Episode 65 – From Shift Work to Ketamine Clinic: What Actually Changes with Dr. Nico Grundmann (Soundbites from the Vault)
Dr. Nico Grundmann of Ember Health shares what shifts when you leave emergency medicine, what patient care looks like inside a ketamine clinic, and three pillars for building your own.
This Soundbite from the Vault packs three genuinely useful sections into one digestible clip, and each one stands on its own.
It opens with something most emergency medicine physicians quietly wonder about before making the pivot: what does it actually feel like to work in a ketamine clinic after years of shift work?
Dr. Nico Grundmann, founder of Ember Health in New York and an emergency physician with an MBA from Stanford, gives a refreshingly honest answer. The schedule changes. The mental model changes. The relationships you build with patients are unlike anything the ER allows. And for the right person, all of that is exactly the point.
The middle section pulls back the curtain on what patient care can actually look like. From the first call to the four-visit induction series to long-term maintenance care, Dr. Grundmann walks through the full patient journey at Ember, including their 84 percent real-world treatment response rate and why they believe the care coordination model is what drives it.
It closes with the three things Dr. Grundmann would tell anyone opening their own ketamine practice. Not generic advice. Specific, hard-won pillars that have shaped how Ember operates across five New York City locations and more than 2,200 patients treated.
What You'll Learn in This Episode:
An honest account of what actually changes when you move from emergency medicine to a ketamine clinic, including the parts most people do not talk about before making the leap
Why care coordination takes up 30 to 40 percent of the day at Ember and what that means for EM physicians who are used to handing off at the end of a shift
A clear picture of what the patient journey looks like inside a well-run ketamine practice, from first consultation through long-term maintenance care
Why Ember's real-world treatment response rate of 84 percent outperforms the published academic data of 75 percent and what Dr. Grundmann believes is driving that difference
The three pillars Dr. Grundmann would share with any provider opening their own ketamine clinic, built from years of operational experience across multiple sites
Key Takeaways:
The shift from emergency medicine to a ketamine clinic is a mental model change as much as a lifestyle change. The schedule becomes fixed, the relationships become longitudinal, and the ability to clock out and leave your patients behind goes away. For the right provider, those changes are deeply fulfilling. For the wrong one, they are a poor fit.
Care coordination is not a side function in a well-run ketamine clinic. At Ember, doctors spend 30 to 40 percent of their day talking to psychiatrists and therapists, managing panel relationships, and coaching patients through the emotional texture of long-term recovery. This is not a skill EM physicians typically develop in the emergency department and it is one of the most important adjustments to prepare for.
A structured four-visit induction series within 14 days, combined with concurrent psychotherapy and care coordination, appears to outperform the published clinical data. Ember's 84 percent treatment response rate versus the academic benchmark of 75 percent suggests that how you wrap care around the infusion matters as much as the infusion itself.
Ketamine therapy is not “treat and release”. Ember's patients stay in care for an average of two years, returning for maintenance infusions on a cadence that is individualized to their symptom pattern. Some return every two weeks. Some return twice a year. Building the infrastructure to support that variability is one of the less visible but most important operational challenges of running a ketamine practice.
The three pillars Dr. Grundmann returns to when advising clinic builders are patient feedback as a continuous input loop, relentless focus on team culture and staff experience, and operational intentionality, having a defensible reason for every clinical and structural decision you make.
Listen to the episode on Apple Podcasts, Spotify, Overcast, or on your favorite podcast platform. Watch the discussion on YouTube here.
Episode 65 show notes:
00:00:00 Teaser: "This isn't a role where you clock out and you're done."
00:00:13 Episode Introduction
00:01:25 What Is It Actually Like to Work in a Ketamine Clinic After Years of Shift Work?
00:03:20 Who Is a Good Fit: Longitudinal Care, Fixed Schedule, and Panel Management
00:05:00 For the Right Person It Checks Every Box: What the Fulfilling Version of This Work Looks Like
00:07:58 What Does the Patient Journey Actually Look Like from First Call to Treatment?
00:10:30 Real-World Treatment Response Data: 84 Percent at Ember vs. 75 Percent in Published Literature
00:12:33 Three Pieces of Advice for Anyone Opening Their Own Ketamine Clinic
00:14:36 Episode Ending
Thanks for Listening
Resources & Links From This Episode
Want to go deeper? This soundbite comes from Episode 040 – Episode 40 - Scaling Ketamine Clinics: From Pilot to Five Locations with Dr. Nico Grundmann, where we cover the full conversation including how Nico built Ember from a one-room pilot site to five locations in New York City and the systems thinking behind all of it.
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
What is the biggest mental model shift for EM physicians moving to a ketamine clinic?
According to Dr. Grundmann, the biggest adjustment is not the clinical work itself but the structure around it. Emergency medicine is built around shift work, a defined start and end, a handoff to the next provider, and the ability to leave your patients behind when you walk out the door. A ketamine clinic does not work that way. The patients you treat are yours longitudinally. They will reach out. You will think about them. And while you are not on call in the traditional sense, this is not a role where you clock out and feel fully done. For providers who have been quietly missing longitudinal relationships and the ability to follow someone through their recovery, that shift is a feature rather than a flaw.
How does a ketamine clinic typically structure the patient journey from first contact to long-term care?
While different clinics may vary in their exact structure, at Ember Health every patient journey begins with a free 30-minute call with one of their physicians. That call covers medical and psychological safety, clinical appropriateness, and an introduction to how ketamine works and what the protocol looks like. Ember requires patients to have a larger outside mental health care team before care begins, and connecting with that team is a prerequisite. Clinically appropriate patients then go through a four-visit induction series within 14 days, with visits never on consecutive days. After a successful induction, patients enter a structured long-term monitoring program where booster infusions are scheduled based on when their individual symptoms begin to return. On average according to Dr. Grundmann, Ember's patients can stay in care for approximately two years and return for a single booster infusion roughly every six weeks, though that cadence varies significantly from person to person.
What role does care coordination play in ketamine therapy outcomes?
Care coordination is increasingly understood as one of the most important variables in how well ketamine therapy works over time, not just the infusion itself. When patients have an assigned therapist or psychiatrist who is actively collaborating with the ketamine provider, the therapeutic gains from infusions appear to be more durable and more meaningful. At Ember Health, requiring patients to have an outside mental health care team before starting treatment is not just a safety measure, it is a clinical one. Dr. Grundmann notes that Ember can statistically see differences in outcomes between patients who are in concurrent therapy and those who are not. The infusion opens a window. What happens inside that window, and how well supported the patient is around it, shapes what is possible.
How much of a ketamine clinic doctor's day is spent on care coordination?
More than most EM physicians expect. At practices like Ember Health, approximately 30 to 40 percent of a physician's day is spent on care coordination, talking to psychiatrists, talking to therapists, and managing ongoing relationships with the mental health providers who oversee their shared patients. This is one of the most significant practical differences from emergency medicine, where consultations happen but ongoing day-to-day collaboration with the same providers over months or years does not. For providers considering this transition, it is one of the clearest signals of whether the role is likely to be a good fit. If the idea of spending a meaningful portion of your day in that kind of collaborative communication feels draining rather than energizing, that is worth knowing before you make the leap.
What advice does Dr. Grundmann give to providers opening their own ketamine clinic?
Dr. Grundmann points to three pillars that have shaped how Ember operates and that he believes apply broadly to anyone building a ketamine practice. The first is continuous patient feedback. Some of the most meaningful operational improvements come directly from listening to patients, not just clinically but through dedicated feedback conversations. The second is relentless focus on team culture. Because a ketamine clinic is a service-based business, the experience patients have is inseparable from how the staff feels showing up to deliver it. The third is operational intentionality, having a clear and defensible reason for every clinical and structural decision you make, from staffing ratios to visit structure to protocol design. His broader message is to avoid winging it and to build a practice where every choice has been made deliberately and can be articulated clearly to anyone who asks.