Why I Quit Emergency Medicine To Start My Own Ketamine Clinic

In 2017, Sam Ko had the choice to become the medical director of the emergency department at San Gorgonio Memorial Hospital, located outside Palm Springs, California. At the time, he was an attending ER physician and the department's associate director.

A promotion to director would have been a logical career step — and a well-paid one. Sam's background, which included a dual MBA and MD, was well suited to an administrative leadership role. Sam’s boss at San Gorgonio told him he could potentially go on to be the department’s executive VP, or even the regional medical director.

“I was like, ‘You know what? That's not really my purpose in life,’” Sam told Offcall. “And I would rather do something that makes less money, but at the same time, I can help more patients.”

So, instead, he continued developing what would become Reset Ketamine, a ketamine-infusion clinic in Palm Springs. After two years of behind-the-scenes work by him and his wife, Kimberly Chan Ko, a physician and ophthalmologist, Reset opened in April 2018. In 2021, Sam left the ER to work as a full-time ketamine specialist. This is Sam’s Side Gig Story.

When spirituality meets entrepreneurship

Sam and Kimberly created Reset to treat people with depression, anxiety, PTSD, and chronic pain using a cutting-edge (and sometimes controversial, according to Sam) approach. Looking back on his career before he started work on Reset in 2016, Sam feels there were hints of the type of business he’d go on to build.

One of the first hints was where he was trained. Sam earned his MD and MBA from the University of Rochester, where Drs. George Engel and John Romano created a holistic model of medicine, called the bio-psycho-social model, in 1977. Sam drew inspiration from this model, and added another element to it — at Reset, he practices bio-psycho-social-spiritual medicine.

For Sam, that means looking beyond standard lifestyle changes and examining how factors such as media consumption, relationships, and work life contribute to a patient's overall health. “I really think about the use of IV ketamine as a catalyst, rather than just this one tool,” said Sam, “to help with neuroplasticity, so you can use that to make the changes.”

Spirituality in medicine reemerged during Sam's residency at Loma Linda, a hospital affiliated with Seventh-day Adventism, a wing of the Protestant church. There, Sam was struck by the doctor-patient interactions he observed. Once (after receiving permission), a physician prayed for a patient. “I could just tell that the patient really appreciated it,” he said.

Sam also points to other, less conventional credentials for his success in the ketamine space. Namely, he's a reiki master and a certified life coach.

Originally, Sam became a life coach because he wanted to work with burnt-out doctors. Although that didn’t take off, Sam says his coaching skills enhanced his bedside manner in the ER. Those skills also informed a subsequent business venture: an online course for physicians on how to start ketamine clinics.

By the time Sam learned about ketamine's off-label potential, he was already familiar with the drug — just in a different capacity. He had administered IV ketamine to ER patients “a thousand times” for sedation. Then, a years-old study on ketamine usage in patients with major depression piqued his interest in the drug's mental health benefits.

Sam got up to speed on the ketamine literature — he read the The Ketamine Papers, a book of essays that explores the history and growing use of ketamine in psychiatry, and began diligently tracking new research. “Anyone who’s interested in entering the ketamine space should be reading every scientific published article about ketamine and mental health,” said Sam. He added that because there are “hundreds” of them, you’d at least need to review the abstracts.

“I saw that it really could be effective for patients who were suffering,” Sam said. “I decided to do something a little bit more creative, a bit more out there, and took the leap.”

Making a business plan as a physician

He couldn’t take the leap into opening a clinic, however, without doing prep work. As Sam points out, none of what he needed to do — e.g., create a business plan, hire workers, negotiate real estate, buy supplies, begin marketing his services — is covered in medical school.

Even having an MBA wasn’t enough to make the process easy. “Business school is still quite theoretical,” said Sam. “The biggest thing is coming up with a business plan and writing it down, even though the clinic may not open according to that plan exactly,” said Sam.

A business plan usually includes things like your company’s mission statement, market and competitor research, a description of your business’s offerings, and how you’ll reach patients or customers. Despite having an actual MBA, Sam says he got help writing his business plan in part from The Personal MBA, a best-selling business book.

Sam also looped in his network. His mentor, another ER physician, owned a large ambulance company. Sam went to him with ideas, as well as questions about things like handling risk.

Sam and Kimberly made it a priority to keep overhead costs low in the beginning. For example, they found their first rental space in Palm Springs (which wasn’t Sam’s preferred location) for around $1,000 a month.

Sweat equity also powered the clinic for a while, Sam said: “We were cleaning the toilets, we were sweeping. We’re answering phone calls. We were making the videos, editing the videos.”

They’ve since outsourced some tasks and added virtual assistants to their roster. Once again, Sam learned by reading; he credits the book Who for guidance on how to hire workers.

Charting a new course

After Reset opened its doors in 2018, Sam’s colleagues took notice, and asked for his advice about their own business ventures. “I was doing consulting, all for free, just because they were friends,” said Sam. He added that life coaching became an asset once more for this work. “But then it became unsustainable. How do I juggle helping my colleagues, plus running the practice, plus doing these other ventures?”

So, he came up with a solution: He created a course, which he later called Ketamine StartUp, about how to start a ketamine clinic. Like Reset, it was a joint venture with Kimberly, who took a course on how to create a course. “It was kind of meta,” said Sam.

Kimberly and Sam put the course up in December 2020 with an introductory offer, just to see if there was interest. The course involved both synchronous and asynchronous elements and cost a few thousand dollars. The first cohort was around three to five people.

“We had the vision for it, we sold it, and then we had to create it,” said Sam. “And so every week, we're like, all right, this has to be released. And so my wife and I are in our house shooting video until midnight.” On top of that, Sam and Kimberly had just welcomed home their newborn daughter, who can perhaps be heard crying in the background of early versions of Ketamine StartUp modules.

The work paid off. So far, the course has given rise to 20 ketamine clinics in the US, and more are on the way, according to Sam. Although he’s not a business attorney, from watching his students, he’s learned about hurdles that different states impose before a clinic can open. For example, some but not all states have corporate practice of medicine (CPOM) laws, which require that a clinic can only be opened by a medical professional.

Though ketamine clinics have started opening in other states, partially thanks to Sam and Kimberly’s work, Reset Ketamine still attracts patients from all over the country and even Canada. Because clinics like Reset administer ketamine for off-label use, treatment often isn’t covered by insurance.

“I think that’s kind of bogus, but that’s the reasoning the insurance company uses,” said Sam. However, some insurance companies have begun to reimburse patients’ out-of-pocket costs, which Sam finds promising.

Even with the challenges, Sam has continued to expand his services. Reset now offers additional treatments, like stellate ganglion block (SGB) procedures and vitamin infusions. “From year one to year two, there was probably 50% growth, and then maybe 20% to 30% each year. It’s just been growing, growing, growing since then.”