Medicine news

News : Starting a Ketamine Clinic: Another Option for PEs : Emergency Medicine News

ketamine infusion, EM activity:

Dr. Ko opens his ketamine clinic.

I’ve worked as an ER doctor for a decade, but I jumped into the side gig world four years ago by starting a ketamine infusion clinic in Palm Springs, California.

The seed was planted years ago when I first came across an article about the off-label use of ketamine for depression. (Biol Psychiatry. 2000;47[4]:351.) I was curious and dove deep into the research and stayed abreast of the latest studies and meta-analyses, which showed continued support for its effectiveness in treatment-resistant depression. (J affect disorder. 2020;277:831.)

I never imagined owning my own clinic. Surprisingly, it’s one of the best decisions I’ve made in my career. I was able to transition between night shifts and holidays. I now decide what time to start and end my clinic hours. Most importantly, my patients experience rapid improvement compared to traditional antidepressants which can take months to kick in.

About depression

Ketamine was invented in 1962 by Calvin Stevens, PhD, while he was a consultant for the Parke-Davis Research Laboratory. It was approved by the FDA in 1970 as a dissociative anesthetic agent and is on the World Health Organization’s List of Essential Medicines.

Ketamine is used in the emergency department for procedural sedation, acute pain control, severe agitation, delayed sequence intubation, and even as a third-line agent for status epilepticus.

Interestingly, research shows that sub-dissociative doses of ketamine infused for 40 minutes can be effective for treatment-resistant depression. The improvement can last for days to weeks after one infusion, but the benefits seem to accumulate with multiple infusions (usually six infusions over two to three weeks).

It’s not ideal to give multiple treatments for depression in a busy emergency department, but it can be done in an outpatient clinic. Ketamine infusions are also not routinely covered by insurance, and the out-of-pocket can be significant for many patients. Janssen Pharmaceuticals, which is owned by Johnson & Johnson, released intranasal esketamine, which was approved by the FDA in 2019 for depression, and is reimbursed by insurance companies.

A recently published systematic review and meta-analysis showed that intravenous racemic ketamine is more effective than esketamine for depression. (J affect disorder. 2021;278:542.) Insurance companies will likely find that this will save them money in the long run to cover IV ketamine treatments.

Current state of EM

Emergency physicians have always been at the forefront of medicine. We are trained in the administration of ketamine as well as monitoring vital signs and managing potential side effects. We are also adept at handling any potential acute respiratory and cardiovascular issues as well as psychiatric emergencies.

I believe ketamine clinics can be an opportunity for emergency physicians who are curious to start a side gig while gaining more control over their future. By collaborating with psychiatrists and other mental health professionals, EPs are uniquely positioned to meet the growing demands of patients with depression. It could also be a solution to the projection that emergency medicine will have an oversupply of 8,000 physicians by 2030 (Ann Emergency Med. 2021;78[6]:726; https://bit.ly/3lVrGYu) and concerns about the inability of graduate residents to find employment due to COVID-19. (AAMC. Feb. 25, 2021; https://bit.ly/2P2M3Vz.)

The wrong side

Starting a ketamine clinic presents challenges. One of the benefits of emergency medicine is being able to clock in and out times and be done. Owning your own medical practice will mean thinking about it all the time. This option is not for those who do not want to devote more time to their clinic.

You will also likely be criticized by your co-workers who might say that you are profiting off the backs of suffering patients and selling snake oil and that you are not a psychiatrist and only they should provide ketamine infusions. They may even accuse you of getting patients addicted to ketamine. And much more.

This adventure is definitely not for you if you have not yet developed a thick medicine skin. You will also need to get involved in the business aspects of medicine, such as marketing, accounting, and hiring. Some of this can be outsourced, but you’ll need to be prepared to learn the basics.

Initial steps

But a ketamine clinic just might be for you if you’re enterprising, proactive, and looking for a change. The first steps will be writing a business plan, finding a location, obtaining business licenses and malpractice insurance, and ordering medications and supplies. It took me about two years before I physically opened up to learn the ins and outs of starting a ketamine clinic. It then took two years after opening to establish a patient base. I continued to work part-time in the ER as the clinic’s patient volume increased to keep my finances stable.

None of us learned how to open a private practice in medical school or residency, so I had to do a ton of research to get the clinic started. I have created a free checklist which you can download at www.ketaminestartup.com to start things off if you’re interested.

Share this article on Twitter and Facebook.

Access links in REM reading this on our site: www.EM-News.com.

Comments? Write to us at [email protected].

Dr Kois the CEO of a ketamine clinic (www.resetketamine.com) and creator of an online course on how to start a ketamine clinic. (www.ketaminestartup.com.) Follow him on Twitter@drsamko.