During my second year in grad school and after a lot of thought, I had finally chosen to specialize in geriatric psychology. During one of our bi-weekly check-ins, my mentor asked, “Why don’t you apply to the VA?” I’m glad he asked the question.
I knew the Veterans Health Administration (VHA) was massive. As a respected training site, I also knew there could be many applications for a limited number of openings.
That said, I decided to apply, and I’m glad I did.
Since that conversation, I have been a research assistant at the San Francisco VA Medical Center (SFVAMC), a practicum trainee at the VA Northern California Health Care System (VANCHCS), and am currently an intern at the Martinsburg VA Medical Center in West Virginia. I am hoping these experiences can give you a general sense of the VHA, what kinds of services they provide, and what my experience has been thus far.
A World Unto Itself
There is a phrase you hear often when you talk to people from different VA training sites: “If you’ve been at one VA…you’ve been at one VA.” Every VA Hospital is different, but there are commonalities that I think are important to share – especially some unique aspects that you may not experience at other sites.
The VHA uses a ton of acronyms for the majority of their programs – it’s the native language – so I will share some of these within the article.
The Department of Veterans Affairs is a federal agency, so you can expect to go through an extensive background check with requirements including fingerprinting, getting a physical exam, and wearing and using a badge to get into buildings and log on to your computer.
The on- and off-boarding process can be extensive, so patience is key!
The VHA is the largest integrated health care system in the United States. It has over 1,245 health care facilities, over 170 medical centers, and 1,065 Community Based Outpatient Clinics (CBOCs). The VHA serves over 9 million veterans a year .
With regards to gender, male veterans comprise the majority of patients you will encounter. The total population of female veterans, however, is expected to increase at an average rate of about 18,000 women per year for the next 10 years. Data from 2015 indicate that 840,000 women used at least one VA benefit or service over the course of that year .
What VA Hospitals Have to Offer
Services provided at VA Hospitals can vary from site to site, but they can include surgery, critical care, mental health care, orthopedics, radiology, and physical therapy. In addition, most medical centers offer specialty services including audiology and speech pathology, dermatology, dental care, geriatrics, neurology, oncology, podiatry, prosthetics, urology, and vision care.
I believe what sets the VHA apart from other training sites is its dedication to providing high-quality, culturally competent, and compassionate mental health care. This training has kept me energized over the past few years.
The VHA provides incredible resources, including trainings, treatment manuals, and assessments. Its online Talent Management System (TMS) offers training, webinars and virtual grand rounds and is accessible to all providers. The VHA also offers education spotlights featuring a wide variety of clinical topics and monthly presentations. Their online library has access to thousands of articles and academic journals, and many VA Hospitals have on-site libraries. There are also opportunities to become certified in various treatment modalities.
The VHA allows trainees and interns the opportunity to give presentations and train other professionals. I found that one of my sites particularly welcomed it when the psychology department trained nurses and other medical professionals about mental health conditions, ethics, and behavior modification techniques. For example, I was able to present to nurses and other trainees about mandated reporting standards and how to identify signs of suspected elder abuse.
The complex cases that I have engaged in have made me a stronger clinician, and I have become more confident in my skill sets. Prior to training at the VHA, I had not worked with any patients with traumatic brain injury (TBI) or combat PTSD. Within the VHA, I was introduced to cognitive rehabilitation, TBI screening and neuropsychological batteries, combat process groups, cognitive processing therapy (CPT), and prolonged exposure therapy. The opportunities are endless if you are interested in PTSD work or neuropsychology.
The VHA requires clinicians to use evidence based practices including cognitive-behavioral therapy, cognitive processing therapy, prolonged exposure, and motivational interviewing. Within each VHA there are opportunities to use other theoretical orientations but it depends on your supervisor, patients, and the flexibility within the organization. While I like to view my patients from a psychodynamic lens, I tend to use manualized treatments to conduct therapy and I administer mood screens to measure treatment outcomes.
There are also many opportunities to facilitate groups. Behavioral health groups include MOVE! (to promote weight loss), smoking cessation, diabetes management, and anger management, to name a few. These groups are interesting to lead because you are facilitating them with other providers including dieticians, physicians, psychiatrists, and nurses. These groups strengthened my ability to work in a collaborative care approach and informed my treatment when I worked with veterans struggling with complex medical issues.
Psychotherapy groups are also available at every VA Hospital, and these vary widely. There are process and psychoeducational groups for combat trauma, PTSD, military sexual trauma (MST), stress reduction, sex and intimacy, sleep, and chronic pain. Some sites may also offer groups based on principles of Acceptance and Commitment Therapy (ACT) or Dialectical Behavior Therapy (DBT). There may be mindfulness-based groups or yoga offered as well. I have found that the VHA has always been open to suggestions for new group ideas.
If you are interested in conducting research, the Office of Research and Development (ORD) is the hub for all research produced with the VHA. Two of the research divisions I have had exposure to are the Geriatric Research Education and Clinical Center (GRECC) and the Mental Illness Research, Education and Clinical Centers (MIRECC).
The aspect of my VHA training that I am most grateful for has been the opportunity to work with people in many different disciplines, and I’ve learned to appreciate the different kinds of care that each discipline can provide to veterans. I have had the chance to see how the trajectory of a veteran’s success can depend on how well we, as providers, communicate, collaborate, and truly care for that veteran, and I feel fortunate to be a part of it.
Resources National Center for Veterans Analysis and Statistics — www.va.gov/vetdata and the VHA FY16 Annual Report — https://www.va.gov/HEALTH/docs/VHA_AR16.pdf  Women Veterans Report: The Past, Present, and Future of Women Veterans. National Center for Veterans Analysis and Statistics, Department of Veterans Affairs, Washington, DC. February 2017.
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