A recruiter from Loyal Source Government Services just reached out to me on LinkedIn trying to hire me (as an employee not a contractor).
I won’t go into detail about their proposed compensation offer except to note that it was dramatically lower than what the VA pays even entry-level psychologists who are VA employees. I’ve been a psychologist for 22 years so their offer of course sounded absurd to me. However, it made me wonder who is even taking such an offer. If people want to work with Veterans then the VA has tons of open psychologist positions, with options for essentially the same schedule but better benefits, all over the country. These are jobs that are paying way more than the contract examiners for psychologists even right out of school who may not even be licensed yet. What type of professional is taking this job? Someone who was already fired from the VA maybe or who can’t succeed somewhere else?
If the VA was serious about having quality C&P exams then they wouldn’t tolerate the absurd low compensation rates even compared to VA psychologists from the contract companies. They would demand that companies like Loyal Source recruit high-quality professionals, and put their money where their mouth is, rather than tacitly support a system which is designed to essentially take what they can get with the leftovers (not to insult all contract examiners, since some are ethical and do an adequate job).
Here are the hours their recruiter proposed:
M/T/W/Th/F
8:00 a.m.-5:00 p.m.
2- 90 minute sessions per day
2- 60 minute sessions per day
I believe that these hours are likely to lead to poor quality exams.
A PTSD exam, especially a first-time PTSD exam, should have the option of going 90 minutes and plenty of other presenting issues can go that long too. So the entire 90 minute “session” (it isn’t therapy) should be taken up with an Initial PTSD interview. The 60 minute blocks may not be enough time for even an interview for other types of exams, however. Any exam that is less than 40-45 minutes is likely substandard. It can take time for people to warm up and also to acquire the relevant functional information. Just because a Veteran goes quiet and stops talking for a moment doesn’t mean it is okay to end the exam. Many disability exams done for corporations/ disability insurance companies can last multiple hours (though of course they may also include more testing). I personally schedule a 2-hour block for the interview alone though the interview rarely goes the full 2 hours.
This suggested schedule from Loyal Source is amusing because, assuming the examiner takes a lunch, if they do a satisfactory interview that leaves only 30 minutes per exam to do a records review and document the exam on the DBQ form (not counting any restroom breaks). This isn’t very realistic when cases often have thousands of pages of records. So of course they are likely skimping on the records review, skimping on the documentation and even skimping on the interview.
Now factor in that surveys of psychologists indicate that it tends to take them 2 to 3 hours to write a report for a psychological evaluation. That is on top of the time spent in any interview or conducting any testing. It is no wonder that these contract DBQ’s look nothing like a high quality psychological evaluation.
These exams have huge consequences for Veterans, the least Loyal Source could do is schedule enough time for their examiners to be familiar with the records and also enough time so they aren’t rushing Veterans out the door. It is no wonder we keep hearing stories of Veterans talking about their psychological C&P exams sometimes lasting less than 15 minutes or that their examiners are not familiar with their case or anything from the records. It is also no wonder that the contract DBQ forms often only have 3 sentences in the narrative sections, with little or no information related to actual functional impairment or showing whether the C&P examiner ever actually even asked relevant questions. These DBQ’s would be viewed as an unethical, substandard psychological evaluation anywhere else in the community. The VA contract exams tend to even be worse than Social Security disability exam reports, and that is saying something.
Insurance companies have started requiring providers to document the time they started seeing the person and the time they stopped. I think it would be beneficial for the VA to require C&P examiners to document directly on the DBQ the time they started seeing the Veteran and the time they stopped, so if there are concerns related to the quality of the exam we can look to reasons like examiners rushing through them due to the volume of exams they have committed to in too small an amount of time. That way we can all laugh together if a rating decision tries to say the C&P examiner did a “thorough” review based on what was a sub-standard, 15-minute exam with no real demonstrated records review. These are the types of issues we see when the VA goes with the lowest bidder. This is one more piece of evidence supporting that the system has essentially set Veterans up to often receive sub-standard contract exams.
Update:
I asked the Loyal Source recruiter for details about the productivity incentives they had and here is how she responded:
Bonus- $24,000 (Complete an average of 4.73-5.15 DBQ’s/MO’s per day= $2000 per month bonus)
Monthly Incentive opportunity:
Complete an average of 5.16-5.58 DBQ’s/MO’s per day= $500 per month bonus
Complete an average of 5.59-6.01 DBQ’s/MO’s per day= $1000 per month bonus
Complete an average of 6.02-6.44 DBQ’s/MO’s per day= $1500 per month bonus
Complete an average of 6.45 DBQ’s/MO’s per day= $2000 per month bonus
(note that there is no mention of quality, just quantity)
The VA’s contract exam system clearly incentivizes rushed and shoddy work.
It is also an interesting contrast with what is expected when a VA employee psychologist does a C&P exam at a VA facility. While it can vary and depend on the facility, the VA psychologist may be given around four hours for one psychology-related C&P exam (including the interview, any testing, records review and report writing/DBQ-completion). If the contract examiner was given the same amount of time that would amount to a 16-hour day for those four exams. For them to earn the 6.45 bonus dedicating 4 hours total with records reviews, the interview and report/DBQ completion, each contract C&P examiner would need to schedule over 25 hours per day… and we know there are only 24 hours in a day (and that people need to eat, sleep, use the restroom, etc. which there would be no time for). No wonder contract exams are so full of errors.
It is interesting to note that Veterans often tell me that the free consultation call they had with me was longer than their entire C&P examination. That means even before I start the actual examination, I have sometimes already spoken with the Veteran longer than the C&P examiner did (and then I go on to schedule a two-hour time slot for the interview in addition to time to do a records review before the examination and time to complete a report/DBQ after). You can get one of those free consultations here: https://nexusletters.com/free-consultation/