In 2025, U.S. mental health systems face record-breaking demand—and staggering backlogs. Executive leaders are pressed to innovate or risk being left behind. Nowhere is this more acute than in ambulatory psychiatry, where call volumes, staffing shortages, and changing regulations converge to threaten both access and quality. But what does successful operational leadership actually look like in this storm?
On a recent episode of the American Journal of Healthcare Strategy podcast, we sat down with Nicole Rodecker, MBA, Director of Ambulatory Operations for Psychiatry at Stony Brook Medicine, who’s navigated two decades of organizational change—rising from temporary file clerk to one of the top operational roles in the system. Her journey is a study in adaptability, data-driven decision-making, and practical leadership lessons that matter for every health executive in 2025.
This article breaks down Nicole’s approach, her playbook for transforming crisis into opportunity, and actionable insights for leaders facing the same headwinds.
What does a two-decade journey in healthcare operations really look like? Nicole Rodecker’s story starts at the ground level—literally with paper files—and ends in the C-suite of ambulatory operations.
Nicole began at Stony Brook as a temp, “hired as a temp to help purge and file medical records,” and credits her work ethic for the first step up: “They ended up liking me so much that they wanted to hire me.” Her big break? A humble high school keyboarding class: “The best class I took in high school was keyboarding class, and that helped my skills. I was able to transcribe for our doctors who did transcription.”
From there, Nicole worked her way up—first as a secretary, then a coder and biller, often in departments where she had no prior experience. “They took a secretary, well a file clerk that was a secretary, and made me a coder/biller—and I had no experience with coding and billing, but I did it. I winged it and I learned it.”
Her trajectory wasn’t linear. Nicole left for family reasons, came back, finished her bachelor’s at Stony Brook, and rose through roles in OBGYN, surgery, and ultimately ambulatory psychiatry. Each step, she says, was built on seizing opportunities from adversity. “A lot of your career, there are things that might look like a challenge, but have really turned into opportunities.”
How did Nicole Rodecker manage full-time work, school, and parenthood—all while learning new skills on the job? The answer: adaptability, rapid learning, and strong mentorship.
Nicole returned to New York with a child and unfinished degree, taking a part-time secretarial job she admits she “bombed the Excel test” for. Yet her prior reputation spoke volumes: “My previous work ethics spoke for themselves… The administrator walked over to my new boss and said you’d be super not to hire her.”
She credits mentors for her growth, especially during her coding and billing years: “I had a great mentor that was teaching me, that had patience with me. I picked it up fairly quickly—it’s just the way I learn, I guess.”
This combination of grit and guidance paid off. Nicole uncovered over $100,000 in lost revenue by fixing billing for postpartum ambulatory care—a result of both learning fast and taking ownership: “Once I learned it, I had a great mentor… I found a little over $100,000 worth of revenue that we were losing on the postpartum unit.”
Key takeaways for aspiring leaders:
Seek and value mentorship, especially in areas outside your current expertise.
Embrace roles outside your comfort zone, learning as you go.
“I just tend to stay in spaces until I feel like I outgrow them, and then I move on.”
Why spend a career in ambulatory operations rather than inpatient or clinical roles? Nicole’s answer is a masterclass in self-awareness and fit.
“I never became interested in the inpatient unit… The only time I ever regretted not doing something is back in urology—one of the doctors I worked with said, ‘You should be a nurse.’ I thought I was too stupid to be a nurse… But I regret it, because I think I would have loved working in the ED.”
Instead, Nicole found her home in ambulatory care: “As a manager, you have to learn to be a leader, and that’s what I’m still doing now. I just kind of stood in the ambulatory space.”
Why do some thrive here?
Ambulatory care offers rapid change and diverse challenges.
It allows for “spaces you can outgrow and move on from,” giving ambitious leaders room to evolve.
The specialty offers a strong blend of administrative and clinical collaboration, without the acute pressure of inpatient settings.
How do you transition from managing a small staff to running operations for an entire department? For Nicole, the answer is learning to lead leaders, not just staff.
In her move from OBGYN to surgery, Nicole went from overseeing 15 people to “probably about 100 staff members—around 90 clinicians in various areas.” She describes the leap: “I was managing the managers… I went from managing entry-level staff and medical assistants and LPNs to managing supervisors and nurse managers.”
When she became Director of Ambulatory Operations for Psychiatry at the start of COVID, the world shifted: “Moving from clinical to mental health was world-changing… I felt like I wasn’t in healthcare anymore, because it’s so vastly different.”
Key leadership lessons:
As you scale up, your job becomes less about direct supervision and more about systems, communication, and empowering other leaders.
“Every ambulatory clinic should have a clinical leader. I work with a fabulous leadership team—we have child, adult, geriatrics, student training program… it’s about teamwork.”
Adaptability is non-negotiable: “Twenty years ago, we had paper charts. Now we’re doing EMR, dictation, and new workflows. You have to go with the flow.”
What does it take to fix patient access when demand is overwhelming and systems are outdated? Nicole’s recent work in psychiatry offers a blueprint.
When Nicole took over, “the biggest complaint was patients can’t get through. We found out that 7,500 patients were calling per month, probably more, trying to get to a doctor but just kept getting voicemails.” Her solution? Stand up a live call center in just two months, leveraging her prior experience setting up similar systems: “If I was somebody new, it would have probably taken longer… It took me two months to get the system up and running.”
Her playbook included:
Setting up both new patient and follow-up call centers.
Hiring and training reps, finding space, and partnering with IT for phone connectivity.
Using metrics to understand true demand and adjust staffing.
Nicole points out the wider crisis: “We have 7,500 phone calls a month and about 2,000 new patient visits. I can’t handle 2,000 patient visits per month… It’s a national mental health crisis right now.”
How do you tackle long waitlists and decide who gets access first? Nicole’s approach is both pragmatic and ethical.
At first, Stony Brook Psychiatry tried to serve everyone, booking out appointments nine months in advance—a plan she called unsustainable: “When people are calling for mental health care, they need it now, not nine months from now.”
So, she narrowed focus: “We had to focus only on Stony Brook patients. Now, when patients call, we ask if they have a primary care doctor. If not, we refer them to our family medicine department, get them established, and then into our integration program for mental health.”
This integration model (sometimes called collateral care) ensures continuity and upstream prevention:
Step 1: Confirm primary care provider.
Step 2: Refer to family medicine if needed.
Step 3: Once established, enroll in mental health services.
Results? The department “dwindled a thousand-patient waitlist down to nothing for medication management,” though therapy remains bottlenecked by a national shortage of providers.
How does data drive Nicole’s strategy—and what should other leaders copy?
“I love data… If you don’t know what to do with it, it’s useless. Right now, my institution is really focusing on the metrics and the data.”
Nicole’s experience shows:
Data reveals true patient demand, access points, and bottlenecks.
Real-time call center analytics inform staffing needs and workflow changes.
Integration across primary care and psychiatry reduces drop-off and improves continuity.
She’s candid about limits: “For individual therapy, there’s just not enough therapists out there… The government really needs to step in and offer free schooling or pay for school to get people into mental health fields.”
What sets Nicole’s teams apart—and what can others learn?
Nicole credits her success to clinical leadership, a culture of teamwork, and constant communication: “Every ambulatory clinic should have a clinical leader… The most important thing is to have a teamwork-based environment, have clinical leadership, and buy-in from your leader, your chairman.”
She’s also intentional about “reverse integration”—creating pathways for community callers to become Stony Brook patients, ensuring they receive both primary and mental health care. “I wanted to give them an option: become a Stony Brook patient by having a primary care doctor here, get healthy, and then receive mental health services.”
Is work-life balance possible at this level? Nicole’s answer is realistic: “Pre-psychiatry, my work-life balance was non-existent. Psychiatry is all about mental health—even for us administrators. I try not to look at emails on weekends unless I want to… I’m just about 42 or 43 hours a week now.”
Nicole pursued her MBA “with three kids, a wedding, a one-year-old at home, and still working full-time.” Her advice: seize opportunities even when timing is tough, but be ready for trade-offs. She’s already considering an MHA next: “I don’t know if it’s a mental illness, but I’m thinking about going back to school again.”
How do you rebuild referral relationships after waitlists or access bottlenecks damage your reputation?
Nicole is practical: “For the OB or surgery side, take care of your referrals—make sure patients get in quickly, get notes back to referring providers quickly, send the letters out, communicate regularly. If there’s an issue, make sure they know who to contact.”
She also highlights creative solutions, like “lunch and learns” with referral partners and dedicated points of contact for high-priority referrals.
Nicole Rodecker’s journey offers a clear roadmap for today’s healthcare executives:
Invest in data and integration to drive operational decision-making.
Build strong, multi-level teams with clinical and administrative leaders.
Prioritize access and patient navigation—call centers, waitlists, and integration must be managed actively.
Embrace adaptability and mentorship as ongoing professional disciplines.
Maintain open communication with referral partners and the wider community.
Model work-life balance—not just for your own well-being, but as a cultural expectation in behavioral health.
As Nicole puts it, “If you want to brainstorm ideas or tackle similar challenges, please reach out to me on LinkedIn—I’d be happy to connect.”
For leaders across healthcare, her story is proof: real transformation comes from grit, partnership, and always—data-driven action.
