Episode 48 - Does a Physician Need to Be Present During Ketamine Infusions?
Kim and Sam explore whether physicians must be present during ketamine infusions, covering current regulations, scope of practice considerations, and different clinic staffing models.
Welcome back to the Ketamine Startup Podcast! It's great to be back with you for our first new episode of 2026. After sharing a couple episodes from the vault in December, we are excited to dive back into fresh content.
In this episode, we tackle the most frequently asked question we get: "Do I need to be present in the room during every ketamine infusion?"
This isn't just about regulations. It's about balancing autonomy, patient safety, business scalability, and your personal values as you transition from traditional healthcare to private practice.
We explore the complex regulatory landscape across different states, the tension between wanting professional freedom and providing exemplary patient care, and the practical considerations every clinic owner must navigate. We share our own philosophy and approach while acknowledging the legitimate business and personal factors that influence these critical decisions.
What You'll Learn in This Episode:
The "loved one test" for making staffing decisions: a simple framework to determine your comfort level and standards
State by state regulatory variations: why Texas, Utah, and California have different requirements and what that means for you
The business reality of scaling vs. safety: how to balance growth aspirations with quality patient care
Building reputation in a small community: why integrity matters more than short term profit in the ketamine field
Key Takeaways:
Federal regulations currently does not require physician presence during ketamine infusions, but individual states have specific requirements that vary significantly
The "loved one test" can help providers decide staffing models: What level of supervision would you want for your own family member receiving treatment?
Providers seeking to scale beyond personal capacity may need to balance autonomy goals with quality care standards and regulatory requirements
Starting with physician presence could allow providers to understand all aspects of care before potentially delegating to qualified staff
Malpractice insurance requirements might influence staffing decisions regardless of regulatory minimums
The ketamine therapy field currently remains a "regulatory wild west" where many questions about best practices haven't been fully answered
Listen to the episode on Apple Podcasts, Spotify, Overcast, or on your favorite podcast platform. Watch the discussion on YouTube here.
Episode 48 show notes:
00:00 Teaser - The most common question…
02:25 The "loved one test": What would you want for your family member receiving treatment?
04:23 Balancing autonomy vs. quality care: The tension clinicians face leaving traditional healthcare
06:32 Federal vs. state regulatory landscape: How regulations vary across different states
09:37 Scope of practice considerations and corporate practice of medicine laws
12:01 Philosophy behind practice decisions: What's right for you and your patients
13:28 Sam's approach: Why he's always present and recommends starting that way
16:56 Balancing physician wellbeing with high-quality patient care
19:26 State-specific research requirements: Medical board, legal, and insurance considerations
21:05 Malpractice insurance requirements and how they affect your practice decisions
23:03 Final recommendations: The decision framework based on your values
24:44 Closing thoughts: What would you want for your loved one?
Thanks for listening
Professional Education Disclaimer: The following information is for educational purposes only and does not constitute medical, legal, or business advice. Clinical approaches discussed reflect individual experiences and should be evaluated within your practice context. Regulatory requirements and business practices vary by jurisdiction. Always consult qualified healthcare, legal, and business professionals for specific patient care decisions and practice requirements.
Frequently Asked Questions
Do I legally need to be in the room during every ketamine infusion?
Federal regulations currently does not specifically require physician presence during ketamine infusions, but state requirements could vary significantly. Some states s might require onsite physician presence, while others may have different staffing requirements or allow qualified mid-level providers with appropriate supervision. Providers should research their specific state medical board requirements and consult with healthcare attorneys familiar with local regulations.
How do I decide what level of supervision is appropriate for my practice?
Consider applying the "loved one test" - what level of care and supervision would you want if your family member was receiving ketamine treatment? Some providers might feel comfortable with trained nursing staff and physician availability, while others may prefer direct physician presence. Factors to consider could include patient acuity, staff training levels, emergency response capabilities, and your own comfort with delegation.
Can I scale my ketamine therapy practice without being present for every treatment?
Scaling may depend on state regulations, scope of practice laws, and your practice model. Some providers might use nurse practitioners or physician assistants with appropriate supervision, while others may train nursing staff for certain aspects of care. The economics of having physicians present for every treatment could impact scalability, but providers should balance business considerations with patient safety and regulatory compliance.
What should I consider before delegating ketamine administration to other providers?
Providers might consider starting by personally performing all aspects of treatment to understand the complete process before delegating. Important factors could include state scope of practice laws, staff credentials and training, malpractice insurance coverage, emergency response protocols, and corporate practice of medicine restrictions. Some providers find that understanding every step personally helps them delegate more effectively later.
How do malpractice insurance requirements affect staffing decisions?
Insurance carriers might have specific requirements for supervision and staffing that could be more restrictive than regulatory minimums. Some policies may require physician presence, specific staff certifications, or particular supervision models. Providers should review their coverage requirements with their insurance carriers and consider how these might impact their preferred practice model, as coverage requirements could effectively override more permissive state regulations.
Want to go deeper on some of these topics? Check out these related episodes:
Episode 007 - Who Can Open A Ketamine Therapy Clinic?
Episode 034 - Ketamine Clinic Insurance: Expert Insights with Canyon Clifton