Most doctors dream about leaving the ER grind, but here's what's remarkable: Dr. Nico Grundmann didn't just escape - he built something that's actually changing how we think about mental healthcare at scale.

In this conversation, Sam sits down with Dr. Grundmann, an emergency physician who took his systems-thinking background and created something unprecedented: a five-location ketamine practice that's generating the kind of data insurance companies actually pay attention to. We're talking about going from solo practitioner to managing 30 team members while maintaining the clinical rigor that makes this work sustainable.

What makes this conversation essential listening? Dr. Grundmann's approach shows exactly how individual practices can drive policy-level change - but it requires thinking beyond your patient panel to the broader healthcare system. His story proves that with the right framework, you can build something that's both profitable and positioned to influence national coverage decisions.

If you've ever wondered how to scale beyond a single clinic without losing clinical quality, or if you're curious about what it really takes to collect data that insurance companies respect, this conversation will give you the roadmap you need.

What You'll Learn in This Episode

🔹 The mindset shifts required when moving from ER medicine to longitudinal ketamine therapy practice

🔹 Clinical evidence behind protocol decisions including the 4 vs 6 infusion debate and IV superiority data 

🔹 Systematic approach to scaling from single pilot site to five-location practice with team management insights

🔹 Insurance advocacy through data collection and the long-term strategy for coverage expansion

Episode 40 show notes:

00:00 Teaser - Ketamine isn’t Treat-And-Release

00:22 Welcome to the Ketamine Startup Podcast

00:29 Interview with Dr. Nico Gruman

01:42 Dr. Gruman's Background and Journey

04:28 Founding Ember Health

05:50 Scaling the Practice

06:29 Challenges and Strategies

07:24 Building a Collaborative Care Model

09:10 Pilot Site and Early Days

16:45 Navigating Insurance and Policy

19:10 Advice for Aspiring Clinic Owners

27:01 Longitudinal Care and Patient Relationships

32:35 Hands-On Training and Patient Care

33:47 The Importance of Patient Trust

35:14 Patient Onboarding Process

36:54 Treatment Protocols and Success Rates

38:12 Long-Term Care and Maintenance

40:17 The 4 vs 6 Treatment Debate

43:07 Mechanisms of Ketamine

47:10 Route of Administration and Safety

51:59 Advice for New Practitioners

54:07 Personal Insights and Hobbies

01:00:02 Final Thoughts and Contact Information

Thanks for listening

Listen to the episode on Apple Podcasts, Spotify, Overcast, or on your favorite podcast platform. Watch the discussion on YouTube here.

Connect with Dr. Grudmann at:

Ember Health Website

Linkedin

Instagram

Selected Links From the Episode:

McIntyre RS, Rodrigues NB, Lee Y, Lipsitz O, Subramaniapillai M, Gill H, Nasri F, Majeed A, Lui LMW, Senyk O, Phan L, Carvalho IP, Siegel A, Mansur RB, Brietzke E, Kratiuk K, Arekapudi AK, Abrishami A, Chau EH, Szpejda W, Rosenblat JD. The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: Results from the Canadian Rapid Treatment Center of Excellence. J Affect Disord. 2020 Sep 1;274:903-910. doi: 10.1016/j.jad.2020.05.088. Epub 2020 May 26. PMID: 32664031.

Wilkinson ST, Rhee TG, Joormann J, Webler R, Ortiz Lopez M, Kitay B, Fasula M, Elder C, Fenton L, Sanacora G. Cognitive Behavioral Therapy to Sustain the Antidepressant Effects of Ketamine in Treatment-Resistant Depression: A Randomized Clinical Trial. Psychother Psychosom. 2021;90(5):318-327. doi: 10.1159/000517074. Epub 2021 Jun 29. PMID: 34186531.

🤖 OpenEvidence

📗 Stranger in a Strange Land by Robert Heinlein

Linkedin

Ketamine StartUp Website

YouTube

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