Self-Awareness and Dealing With Burnout with Dr. Kim Chan Ko: Podcast Excerpt
This is an edited excerpt from the transcript of two podcast episodes Kim did on The Revitalizing Doctor with Andrea Austin, MD. In this podcast we discuss Kim’s experience pivoting from ophthalmology to marketing a ketamine infusion clinic, burn out in women physicians, starting your own ketamine clinic, and more.
If you want to check out the rest of this episode, head over to her website or listen on your favorite podcast platform.
Part 1 with Dr. Kim Chan Ko: The Multifaceted Career
Andrea Austin, MD (0:31):
I am really excited to be speaking with Dr. Kimberly Ko. She is a board certified ophthalmologist and diplomat of the American College of Lifestyle Medicine. She is co-founder of Ketamine Startup, an online course that teaches physicians how to open their own ketamine infusion clinic. Dr. Kim Chan Ko created Ketamine Startup with her emergency medicine physician husband after several years as the creative director of their own ketamine infusion clinic, Reset Ketamine in Palm Springs, California. Welcome to the podcast.
Kimberly Ko, MD (1:04):
Thank you for having me. I'm just super excited to talk and share and I've really enjoyed the other people you've had on your podcast, so I’m just excited to be amongst them.
Taking a pause from ophthalmology: Importance of knowing yourself
Andrea Austin, MD (1:19):
I think I'm gonna jump in with a bit of a juicy question. You are an ophthalmologist, and I know a few ophthalmologists in my life and, especially compared to emergency medicine, it kind of feels like the grass may be greener in ophthalmology and that it's a great lifestyle specialty, but it sounds like your day-to-day is no longer ophthalmology.
Kimberly Ko, MD (1:45):
That is right. I mean you hit a really good point with the whole “grass is greener” because you know, as you mentioned before, my husband's ER and I would be jealous of how when he was done, he could turn it off. I mean as physicians, we really can't turn off helping and wanting to take care of people. But I'm like, “Oh when you're done, you're done,” unlike me, I might see Mr. Smith again in like three months and it would just keep coming with me. So while it's true for many ophthalmologists, it is a great lifestyle. I mean we're one of the few surgical specialties where you get to sit during surgery. I mean come on, it's a good life but it wasn't for me.
It could be a combination of where I was practicing. I practiced at the institution that I trained at, so I was a junior attending, no matter how long I was there. I was still a junior attending even if new people came on. There's pros and cons to that. I don't like to just throw being female, but it also is there. Having a family, having these responsibilities, I think that combined with where I was working, which was a level one trauma center with a huge catchment area. We'd be getting people from Arizona, New Mexico, all the way up to like Irvine up to L.A. just because of the nature of that location. And I would do so many ruptured globes. So for me and the way the practice was, I would get a lot of these difficult patients and really difficult eye situations. It would just be seeing them week after week or people knew that they could trust me with watching their patients if they went on vacation. I felt this duty-bound responsibility to take care of people and for me personally, I couldn't turn it off. That's for me and I think that's the key: knowing oneself. I finally got to a place where I realized it is easy for other people who find it more lifestyle supportive, but it wasn't for me.
The non-linear path: how to go from burned out to happy
Andrea Austin, MD (4:17):
Tell us about your journey to really discovering what you wanted to be doing, because that space of “this isn't working” to finding something that is working can be so long and so arduous and a big part of what we're trying to do at Revitalize is to make that process more clear. Knowing that everybody needs to go on their own journey, but there are some pretty common steps that if you kind of start looking into that, we can shorten that learning curve for women
Kimberly Ko, MD (4:54):
I wish I could say there was something super straightforward and easy. For me, it was this kind of circuitous path that I wasn't clear on what I wanted to do but I was very clear on what I didn't want to do. And I think that's a good starting place. At least it worked for me. I just knew that I needed more of a creative outlet because I was good at repairing broken eyes. There was something very satisfying, especially with imposter syndrome of thinking, “I'm not as smart as the next person but I can work really hard and I can fix things that are broken.” That worked for me, but then it wasn't as fulfilling.
So I knew I needed something beyond that. So first off, recognizing what I didn't like doing but then also recognizing within medicine and clinical practice what I did like. What I enjoyed was the patient education. I did so many diabetic eye screens and it's figuring out new ways to really drive the point home and figuring out how I can approach getting this message of my patients taking care of themselves for the sake of their vision not now, but maybe in 20 years. That's going to make a big impact. I loved interacting with residents. I think I stayed in medicine and clinical practice longer than I wanted to because there was something that just felt so good when I was with residents. Not because they were doing extra work for me but the feeling of having a mentorship role, sharing the struggles I went through. It's that human connection, that sharing of information, which at that time I didn't realize would translate to marketing and teaching other physicians later on. But I dabbled with that and then just leaned into whatever kind of came up. Saying “yes” in the sense of being open to something that you may not expect.
Earlier on, you had mentioned that you do some of the editing for the podcast. So I started editing video back in high school, back when it was really not cool to be sci-fi nerd and video yearbook editor type, working on the computer making content and stuff. Little did I know that later on, it's really important and a lot of people want to do that, but I was starting to kind of dabble in videos and if you search the depths of Youtube, you're gonna find some clips of me and some videos where i'm trying to come up with lifestyle and advice for residents and med students. I thought if I could do it one-on-one, I can scale it and teach others. I just tried it and my husband was like, learn how to do YouTube, maybe you'll have some fun with this. And I realized it wasn't the direction I was going in. Ultimately, it wasn't what I ended up doing. I realized I don't want to be a medical influencer or Insta doctor. We all have our paths and all that good stuff but it wasn't for me. Fast forward two, three, four years later, I'm using those skills to make the videos for the course we made for our ketamine clinic. It's the seeds of that journey and just getting on that journey of figuring out what do I want that ultimately you'll see that if it doesn't go anywhere at the beginning, later on those would be like the building blocks to help create what you want to do in the present or in the future.
Andrea Austin, MD (10:48):
I really like that message. You just need to get on the journey and maybe not every single step will seem linear or lead to something immediately but it's part of you and your experiences and you don't know how that's going to weave into something that you do down the road.
Kimberly Ko, MD (11:10):
Exactly. I think that's the misconception. Especially when we go through that medical education, everything was very clear from high school to college to med school. It’s a very linear path and so we're used to that or we anticipate that. But for many of us, a linear path is kind of meandering. It’s the reality of what's going to help you figure out what you want and I had to embrace that because I really had struggled and felt I had to be very logical and that I should just figure out something that I already have some skill level in from all the years of training. It's like, let's leverage that, but that wasn't for me. Sometimes it's not clear, sometimes it's just meandering, kind of thinking, “I like this thing, I don't know why. It’s fun, but let me figure out how to utilize it.”
Life coaching: a tool for physicians
Andrea Austin, MD (12:13):
In the materials that you sent me when I was prepping for this interview, you did some personal development courses and I find among the physician community, there's a lot of hesitancy around various types of personal development and coaching programs, that there's this idea that maybe they're snake oil sales people, but what was your approach? How did you find coaches or resources that were actually helpful to you?
Kimberly Ko, MD (12:51):
I mean it's so true. When I was starting to take some courses and workshops, whenever I had attendings or fellow residents or colleagues ask “what do you do?” I'm like, “I'm going to a leadership workshop.” because I wasn't in that place to feel confident and strong enough to be like, “I'm learning how to live my best life and ask deep probing questions to dive in.” So yeah, it's very true. Even back then and how I feel currently. So finding those resources, luckily my husband was having a similar journey. He's a few years ahead of me and so he had discovered the Co-Active Training Institute, formerly known as CTI and he had taken some weekend courses. I was so busy working as a physician, as we all are right, and so he would go off on the weekends and i'm like, “okay great, i'll have the house to myself or I can catch up on charting and we won't feel bad that we're both busy because you're off doing this coaching thing with people and crying and sharing thoughts and all that kind of stuff, whatever.” I mean, I was dismissive at first too. I was thinking if there’s science to back this up? Where's the evidence-based research for all this? But he would come back and he was like “you might enjoy this.”
It's not all that different, at some level, from when we are teaching medical students or teaching residents. When we're teaching them and talking with them with soft, less technical things.
This was an easier transition for me because I was already enjoying the teaching interaction and so you know just diving into that and thinking that maybe this is another skill set of not just being able to provide better care for my patients and teach better, but also I went through this the training, I was thinking that physicians need this. Once I was done with my training for life coaching, I was like, “I want to coach other physicians,” but I realized that wasn't for me, or the way I was marketing wasn't getting people that were ready or were open to it. So I realized that I didn't know how to market for life coaching and all that. I don't know if that really answered your question.
Struggling with identity as a female physician
Andrea Austin, MD (18:37):
Maybe we can just spend a moment on that, because I interact with a lot of women physicians that are struggling with identity and a lot of their personal identity is linked to their specialty identity. How have you navigated that space well?
Kimberly Ko, MD (19:01):
I think what helped was I always felt like a bit of an odd duck being an ophthalmologist. I always felt a little bit like I didn't fit in. I'm not like everyone else. I felt like all my other colleagues were really into eyeballs and they really loved the research and everyone seemed super excited at grand rounds and really engaged, and I was struggling to be really focused here and really excited about it too. So I think what helped. I already felt a little bit like an outsider which, you know at that time, when I'm in the middle of it, it was a struggle. I mean, that's why I was thinking that I need to figure something out because I'm not happy. But that allowed me to be a lot more fluid with my identity of not saying necessarily, “I am an ophthalmologist.” We were really trained at our institution, which I'm very grateful for, that you're a physician first, then an ophthalmologist and so I really took that to heart. So the fact that I'm not looking through a slit lamp, repairing ruptured globes, doing cataract surgery anymore, I was like, “I am a physician, I think it's being of service and to help the health of the individual,” that has helped me shift my identity to something that is much more aligned with me. I’m still working on vision and clarity, but in a different way. And so thankfully for me, what was a struggle and painful when my only identity was an ophthalmologist was that I was uncomfortable in it, so it was a blessing in disguise at that time.
Andrea Austin, MD (20:55):
I think there's so much in there for listeners to really contemplate, and one little pearl I would add in there is changing the way you introduce yourself. Instead of, “I am a doctor,” or “I am an emergency doctor,” is “I practice emergency medicine,” or “I practice medicine” and that helps us think about the other things that we do, and that we are a multi-faceted individual and that we still have worth and value that's not tied to what we do.
Kimberly Ko, MD (21:30):
Totally. I think it's the power of the “I am” or “I am doing” that really made it clear to me that I am a multifaceted individual. I remember shouting that out during one of my coaching trainings and that helped me realize that this is just one aspect of me and I'm just practicing ophthalmology. Wonderful pearl, I love it.
Part 2 with Dr. Kim Chan Ko: Action Brings Clarity
How we started our ketamine practice: our story
Andrea Austin, MD (2:31):
So I want to move to talking about your ketamine practice and it's super interesting to me as an emergency physician, because I can't even imagine how much ketamine I've given to patients over the years and I have a lot of colleagues that are interested in maybe opening their own ketamine practice. Maybe we'll start with the question, how did you and your husband get into this practice?
Kimberly Ko, MD (3:11):
It started off with my husband who is an emergency physician, as we mentioned earlier, and loves his ketamine and was utilizing it already. So he started seeing some of the emerging research that was coming out in the early 2000s when the research was some of the more pivotal, foundational studies. He was practicing emergency medicine, feeling a bit of the burnout and realizing he couldn't really do this for a long time. This wouldn't work out for him and so he started this group of other physicians that he was working with to figure out how to start a ketamine clinic, and it didn't work out. These other individuals were busy or they had other things they wanted to do, and of the four, he was the last man standing. So he thought he’d just figure this out himself. I think that was around 2016 and by then, I was just an early newbie attending and was already kind of feeling some frustration and I would notice Sam, my husband, would be working on figuring out all these paperworks and all these different things on evenings, mornings, weekends. So I offered to help him take a look at some of this stuff and give a second pair of eyes.
I started to help a little bit and then we figured out just the logistics of starting up a private medical clinic ourselves, would go find a location and would just help out as the partner. I was excited at the thought that there was another avenue. Because I was burning out, and I wasn't sure what I wanted to do, I was thinking I need an exit strategy and right now, I can't figure out my own stuff, so I'm going to support you in creating this exit strategy but we'll figure out my stuff later.
Then we had to start marketing our clinic and I realized, as I mentioned before, that I made some Instagram posts, wrote some blogs and supported Sam in writing some too. We also bought an updated version of Final Cut Pro because I'd used it back in high school. I just kind of fell into it while supporting him. Because Sam was working three ERs and I was working at the academic center and I would get all these ruptured globes, so we're both really busy. We were growing slowly and open only by appointment. It was a really slow start with our clinic but then things started to pick up. The content that we were creating, the videos, the blogs, the social media, were starting to pay off and we started to get busy and by 2020, Sam went to do this full-time. And it coincided with all the turmoil of the pandemic.
I have some ER friends and relatives [working in the ER] on the East Coast and they were dying and they were slammed. Sam was being furloughed at where we were at because it was just so slow at that time and there was so much uncertainty and until now it still is. I don't know where we are in this pandemic thing quite yet, but hopefully towards the end of it. But it was a very difficult time for us. We were very lucky and fortunate that we were already kind of diversifying what we were doing and that health-wise, we were fine and our daughter was fine and our family was fine. So we made the transition to focus on our ketamine clinic and that's kind of the short version of it.
What types of patients go to a ketamine infusion clinic
Kimberly Ko, MD (8:17):
Mostly, it can fall into two camps. You have those with mood disorders like treatment resistant depression, PTSD, anxiety, and then you have your chronic pain patients. They’ve tried other things that could be offered at pain clinics and such. So for us, the majority of our practice is treatment of depression, PTSD, and anxiety. But we also provide treatment for chronic pain.
Andrea Austin, MD (8:43):
Let's say you have a patient that has refractory depression and maybe they've had a couple of hospitalizations in the past and they're on maybe two different medications. Are they coming to you independently or is it in conjunction with their psychiatrist or psychologist?
Kimberly Ko, MD (9:04):
It really depends. We've had both. We make a point of how we practice is that we're like a team if they do come with their psychiatrist or a mental health care professional, whether they're referred by them or they have one. But they came to us because they feel like they're not getting better, even though they're being treated by somebody else. So we work collaboratively. We never try to pretend that we're a psychiatrist or we're a mental health provider. We are physicians who know ketamine and Sam knows how to provide it safely and knows what to do when something goes haywire, which is very rare by the way. But we know how to take care of the patient with ketamine, but we like to work collaboratively with our mental health care provider. I know some clinics have an in-house psychiatrist or psychologist there but as of right now, we found that it's effective working with a psychiatrist that may not feel comfortable providing IV ketamine infusions.
Managing the ketamine experience and emergence reaction
Andrea Austin, MD (10:24):
I've been given a fair amount of ketamine and one of the potential reactions that can occur is this emergence phenomenon and in a couple of the emergence reactions that I've seen, the patient has become quite agitated and we have medications to assist with that. I've been in an emergency department with enough staff that can help if there’s someone trying to get out of the bed or become violent. How would your clinic or how do you manage an emergence reaction? Because it's not like you have a security team that's going to come in.
Kimberly Ko, MD (11:05):
It all depends on how you utilize ketamine and for what the intention and the purpose are. For our patients, and most clinics do this as well, they do a thorough consultation and a review of medical records to make sure that this is a right fit. We're not doing it as sedation to do something else, we're doing it with the sole purpose for you to receive ketamine and to address your refractory depression or to address your treatment-refractory chronic pain. So you're already coming in with that intention of this and with ketamine and this rise of interest and in research into psychedelics, there's this concept of “set and setting”. So by having the set, which deals with the patient's mindset of what they are hoping to achieve by getting their treatment, it makes them very conscious and very aware of why they’re here today to receive a treatment, to help them with [you fill in the] blank.
This is where that coaching actually comes. It’s about asking what do they hope to gain from this, how will they know they will feel better, and so they're already kind of thinking in that space and we're also preparing them. We're letting them know that these are things that can happen and that there’s going to be somebody watching your vital signs and physical indicators of how you're doing, but also you may see something or you may experience things during then and we want you to know we're here. The beauty of having it be IV as opposed to oral ketamine is we can turn it off. We just stop the infusion so we're priming them and we're letting them know what to expect, and also helping them get into a better mind space going into it.
We don't want somebody that's going to be listening to heavy metal during or even before their treatment. We have a playlist of very soothing music so they're prepared. And then during the experience, we're very conscious of monitoring how they are responding both physically and whether they are saying things that are very emotional or if they’re getting anxious. So addressing it there and then also being there for them when they come out of it too. That's the setting aspect: the environment that the patient is receiving their treatment. That includes a very comfortable chair, supportive music, maybe it's aromatherapy, or a warm blanket. For us, a huge part is being very mentally present.
When I've been busy in a clinic, I can dissociate a little bit and just try to get through and not really be there, but enough to make sure people are safe for us. That doesn't cut it when we're treating somebody who has emotional pain or chronic pain that's related to emotional pain or vice versa. So part of that setting is when we tell our staff that this is your job, to be right here with them, to be of support, to hold space and be not scrolling on your phone or thinking about what you're going to go do next. And so having that presence. I've yet to be in an emergency room where you have that kind of experience, where it's nice and quiet and everyone’s attention is to be present and of service and of love without getting too hokey about this. We find most patients do very well and they don't have that emergence phenomenon or if somebody's very much struggling, which of course it can happen, you, have you know, medication to address that too if need be.
Andrea Austin, MD (15:34):
I think that's a really good point, that it's not lost on me that probably a lot of the emergence reactions that I saw happens if i'm using ketamine on somebody who, by definition, had a bad day, in order to facilitate a procedure because they have a broken bone or you know really horrific laceration or some other injury so something traumatic by definition has already happened to them. They're already in, oftentimes, a lot of pain before the ketamine and then there's usually a lot of people around them just because the nature of most procedures that we do involves various people. All of that can be extremely triggering for somebody, so that's a really interesting point.
The concern about ketamine and drug abuse
The other question I had is the history of ketamine. Some people know it as “Vitamin K”, as a club drug, so there is the potential for abuse with ketamine. I think emergency medicine physicians are particularly sensitive to this especially people my age and older because we trained during the “pain is the fifth vital sign” and we dealt with the fallout of a lot of our patients becoming addicted to opioids and coming to the emergency department for their fill-in-the blank opioid of choice. How do you avoid becoming a one-stop shop for this to become a drug of abuse?
Kimberly Ko, MD (17:18):
Oh, wonderful question. It's a question that ketamine providers and clinics talk about in conferences. How do we treat people with a medication that is very powerful and has a lot of use and without it falling into the stigma of “you're just a clinic that gets people high”? I hear that all the time. While there is some truth to that, I think it's that underlying, “you're just getting people high” and “you're just having them escape,” which goes back to the intention of why we are doing this. Within a clinical setting, it is the only time the patient's getting the ketamine, at least at our clinic. It's only when a physician, Sam in our case, is there giving them ketamine. Or there are specific patients where we would feel they are best served with having lozenges or troches that they could use so they don't have to be coming all the time. That's where it could get tricky though because you're not going to have somebody there with them to watch and monitor how much they're taking by themselves during self-administration.
I think that goes to recognizing why we need to utilize those non-IV forms at home because, if you may or may not be aware during the pandemic, there's a change where people could be prescribed medications without having to be physically seen in a clinic. We had the rise of all these virtual appointments and all that good stuff. As a result of that, people are getting access to medications that they weren't necessarily being monitored as closely and as ideally we'd like as clinicians to make sure our patients are being served by the medication as opposed to using it as a crutch or using it inappropriately. That's when ketamine is utilized in that way. You can have patients that are addicted, it is a possibility.
When it is utilized, and by that I mean ketamine infusions just in the clinic, receiving the infusions under the supervision of a physician, you see very low rates of addiction, because you're coming in for the infusion. We check how you are doing depression-wise, we have all these PHQ-9’s or the Beck Depression scores, we ask them how they are doing. And we adjust the dose and how often we treat based on how the patient is responding. So when you're coming at ketamine from that mindset, as opposed to popping some ketamine and going to the club, it's a very different experience, and I feel that way for our patients. We tell them that ketamine is here to help catalyze and change in your life and that ketamine itself is not going to help you, it is going to support you in transforming your life, but it's not the end all. For some patients, it's not going to be the end all or it's not going to be the absolute cure, so it's just being very intentional, being very aware of how the patients are responding so that we can avoid addiction to ketamine infusions.
Physicians starting their own private practice
Andrea Austin, MD (22:03):
I think that when a lot of us picked our specialties like emergency medicine in particular, it really didn't dawn on us about this idea of having our own practice and frankly at the time, I was thinking that it'd be great not to have my own business and deal with all that but as I've gotten older, I do value autonomy more. So if there's somebody out there that would like to learn more about whether it would be right to start their own ketamine clinic, what would be a first step.
Kimberly Ko, MD (22:40):
You're welcome to check our website out at www.ketaminestartup.com and we have a lot of blogs on there. Sam and I both love writing, that's part of my creative outlet and we write a lot about things that we've experienced or surprises and all that kind of stuff that comes with starting your practice. One other way outside of interacting with our content is speaking to fellow physicians that do have private practices and see what their experience is like. I tell you, it is very different, at least for me being partnered with an emergency physician. I'm used to getting Christmas presents because I have a panel of patients, but my husband finds it very odd that I'll see the same patient or see multiple people from the family. So when he told me that, I realized it is a very different experience from seeing patients that come into your ER and leave by whatever means, and then going to scheduling patients and reminding them that you may potentially see them in 6 months. That is a transition.
Then also with a private practice, not only are you practicing clinical medicine but then there's all that business administrative stuff that, love them or hate them, administrators at the hospital take care of. Now, those responsibilities are yours. If you're considering starting a clinic and if your desire and reason to do so is beyond having an easier life, meaning thinking about why you want to do this, or hope this can be of service to the world or yourself or your community, that can help you go through all this paperwork that we were never aware of because all these administrators took care of it for us.
Now that we have our own private practice, we understand why all those modules were there, because there are these laws and requirements. I think being really aware of why you want to do this, and sometimes it's not very clear. I'll be honest, it can start off with just wanting more autonomy but I feel there's something beyond that. It could be wanting more autonomy to practice a certain way, to be of service to others, to be able to spend time with my children, and also continue to utilize all those years of experience with ketamine. There's something beyond that and that's what I find helpful for those that helped us get through all the paperwork and frustrations of the administrative part of being in a private practice.
A message to burnt out women physicians: Action Brings Clarity
Andrea Austin, MD (27:29):
That's awesome. Are there any parting thoughts or maybe a message you'd want to send to the burnt out women physicians that's maybe contemplating starting her own practice?
Kimberly Ko, MD (27:45):
I've been there and I'm finally at a point where I don't feel burnt out, granted I don't practice medicine and I just want to acknowledge that, but what I encourage you to do, and it can be scary, is just to take a step, take action. As physicians, we practice a lot out of fear, we want to avoid things that could kill or maim our patients. I personally just want my patients to do better and get well. Fear of, “did I make the right decision?” or “did I prescribe the right thing?” or “did I forget to order something?” So a step can seem very scary, but this is a step for your life. This is a step of wanting to be happier, to not be burnt out. Imagine not being burnt out, but to be happy or content. Well, “happy” sometimes gets overused, so just to be content. Just take a step, maybe it's as simple as saying no to providing another lecture for the residents. Yes, you love them but you need some more time. So just like a little action, and you'll find either it works or it doesn't and that's there's so much information from there and just taking a small step and find what brings a little bit of joy, a little bit of lightness, a little bit more contentment, and just go with that. I think from these small steps, there's much more clarity and I wish I had known that earlier because I just waited until it was so uncomfortable and I had to take a step that felt super scary. Learn from my mistakes and just take a step.
Action Starts Right Now
We hoped you enjoyed our conversation on The Revitalizing Doctor podcast. If you enjoyed this, Dr. Austin and Kim do a third episode where they go over questions related to starting your own ketamine practice! If you’re a burned out 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.
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