Contrarian Posted June 8, 2014 Share Posted June 8, 2014 "Weezianna"... are you a Veteran...???? Link to comment Share on other sites More sharing options...
weezianna Posted June 15, 2014 Share Posted June 15, 2014 No, I am not. Any more questions? Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 17, 2014 Moderator Share Posted June 17, 2014 I can relate to the Fort Bragg experience; I worked at an Air Force Base primary care clinic, and the emphasis was on keeping everyone deployable. The big joke was that there was a mysterious room, somewhere, with a mountain of Motrin in it! Provider were discouraged from labeling active duty members with depression, and advised to diagnose them with adjustment disorder. I didn't like the style of medicine practiced there; sick call brevity at best, which of course may have its place in another setting. The demands on the VA system have increased, as previously noted, by the influx of veterans who have served in recent, endless conflicts. Now, I'm not making a statement on the general quality of today's military, but a lot of these folks were, quite frankly, marginally employable prior to service, and when they get out, they either can't find a job or aren't qualified for anything. As a provider who has worked both in primary care and compensation and pension, I have to say that there is a big rush to get on the VA bandwagon. Between the double dippers with insurance and the unemployed/uninsured, primary care clinics are bursting at the seams. Providers may get a big more time with patients than in the civilian world, but each patient is the proverbial "train wreck", with multiple problems/issues, who gets seen once or twice a year. There is a hue and cry about the delay in processing disability claims. In my opinion, this is a big racket for many claimants. Now, of course, there are so many deserving vets who are injured, broken, from their service, either physically, mentally or both, and warrant as much help as we can give them. But then again, it is well known in VA circles that the name of the game is getting a check. C & P is clogged with frivolous claims, generated by vet reps who comb through charts looking for potential service connections, however medically implausible. It is not unusual to have to review years of medical records to process a claim for 15 or 20 possible conditions, so it's not like we can see 20 vets a day and take care of their claim. VA disability payments are a source of income, and many vets keep pushing for a greater percentage of service connection. It is sad to see stoic vets, who never complained a day in service, who come in with injuries that will plague them lifelong, struggle to get compensation without supporting evidence, while other vets spend their entire enlisted period in sick call, racking up documentation of complaints, because they know that's what they'll rely on after separation to get them a service connected disablilty. In general, vets get excellent care once they get in the system. The system is indeed burdened with a lot of dead weight, employees that can't be gotten rid of. Specialties have no incentive to see patients, as they get paid the same whether they see more or less, so some cherry pick their patients and find ways to decline referrals. Primary care is an endless job, with complicated patients and endless "view alerts" to answer daily. I have to say, though, that most people, both clerical and medical, prioritize the care of the veterans, and give them the best care possible. yeah vets get great care when they are in the system.... that is why a friends son hung himself in the woods, and why there is horror stories of delays in treatment.... sorry, but you have only seen one side of it....... and this does not encompass the full spectrum of what is out there.... did you know that even to get a decision on a disability claim is is OVER 450 days right now in my VISN! What about the guys that are coming home with physical and mental difficulties..... what are they supposed to do for a year and a half? We owe them better! As for some people making a claim for a check - welcome to america, no different then anything else...... I understand that you have seen one side of it - but this is a very small side, I as a veteran have seen a different side (I am non war time but have a legit service connected disability that I asked to be rated at 0% on separation). As mine is borderline trivial I continue to use my own health insurance and decline to follow with the local VA, and I am sure I see a very different side of the VA then what someone coming back from the desert having seen things no human should have seen....... The system is broken.... period...... Link to comment Share on other sites More sharing options...
weezianna Posted June 17, 2014 Share Posted June 17, 2014 Of course the system needs revamping in many aspects, and no one profile that fits providers or patients. There are providers who give patients short shrift, and there are many who go out of their way to address problems in a comprehensive and compassionate manner. There are deserving patients in dire need and there are malingerers and drug seekers. Compensation and pension can make all the difference for some, and a factitious way to earn an income for others. I believe that different VISNs have disparate delays in processing disability claims. We are still seeing delayed claims but the goal is 120 days, if I recall correctly. There is an increased awareness of issues of PTSD and the impacts on the physical and mental affects of our endless wars. The system has seen burgeoning numbers from veterans who are unemployed and/or uninsured, and it's provided a welcome safety net. The VA is a ponderous bureaucracy that at times seems to crush itself under its on weight. It can be difficult for both patients and providers to navigate. Link to comment Share on other sites More sharing options...
gleannfia Posted June 17, 2014 Share Posted June 17, 2014 Agree, weeziana. Link to comment Share on other sites More sharing options...
PACProvider Posted June 26, 2014 Share Posted June 26, 2014 I work at the VA and have positive and negative feelings about my work. However, I feel a sense of pride in the responsibility for caring for a Veterans. Despite the negative press, I see my colleagues (PAs, NPs and Physicians) as sincere, competent practitioners. Trying to describe what the VA is like as an employer is a challenge because there is a lack of uniformity. This was noted in an earlier post. In some regions, CME is generous, others not. In some regions, pay is much better, in others, the Director can drive down wages. In some regions, PAs enjoy greater autonomy and respect, in others, they don't. On the positive side, there is a process in the government for handling legitimate complaints. In my VA, the service chief, a physician, was eventually stripped of supervising responsibility due to multiple management problems. She was hostile to the PA profession and generally had a low view of most of her colleagues. Ultimately, the Director relieved her of her responsibilities as service chief while she retained her physician role. The PAs who most enjoy the VA seem to be those with kids who like getting home at a reasonable hour and enjoy vacation time. Link to comment Share on other sites More sharing options...
Contrarian Posted June 30, 2014 Share Posted June 30, 2014 No offense, but most of my patients would beg to differ with you. When is the last time your doctor spent an hour with you? I spend an hour (or more) with new patients, 30 minutes with returns. That would not fly in the cha-ching of corporate health care. Watched 2.5hrs of talk about the problems on CSPAN yesterday... Funny thing is... half the committee on Vet Affairs blamed the backlog and delayed access on what you speak of above. The 3 physicians on the commitee... two of whom are also Veterans... all chimed in on the laid back VA culture of low patient panels and long in the exam room appointment times as part of the problem. They Kept talking about how civilian sector providers typically carried ~3500 patients per provider panel and flat out reported that the VA providers aren't near this number. So that's about to change if they have their druthers. Contrarian P.s... I've recently finished 4 interviews with the VA as a Mental Health provider. I've been "selected" for: 2 positions in Colorado (Pueblo & Colorado Springs) Tulsa, OK, Alexandria, LA, Roanoke, VA. I'm also awaiting grade determination. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 30, 2014 Moderator Share Posted June 30, 2014 Funny how the VA doc's say then need to see more, yet in the private sector a panel is considered full between 1500 and 2500. 3500 is just insane and no way to manage in a PCP office. Then add in all the ACO PCMH and all the other things trying to get PCPs to be more efficient with managing all the health care of the panel and increasing the panels is clearly not the answer. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 30, 2014 Moderator Share Posted June 30, 2014 I'm also awaiting grade determination. that seems to be million dollar question..... I have heard they do not tell you till right before your first day, or sometimes after your first day... makes it hard to accept or decline. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted June 30, 2014 Share Posted June 30, 2014 ^^^ This wasn't the case in my situation. I was told when the grade/level determination meeting was to be held (had to be re-scheduled due to dept head having a scheduling conflict, and I was told so during a follow up inquiry the day following the intially scheduled meeting) and was then notified within 48 hours as I recall. Following that, I completed the required paperwork (carried in by hand), had the SP whom I had never met since the interview was by phone sign my paperwork allowing for application of DPS/DEA authorization, went ahead and was fingerprinted, and they then had a consent signed for a background check. I went in this past Friday for the pre-employment physical (exam was somewhat surprising and since I had been doing those the preceding eight years I would love to have that job) and am being asked to provide additional information related to a medical condition that was isolated from three years ago without further sequela. From time of notification of offer to this past Friday was 25 days. Link to comment Share on other sites More sharing options...
BruceBanner Posted June 30, 2014 Share Posted June 30, 2014 I do disability evals for the VA as an outside contractor. These guys (and girls) wait up to 6 months just to see me, then another 3-6 months to get their rating decision. I don't know much about the inner workings of the VA, but from talking with a few hundred veterans I get the sense that they are treated pretty poorly from a variety of fronts. VA providers are cavalier and disregard many conditions (had a friend who died of an aortic dissection WITH a positive family history, misdiagnosed as a "chest wall strain"), the delays in receiving care are absurd, and the system is bogged down with veterans who don't even have service-connected conditions, many of which are minor or insignificant. My claimants will claim ANYTHING under the sun to get a better rating. On one hand I don't blame them, but on the other it just belies the culture of veterans vs. the VA. Link to comment Share on other sites More sharing options...
gleannfia Posted July 1, 2014 Share Posted July 1, 2014 Can only speak for myself, but I like the autonomy the most. Link to comment Share on other sites More sharing options...
gleannfia Posted July 1, 2014 Share Posted July 1, 2014 15 minute appointments are fine for patients who are exceptionally healthy like me (great genes-thanks Mom and Dad!). For your average VA patient who has COPD, uncontrolled DM, CAD, and a myriad of other maladies, not so much. Also, seeing the patient is only part of the job. There are phone calls to be made, studies to follow up on, etc. If vets are complaining now, wait until we start emulating the corporate sector. Link to comment Share on other sites More sharing options...
gleannfia Posted July 2, 2014 Share Posted July 2, 2014 I am going to give you the benefit of the doubt and choose to believe that you did not mean to insult a legion of very hard-working clinicians, including myself. Do you really want to go down the road of horror stories? I worked across the street from Duke Medical Center in 2006 when a teenage girl died because the surgeon transplanted the wrong organs. I also was there when they were using hydraulic fluid to clean OR instruments. Google Josie King and Johns Hopkins-a toddler died because the eggheads in the pediatric ICU could not figure out what her mother knew--she was dehydrated. Her mother has made education about medical errors her life's mission. My CBOC has no wait list. It can take a long time to be seen in the private sector as well. Also, be discerning when you are listening vets' stories. That guy on the front page of the local paper who claims the VA will not address his pain is the same guy who signed a pain contract, then violated one or more of the terms. And some of these people are not happy anywhere. I have personally sent vets to the private sector at their request, only to have them return to the VA, dissatisfied. You are probably a nice person and a fine PA, but you are very misguided in your criticism. I do agree with you on one front: The VA is overwhelmed with vets who are not service-connected and have other resources. I have spoken before on this forum about the middle and upper middle class men who want free Viagra, because apparently it is their God-given right to feel and perform like an 18 year-old at 85. If we could limit care to those who are truly indigent or who are service-connected, I believe everyone would be much happier. Sorry to be so harsh, but a lot of us in the VA are feeling especially sensitive these days. Most of us do not deserve this overwhelmingly negative press. Link to comment Share on other sites More sharing options...
gleannfia Posted July 2, 2014 Share Posted July 2, 2014 That's odd. Everyone in my CBOC appears to have been born in the US, and speak flawless English. Must be where you live, Boats. Link to comment Share on other sites More sharing options...
gleannfia Posted July 2, 2014 Share Posted July 2, 2014 Sorry, did not realize I was loading spam on here. Link to comment Share on other sites More sharing options...
gleannfia Posted July 2, 2014 Share Posted July 2, 2014 Hmmm. Wonder what your patients might say about the system (not you) that you work in? Link to comment Share on other sites More sharing options...
db_pavnp Posted July 2, 2014 Share Posted July 2, 2014 Learn to use the multiquote button, dude, no one can follow the spam. Link to comment Share on other sites More sharing options...
gleannfia Posted July 2, 2014 Share Posted July 2, 2014 Oops, sorry. Link to comment Share on other sites More sharing options...
Contrarian Posted July 2, 2014 Share Posted July 2, 2014 Offered... GS-13/Grade-10 Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 2, 2014 Moderator Share Posted July 2, 2014 Offered... GS-13/Grade-10 congrats. did you ever finish the msn? , and if so did that factor in? Link to comment Share on other sites More sharing options...
Contrarian Posted July 3, 2014 Share Posted July 3, 2014 congrats. did you ever finish the msn? , and if so did that factor in? NOPE...!!!! Couldn't bring myself to do it... but will likely do THIS program. Since I will start at GS13-Step10 and will hit that GS15 ceiling quick...This ASU-Doctorate will launch me out of the GS system and into the "SES" ranks. EMEDPA, it was the MPAS-focused in Addiction Psychiatry + state wide Geriatric Mental Health Specialist designation + yrs of experience in various outpatient/inpatient/crisis triage/detox psychiatric settings that did it. I'll also be able to retire from Federal Service in 12yrs if I want, due to my previous 8yrs in the military. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 3, 2014 Moderator Share Posted July 3, 2014 How did you get the geripsych cert? Link to comment Share on other sites More sharing options...
Contrarian Posted July 3, 2014 Share Posted July 3, 2014 According to: WAC 388-865-0150 Agency filings affecting this section Definitions. "Mental health specialist" means: (1) A "child mental health specialist" is defined as a mental health professional with the following education and experience: (a) A minimum of one hundred actual hours (not quarter or semester hours) of special training in child development and the treatment of children and youth with serious emotional disturbance and their families; and (b) The equivalent of one year of full-time experience in the treatment of seriously emotionally disturbed children and youth and their families under the supervision of a child mental health specialist. (2) A "geriatric mental health specialist" is defined as a mental health professional who has the following education and experience: (a) A minimum of one hundred actual hours (not quarter or semester hours) of specialized training devoted to the mental health problems and treatment of persons sixty years of age or older; and (b) The equivalent of one year of full-time experience in the treatment of persons sixty years of age or older, under the supervision of a geriatric mental health specialist. I was working at a involuntary inpatient psych facility in Mukilteo so took THIS course.The training was ON the Western State Hospital Campus. For 4 weeks, I'd drive down to Lakewood-Tacoma area on Sunday night and check into a hotel room until Wednesday morning. I'd Sit in Class Monday, Tuesday 0830-1700 and Wednesday 0830 until noon. If I needed to see any new admits at the facility on those days, I would do it after class, as it was only 30 mins away at that time of night. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 3, 2014 Moderator Share Posted July 3, 2014 looks like a great course and hard to beat the price. Link to comment Share on other sites More sharing options...
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