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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. 

A year of freedom

This week marks one year as a contractor (fee basis) in my previous job. Fewer workdays, better compensation, and I'm almost exempt from the typical workplace drama (almost). Job security is lower in context, but otherwise there's really no downside. Our mid-range plan is to pay off the house and then we'll reassess. We may stay where we are, we may still pursue that house in the country.

This last year has seen the completion of several original tunes and videos. It's been a great year of development in most creative aspects. I'm not over the moon about anything I've done so far, but I would at least call all my projects successful in achieving what I had in mind in the beginning, and even moreso as learning processes. I expect my highly d̶r̶e̶a̶d̶e̶d̶/̶i̶g̶n̶o̶r̶e̶d̶ coveted creative efforts will likely only increase.  Not that I need more interests, but I've taken up drawing as part of my overall pursuit of visual arts. I hope to combine music, video and illustration in various ways. 

High Productivity is Celebrated...until it isn't.

In an ironic twist to my elevated productivity as a fee basis examiner, I had his supreme indolency take the trouble to drop by my office and let me know that my increased numbers (which had necessitated a salary waiver as I had hit my max after five months) had raised a few eyebrows. Although he was attributing it to "someone pretty high in Dallas" (high, he he), I'm sure most of it was coming from him. 

I reacted immediately (as I usually do, sometimes to my detriment) by telling him that I would welcome anyone who wants to take a close look at any of my work/exams and let me know what's lacking or inappropriate. I know my exams are complete by VA standards and I also know that I don't perform exams unless they're requested or justified in the case of a recently discharged veteran who requests to add a few more claims. 

As I explained to dicktug, I'm preferentially getting these bulk Gulf War exams which typically include 10+ actual claims and then an equal number of medical opinions for each claim. This can very quickly run my daily numbers to 20+. He made some sort of brief comment about his ability to generate those numbers which I just ignored because this jackhole was one of the examiners that weren't breaking 40 exams in a month. I've done more than that in one day. 

I also explained to him that I often take on other examiner's work because they call in sick or because they can't be bothered to complete opinions or equivalent. Our admin staff preferentially asks me to do these types of exams because I don't argue with them or make them feel bad for asking. Many of the regular Federal employees are downright adversarial to the people who are just trying to do their jobs and help veterans. 

When I was a regular Federal employee I had the second highest (out of 20ish examiners) productivity in the clinic. Now as a fee basis, I think it's possible I'm the highest, but I haven't been looking at the clinic numbers anymore. I'm definitely generating higher per day numbers as it's not uncommon that I get 25 or more exams in a day. I assume part of his problem is that my elevated productivity makes the glacial examiners look even worse by comparison. 

I'm not sure if the current scenario can be sustained, but I'm hoping things will move slowly as they do in the Federal government. I'm also hoping that we'll continue to have our minimal producers occupying full time slots which will in turn keep the demand up for fee basis examiners like myself.

I think he is offended by the situation in which a lowly PA like myself (in his eyes) can earn an equal income to his while working significantly fewer days and not having to deal with a lot of the regular federal pain (actually my total is probably greater considering my other incomes). I've met several doctors like him in the past that seem to think they have earned a perpetual income just based on their diplomas and not based on any work they're doing now. The good doctors (most of them) judge other providers on their own merits and don't make assumptions based on degrees held. We've never heard them express concern that we have doctors earning huge salaries while doing little to no work. The VA has a prevalence of these types, I think it's one of the primary attractions to the job. 

A busy two weeks

It's the Saturday after I completed my first two weeks as a fee basis (contractor) examiner for the VA in essentially the same job I was performing previously. I worked a total of seven days over two weeks and completed a record (for me) of 161 exams. This will result in a take home pay of about four times what I typically make. I don't necessarily think this workload will be typical, and I don't plan on working any more than three days a week going into the future as I was on the verge of burning myself out after four straight days of full speed ahead. I think it is feasible I could maintain an average of 60 a week with one week off a month for a monthly average of 180ish. Doing the math, this would put me right at the max salary for a year. I could earn more, but I'm pretty sure they wouldn't authorize any more.

At this rate, I think it's completely feasible to pay off the house in five years and move forward with our plan to have a home on 1-2 acres on the outskirts as well as getting my dedicated music studio built. This will largely depend on a continued steady supply of exams from work. The proposed presidential budget, as corrupt, lopsided, and tunnel visioned as it is, does allow for an increase in funding for the VA, so at least for the near future work should be plentiful. I'm hoping I may look back at this post some day in 5-10 years to confirm my projections were close. It's possible the timeline could be even shorter if they keep supplying me with exams. In the present environment, I'm not having any problems getting extra exams. I was even turning down a few every day last week because I was already swamped with 20+ exams each day. The lazy and ambivalent federalistas in my department are now a source of extra income for me, so as long as they stay around I should have no problem keeping my dance card full. 

Work related updates

Another infrequent update. I've been staying busy at work and school. I can't recall if I ever mentioned it before, but in the wake of a lot of upheaval in the VA system, not to mention crossing over the five year mark last August, I decided to request a change from a full time permanent position to fee basis (contract). This would see me forfeiting any additional deposits to my 401K as well as earning any more rate increase on my federal pension. I'm also technically forfeiting the other federal benefits (healthcare, dental, vision, paid leave) but those losses are negligible. I'm already eligible (and using) my retiree benefits for these and the loss of paid leave becomes irrelevant under the fee basis paradigm.  

What I gain from fee basis is getting paid for the amount of work I do, dictating what schedule I want to work (meaning I can work 5 days, 3 days, take a month off, etc.), and the ability to leave work as soon as I'm finished on any given day. The rate at which they pay (and considering how fast I work), means that if I maintain my current production levels I can realistically take home more money while working fewer days. Although I'll be forfeiting additional increase in my federal pension, it was never going to be a significant portion of my retirement and I will still be able to draw some money when I reach 62.  The 401k (TSP) may be eligible for transfer to another similar IRA type account. I will look into this in the future. Regardless, the cons are minor and the pros are great for this change. 

The decision to change was made in the wake of perceived sweeping changes in the VA (including an increased use of contractors) and the concerns about a new administration coming into power. I made the request in December and received fast and positive feedback from my direct supervisor. In this process, he has actually been the only real support and has moved things along at every step. It's still pending because of sitting in the Dallas VA mailroom for a month (literally) and then sitting on someone's desk in HR until my supervisor personally visited and got them to do their jobs. The complete lack of inertia among many employees in the VA is what gives us a bad name. There are people content to draw a paycheck and all the benefits and perform as little actual work as they can get away with. They act like they're doing you a personal favor just to listen to your request. 

All that being said, hopefully things are in the home stretch now and I can adopt a condensed schedule. My plan is to work Tue-Thu, but I'm requesting that they give me a dense schedule every day in the hopes I can maintain similar numbers. I'm hopeful I can nearly double my current take home pay, but that will be predicated by how much they offer in compensation and how high demand remains. 

Bloggery bloggington

Time for another infrequent update. What's happened since last I committed electrons to this dark, forgotten corner of the internet?  Of most significance is that I have applied for the Berklee College of Music (Online) Bachelor of Music Production degree, with an anticipated start date of January 2015. I'm not sure why I didn't previously make the connection between this course and my still valid (but eventually expiring) GI Bill benefits. I had looked at individual courses within Berklee and some other online colleges, but for whatever reason I didn't realize that there was actually a Bachelor's program in a Music related field that I was actually interested in that would be eligible for the GI Bill.

I won't know if I'm accepted until next month, but I'm cautiously optimistic. Firstly, since I have a reliable means of paying for the degree, and secondly, my academic records while not perfect, (I made a couple of Bs in PA school) are pretty competitive (3.8 cumulative GPA with two master's degrees).  What I don't have is any significant professional or academic music experience, but I'm hoping that since there aren't any specific prerequisites in those areas, that I will make up for in my enthusiasm for music. In my personal statement I related my lifelong love of music, my rekindled musicianship of 10+ years, my multi-instrumentalism and love for all things music production related. 

The course curriculum reads like all of my online self learning activities for the past 10 years. Looking through the entire course requirements and syllabi, I was amazed at how every course was something I was either interested in learning, or something I actually had already studied on my own. My dream scenario would be to channel this knowledge into a musical occupation that could pay the bills, but that isn't the only end goal. I know that regardless of whether I continue to need to work full or part time in healthcare, that the knowledge and experience I gain from this course will make me a better musician and I can't put a price on how valuable that is for me. 

My realistic goal is to continue improving my home studio as much as possible (without making structural changes to our current home), and eventually buying a home on a one acre lot and building a music studio from the ground up. I hope that with time and experience I can begin to attract clients and gain work through word of mouth and advertising. This is a path that some full time (and highly regarded) professional studio owners have followed. The other nice thing about owning/running a studio is that age isn't the limiting factor that it may be for musical artists that are just starting out. I will continue to be a musician, and hope that this knowledge and experience with facilitate opening new doors for me in that area as well. I just never get tired or bored with music at large. I may briefly run out of steam when I've been practicing a certain instrument, but that's easily remedied by picking up a different one, or studying an aspect of production, etc. 

It's hard to express how exciting these possibilities are for me. It's also nice to at least consider that it may be possible to earn a living equivalent to our current standard of living. Success as a musical artist can be a much more fickle target. I know plenty of world class artists who have their dedicated fan base but are otherwise ignored by the public at large. Success in music is often not directly correlated to talent and hard work (a small caveat in that the really hard working musicians who understand that they must do more than just write/record songs, often find a way to succeed through touring, videos & other merchandising).  

The true "If I win the lottery" (in a music sense) would be to build up a successful studio/operation as well as create my own music that might actually garner enough interest to release albums and even tour, if only on a small, regional level. Neither one of these is necessary for me to be happy in music, because I'm already there and I'm not making a penny doing it (quite the contrary, I spend quite a few pennies doing it). The greatest satisfaction would be in having the freedom to only need to "work" in music, and to have my own business that I can dictate the schedule, etc. I am confident that if I'm accepted to Berklee that I will be able to eventually build a free standing professional (albeit, not in the league of the Power Station or equivalent) studio and with the knowledge and experience gained in school I'll be able to record my own as well as others music in the best possible format. Maybe it will only be on nights/weekends when I have the time away from my regular job or maybe it will grow to a full time operation. I'm on board for the long haul either way...

Why I love my job(ish)...

Love is probably a bit strong, but there are several things about my job that make me not hate it. To wit:  1.  Regular hours with no nights, weekends, or call (unless I want to work overtime on Saturday to make extra money. Which I don't.)  2.  I'm mostly in control of my day and destiny. In other words, I can work as fast or as slow (usually the former) as I want and I'm not affected by the productivity of others (or the lack thereof). 3.  I have my own office, which is my private sanctuary where I can listen to music, use my iPad, etc. without interference/noise from outside. I sound like I hate people which is not the case, but it's nice to have your own personal space when you have noisy/smelly/etc. co-workers. 4. Kind of related to number one - the work is predictable and manageable. Some days I'm busy all day, but most days there are cushion times built into the schedule so I never feel overwhelmed. 5. Pay, benefits - while federal salaries are normally 10-30% below their civilian equivalents in gross salary, when you consider the benefits (pension, paid leave, health insurance, 401K), then my job is very competitive. Never underestimate the value of a pension. Even if I had been a smart investor and had been saving/investing towards my future since a young age, I most likely would have lost a huge chunk of that in 2008-2009. Because I retired from the Army I will have a very sizable monthly check for the rest of my life, regardless if I work or not. While the federal employee pension isn't as sizable as the military pension, it's essentially the same benefit. Although I do have a 401K that I've been investing in, the federal pension I'll be eligible to receive when I retire will combine with my Army pension and VA disability to essentially ensure that I won't need to work past my mid 60's unless I really want to. Also, the benefit of paid leave is considerable in this job. I worked as a DA civilian and then contractor after I first retired and my annual leave was somewhere around 10 days total. I think I had 10 sick leave days as well. In this job I am authorized 26 days of regular leave and 13 days of sick leave for a combined total of 39 days paid leave per year. And  I've been accruing that amount since I was hired. Most jobs require you to build up tenure to accrue the higher amounts, but not this one. Authorized/paid leave is a huge deal for me. I grew accustomed to 30 days of paid leave per year in my 23 year Army career, and that first year as a civilian with only 10 days of paid leave was a stark contrast to what I was accustomed to. This total doesn't include federal holidays.

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...

Back to work

It's been a busy two months, moving from Killeen to Crowley (south Fort Worth) and all that goes along with that. Our house has been on the market nearly two months with little to no interest expressed so far. We may need to adjust the price or adjust our realtor (again).  The credentialing process with the VA added a month to my start date, primarily because of inattention from one of the credentialing clerks if my suspicion is correct. Not that I'm complaining about having two months off of work. This first week back will be mostly new employee orientation in Dallas with the requisite one hour drive and musical parking spaces at the D/FW VA Hospital. I assume that on Friday I'll be reporting in at my permanent job location (a more convenient 20 minutes away).

I am being sorely tested...

by all involved parties. First we get smoked by our walkins today (3x the usual number) and then our staff is doing their best to give the exponentially enlarging snowball an extra kick before it gets to me. I love the fact that people who are not ultimately responsible to care for a patient are more than willing to sign them in when they don't have an appointment since it's my responsibility to take care of them. Soon I will be in a job that doesn't have walkins and I won't have subordinate personnel who can arbitrarily add to my workload.

Being a provider with a schedule of patients is an occupational experience that most people don't comprehend. When you have a schedule, you are locked into that schedule. Your day is dictated by the schedule and you must stick to it or suffer complaints and backlash from patients and staff alike. As a provider I accept this, because it's what I get paid to do. Where I get really frustrated is when other people through ambivalence, naivete or outright intention add to or otherwise complicate my schedule. I don't mind a busy, fully booked schedule. The busier I am at work, the faster the day goes by. I pride myself on staying ahead of my schedule, finishing my notes in a timely manner, and getting all the time sensitive issues handled as soon as safely possible. When it's up to me, this is very rarely a problem. The only time I typically fall behind is through the action or inaction of others.

Today we had 15 people signed in for sick call, and we only have 90 minutes to see them before appointments start. The frustrating thing is that most of these people don't truly have acute medical issues. Most of our sick call patients are here because they don't want to wait for an appointment, or they are trying to get out of work. Rarely do I see a patient on sick call that I think "It's good you came in when you did, because this was a serious issue". Most of the time I think "Why would anyone ever seek medical treatment for this issue?" This gets back to my fundamental problem with most clinic visits by soldiers which is that they get free healthcare and have the secondary gain of time away from work, duty modification, etc.

The NCOs responsible for triaging the acute patients are not very good at what they do. They have a tendency to not want to enforce sick call complaints to acute only, and if the patient argues with them or insists on being seen, they sign them in. Military patients essentially have no negative reinforcement system for spurious complaints. The worst thing that happens to them is being told they are normal or their issue doesn't require any more workup or treatment. Even in those cases, they were at least able to get out of pt and work for a few hours. Patients can no-show, malinger, drug seek, or engage in a multitude of fraudulent or exaggerative behaviors and they very rarely get held accountable. This is one of the reasons I have sought employment elsewhere. The secondary gain issue is fairly common with the normal active duty population, but it's the modus operandi of the meb patient. I don't know how any competent provider with military experience could tolerate long term employment with this population. "Never has so much been done for so few who are so less deserving" - this should be the clinic motto. I find myself less and less proud to be an American citizen and retired soldier the more of these types of patients I am exposed to. There is a significant portion of the young population who look at the world as a set of entitlements with no requirement to work or produce for those entitlements.

I'm rambling now. Rant over. I expect my relative attitude will improve here shortly.

3 clinic days left...

and then hopefully <1 day of clearing. Not that I'm counting. The realtor should be coming over later today to take pictures of our house and then hopefully get it listed here in the next few days. We're going to be taking it somewhat in the shorts since we've only lived here two years and the market is pretty flat (better than most other places, though). We've accepted the loss because of all the positive reasons for the move and job change. It's also taught us a bit about the home buying/selling process.

We're Coming Home

I received the offer via HR over the phone, and although it will mean a modest pay cut from my current wage it's still more than I was expecting the VA to offer. I accepted and the paperwork train is leaving the station. I'll have loads of credentialing fun as well as the requisite physical and security checks in the coming weeks. Not to mention dealing with the fall out of my departure from my current position.

Zee job, she has been offered...

I said that in my best impersonation of John Cleese impersonating a frenchman. Oh, and since you'll ask, we already got one.  You know, a grail. Of the holy variety. Annnnnyyyywhhhoooooo, I got the job offer and now my resume goes before the committee and they decide what I'm worth. I'll get the salary offer by the end of next week hopefully. If it's adequate, the lumbering beast that is our worldly possessions and associated accoutrements will begin the journey northward.