No Prior Auth

Mike Asbach is the first physician associate on this show, and he set the bar high. He's the Associate Director of Interventional Psychiatry at DENT Neurologic Institute in Buffalo, where he leads a team of 17 prescribers delivering TMS, ketamine, and Spravato. He's also the AAPA's liaison to the American Psychiatric Association, a professor, a medical writer, a podcast host, and a captain in the Army Reserve.Here's what surprised me: he hates networking. A perfect night for Mike is a good book and a quiet porch. Nearly everything on that resume exists because he overrode that preference, introduced himself to conference speakers, sat through the mixers, and kept showing up. It's how we met, at a schizophrenia ad board in Arizona. A two-minute conversation with him on his way to the airport put biotech consulting on my radar, and I've since done it.He never planned on psychiatry. Male PA students went into surgery or ortho, so that was his plan too, right up until he pictured himself at 35 getting called in for a hip fracture on Christmas Eve. He applied to one psychiatry job on a whim. Mid-interview, the medical director walked him down the hall, put a TMS magnet over his palm, and made his hand jump. That was it. Fifteen years later he's still there, four doors down from the same boss.We get into career design: how to move toward 0.7 FTE clinical without taking a pay cut, and why teaching scales in a way one-on-one patient care never will. We talk about money, a subject providers are trained to avoid, and where the line sits between a social media presence that builds trust and one that costs it. He's honest about the weight of this work too. Our patients come to us on the worst day of their lives, and for us it's a Tuesday.Then he tells the story behind his industry work. His sister-in-law has cystic fibrosis, and when she married his brother they hoped she might reach 35. A drug approved in 2019 changed her expected lifespan to nearly normal, and Mike now has two nephews who wouldn't exist without it. He's clear-eyed about profit motives, and just as clear about what that innovation gave his family.If you're a psych NP or PA wondering whether this career comes in a version with more range and less grind, Mike is proof that it does.CONNECT WITH MIKE: https://www.linkedin.com/in/michael-asbach/ Associate Director of Interventional Psychiatry, DENT Neurologic Institute (Buffalo, NY) 🎙️ Co-host, White Coats of the Round Table - https://www.masterclinicians.net/podcast-whitecoatsLISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych#PsychPA #PhysicianAssociate #PMHNP #InterventionalPsychiatry #TMS #Ketamine #MentalHealth #NoPriorAuth

Andrea Kemp is back for Part 2, and this one is for the students. If Part 1 took you inside the inpatient unit, this is the practical playbook: how to find a preceptor when your program won't, how to walk into day one of clinical ready, and how to actually learn once you're there instead of watching someone else work.Andrea has precepted students for years and now teaches in a PMHNP program, so she sees both sides. She's blunt about what separates the students who get hired from the ones who get forgotten, and almost none of it is knowing every diagnosis. Show up with a notebook, not an iPad. Make yourself an asset, not a liability. Ask three good questions at the end of the day and look up the rest yourself. Curiosity over confidence, every single time.The part that stuck with me: your didactic classes teach you how to be a provider, but your clinicals teach you how to be in a room with a human, and those are two different skills. Andrea walks through how she actually talks to patients — the five questions she never skips, why silence is a tool, why she'd rather ask a hard question than let someone off the hook, and how she narrows two hundred medications down to five without ever tricking anyone into a prescription.We also get into the stuff nobody warns you about. Paying for clinicals. Preceptors who don't know how to use you. What to do when a patient doesn't want to be there. And how to protect your license when the board holds NPs to a harder line than physicians, including the state-board resource most students don't know exists.If you're in a program right now, or about to start clinicals, take notes on this one.Go listen. Then tell me what you wish you'd known sooner. — LindsayLISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych#PsychNP #PMHNP #PMHNPstudent #NPschool #NursePractitionerStudent #ClinicalRotations #MentalHealth #NoPriorAuth

I went to school with Andrea Kemp at Arizona State, so I've watched her become one of the sharpest inpatient psych NPs I know. She almost went to law school. Psych won. Eleven years later she runs a step-down unit, teaches in a PMHNP program, and says the thing most people get wrong about inpatient psychiatry starts at the front door.That locked door? It isn't there to protect the world from the patients. It's there because someone is not safe, and the unit is where they finally get to be. Most of what you picture from TV is wrong, and Andrea spends this episode setting it straight.This is Part 1 of two, and we stay on the unit: what inpatient psych actually is, the medication puzzle she loves solving, and the hardest part of the job — involuntary treatment, and what it means to take someone's autonomy while still treating them like a person. Her rule has stuck with me. A patient may not remember the meds you gave them, but they will always remember whether you talked to them like a human being.We also get honest about safety. Andrea has been assaulted on the job, and she doesn't sugarcoat it. It's also, oddly enough, where she met her husband — he stepped in the day a patient's family member threatened her. She talks about all of it without flinching, and about why she still loves this work.And because she got hired five months before graduation and negotiated $130,000 as a brand-new grad, she walks through exactly how she pulled it off. If your first job is for learning and not earning, she'll show you how to still get paid while you learn.Come back for Part 2, where we get into prepping for clinical and everything she wishes psych NP students knew.Go listen. Then tell me what surprised you. — LindsayCONNECT WITH ANDREA Inpatient-focused community for psych NPs & PAs — launching soon Speaking on NP decision fatigue at the Southwest NP Symposium (Mesa, AZ · late July) [add Andrea's TikTok / community link]LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych#PsychNP #PMHNP #InpatientPsych #PsychiatricNursing #MentalHealth #NursePractitioner #PMHNPstudent #NoPriorAuth

Most of the guests on this show built private practices and never looked back. Ben Egbers is the outlier. He built one in rural Montana, and then he walked away from it.Ben came to psychiatry the long way. A psychology and German degree in 2000. Years as a case manager, then teaching English in Europe. An avalanche in the backcountry that he barely survived, and that he dug his best friend out of. A career in pharma he hated, a $60,000 pay cut to go back to bedside psych nursing, and his own recovery from alcohol use disorder — this month he's ten years sober. He didn't finish his nursing doctorate until 2021.Today he runs some of the most intensive treatments in the field, deep TMS and ketamine, while holding a belief that sounds almost backwards: the goal is the least medication a person needs, not the most.We get into all of it. Why he opened a private practice and then let it go (the billing alone will make you wince). How he partners with therapists in a way that has them telling him "you're the first psychiatric provider who ever called me." What ten years of sobriety taught him about who's actually ready for help. And why he's now stepping back from the interventional work to train in psychodynamic therapy and do something that feels more like him.If you've ever felt like an outlier in this field, or like the "right" path just wasn't fitting, this one's for you.Go listen. Then tell me which part landed. — LindsayCHAPTERS 00:00 The cold open 01:09 Meet Ben Egbers 02:40 From a psychology & German degree to psych NP 03:30 The book that hooked him: "An Unquiet Mind" 05:10 Community mental health, then a pivot to Europe 08:30 The avalanche that changed his path 09:55 Hating med-surg and pharma — the 2am misery 12:50 A $60K pay cut back to bedside psych nursing 14:20 Why he's the "outlier": walking away from private practice 21:00 Networking with therapists (and picking up the phone) 24:50 What he hated most: the billing 25:40 Ten years sober: his recovery story 30:40 Being a provider in recovery, and who's ready for help 34:00 Psychodynamics 101: the unconscious and transference 39:40 The fellowship, and training toward therapy 47:10 What "No Prior Auth" means to himCONNECT WITH BEN Axis Integrated Mental Health — Colorado (deep TMS, ketamine) | https://axismh.com/LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych#PsychNP #PMHNP #InterventionalPsychiatry #Ketamine #TMS #Recovery #Sobriety #Psychodynamic #MentalHealth

Nick Goodwin built one of the more interesting psychiatric practices in the country, and he did it on a shoestring. Eight years ago he opened Goodwin Health Cafe in Spokane with $800 for his DEA license, a free fax tool, and a friend's spare office. Today it's a four-provider practice across two locations, built around treatment-resistant depression — Spravato, TMS, and a space designed to feel nothing like a clinic.He's also the psych NP who writes the psychiatry courses for The Elite Nurse Practitioner, so he's taught thousands of new NPs both the clinical and the business side of this work. And he came on the show to give it all away.We get into the real stuff. How he bootstrapped a practice for almost nothing, and which expenses he'd actually pay for up front. The hiring mistakes that cost him friendships, and the business rule he got from his dad (whose old company inspired the movie Office Space) that he'll never break. His honest read on new grads jumping into private practice, what to do if you're shaky on pharmacology, and the EHR headaches nobody warns you about.Then he says the thing a lot of nurse practitioners have been waiting to hear out loud: the constant dunking on NP education is, in his words, "horrifically sexist." He explains why, and it's worth the listen.If you're building a practice, thinking about it, or just tired of the gatekeeping, this one's a gift.Go listen. Then tell me which part landed. — LindsayCHAPTERS 00:00 The cold open 01:11 Meet Nick Goodwin & Goodwin Health Cafe 06:24 How he got into psych (his mom and the state hospital) 08:51 Clinical hours vs. running the business 10:49 "The criticism of NP school is sexist" — Nick's take 12:27 What to actually do in your psych NP clinicals 14:43 Opening a practice in 2018 for $800 16:33 The expenses worth paying for on day one 17:08 EHR lessons (and the billing trap to avoid) 18:25 Hiring NPs — and the friendships it cost him 22:00 His dad, "Office Space," and why he'll never take a partner 23:45 Honest advice for new grads going solo 29:33 Becoming the Elite NP psych course creator 31:50 "Get out of here" with the scope-of-practice gatekeeping 39:50 What "No Prior Auth" means to himCONNECT WITH NICK Goodwin Health Cafe — Spokane, WA: https://www.goodwinhealthcafe.com/ Nick's psychiatry & practice courses at The Elite NP: [add the course links Nick is sending]LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych#PsychNP #PMHNP #PrivatePractice #NursePractitioner #Spravato #TMS #MentalHealth #PMHNPlife