarks from the veterans as females go about their business. "Why can't you smile honey?" "Someone so pretty shouldn't look so stern." "Let me get that box for you, I can't believe other men let you carry that." "Ladies can't tolerate swearing, so I'll have to watch my tongue." Sure, it's not meant to be rude (quite the opposite), but it still rubbed me the wrong way. It was much more prevalent in the VA than in any other system I've encountered.

Can't you just smile more? 😉

Seriously, there is a certain amount of sexism in our general culture. I would even argue that some of it is not all bad... respect for motherhood comes to mind. I know that I am hanging dangerously out there on the outer branches, but men and women are different and these differences can be celebrated. I, like most evolved people, abhor the belief that men and women are not equally valuable in society. I believe that most women and most men are capable of performing many tasks with equal ability. The same challenges exist for men too... "Why can't you be more serious?" for example.

Is it one of the downsides of working in the VA system? Perhaps, but it can equally be empowering and beneficial as well when exploited by a capable and confident woman.

Don't take this wrong, I am not promoting sexism in the work environment, but environmental demands and constraints can be either endured or exploited. As psychologists we should know the right time to stand up and confront injustice as well as the right times to either endure or exploit our environment.

Mark

PS - Yes, I expect a certain savage response to my comments.
 
I dont see any probelm with what you said, I thought the same myself. My wife agrees and noted that she wished more men would offer to carry heavy objects for her at her work....🙄
 
I did a number of practicum at my graduate-affiliated VA and am now an intern at a large VA facility. I think responders before me have captured the positives (good pay, good benefits, excellent trauma training) and the negatives (red tape galore) pretty well. Just to add to that list:

Positives:
  • Structured hours/expectations-this is especially important for interns. At the VA, 40 hrs/wk really means only 40 hrs/wk, unlike other internship sites that end up being massive time sucks
  • Great advantages as far as job relocation aspects- it is easier to move from VA to VA than from another institution
  • Diverse patient populations-most private hospitals are going to be white (generally), older, upper-middle class folks who can afford health insurance, wheras VAs run the gamut in terms of race and SES. Also seeing improvements in access to female and young populations with the returning vets
Negatives:
  • This is def a site-specific issue, but getting a good amount of time carved out for research is a bit more taxing at a VA than at other university-affiliated medical centers
 
Can't you just smile more? 😉

Seriously, there is a certain amount of sexism in our general culture. I would even argue that some of it is not all bad... respect for motherhood comes to mind. I know that I am hanging dangerously out there on the outer branches, but men and women are different and these differences can be celebrated. I, like most evolved people, abhor the belief that men and women are not equally valuable in society. I believe that most women and most men are capable of performing many tasks with equal ability. The same challenges exist for men too... "Why can't you be more serious?" for example.

Is it one of the downsides of working in the VA system? Perhaps, but it can equally be empowering and beneficial as well when exploited by a capable and confident woman.

Don't take this wrong, I am not promoting sexism in the work environment, but environmental demands and constraints can be either endured or exploited. As psychologists we should know the right time to stand up and confront injustice as well as the right times to either endure or exploit our environment.

Mark

PS - Yes, I expect a certain savage response to my comments.

Heh, I'm not going to respond savagely 🙂. You're being diplomatic. Let me illustrate my point a bit further, though, to see if I can clarify why I view this as a negative. I don't think calling someone "sweetie", "honey", or "doll" is appropriate within a professional context. I'm not a customer in a diner, I'm a health care provider working in a hospital. Also, I wear a name badge. Even if these remarks were construed as respect for the positive aspects of femininity (like motherhood), it is not relevant to my role as a provider.

I'm not naive, and I understand that people make assumptions based on an individual's sex all the time. However, I have never had my sex be as salient an aspect of myself as when I was working at the VA. Heck, it wasn't even as big of an issue when I was the only girl on my baseball team. So, I do view this as a negative compared to other environments. It is clear that conformity to gender roles is expected by many veterans, and that can be intimidating.

You're right, these moments can be opportunities for discussion. However, it gets exhausting having to either confront or quietly endure stereotypes day after day.
 
Wait, hold the phone, you mean to tell me that women are NOT fans of the Madmen work enviornment?...:laugh:
 
Wrong! ALL the women's outfits in the show are AWESOME!
 
I won't claim to speak for KD, but I can certainly understand why this would be a negative for someone even if it in no way affected her career and regardless of how it is "Intended".

At the very least, the attitude could be significant hurdle to overcome when it comes to rapport and therapy with that population. While these incidents may seem benign, I could see them being manifestations of a general demeanor towards women not being taken seriously as professionals. Think "You're my nurse, go get the doctor". While each setting and client carries their own set of challenges when it comes to that, I can understand some frustration with the same issue occurring with such regularity. Not insurmountable by any means, but I think she is perfectly justified in calling it a negative.
 
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Hmm, this isn't your boss calling you sweetie, honey, or doll, it's patients. Go work in a men's prison and see if you prefer that 🙂 Also, I'm curious, how is that a stereotype issue (toward you)? I've been called "honey" repeatedly by, mostly black women and older southern white women (employees at the VA too, they don't know who I am or what I do, but I don't think it would change anything). I'm a guy. I take it as a friendly greeting or comment.

Ollie summed up my experience well.

Whether or not it is worse in a men's prison doesn't mean that it is not still a negative aspect of working at a VA. That's like telling someone complaining about OSHA violations that they should try working in a sweat shop.

If you didn't like being called "honey" by employees there, I would support your right to claim that as a negative aspect of that environment. The fact that it doesn't bother you doesn't mean it shouldn't bother me or anyone else considering working there. I explained how it relates to stereotyping in a previous post. It's not a giant leap to go from "sweetie" to "she is not an authority figure" and "I don't have to listen to her lead group." This is a problem that needs to be negotiated and I don't see why I can't call it a negative of my experience there. I never said that I didn't manage to handle these issues. I am saying, though, that it got old and exhausting.
 
I just meant that a VA position generally is something held in high regard, it's relatively prestigious. Just my sense of things.

I think this is true, althoug its kinda weird to most people. The view within my family (and I know many others) is that VAs are crowded, dirty, often run down facilities that provide adaquate (and sometimes subpar) medical care. Unfortuanly I think this comes from a subset of bad facilities who gathered that rep duringt the 70s and 80s.
 
While working for the VA, is the employee offered any loan repayment assistance? Is it still valid that after a certain number of years, loans can be forgiven, or greatly reduced?

Two separate issues, actually. There is the Student Loan Repayment program, where monies are doled out by individual agencies (see http://www.makingthedifference.org/...ents/StudentLoanRepaymentandProgramsGuide.pdf) kind of as a mad scramble. I'm trying to get in on that myself.

The second thing you bring up is the new Federal Student Loan Forgiveness program http://www.studentloannetwork.com/repayment/public-service-loan-forgiveness.php which allows for those carrying Stafford and other federal loans to get their entire loan principal forgiven after 10 years. Which sounds great, although the catch is that you *can't* consolidate any of your loans during that time (so your rate may rise, I believe, as all of the federal loans carry variable rates with a minimum of 6.8%, although I may be wrong about this), and of course, 10 years is a long time from now and no one can make any promises about the existence of a program like this a full decade from now.
 
I think this is true, althoug its kinda weird to most people. The view within my family (and I know many others) is that VAs are crowded, dirty, often run down facilities that provide adaquate (and sometimes subpar) medical care. Unfortuanly I think this comes from a subset of bad facilities who gathered that rep duringt the 70s and 80s.

Yes, I think the VA really kind of earned a well-deserved reputation for suckitude in the 70s and early 80s. It's overcome that, though, in a lot of quarters, from what I understand. My understanding as well is that "Born on the Fourth of July" is a pretty good representation of what VA care was like way back when....
 
Positives
-It is easy to be a "career" VA psychologist. At my old VA, the majority of psychologists on staff were 20+ yr (some 30+ yr) and most of the other staff were on the same path.

-8:00-4:30pm are really the hours. Some psychologists come in early/late, but they tend to leave early/late to make 40 hours. I did see a couple instances where staff was asked to do some additional work (usually to meet a new compliance requirement or VA directive), but comp time was provided and/or money paid to compensate for the time.

-Flexibility in what you do as a provider. I have seen a number of psychologists carve out their niches and re-allocate their time to match their interests. It obviously varies by VISN and your direct supervisor, but I've talked to a bunch of psychologists at various conferences and it seems to be the rule and not the exception.

-Insurance headaches are generally avoided. There can still be issues with coverage, but they are more bureaucratic/red tape than actual denials of service.

Negatives
-Red Tape. It can happen with clinical treatment (limited Tx time, group v. individual Tx changes, etc), administrative requirements (VA directives, conflicting policies, etc), training (MyPEAK/LMS courses), and research (extended IRB reviews, overly stringent requirements, etc)

-Some of the "lifers" can be difficult to navigate, whether they are in HR, IT, Nursing, Medicine, etc. You learn who they are and try and not interact with them. They can also be cynical and/or really drag down some of the good things happening around the hospital.

-Variability between facilities. Some VA hospitals are outstanding, others are mediocre, and there are still some that lag behind the rest. It is really important to talk to other providers about specific VA hospitals and make sure that you'll fit in with the culture.
 
...the catch is that you *can't* consolidate any of your loans during that time (so your rate may rise, I believe, as all of the federal loans carry variable rates with a minimum of 6.8%, although I may be wrong about this), and of course, 10 years is a long time from now and no one can make any promises about the existence of a program like this a full decade from now.


I actually spent a great deal of time just today reviewing the specifics of the PSLF program. My understanding is that if you consolidate all your federal loans and make 120 payments on them, while fulfilling the rest of the criteria, you are eligible for the loan forgiveness: http://studentaid.ed.gov/PORTALSWebApp/students/english/PSF.jsp

And to speak to the variable interest rate issue: if your loans were disbursed after 7/1/06, all federal loans are fixed rates. http://studentaid.ed.gov/PORTALSWebApp/students/english/repaying.jsp

Hope this helps. I too am very interested in working for a VA and applying for PSLF.
 
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Heh, I'm not going to respond savagely 🙂. You're being diplomatic. Let me illustrate my point a bit further, though, to see if I can clarify why I view this as a negative. I don't think calling someone "sweetie", "honey", or "doll" is appropriate within a professional context. I'm not a customer in a diner, I'm a health care provider working in a hospital.

You're right, these moments can be opportunities for discussion. However, it gets exhausting having to either confront or quietly endure stereotypes day after day.

One provider I worked with took to wearing a medical white lab coat, seemed to solve the problem pretty effectively actually. Make the demand characteristics of the environment work for you. 🙂

If you dress like a doctor, rightly or wrongly, you'll be treated like one. If you dress like a psychologist, you usually won't get the respect commensurate with your education. The nice thing about being a psychologist is that we understand, in general, the idea of how the environment can shape the attitude of our clients.

I understand your frustration though, and it's wrong for them to pursue these stereotypes and for you to endure them. I get it. So do what you can to manipulate the environment. Ensure that your co-workers address you by title in front of patients, grab a white lab coat if need be, dress in a less approachable manner. Leave no question as to how you expect to be treated, firm, polite, and professional.

Mark
 
I actually spent a great deal of time just today reviewing the specifics of the PSLF program. My understanding is that if you consolidate all your federal loans and make 120 payments on them, while fulfilling the rest of the criteria, you are eligible for the loan forgiveness: http://studentaid.ed.gov/PORTALSWebApp/students/english/PSF.jsp

And to speak to the variable interest rate issue: if your loans were disbursed after 7/1/06, all federal loans are fixed rates. http://studentaid.ed.gov/PORTALSWebApp/students/english/repaying.jsp

Hope this helps. I too am very interested in working for a VA and applying for PSLF.

OK, you're probably right about the variable rate issue - although I think there's a rather unforgiving rate they give you (which, I think, is where I got the 6.8% figure from).

Regarding the consolidation issue, I am not eligible for the loan forgiveness program because I did private consolidation. If there is an approved federal consolidation loan you can do that still allows you to qualify for loan forgiveness, that's great.

*Sigh*. My only hope is to somehow over the next few years of my VA career get a few thousand (and with any luck, the 60K maximum allowed) knocked off my principal.
 
you can, of course, dislike or like anything you want. That's personal preference, but you called it sexism, which is a serious charge, and then gave no examples of sexism. I'm not saying it doesn't exist, but there are many other explanation for the behavior. Could be general area cultures, asi gave some examples of, could be your age. In our field, a thick skin is a plus.

The first definition of sexism on dictionary.com is "attitudes or behavior based on traditional stereotypes of sexual roles." If you really don't think my examples have to do with the stereotype that women are sweet, pretty, and fragile, then I'm not going to spend more energy trying to convince you otherwise. We'll have to disagree. Maybe you're right. Maybe all that would have still happened if I was a male.

I don't think I'm being hysterical about this issue; I think my frustration is reasonable and is shared by others. I also think I've developed a perfectly adequate thickness for my skin, even before doing my practicum at a VA.

Anyway, I've derailed this thread enough (albeit unintentionally).
 
[*]Structured hours/expectations-this is especially important for interns. At the VA, 40 hrs/wk really means only 40 hrs/wk, unlike other internship sites that end up being massive time sucks

Not always the case - definitely varies according to VA. I just finished my internship in neuropsych at a VAMC and I hovered around 50 hours per week, as did the 5 other non-neuro interns. Back in the beginning some interns were here until 7pm just trying to get all the paperwork done.
 
Not always the case - definitely varies according to VA. I just finished my internship in neuropsych at a VAMC and I hovered around 50 hours per week, as did the 5 other non-neuro interns. Back in the beginning some interns were here until 7pm just trying to get all the paperwork done.

It should be noted that some clinicians prefer to do some prep at home, you obviously you can't bring pt. data home, but organizing material for groups is something I did at home. During my intern year I put in 5-10 hours a week of reading at home (mostly nuero stuff), though it wasn't a requirement of the internship. I also put in 10-15 hours per week towards fellowship applications. I think once someone is on staff they can settle into a routine that minimizes any need to take things home.
 
Not always the case - definitely varies according to VA. I just finished my internship in neuropsych at a VAMC and I hovered around 50 hours per week, as did the 5 other non-neuro interns. Back in the beginning some interns were here until 7pm just trying to get all the paperwork done.


Hmm... that is interesting. I've only had direct experience in 2 VAs so I'm sure there are exceptions. However, that sounds really extreme. There are some evening groups at my current facility, but for trainees, they are always optional and if we choose to do them we get comp time.

But as far as staying late to finish notes, it is strongly discouraged. In fact, our DCT actually instructed us to let her know if we find ourselves routinely staying beyond 4:30 for clinical duties as it is a sign that there may need to be some adjustments in the workload. Now, there is a good amount of reading (for rotations and didactics), but that is to be expected when taking on new experiences. Did anyone ever address this issue with your DCT?
 
Now, there is a good amount of reading (for rotations and didactics), but that is to be expected when taking on new experiences. Did anyone ever address this issue with your DCT?

To make the 2,000 hour requirement (because of holidays, PTO, sick days, etc), you'll have to log hours at home. We had a weekly hour sheet that we completed to track all of our hours. It was very very helpful in staying on top of things.
 
Hmm... that is interesting. I've only had direct experience in 2 VAs so I'm sure there are exceptions. However, that sounds really extreme. There are some evening groups at my current facility, but for trainees, they are always optional and if we choose to do them we get comp time.

But as far as staying late to finish notes, it is strongly discouraged. In fact, our DCT actually instructed us to let her know if we find ourselves routinely staying beyond 4:30 for clinical duties as it is a sign that there may need to be some adjustments in the workload. Now, there is a good amount of reading (for rotations and didactics), but that is to be expected when taking on new experiences. Did anyone ever address this issue with your DCT?

I should say that I live right outside what is arguably the most competitive academic city in the northeast and I know that my VA, as well as the other area VAs are notorious for setting a very high bar. A high bar is great, but along with that comes a "do what you have to do" attitude. I actually don't know one person in my geographic region who, as an intern, was ever discouraged to stay late. My DCT is well aware and takes pride in having a rigorous program. The obviously don't advertise for a 55+ hour per week position, but it is pretty much a known fact when people apply. It's all relative, I know that other geographic areas are far less competitive and therefore less demanding than here.
 
I should say that I live right outside what is arguably the most competitive academic city in the northeast and I know that my VA, as well as the other area VAs are notorious for setting a very high bar. A high bar is great, but along with that comes a "do what you have to do" attitude. I actually don't know one person in my geographic region who, as an intern, was ever discouraged to stay late. My DCT is well aware and takes pride in having a rigorous program. The obviously don't advertise for a 55+ hour per week position, but it is pretty much a known fact when people apply. It's all relative, I know that other geographic areas are far less competitive and therefore less demanding than here.

:laugh:

I think I know your VA, as it was one the two I looked at in the Northeast, both of which had too much of a hustle and bustle feel to them. Good training though.
 
:laugh:

I think I know your VA, as it was one the two I looked at in the Northeast, both of which had too much of a hustle and bustle feel to them. Good training though.

I'm sure you are right - location, location, location 😉
 
-Some of the "lifers" can be difficult to navigate, whether they are in HR, IT, Nursing, Medicine, etc. You learn who they are and try and not interact with them. They can also be cynical and/or really drag down some of the good things happening around the hospital.

I became painfully aware of this point today at my VA internship. :-(

There are certain people within the VA system (typically have been there a long time) who are simply hell-bent on making life difficult. And unfortunately (as is my present situation) are oftentimes in positions of "petty tyrant" power, like administrative assistants, HR, training instructors, etc. I would certainly concur that there is a general culture of tolerance within the VA for the age-old stereotype of the disgruntled, cranky, government employee.
 
Example: one psychologist I know of got hired as a director of a prestigious clinic at one of our other facilities. She got paired with an administrative assistant that was supposed to work for her, but she had no formal authority over, and worse, this admin person was personality disordered as well - but no one could figure out how to get rid of her. To make a long story short, this psychologist friend of mine quit her prestigious job basically because this administrative assistant was literally making her crazy. She works somewhere else now in an equally prestigious position, but likely makes less money.

Oh, my! I think I know this person of whom you speak. 😱 lol
 
I'm learning the fun of this system right now. First, they don't return my messages. Then they lose my paperwork. Then they try and get me to drop everything to jump through their hoops on 24 hours notice so they don't look bad because I'm nowhere near being cleared by the time of my supposed start date.

Gotta love it! I know 5 people who have been through this process here and it did not go smoothly for a single person. And supposedly, this is one of the "better" VA systems I am talking about....
 
-
 
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I'm learning the fun of this system right now. First, they don't return my messages. Then they lose my paperwork. Then they try and get me to drop everything to jump through their hoops on 24 hours notice so they don't look bad because I'm nowhere near being cleared by the time of my supposed start date.

Gotta love it! I know 5 people who have been through this process here and it did not go smoothly for a single person. And supposedly, this is one of the "better" VA systems I am talking about....


That tends to be the norm for administrative stuff at the VA. Luckily for me, the training opportunities and my actually daily work is awesome enough to motivate me through the absolute absurdity of the HR shenanigans.
 
i tried a search and nothing came up, so i apologize in advance if there is already a thread talking about this

can anyone who has worked as a clinician/practicum student/intern at a VA please say a little bit about their experience? i am interested in this population but i'm not really sure what working with them would fully entail. i hear opposing opinions--some really like it, some really don't like it. any help would be great.

thanks.
 
Well, what it would entail would depend on what kind of clinic you were working in, right? -just like everywhere else.

The range of psychoapthology seen in the gen pop is also seen in the vet pop. Some unique factors include large proportion of PTSD, head injury, cognitive impairments/decline and dementias (due to aging WW-II and Vietnam vets), a seemingly excessive amount of diabetes and diabetic complications (thats my own personal obervation), and, of course, a predominately male population. I worked in a memory disorder clinic and did get to see several women over the course fo the year though. Vets are a proud bunch and tend to lean to the right in their political views and lifestyles. They also have the reputation of not being very psychologically insightful/minded. However, I have NOT really found this to be the case.

There is a good chance that I will be doing my predoc internship at a VA. The practicum training I recieved at my local VA (which is one of the most prestigious in the nation) was top-notch and veterans were truley cared for by all the psychologists and attendings I worked with.
 
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I am currently finishing my clinical internship as a psychotherapist at a VA hospital. I am working between the inpatient acute psychiatry unit and the PTSD unit. I am a Vet myself, so my take on it might be a little different then others.

What we are seeing a lot of is some mild patient evolution in terms of war trauma. The Iraq and Afghanistan war Veterans are a lot younger and are dealing with issues a lot differently than Veterans from previous wars.

Such as erg923 pointed out, there really is a a wide range of issues to deal with. One thing I will add, is that if you plug yourself into the VA system as an intern, be prepared to get somewhat frustrated sometimes.

As a Veteran obtains sometimes that "magical" diagnosis they receive anywhere from $200 to $3400 per month, tax-free in service-connected disability compensation. So in a sense, there is an incentive to be sick. Of course this does not apply to all the Veterans, it will just be something that you have to learn to work with as a clinician at a VA.

Overall, I am EXTREMELY happy with my internship and am pursuing a career with the VA or DOD Military hospitals. Feel free to ask me any specific questions.
 
As a Veteran obtains sometimes that "magical" diagnosis they receive anywhere from $200 to $3400 per month, tax-free in service-connected disability compensation. So in a sense, there is an incentive to be sick. Of course this does not apply to all the Veterans, it will just be something that you have to learn to work with as a clinician at a VA.

I dont think its coincidence that many of the top names in effort testing/symptom validity research happen to be VA psychologists or VA-affiliated researchers. Those intersted in malingering and symptom validity within the context of neuropsychological asessment will certainly get there fill of that work in VA neuropsych and C&P clinics. I sure did.
 
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Good topic. I'll give my 2 cents later (too many notes to write), but the quick & dirty is I really enjoyed my time in the VA system and it can be a great place to train and also have a comfortable career. It can get quite competitive for the top sites, so applying with existing experience is advised.
 
My experience with the VA has been completely positive, although I think my experience is somewhat of an exception. I'm the only psychologist at my facility (a VA nursing home or "CLC" - I'm the staff geropsychologist), my boss is about 50 miles away, I have complete freedom to schedule my work duties, I have no performance measures attached to anything I do (save the formality of periodic peer review from other psychologists), and all of my co-workers with few exceptions are very supportive and enjoyable to work with. I work an 80% off-tour schedule I created myself, I have 25% professional development time built into my position, and I get to play with research projects (AKA, "quality management / quality improvement") when I have the time. I get to hone my assessment skills with a hospital full of patients, and the VA buys me whatever assessment kits I ask for, with no hassle (aside from the wait time).

The only thing that would make my job perfect is more money so my wife could spend more time at home with the kids. 🙁 But no situation is perfect.
 
I'm doing a practica in a VA substance use/dual diagnosis clinic right now.

I have very mixed feelings for it. I think the population has been great to work with, but it is definitely not for everyone. This is true of substance use in general, but the VA seems particularly treatment "resistant" in a lot of ways. It is a medically complex population...pretty much every person Is ee is on anywhere from 5-20 different medications (though I think some of that is just due to poor medical care and overmedication). They are definitely a bit more rough & tumble than the average client I've seen in other settings. You need to be very good at keeping healthy boundaries and simultaneously caring and remaining detached, because this is definitely a population that can suck you down into misery if you let it happen. This is NOT a good population for the extremely sensitive. They have generally been blunt, no BS kinda folks, and will not tolerate pleasantries, beating around the bush, and other stuff that therapy clients I have had in other settings will. They will tell you if they think you are wasting their time. I've found rapport easy to establish with some, almost impossible to establish with others, but I do have an appreciation for the fact that I feel like I always know where I stand with these guys. That isn't for everyone though.

One big complaint is the bureaucracy and astonishing amounts of incompetence that pervade "support" staff. Another is the actual quality of care, which I find to be mediocre at best. It is a major VA system, so one with a good reputation, academic-affiliations, and I've heard that it generally is viewed as providing much BETTER care than what you see at some of the smaller facilities and CMHC's nearby. It is still pretty crummy compared to what I see in more purely academic settings. I would describe certain individuals as evidence-based, but I don't think I could describe the VA as a whole that way despite their reputation. This is my first venture out into the community for clinical work (I've just been in the school clinic and lab previously) and it took some adjusting. I am extremely research-focused and always considered clinical work one of my weaker points before I got there, but now that I see what the ACTUAL standards of care are in these sorts of settings I realized that my standards are much, much higher than standard care.

As a whole, its good experience. I hold no regrets about working there, and am enjoying it. It wasn't at all what I expected, but its given me a great deal of insight into how things work in real world and I've learned a lot from that.
 
I'm currently on internship at a large VA and I love it! I find that the level of training is impeccable and probably the most comprehensive you will find in that you can get access to a variety of clinical populations, modalities, and disciplines. There are no billing headaches and I *LOVE* electronic records. There is more diversity among the populations you treat in terms of races, education, and SES than in private hospitals (largely upper-middle class) and community mental health centers (larger lower income). Of course, it is a male-dominated setting (slowly changing with female OEF/IEF vets) which can be a bit dicey for some women. Personally, it doesn't bother me. I am also pleased with the emphasis placed on research and continuing education, at least at my facility. In terms of downsides, it is highly bureacratic and support staff can be problematic, but that is variable depending on where you are. Most importantly for me is feeling like I am giving back to our nation's heroes. But that is just my sentimental, military-family side showing. 😉
 
This is my first venture out into the community for clinical work (I've just been in the school clinic and lab previously) and it took some adjusting.

Interesting observation.

I think this is one of the drawbacks of sheltering students in the "in-house" clinic until 4th year. Its kinda traumatic to see that thats not really the way things work in the real world. It also, in my mind, has the tendency to restricted ones thinking about therapy and the therapeutic process. That is, that therapy is 50 minutes once or twice a week and takes place in a small quite room with some chairs and a nice clock. Personally, I think everyone should have to do a practicum in an underfunded, county hospital/rehab facility where you have to fight OT/PT and nurses for time to do short, bedside therapy with patients who would probably never approach a psychologist on their own as outpatients. If there is only one thing that this accomplishes it is that it will certainly make you a more open-minded and flexible therapist who is a little more in touch with the average mentally-ill person. Personally, I find this setting to be alot more fun than my boring ole school clinic. I may not have studied any treatment manuals at this place, but I sure have learned a heck of alot more about how to "handle people" than I did at our counseling center. More dangerous and def less academic, but, to me this=more fun....😀
 
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Ollie, I know what VA you're at and I'm surprised. My VA, which is only marginally more well-known and prestigious than the one where you are provided amazing care to vets. The psychology services staff couldn't have been more dedicated and believe me, not having to worry about billing was taken full advantage of by supervisors and prac students. I regularly tested a person over the course of 2 or more sessions, giving 7-8 batteries...both to get the most comprehensive functional neuropsych assessment possible and simply to experiment and learn with different assessment measures. The PTSD clinic ran pure EST stuff, although other therapists and the cog rehab folks had a mix of orientations and used numerous technologies in their therapy. I didn't find anything to be overly manualized though, and their was always room/permission to basically do what the clinician thought was best. This, in my view, is a good thing.

I too found patients to be on tons of meds and antidepressants were given out like candy teh moment somebody said they were "sad"...but otherwise. I thought it to be top-notch facility.
 
I agree (sort of) and have definitely found it eye-opening and invaluable.

While there are aspects of it that I consider fun too, I'm not a fan of doing things poorly. Part of this adjustment has required me to let go of the need to do things "correctly". Depending on the area and the goals, I remain unconvinced that those 5-minute bedside visits actually accomplish anything. Most folks here know I am all about EBP, and I feel like a fair amount of the "work" in those settings is frankly, not a good use of my time. They can hire a high school kid to pass out sugar pills instead of a PhD level psychologist, and I doubt it would affect patient outcomes.

I know that's a very pessimistic view, and deep down I do think reality falls somewhere in the middle, but its hard to come home at the end of the day and read articles demonstrating that everything that is being done is utterly ineffective. Is bad care better than no care?

The saving grace for me is that this is meant to be a learning experience, not a transition into a career. I can get out of it what I need, and move on. It is giving me insight into the system and how things REALLY work on a practical level so I can know how to improve things in the future, and make the case for raising standards of care. I do believe the research has often not accounted for pragmatic issues in these treatment settings, and this has been re-emphasized by my VA experience. I truly take that to heart and while I am more of a basic scientist than a treatment researcher, I'm sure I will be involved in treatment research at some point in my career and it will definitely affect the direction I take things with my work. Even if it is heartbreaking to see where things currently stand.
 
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