A Look Inside Ketamine Clinics: How to start your own - A Podcast Interview excerpt with Sam Ko, MD

This is an edited excerpt from the transcript of a podcast episode Sam did on the Stimulus Podcast with Rob Orman, MD. In this podcast Sam discussed what it takes to open a ketamine clinic, what people get wrong when they start a clinic, and more. If you want to check out the rest of this episode, head over to his website or listen on your favorite podcast platform.

Using ketamine in the emergency department can be a transformational experience if you help your patients set the right mindset prior to the infusion.

Utilizing ketamine in the ED and the patient experience

Rob Orman: You ever debrief with adult patients after you've done a procedure using ketamine and just discussed their experience to get into what's going on?

Dr. Samuel Ko: Oh, totally. And at least in the emergency department. For example, with pediatric patients, we do that frequently. And they taught us “Hey, Sam, before you give the sedation, you want to put them in a happy setting, or in a mindset.” So  I would ask them, “where's your favorite vacation spot?” Or “what movies do you like?” and then get them talking about something enjoyable to them before I administer the ketamine. This is in the IDI. And what I noticed is afterwards, I would ask him, “what was it like?” And some of our pediatric patients would say, “ I just thought I was back in Hawaii sitting on the beaches and seeing the ocean.” And I just noticed how the mindset prior to getting the ketamine really influenced their experience after. 

There was one profound moment I can think of which was when a patient had a shoulder dislocation. He was probably in his 60s or 70s. I was going to use ketamine because it’s a big proponent for procedural sedation. And after the procedure was completed, he was crying and I was what was going on, so I talked with him. He had this near death experience where he said he went to heaven. He also said that he felt all of this love for his wife and that his wife was waiting in the waiting room. He just felt this overwhelming sense of gratitude and love for his wife. It was such a profound experience for him even if we weren’t administering ketamine for depression or PTSD. Merely just for a shoulder dislocation. It was quite transformational to see that experience for him afterwards.

Learn more about what patients can experience at our The 4 Types of Non-Ordinary Experiences Your Ketamine Patients Can Have blog post.

Starting a ketamine clinic can be intimidating, but with the proper resources and support, the whole process can be much more achievable.

What it takes to open a ketamine clinic

Rob Orman: For opening up a ketamine clinic, is this something that any doctor could do out of the box? Is there specific licensing? Do you need additional training? Is it only open to certain specialties?

Dr. Samuel Ko: Ketamine therapy is very cutting edge, there's not a lot of regulations. So technically, anyone with a DEA license or a medical license can start up their own clinic. As a matter of fact, there's family practice physicians, there's psychiatrists, there's anesthesia, there's CRNAs, there's psychiatric nurse practitioners, that can open up their own practice. This is, of course, state dependent. In some states like California, you need a physician to open up a medical clinic, but in other states like Washington, a nurse practitioner can open up their own practice. So there are some state regulations involved but yes, if someone feels comfortable with it, and they've received some training, whether it's intramuscular ketamine training, or if they have a particular interest, it's wide open at this time actually.

Rob Orman: This is a brick and mortar clinic, right? People come in, they get ketamine, which we're going to talk about more in a bit. But one of the intimidating things about this is getting the space and being a property owner or renter. And to that end, what kind of space would you say would be the minimum viable product to get this up and running  to do it? 

Dr. Samuel Ko: I've seen it kind of all over the place, there was a friend of mine, he's also an emergency physician based out of Texas. And when he started up his clinic, it was literally in a shopping mall. And he said, it was just one office. So like a studio basically, in a strip mall. And that's where he started up his practice. There's another guy, an anesthesiologist, and he's like, “I'm just renting out a room from another physician. They had an extra room available, and I started there.” And then you have the opposite end of the spectrum where they're buying a building, and they're dropping, 100k, 150k for the build out. So it's a pretty wide spectrum. 

But as far as the minimum, you basically need a room. In that scenario, you can do one patient at a time. Yes, it can be intimidating, because we don't really know things like negotiating a lease and finding the right space. That can be challenging, for sure. But getting outside resources, talking with real estate agents, business attorneys who specialize in health care is going to be really supportive.

A big chunk of your investment when starting a ketamine clinic will go to equipment and the build.

How much its costs to start a ketamine clinic

Rob Orman: How much did you have to put into that to make it a viable space?

Dr. Samuel Ko: I was thinking about this. Probably around 75k to start it up. So if someone is interested in starting it up, you probably need anywhere from, depending upon your geographic location, 50 grand to let's say 150. You also want to have some money for a runway, because when I started up the clinic back in 2018, it was super slow. I think I did four infusions the first month and it was just an empty space. It was great because I was working part time at a couple of different ERs where I would just do two to three shifts and then one day of clinic work. And it was interesting because with each month, we started getting more patients through word of mouth. And by December 2021, I shifted out of the ER completely and I just went full time to work in the ketamine space.

Rob Orman: When you're talking 50 to 75 grand, what's the big chunk that's going into?

Dr. Samuel Ko:The big chunk would be equipment. And that includes having a nice recliner, having the pump, having the vital sign monitoring, basically all the supplies that you need. And then the build out because you may want to paint and build walls. So I would say the build out and the equipment takes the most chunk. And then of course there is malpractice insurance, which is quite a bit of money, and hiring staff.

When starting a ketamine clinic, it can be difficult to get patients at first. You may have to rely on self-referral most of the time.

Rob Orman: How did most people find you? You were talking about the beginning which was slow. But now that you're up and running, is it still mostly self-referral to mental health professionals, advertisements, just kind of the ketamine curious?

Dr. Samuel Ko: They're mainly finding us through Google, Yelp, self-referral, a lot of word of mouth. When we first started, I remember sending a letter to every psychiatrist and internist and family practice and OB GYN. I think I sent like 500 letters. I think I got like one response, I'm assuming they just threw it away. So there were no real referrals from the provider network. But now, we’re more established and so I'm working with psychiatrists and getting referrals from them, therapists, and primary care doctors. There are more referrals coming and then also word of mouth from current patients who had a good experience. But when I first started, it was pretty much self-referral.

Learn about the 3 Ketamine Infusion Marketing Mistakes To Avoid when starting your ketamine clinic here at our blog.

One of the most common mistakes people make when starting a ketamine clinic is that they think it’s going to be an easy, get rich quick scheme.

What people get wrong when starting a ketamine clinic

Rob Orman: We've been talking about what it looks like to have an up and running and functional ketamine clinic. And you were talking in the beginning about how to start this and what space you need. You now consult and help walk through people starting their businesses on this. What do you think people get wrong when they start a ketamine clinic?

Dr. Samuel Ko: I think people who start up a ketamine clinic think this is going to be a get rich quick scheme and that it's going to be super easy. They think there’s going to be a line of patients waiting at the door. If they're really just strictly driven by the profits and the cash component, I would say it's probably not worth it. So if someone's already doing well financially in the clinical space, and their mindset is that they can make more money with a ketamine clinic, that's probably going to take a lot of work. Because when I was working in the ER, I clock in, clock out, I'm done. I do my 10 hour shift, I do my 8 hour shift, I'm done. Of course, I might go home and think about the patient, and the missed dissection or whatever. But with the ketamine clinic, I'm just thinking about it all the time.  Even at like 9pm or 10pm I still think about clinic. So I think the biggest mistake is if someone is just going in for the money component.

Rob Orman: That sounds a lot like medicine, right? If you're not mission driven, you just don't anticipate the challenges that you’re going to face. And if you are mission driven, then you have something that is pushing you forward and serves as your compass. If it's just making money, then all of the BS becomes just BS.

Dr. Samuel Ko: Exactly. There's a great book, Simon Sinek, "Start with Why." He also has a TED talk. So for those who have not heard of it, just Google the book. What he talks about is asking yourself why you’re doing this, whether it's medicine, or whether it's starting up a business. You really have to get strong on your why. And if you don't have a strong way, you're going to face an obstacle and you’re just going to stop. But if someone has a strong, why they're going to do all of these hurdles, they're going to jump over it because they are mission driven. And I think that's really crucial when you're starting up something like this.

Get Started Now

We hoped you enjoyed our conversation on the Stimulus podcast. Definitely check out the entire podcast here along with show notes. If you’re an emergency medicine physician who’s thinking of starting your own private practice, we hope this podcast has inspired you to take action. We encourage you to take small steps and if you need a place to start, feel free to check out the rest of our blogs on our website!

Are you ready to take the next step and start your ketamine clinic? Join our email list and be notified about the next free webinar and open registration for Ketamine StartUp.

If you enjoyed this blog here are a few others you could check out:

How Much Money Do You Need To Start A Ketamine Clinic?

How much do you really need? It all depends on the choices you make. Learn more about the factors that go into calculating your startup costs at our blog.

5 Truths About Owning A Ketamine Clinic

Many people who start a ketamine clinic aren't aware of the realities of running it. They end up getting discouraged, thinking that starting a ketamine clinic is much easier than working in the hospital! In our blog post, we talk about what it's actually like to run a ketamine clinic. 

Ketamine Clinics: An Option For Emergency Medicine Physicians

Emergency medicine has been known to be one of the most popular specialties for graduating medical students. Unfortunately, this reputation is slowly fading as the demand for ER doctors is dwindling. In our blog post, we talk about why starting a ketamine clinic is another great option for ER doctors to venture into.

Many physicians dream of having a ketamine clinic, but there are a lot of steps needed to get one up and running. In this podcast excerpt with the Stimulus Podcast, we talk about who can start a ketamine clinic, how much it takes to start one, and some mistakes you should avoid along the way.