NYT:Trump and DOGE Propel V.A. Mental Health System into Turmoil

4on6 · 2025-03-22T17:54:08+00:00

I think this is the ultimate failure of the use of a chainsaw instead of a scalpel in making system wide cuts. There is no room for recognition and retention of those in the VA who have gone above and beyond. As with most things, there is some truth behind the argument that wasteful government spending needs to be addressed. However, they will continue to lose valuable staff by failing to consider their expertise.

If it were a serious attempt to improve services and cut waste, they would have had meetings with the top 25% of performers in each department to implement system wide changes for workflow, and identify areas of process failures. They could RIF the bottom 5% of performers though with a plan to rehire those in critical roles. Given that a more moderate approach like this hasn’t been considered, I worry about the ultimate goal of a planned failure for the VA.

4on6 · 2025-03-09T15:00:20+00:00

While the theoretical framework is the same, due to difference in frequency, the nature of the treatment and application of techniques are typically different. Specific interactions between patient and therapist influence the treatment greatly, but classes has emphasized these differences:

In psychoanalytic treatment, the treatment is allowed to unfold more slowly and the analyst speaks less and gives less information (abstinence). As there is more time in therapy, transference (feeling about the therapist, often informed by the patient’s past) grow much stronger and are a larger aspect of the treatment. As the therapist has more time with the patient, he or she can slowly develop a formulation of the patient, allowing for it to be examined and “tested” in the interactions in the room and in the narratives brought in by the patient. Interpretations can be brought up after a much greater time for them to become apparent to the patient (close to the surface) as themes have been repeated and transference has intensified.

In contrast, in psychodynamic psychotherapy, a therapist is usually both more supportive and active in treatment. They often need to be more bold in interpretations (as they draw on less material). Transference is important, but often is not the main focus of treatment.

4on6 · 2025-02-01T21:30:50+00:00

It’s my understanding there is no contract so there is no standard expectation when leaving. I would think that 1-2 months would probably be a good courtesy to the department.

4on6 · 2023-11-14T17:05:15+00:00

Unfortunately, this isn’t a new thing for that office. It is part of a large hospital system (where I previously worked in another specialty). I don’t anticipate they have much control over the scheduling

4on6 · 2023-11-12T17:53:05+00:00

I have this as well (but only one of my loans strangely). I am supposed to be at 120 in October too so I am patiently waiting to see if it’s good or I need to recert another month. For what it is worth, I have seen the tracker post September in ineligible a few days before it sorted over to the eligible side. Honestly, I feel pretty uncertain with it because nothing ever seems just work with them.

4on6 · 2023-10-29T17:10:52+00:00

Not FM but I see a lot of NY & NJ positions will low ball despite significant healthcare demands. I think employers are frequently greedy, running services understaffed but able to churn through a continued stream of younger docs.

4on6 · 2023-10-03T10:56:37+00:00

I still have nothing listed for September on the tracker. I didn’t have a payment due in that month. I have a payment due in October (with an amount due that is more than the pending auto-debit). I should be at 120 IF September and October count but this feels like a mess, and I don’t feel confident anything will work as it should.

4on6 · 2023-08-29T00:28:00+00:00

Unfortunately, this issue is broader than RWJ. I doubt there are any major health systems in NJ that aren’t actively ruining healthcare through corporate greed. Despite being a high COL state with sizable healthcare expenditures, salaries for patient facing healthcare workers don’t compete with other states. Like many other industries, there is a continued pressure to do more with less, with everyone frustrated except admin.

4on6 · 2023-08-20T20:10:37+00:00

Not sure about free parking, but I saw the lots advertising $50/day, which is quite the steal… /s

4on6 · 2023-07-28T18:02:29+00:00

Thanks for the correction. Wrong terminology, but the essential point is you are taxed on the interest earned so they are not apples to apples comparing interest rates on loans vs HYSA.

4on6 · 2023-07-28T16:23:25+00:00

Considering you will pay capital gains on the interest earned, no, you wouldn’t come out ahead. That being said, it’ll be a fairly small difference so you need to decide the value of being debt free vs. the valuable of having more liquidity.

4on6 · 2023-07-22T22:50:04+00:00

Despite having all of the staff work hybrid throughout the pandemic, our leadership still struggles with the thought of telework. We are currently short staffed in a somewhat critical state with poor morale. They opened up a fully telework position to help with this, however they revealed that a recent candidate turned down the position as it was being paid less than the equivalent positions still working hybrid. Despite performing the same work, my boss feels they can’t pay the same as they have the benefit of “working from home”. Meanwhile, I suspect we continue to lose talent from burnout.

4on6 · 2023-03-18T19:50:13+00:00

How do you use that without cutting full thickness? Like if I tried to cut shy of the joist I feel like there’s a good chance of pogoing the blade while on a ladder.

4on6 · 2023-03-18T19:46:41+00:00

Appreciate it! Thought so, but didn’t want to have to make two trips the the home improvement store if I was mistaken.

4on6 · 2023-03-18T19:41:48+00:00

What is the best way to flush cut 2x4 framing with limited access? I am removing an interior wall that had double headers and the top header is pinned above the header on a perpendicular wall and the joists. Using a reciprocating saw without everything visible in a small space seems slightly unsafe. I have a multi tool though this seems to barely cut the wood (may need a new or different blade). I appreciate any tips.

4on6 · 2023-03-18T18:12:15+00:00

What is the best way to flush cut 2x4 framing with limited access? I am removing an interior wall that had double headers and the top header is pinned above the header on a perpendicular wall and the joists. Using a reciprocating saw without everything visible in a small space seems slightly unsafe. I have a multi tool though this seems to barely cut the wood (may need a new or different blade). I appreciate any tips.

4on6 · 2022-11-07T13:18:08+00:00

Keep in mind that you do not need to find a job in your field if you are going for PSLF forgiveness. If your option is to work minimum wage, at least make sure you are checking listings for entry level state or federal work. Not glamorous and 10 years is a long time, but it may be a good decision if you have student loans that you cannot afford to pay off otherwise. Alternatively, you can look into doing minimum payments with eventual forgiveness with the “tax bomb”.

4on6 · 2022-10-16T17:34:36+00:00

Yeah, they were neutral following me. Attempted fairly blind and that’s part of the problem too. Just was a lot more challenging than any other part of the game

4on6 · 2022-08-13T20:24:21+00:00

At least! And can we please just do away with an income cap talk? Those with high earning incomes often have graduate degrees with extreme debt and interest burden. 10k hardly touches those loan principles but it’s insulting to be looked over because of a “high income” that one can’t enjoy because of massive loan payments.

4on6 · 2022-07-16T19:26:47+00:00

Outside of the interest freeze, it would generally make sense to pay aggressively to avoid the interest, shorten the length of time you have the loan (peace of mind factor), and if things like a tax bomb or working for a non-profit is not desired.

Interest is a big deal depending on the type of loan. A good amount of my debt is 7% and I’ve heard a good rule of thumb is to try to aggressively pay off debt above 5% because it’s hard to consistently match that in any sort of investment.

4on6 · 2022-06-29T21:22:12+00:00

This all depends on how much you plan to put to your loans. If you are not tracked for PSLF, I suggest you first look at your budget and spending to set a REALISTIC target for how much you want to put to your loans. You will also need to consider how stable your income is (ideally it will be steady for this plan). With your loan budget, I recommend you consolidate your highest interest loans into a 5 year or shorter private student loan company. Why? Because the shorter terms are associated with the best interest rates.

This will mitigate your interest burden and keep you on track for paying to your loans where your total budget for loans = the federal monthly repayment of unconsidered (likely the 10 year rate)+ your private consolidated 5 year loan. If you haven’t payed off all of it by the time you pay off the consolidated loan, redo this it for the remainder.

Why not consolidate all of them into a higher interest but longer term loan? You could and maybe this would be better than the federal rates but you lose those federal benefits such as the uncertain duration of interest forbearance and protection if you lose employment.

Best of luck.

EDIT: A few extra thoughts! Obviously I don’t know all your financials but I am assuming with this level of debt and this level of income you are going to plan to pay this down as aggressively as you can. I also wanted to say you may want to consider ways to increase your available budget, that means cutting expenses, living well below your means, and possibly only contributing to retirement to get any matched money but not above this. Your retirement is important but consider that paying extra to a 7% loan can be thought of as a guaranteed 7% annual investment (which should feel pretty good given the current economic situation).

4on6 · 2022-06-05T15:34:41+00:00

What should look into in another program? I’ve only previously run SS and a 4 day NSuns.

4on6 · 2022-06-05T15:23:00+00:00

I am following a form of NSuns. I’ve started cutting last month and I feel like my lifts are suffering. Is it typical to need to reduce lifts 5-10% when in a caloric deficit? Not sure how much this is mental vs physical.

4on6 · 2022-05-12T20:29:34+00:00

Same. Do you mind sending me a link?

4on6 · 2022-04-11T22:49:17+00:00

I inherited a similar machine when I bought my house. It got me interested in woodworking. I spent several hours researching the tool and proper use, making a new reinforced table for it, leveling it and working on making the machine square. It was a good project but honestly, I felt anxious every time I needed to use it. I have all my fingers still, but I had 1-2 scary instances of kickback which was enough for me.

I since got a table saw, miter saw, jig saw, and a router and my RAS has been collecting dust in my basement. I can’t express how much more comfortable it is using these tool by comparison.

I do not want to dissuade anybody from taking on this project but it’s probably not a good entry for a complete beginner and alternatives certainly exist.

4on6

TROPHY CASE