In part 2 of my interview with Dr. Kimberly Chan Ko, we discuss the details of owning a ketamine clinic. We talk about the importance of exploring your why behind wanting to open your own practice and how to get started.
Kimberly Chan Ko, M.D. is a board-certified ophthalmologist and diplomate of the American College of Lifestyle Medicine. She is the co-founder of Ketamine StartUp, an online course teaching physicians how to open their own ketamine infusion clinic. Dr. 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, CA.
She is a graduate of Pacific Union College with a B.S. in Business Administration. She obtained her medical education at Loma Linda University where she also completed her ophthalmology residency. She has been trained in coaching by Co-Active Coaching Institute. She is passionate about professional development, and how patient care begins with personal healing and growth in physicians.
You can download your free ketamine clinic checklist and business plan worksheet at: https://ketaminestartup.com/revitalizingdoctor
Social media/ways to connect:
Dr. Kim Chan Ko's IG profile is @Drkimberlyko
Her husband and her's ketamine clinic @resetketamine (FB, IG, Twitter)
To learn more about starting your ketamine clinic, follow them: @ketaminestartup (FB, IG, Twitter)
MicroSkills is built on one core, easy-to-learn principle: every big goal, complicated task, healthy habit, and, yes, even what we think of as character traits, can be broken down into small, learnable, skills that can be practiced, and incorporated real-time. Pre-order wherever you buy your books or on Amazon; launches Apr 16.
In part 2 of my interview with Dr. Kimberly Chan Ko, we discuss the details of owning a ketamine clinic. We talk about the importance of exploring your why behind wanting to open your own practice and how to get started.
Kimberly Chan Ko, M.D. is a board-certified ophthalmologist and diplomate of the American College of Lifestyle Medicine. She is the co-founder of Ketamine StartUp, an online course teaching physicians how to open their own ketamine infusion clinic. Dr. 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, CA.
She is a graduate of Pacific Union College with a B.S. in Business Administration. She obtained her medical education at Loma Linda University where she also completed her ophthalmology residency. She has been trained in coaching by Co-Active Coaching Institute. She is passionate about professional development, and how patient care begins with personal healing and growth in physicians.
You can download your free ketamine clinic checklist and business plan worksheet at: https://ketaminestartup.com/revitalizingdoctor
Social media/ways to connect:
Dr. Kim Chan Ko's IG profile is @Drkimberlyko
Her husband and her's ketamine clinic @resetketamine (FB, IG, Twitter)
To learn more about starting your ketamine clinic, follow them: @ketaminestartup (FB, IG, Twitter)
MicroSkills is built on one core, easy-to-learn principle: every big goal, complicated task, healthy habit, and, yes, even what we think of as character traits, can be broken down into small, learnable, skills that can be practiced, and incorporated real-time. Pre-order wherever you buy your books or on Amazon; launches Apr 16.
Andrea Austin, MD:
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:
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.
Andrea Austin, MD:
So what type of patients access a ketamine clinic?
Kimberly Ko, MD:
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:
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:
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.
Andrea Austin, MD:
I've 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:
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:
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 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:
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.
Andrea Austin, MD:
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:
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.
Andrea Austin, MD:
Correct me if I'm wrong, but you do have a resource that people can see if their community is already saturated?
Kimberly Ko, MD:
Yes, there's a couple things. First, the resource you're talking about is www.askp.org, or the American Society of Ketamine Physicians, Psychotherapists & Practitioners. They just had a rebranding of their name. There is a directory in there that you can put your zip code in and we utilize this for both physicians that want to start a clinic, as well as patients. We'll have somebody call us from like Milwaukee and because they really like our videos and we see if there's somebody closer to them so they don't have to be committed to coming all the way out to see us. So that's a great resource both for finding patients and all also if you're concerned about whether you’re too close to somebody else already practicing this.
For your listeners in particular, we have a free resource at www.ketaminestartup.com/revitalizingdoctor where you put your email in and then you'll get access to a free checklist that goes over all the main steps to starting a clinic, but also a business plan template that I created that is more geared towards starting a ketamine clinic. So check it out. For some people, just taking that step of checking it out and realizing that it’s too much or not as much as they thought is very clarifying.
Andrea Austin, MD:
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:
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.
Andrea Austin, MD:
I love that and that ties into Dr. Naomi Lawrence Reid's second episode, I think I titled it “Just take a step” so we're seeing that as a theme throughout the guests we've had on season one of the podcast. Actually I was coaching somebody today that has, you know the term “BHAG” which is a big, hairy, audacious goal. We were going through the sub goals and steps to get there. So that's a great message as we tie up.
I want to make sure our listeners know how they can connect with you. I know you've mentioned your website a couple of times but are you on Twitter or Instagram or any other ways?
Kimberly Ko, MD:
If you're curious about our ketamine clinic just purely for your potential patients, yourself, or whatever it may be, we're at resetketamine.com and we're the same handle for all the social media accounts. We have an active instagram and all that. If you're curious about learning how to start a practice and what it's like to own a ketamine practice, that's ketaminestartup.com as well as the same handle for all the social media. We're mostly active on Instagram and we do also have Twitter which is @ketaminestartup. Me personally, I have an Instagram which is @drkimberlyko, but if you're really interested in exploring the whole ketamine world, the two aforementioned websites are key. Also the one for your listeners in particular, this is only where you can get that business plan, because we wanted to make something special for you guys.
Andrea Austin, MD:
Wow that is such an awesome gift and I can't wait to share that. We'll make sure that link is in the show notes, we'll feature it in our next Revitalize newsletter as well. So that is so cool. Our listeners can start making their own business plan or may see that ketamine sounds exciting. I think when you're really burned out, it's not uncommon that a lot of things are going to sound exciting because you're unhappy and what you said earlier is the message we're seeing a lot of times is that you don't know what you want or what you don't want. So working with a coach to clarify your values will really help to make it more clear on what you actually do want, but I also think, and Naomi talked about this in her episode too, is it's okay to try stuff, it's okay to explore this and maybe spend a couple months looking into if a ketamine clinic works out for you. And even if you decide ultimately that's not going to be a good fit for you, there's so much that you learned through that process.
Kimberly Ko, MD:
Totally, I mean I thought I was going to be a YouTuber for a hot minute. By the way, I loved that episode with Dr. Naomi. Just take action, just try things out, action brings clarity.
Andrea Austin, MD:
I love that: action brings clarity. Oh my gosh I think you just made the title of the episode, “action brings clarity.”
Kimberly Ko, MD:
I had to throw in some sort of vision related thing.
Andrea Austin, MD:
Awesome, thank you so much Dr. Kim for being on the podcast, and I'm gonna have to have you back. I actually think my call to action for our listeners is to go ahead and come up with some questions that you have for Kim. You can tweet at both of us or email me or reach out to her directly and we can do a follow-up episode of listener questions related to starting your own ketamine practice. How does that sound?
Kimberly Ko, MD:
That sounds great, I would love to. This was a blast, I had so much fun. I’m not usually this chatty, so that means I had a good time.
Andrea Austin, MD:
Awesome, alright, thanks and I will see you back next time.
Kimberly Ko, MD:
Thank you.