WEBVTT 00:00:00.000 --> 00:00:01.860 Someone told me, they said, hey, Lindsay Hill 00:00:01.860 --> 00:00:03.839 is here. She's going to sit in on this ad board. 00:00:04.000 --> 00:00:06.120 She is someone to keep an eye on. She's incredible. 00:00:06.360 --> 00:00:08.779 It's very difficult, especially in psychiatry, 00:00:08.800 --> 00:00:11.880 where so often we are going through or living 00:00:11.880 --> 00:00:13.880 with our patients through their worst moments. 00:00:14.019 --> 00:00:16.260 When a patient maybe is coming to see us because 00:00:16.260 --> 00:00:18.300 their spouse passed away, and we're supposed 00:00:18.300 --> 00:00:20.899 to help them, we're supposed to support them, 00:00:20.960 --> 00:00:23.500 but also then go home and still be fully present 00:00:23.500 --> 00:00:26.120 for our families. I wanted to do ortho for many 00:00:26.120 --> 00:00:28.239 years, but I think about orthopedics as being 00:00:28.239 --> 00:00:30.719 more cookbook. If someone has a fracture, we 00:00:30.719 --> 00:00:32.179 already know the game plan. We're going to put 00:00:32.179 --> 00:00:34.259 them in a cast. We're going to do six weeks of 00:00:34.259 --> 00:00:36.320 PT, and then they're going to get back to normal 00:00:36.320 --> 00:00:39.200 life. Psychiatry is not that. Psychiatry is still 00:00:39.200 --> 00:00:42.060 an art where we don't necessarily have all the 00:00:42.060 --> 00:00:43.920 answers. We don't even necessarily know what's 00:00:43.920 --> 00:00:46.920 going on. Social media is so powerful. The reach 00:00:46.920 --> 00:00:49.299 that you can have if you have a presence, you're 00:00:49.299 --> 00:00:51.119 trying to build relationships with companies 00:00:51.119 --> 00:00:53.100 so that you can provide clinician consulting 00:00:53.100 --> 00:00:55.939 opportunities. Social media is an incredibly 00:00:55.939 --> 00:01:00.030 powerful tool. This week on No Prior Off, I'm 00:01:00.030 --> 00:01:02.210 sitting down with Mike Asbach, and we're doing 00:01:02.210 --> 00:01:04.829 something a little different. Mike is a physician 00:01:04.829 --> 00:01:07.769 associate, not a nurse practitioner, and he's 00:01:07.769 --> 00:01:09.769 one of the most credentialed psychiatric PAs 00:01:09.769 --> 00:01:13.549 in the country. Associate Director of Interventional 00:01:13.549 --> 00:01:16.370 Psychiatry at Dent Neurologic Institute, where 00:01:16.370 --> 00:01:19.349 he runs TMS, ketamine, and spermato every day. 00:01:20.189 --> 00:01:23.310 He's also the AAPA's liaison to the American 00:01:23.310 --> 00:01:26.609 Psychiatric Association, a professor, a podcaster 00:01:26.609 --> 00:01:28.989 with a six -figure audience, and a captain in 00:01:28.989 --> 00:01:31.310 the Army Reserve. His message is simple and I 00:01:31.310 --> 00:01:33.530 think exactly right. As psychiatrists retire 00:01:33.530 --> 00:01:37.670 and the need for care explodes, PAs and NPs can't 00:01:37.670 --> 00:01:40.189 afford to compete. It's all hands on deck. Today, 00:01:40.269 --> 00:01:42.090 we're talking about where our field is headed. 00:01:42.250 --> 00:01:44.609 Let's get into it. Thanks for being here, Mike. 00:01:45.450 --> 00:01:48.090 Wow. Thank you, Lindsay. What an intro. I can't 00:01:48.090 --> 00:01:49.790 possibly live up to that. So now we've already 00:01:49.790 --> 00:01:52.310 set a bar that's far too high. But I appreciate 00:01:52.310 --> 00:01:54.430 it because that's the kindest thing I've ever 00:01:54.430 --> 00:01:56.349 heard since my mother told me that she loved 00:01:56.349 --> 00:02:00.150 me. So that's great. Oh, my goodness. You're 00:02:00.150 --> 00:02:03.409 funny. You are funny. You're the first PA that 00:02:03.409 --> 00:02:05.469 I'm having on the podcast. So I'm pretty excited 00:02:05.469 --> 00:02:08.680 about that. I'm honored. Yeah, it's a wonderful, 00:02:08.960 --> 00:02:10.979 it's really interesting in psychiatry, isn't 00:02:10.979 --> 00:02:13.479 it? Because PAs and NPs fill very similar roles, 00:02:13.620 --> 00:02:16.199 but at the same time, different educational pathways, 00:02:16.400 --> 00:02:18.620 maybe different ways that we approach medicine 00:02:18.620 --> 00:02:21.460 as well. So I think any opportunities that we 00:02:21.460 --> 00:02:23.219 can have more crosstalk, more collaboration, 00:02:23.439 --> 00:02:26.319 it's good for everybody. I agree. And I think 00:02:26.319 --> 00:02:29.939 what's cool about our networking dynamic relationship 00:02:29.939 --> 00:02:33.939 is like, you're the first psychiatric PA that 00:02:33.939 --> 00:02:36.280 I've really like gotten to know more. And I'm 00:02:36.280 --> 00:02:38.759 like, man, psych PAs are really cool. And I want 00:02:38.759 --> 00:02:41.319 like more conversations and more learning, you 00:02:41.319 --> 00:02:44.759 know, both ways. So I've enjoyed, you know, since, 00:02:44.900 --> 00:02:46.719 since I met you at that conference, I think it 00:02:46.719 --> 00:02:52.419 was January of 2025, maybe I've enjoyed 24 even, 00:02:52.500 --> 00:02:55.340 but yeah. Yeah. Let's talk about that though. 00:02:55.360 --> 00:02:57.300 The power of networking. I will tell the story 00:02:57.300 --> 00:02:58.919 because I think it's interesting for your audience. 00:02:59.280 --> 00:03:01.610 I had never heard of you. We were both at this 00:03:01.610 --> 00:03:04.310 conference in Arizona and someone actually told 00:03:04.310 --> 00:03:05.870 me, I don't know if I've ever told you this. 00:03:05.930 --> 00:03:07.870 Someone told me, they said, hey, Lindsay Hill 00:03:07.870 --> 00:03:10.469 is here. She's going to sit in on this ad board. 00:03:10.909 --> 00:03:14.210 And she's the president of the Arizona Psychiatric 00:03:14.210 --> 00:03:17.389 Nurses Association at the time, but said she 00:03:17.389 --> 00:03:19.349 is someone to keep an eye on. She's incredible. 00:03:19.830 --> 00:03:22.590 And we were in a meeting for schizophrenia. And 00:03:22.590 --> 00:03:25.150 every time you opened your mouth, I was like, 00:03:25.229 --> 00:03:28.250 wow, that's a really good point. Every time you 00:03:28.250 --> 00:03:30.030 said something, I was like, oh, man, I totally 00:03:30.030 --> 00:03:32.409 agree with that. So afterwards, we made sure 00:03:32.409 --> 00:03:34.650 to connect. And I just I love that because I 00:03:34.650 --> 00:03:36.750 have so many conversations with PAs and NPs, 00:03:36.830 --> 00:03:38.810 and I feel like I'm constantly preaching the 00:03:38.810 --> 00:03:41.900 importance of networking. collaboration, especially 00:03:41.900 --> 00:03:44.759 because so many of us work in telemedicine or 00:03:44.759 --> 00:03:47.680 more isolated settings. It really is an important 00:03:47.680 --> 00:03:49.900 thing. There's just so much opportunity to learn 00:03:49.900 --> 00:03:52.479 when you're in person at a conference or even 00:03:52.479 --> 00:03:55.159 if it's going out to a monthly meeting with your 00:03:55.159 --> 00:03:57.180 local association, those creative collisions 00:03:57.180 --> 00:03:59.439 that can happen when you're with people. It's 00:03:59.439 --> 00:04:01.800 unmatched. You can't find that elsewhere. Yeah. 00:04:01.879 --> 00:04:04.659 And one of the things that really stuck out to 00:04:04.659 --> 00:04:08.039 me about you is you were, I remember in our conversation, 00:04:08.810 --> 00:04:11.310 you were like needing to get your vehicle to 00:04:11.310 --> 00:04:13.990 go to the airport in like a very short amount 00:04:13.990 --> 00:04:16.490 of time. So it was a short conversation, but 00:04:16.490 --> 00:04:19.089 like you provided a ton of value to me in like 00:04:19.089 --> 00:04:21.209 two minutes. Like I left the conversation like, 00:04:21.310 --> 00:04:24.029 oh wow, I learned a lot of things. And one of 00:04:24.029 --> 00:04:27.089 those things was, you know, the idea of consulting 00:04:27.089 --> 00:04:29.949 with biotech companies in exchange for equity, 00:04:30.089 --> 00:04:33.069 which I now have accomplished. And I would have 00:04:33.069 --> 00:04:35.470 never, that wouldn't have been on my radar if 00:04:35.470 --> 00:04:38.529 that, and you just like. you shared openly about 00:04:38.529 --> 00:04:41.850 just your journey and your experiences. You've 00:04:41.850 --> 00:04:45.550 always like offered like way more value than 00:04:45.550 --> 00:04:49.490 you've ever asked for, which I think is just 00:04:49.490 --> 00:04:53.170 like a testament to kind of why you are where 00:04:53.170 --> 00:04:57.269 you are today. Thank you. Yeah, it's good to 00:04:57.269 --> 00:05:00.209 not be transactional, right? You want to surround 00:05:00.209 --> 00:05:02.410 yourself with good people and then not necessarily 00:05:02.410 --> 00:05:05.689 only have those relationships be built on exchange 00:05:05.689 --> 00:05:09.509 of value. My goodness, I love that we're across 00:05:09.509 --> 00:05:11.550 the country. We're 5 ,000 miles apart, and yet 00:05:11.550 --> 00:05:14.370 you and I stay in touch frequently, and we've 00:05:14.370 --> 00:05:15.990 found a lot of cool stuff to work on together. 00:05:16.170 --> 00:05:19.290 So it has been great. Yeah, absolutely. Love 00:05:19.290 --> 00:05:21.430 that. Okay, one of the things that our audience 00:05:21.430 --> 00:05:23.410 really loves to hear about, and I think that 00:05:23.410 --> 00:05:27.009 you are further ahead than a lot of PAs and NPs, 00:05:27.170 --> 00:05:30.860 is, you know, the idea of just like... multiple 00:05:30.860 --> 00:05:33.899 revenue streams and not just for more income, 00:05:33.980 --> 00:05:36.839 but also like as a way to not burn out and like 00:05:36.839 --> 00:05:39.300 do more things that are interesting and that 00:05:39.300 --> 00:05:41.920 kind of fit your skill set. Can you talk to us 00:05:41.920 --> 00:05:46.319 a little bit about what how you got into kind 00:05:46.319 --> 00:05:48.500 of all the different things that you do and what 00:05:48.500 --> 00:05:50.959 some of your revenue streams are and help our 00:05:50.959 --> 00:05:53.860 audience that way? Yeah, so just a little bit 00:05:53.860 --> 00:05:56.980 about myself. I am still full time in clinical 00:05:56.980 --> 00:06:01.709 practice. I run a team now of 17 prescribers. 00:06:01.709 --> 00:06:04.350 So we're a fairly large clinic. And as you said 00:06:04.350 --> 00:06:06.089 earlier, we do a lot of really cool stuff. We 00:06:06.089 --> 00:06:08.769 do research. So we're now starting to do a lot 00:06:08.769 --> 00:06:12.029 of research and advisory work with psychedelics, 00:06:12.029 --> 00:06:15.029 but then we do ketamine, esketamine, TMS. So 00:06:15.029 --> 00:06:17.389 still very much in the clinical setting, but 00:06:17.389 --> 00:06:20.629 my role is evolving a bit where I'm not seeing 00:06:20.629 --> 00:06:22.870 patients back to back to back to back to back, 00:06:22.949 --> 00:06:24.850 because I do think that that's a really good 00:06:24.850 --> 00:06:28.019 recipe for burnout. Medicine is... incredibly 00:06:28.019 --> 00:06:29.980 overwhelming. It's very difficult, especially 00:06:29.980 --> 00:06:33.160 in psychiatry, where so often we are going through 00:06:33.160 --> 00:06:35.740 or living with our patients through their worst 00:06:35.740 --> 00:06:39.120 moments. And it's hard when a patient maybe is 00:06:39.120 --> 00:06:40.959 coming to see us because their spouse passed 00:06:40.959 --> 00:06:43.800 away or something else has happened, and yet 00:06:43.800 --> 00:06:46.420 it's a Tuesday for us. And we're supposed to 00:06:46.420 --> 00:06:49.360 help them, we're supposed to support them, but 00:06:49.360 --> 00:06:51.779 also then go home and still be fully present 00:06:51.779 --> 00:06:54.870 for our families. And that's, I think, a big 00:06:54.870 --> 00:06:57.509 challenge. So I very much believe that it's imperative 00:06:57.509 --> 00:07:00.009 for all of us to think about how we can build 00:07:00.009 --> 00:07:02.829 careers that are not exclusively focused on being 00:07:02.829 --> 00:07:06.170 40 clinic contact hours with our patients, but 00:07:06.170 --> 00:07:08.350 rather how can we contribute in different ways. 00:07:08.449 --> 00:07:11.930 So more and more of my weekly schedule is doing 00:07:11.930 --> 00:07:15.370 leadership, admin for my clinic that employs 00:07:15.370 --> 00:07:17.470 me. But then also I love to do a lot of medical 00:07:17.470 --> 00:07:21.430 writing. I love teaching. precept a ton of students. 00:07:21.649 --> 00:07:25.129 I also do research advisory work for a doctoral 00:07:25.129 --> 00:07:28.589 program in Virginia for PA. And I think it's 00:07:28.589 --> 00:07:31.009 been a wonderful thing. And I always encourage 00:07:31.009 --> 00:07:33.290 any PAs or NPs when we have these conversations, 00:07:33.550 --> 00:07:35.610 think about different things that you can do 00:07:35.610 --> 00:07:39.050 that maybe get you to a point where you're 0 00:07:39.050 --> 00:07:43.269 .7 FTE in the clinic. And that doesn't mean necessarily 00:07:43.269 --> 00:07:45.970 taking a pay cut, but finding other things that 00:07:45.970 --> 00:07:48.050 where you can contribute, where you can do things 00:07:48.050 --> 00:07:51.079 that drive passion. but also break up your work 00:07:51.079 --> 00:07:53.680 week a little bit. Yeah, that's a great point. 00:07:53.819 --> 00:07:55.379 That's a great point. How long have you been 00:07:55.379 --> 00:08:01.300 a psych PA now? This is my 15th year. So early 00:08:01.300 --> 00:08:03.639 career is generally defined as 10 years and I 00:08:03.639 --> 00:08:05.699 am no longer early career, which makes me, I 00:08:05.699 --> 00:08:09.000 guess, a little sad. Yeah. How did you get into 00:08:09.000 --> 00:08:11.339 psych as a PA? I feel like it's different for 00:08:11.339 --> 00:08:13.240 you. You know, obviously it's different, but 00:08:13.240 --> 00:08:16.019 yeah. Did you know you wanted to do psych? No, 00:08:16.079 --> 00:08:18.990 not at all. I dragged into it kicking and screaming. 00:08:19.129 --> 00:08:22.810 So PA is different where all PAs graduate as 00:08:22.810 --> 00:08:25.189 generalists. So our training is in the medical 00:08:25.189 --> 00:08:27.389 model. We do our clinical rotations through many 00:08:27.389 --> 00:08:30.050 different specialties. And through PA school, 00:08:30.149 --> 00:08:32.669 I was convinced that I wanted to do either surgery 00:08:32.669 --> 00:08:35.070 or ortho because generally if you are a man and 00:08:35.070 --> 00:08:37.389 you are in PA school, you go into surgery or 00:08:37.389 --> 00:08:40.629 ortho. So this was my lot in life. I was going 00:08:40.629 --> 00:08:42.809 to go the path that every other male PA student 00:08:42.809 --> 00:08:46.480 went. And I did all of my electives during my 00:08:46.480 --> 00:08:48.559 clinical year in surgery and ortho. I really 00:08:48.559 --> 00:08:51.919 loved it. I enjoyed it. I had several job offers 00:08:51.919 --> 00:08:55.659 in surgery and ortho. And thankfully, fairly 00:08:55.659 --> 00:08:58.279 early on in the interview process, I recognized 00:08:58.279 --> 00:09:02.059 this is really cool. And as a student, I loved 00:09:02.059 --> 00:09:04.899 being in the OR. I loved doing mechanical hands 00:09:04.899 --> 00:09:07.759 -on things. But at the same time, I'm not quite 00:09:07.759 --> 00:09:12.500 sure I want to be doing this. at age 35 on Christmas 00:09:12.500 --> 00:09:14.860 Eve, getting called into the hospital for a hip 00:09:14.860 --> 00:09:17.480 fracture. So I recognized that even though I 00:09:17.480 --> 00:09:20.879 thought it was cool, designing my career was 00:09:20.879 --> 00:09:23.039 not something where I wanted to just think about 00:09:23.039 --> 00:09:25.240 the excitement or the novelty, but rather what 00:09:25.240 --> 00:09:27.639 is something I could sustainably do for 35, 40 00:09:27.639 --> 00:09:31.059 years. On a flyer, I applied to psychiatry. I 00:09:31.059 --> 00:09:33.340 had really enjoyed my mental health rotation. 00:09:33.440 --> 00:09:35.860 I did it at the VA because I was already in the 00:09:35.860 --> 00:09:39.779 ROTC program and tracking to do the Army Reserve. 00:09:39.960 --> 00:09:42.620 So I had enjoyed mental health. At the time, 00:09:42.620 --> 00:09:44.620 I thought I enjoyed it just because of the military 00:09:44.620 --> 00:09:47.820 connection, but applied for a job in psychiatry 00:09:47.820 --> 00:09:51.240 with my current clinic and fell in love within 00:09:51.240 --> 00:09:54.399 five minutes. So when I went in for my interview, 00:09:54.480 --> 00:09:57.450 my medical director, Dr. Capote, Within two minutes 00:09:57.450 --> 00:09:58.809 of us sitting down, he said, hey, do you want 00:09:58.809 --> 00:10:01.230 to see something cool? And he took me down the 00:10:01.230 --> 00:10:05.629 hall and he showed me TMS. And he showed me how 00:10:05.629 --> 00:10:08.850 you find the motor threshold. He put the magnet 00:10:08.850 --> 00:10:11.909 over my palm and made my hand jump. And that 00:10:11.909 --> 00:10:14.070 was the aha moment where I realized that I could 00:10:14.070 --> 00:10:17.149 find a path to do hands -on medicine, but still 00:10:17.149 --> 00:10:20.029 also have a nine to five more predictable schedule. 00:10:20.509 --> 00:10:23.230 And I never left. It's been 15 years at the same 00:10:23.230 --> 00:10:27.289 role. That is so cool. Wow. Because you have 00:10:27.289 --> 00:10:30.509 four boys, right? I mean, you're busy. Correct. 00:10:30.649 --> 00:10:34.870 Yes. Very busy. Very chaotic. Yeah. Wow. That's 00:10:34.870 --> 00:10:38.669 that's cool. How did you kind of become such 00:10:38.669 --> 00:10:44.549 a visible psychiatric PA? Like, was it doing 00:10:44.549 --> 00:10:48.009 stuff with industry? Like, did it just kind of 00:10:48.009 --> 00:10:52.419 happen or were you like intentional about? Kind 00:10:52.419 --> 00:10:54.799 of building this personal brand for yourself 00:10:54.799 --> 00:10:57.679 where people know who Mike is. Because I remember 00:10:57.679 --> 00:11:00.419 someone from Psych Times being like, you've got 00:11:00.419 --> 00:11:02.600 to connect with Mike Asback. I don't think it 00:11:02.600 --> 00:11:05.620 was intentional at first. I love to teach. I 00:11:05.620 --> 00:11:08.940 love psychiatry because I feel like it's no knocking 00:11:08.940 --> 00:11:11.360 on ortho. I wanted to do ortho for many years. 00:11:11.460 --> 00:11:14.539 But I think about orthopedics as being more cookbook. 00:11:14.659 --> 00:11:17.309 If someone has a fracture. We already know the 00:11:17.309 --> 00:11:18.789 game plan. We're going to put them in a cast. 00:11:18.970 --> 00:11:21.210 We're going to do six weeks of PT, and then they're 00:11:21.210 --> 00:11:24.370 going to get back to normal life. And yet psychiatry 00:11:24.370 --> 00:11:27.269 is not that. Psychiatry is still an art where 00:11:27.269 --> 00:11:29.690 we don't necessarily have all the answers. We 00:11:29.690 --> 00:11:31.529 don't even necessarily know what's going on. 00:11:31.850 --> 00:11:34.450 And we have theories, but all theories are wrong. 00:11:34.529 --> 00:11:38.490 Some are useful. And I was attracted to psychiatry 00:11:38.490 --> 00:11:40.490 because of how much of this was still unknown. 00:11:41.309 --> 00:11:43.590 And very early in my career, I recognized that 00:11:43.590 --> 00:11:46.149 I enjoyed teaching. I started precepting for 00:11:46.149 --> 00:11:49.570 PA programs fairly early on and then started 00:11:49.570 --> 00:11:53.409 submitting CME presentations. I started submitting 00:11:53.409 --> 00:11:57.070 case studies to journals. And I recognized that 00:11:57.070 --> 00:11:58.990 teaching was something that I, it just brought 00:11:58.990 --> 00:12:02.370 me a ton of joy, but I never went into it intentionally 00:12:02.370 --> 00:12:07.000 trying to. build as big of a platform as possible. 00:12:07.320 --> 00:12:10.100 I think that ended up being just a slow incremental 00:12:10.100 --> 00:12:15.299 thing. But at some point I did realize that with 00:12:15.299 --> 00:12:17.440 teaching, there's an opportunity where when you 00:12:17.440 --> 00:12:19.639 see a patient, you can make a really big difference 00:12:19.639 --> 00:12:22.100 in that patient's life. But ultimately you're 00:12:22.100 --> 00:12:24.940 stuck in this one -to -one ratio where the number 00:12:24.940 --> 00:12:27.240 of people you can help is limited by how many 00:12:27.240 --> 00:12:30.679 hours you can see patients. And one of the coolest 00:12:30.679 --> 00:12:32.899 things of teaching is that you have this opportunity 00:12:32.899 --> 00:12:36.889 to speak to a room of, who knows, 10 people, 00:12:37.070 --> 00:12:40.629 100 people, 1 ,000 people, and if you can effectively 00:12:40.629 --> 00:12:44.809 help them translate science into actionable clinical 00:12:44.809 --> 00:12:47.769 practice, the number of patients you can help 00:12:47.769 --> 00:12:50.169 is infinitely scalable. And that's something 00:12:50.169 --> 00:12:52.789 that's always been incredibly enticing to me, 00:12:52.830 --> 00:12:54.570 the idea that we can really make a difference 00:12:54.570 --> 00:12:57.730 by helping empower other clinicians to be more 00:12:57.730 --> 00:12:59.830 adept and more prepared for clinical practice. 00:13:00.750 --> 00:13:05.820 Yeah, absolutely. That makes sense. So were you 00:13:05.820 --> 00:13:10.220 always like so into networking? Because for me, 00:13:10.220 --> 00:13:13.940 I was like not. I was like invisible at the conferences 00:13:13.940 --> 00:13:17.139 for the longest time until I started seeing more 00:13:17.139 --> 00:13:19.059 like the power of networking and the power of 00:13:19.059 --> 00:13:21.980 visibility, you know. But that was pretty recent, 00:13:22.100 --> 00:13:23.919 you know, last couple of years. Before that, 00:13:24.059 --> 00:13:25.700 I was just like, I'm going to be hanging out 00:13:25.700 --> 00:13:28.120 with my family. I was just kind of like going 00:13:28.120 --> 00:13:30.200 to the, you know, some of the sessions, but it 00:13:30.200 --> 00:13:33.070 was not. the same approach that I now have when 00:13:33.070 --> 00:13:36.690 I go to a conference. Yeah, same. I hate networking. 00:13:37.590 --> 00:13:40.169 I understand the value of it. It's so important 00:13:40.169 --> 00:13:42.730 to our careers. I've learned so much because 00:13:42.730 --> 00:13:45.409 I put myself out there and I've done uncomfortable 00:13:45.409 --> 00:13:48.289 things of going up to the speaker at a conference 00:13:48.289 --> 00:13:51.409 and introducing myself or asking follow -up questions. 00:13:51.710 --> 00:13:55.870 But man, I hate it. I think I'm a natural introvert 00:13:55.870 --> 00:14:00.029 where a good night to me is a good book. And 00:14:00.029 --> 00:14:02.409 maybe a nice cocktail on the back porch and a 00:14:02.409 --> 00:14:06.090 quiet evening without people. And yet so often 00:14:06.090 --> 00:14:08.350 at these conferences, it's not that. It's making 00:14:08.350 --> 00:14:11.049 small talk and, you know, doing these random 00:14:11.049 --> 00:14:13.889 mixers and going to things. And I don't enjoy 00:14:13.889 --> 00:14:16.789 it necessarily. It's not how I would choose to 00:14:16.789 --> 00:14:20.730 spend my evenings. But it's so valuable and it's 00:14:20.730 --> 00:14:23.909 necessary. And exactly as you just described, 00:14:24.129 --> 00:14:26.590 I think there is so many opportunities that come 00:14:26.590 --> 00:14:30.139 from it. And I think sometimes we feel silly. 00:14:30.259 --> 00:14:33.399 We feel like, oh, if I go to this networking 00:14:33.399 --> 00:14:37.360 mixer at the end of the conference, I'm just 00:14:37.360 --> 00:14:39.500 going to make small talk with people and nothing 00:14:39.500 --> 00:14:42.940 ever gets done. But there are so many projects 00:14:42.940 --> 00:14:46.100 that I have been privileged to work on that came 00:14:46.100 --> 00:14:48.120 from those conversations where you're talking 00:14:48.120 --> 00:14:51.799 to other people. You find out that an NP in Arizona 00:14:51.799 --> 00:14:56.309 is doing something really cool. find ways to 00:14:56.309 --> 00:14:58.669 either change your practice as a result. You 00:14:58.669 --> 00:15:01.889 can find ways to maybe join forces and collaborate. 00:15:02.330 --> 00:15:05.629 Several of the schools that I work with for precepting 00:15:05.629 --> 00:15:07.809 or other things, those are opportunities that 00:15:07.809 --> 00:15:10.549 came from attending conferences that are oriented 00:15:10.549 --> 00:15:14.350 towards PAs. So I don't enjoy it. It's something 00:15:14.350 --> 00:15:16.389 that doesn't come naturally to me. It's something 00:15:16.389 --> 00:15:19.009 that I have to do consciously, but it is something 00:15:19.009 --> 00:15:21.610 that I think has paid incredible dividends throughout 00:15:21.610 --> 00:15:24.799 my career. I think that's extremely valuable. 00:15:24.960 --> 00:15:28.539 And I think our audience will be in a way relieved 00:15:28.539 --> 00:15:31.320 to hear that because I think sometimes it's easy 00:15:31.320 --> 00:15:34.500 to just look at people who have some type of 00:15:34.500 --> 00:15:37.580 online presence or have more opportunities and 00:15:37.580 --> 00:15:40.340 kind of wonder how it happened. And it's like 00:15:40.340 --> 00:15:43.179 most of the time it is just putting in the reps 00:15:43.179 --> 00:15:46.500 and like being putting a lot of times we're uncomfortable 00:15:46.500 --> 00:15:49.440 with it, you know, and it's like and yet we still 00:15:49.440 --> 00:15:52.960 do it and we see the value in the payoff. That's 00:15:52.960 --> 00:15:55.659 pretty cool. That's pretty cool. So true. I think 00:15:55.659 --> 00:15:57.500 there's a perpetual imposter syndrome, right? 00:15:57.580 --> 00:16:00.460 As everyone looks and assumes, oh my gosh, you 00:16:00.460 --> 00:16:02.759 know, Lindsay's online. She's got a great Instagram 00:16:02.759 --> 00:16:05.559 presence. I could never do that. I'm not as talented 00:16:05.559 --> 00:16:07.620 as her. And that may be true because you are 00:16:07.620 --> 00:16:10.620 very talented online. But at the same time, I 00:16:10.620 --> 00:16:13.500 think all of us internally are trying to fight 00:16:13.500 --> 00:16:15.779 our inner critic or feel like it's cringy or 00:16:15.779 --> 00:16:17.580 feel like, oh, this isn't really something that 00:16:17.580 --> 00:16:20.539 I want to do. And a lot of times you just got 00:16:20.539 --> 00:16:22.440 to put yourself out there. And when you do it, 00:16:22.480 --> 00:16:24.299 it ends up working out well. And guess what? 00:16:24.320 --> 00:16:26.559 A lot of times it doesn't. And I think that's 00:16:26.559 --> 00:16:28.820 the other thing. I'm sure you've had this is 00:16:28.820 --> 00:16:30.759 I think one of the best things that I've done 00:16:30.759 --> 00:16:32.539 in my career is just accepted that I'm going 00:16:32.539 --> 00:16:35.860 to fail fast. I want to try a lot of things and 00:16:35.860 --> 00:16:38.340 I'm going to just accept that many of them may 00:16:38.340 --> 00:16:40.220 not work and that's okay. I don't want to get 00:16:40.220 --> 00:16:42.639 too over invested in something if it's not panning 00:16:42.639 --> 00:16:45.240 out. And I want to make sure that I'm just continuing 00:16:45.240 --> 00:16:48.600 to, to take as many bites at the apple as I can. 00:16:48.659 --> 00:16:50.559 Cause I know that that's the greatest opportunity 00:16:50.559 --> 00:16:53.620 to find things that work. Yeah, no, absolutely. 00:16:53.940 --> 00:16:56.639 Yeah, that makes that makes a lot of sense. I 00:16:56.639 --> 00:17:01.480 remember feeling insecure about my online presence 00:17:01.480 --> 00:17:05.640 at that conference where we met because I was 00:17:05.640 --> 00:17:09.900 new to kind of networking with industry or, you 00:17:09.900 --> 00:17:12.490 know, I hadn't even heard that like. term before, 00:17:12.589 --> 00:17:14.970 you know, like, and somebody giving me that advice, 00:17:15.089 --> 00:17:16.849 like, you need to kind of start networking more 00:17:16.849 --> 00:17:19.589 with industry. Anyway, I just noticed that people 00:17:19.589 --> 00:17:21.349 seemed confused when I would tell them kind of 00:17:21.349 --> 00:17:23.730 what I was doing online. So I remember kind of 00:17:23.730 --> 00:17:26.509 like, looking to you for validation about like, 00:17:26.670 --> 00:17:29.130 basically, what I was getting at is, do you think 00:17:29.130 --> 00:17:32.190 I can still be like a respectable psych NP in 00:17:32.190 --> 00:17:35.230 the community and be on social media? Or you 00:17:35.230 --> 00:17:38.750 think it's going to kind of make me a joke? You 00:17:38.750 --> 00:17:41.210 know, and I think that tension there is difficult. 00:17:41.609 --> 00:17:43.630 because not everybody finds the right balance. 00:17:43.769 --> 00:17:45.390 And it is something that I think you've done 00:17:45.390 --> 00:17:49.410 quite well, that we want to use social media 00:17:49.410 --> 00:17:52.809 to kind of build our brand, whether that's our 00:17:52.809 --> 00:17:55.690 practice, what we're doing personally as educators. 00:17:56.130 --> 00:17:59.049 But at the same time, we have to be so cautious, 00:17:59.109 --> 00:18:02.589 I think, because often social media rewards parasocial 00:18:02.589 --> 00:18:05.609 relationships. And I think the temptation is 00:18:05.609 --> 00:18:09.170 to let people in to every aspect of your life. 00:18:10.589 --> 00:18:12.950 That may work. I certainly I think people can 00:18:12.950 --> 00:18:15.609 do it successfully. But at the same time, patients 00:18:15.609 --> 00:18:18.690 are watching as well. Other colleagues are watching. 00:18:18.849 --> 00:18:21.390 And it's very important that we're still presenting 00:18:21.390 --> 00:18:24.609 in a way that is authoritative, that is demonstrating 00:18:24.609 --> 00:18:29.289 our knowledge. If we're on TikTok dances, I'm 00:18:29.289 --> 00:18:31.650 not confident that patients may view that and 00:18:31.650 --> 00:18:33.589 then say, wow, that's someone that I want to 00:18:33.589 --> 00:18:36.109 go see when I'm struggling. So it is something 00:18:36.109 --> 00:18:38.210 that I think we have to be thoughtful of. We 00:18:38.210 --> 00:18:41.500 have to be very mindful. But at the same time, 00:18:42.220 --> 00:18:44.859 social media is so powerful. The reach that you 00:18:44.859 --> 00:18:48.400 can have if you have a presence and the opportunities, 00:18:48.500 --> 00:18:51.319 whether it's as a practice owner to build your 00:18:51.319 --> 00:18:53.420 practice and awareness for referrals, whether 00:18:53.420 --> 00:18:55.920 it's as a consultant and you're trying to build 00:18:55.920 --> 00:18:57.960 relationships with companies so that you can 00:18:57.960 --> 00:19:01.539 provide clinician consulting opportunities, social 00:19:01.539 --> 00:19:04.720 media is an incredibly powerful tool. And we 00:19:04.720 --> 00:19:07.079 have to recognize that there is a role, but we 00:19:07.079 --> 00:19:08.920 also have to be very careful in how we deploy 00:19:08.920 --> 00:19:12.480 it. Yeah, no, absolutely. Absolutely. One of 00:19:12.480 --> 00:19:15.059 the other kind of interesting things when I when 00:19:15.059 --> 00:19:18.839 I look at people who I look up to, you know, 00:19:18.859 --> 00:19:21.279 obviously I look up to you. I look up to Dr. 00:19:21.420 --> 00:19:24.200 Carlat, as you know, and I see kind of how his 00:19:24.200 --> 00:19:28.559 choices have shaped who he is today. And I'm 00:19:28.559 --> 00:19:30.460 like, you know, wow, that was a pretty bold move 00:19:30.460 --> 00:19:34.019 of him to not accept any industry funding because 00:19:34.019 --> 00:19:38.539 I still see. the struggle of like him trying 00:19:38.539 --> 00:19:40.799 to get his great content out there and dealing 00:19:40.799 --> 00:19:43.779 with things like sometimes clunky platforms or 00:19:43.779 --> 00:19:47.019 sometimes like the stress of like launching your 00:19:47.019 --> 00:19:49.960 own like product essentially, you know what I 00:19:49.960 --> 00:19:53.180 mean? And it just has had me thinking more about, 00:19:53.279 --> 00:19:56.480 you know, we also talk about like industry funded 00:19:56.480 --> 00:20:00.960 education and. And also integrative psychiatry 00:20:00.960 --> 00:20:03.480 is such a thing right now. And sometimes I wonder, 00:20:03.500 --> 00:20:07.059 too, like how much of that education is big wellness 00:20:07.059 --> 00:20:11.200 might have, you know, something to do with. Just 00:20:11.200 --> 00:20:14.279 like a lot of different things that can get kind 00:20:14.279 --> 00:20:17.599 of overwhelming to sift through. I'm not doing 00:20:17.599 --> 00:20:19.759 a great job of articulating this, but I know 00:20:19.759 --> 00:20:21.759 that you get it because we've kind of talked 00:20:21.759 --> 00:20:23.299 about these things before. And I just wondered 00:20:23.299 --> 00:20:28.730 if you have any insight on. Yeah. Kind of, yeah, 00:20:28.789 --> 00:20:32.970 how to think about all of that. Yeah, so I'll 00:20:32.970 --> 00:20:35.829 start with a story. So I do a lot of consulting 00:20:35.829 --> 00:20:38.809 for the pharmaceutical industry. I do a lot of 00:20:38.809 --> 00:20:40.910 research for the pharmaceutical industry. Our 00:20:40.910 --> 00:20:43.769 organization has, at any given time, about 100 00:20:43.769 --> 00:20:45.930 clinical trials going on, and many of those are 00:20:45.930 --> 00:20:48.950 in partnership or funded and supported by industry. 00:20:49.190 --> 00:20:51.589 It's a thing that I've also put a lot of thought 00:20:51.589 --> 00:20:57.170 into. And the reason, my why. My sister -in -law 00:20:57.170 --> 00:21:00.509 has cystic fibrosis. And when my brother married 00:21:00.509 --> 00:21:05.190 her, they talked about their life together in 00:21:05.190 --> 00:21:07.650 fairly grim terms. They said, well, we don't 00:21:07.650 --> 00:21:09.609 know how many good years we'll get, but we're 00:21:09.609 --> 00:21:11.849 going to be thankful for whatever it is. And, 00:21:11.849 --> 00:21:15.049 you know, through thick and thin, through sickness 00:21:15.049 --> 00:21:18.970 and health. And at the time, they were expecting 00:21:18.970 --> 00:21:23.289 that maybe she would make it to 35. and that's 00:21:23.289 --> 00:21:26.430 that's really depressing right yeah yeah and 00:21:26.430 --> 00:21:29.750 then in i think it was 2019 a new medication 00:21:29.750 --> 00:21:32.849 came out for cystic fibrosis that was a paradigm 00:21:32.849 --> 00:21:35.410 shifter it went from the average lifespan of 00:21:35.410 --> 00:21:37.670 cystic fibrosis being i think in about the mid 00:21:37.670 --> 00:21:40.170 40s with your last decade of life being pretty 00:21:40.170 --> 00:21:43.269 crummy to now having a lifespan or an expected 00:21:43.269 --> 00:21:46.789 lifespan with cf that is almost normal where 00:21:46.789 --> 00:21:50.710 instantaneously one drug completely changes it 00:21:51.150 --> 00:21:55.190 And now I have two incredible nephews that would 00:21:55.190 --> 00:21:59.269 not exist without pharma. So my nephews are here. 00:21:59.410 --> 00:22:01.950 They were not even thought of. Having kids was 00:22:01.950 --> 00:22:04.150 not something they ever even thought was a possibility 00:22:04.150 --> 00:22:06.170 because they weren't even sure if she was going 00:22:06.170 --> 00:22:08.950 to make it to 30. And now I have two healthy, 00:22:08.990 --> 00:22:11.109 amazing nephews that wouldn't be here. So this 00:22:11.109 --> 00:22:13.829 is why I'm comfortable with the work that I do 00:22:13.829 --> 00:22:17.430 because there's plenty of criticisms of any industry. 00:22:17.930 --> 00:22:20.170 And I think it's always appropriate that we are 00:22:20.170 --> 00:22:22.329 fair and balanced and we make sure that we call 00:22:22.329 --> 00:22:24.589 out things that are inappropriate or wrong. Because 00:22:24.589 --> 00:22:27.369 if a car manufacturer is doing something that 00:22:27.369 --> 00:22:30.789 is not great, we want to talk about it. But at 00:22:30.789 --> 00:22:34.309 the same time, we cannot undermine how much good 00:22:34.309 --> 00:22:36.829 and how much innovation comes from the private 00:22:36.829 --> 00:22:40.069 sector. And even with COVID, I know vaccines 00:22:40.069 --> 00:22:42.150 are controversial and we don't talk about it 00:22:42.150 --> 00:22:44.089 enough. But my goodness, we went from start to 00:22:44.089 --> 00:22:47.400 finish of developing a vaccine in COVID. in a 00:22:47.400 --> 00:22:51.000 year and a half. That's remarkable. So I see 00:22:51.000 --> 00:22:54.079 industry as something that drives innovation. 00:22:54.559 --> 00:22:57.900 It really is important in an era of psychiatry 00:22:57.900 --> 00:23:01.220 where we are seeing true, new, novel agents coming 00:23:01.220 --> 00:23:04.240 down the pipeline that I hope we'll see, I hope 00:23:04.240 --> 00:23:06.440 will meaningfully change outcomes for patients. 00:23:13.740 --> 00:23:17.259 There may be for -profit motives, right? We don't 00:23:17.259 --> 00:23:19.319 want to necessarily pretend that that's not there. 00:23:19.480 --> 00:23:22.160 And we always need to take that into account 00:23:22.160 --> 00:23:24.559 and make sure that we're always making our own 00:23:24.559 --> 00:23:27.819 judgments. Yeah, no, well said. Very well said. 00:23:28.079 --> 00:23:31.039 Yeah, I think that's another actually just area 00:23:31.039 --> 00:23:36.619 of maybe tension too that I've run into is I 00:23:36.619 --> 00:23:39.079 find on social media, people want to, providers, 00:23:39.359 --> 00:23:42.789 psych NPs, they want to know about like, money. 00:23:42.910 --> 00:23:46.450 And it feels weird to talk about money as a healthcare 00:23:46.450 --> 00:23:49.990 provider who has not been conditioned to do so. 00:23:50.049 --> 00:23:52.069 You know what I mean? I've even had some feedback 00:23:52.069 --> 00:23:54.430 from different larger organizations that are 00:23:54.430 --> 00:23:58.309 like, you know, basically don't talk about money 00:23:58.309 --> 00:24:01.730 in this talk. And, you know, sometimes your content 00:24:01.730 --> 00:24:05.289 can come off a little bit like, and so I have 00:24:05.289 --> 00:24:09.349 like this tension of like, is this okay to talk 00:24:09.349 --> 00:24:13.839 about, you know? So it's just a lot to navigate, 00:24:13.940 --> 00:24:17.640 I think, in 2026. You're with everything being 00:24:17.640 --> 00:24:22.119 so online and so out there for everyone to see. 00:24:22.400 --> 00:24:25.319 I agree. It's hard, right? Because in a perfect 00:24:25.319 --> 00:24:28.759 world, money doesn't play a role. But at the 00:24:28.759 --> 00:24:32.680 same time, I don't think anyone would do anything 00:24:32.680 --> 00:24:35.380 for free, right? I don't necessarily think that 00:24:35.380 --> 00:24:39.000 we would all do this for charity. We all want 00:24:39.000 --> 00:24:41.000 to pay our mortgages. So it is a tough balance. 00:24:41.160 --> 00:24:43.559 And I think it's very important for us to understand 00:24:43.559 --> 00:24:47.200 how to run a small business, how to own a practice. 00:24:47.319 --> 00:24:51.039 And many small businesses fail. And medicine 00:24:51.039 --> 00:24:53.339 is no exception. Nine out of 10 businesses fail. 00:24:53.440 --> 00:24:56.000 And a large part of that is going to be finances. 00:24:56.200 --> 00:24:59.099 So having good, open, transparent conversations 00:24:59.099 --> 00:25:01.720 about money matters. But the flip side to that 00:25:01.720 --> 00:25:03.640 is I think sometimes there can be a disconnect 00:25:03.640 --> 00:25:06.619 with the public where... people don't realize 00:25:06.619 --> 00:25:10.579 how expensive it is to deliver care. And we talk 00:25:10.579 --> 00:25:12.579 about, in our clinic, we talk about overhead 00:25:12.579 --> 00:25:15.819 a lot in all of the things that go into a visit 00:25:15.819 --> 00:25:19.180 with your provider. There's ER costs, there's 00:25:19.180 --> 00:25:21.079 malpractice, there's a lot of things that go 00:25:21.079 --> 00:25:23.579 into that that I don't necessarily think the 00:25:23.579 --> 00:25:26.599 public always appreciates. So transparency is 00:25:26.599 --> 00:25:28.920 good, but also context is good, that we have 00:25:28.920 --> 00:25:31.819 to help people understand that I don't think 00:25:31.819 --> 00:25:33.619 there's anyone that goes into money to get rich. 00:25:34.349 --> 00:25:36.869 Right. I think that finance probably would have 00:25:36.869 --> 00:25:38.950 been a better route for that. Wall Street might 00:25:38.950 --> 00:25:40.730 have been a little bit more of a fruitful career 00:25:40.730 --> 00:25:42.990 if we were looking to just accumulate massive 00:25:42.990 --> 00:25:45.269 amounts of wealth. We're all here because we 00:25:45.269 --> 00:25:47.710 want to help people and we can't help people 00:25:47.710 --> 00:25:51.410 if we're not solvent. Yeah, no, absolutely. That 00:25:51.410 --> 00:25:55.069 makes sense. People have given me feedback that 00:25:55.069 --> 00:25:56.509 they like the shorter episodes. I'm going to 00:25:56.509 --> 00:25:59.609 try to keep it at 30 minutes, but I have, I think, 00:25:59.609 --> 00:26:03.289 two more questions for you. Who are your main? 00:26:04.110 --> 00:26:07.390 mentors right now and any tips for finding mentors? 00:26:07.890 --> 00:26:10.049 Yeah, that's a good question. So I think from 00:26:10.049 --> 00:26:13.210 a clinical perspective, the people that I always 00:26:13.210 --> 00:26:16.329 look up to is my medical director, Dr. Capote. 00:26:16.630 --> 00:26:19.410 We've been doing this for 15 years together and 00:26:19.410 --> 00:26:21.670 he is someone that we've gone through thick and 00:26:21.670 --> 00:26:24.549 thin together. So I appreciate that every single 00:26:24.549 --> 00:26:27.329 day I get to work four doors down from him and 00:26:27.329 --> 00:26:30.529 now we're, man, we're both getting very long 00:26:30.529 --> 00:26:33.289 in the tooth and that's okay. So he is someone 00:26:33.289 --> 00:26:36.349 that I'm very appreciative that one job my whole 00:26:36.349 --> 00:26:38.410 career, I know how unusual that is these days, 00:26:38.450 --> 00:26:40.289 and it's been a lot of fun to do it with the 00:26:40.289 --> 00:26:45.329 same boss. But outside of my job, I very much 00:26:45.329 --> 00:26:48.049 look up to Dr. Roger McIntyre. He's just down 00:26:48.049 --> 00:26:50.930 the road from me in Toronto. And I think his 00:26:50.930 --> 00:26:55.230 approach is amazing in the sense that he is doggedly 00:26:55.230 --> 00:26:57.710 pursuing hypotheses that may or may not work 00:26:57.710 --> 00:27:00.490 out. One of the recent conversation I had with 00:27:00.490 --> 00:27:03.539 him. He's been very excited about GLP -1s, and 00:27:03.539 --> 00:27:06.259 he strongly believes that there is a neuropsychiatric 00:27:06.259 --> 00:27:09.359 signal, that there may be a really positive mood 00:27:09.359 --> 00:27:12.819 -modifying effect within GLP -1s. And one of 00:27:12.819 --> 00:27:14.220 the things I asked him, I said, well, what if 00:27:14.220 --> 00:27:16.619 you're wrong? And he said, that's the point of 00:27:16.619 --> 00:27:19.559 science, is if every single theory was right, 00:27:19.680 --> 00:27:22.279 then we wouldn't need to pursue these hypotheses. 00:27:22.519 --> 00:27:27.170 So I always appreciate his approach that... What 00:27:27.170 --> 00:27:29.490 makes this field so cool is that we don't know 00:27:29.490 --> 00:27:32.269 the answers and we're on this lifelong journey 00:27:32.269 --> 00:27:35.210 to try and accumulate more knowledge to nudge 00:27:35.210 --> 00:27:37.410 our patient outcomes in a positive direction. 00:27:38.029 --> 00:27:42.269 Beyond that, I think Dr. Rakesh Jain is someone 00:27:42.269 --> 00:27:44.990 that I also look up to incredibly. He is just 00:27:44.990 --> 00:27:49.019 such a wonderful person. to look at in terms 00:27:49.019 --> 00:27:51.180 of psychiatry, because I think he has a wonderful 00:27:51.180 --> 00:27:54.460 balance of the role of neuroscience and neurobiology, 00:27:54.539 --> 00:27:57.339 the role of medications within psychiatry, but 00:27:57.339 --> 00:28:01.220 then also not neglecting psychotherapy, mindfulness, 00:28:01.559 --> 00:28:04.440 spirituality. And I think it's a really great 00:28:04.440 --> 00:28:07.420 representation of what psychiatry should be, 00:28:07.460 --> 00:28:10.259 where it's not just medication management. It's 00:28:10.259 --> 00:28:12.900 not just therapy or psychodynamic approaches, 00:28:13.019 --> 00:28:15.299 but truly an all the above approach where we're 00:28:15.299 --> 00:28:17.880 going to pull on every single lever that helps 00:28:17.880 --> 00:28:20.839 the patient restore wellness. Yeah, no, absolutely. 00:28:21.140 --> 00:28:23.579 Great points. Yeah, I saw that his wife was putting 00:28:23.579 --> 00:28:25.900 out a podcast and I can't remember the name of 00:28:25.900 --> 00:28:27.799 it now, but I'm really excited to listen because 00:28:27.799 --> 00:28:30.859 I saw that as well. His is a positive psychiatry. 00:28:30.900 --> 00:28:33.900 I don't know Sondra Jane's podcast name, but 00:28:33.900 --> 00:28:35.500 it's definitely going to be a worthwhile one 00:28:35.500 --> 00:28:39.450 to check out. Yeah, absolutely. Okay. And I ask 00:28:39.450 --> 00:28:42.809 all my guests this, what does the term no prior 00:28:42.809 --> 00:28:45.450 auth mean to you? Oh man, the term no prior auth 00:28:45.450 --> 00:28:47.950 to me sounds like a world where we can make decisions 00:28:47.950 --> 00:28:52.089 for our patients that are based on our judgment, 00:28:52.150 --> 00:28:56.410 based on the best clinical appropriateness without 00:28:56.410 --> 00:28:59.970 insurance or third parties interfering. So to 00:28:59.970 --> 00:29:02.869 me, that's a very utopian and idealistic approach 00:29:02.869 --> 00:29:05.710 that... maybe never happens, but certainly is 00:29:05.710 --> 00:29:07.930 one that I hope we continue to get closer to. 00:29:08.369 --> 00:29:11.750 Because so often in psychiatry, what's best for 00:29:11.750 --> 00:29:14.289 the patient isn't necessarily always what we 00:29:14.289 --> 00:29:16.250 get to implement for the patient. And insurance 00:29:16.250 --> 00:29:18.289 a lot of times makes that more difficult. So 00:29:18.289 --> 00:29:21.630 my hope is no prior auth is an aspirational statement 00:29:21.630 --> 00:29:24.950 moving closer to having the patient and the clinician 00:29:24.950 --> 00:29:28.150 be the ones making the decision in care. Awesome. 00:29:28.720 --> 00:29:30.539 Well, thank you so much, Mike, for taking the 00:29:30.539 --> 00:29:32.700 time out. And we'd love to have you back for 00:29:32.700 --> 00:29:35.039 another episode down the line and keep up on 00:29:35.039 --> 00:29:38.819 just what you're doing. And yeah, we appreciate 00:29:38.819 --> 00:29:40.980 it. Thanks, Lindsay. This was great.