If you’re a hospital-based anesthesiologist considering private practice, you’ve probably had several people suggest opening a ketamine clinic.
Just hold on a second before you max out your credit card on psychedelic-themed decor and infusion chairs as we explore why the ketamine gold rush might end up leaving you with fool’s gold, and why specializing in the high-demand field of spinal leak care is a more sustainable alternative.
The pain management field is imploding as insurance fraud crackdowns, slashed reimbursements for procedures like epidural steroid injections (ESIs), and a growing number of patients who aren’t getting their needs met have turned this once-lucrative specialty into a minefield for anesthesiologists considering opening pain management clinics.
Ketamine clinics are now being peddled as the next big thing, but there’s a more sustainable private practice path for anesthesiologists: spinal leak treatment using fluoroscopy-guided epidural blood patches (EBPs).
Let’s explore why ketamine clinics aren’t the slam dunk many anesthesiologists think they are and how your experience with epidurals and nerve blocks makes you uniquely qualified to dominate an underserved market valued at a trillion dollars.
You didn’t survive med school and residency to chase cash-paying patients seeking psychedelic therapy for chronic pain or depression. Don’t get fooled by the countless ketamine clinic consultants, medical sales companies, and alternative medicine investors claiming it's a great niche to build a private practice around.
Here’s the reality:
The spinal care market has emerged as a goldmine for anesthesiologists with hospital experience looking to transition to private practice. This includes:
The demand for fluoroscopy-guided EBPs is growing while ketamine clinics fight over a shrinking pie. Some of the reasons for the tremendous demand for spinal leak care include:
Spinal leak patients often spend years bouncing between neurologists and radiologists, going from one misdiagnosis and unnecessary treatment to another. Online forums have turned patients into knowledgeable advocates for themselves as they look to figure out the cause of their chronic pain.
Many patients now demand fluoroscopy-guided EBPs, the gold standard for spinal leaks, while avoiding physicians who think lumbar punctures are an appropriate way to diagnose CSF leaks, despite research showing the non-invasive Bern Score combined with brain imaging is more accurate.
Radiologists have high failure rates due to misinformed practices like using 22-gauge needles and performing multi-level (even at the same time) transforaminal EBPs of only 4 mLs or less for an initial approach. In general reviews of their work, radiologists have demonstrated that they do not understand how blood naturally flows in the epidural space around the spinal cord even with an interlaminar approach and believe they must put the blood exactly at the leak spot. They also misbelieve that blood will remain where it was left instead of understanding that liquid migrates in an open space with low comprehension on the laws of physics involved here. Research shows fluoroscopy-guided epidural blood patches have a considerably higher success rate than blind procedures.
This makes anesthesiologists like you with epidural skills superheroes for patients with spinal leaks. These patients aren’t paying just for the procedure; they’re paying for your expertise and are willing to pay premium prices.
A subscription-based model can be highly effective for clinics specializing in spinal leak care. For instance, a structure of $100 per month in subscription fees, $300 per quarterly telehealth visit, and $750 per epidural blood patch (EBP)—administered as clinically indicated, both during initial treatment and later for relapse management—could generate over $800,000 annually with a patient panel of just 200 individuals.
To be clear: we do not advocate patching for profit. We advocate patching based on need, as supported by clinical research. We firmly reject any financial framework that pressures patients into procedures. Instead, we promote models built around what patients value and consent to—and we help you evolve your clinic operations to align with this while remaining financially viable and ethically sound. For example, if you onboard 200 patients and none of them opt for an EBP after receiving comprehensive education during consultations, that’s a valid outcome. We will enforce an ethics clause in our B2B contracts if we discover that a provider is pushing procedures inappropriately.
Our role is to help you build a customized, research-supported model based on your unique patient population—one that may include more frequent telehealth visits, greater emphasis on non-invasive alternatives, or other high-value services. Simultaneously, we encourage providers to refine their patching techniques and document outcomes, such as improvements on the Bern score pre- and post-EBP, for patients who do opt in. Lastly, we strongly recommend having a healthcare attorney on your advisory team to ensure regulatory compliance, safeguard documentation standards, and minimize legal risk so that you can focus on delivering patient-centered care with confidence and integrity.
Think private practice is for you? Here’s how to test the waters while keeping your hospital job:
Launching a virtual clinic lets you slowly transition to private practice while keeping your initial investment low. Use telehealth tools to help patients understand their MRIs and make diagnoses. These sessions also help build trust with patients.
Patients are constantly searching for information about whether they actually need a lumbar puncture or whether a spinal CSF leak heals by itself. These are perfect opportunities to provide telehealth visits with patient education, such as educating patients on how to self-advocate before procedures with radiology for the needle type least likely to cause post-dural puncture headaches (PDPH).
Seek opportunities for hands-on fluoroscopy training, such as fellowships, mini-fellowships, or shadowing. This will make your practice more attractive to knowledgeable patients seeking spinal leak care and reduce failure rates. It will also let potential patients know their well-being is your top priority.
The demand for comprehensive spinal CSF leak care is high, so make sure the people who need your services know how to find you. Hire a marketing team to launch a search engine optimization (SEO) campaign that targets keywords patients would search on search engines. Make your SEO campaign a two-way channel of communication. Are you noticing other related keywords popping up from patient searches? Make sure you are educating yourselves on these additional topics to be better prepared for patient consultations.
Highlight your hospital-grade expertise with epidural blood patches and cater to patient pain points on your website. Spend time on online support groups as a silent observer to understand potential patients’ perspectives.
Track success rates with before/after Bern score readings on brain MRIs and patient testimonials to combine quantitative and qualitative measures of success. Patients don’t mind paying premium prices for proven results, so scale up your practice as your patient base grows and your patient results speak for themselves.
The collapse of traditional pain management clinics isn’t a crisis—it's your time to shine as an anesthesiologist. You can build a profitable, purposeful, and sustainable practice by focusing on the high-demand spinal leak care market instead of gambling on fads like ketamine treatment.
Unlike ketamine clinics, which require aggressive marketing to counter poor patient retention, image-guided EBPs are in high demand, have better cash-pay potential, and are more likely to lead to long-term relationships. You don’t just get financially rewarded for your epidural skills; you get to watch patients go from bedridden in isolation to rejoining the upright world without any ketamine!
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