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.
<p>hello everyone this is Cole from the American Journal of healthc care strategy and I have a special guest today director of operation ambulatory operations for Stony Brook Psychiatry Nicole Nicole please introduce yourself hi my name is Nicole verer I currently work in the department of uh Psychiatry I've been working for Sun Brook medicine for the past a little over 20 years [Music] 20 years is so long that is so impressive and a wonderful Journey that you've had there looking through your resume has been inspiring we've talked a little bit before and it is just a really fascinating Journey that I think will motivate a lot of people hearing about it can you tell me where you started off at Stony Brook those 20 years ago so I might be dating myself but 20 years ago we had paper records so I was hired as a temp to help Purge and file medical records and they ended up liking me so much that they wanted to hire me and this is I started at styberg Urology and I stood there for about four years and then I while I was there I was promoted to a secretary because I knew had the probably the best class I took in high school was keyboarding class and that helped my skills and I was able to uh transcribe for one of two of our doctors that did transcription so listen to here uh headphones and then you know hearing them talk and chew and me type so and during that time you went and got your Bachelor's in Business from Stony Brook right yes so I actually when I went when I when I was actually hired I had a fascinating administrator that worked I worked with and she said you know if you get to work with me you going to go to school so I went to I went to school I applied I first started at Bri Cliffe and Brier Cliffe was a private school that wasn't ideal thankfully they they they lost my registration and kind of kicked me out believe it or not but thankfully my GPA was so good I applied for sonyy Brook business and I got accepted right away so I didn't have to go wait to be accepted I was automatically accepted due to my GPA so it was actually good luck on my part that I could kicked out of Bri Cliff um so that is very interesting it it's funny how a lot of your career there are things that might look like a challenge but have really turned into opportunities for you and looking at your your resume because you know after getting that degree right you went on to become the senior practice administrator there right right so yes so in different departments so I'll tell you the long history so after Urology I I left the state briefly because I had my child I wasn't done my degree just yet and I came back to New York and I ended up finishing my degree but I applied to a part-time secretarial position and when I applied to the position I was told you know after I applied and I took an Excel test and bomb the test did go to the interview somehow but actually no I think my previous work ethics were were spoke for themselves because I was applying right across the hall for my previous job so the administrator walked over to the to my new boss and said you'd be super not to hire her so what they did was they took a secretary well a fall clerk that was a secretary and made me a coder biller and I had no experience with coding coding and billing but but I did it I winged it and I learned it and then I eventually became a CPC after I graduated with my bachelor's and you so you mentioned there that you had a trial during the time that you were working on completing your Bachelor you had moved out of state come back and you were completing the bachelor's while working and raising a a fairly new newborn child right it wasn't full at the time yeah I I came back to school I had about I think a year and a half left to do and and I I started back in 2008 in an an OBGYN and then as a quoda biller and then a year and a half later I I graduated 2009 2010 is when I graduated I forget what year it was how did you manage all that because coding and billing is not easy to learn either right it's not as as easy as many people probably think it is and it it leads to a lot of revenue losses right so how did you learn to be good at that go to school work and then you know you raise your child all at the same time what was some skills allows you to do that and the funny thing is when you save everything losses is it's just like I was able once I learned it I had a great mentor first of all I had a great mentor that was teaching me uh that had patience with me I picked up it fairly quickly it's just it's just the way I just I guess I learn I just learn fairly quickly and when I went for my CPC I kind of went back and I was like all right let me look at this big bigger pict let me let me own my part of this department right so and I found like a little over $100,000 worth of Revenue that were we were losing on the postpartum unit so when patients were delivering but never coming back for their postpartum visit in the ambulatory setting we we weren't billing for that so I was able to find about uh you know about $100,000 wow wow yeah that is impressive I've I've heard that billing errors account for quite a bit ofit of that and that's an incredible example of that and and so you kind of spent most of your career in ambulatory right is there is there times when you went outside of ambulatory um very very few um when I was in the department of surgery I used to help with trauma a little bit but not full foot in the door um a little bit it's it was more ambulatory so I did all of the ambulatory stuff I worked with surgeons who obviously did impatient and unall and and whatnot the the the closest thing I did to impatient was having my babies that's it so why did you stay in ambulatory you know some people might not like it they think it's not as glamorous as the impatient side but other people seem to have really found a home there like yourself why did you stay in that ambulatory world I think as when when I went to OBGYN and and I became that coder biller when I Gra graduated my bachelor my administrator at the time believed in me so much she ended up offering well I applied and got the job but but offering me the Bohemia manager position which she trusted me enough because she was like you don't have the personality to be like a dictator you know you have a leader personality and at the time I wouldn't consider myself a leader as a manager you know you have to learn to be a leader and that's what I'm currently still doing now I'm learning to be a leader but I just kind of stood in the amatory space I I just tend to stay in spaces until I feel like I out grw grow them and then I move on I I never became interested in the impatient unit or impatient units the only time I ever regretted not doing something is like back when Urology one of the doctors I worked with he was like you really should be a nurse I was like too stupid to be a nurse you know I'm like that's not for me but I regret it because I I really think I would have been a great nurse I would have loved work on the Ed and I think that's the only time I probably would have worked on the N unit NP unit or um is through the clinical side of things administrative pretty good withar we're glad that you're not a nurse though you know you're you're here on the on the podcast if if you were a nurse not that we have anything against nurses but that's not our area so there it is very they are very impressive I'll say and I attempted nursing school and I did not do well at some of the prxs so I thought that the prxs I saw the prere I was like I'm not good at that so yeah that's it's it's there very challenging that's for sure and so you you worked your way up really well and eventually you reach this level where you're at now where you're the director of operations can you tell us about the department of Psychiatry and how many people are are under you and and you know what's your team look like well prior to me actually even getting to where I'm at as a director I had become a because remember in OBGYN I was just a single office manager okay and then I went to surgery as a proess manager so and then the proess manager that's where I learned to pick up different Specialties and pick up different you know the way different Specialties worked like vascular and plastic surgery and Bariatrics and general surgery and we had a medis spa so I was able I was overseeing probably about a 100 staff members you know in total around like 60 Clin U actually probably about 90 clinicians and you know in various areas once I did that for about three years in the very beginning of covid I apply I began my role as a director of operations for Psychiatry and moving from Clinical to mental health was world changing world changing so I felt like I I was I wasn't in healthcare anymore because it's just so vastly different so so when you started kind of having the leadership role back in OBGYN that was your first kind of how many people were you overseeing then it was close to I was doing what overseeing clinical like I think both administrative and clinical staff I think about 15 people 15 and then you you I mean that's a lot of people that you went onto next right the yeah I mean you said how many was that like 90 to 100 yeah so it was more I was managing the managers so I went from managing uh you know entry level staff and medical assistants and LPNs to managing me supervisors and managers and nurse managers in that role eventually I obviously can't manage a nurse doing the clinical stuff so I would get another nurse leader to oversee that piece of it I don't want people thinking that I'm like telling knows what to do you know it increases in complexity right you you get more and more people that you're working with and then now you're working with with even a different set right and so yeah how you know were you always throughout your whole career adaptable is that something that you you have a skill that you think is needed in Ambulatory Care is adaptability definitely especially with all the changes that are happening in healthcare because look like I said 20 years ago we had paper charts and then we switched to you when used to do dictation and then they were talking through a microphone and then now we're doing EMR you know and and now it's just it just keeps there's always changes there's always rules to go by join commission when you're in ambulatory offices if you're managing in hospital we a hospital site it's it's you just have to go with the flow with the punches and there's always something that you have to make sure that you're doing uh right now I'm glad my institution is really focusing on the metrics and the data so and I love data that's one thing I want to kind of learn more about because there's so much data but if you don't know what to do with it it's useless right so that's one of the things that I I look at a lot in my in my space uh when I went into Psychiatry they didn't have an administrator that never that had never been over them usually it was one administrator in Psychiatry is such a large Department with research and ination and grants and there're they are really large research search and grant department so ambulatory was kind of I guess neglected so what they did is they split the administrator in half so I'm half administrator and then I have my partner who does the other half uh and uh what she's yeah so so now I was able to focus on the ulatory side and what I found out when I first door when I walked in I found out that all the patients were not getting through the biggest complaint was patients can't get through and then we found out that 7,500 patients were calling per month probably a little bit more than that at the time trying to get through to get to a doctor but they just kept getting voicemails all the time so I had to put a live call a call center system system in order for the patients to get through so there was a live answering service so when you call you just wait and you'll get somebody on uh to call you know to answer the phone so let's pretend just for a minute and I don't think I I sent you know sent you any of these questions so I appreciate you you letting me go off script a little bit here um let's pretend that I'm at a a hospital and our you know maybe a smaller institution in our Psychiatry department is overrun with these calls and it's going to voicemail what advice are you giving me to get this done right because I wouldn't know the first thing on how to establish a live call line Center any of this stuff right so and how did you know how to do that too it's probably because I did it a lot of times in surgery so in OBG we already had the call center set up so well now they Chang in the verbiage the contact center because this the first point of contact when you call the the office so I knew how to do it I I I set it up for multiple Specialties on the surgery side so I knew exactly and that's I think that was the benefit of having years at Stone ebra because I knew the system I knew who to contact I knew who the players were so if if if I was somebody new coming from out from outside it would have probably took a little bit longer I it got me two months to get the system up and running um so and it was um yeah so patients just kept calling and leaving voicemails they would they would leave like 65 voicemails within like two hours so I knew the volume was a lot I was like that was like that was my that was my number one goal was to get the upper running so I could figure out how many phone calls we're getting and then we're going to split it out get more staff and then just uh be more efficient and so you you just hire more you know call center reps you find space for them you you know get the it to give them the the phone connection and that must have been a large undertaking I mean two months you know is is a short period of time I want to ask you about work life balance in your role are you finding that you're working during times like this 60 80 hours a week or are you still maintaining your work life balance during that time it's it's funny pre pre Psychiatry I would say my work life balance was non-existent I used to just work work work and emails all night and whatnot Psychiatry is all about mental health so even for us and even for our administrators even for our doctors so I've kind of taken a few of their hints and try not to look at emails on weekends unless I feel unless I want to if I want to then fine it's it's fun for me sometimes so but I I've been better with it so I would say I'm just about like around 42 43 hours so well that's pretty good especially I mean considering during this time you got your mha oh M MBA you got your MBA oh my goodness yeah yeah MBA and that was with three kids yeah so that's what I'm wondering is how did you do that I don't know I think I definitely needed Psychiatry after that so I started I started in 2018 when I was still in surgery I didn't realize if you went to a private school that you didn't know you didn't need to get your to do the gr of GMAT and that's what was stopping me it was like oh I can't study for these tests these test tests are too much whatever and then my minister at the time was like he's like just go to her private go to St Joseph's I was like oh and then as soon as they had an open house I was there I got accepted and I started right away didn't matter that my wedding was the fall during that fall didn't matter that I still had a one-year-old daughter it didn't matter that I had a small father at home and and it was just I I was like I when I want to go for something I just go for it and then I think about the consequences later probably I probably should have thought about it a little bit longer but I wanted to get it done while my kids were small so now I graduated in 2022 big load off my shoulders and can you believe it or not I'm actually thinking about going back to school again I I don't know why but it's I don't know if it's a mental illness but what is your what is your your choice this time that you're you're thinking you're considering I was thinking about mha okay really okay yeah yeah because you know policies and laws and in changes and then also maybe accounting wow very interesting yeah I I like both of those ideas that's I'm I'm doing the MBA and then the mph similar logic there you know trying to to get the other side of things with policy but that accounting is also very fascinating I I love one of the things I love about interacting with people is there's so many different paths that people take and there's all so unique and so I appreciate you sharing all of it with us now that you've been in this role you mentioned earlier that there are changes there are things that are changing in health care especially in ambulatory care what do you mean by that what is what is going on what changes are you seeing so they Chang the names over the years so like for for big systems we have to follow like meaningful use or you know now we're ACO or a cin and then we have to make sure we're meeting certain metrics uh so if we have to make sure we're screening and following through with the depression screenings or following through with um breast cancer and colal screenings so as a system so if we get a referral we want to make sure that we're calling that referral and making sure we're reaching out to them so besides that you know the institution has goals so the institutions is implementing goals for each department um so so we can make sure that we're being as uh efficient and making sure we have access and as I said before like with Psychiatry there's like I don't think I even said this before uh Psychiatry has a big access issue so we have 7,500 phone calls calling per month and about 2,000 of them are about or new patient visits I can't handle 2,000 patient visits per month and that it's a it's a national Mental Health crisis out there right now how how many call centers staff are you are you employing I'm trying to do the math on that I mean if you had you know you have to be making 250 answers per day for for that Stu that's a lot yes so so right now I have five PE the way I split it up is I have a new patient call center so they people that deal with the new patient calls and then I have the regular uh call center that deals with the follow-up medication management and whatnot I don't have nurses so usually that goes with what when I go to a nurse we don't have nurses so we have um the staff take messages and we send the messages to the doctor uh with the new patient coordinators what we have to do is we have to F them out so what we were doing is we we had to focus only on stunning Brook patients right now so we at first actually right after covid we were taking everybody we were taking every single phone call then we were booking out nine months that's not doing anybody help because when people are calling for help for mental health care they need it now not nine months from now so we had a make a decision and just say all right we're we're GNA Focus On the Sunny Brook patients now that we we had over a thousand patient weight lless and we were able to dwindle it down to nothing for medication management so now we're able to take on more referrals which is great individual therapy there there's just not enough therapists out there the government really needs to kind of step in and offer free schooling or or you know pay for school in or or do something to to get people and wanting to go into the mental health Fields So when you say you know and this is great advice because so many organizations are struggling with this exact problem right now right I mean as you know it's a nationwide it's a worldwide issue right so worldwide you say you know we're gonna focus on sty Brook patience and what that means is is people who are already attributed to Stony Brook is that's where they get their Primary Care from yes and then what ended up happening is that now that we went through our weight list we want when patients call us we um we ask patients if they have a primary care doctor because what's what's most important to prevent things right is to have a primary care doctor so we can make sure we're getting checked up on so we now ask patients do you have a primary care doctor if they don't have a primary care doctor we work with our family medicine department and we refer patients over uh to Family Medicine so they could get a primary care doctor once there established with their primary care doctor they go into our integration program to get the mental health services that they need we have we we need to work as a team and I then this is like it's uh collat it it has many names collateral care but we're we have an integration model where we just kind of we refer patients to Primary Care they refer patients to us we get referrals from all departments but we're trying to get these Community callers that don't have a primary care doctor into Stony Brook get them established get them healthy and then get them mental health care as well what are we looking at now for Stony Brook attributed patients in terms of weight times has that gone down so with medication management it has definitely gone down uh for individual therapy we cannot offer it to anybody so what we're doing is is we're making the the main mode of treatment is group therapies so we have a different a wide Varity of group therapies depending on what the treat what the diagnosis is so when you say you can't offer it to anybody does that mean you can't offer it to new people or there's simply not enough therapists to do any individual therapy so basically I have about 450 patient weight list on my individual therapy weight list and the reason why is there's a lot of you know you could get therapy within a few days if you wanted to if you want to pay out of pocket right but these are patients that are want to use their insurance which rightfully so who could afford $800 a month $200 a visit or less you know so it's it's it's a very you know that's why I said we're we're in a mental health crisis where we you know the government needs to kind of step in and do something about it now is that 400 Stony Brook attributed only or Stony Brook patients that have been referred to us or our patients that have seen the medic medication management clinician and they they're referred over for individual therapy and then they're they're they're waiting so we're trying to figure something out but you know we we're we're working on it so oh yeah well that's what I want to say is that you're see you're dealing with these high volumes where it's almost like if something goes wrong there's going to be a backup even further right so your staff must operate as a well-oiled kind of machine I want to ask why your staff operates so well why you've had such success are there any things in leadership that you were doing that other leaders should work on adopting as well to make their work environment good well I think every ulatory Clinic should have a clinical leader because obviously I can't do everything myself and I I work with a fabulous leadership team that we you know we have the child we have adult we have geriatrics we have our student training program which is a self-pay clinic uh which has low fees it's like you know really really low fees it's between I think 60 no I lied 20 and $65 I think at the moment we'll be increasing it just a little bit shortly but I think it's the most important thing is to have a teamwork based environment have a Clin clinical leadership and have you know Buy in from your leader from your chairman from you know anybody that's you know if you want to make changes and you have to kind of think outside the box so what you know one of my examples is is this what we call is the reverse integration program I want to help the community callers I don't want to just like just send them away I wanted to get them give them an option so we give them an option of like do you want to become the styberg patient by you know having a primary care doctor here and then we turn to styb patients we feed the system we get them patients healthy and then you know we get them mental health services so I want to ask another question this will be my last one for you you've been giving such awesome answers I really appreciate it you talked about in the resume how you rebuilt relationships with ob provide or OB refers yeah does when you have such a long weight list or you're not able to accept Services you know of course that might damage the relationships but now you're of course doing better we're getting more you know volume coming in are there any tips you have for that for repairing relationships or strengthening or building new relationships with the community and people in the community from your department standpoint so in Psychiatry we we are like at the opposite level we're like we don't we don't want to be seen we we don't have any you know don't see us right now right because we have too many patients but for you know the OB surgery side you know take care of your referrals you know make sure that the patient the the the the the doctors that are referring patients to you they get their patients in quickly you make sure you get the notes back to them quickly you make sure you get the Letters Out you make sure you just communicate with them keep in contact with them like once a month or every other week just to say how's everything going in surgery we used to have a RN that did um lunch and learns so about vascular so I think that's important too and I think you know and we did that with other Specialties as well so I think just keeping that line of communication open so if there is an issue with the referral process they know who to go to they could talk to somebody they don't have to say all right who Sony Burke am I calling they're like no I'm going to call the call because she could take care of it so excellent advice thank you so much for for coming on and buying out time out of your busy day with your your children there I know you have many things going on so I do really appreciate it and just awesome advice I think it's going to be really useful for people who um are in similar situations and as you know there's a lot of us in similar situations especially in the Psychiatry space yes and yes and anybody that's in the Psychiatry space please reach out to me at LinkedIn i' be happy to to brainstorm ideas with you guys so</p>
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