By: Matt Emma
In 2019, on opposite sides of a university campus in Michigan, a psychiatry resident and a business school student compared notes in a healthcare ventures course and arrived at a deceptively simple premise: build a clinic where operations and finance exist to serve one non‑negotiable rule: patient care is prioritized above all else. Five years later, that rule has scaled from a single interventional psychiatry clinic in Ann Arbor to a seven‑site footprint across the United States and a consulting arm that helps others replicate the model. The bet they made then continues to guide them: prioritizing outcomes and experience over short‑term margin is likely to yield the ideal results.
Inside Michigan Advanced Psychiatry, co‑founders Dr. Andrew Schmale and Dane Reinhart run every decision, clinical, operational, or financial, through a single test: If patient care truly comes first, what is the right decision?
In practice, that means funding staffing ratios that help reduce wait times and preserve continuity even when a spreadsheet suggests leanness. It means allowing evaluations and follow‑ups to run longer than industry norms so clinicians can more effectively calibrate treatments, and patients report feeling more supported and experiencing progress in their treatment. It means investing in training, measurement, and quality assurance before expanding to new sites, and defaulting to transparent, compliant billing even when it might have been possible to maximize earnings this quarter.
“We aren’t focused on maximizing every last minute of our providers’ time,” says Dr. Schmale, a psychiatrist specializing in neuromodulation. “We’re focused on the next referral that comes because a patient felt seen and got better.” Reinhart, who leads operations and finance, puts it more bluntly: “If you build trust with patients and referrers, your pipeline is likely to remain full. Patient‑first isn’t anti‑business. It’s good business, just with a longer time horizon.”
The pair met when Dr. Schmale, finishing his psychiatry residency in 2019, started taking business courses at Michigan in anticipation of a career at the intersection of medicine and entrepreneurship. Reinhart, then completing his master’s degree at a prestigious business school in Michigan, approached the classroom venture with the same conviction: clinical rigor and operational discipline should reinforce each other, not compete. Grouped together to design a mental health startup, they realized the culture they wanted to build could be engineered if they hardwired principles into systems.
In mid-2020, they launched Michigan Advanced Psychiatry in Ann Arbor with a focus on interventional psychiatry, providing transcranial magnetic stimulation (TMS), ketamine, and esketamine (Spravato) for treatment‑resistant depression and PTSD, alongside traditional outpatient care. Dr. Schmale designed the clinical protocols and governance, drawing on research experience and specialist training, while Reinhart architected the operating backbone – the business plan and structure, staffing models, payer strategy, compliant coding and billing, and internal systems that could scale. Word traveled fast. Patients and referrers cited attentive care, clear communication, and measurable improvement.
By 2022, the pair expanded to Troy, Michigan, replicating an outcomes‑driven playbook without losing the feel of a calm, reliable patient experience. Then came an unplanned catalyst. An out‑of‑state psychiatrist reached out for help launching a similar clinic. The request turned into a second business, Advanced Medical Solutions, which formalized what Dr. Schmale and Reinhart had been building: an end‑to‑end operating system for interventional psychiatry clinics.
They implemented processes, trained teams, implemented measurement, and stayed engaged as volumes grew. The non‑negotiable for partner clinics was the same as at home: adopt the patient‑first decision test and build systems that make it the default, not the exception. Clinical pathways for TMS and ketamine/esketamine are standardized and paired with outcomes measurement that informs iterative protocol refinements across sites. “We treat measurement like a clinical instrument,” Dr. Schmale says. “It’s how you learn, site to site.”
Capacity and internal processes are designed to prioritize consistent, dependable performance under real-world conditions over achieving maximum output in ideal, theoretical scenarios. This approach reflects a deeper understanding of what drives lasting success. “It’s easy for operators to overlook the intangibles that truly set apart organizations and position them to thrive over the long term,” Reinhart says. “Trust compounds, and not everything can be measured as a line item.”
Michigan Advanced Psychiatry has set itself apart through a culture that values people as much as profits. Dr. Schmale and Reinhart view employee satisfaction, team cohesion, and patient trust as important drivers of long-term success. This perspective has fostered low turnover, high clinician morale, and a reputation for care that grows over time, allowing the clinics to grow responsibly while maintaining the quality and integrity that drew patients and referrers in the first place.
Choosing patient care over immediate profit is unfortunately not the industry norm. It can mean more staff, longer visits, and slower rollouts. But the founders argue that the math works in the medium term. Ultimately, clinicians want to work where care isn’t subordinated to throughput, easing recruitment and retention. “In healthcare, the cheapest thing you can do is get it right the first time,” Drew says. “Rushed intakes and thin staffing may appear efficient until you tally rework, drop‑outs, and missed improvements.”
Five years after the Ann Arbor launch, the co-founders either directly own or operate seven clinics across the United States, with more in the planning stages. In 2025, Michigan Advanced Psychiatry opened a new site in East Lansing, a decision that’s both personal and practical. It’s where both founders completed their undergraduate degrees, and a region they view as underserved.
For an industry often trapped between mission and margin, the approach is a pragmatic third path: build the business so the mission is most likely to succeed, reliably, repeatedly, and at scale. That philosophy extends beyond their own clinics. Through Advanced Medical Solutions, they are helping independent psychiatrists launch and expand interventional practices that keep clinicians in control while elevating standards. The playbook is replicable because it is principle‑driven and systems‑based; it travels well from one geography to another without losing its integrity.
In the coming year, Dr. Schmale and Reinhart plan to add capacity in several new regions while maintaining the standard that built their reputation. The guardrails remain the same: train before you launch, measure what matters, and don’t trade long‑term trust for short‑term gain. “We’ll grow,” Drew says, “but only as fast as we can train, measure, and maintain the standard. If we have to choose, we choose the highest standard, all while keeping patient care at the forefront.” In an era of rising demand and stretched capacity in mental health, that might be the most effective and replicable innovation of all.
