Where I’ve been

It’s been over a year since we lost our dear April. I haven’t retreated from the world (any more than usual), but I’ve had little impetus to post here. I’ve been busy pursuing my various creative disciplines, including guitar, drums, bass, keys, and vocals. I’ve been increasing my focus on the various visual arts to include drawing, 3D environments & modeling, and dabbling in video editing and VFX. I’ve been busy, is what I’m saying.

I’ve been more active on social media with occasional creative posts, but nowhere near the level I need to build a community yet. I’ve mostly finished the Unreal Sensei course on UE5, although he has been updating content that I will revisit. I enrolled in Marc Brunet’s digital art course, a big commitment since I’m not bringing any additional money in now.

On that note, I’ll briefly explain. I’m no longer working with VES. They were bought out by a bigger defense contractor called Maximus last year. Word came down in March-ish that we would no longer be able to have schedule limitations and would need to let them schedule as they pleased.

The big issue with that (which I’m not sure I covered before) is that they have a policy where joint exams are all lumped together as a single worksheet for payment purposes. This means they get 6-7 worksheets for the price of one. As it happens, these are some of the most common claims we get. My experience in the past was that I would have my schedule filled with these types of exams, and the result was that I’d have 15-20 exams but end up getting paid like I did 3-5 exams. I had limited my schedule, so they couldn’t pile these exams on. Once, I decided to try opening my schedule up to get more exams, but I immediately got booked with those joint exams, so I reverted to my old policy. This was fine until Maximus required an open schedule.

At the time, I explained to them why I limited my schedule that way and that going forward, I would just be working less because this payment policy wasn’t sustainable. Why would I spend 8 hours in their clinic with only 1-2 hours’ worth of pay to show for it? I didn’t hear anything back and a month or so went by with no communication. Sometime in April or May, I find myself unable to log in to their system. I asked tech support, and their response was, “we’ll forward your request to the appropriate department.” Which is a very non-tech support kind of response.

I knew something was up. The answer I got (through an intermediary) was that “upper management” had decided for one of the following reasons: Veteran complaint, timeliness of reports, the accuracy of reports, employee/Veteran relations, and/or something else we’re not saying, blah, blah, blah, VES had decided to cut ties with you. I responded that this wasn’t satisfactory, and they could at least give me a specific reason (assuming it was possible it could be one of those reasons, although I didn’t believe so).

All I got back was that it was “schedule related,” but they might consider the matter again if I wanted to change my request. I said I never refused to work under the new policy, only that I would be working less because it wasn’t fair payment. I proposed that if they would alter my contract to pay fairly for the joint exams, I would be willing to work more often. My productivity was established over the past year (especially since I completed two of their travel weeks last year, and those are a slog). The intermediary said he’d forward it.

I had some residual emails from other departments about training and the like, and when I got those, I would cc this intermediary as a way to get updates on my proposal. After several weeks there was no answer, so I quit checking.

Since I have no specifics to go by, I think VES doesn’t tolerate any providers challenging their payment system, whether it’s done professionally or non-adversarial. I’ve never made any demands or ultimatums to them; I’ve only explained my reduced hours and why that policy is unfair, in my opinion. I’ve never been shown the courtesy of a response from management.

VES doesn’t hire providers, which prevents them from needing to provide any of the benefits or protections that a normal employer would be required by law to provide. They never hire you, so they don’t need to fire you; they can just say we’re no longer going to schedule appointments with you.

There was a precedent in my experience, my colleague from the VA fee basis days, Dr. Brooks, had experienced the same scenario, although his occurred within a few months while mine was over a year later. I think he may have been more direct in challenging them, going so far as to try and obtain a copy of their VA contract under the FOI act. I don’t think he ever got it, and not long afterward, he was “fired.”

He had been my collaborating physician, so maybe my dismissal was partly due to guilt by association in their minds, I don’t know. I never got a real answer, but I think I’m right in my thinking. Changing that policy to pay providers fairly would likely result in the loss of hundreds of thousands, if not millions, in revenue for them.

All that to say, I just decided to end it with them. I had never appreciated their culture. Despite all their flowery quotations about caring for Veterans, including those awful self-help and uplifting quote framed photos filling the walls in their clinic, their consistent behavior is that profits are the priority, not the Veteran. I often would have a Veteran who had an issue I could address in the clinic, but VES would never let me add or change the report even though it would likely save the Veteran months of waiting and potentially get them their benefits faster.

All this is anecdotal, but I felt that if there was ever a question of payment, their policy was to refuse the exam and make the VA request it formally to ensure they got their money. Whether it was the right thing to do for the Veteran didn’t matter. The other ongoing issue of frustration with them was their QA policy. They would go over each report and make these small corrections that were irrelevant, but I assume it was to ensure their reports were buffed to such a blinding shine that the VA would never question them and they could maintain their contract. Without their VA contract, they essentially have no business model.

I worked directly for the VA for nine years, and the issues that would be flagged by VES QA personnel never got questioned or challenged by VBA. Never. So, that was an ongoing frustration because they could commandeer your time and make you re-visit a report, and they weren’t going to pay you for it.

How’s that for a short explanation? Lol. Apparently, I still have some feelings about it. Mostly I find it frustrating that not only the VA (considering what happened to all of us fee basis providers) but VES and likely the other contractors truly don’t value hard work and competence and mostly want people who will swallow the corporate Kool-Aid and keep their heads down and their mouths shut.

The outcome is that this scenario has driven me into full-time creative pursuits and will eventually provide a means of income derived from the things I love, not the whims of some crass corporate entity.

In a forthcoming post, I’ll get back to the more important updates about my creative pursuits.

Three days later and still no answer on the election, but a bombshell at work...

The election still hasn’t been decided, with several states still counting ballots and the necessary 270 electoral votes not yet attained by either candidate. That said, former Vice President Joe Biden is sitting in a better position with 253 called electoral votes to 214 for President Trump, and by appearances, he’s doing well enough in a few of the remaining states to push him over the top. To no one’s surprise, the incumbent has been crying foul since election night and has been trying to claim victory multiple times. I won’t describe it any further, it’s being heavily covered by the media and will be well documented in the historical records I’m sure.

Just to add a bit of spice to our lives, I was following up on my credentials packet renewal at work when the clinic chief responded to an email saying that my credentials didn’t need renewal because fee-basis providers weren’t going to be used by C&P going forward. That was it. Abrupt, and with little explanation or attempt to soften the blow. The other people I’ve talked to share my opinion that this isn’t permanent, but it’s hard to predict at this point how long it will last. It was out of character for this person, although I’ve had little interaction with him so I don’t have a great deal of basis to judge how he handled it. I do consider it a failure of leadership to not have informed all the affected fee basis providers as a group.

I’ll probably pursue work with one of the contractors in the interim depending on how this plays out. I was already assuming it would be months or longer before there was any resumption of normal work, so this isn’t beyond the realm of what thought possible. That said, the manner in which the message was delivered strikes a hit against my long term loyalty to the C&P clinic and its leadership. It doesn’t seem that all the years of hard work and the thousands of exams really amounted to much, at least in the eyes of the current leadership.

Workplace Drama, Part Deux?

The drama from last summer apparently is rearing its head again with the same provider making accusations of misconduct and wrongdoing against multiple employees. I’m not sure if I discussed it here, but this person had been one of three temporary acting chiefs and ultimately lost that position because of increasingly erratic behavior and outrageous claims against multiple people. Things had seemed calm for several months, but supposedly this provider had been looking into other people’s records and made an accusation against another provider that resulted in a suspension. This is all second hand info, so take it with a grain of salt. The source is an honest and reliable person, but I have a feeling there may be some added drama to the story, whether an intentional exaggeration or not.

Following that, it seemed that this accuser appeared emboldened by this action and resumed the campaign against everyone that had rubbed them the wrong way, including yours truly. At this point, I was fed up with the bullshit enough that I sent an email to our new chief as well as his boss and included the memo I had written back in June. He spoke to me in person about it, and although non commital about anything specific, seemed to agree with my points and endorsed that this issue was a problem centered around the source and not the accused. I’ve not heard anything further, and honestly I don’t expect them to take any serious action other than telling this person to do their job and mind their own business. I’m wondering if this person will go even further off the rails to the point they must take action.

My experience with the leadership at work (in my seven years there) is that they avoid conflict and try for a quick and quiet resolution. Which usually doesn’t involve dismissals or transfers. If nothing else comes out of it, they got a detailed description of how I work now, so there can’t be any protestations of ignorance if there are any issues in the future. There shouldn’t be, as I’m following the same procedures (as directed and endorsed by my supervisors and our colleagues at the regional office) that I’ve always followed. I felt it was important to make sure our relatively new leadership chain (the clinic chief has only been here a month or so, and his boss around a year) was aware of my process.

I’m hoping the leadership will finally understand that this is a purely personal episode and this person is pursuing vendettas against multiple people to serve their own ego and not for the good of the organization or our customers. I stated that this episode was hurting morale and hindering our ability to care for our patients, and I’m hoping if nothing else that will mean something to them. We’ll see.

Drama on television or record is great, elsewhere not so much...

It's been a tumultuous couple of weeks at work and somewhat at school. At work we're hopefully near the end of a cycle that saw one of our doctors going off the rails. She was named an acting chief while they were looking to a hire a new permanent chief after the illness related departure of our former permanent chief.  To distill it down to a few sentences, let's just say she had a bit of a power trip and was butting heads and attacking several people in the clinic. 

We had been friends and supportive co-workers for many years but had a falling out a few months ago when we disagreed about implementation of the Gulf War illness policy. She's relatively new to government service and thought it was within her authority to implement the policy as she saw fit. It isn't, and she can't. But, in most cases we're willing to let individual providers rationalize their own opinions on cases as long as they understand they'll have to defend it if it's appealed or a complaint is filed. But in this case, and as part of her newly acquired (if temporary) authority, she decided the policy needed to change for the whole clinic and had directed our schedulers to change they way they scheduled these exams. 

This is where our big disagreement arose. She has this idea that if a claimed condition doesn't fit within a medical diagnostic criteria, then it's not valid. Something I've tried to explain to her for years is that our specific corner of government service is not strictly concerned with medical criteria. We work in disability claims and it's equal parts legal and even political. The entire philosophy of our claims is based on uncertainty. Our opinions typically include the statement "at least as likely as not", which basically says that if our determination of a claim is that it's fifty/fifty parts for and against the claim, then we grant the claim. 

Compared to what's happened between her and other people in the clinic, this has been pretty tame. Until she decided to go around me and accuse myself and our program analyst of inflating exams unnecessarily.  I have been a fee basis provider for over a year. This means that I am compensated by the exam. In the case of Gulf War exams, they tend to generate not only exams for conditions but also opinions for each condition. So, if a veteran claims four conditions, it results in eight total worksheets and I'm paid for each. The typical claim can generate from ten to twenty exams. Occasionally, that number can go significantly higher. 

I had an exam a month or so ago that was for around twenty claimed conditions but it also generated an equal number of direct opinions as well as fourteen or so Gulf War opinions. It ended up totaling fifty three worksheets. This is the highest number I've ever completed, and it's not typical by any stretch. A typical day for me is around twenty exams. I'm not sure if this is the exam which she questioned, but if not it was a similar one. I've had a few in the forties and many in the thirties. It should be noted that the FTE often don't reach these numbers in the course of a week, much less a day. 

My previous post history tells the story of the relative level of productivity among regular federal employees. Let's just say that they typically underachieve, at least compared to my levels. To make a long story short, she basically accused me and the program analyst of stealing money. Because she questioned the validity of the claims (going back to our fundamental disagreement of Gulf War), then she surmised that meant that any Gulf War related claims/opinions were invalid and shouldn't be billed. Like I said before, she doesn't have this authority. No one at our level has this authority. This is national policy and you're not allowed to take away from a regulation to suit your own needs. For what it's worth, my performance of these exams and opinions was directed before I was ever fee basis and had specific approval by the former chief (on more than one occasion), not to mention that the whole policy was directed by VBA personnel outside our clinic. It's a well established and approved policy that has been in place for a long time before she got here. 

All of this scenario is rather tame to what else she has been doing. To keep it short, let's just say she's accused others of outright fraud, abuse, and even having sex in the clinic. It's all bullshit and an attempt by her to discredit and destroy anyone who's crossed her path. I avoid psychoanalyzing in general, and also because I'm not qualified, but I think her specific pathology has something to do with growing up in an authoritarian regime which tends to encourage similar behaviors in those victimized or oppressed once they possess any power. She's demonstrated a feeling of superiority over others, including her own MD/DO peers. She has never understood that her authority as a doctor is strictly clinical. In the federal system, and in our country for that matter, we don't recognize social castes. Although we do have great inequalities in our country, we don't recognize our defer to people because they are part of a ruling class or aristocracy. She seems to think differently. Although some actions are still pending, it seems apparent they are going to remove her from the temporary position and her application for the permanent position would likely be dead in the water. Honestly, I hope she has enough personal shame to resign from the department if not the government as well. 

Although I know myself and our program analyst didn't do anything untoward or dishonest, it's still stressful to have those sorts of accusations hanging over you, because if they were true they would likely result in termination as well as a permanent black mark on our records. Mostly the stress derived from uncertainty to how far the accusation would go, and that the people passing judgement would be strangers who might be given incomplete and biased information. It appears that nothing will come of this for now, but it's still very troubling to face a sudden unexpected threat to your livelihood. As I have discussed with our program analyst, this was the ultimate betrayal and bridge burning offense from which a person will never come back. 

Ahhh, professionalism...

I would have posted this to facebook, but this is probably a better venue (because no one will read it) for a short vent. When I arrived at work today, I discovered my computer had basically called it quits. It had done this a few times in the past, but it was usually revivable with a few hard reboots. This time, after 6 or 7 attempts it was still down for the count. I notified our administrator and the clinic chief and switched to an office across the hallway until they could fix the problem. We can't do our job in C&P without the computer (well, technically you could if you had the forethought to print out exam worksheets before the exam, but why would you do that, it would be wasting paper since they have to be submitted electronically anyway).

Long story short, the office I was borrowing had been reserved for another PA but he hadn't ever used it yet (he already has an office). I didn't think it would be a problem since I would most likely only need it for one or two days. I had notified the chief and administrator when I told them my computer was down that I was going to be using that office. Apparently he had received his keys last week, and today was going to be his big move-in day. He walked into the office after 8am and I was preparing to see my first patient and I quickly told him that I had to borrow his office until my computer was fixed.

Without going into all the gory details, he essentially threw a temper tantrum and said I had to get out of his office and he was going to call security. I explained to him that this was cleared through the chief of the clinic, and we could talk to him about it. This guy refused to talk to the chief and said he would get security if he had to.

He was blowing smoke, because this wasn't "his" office anymore than it belongs to anyone. It's the VA and everything is government property. He then later barged in while I was seeing a patient and acted like an ass in front of the patient as well.

I spoke to the chief of the clinic about his behavior and the chief said he would counsel him later. I made a point of documenting the encounter in detail and sending it to the chief. I haven't seen Mr professional since then, I'm hoping he's coming to realize what an unprofessional ass he was and is perhaps rethinking his conduct.

It was really random. I don't know this guy at all, we haven't previously interacted much at all. I almost wonder if he has borderline personality disorder or some other mental illness. That does stand out as the single most immature episode of behavior I have ever seen in a colleague since I became a PA nearly 14 years ago. I expect that sort of behavior from privates in basic training, but this was just plain weird. What an ass clown...