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She got fired three times from community mental health jobs for refusing to see patients in 15-minute pill mill rotations. The third time, in October 2020, she had a mortgage, a husband in nursing school, and zero interest in starting a private practice. She did it anyway.

Dr. Maria Ingalla is the founder of Paper Flower Psychiatry, a 16-provider, five-location neurodivergent-affirming practice in Arizona. She launched it with about $150 — a $100 website she built herself, a $20 Fiverr logo, and a Psychology Today listing. No loans. No investors. No business plan. Just a refusal to keep getting fired for having ethics.

In this episode, Maria and Lindsay get into all of it: how insurance companies deliberately underpay claims by pennies hoping you won't notice (she lost $30,000–$40,000 to Blue Cross before catching it), why she hires virtual assistants directly from the Philippines and pays them fairly instead of going through exploitative agencies, and how she built a nonprofit — Paper Flower Foundation — that pays for psychiatric medications and therapy sessions for patients who fall through the cracks.

Maria also talks about why she thinks most psych NP programs are failing their graduates, what she actually looks for in a preceptor application (hint: ditch the professional cover letter), and why she diagnoses autism in adults when other providers are still ruling it out because the patient makes eye contact. She's autistic herself, late-diagnosed, and both of her kids are autistic.

And yes, she tattoos herself in her free time. Her dogs are named Marshmallow and Potato. She's been offered millions for her practice and turned it down without thinking twice.