On this episode of No Prior Auth, Lindsay speaks with Miguel De La Mora about his decision to start his private practice immediately after graduation.

Many new graduates ponder the path to independence versus traditional employment. This discussion explores what it takes to build "self confidence" and embrace "entrepreneurship" early in one's career journey. We dive into essential "career advice" for those considering "how to start a business" right out of school, focusing on "personal growth" and the motivations behind such bold steps. 🚀

Heidi Reed contacted over 200 people trying to find preceptors for her psych NP program. She paid $5,600 out of pocket for her last two rotations — and the teaching wasn't worth the price tag. She once asked her nurse anesthetist for a preceptor connection right before being put under for surgery. When she woke up, the name was sitting on her lap.

That's the kind of person Heidi is. Scared and doing it anyway.

In this episode, Heidi talks about going from substitute school nurse to board-certified PMHNP, graduating during COVID in 2020 after more than a decade of starting and restarting nursing school while raising three kids. She shares why she decided to skip the employed-provider route entirely and build Intersect Mental Wellness, a cash-pay telehealth practice launching across Arizona and Nevada with her husband handling the tech side.

She breaks down the real startup costs — roughly $10,000–$11,000 including a $7,500 attorney retainer for a healthcare-specialized law firm that handled federal and state compliance so she could sleep at night. She walks through the DEA registration process, why each state handles it differently, what a registered agent actually is (and that it costs about $35–$50 a year), and why she refused to take insurance after watching providers get paid and then forced to give the money back months later.

Heidi's advice to anyone behind her in the journey: ask everybody, start early, and swallow your fear. Don't let it make the decision for you.

Lindsay Hill is a psychiatric NP and coach helping NPs scale freedom and impact.

Allison Sikorsky has been in healthcare since she was 16. Pharmacy tech, hospice nurse, clinical coordinator, geriatric psych on a floor so acute the ratio was 1:2. She graduated from Rush University's PMHNP program in 2011, spent seven years learning every setting she could get into, and then decided she was done being an employee.

• In this episode, Allison talks about building At Your Service Psychiatry into a multi-state telehealth practice years before COVID made virtual care mainstream. She did 50 EHR demos, couldn't find what she needed, and built her own system. She walked away from insurance contracts, applied for licensure in 25 states, and figured out direct-to-consumer psychiatric care when most people thought telehealth was "just for rural."
• She also gets real about the hard stuff. A colleague getting stabbed by a patient. Losing patients to suicide and sitting through root cause analysis meetings. A very public meltdown on an inpatient unit that ended with her walking out for good. And how she processes all of it now, including breathwork, calling families, and giving herself exactly 30 minutes to obsess before putting it down.
• Then there's PMHScribe, the AI documentation tool she built from her own audit-tested templates after years of being flagged as a "high numbers provider." She designed it so the charting practically writes itself for the auditor. https://pmhscribe.com/

If you've ever thought about going independent, going telehealth, or building something that doesn't exist yet, this one's for you.