No Prior Auth Podcast — EP 01: Forging an Independent Career Path with Allison Sikorsky

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When did you first think I need to do this on my own? What was that push to start at your service psychiatry? Would you say? >> I knew that I went back to school to not be an employee anymore. When I went back to nurse practitioner school, I knew I was not cut out for being working for someone. I started learning about API and all this software stuff. >> When was your like biggest burnout period, would you say? I had a very public meltdown in in the inatient um in front of many people, two of whom were my students later, so they didn’t judge me too harshly. I do have to tell myself, you get 30 minutes and then you have to put this down and I go over everything and I obsess for a while. Oh, you know, I don’t like following rules. So, I think it’s everyone say you can’t do that. A girl can’t start a health tech company. And even if it is just seeing patients, you’re caring for hundreds of people.

Hi everyone, welcome to No Prior Off, the podcast where we celebrate psychiatric NPs who didn’t wait for permission to build something extraordinary. I’m Lindsay Hill and today’s guest is someone who didn’t just start her own practice. She saw a broken system and decided to fix it. Allison Sakorski is a board-certified psychiatric mental health nurse practitioner with over 30 years in healthcare. She built at your service psychiatry into a multi-state telescychiatry practice. And then because apparently running a practice across 20 states wasn’t enough, she founded PHC Scribe, an AI powered documentation tool built by a psych for psych. And here’s the thing I love. PMHCribe literally has a built-in prior authorization tool. So, if anyone understands why this podcast is called No Prior Off, it’s Allison. Today, she’s going to walk us through her journey from the bedside to building health tech and what drove her to create a tool she couldn’t find anywhere on the market.

Also, what she would tell every NP who’s been up till midnight finishing charts. So, let’s get into it. Thanks for being here, Alison, for that nice introduction. Wow. Thank you. I’m honored. We are honored that you’re our first guest. Um, okay. So, you’ve been in healthcare for over 30 years starting as a pharmacy tech. Take me back to that moment you realized you wanted to become a psychiatric nurse practitioner. >> Well, it did not start there. I was I will say my first job I was 16. So, that’s my journey. That’s when I started as a pharmacy technician and started learning a little bit about medications and calls into the pharmacy and things like that. And then after that, I knew I wanted to go to nursing school. I didn’t quite know what I wanted to do and worked at an apartment complex for adults with physical disabilities and built a team of they called them unlicensed assisted personnel there that did a lot of health care, but they also were not nursing assistants or anything like that and did a lot of staffing and fundraising and working with state uh billing and things like that. and then became a nurse in 1999.

And at the time my father was ill, so I wanted a terminally ill. So I wanted a job that I could have my nights and weekends and holidays off. So I went right into an office. I did not do bedside. I went right to soft nursing and went into internal medicine in an office where I was very much the youngest uh person there in my early 20s. and quickly became the clinical coordinator, building the team of clinicians there, staffing with uh physicians and a we had a laboratory and we put a pharmacy in there and we brought in some alternative treatment like a chiropractor and integrated that into the system and then did a concierge branch off of that and how that all worked in 2001. I was often brought in to maximize billing and coding and to clean up after an audit and figure out the national coverage determines all kinds of fun projects I had back then and fix up the after hours coverage and things. And after my father passed, I became a hospice nurse for a bit and I did a bit of bedside and then I had been looking at what degree I wanted. I wasn’t thrilled about nursing at the time. It was okay. It was good, but I don’t like blood and guts. I’m not a say I’m a sit and chat kind of person. So, it just didn’t suit me as well. And I was looking into >> going into counseling or something like that. And >> it just didn’t financially make a lot of sense. And then I was looking into psychology and then half-hazardly someone said, “Well, why wouldn’t you do psychiatric nurse practitioner?” And I had never heard of it. None of my nursing instructors, I had called them, asked them what to do. And I looked it up and ran home that day and told my husband, I’m quitting my job and going to school right now. I need to do this.

And it didn’t happen that fast, but it was I need to stop everything I’m doing and go to the psych school. And so I signed up at Rush University at the time. It was the top one in the nation, one of the first founding ones. They did not like my soft nursing, so they made me go back and get some bedside nursing experience. So, I had been a nurse since 99 and I had gotten in the interim a bachelor’s in behavioral science uh because it was half psychology, half business and team leadership and that fit me well. And so though I had done a lot of volunteerism in high school at a community mental health center and I had been a hospice nurse with a lot of grief therapy and pharmacy and all that and managing an office, outpatient office and such. They didn’t feel it was the nursing experience I needed. So >> I had to go get some bedside nursing experience. I went into geriatric psychiatry. I thought it would be close to hospice nursing. It was not.

>> And it was a very wild time. It was a wild floor. It was all of the local geriatric psychiatric units. When they couldn’t handle the patients, they transferred them to Rush. And so for context, the nursing ratio was 1:2. So we had two at max patients because it was so highly acute. So I did that for a while and that was terrible. And then I was having babies at the time and I was going to school and I had three babies in three and a half years. and I got a bit burnt out and said I I just can’t do school and everything and work in this unit and all of that. So I ended up quitting for a while and then just went back to hospice but more management. I did weekend teen leader. I built the after hours team. We went from one to 35 within a year, building that team and frontloading all of our home health and hospice staff on the weekends and nights when it made more sense to do a lot of those intakes.

So, we built this whole after hours on call triage telephone triage system and sending people out. We covered about eight counties. So back then we were faxing people other things and we had all this cool remote work but it was back in the day we were printing up Map Quest directions and faxing it to their paper faxes at home. It on their beepers. It was it was wild. So I did that for a while and then my heart hurt that I wasn’t a psych anymore. So I went back to school and graduated. By then it was 2011. So it was quite the journey to get there. >> Wow. What was your experience like at Rush and how did that shape the clinician that you are today? >> I had a lot of rigorous ex as I said they made me go back and get some bedside. They said don’t come back until you have at least 6 months under your belt. Don’t apply. I also didn’t have the best registered nurse grades. So, I had to really push myself into rush and say, “I will get the good grades. I was a kid. My dad was dying, like all of the things and working full-time and yeah, I got seasoned my nursing degree, but I will be the top of my class here.” So, and I pushed and pushed and was but it was an interesting time back then. We had to interview to get matched into a system that would take us on. and I had a community mental health provider who was amazing, took me on into a facility.

Why Allison Left Employment at Rush to Build a Psychiatric Nurse Practitioner Private Practice

So, back then we stayed in the same place. So, we got to manage the same patients for over a year and have our own patient panel. And they really plugged me in there so I could learn all about the billing and the fundraising and state funds and and how to balance it in a community mental health center. We had a capstone back then. So we mine was on cardiomabolic monitoring of p seriously mentally ill patients on atypical antiscychotics. So we did chart reviews and then trying to get like a blood pressure station so they could learn self-efficacy and then the fundraising for that. So, it was a really long capstone process which was fun and cool and rigorous and we got to do some inpatient work and um all the different run groups and run individual therapy and then have our own case load. So, it was a really amazing experience.

>> That sounds incredible. >> It was It was good. >> Like very high quality experience. >> It was good. So, >> when did you first think I need to do this on my own? like what was that push to start at your service psychiatry would you say? >> I knew that I went back to school to not be an employee anymore. I went back to nurse practitioner school. I knew I was not cut out for being working for someone. So I initially went and wanted to learn all the things about psychiatry. So, I went to a practice where I was self-employed contractor that could plug me into outpatient, do inpatient rounds, partial hospitalization rounds, long-term care. I still wanted the Jurosych and hospital consultant liaison for a few hospitals. So, I knew this place could get me into all those places. A lot of times I got to be the first nurse practitioner in a hospital system, which was strange and fun. also um going and trying to explain our role to a panel of people who weren’t thrilled to have us there and talking myself into getting into the facility. So I had been doing that about 7 years and even before that thought about tellaalth and concierge and could I do this I came up with the name in 2013 so I had only been practicing a couple years but I just kept putting it off because I felt like I needed to see everything in psychiatry and I did not but I saw all but I felt like it was all of the things and then around 2017 I decided I wanted to keep my insurance practice I thought at the time and then have this little side gig where I would see go to other places Illinois had dropped the ball on full practice authority they didn’t we just couldn’t get it to go through and it they went through and it was still limited and I still needed a physician collaborator for if I ever prescribed a benzo and I we had all been fighting so hard like going to the capital and and talking to legislators that I just became very frustrated and signed up for all the full practice authority states.

I said that’s enough. I’m just going to go and I’m going to spread my netwide because tellahalth was not a thing that everyone was doing back then. So like well I’ll just have patients throughout um the different states that also was intentional to not mess with my Illinois insurance contracts or Medicaid contracts. So, I wasn’t some of them specified you can’t be charging out a network and things like that and I said, “Well, if I’m not even in Illinois, it’s not going to mess with my contracts. It won’t mess with my non-compete.” And so, I started applying and then looking at the rules. And back then, nothing was in a concise place. Like, now we have the Center for Connected Health and you could just look it up and you have all the back links. And back then I had to get a lawyer to do a lot of that research for me and figure out I I figured out which states were independent but then which ones had good tellahalth rules. The rules were very different in 2017 and then >> started I had this vision of how patients would come to see me. They would >> find me online. I already knew I’d been eight years in in a outpatient practice that what the pain points were and I said I don’t want them having to call the office. I don’t want them filling out these big packets and waiting for a call back and I don’t want to hire just a staff member for scheduling and then another one for prior office and then another one for this and all that.

>> So I did the self-chuling and how to kind of make sure they’re the correct patient to come on that it wasn’t drug seeeking but it was people who wanted care and that they were the right fit but in a digital way without having any touch points of a person. So kind of built found I couldn’t find any HR for it. I kept looking. I did 50 demos. I did 150 more other ones looking at them and couldn’t find it. So I had to build my own system. And that’s where I started getting excited with technology. I was like, wait, what is this? Oh, this is really cool. Like I started learning about >> API and all this software stuff and really just had so much fun with it. So spent about 6 months looking at different systems, building it out. Back then again, we didn’t have all of the places I demoed. I’d say, you know, all I need is the patient to see the availability first so they can decide if they want to wait or not and then get through the consents and they want them brief and I want them consistent with what I would need like we don’t prescribe this but we do this. Are you okay? And then pay to secure the visit.

And that flow didn’t exist back then. And so I had to build that out. None of them, they all said, “You have a unique use case.” And so I said, “Okay, I’ll just build it.” >> I feel like you were always like ahead of your time. It feels like when I hear about all the different things you were do doing early on, like even doing Tellah Health like before it was mainstream. >> Did you see somebody else doing that or like what made you kind of go all in on teles psychiatry? I did call or no I Facebook messaged someone and I for the life of me I don’t even remember who it was. It was this lovely lady and I said I want to do concierge and I want to do tellaalth. Can it be done? She said yes I do that. And I said how long have you done it?

I’ve been doing it for 3 years. And I said that’s all I needed. Thank you. I just needed to hear you could do it and that it was okay. And then I was in the office and my colleague was attacked and stabbed by a patient and >> oh my gosh >> that shook me more than it probably even shook her. She was a trooper and went back to work within 3 days. But I was rattled and I had been through inatient and I always rounded with a guard and I had done hospital CL and you have to take all the precautions and I didn’t want to and I started taking crop maga and doing things to protect myself and then it just clicked that if I was tell I wouldn’t be exposed to the violence and I won’t go back in person and so at that moment when that happened I it kind of clicked that I’m just going to do all Tellah health from now on. And it again wasn’t instantaneous, but it was I’m not going in person anymore. And then >> at the same time, I got the idea for I had already been doing a little tellaalth, but I got the idea for online ADHD care where I could pre-screen someone, see them in person one time, and then we could just forever be teleaalth, and that would be great. I love my ADHD population. I had already been just seeing when I had regular outpatient psych. I would just do ADHD on Saturdays and it was like we were just talking and everyone’s quick and we’re like having fun and I was like what if I did that all the time. So that’s where I specialized in ADHD. We had a little system for an inperson and then right away I you know called up a girlfriend at Rush. I’m like what are you doing? you want to do tellahalth with me where you live right now? And so I added her right away. And so we had a system where we had some other locations where someone could be seen in person one time and then transfer them to teleaalth. That was a little known kind of loophole back then was there was a few ways of >> getting that one time inerson visit and was the inperson visit even needed and there wasn’t a lot of drama around ADHD.

So it was that you could have a live visit like we’re doing right now with the patient. So 1 2 3 you’re sitting with the patient in another state. You’re the DEA registered primary care provider. I’m the tellaalth and you can do a pass off with all the contracts and things like that in place. So at the time I I can’t recall anyone else doing ADHD care that way. And then COVID hit and a lot of my friends in the field said, you know, I need to figure out this teleahalth. A good friend of mine said she was taking care of her husband who had a physical disability and she said, I can’t be going in the hospital and bring this disease home to him and I can’t get caregivers in the house anymore. Can you teach me how to do tellahalth? I’m like, just join me.

Going Multi-State and Telehealth-First Before COVID

It’ll be fun. And so she joined me. And then a few others joined the group. And then we also had before any of the waiverss then we had a few offices throughout the different states that they had a little practice here or there maybe were struggling to get it going or they had a location where they’d see someone one time in person then convert them to teleaalth and then the waiverss went through and then we then no one knew how to do tellahalth back then. So there was this big surge especially ADHD no one knew if they could do it or not. we had already been doing it for years, so it was a natural progression to do that. Um, and then >> then some bad actors came in after and kind of started up ADHD focused, but their focus was opposite. Instead of us looking to make sure they had ADHD and if not, okay, we’re going to treat your bipolarism or we’re going to treat your other things. other companies seem to be convincing people they had ADHD or not or starting them on medicine for maybe nefarious reasons or not for good reasons and then not having a system if it went bad and we had already had years of a system if it went bad what to do next.

>> Yeah. Wow. That’s interesting. Did you have a lot of naysayers or like skeptics that were like kind of instilling fear in you or trying to >> trying to I didn’t let him but um at my old practice I was balancing both. I had this insurance practice I had this tellalth practice for a while I was overlapping especially building up a direct to consumer model where there’s no insurance. You don’t you have to do a lot of marketing and a lot of networking. So, I just assumed I would have both all the time. Um, until COVID hit, then I couldn’t manage them both cuz the other one blew up. But at the time, people are like, “No one’s going to like tella health. That’s just for rural care.” Like I was doing talks about this cool new thing called tella health that’s like can be used for the convenience factor and trying to explain to people what tellahalth was and why it’s so cool and why teles psychiatry is the perfect fit for it. Back then a lot of clinics would not see someone on an atypical antisycchotic because they couldn’t fathom how to do an abnormal involuntary movement scale or something like that. So I had a lot of naysayers there. I also had a surprising phenomenon that people were a bit aggressive about not taking insurance.

Like they they were really offended that someone would take on that model instead. And there was a misconception that there was that concierge or direct to consumer model meant patients could come and order up drugs like of abuse. And I it was no that they don’t even come in because they’ve been filtered out to not be attempting to get drugs of abuse by paying direct to consumer. So that was a big stigma that I had to overcome. >> Yeah, absolutely. I feel like you’re one of the few group practices I know that’s direct to consumer and that was kind of what always intrigued me when I first heard about what you were doing. I was like that’s very unique because I feel like I run into this all the time with my mentees where they’re like do I take insurance? How did you make that decision? Like did you kind of I felt like taking insurance initially helped me understand how to navigate the health care system? Now I had been in the health care navigating outpatient offices and such since 1999 and even Medicaid before that. So, I knew I would go into the insurance world because I wanted to learn acute psychiatry and the all the different facets. You can’t really work in a hospital and be direct to consumer or that kind of thing. And I wanted to have all the settings to be well-rounded. So for that reason, I always thought I would take insurance, but I had that concierge where they pay a subscription fee model or just direct to consumer pay in the back of my head because I had that exposure back in 2000 when we we took a clinic a physician who had I think his clinic had two or three thousand at the time. it was internal medicine and we brought it down to 500 and turned them into concierge and and did that >> break off of the insurance process back then and so I had that in my mind and then knowing that psychiatrists about 46% of them are out of network don’t take any insurance that it’s the way our insurance is set up with separating mental health from medical and and all of that I knew psychiatry is a place where people often can do out of network. But if I also knew that it took would take a lot longer because I had to rebuild a panel.

I didn’t take my 880 people from my insurance panel over. I knew that would be a huge burden for them and I wasn’t even going to ask of that or anything. So I figured it would take me double the time to create an out ofnet network panel and had all the that’s why I did two. But if I were a new grad, I would start out with insurance. You learn the ins and outs. You You get it. You get filled right away. It doesn’t take you two and a half years to get 300 patients. It >> Yeah. And are you talking about in private practice or just like in general? >> I’d say in general, but in in outpatient office or private practice, I think it helps to understand the insurance. I also I think a lot of people are willing to pay out a network or want to because I have experience and they’ll say I need an expert and they’ll come they’ll say okay I need a second opinion. I also don’t have a lot of things like if you’re not keeping up and seeing me I don’t want to see you. If they’re coming to me just for a second opinion that’s no problem. Then I’ve served them one time and I’ll be here if they want it.

Or if they want a bridge person because we’re in different states and they say, “I got to pop in. I move around every six months for my work.” I say, “Okay, you’re always with me. You just come back in when you move back into one of my states.” That flexibility. So, the things I knew people would pay out of network for. So, flexibility, some um >> y >> not not having some people call them boundaries. I don’t I don’t have a lot of rules. Other than a I do have a lot of controlled medication rules before they come in. But the ones who come in, I I’m flexible. If if they change their appointment the last minute, okay, and they’ve already paid for it, they just move it around. I I don’t fuss about some of the small things that get that you need to in insurance on a big big scale.

>> Right. How much did it cost you, do you remember, roughly to kind of do your own thing, launch your own? >> About $30,000. >> Okay. >> So, I had a pretty big marketing budget back then. >> A lot of teleaalth Yeah. >> platforms out there to contend with. I was going in 30 states or I think I applied to 25. I think I ended up with 22 or something around there. So there was that cost of the lure which was typically about $1,000. It wasn’t a huge cost but >> and there was a pretty big marketing cost. And how do I set up marketing when you don’t have a Google My Business account and and those things. So >> but if someone is just starting tellaalth in their state, they’re not going to need a huge budget and if they’re not hiring a bunch of people right away. And I brought on staff day one because I wanted to build this into kind of an enterprise where nurse practitioners could join, >> right? Yeah. No, that makes sense.

So, there’s a misconception that tools like PMHCRE are only for cash pay. Can you talk about how you specifically designed the templates for insurance billing and audit readiness and whatnot? >> Yes. Um, when I was in the insurance world, I was audited quite a bit. I was told I was a high numbers provider, so received audits more is what the reason UBH gave me to audit me every year. I saw about 100 people a week. And so it might have looked different to insurers because I’d be in a PHP in the morning and the like the place of service was changing all the time and I would do Saturday rounds at a hospital. So that’s 20 people right there. So I was audited at least every year if not a couple times a year that I was in the insurance world for eight years. So really built it based on how the auditors knowing that they are not always medical people.

They don’t always have a degree in it. They have the checklist that they would just go down and they would be looking for particular words. And now with AI doing that and a lot of these audits, setting it up for the words that they look for. So every year since 1999, I would get the CPT AMA CPT book and I would pour through it, see the changes and adjust the templates to really capture every word that they’re looking for. So yeah, >> I have I probably even have it in here. Like there’s a book with tabs every year that I go through and >> oh wow get all of the new billing codes everything. Oh here’s the 26 2026 had a lot of codes for us. So get all of the codes that we could ever bill. Also was always into maximizing collections for outpatient practices and internal medicine labs and home health and and all of those. And then psychiatry when I was billing on my own, I was out. So I would always set up the templates to follow along all the new parameters, every new checklist that they’re looking for and spell it out the way the auditors, they take their sheet and they go down. It’s probably not a sheet anymore, but um they take their audit tabs or the AI is programmed to look for these things. So really doing it in a manner that captures what they’re looking for and making it should I say dummy proof make it try to make it real dummy like spell out the words they use for example the psychotherapy add-on is is it separate and distinct mine will say psychotherapy outside of the ENM visit this like spelling it out for the auditors same with all the the phone calls and the collaborative calls and um any asynchronous tele medicine and nursing homes. I had a very big Medicare audit in the nursing homes where they froze all my collections past and anything in the future until they finished their audit. So really looking at like getting it real clear for them. My audit passed very quick compared to my colleagues because I had it templated for the auditors. So all of us were audited. Me and everyone using it, my templates were fine and it passed in a couple weeks.

How Audit-Proof Documentation Protects a Psychiatric Nurse Practitioner Private Practice

Everyone else’s took months and then they got downcoded. So >> wow, >> that and then the state audits when they I don’t know if it’s Jacob or who the state is anymore in nursing homes, but how they would audit the gradual dose reductions and spelling it out for them and and things like that. >> Gotcha. Gotcha. Gotcha. So you’ve been a psych for how many years? since 2011. So about 15 or >> No. >> When was your like biggest burnout period would you say? >> I had a very public meltdown in in the inatient um in front of many people, two of whom were my students later, so they didn’t judge me too harshly. It had been a period of time where one something happened with the insurance reimbursement. So my collections were off which was making upsetting me because I believe they put me through as an FNP instead of a PHNP. So my rates dropped in half >> and at the same time I had lost a few patients to suicide inatient and >> we can’t know what someone’s going to do when you discharge them. And if you’re in that discharge period of seven days from inpatient, then you all have to sit in a root blame analysis. It’s called a root cause analysis meeting or any of those. And they ask they kind of pick apart your charts and and how’d you let them die and all of this. Um >> my gosh, >> and that kind of scenario. And then you’re proving the nurses did everything they could. This wasn’t anyone’s problem. No one did this. We spelled out, you know, the assessments we did.

It’s a tragedy. And everyone’s very stoic. And I’m like my mushy squishy self, like sobbing for this person who family is left. >> The family understood. They weren’t upset. But that was probably my biggest burnout is like sitting there trying to explain to non-medical people how someone may pass from suicide and how that occurs when you discharge someone and the limitations of what you can do in patient with all the feelings of that and how heavy it was and you know they’re well how can we support the physicians and I’m like well you know the nurses are here too like there’s these nurses on the floor. No one stopped and held space for them. No one stopped and held space for this person who lost their life or their family. And it had just been a bit too much. Uh and the level of violence had been escalating in the inpatient unit that I really didn’t feel comfortable there anymore.

>> So I probably sobbed through the eventually sobbed through the meeting. First I was mad that we were having it and then I I just said, you know, don’t worry about us cuz I quit. Like I’m done. Then I just kind of walked out and was done with that chapter. And so that was probably my biggest burnout moment is the emotional stuff with it in psychiatry. >> Makes sense. What would you suggest to a psych who loses a patient to suicide? I know that’s a heavy question. I just I’ve had mentees in my boot camp who have gone through it and so I’ve been in situations where I’m like okay how do I best support this person and I just didn’t know if you had any I’ve had things I do that’s not right and things that do and so my not right thing is obsessively check the charts for I do have to tell myself you get 30 minutes and then you have to put this down and I go over everything and I obsess for a while and >> yeah, >> I blame myself and I fall in a puddle and I just sit there and >> yeah, >> I’ve even gone on social media and looked them up just to see their face again. And then I tell myself, that’s enough. I can’t keep doing that. And then I reach out. I do a therapy modality called breath work where you I have a lady I go to on speed dial and I say, “I need a breath work session.” And we just it’s very outside of what we typically do in psychiatry. So it takes me out of like I can CBT myself all day long. I can grief therapy myself quite a bit from being a hospice nurse, but I can’t breathe off the trauma and scream out whatever is in my subconscious. Like one time it was why didn’t you try as hard as I did >> or damn it like damn it we didn’t catch it or I’m sorry or any of that stuff that comes up. And so doing that in a safe space. There’s this beautiful, if you’re going to have someone else on a podcast, there’s this beautiful nurse practitioner out in Virginia who does all this breath work. What’s her name?

>> Mary Crutchfield is the beautiful soul. Yes. Um who does that breath work and I believe she does it for nurse practitioners and other clinicians. I have someone local who does it. But it’s a very powerful way of processing that. I like active resolution therapy is another interesting therapy modality. But I I like the breath work. I’m a bit spiritual. So I put their name >> and something about them. Just their first name >> and put it in the Bible. I don’t read the Bible, but I just put it in there. Um I don’t even know where my Bible is. It’s just my symbol of I’m giving this up to God. >> Yeah. And that’s kind of my routine after having been impatient in PHP and >> my specialization was high suicidality and treating people with electrocomvulsive therapy and and all of those things. >> So I probably in that space lost a patient a year and sometimes a couple and and with people with substance use disorder and and when they relapse they often >> pass from that.

>> Yeah. Having been through that, I kind of picked up a a thing to do. And then >> I would always call my collaborator and say, “What did I do?” And they would say, it was a very kind man. He’d say, “Allison, do you remember where they started? You met them in the ICU after their first very serious attempt. You took them through impatient. You took them and this was a cycle >> that you couldn’t stop. and you’re watching a derailed train off the tracks going down a hill and you’re trying to jump in front and you can’t always >> stop it. >> Yeah. Thank you for sharing so vulnerably cuz I think it’s something that a lot of us have dealt with and it’s and it really it really makes you feel burned out and just like what’s the point? Feels very bleak, you know?

>> And I will say I always call the family. I know that’s controversial, but I call the family and I’m usually sobbing and like a mess, but I I call the family and I even invite them in and I even sit with them and spend space. When we lost someone in PHP, I had to go in that room. There’s, you know, 10 other people who were sharing space with that other person >> and say they didn’t make it and you all are in this very vulnerable spot. So, I talk to the people around them. I invite the family in. Um, I’ve had a few come in >> and >> I don’t charge for it. It’s just I sit with them and share space with that sorrow. >> Yeah, that’s really beautiful. To pivot a little bit, your streams of income. Now, if we were looking like at a little prime chart, I feel like it’s a hemorrhage out because I’m funding because I was self-funded for the startup of the um of PHC Scribe, the health tech. So, yeah, I don’t know if it’s a stream. It feels like a a tiny little drip right now is how it is.

>> Yeah. with your businesses. Have you like did you set out to build a business that you would eventually sell or maybe not? >> I love creating things. So I like I could see at your service psychiatry maybe one day as I’m spending less and less time in there and just mostly focusing on the AI scribe, but it also runs itself now. So, I just get like I want to do something new and the AI scribe has been cool because I’ll hear something. I’m on social media all the time and someone will say like, “Oh, you could charge for a phone call.” And I was like, “Yeah, you just chart for it.” And someone’s like, “Well, how do you chart for it?” I’m like, “Oh, well, I’ll just build that. Let me show you.” And I’ll go and build it and bring it. And like that’s so exciting for me. So those things and we have all kinds of things on our road map for PMHCRE to build this AI layer into psychiatry practice that that will just be continual development with our team.

>> That’s cool. What would you say makes PMC scribe different from all the other AI scribes that we’re kind of like inundated with now? Like try this one, try that one. you know what’s the specialization for psychiatry the setting it up to be audit ready for the auditors the practice management tools so things >> outside of just the scribe and as we’re building onto it and onto it it’s been interesting because a lot of their users are nurse practitioners and how much they like to chart they like to do these very long charts so we had to tweak them for like the psych atrists use these and then some of the nurse practitioners. Sometimes there’s overlap, but we learned pretty quick we better make a system where we can like get more verbose charts. And so having these prompt engineers and hiring people to put together people’s templates and making systems to build templates and all the things behind the AI building.

Hard Days, Patient Loss, and Self-Care

So we also have medication education specific for psychiatry. So the way you would talk to your patient if a patient is a sophisticated patient and really wants all the details we’ll have that we’re like Prozac it’s can be used for depression or OCD or this or this and explains to them the way we would talk to a patient so that the provider can send it or patient is an ADHD medicine it’s like well if you’re traveling just bring the exact amount you need it’s often stolen there keep it in a safe place like all of those little things you wouldn’t see on a print out from the pharmacy. Um, or if you have an anxious patient who you might say, you might not want to read the print out from the pharmacy, but here’s the actual information, lots of details, might get an upset stomach for a few days, but it’ll go away and and those kind of things. So, >> that specialization to psychiatry and trying to build a tool with care as the underlying care of the clinicians, care of the patients. You know, when I’m telling a patient about I they’re like, “Oh, I need this letter. I got AI to do it. I’m gonna say Lindsay’s great, but you need some noise cancelling headphones and I’ll shoot it off to you in a minute.” And they’re like, “Oh, that’s cool. I like that.” So, it’s been >> I love how they’re both. Yes.

>> Yeah. You’ve always wanted things to be automated before. >> Yeah. I don’t like doing the stuff. >> I don’t think it makes perfect sense, you know. Um, yeah. I use PMHCribe and I love it. Um, I’m not, this isn’t sponsored or I’m not an affiliate or anything like that, but one of the things I’ve noticed about it is it’s I think it’s much less verbose than a lot of the other tools at the baseline templates. It’s it’s concise like a typical like a psychiatrist might chart or someone who’s passing notes on to a patient. >> Yeah. I don’t like to put too much in there, but >> if they want it in there, we’ll build a template for it for all the including more and more stuff. But >> yeah, what’s your proudest moment across both businesses? >> I had this woman reach out and she was she was frantic. She was like, “My job is going to take away this because I can’t produce security documents.” I’m like, “I got that. Don’t worry. I will get it for you.” She’s like, “I have for the first time in four years of practice, I watched a movie with my son after work.” And she had not done it in 4 years. She had been spending hours.

She said, “I have ADHD. I can’t do this. I’m running my own practice. I am a single mom. I make all the money for the household. I can’t cut down.” And I got to watch a movie after using this software. And I was like so touched and even I brought on this like wonderful salesman and he says, “I can’t believe how nice all these people are and they tell us these great stories.” And he came from like facial recognition software and all this other kind of software that doesn’t seem related. He’s like, “We’re just making a difference here. These people need us.” And it was such a touching moment that even >> someone outside of our field who doesn’t quite get it, >> it’s like, “Wow, >> this is >> impactful. You’re helping people help people.” And >> when I’d see a provider say, “Hey, I’m, you know, I had a busy day.” And we don’t really look into it, but they said, “I saw 40 people. I have a Saturday provider who not a nurse practitioner, but a provider who sees that’s they spend their whole Saturday.

That’s their week. Yep. >> And they said I could see them all. >> And I got home and I was done. >> Yeah. >> And and that’s my week and that’s all I do. And that was really cool to see it work for two. And then I got to do a talk with another gentleman who does like slow visits. He’s he’s like he does acupuncture and he does all these like cool like >> fun things which I’ll give you his name too cuz he’s a great speaker. I just got to speak with him and and he uses AI so he can do all the other things. So he’s not a pace person. He’s a I want to share space and do these cool things and just have it in the background so I don’t have to think about the charting and then >> 100% >> just really >> Yeah.

>> touching how many ways people can use these tools. >> Yeah. And there’s like there’s a lot of pain associated with if you know the pain of like just having those charts, you know, built up and then you’re carrying the emotional heaviness and then it’s like most of my weekend I’m going to be charting. It’s very heavy. So that’s incredible to hear. I know that’s one of the biggest things I’ve loved too in private practice, like how present I can be. You know, that’s part of kind of why I felt like I needed to pivot because I was more worried about my checklists. Not more worried about them, but it was taking away from my the focus. Right. So, right. >> It’s pretty incredible what you’ve built. Okay. One last question. I guess you recently became the co-chair of the telemental health special interest group at the American tele medicine association. What does that role mean to you?

>> That organization has been amazing. It’s typically for enterprises and because I was in so many states I joined that and back when I started. So I think I’ve been a member since 2018 or 19. It was a larger investment for me because it’s an enterprise thing but to have them ask me to join and help do talks about either AI or tele medicine and then speak with all these people who are in the field and they just love it’s like oh they do they love tele medicine they think everything’s great in that world and then the president is his mother’s a nurse practitioner and so it’s one of the rare organ organizations that brings enterprises, payers, >> individual providers and physicians and nurse practitioners and physician associates all together. And they have the stance that nurse practitioners and physician associates should be to the top of their license. And so they really promote independent practice and tele medicine and nursing. the nursing has grown in the last few years of having a whole department. So >> yeah, >> being able to even facilitate these the important talks about getting the rules and regulations out there and how to safe prescribe and tele medicine and deliver care in a safe manner has been really impactful in that part and getting to talk to the DEA directly and say hey I’m a little guy I’m just a compared to these I’m the little guy and this is what it means. means to treat either ADHD or prescribed testosterone or how that impacts the world and if it’s taken away for no reason, >> you know, the communities that we’re supporting are going to have that cliff where all their care drops off and that those of us doing it do it well and safely and I even argued safer than it was in patient or in person because I didn’t get pinned in a room threatened if I don’t prescribe. If that occurs in tele medicine, I can and I can check all the prescription drug monitoring before they even come in across all the states, cancel it out before it happens, call everyone. So just bring being able to bring that to the DEA advocates there and talk directly to them who the rulemakers has been exciting.

What Allison Would Tell Anyone Going Independent

>> Yeah, that’s awesome. Okay, I lied. I have two more questions. What does no prior off mean to you? Not just the insurance term, but as a philosophy. >> Oh, you know, I don’t like following rules. So, I think it’s I think it’s not waiting. No, I follow the rules, but I will push it to the edge of the rules or help foster change in the rules. So, yeah, >> just like with tele medicine, someone says you can’t do that. And so I go to my lawyer and I say they they say I can’t do that. And the lawyer says, “Yeah, I don’t know. I don’t know if you can do that.” Instead, I say, “How can I do that within these rules? How can I do that?” So, not letting everyone say you can’t do that. Not you can’t a girl can’t start a health tech company. Um, you can’t change careers while having children. Um, you can’t do any of this. I didn’t ask for authorization or allowance to do it. So to me, that’s what it means. Um especially in this field as advanced practice providers and advanced practice nurses, we have the capacity to do all these different things.

>> Yeah. And even if it is just seeing patients, you you’re caring for hundreds of people and they’re caring for hundreds of families and caring for hundreds of others. So your reach >> has all of that and and not letting the box put getting put in a box hold you back. >> Yeah, that’s incredible. Uh where can people find you? And then also I think I think you made my audience a custom code that they can get a discount, right? >> Yes. I think it’s Lindsay. So we’ll just >> we’ll put it in the show notes. >> Put Lindsay in the uh coupon then they can get the discount. >> I’m on probably Facebook the most because of I don’t know my age there or Allison PMHscribe. I LinkedIn I try to stay active on that. Yeah, I I’m not active on TikTok other than watching and lurking and liking people’s stuff. So, one day I’ll get active on it, but I haven’t had time for that one. But, >> um any of those places.

>> Cool. Well, thanks for being on. I’d love to have you on again. You’re the kind of person that I know nurse practitioners want to hear from. Um, and I know your time is limited, but yeah, I I think I found you in the in the big PMHMP group is how I first came across you. >> I moderate quite a few of them. Um, just to see what’s going on. And because I’m on social media so much because of the businesses, >> like might as well moderate the groups and make sure they’re >> usually I’m just the one checking the licenses. The people at Nurses know me well. The NUR SYS system. I got to meet them. They talked to me about how I use it. Like, we’re using it in Facebook groups to ensure that the people are who they say they are. I’m checking the licenses. So, that’s usually a lot of free value on there, too, because I see your responses to people and I’m like, “Wow, that was jam-packed, you know.” >> Yeah. Try to pass it on to empower anyone to just go do it. Do your thing.

>> Yep. >> Can learn. There’s so much you can learn. You can ask questions. Sometimes it’s just reaching out to someone who’s been there, done that. Get some support. Go to mentors like yourself. Always had a business coach or business mentor or personal coach. I know it’s cheesy, but I like life coaches and things like that. So, >> I employ all of them in the journey. It helps me have someone on my side and then see things I can’t see if if we need to see forest for the trees and have another pair of eyes on that. So having a good mentor the whole way is probably the most helpful especially when starting businesses or navigating family and >> practice. >> Yeah, that was one of the biggest things I did different was starting to invest in like coaching and mentorship when I went out on my own. I was actually just at um a scaling workshop this last week.

Uh do you know who Alex Hermosi is? >> Not yet. I’ll look. might not. But he’s all over social media. He’s a marketing guy. And I got to ask him a question. So, I was like fanirling >> naturally. >> I came up with the practice in a in a set a breath work session with my life coach lady. And I said, I’m going to call it at your service psychiatry because it’ll be a service-based tech enabled practice. And it was having a coach just kind of take me out of my head for a bit and think about what’s possible. Or same with the scribe. I was in a mastermind group and >> even unrelated to healthcare and they’re like you just light up when you talk about technology. I don’t know any other nerds that are that excited about automation but you light up. You need to put your energies on that because it >> brings you so much joy. So >> yeah, >> having that mentorship >> to have those areas in your life where you find joy. So >> okay. Well, thanks Alison. We’ll talk to you next time.

>> All right. Take care. Thank you.