Telepsychiatry, TMS & Women’s Mental Health: Victoria Starner, PA-C, CAQ-Psych

Origin Story

Victoria Starner didn’t start in psychiatry. She began in outpatient pediatrics, transitioned during the height of COVID into a fully remote psychiatric practice, and built her confidence through structured mentorship. Today, she works on-site in a New York practice offering TMS and Spravato while focusing on ADHD, anxiety, and women’s mental health. Her story reinforces one truth: it only takes one connection to build a career in psychiatry.

How She Got Here (and Why Mentorship Made the Difference)

Strong foundation: Victoria completed a psychiatry rotation in PA school — an opportunity not every program offers.

First role: Outpatient pediatrics.

The transition: In 2021, she joined a small private psychiatric practice in Maryland during COVID, practicing fully remotely.

What made it work:

• Three months of structured onboarding

• Psychiatrist joining initial visits and introducing her to patients

• Warm handoff model

• Close mentorship from an experienced psychiatric PA (Carol Smith)

“Mentorship determines confidence.”

That gradual exposure allowed her to safely build skills in psychiatric interviewing, medication management, and telepsychiatry workflows.

Telepsychiatry Done Right

Victoria practiced telepsychiatry for four years.

Benefits she observed:

• Improved access to care

• Higher appointment retention

• Flexible scheduling for patients

• Reduced commute barriers

What made it sustainable:

• Clear supervision structure

• Strong provider collaboration

• Defined communication channels

Telemedicine wasn’t just convenient — it expanded psychiatric access while preserving quality.

Expanding into TMS and Spravato

Victoria recently transitioned to an in-person role in New York at a practice offering:

• Transcranial Magnetic Stimulation (TMS)

• Spravato (esketamine)

Her role includes:

• 40-minute monitoring visits during Spravato sessions

• On-site patient support

• Collaborative management alongside four psychiatrists

This shift reflects a growing trend in psychiatry: neurostimulation and rapid-acting treatments are becoming more integrated into outpatient psychiatric practice.

Clinical Interests: ADHD, Anxiety & Women’s Mental Health

Victoria is particularly drawn to:

• ADHD across the lifespan

• Anxiety disorders

• Women’s mental health

She highlighted the importance of:

• Recognizing PMDD vs bipolar misdiagnosis

• Educating patients about menstrual cycle-related mood changes

• Supporting pregnancy planning and peripartum care

• Providing validation in psychiatric diagnosis

“Sometimes the diagnosis itself becomes the treatment.”

Accurate labeling and education can reduce stigma and empower patients — especially women whose symptoms are often dismissed.

What She Actually Uses (and Recommends)

Core resources:

• Stahl’s Prescriber’s Guide

• Psychiatry & Psychotherapy Podcast (David Puder)

• Peer mentorship

Her advice for new PAs:

• Network intentionally

• Ask about onboarding structure

• Clarify supervision expectations

• Seek out experienced psychiatric providers

• Trust your medical training

“Every new grad feels nervous — but you will figure it out.”

Practice Design & Career Longevity

Victoria works a four-day schedule with extended shifts, prioritizing:

• Provider collaboration

• Team culture

• Professional tribe-building

• Personal interests (dance, movement, community engagement)

Her background in dance influences how she speaks to patients about movement — focusing on joy rather than rigid exercise prescriptions.

“Make movement fun.”

Whole-person psychiatry starts with whole-person clinicians.

Shareable Takeaways

• A pediatrics-to-psychiatry transition is possible with mentorship.

• Telepsychiatry can be high-quality and sustainable.

• Structured onboarding builds confidence in new psychiatric PAs.

• Women’s mental health requires diagnostic nuance and validation.

• Psychiatry careers are built through connection, not perfection.

Connect with Victoria

Instagram: @torstarner

If you enjoyed this conversation, catch the full episode of Mindset Matters and share it with a PA considering a career in psychiatry or exploring telepsychiatry, TMS, or women’s mental health.

Because when psychiatric PAs support each other — we expand access, confidence, and impact.

Navigating Trauma-Informed Care: Key Clinical Insights from the Mini Mindset Series

Trauma shows up everywhere in healthcare—not just in psychiatry. In this Mini Mindset edition, we take a focused, clinician-centered look at trauma-informed care and why understanding trauma is essential across primary care, pediatrics, urgent care, orthopedics, and mental health settings.

Trauma is common, often unspoken, and deeply impactful. Yet many clinicians feel underprepared to recognize it, explain it, or integrate it into care. This post highlights the core concepts every provider should understand when trauma is part of the clinical picture—which, in practice, it almost always is.

A Brief History of Trauma and PTSD

Trauma was formally recognized as post-traumatic stress disorder (PTSD) in the 1980s with the DSM-III, expanding awareness beyond combat-related trauma to include survivors of sexual assault and other civilian experiences. With the DSM-5, trauma-related disorders were further refined, emphasizing changes in cognition, arousal, mood, and dissociation.

This evolution marked a critical shift: trauma was no longer viewed as a moral failing or personal weakness, but as a biological process that alters how the brain and nervous system function.

One of the most influential contributions to this understanding came from the Adverse Childhood Experiences (ACE) Study, which revealed strong associations between early trauma and long-term health outcomes—including chronic disease, mental illness, and reduced lifespan. Trauma, we now know, is not just psychological—it is systemic and physiological.

What Trauma-Informed Care Really Means

Trauma-informed care begins with understanding how chronic stress affects the nervous system, particularly when exposure occurs in early childhood. Persistent activation of the sympathetic nervous system can lead to long-term changes in emotional regulation, threat perception, and physical health.

Clinically, this requires a shift in mindset. Trauma-informed care asks us to move from “What’s wrong with you?” to “What happened to you?”—opening the door to curiosity, compassion, and more accurate diagnosis.

Treatment is not about avoiding symptoms or immediately medicating distress. It’s about stabilizing biology, restoring safety, and supporting regulation, often through a combination of therapy, education, and—when appropriate—medication.

Medication and Trauma: Context Matters

Medications can play an important role, but they are not standalone solutions. SSRIs remain first-line pharmacologic treatment for PTSD, helping reduce hyperarousal so patients can engage more effectively in therapy. Adjunctive medications may be useful in specific cases, particularly for sleep or autonomic symptoms.

Equally important is knowing what not to prescribe. Benzodiazepines are generally contraindicated in trauma-related disorders, as they may worsen dissociation, interfere with trauma processing, and increase dependency risk.

Trauma-informed prescribing means treating the whole person—not just the symptom that shows up in the room.

Therapy as the Foundation of Healing

The strongest evidence for trauma treatment supports structured psychotherapies, including:

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

• Eye Movement Desensitization and Reprocessing (EMDR)

• Prolonged Exposure Therapy

• Cognitive Processing Therapy

Across modalities, effective trauma therapies share core principles: reducing avoidance, safely confronting traumatic memories, rebuilding meaning, and strengthening emotional regulation.

In both adults and children, therapy works best when it prioritizes safety, trust, and skill-building, helping patients reconnect with a sense of control and agency.

Connection, Resilience, and the Clinician’s Role

Healing from trauma is not just about symptom reduction—it’s about restoring identity, connection, and hope. A strong therapeutic alliance is as powerful as any medication, and clinicians play a critical role in modeling safety and regulation.

This work also requires attention to the clinician’s well-being. Trauma exposure is cumulative, and secondary or vicarious trauma is real. Grounding strategies, reflective practice, and self-care are essential for sustainable, ethical care.

Why Trauma-Informed Care Matters

Trauma-informed care is not a specialty skill—it’s a core clinical competency. When clinicians understand how trauma shapes behavior, physiology, and health, we improve outcomes not just for patients, but for ourselves and our healthcare systems.

Trauma is common. Healing is possible. And informed, connected care makes the difference.

To hear the full conversation and deeper clinical insights, listen to this Mini Mindset episode on your preferred podcast platform. You can find us on Apple Podcasts, Spotify, Podbean, and YouTube. Join us as we continue exploring how thoughtful, trauma-informed care can transform both patient outcomes and clinician well-being.

No Expectations, Deep Impact: Yuliya Bjorgan on Curiosity, Addiction Medicine, and Growth in Psychiatry

Curiosity Without Expectations: Yuliya Bjorgan’s Thoughtful Approach to Psychiatry

In psychiatry, curiosity can be one of the most powerful clinical tools—and for Yuliya Bjorgan, PA-C, it has shaped both her career and her approach to patient care.

In this episode of PA Mindset Matters, Yuliya joins us to reflect on her journey into psychiatry, her work in addiction medicine, and why letting go of expectations has helped her grow as both a clinician and a person.

A Lifelong Interest That Felt Natural

Unlike many nonlinear medical paths, Yuliya’s interest in psychiatry was present early. During her training at Bethel University in St. Paul, strong preceptors and meaningful clinical experiences reinforced what already felt intuitive: psychiatry made sense to her.

She describes the field as intellectually engaging, deeply human, and uniquely positioned to explore the “why” behind behavior—an aspect that continues to motivate her work today.

Psychiatry and Addiction Medicine: Understanding the “Why”

Yuliya’s curiosity naturally extended into addiction medicine, where she became fascinated by how substances can override decision-making and reshape lives. Integrating this perspective into psychiatric practice has given her a broader lens for understanding motivation, relapse, and recovery.

In outpatient private practice, she commonly treats bipolar disorder, depression, and anxiety, using a blend of psychopharmacology and psychotherapy to support patients through complex emotional and behavioral patterns.

Learning as a Professional Anchor

For Yuliya, growth in psychiatry requires constant learning. She relies on evidence-based tools such as Open Evidence, UpToDate, NIH resources, and professional conferences, while also valuing books that offer deeper insight into trauma, resilience, and the human experience.

This commitment to learning isn’t about perfection—it’s about remaining curious, adaptable, and open to new understanding as both science and patients evolve.

Practicing With No Expectations

One of Yuliya’s most impactful reflections is also her simplest advice to aspiring psychiatric PAs: have no expectations.

Letting go of assumptions—about patients, outcomes, or even career trajectories—creates space for presence, flexibility, and genuine connection. It allows clinicians to meet patients where they are, rather than where we think they should be.

Creativity, Balance, and Staying Grounded

Outside of clinical work, Yuliya finds balance through movement and creativity. Running clears her mind, while painting, beadwork, and elaborate cooking offer tactile ways to decompress and recharge. These rituals serve as reminders that sustainability in psychiatry isn’t accidental—it’s intentional.

A Quietly Powerful Path

Yuliya Bjorgan’s journey reminds us that psychiatry doesn’t always call loudly. Sometimes it unfolds through curiosity, openness, and a willingness to learn without expectation. Her thoughtful approach offers a grounded, compassionate model for clinicians at any stage of their careers.