The moment Dr. Martha Koo knew she needed help wasn't dramatic. It was just math.

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Four TMS patients a day. One psychiatrist running between offices. A private practice that she couldn't continue to interrupt while delivering 36-minute daily treatment sessions in a growing TMS practice.

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"I realized I couldn't do it alone," she recalls. "I was taking a lot of time out of my private practice."

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Fifteen years later, she's built a multi-location interventional psychiatry practice with staff across clinical, administrative, and leadership roles. One of her very first TMS technicians? Now runs recruiting for the entire organization.

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The path from solo practitioner to practice owner is one of the least-documented journeys in psychiatry. We sat down with Martha Koo, MD, and Will Sauvé, MD—both founders of thriving multi-site interventional practices—to map it out.

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What You'll Learn

1. Who should you hire first when starting an interventional psychiatry practice?
2. How do you know when it's time to hire?
3. What credentials should you look for in interventional psychiatry staff?
4. What traits predict success in mental health clinic staff?
5. How should you structure interviews for clinical staff?
6. How long does it take to train a TMS or Spravato technician?
7. How do you retain ambitious employees in a small practice?
8. When is it time to let an employee go?
9. Treating your team like patients

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Who Should You Hire First When Starting an Interventional Psychiatry Practice?

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A Decade Ago: Psychiatrists Did Everything Themselves

When Dr. Koo started offering TMS in 2009, she did everything herself. Answered phones. Managed invoicing. Collected revenue. Delivered treatments.

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"For me, when I started with TMS, I took the same approach as with my individual psychotherapy practice," she says. "I would just run back and forth between my offices and treat the patients individually."

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Dr. Sauvé had a similar awakening. Even with Navy resources at his disposal, "it didn't occur to me that I wouldn't just do it all myself." TMS was just another clinical task—like rounding on the inpatient unit or doing ECT upstairs.

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The breaking point for both: realizing their time had a different value.

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Today: Hire Admin Support Before You Open

The field has transformed dramatically over the past 16 years. TMS is increasingly insurance-based. Spravato is covered 100% by insurance. And the administrative complexity has exploded.

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"Now my first hire would be administrative staff— you really need support," Dr. Koo says. "You need admin support for scheduling, insurance processing and verification of benefits, invoicing and billing support. I think that literally... it's your hire before you can hang your shingle."

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Dr. Sauvé frames it around the patient experience: "This has to be a one phone call shop. A depressed person who picked up the phone—that's the victory. If they have to fool around for more than a few days with the paperwork, there's a very good chance we won't see them again."

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Initial appointment no-show rates in mental health run as high as 30%—roughly double the rate in general medicine. Every extra step in your intake process carries real attrition risk.

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With Spravato specifically, the complexity multiplies. The REMS program requires enrollment of patients, prescribers, pharmacies, and treatment sites, plus mandatory two-hour post-dose monitoring after every session. Someone on your team must own these workflows from day one—it's not optional.

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"People are going to be waiting weeks to start treatment if you don't have some kind of dedicated system," Dr. Sauvé adds.

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The modern hiring sequence:

1. Admin/Insurance Support: Verification of benefits (VOB), prior authorizations, patient coordination
2. Clinical Technician: TMS and/or Spravato administration
3. Additional Staff : As volume and complexity grow

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How Do You Know When It's Time to Hire?

The breaking point varies by role. Here's what signals it's time:

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For admin support:

• You're spending 10+ hours per week on billing, insurance verification, and scheduling
• Patients wait more than a week from first call to first appointment due to paperwork
• You're losing track of prior authorization follow-ups

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For your first tech:

• You're treating 4+ TMS or Spravato patients daily
• You're physically unable to see other patients during treatment sessions
• You're canceling consultations to supervise ongoing treatments

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For another prescriber:

• You've been consistently booked for 3+ months
• You're turning away 5+ new patient requests per week
• Your voicemail says "don't leave messages" (Dr. Sauvé knows a Chicago colleague who's been overfull for 15 years with exactly this voicemail)

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What Credentials Should You Look for in Interventional Psychiatry Staff?

Here's something device manufacturers used to tell new TMS practices about technician requirements: high school graduate.

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"There is no standardized esketamine certification, no standardized TMS certification," Dr. Sauvé confirms.

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You're hiring for roles where:

• No accredited training programs exist
• No board certifications to verify competence
• No credentials to filter your applicant pool

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"You're going to have to train those people yourself," Dr. Sauvé explains, "which means you need to be the one who has made up a certification in your mind. The Clinical TMS Society Clinical Standards Committee has published documents on TMS Tech competencies to assist clinic owners.”

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Both doctors estimate three months minimum to train a technician properly. You need enough patient volume during that period for genuine hands-on experience.

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What Traits Predict Success in Mental Health Clinic Staff?

Dr. Koo's practice has hired from all backgrounds: psychology graduates, pre-med students, future therapists, and career customer service professionals.

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"We don't necessarily look for any clinical background, but more assess their life experience," she says. "We rely heavily on the interview."

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We polled clinicians in the Osmind Psychiatry Collective: "What quality matters most in a new hire?" Empathy and patient-centered mindset came in first. Technical or clinical skill level came in dead last.

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Clinical skills transfer. Temperament doesn't.

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Empathy. "You're going to deal with people that sometimes are irritable, or get angry, or get upset easily," Dr. Koo says. "Staff need to understand to not take interactions personally." Not performative kindness; genuine understanding of what patients are going through.

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Psychological mindedness. The ability to understand that behavior has context. As Dr. Sauvé tells his staff: "Nobody comes to this clinic because they're feeling great and everything's going perfect."

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They also look for customer service instincts (staying helpful when things get chaotic rather than escalating) and frustration tolerance, which the back-to-back communication exercise specifically tests. How does someone respond when their clear instructions aren't producing results?

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And finally: genuine interest in mental health. Not just any healthcare job. Curiosity about psychiatric treatment specifically.

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Red Flags to Watch For

For techs: Easily flustered by the communication exercise, gives up when something is difficult, shows discomfort discussing mental health topics, can't sit still for extended periods (TMS sessions are 20-40 minutes of mostly standing in one place)

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For admin: Vague about attention to detail, becomes flustered when you describe insurance complexity, no examples of persistent follow-up on tasks, uncomfortable making phone calls (they'll be on the phone all day)

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How Should You Structure Interviews for Clinical Staff?

Standard interviews test how well someone interviews. Dr. Koo's practice has developed something more useful.

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Stage 1: Recruiting Screen

Basic fit assessment. Can they do the job logistically? Are they genuinely interested?

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Stage 2: Supervisor Interview

The person who would manage them directly goes deeper on experience and expectations.

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Stage 3: The Paid Working Day

Candidates come in for a compensated full day. They observe, receive some training, and participate in structured exercises.

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Exercise 1: Back-to-Back Communication

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Two people stand back-to-back. The candidate describes an image; the other person tries to draw it without seeing it.

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"There's a difference in communication between 'draw a circle on the page' versus 'please draw a circle, about the size of a quarter, in the exact center of the page," Dr. Koo explains.

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What you're watching for:

• Precision in communication
• How they adjust when something isn't working
• Patience when the other person struggles
• Whether they blame or collaborate

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Exercise 2: Role-Based Assignment

Given several days in advance: Create patient education on a topic of your choice.

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"The point isn't really what they're teaching. It's looking at how much effort they put into the ask. Did they just come in and want to talk about it? Did they actually come in with a patient handout or other prepared material?"

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Exercise 3: Scenario Role-Plays

Real situations from practice experience. Plus behavioral questions: Tell me about a conflict with a supervisor. How did you handle it?

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Exercise 4: Self-Evaluation

The final question: How do you think you did today?

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This reveals self-awareness and coachability—whether they can accurately assess their own performance and identify growth areas.

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Is a paid working interview worth the investment?

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Consider the cost of a bad hire:

• 3 months training (your time + their salary): $15,000–20,000
• Lost productivity: $5,000–10,000
• Recruiting a replacement: $3,000–5,000
• Total: $23,000–35,000

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A $200 paid working interview is worth it.

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How Long Does It Take to Train a TMS or Spravato Technician?

Both doctors agree: three months minimum, regardless of background.

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"It takes about three months of training—enough patients coming through to really determine if someone knows what they're doing," Dr. Koo says. "It's an apprenticeship. You're there the whole time in the beginning, essentially doubling up."

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Sample 12-Week Onboarding Structure

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Weeks 1–2: Observation

• Shadow every treatment session
• Watch doctor consultations
• Review all treatment protocols
• Complete device manufacturer training

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Weeks 3–4: Assisted Practice

• Set up equipment with supervision
• Document sessions with review
• Interact with patients under observation
• Practice troubleshooting scenarios

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Weeks 5–8: Supervised Independence

• Run sessions while doctor is in building
• Handle patient questions independently
• Respond to equipment issues with backup available
• Begin training on advanced protocols

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Weeks 9–12: Full Independence

• Run sessions without direct supervision
• Troubleshoot independently (escalate when appropriate)
• Train on new devices or protocols
• Begin mentoring any newer hires

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How Do You Retain Ambitious Employees in a Small Practice?

Three months of training. Finally hitting full productivity. Then: "I got into PA school."

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"We can never seem to find that perfect person who's really, really competent yet somehow lacks ambition," Dr. Sauvé says. "You get this person, they're the best tech you ever had—well, they want to go to medical school."

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The solution isn't hiring less ambitious people. It's giving ambitious people somewhere to go.

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Dr. Koo shares examples from her own practice:

• An admin became a TMS tech → then clinic manager → now heads the therapy department
• One of her first TMS technicians from 2009 → progressed through multiple roles → now leads recruiting

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"People who are good employees want to have upward mobility and other opportunities. You need to be able to offer them that."

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Dr. Sauvé knows a colleague in Southern California whose story captures this perfectly: someone who started doing TMS treatments "now runs pretty much the whole shop."

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Concrete upward mobility paths:

• TMS Tech → Senior Tech → Clinic Manager → Regional Manager
• Admin → Billing Specialist → Practice Manager
• Spravato Coordinator → Clinical Trainer → Clinical Operations Lead

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Even if you're a solo practitioner with one tech, define what "senior tech" looks like: they train new hires, handle complex patient situations, get a pay bump and title change after one year.

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When Is It Time to Let an Employee Go?

The hardest retention lesson Dr. Koo learned had nothing to do with keeping people.

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"I have a sort of a bleeding heart on this matter," she admits. "You see people struggling and my tendency would be like, 'we just need to give them more training, invest a little bit more time.'"

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She's learned that emotional resistance is usually wrong.

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"When's the right time to let somebody go? The answer really is: the first time you're thinking you should let them go."

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This doesn't mean the person is a bad employee. They might excel in a different role. But endless training hoping to fix a fundamental mismatch? That's a disservice to everyone.

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"Really good evaluations early in those first 90 days—you pretty much have an answer."

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Treating Your Team Like Patients

When asked for a final billboard message to new practice owners, Dr. Koo's answer was disarmingly simple:

"The same way we are with patients, we have to be with our team members."

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She schedules regular check-ins—"How are you doing? And like, really how are you doing?"—gives positive feedback when it's earned, and has improvement conversations before problems escalate. Her practice invests in team culture: fun activities, team building retreats, genuine connection.

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"Team members want to hear positive feedback in real time, and they want to hear opportunities to improve before problems arise."

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"We're all human," she adds.

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Conclusion

Hiriing your interventional dream team lets you scale your practice and deliver better care. The clinicians who get it right treat hiring with the same rigor they bring to treatment protocols.
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WantDr. Koo's Complete Hiring Toolkit?

Join Osmind's virtual community, The Psychiatry Collective (free to join). Get instant access to private practice templates and resources, including Interview exercises, evaluation rubrics, scoring templates, onboarding checklists, and scenario scripts—everything you need to build your own multi-stage hiring process.