Someone told me, they said, hey, Lindsay Hill
is here. She's going to sit in on this ad board.
She is someone to keep an eye on. She's incredible.
It's very difficult, especially in psychiatry,
where so often we are going through or living
with our patients through their worst moments.
When a patient maybe is coming to see us because
their spouse passed away, and we're supposed
to help them, we're supposed to support them,
but also then go home and still be fully present
for our families. I wanted to do ortho for many
years, but I think about orthopedics as being
more cookbook. If someone has a fracture, we
already know the game plan. We're going to put
them in a cast. We're going to do six weeks of
PT, and then they're going to get back to normal
life. Psychiatry is not that. Psychiatry is still
an art where we don't necessarily have all the
answers. We don't even necessarily know what's
going on. Social media is so powerful. The reach
that you can have if you have a presence, you're
trying to build relationships with companies
so that you can provide clinician consulting
opportunities. Social media is an incredibly
powerful tool. This week on No Prior Off, I'm
sitting down with Mike Asbach, and we're doing
something a little different. Mike is a physician
associate, not a nurse practitioner, and he's
one of the most credentialed psychiatric PAs
in the country. Associate Director of Interventional
Psychiatry at Dent Neurologic Institute, where
he runs TMS, ketamine, and spermato every day.
He's also the AAPA's liaison to the American
Psychiatric Association, a professor, a podcaster
with a six -figure audience, and a captain in
the Army Reserve. His message is simple and I
think exactly right. As psychiatrists retire
and the need for care explodes, PAs and NPs can't
afford to compete. It's all hands on deck. Today,
we're talking about where our field is headed.
Let's get into it. Thanks for being here, Mike.
Wow. Thank you, Lindsay. What an intro. I can't
possibly live up to that. So now we've already
set a bar that's far too high. But I appreciate
it because that's the kindest thing I've ever
heard since my mother told me that she loved
me. So that's great. Oh, my goodness. You're
funny. You are funny. You're the first PA that
I'm having on the podcast. So I'm pretty excited
about that. I'm honored. Yeah, it's a wonderful,
it's really interesting in psychiatry, isn't
it? Because PAs and NPs fill very similar roles,
but at the same time, different educational pathways,
maybe different ways that we approach medicine
as well. So I think any opportunities that we
can have more crosstalk, more collaboration,
it's good for everybody. I agree. And I think
what's cool about our networking dynamic relationship
is like, you're the first psychiatric PA that
I've really like gotten to know more. And I'm
like, man, psych PAs are really cool. And I want
like more conversations and more learning, you
know, both ways. So I've enjoyed, you know, since,
since I met you at that conference, I think it
was January of 2025, maybe I've enjoyed 24 even,
but yeah. Yeah. Let's talk about that though.
The power of networking. I will tell the story
because I think it's interesting for your audience.
I had never heard of you. We were both at this
conference in Arizona and someone actually told
me, I don't know if I've ever told you this.
Someone told me, they said, hey, Lindsay Hill
is here. She's going to sit in on this ad board.
And she's the president of the Arizona Psychiatric
Nurses Association at the time, but said she
is someone to keep an eye on. She's incredible.
And we were in a meeting for schizophrenia. And
every time you opened your mouth, I was like,
wow, that's a really good point. Every time you
said something, I was like, oh, man, I totally
agree with that. So afterwards, we made sure
to connect. And I just I love that because I
have so many conversations with PAs and NPs,
and I feel like I'm constantly preaching the
importance of networking. collaboration, especially
because so many of us work in telemedicine or
more isolated settings. It really is an important
thing. There's just so much opportunity to learn
when you're in person at a conference or even
if it's going out to a monthly meeting with your
local association, those creative collisions
that can happen when you're with people. It's
unmatched. You can't find that elsewhere. Yeah.
And one of the things that really stuck out to
me about you is you were, I remember in our conversation,
you were like needing to get your vehicle to
go to the airport in like a very short amount
of time. So it was a short conversation, but
like you provided a ton of value to me in like
two minutes. Like I left the conversation like,
oh wow, I learned a lot of things. And one of
those things was, you know, the idea of consulting
with biotech companies in exchange for equity,
which I now have accomplished. And I would have
never, that wouldn't have been on my radar if
that, and you just like. you shared openly about
just your journey and your experiences. You've
always like offered like way more value than
you've ever asked for, which I think is just
like a testament to kind of why you are where
you are today. Thank you. Yeah, it's good to
not be transactional, right? You want to surround
yourself with good people and then not necessarily
only have those relationships be built on exchange
of value. My goodness, I love that we're across
the country. We're 5 ,000 miles apart, and yet
you and I stay in touch frequently, and we've
found a lot of cool stuff to work on together.
So it has been great. Yeah, absolutely. Love
that. Okay, one of the things that our audience
really loves to hear about, and I think that
you are further ahead than a lot of PAs and NPs,
is, you know, the idea of just like... multiple
revenue streams and not just for more income,
but also like as a way to not burn out and like
do more things that are interesting and that
kind of fit your skill set. Can you talk to us
a little bit about what how you got into kind
of all the different things that you do and what
some of your revenue streams are and help our
audience that way? Yeah, so just a little bit
about myself. I am still full time in clinical
practice. I run a team now of 17 prescribers.
So we're a fairly large clinic. And as you said
earlier, we do a lot of really cool stuff. We
do research. So we're now starting to do a lot
of research and advisory work with psychedelics,
but then we do ketamine, esketamine, TMS. So
still very much in the clinical setting, but
my role is evolving a bit where I'm not seeing
patients back to back to back to back to back,
because I do think that that's a really good
recipe for burnout. Medicine is... incredibly
overwhelming. It's very difficult, especially
in psychiatry, where so often we are going through
or living with our patients through their worst
moments. And it's hard when a patient maybe is
coming to see us because their spouse passed
away or something else has happened, and yet
it's a Tuesday for us. And we're supposed to
help them, we're supposed to support them, but
also then go home and still be fully present
for our families. And that's, I think, a big
challenge. So I very much believe that it's imperative
for all of us to think about how we can build
careers that are not exclusively focused on being
40 clinic contact hours with our patients, but
rather how can we contribute in different ways.
So more and more of my weekly schedule is doing
leadership, admin for my clinic that employs
me. But then also I love to do a lot of medical
writing. I love teaching. precept a ton of students.
I also do research advisory work for a doctoral
program in Virginia for PA. And I think it's
been a wonderful thing. And I always encourage
any PAs or NPs when we have these conversations,
think about different things that you can do
that maybe get you to a point where you're 0
.7 FTE in the clinic. And that doesn't mean necessarily
taking a pay cut, but finding other things that
where you can contribute, where you can do things
that drive passion. but also break up your work
week a little bit. Yeah, that's a great point.
That's a great point. How long have you been
a psych PA now? This is my 15th year. So early
career is generally defined as 10 years and I
am no longer early career, which makes me, I
guess, a little sad. Yeah. How did you get into
psych as a PA? I feel like it's different for
you. You know, obviously it's different, but
yeah. Did you know you wanted to do psych? No,
not at all. I dragged into it kicking and screaming.
So PA is different where all PAs graduate as
generalists. So our training is in the medical
model. We do our clinical rotations through many
different specialties. And through PA school,
I was convinced that I wanted to do either surgery
or ortho because generally if you are a man and
you are in PA school, you go into surgery or
ortho. So this was my lot in life. I was going
to go the path that every other male PA student
went. And I did all of my electives during my
clinical year in surgery and ortho. I really
loved it. I enjoyed it. I had several job offers
in surgery and ortho. And thankfully, fairly
early on in the interview process, I recognized
this is really cool. And as a student, I loved
being in the OR. I loved doing mechanical hands
-on things. But at the same time, I'm not quite
sure I want to be doing this. at age 35 on Christmas
Eve, getting called into the hospital for a hip
fracture. So I recognized that even though I
thought it was cool, designing my career was
not something where I wanted to just think about
the excitement or the novelty, but rather what
is something I could sustainably do for 35, 40
years. On a flyer, I applied to psychiatry. I
had really enjoyed my mental health rotation.
I did it at the VA because I was already in the
ROTC program and tracking to do the Army Reserve.
So I had enjoyed mental health. At the time,
I thought I enjoyed it just because of the military
connection, but applied for a job in psychiatry
with my current clinic and fell in love within
five minutes. So when I went in for my interview,
my medical director, Dr. Capote, Within two minutes
of us sitting down, he said, hey, do you want
to see something cool? And he took me down the
hall and he showed me TMS. And he showed me how
you find the motor threshold. He put the magnet
over my palm and made my hand jump. And that
was the aha moment where I realized that I could
find a path to do hands -on medicine, but still
also have a nine to five more predictable schedule.
And I never left. It's been 15 years at the same
role. That is so cool. Wow. Because you have
four boys, right? I mean, you're busy. Correct.
Yes. Very busy. Very chaotic. Yeah. Wow. That's
that's cool. How did you kind of become such
a visible psychiatric PA? Like, was it doing
stuff with industry? Like, did it just kind of
happen or were you like intentional about? Kind
of building this personal brand for yourself
where people know who Mike is. Because I remember
someone from Psych Times being like, you've got
to connect with Mike Asback. I don't think it
was intentional at first. I love to teach. I
love psychiatry because I feel like it's no knocking
on ortho. I wanted to do ortho for many years.
But I think about orthopedics as being more cookbook.
If someone has a fracture. We already know the
game plan. We're going to put them in a cast.
We're going to do six weeks of PT, and then they're
going to get back to normal life. And yet psychiatry
is not that. Psychiatry is still an art where
we don't necessarily have all the answers. We
don't even necessarily know what's going on.
And we have theories, but all theories are wrong.
Some are useful. And I was attracted to psychiatry
because of how much of this was still unknown.
And very early in my career, I recognized that
I enjoyed teaching. I started precepting for
PA programs fairly early on and then started
submitting CME presentations. I started submitting
case studies to journals. And I recognized that
teaching was something that I, it just brought
me a ton of joy, but I never went into it intentionally
trying to. build as big of a platform as possible.
I think that ended up being just a slow incremental
thing. But at some point I did realize that with
teaching, there's an opportunity where when you
see a patient, you can make a really big difference
in that patient's life. But ultimately you're
stuck in this one -to -one ratio where the number
of people you can help is limited by how many
hours you can see patients. And one of the coolest
things of teaching is that you have this opportunity
to speak to a room of, who knows, 10 people,
100 people, 1 ,000 people, and if you can effectively
help them translate science into actionable clinical
practice, the number of patients you can help
is infinitely scalable. And that's something
that's always been incredibly enticing to me,
the idea that we can really make a difference
by helping empower other clinicians to be more
adept and more prepared for clinical practice.
Yeah, absolutely. That makes sense. So were you
always like so into networking? Because for me,
I was like not. I was like invisible at the conferences
for the longest time until I started seeing more
like the power of networking and the power of
visibility, you know. But that was pretty recent,
you know, last couple of years. Before that,
I was just like, I'm going to be hanging out
with my family. I was just kind of like going
to the, you know, some of the sessions, but it
was not. the same approach that I now have when
I go to a conference. Yeah, same. I hate networking.
I understand the value of it. It's so important
to our careers. I've learned so much because
I put myself out there and I've done uncomfortable
things of going up to the speaker at a conference
and introducing myself or asking follow -up questions.
But man, I hate it. I think I'm a natural introvert
where a good night to me is a good book. And
maybe a nice cocktail on the back porch and a
quiet evening without people. And yet so often
at these conferences, it's not that. It's making
small talk and, you know, doing these random
mixers and going to things. And I don't enjoy
it necessarily. It's not how I would choose to
spend my evenings. But it's so valuable and it's
necessary. And exactly as you just described,
I think there is so many opportunities that come
from it. And I think sometimes we feel silly.
We feel like, oh, if I go to this networking
mixer at the end of the conference, I'm just
going to make small talk with people and nothing
ever gets done. But there are so many projects
that I have been privileged to work on that came
from those conversations where you're talking
to other people. You find out that an NP in Arizona
is doing something really cool. find ways to
either change your practice as a result. You
can find ways to maybe join forces and collaborate.
Several of the schools that I work with for precepting
or other things, those are opportunities that
came from attending conferences that are oriented
towards PAs. So I don't enjoy it. It's something
that doesn't come naturally to me. It's something
that I have to do consciously, but it is something
that I think has paid incredible dividends throughout
my career. I think that's extremely valuable.
And I think our audience will be in a way relieved
to hear that because I think sometimes it's easy
to just look at people who have some type of
online presence or have more opportunities and
kind of wonder how it happened. And it's like
most of the time it is just putting in the reps
and like being putting a lot of times we're uncomfortable
with it, you know, and it's like and yet we still
do it and we see the value in the payoff. That's
pretty cool. That's pretty cool. So true. I think
there's a perpetual imposter syndrome, right?
As everyone looks and assumes, oh my gosh, you
know, Lindsay's online. She's got a great Instagram
presence. I could never do that. I'm not as talented
as her. And that may be true because you are
very talented online. But at the same time, I
think all of us internally are trying to fight
our inner critic or feel like it's cringy or
feel like, oh, this isn't really something that
I want to do. And a lot of times you just got
to put yourself out there. And when you do it,
it ends up working out well. And guess what?
A lot of times it doesn't. And I think that's
the other thing. I'm sure you've had this is
I think one of the best things that I've done
in my career is just accepted that I'm going
to fail fast. I want to try a lot of things and
I'm going to just accept that many of them may
not work and that's okay. I don't want to get
too over invested in something if it's not panning
out. And I want to make sure that I'm just continuing
to, to take as many bites at the apple as I can.
Cause I know that that's the greatest opportunity
to find things that work. Yeah, no, absolutely.
Yeah, that makes that makes a lot of sense. I
remember feeling insecure about my online presence
at that conference where we met because I was
new to kind of networking with industry or, you
know, I hadn't even heard that like. term before,
you know, like, and somebody giving me that advice,
like, you need to kind of start networking more
with industry. Anyway, I just noticed that people
seemed confused when I would tell them kind of
what I was doing online. So I remember kind of
like, looking to you for validation about like,
basically, what I was getting at is, do you think
I can still be like a respectable psych NP in
the community and be on social media? Or you
think it's going to kind of make me a joke? You
know, and I think that tension there is difficult.
because not everybody finds the right balance.
And it is something that I think you've done
quite well, that we want to use social media
to kind of build our brand, whether that's our
practice, what we're doing personally as educators.
But at the same time, we have to be so cautious,
I think, because often social media rewards parasocial
relationships. And I think the temptation is
to let people in to every aspect of your life.
That may work. I certainly I think people can
do it successfully. But at the same time, patients
are watching as well. Other colleagues are watching.
And it's very important that we're still presenting
in a way that is authoritative, that is demonstrating
our knowledge. If we're on TikTok dances, I'm
not confident that patients may view that and
then say, wow, that's someone that I want to
go see when I'm struggling. So it is something
that I think we have to be thoughtful of. We
have to be very mindful. But at the same time,
social media is so powerful. The reach that you
can have if you have a presence and the opportunities,
whether it's as a practice owner to build your
practice and awareness for referrals, whether
it's as a consultant and you're trying to build
relationships with companies so that you can
provide clinician consulting opportunities, social
media is an incredibly powerful tool. And we
have to recognize that there is a role, but we
also have to be very careful in how we deploy
it. Yeah, no, absolutely. Absolutely. One of
the other kind of interesting things when I when
I look at people who I look up to, you know,
obviously I look up to you. I look up to Dr.
Carlat, as you know, and I see kind of how his
choices have shaped who he is today. And I'm
like, you know, wow, that was a pretty bold move
of him to not accept any industry funding because
I still see. the struggle of like him trying
to get his great content out there and dealing
with things like sometimes clunky platforms or
sometimes like the stress of like launching your
own like product essentially, you know what I
mean? And it just has had me thinking more about,
you know, we also talk about like industry funded
education and. And also integrative psychiatry
is such a thing right now. And sometimes I wonder,
too, like how much of that education is big wellness
might have, you know, something to do with. Just
like a lot of different things that can get kind
of overwhelming to sift through. I'm not doing
a great job of articulating this, but I know
that you get it because we've kind of talked
about these things before. And I just wondered
if you have any insight on. Yeah. Kind of, yeah,
how to think about all of that. Yeah, so I'll
start with a story. So I do a lot of consulting
for the pharmaceutical industry. I do a lot of
research for the pharmaceutical industry. Our
organization has, at any given time, about 100
clinical trials going on, and many of those are
in partnership or funded and supported by industry.
It's a thing that I've also put a lot of thought
into. And the reason, my why. My sister -in -law
has cystic fibrosis. And when my brother married
her, they talked about their life together in
fairly grim terms. They said, well, we don't
know how many good years we'll get, but we're
going to be thankful for whatever it is. And,
you know, through thick and thin, through sickness
and health. And at the time, they were expecting
that maybe she would make it to 35. and that's
that's really depressing right yeah yeah and
then in i think it was 2019 a new medication
came out for cystic fibrosis that was a paradigm
shifter it went from the average lifespan of
cystic fibrosis being i think in about the mid
40s with your last decade of life being pretty
crummy to now having a lifespan or an expected
lifespan with cf that is almost normal where
instantaneously one drug completely changes it
And now I have two incredible nephews that would
not exist without pharma. So my nephews are here.
They were not even thought of. Having kids was
not something they ever even thought was a possibility
because they weren't even sure if she was going
to make it to 30. And now I have two healthy,
amazing nephews that wouldn't be here. So this
is why I'm comfortable with the work that I do
because there's plenty of criticisms of any industry.
And I think it's always appropriate that we are
fair and balanced and we make sure that we call
out things that are inappropriate or wrong. Because
if a car manufacturer is doing something that
is not great, we want to talk about it. But at
the same time, we cannot undermine how much good
and how much innovation comes from the private
sector. And even with COVID, I know vaccines
are controversial and we don't talk about it
enough. But my goodness, we went from start to
finish of developing a vaccine in COVID. in a
year and a half. That's remarkable. So I see
industry as something that drives innovation.
It really is important in an era of psychiatry
where we are seeing true, new, novel agents coming
down the pipeline that I hope we'll see, I hope
will meaningfully change outcomes for patients.
There may be for -profit motives, right? We don't
want to necessarily pretend that that's not there.
And we always need to take that into account
and make sure that we're always making our own
judgments. Yeah, no, well said. Very well said.
Yeah, I think that's another actually just area
of maybe tension too that I've run into is I
find on social media, people want to, providers,
psych NPs, they want to know about like, money.
And it feels weird to talk about money as a healthcare
provider who has not been conditioned to do so.
You know what I mean? I've even had some feedback
from different larger organizations that are
like, you know, basically don't talk about money
in this talk. And, you know, sometimes your content
can come off a little bit like, and so I have
like this tension of like, is this okay to talk
about, you know? So it's just a lot to navigate,
I think, in 2026. You're with everything being
so online and so out there for everyone to see.
I agree. It's hard, right? Because in a perfect
world, money doesn't play a role. But at the
same time, I don't think anyone would do anything
for free, right? I don't necessarily think that
we would all do this for charity. We all want
to pay our mortgages. So it is a tough balance.
And I think it's very important for us to understand
how to run a small business, how to own a practice.
And many small businesses fail. And medicine
is no exception. Nine out of 10 businesses fail.
And a large part of that is going to be finances.
So having good, open, transparent conversations
about money matters. But the flip side to that
is I think sometimes there can be a disconnect
with the public where... people don't realize
how expensive it is to deliver care. And we talk
about, in our clinic, we talk about overhead
a lot in all of the things that go into a visit
with your provider. There's ER costs, there's
malpractice, there's a lot of things that go
into that that I don't necessarily think the
public always appreciates. So transparency is
good, but also context is good, that we have
to help people understand that I don't think
there's anyone that goes into money to get rich.
Right. I think that finance probably would have
been a better route for that. Wall Street might
have been a little bit more of a fruitful career
if we were looking to just accumulate massive
amounts of wealth. We're all here because we
want to help people and we can't help people
if we're not solvent. Yeah, no, absolutely. That
makes sense. People have given me feedback that
they like the shorter episodes. I'm going to
try to keep it at 30 minutes, but I have, I think,
two more questions for you. Who are your main?
mentors right now and any tips for finding mentors?
Yeah, that's a good question. So I think from
a clinical perspective, the people that I always
look up to is my medical director, Dr. Capote.
We've been doing this for 15 years together and
he is someone that we've gone through thick and
thin together. So I appreciate that every single
day I get to work four doors down from him and
now we're, man, we're both getting very long
in the tooth and that's okay. So he is someone
that I'm very appreciative that one job my whole
career, I know how unusual that is these days,
and it's been a lot of fun to do it with the
same boss. But outside of my job, I very much
look up to Dr. Roger McIntyre. He's just down
the road from me in Toronto. And I think his
approach is amazing in the sense that he is doggedly
pursuing hypotheses that may or may not work
out. One of the recent conversation I had with
him. He's been very excited about GLP -1s, and
he strongly believes that there is a neuropsychiatric
signal, that there may be a really positive mood
-modifying effect within GLP -1s. And one of
the things I asked him, I said, well, what if
you're wrong? And he said, that's the point of
science, is if every single theory was right,
then we wouldn't need to pursue these hypotheses.
So I always appreciate his approach that... What
makes this field so cool is that we don't know
the answers and we're on this lifelong journey
to try and accumulate more knowledge to nudge
our patient outcomes in a positive direction.
Beyond that, I think Dr. Rakesh Jain is someone
that I also look up to incredibly. He is just
such a wonderful person. to look at in terms
of psychiatry, because I think he has a wonderful
balance of the role of neuroscience and neurobiology,
the role of medications within psychiatry, but
then also not neglecting psychotherapy, mindfulness,
spirituality. And I think it's a really great
representation of what psychiatry should be,
where it's not just medication management. It's
not just therapy or psychodynamic approaches,
but truly an all the above approach where we're
going to pull on every single lever that helps
the patient restore wellness. Yeah, no, absolutely.
Great points. Yeah, I saw that his wife was putting
out a podcast and I can't remember the name of
it now, but I'm really excited to listen because
I saw that as well. His is a positive psychiatry.
I don't know Sondra Jane's podcast name, but
it's definitely going to be a worthwhile one
to check out. Yeah, absolutely. Okay. And I ask
all my guests this, what does the term no prior
auth mean to you? Oh man, the term no prior auth
to me sounds like a world where we can make decisions
for our patients that are based on our judgment,
based on the best clinical appropriateness without
insurance or third parties interfering. So to
me, that's a very utopian and idealistic approach
that... maybe never happens, but certainly is
one that I hope we continue to get closer to.
Because so often in psychiatry, what's best for
the patient isn't necessarily always what we
get to implement for the patient. And insurance
a lot of times makes that more difficult. So
my hope is no prior auth is an aspirational statement
moving closer to having the patient and the clinician
be the ones making the decision in care. Awesome.
Well, thank you so much, Mike, for taking the
time out. And we'd love to have you back for
another episode down the line and keep up on
just what you're doing. And yeah, we appreciate
it. Thanks, Lindsay. This was great.