Isn't a psychiatrist 'higher level' than a CRNA?

Different specialties, not a hierarchy. A psychiatrist is the right clinician to evaluate whether ketamine is appropriate for your diagnosis and to manage your overall mental-health care. A CRNA is the clinician trained to actually administer an IV anesthetic and monitor you during it. Many strong programs use both. The question is not 'which credential is higher' but 'who is at the controls during the infusion itself.'

Are CRNAs allowed to give ketamine without an MD on site?

It depends on the state. In Tennessee, CRNAs practice within a defined scope that includes anesthesia administration in office-based settings, following the AANA Standards for Office-Based Anesthesia Practice. Music City Ketamine operates within Tennessee's regulatory framework. For the specifics of how Tennessee licenses and oversees ketamine clinics, see our overview of Tennessee ketamine clinic regulations.

Why does anesthesia training matter for a sub-anesthetic dose?

Because the same complications that can occur at full anesthetic doses can still occur at sub-anesthetic doses, just less often. Blood pressure can rise, breathing can become shallow, emergence reactions can spike anxiety, and rare airway events still happen. Anesthesia training is for the moments when things deviate, not the moments when everything goes smoothly. The training is what is in the room when you need it.

Does Music City Ketamine have an MD involved as well?

Music City Ketamine operates under Tennessee's CRNA practice framework with the supervising-physician relationships required by state regulation. The clinician administering and monitoring your IV ketamine is Marla Peterson, CRNA. We are transparent about who is in the room and what their training is. If you want a clinic where a psychiatrist also evaluates and manages your mental-health care, we are happy to coordinate with your existing prescriber.

Why a CRNA-Led Ketamine Clinic Matters (vs. MD-, DNP-, or RN-Led Models)

Q: What about an RN-only clinic with an MD medical director off-site?

The honest answer is that this is a scope-of-practice question that varies by state. An RN can monitor vitals and administer medications under appropriate supervision. Whether an RN can independently titrate IV ketamine without an anesthesia provider physically on site is regulated differently across jurisdictions. A reasonable question to ask any clinic is simply: who is physically in the building during the infusion, and what is their training?

What “leadership” actually means inside a ketamine clinic

The phrase “CRNA-led” or “MD-led” ketamine clinic gets used in marketing more than it gets defined. From the patient’s perspective, only one question really matters: who is physically in the room running the IV during your infusion, and what is their training?

An IV ketamine session is, in clinical terms, an anesthetic procedure. The dose is sub-anesthetic, but the medication is the same one used in operating rooms. It produces dissociation, sedation, and predictable cardiovascular effects—blood pressure can rise, heart rate can climb, breathing can become shallow, and emergence reactions can spike anxiety. Most sessions are uneventful. The training is for the sessions that are not.

That is why the credentials of the person at the controls—not the medical director’s name on the website, not the CEO’s degree—are the meaningful question. Ketamine’s safety profile is excellent when it is administered by clinicians trained to manage anesthetics. It is less excellent when it is not.

Ketamine is FDA-approved as an anesthetic. Its use for depression, anxiety, PTSD, and chronic pain is off-label. That off-label status does not change the underlying pharmacology: the medication still acts as an anesthetic agent regardless of the indication.

What a CRNA is trained to do that other clinicians are not

A Certified Registered Nurse Anesthetist (CRNA) is an advanced practice registered nurse who has completed an accredited doctoral nurse-anesthesia program after years of critical-care nursing experience. The training is specifically and exclusively about administering anesthesia: induction agents, sedation, airway management, hemodynamic monitoring, and emergency response.

According to the American Association of Nurse Anesthesiology’s Scope of Nurse Anesthesia Practice (2023), CRNAs deliver the full spectrum of anesthesia care across operating rooms, ambulatory surgery centers, and office-based practices. They are trained in Advanced Cardiac Life Support (ACLS), airway management, and the full chain of emergency response that an anesthetic procedure can require. CRNAs administer roughly 50 million anesthetics in the United States each year, including the majority of anesthetics in rural hospitals and a large share of office-based sedation cases.

That training is what an IV ketamine session draws on. Setting an IV, calculating the right dose, titrating to clinical effect, recognizing the early signs of a problem, and managing it before it escalates—that is the daily work of anesthesia practice. A CRNA brings that whole skill set into the ketamine room, even when the dose is small and the session is calm.

Other excellent clinicians—psychiatrists, family-medicine physicians, DNPs, RNs—bring different skill sets that matter elsewhere in the care pathway. The point is not that CRNAs are “better” than other providers. The point is that anesthesia training is the right training for the specific moment when a sedating IV medication is going into a patient’s arm.

AANA office-based anesthesia standards—the rulebook MCK follows

When anesthesia happens outside a hospital, the AANA’s Standards for Office-Based Anesthesia Practice (2020) are the published baseline for how it should be delivered. The standards require a qualified anesthesia provider, continuous monitoring of oxygenation, ventilation, circulation, and level of consciousness, and an anesthesia provider in continuous attendance throughout the procedure. They also require resuscitation equipment, emergency drugs, and a documented plan for transfer if a higher level of care becomes necessary.

These are not optional. They are the standard the profession has set for itself for any anesthetic delivered in an office, including IV ketamine. A clinic can describe itself however it wants in its marketing; what matters is whether its practical setup—monitoring, drugs, equipment, training of the person in the room—actually meets that bar.

The American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3) Standards of Care for Ketamine Therapy (2024) reach a similar conclusion from a different direction: IV ketamine sessions should be conducted by a clinician trained in ACLS and airway management, with continuous vital-sign monitoring and qualified emergency-response capability on site. That language is consistent with what CRNA training already provides as a baseline.

MD-led clinics: what they do well, and where the model strains

Many ketamine clinics are led by physicians—psychiatrists, anesthesiologists, emergency-medicine docs, family-medicine docs. The strongest of these clinics use that medical training in the places it matters most: differential diagnosis, medication review, coordination with prescribers, complex psychiatric assessment.

The model strains when the MD’s specialty is not anesthesia and the MD is also the person actually running the infusion. A psychiatrist is the right clinician to evaluate whether ketamine is appropriate for treatment-resistant depression, bipolar depression, or PTSD; that is exactly what their training is for. A family-medicine physician can be excellent at primary care and medication management. Neither specialty is anesthesia, and neither training pathway emphasizes airway management or hemodynamic rescue at the same depth as a nurse-anesthesia or anesthesiology program.

That gap is closeable. An MD-led clinic that staffs a CRNA or anesthesiologist for the infusion itself, or that has a physician with explicit anesthesia training in the room, has the same safety floor a CRNA-led clinic does. An MD-led clinic that does not—where the psychiatrist or PCP is also pushing the medication and watching the monitor—has a different floor. Neither is necessarily “wrong.” They are different clinical models, and patients deserve to know which one they are walking into.

DNP- or RN-led clinics: the scope-of-practice question

A Doctor of Nursing Practice (DNP) is a terminal nursing degree. It is not, by itself, an anesthesia credential. A DNP can be a psychiatric nurse practitioner, a family nurse practitioner, or any number of other specialties. CRNAs typically hold a DNP in nurse anesthesia—but a DNP without nurse-anesthesia training is not the same thing.

RN-only models, where a registered nurse administers ketamine under an off-site medical director, raise a more direct scope-of-practice question. RNs are excellent at vital-sign monitoring and medication administration under supervision. Whether an RN can independently titrate IV ketamine without an anesthesia provider physically in the building varies by state and by interpretation of state nurse practice acts. Tennessee’s framework, like most states’, treats anesthesia as a defined practice area with specific credentialing.

If you are evaluating an RN-led or DNP-led clinic, the fair question is the same one to ask any clinic: who is in the building during your infusion, what is their training, and what is the plan if your blood pressure spikes or your breathing changes?

Psychiatrist-led models: strong on selection, variable on monitoring

Psychiatrist-led ketamine clinics are often the strongest in the country at patient selection—at deciding who is a good candidate, what the working diagnosis is, how ketamine fits with the patient’s other treatments, and how to stay coordinated with the rest of the mental-health care team. That is exactly what a psychiatrist’s training is for, and it is genuinely valuable.

Where these models vary is on the monitoring side. Some psychiatrist-led clinics partner with anesthesiologists or CRNAs for the infusion itself. Some run intramuscular or intranasal protocols that have a different risk profile than IV. Some hire RNs to monitor while the psychiatrist sees other patients. The label “psychiatrist-led” covers all of these. The practical question is, again, who is at the controls during your specific infusion.

Why “who runs the pump” is the right question to ask

Patients shopping ketamine clinics often get distracted by credentials that do not actually answer the safety question. A clinic with an impressive medical advisory board, a published medical director, and beautiful branding can still have an undertrained person running the actual infusion. A clinic with simpler marketing can have a CRNA in every room.

The cleanest question to ask any ketamine clinic is: “Who is physically in the building during the infusion, what is their training in airway management and ACLS, and are they monitoring me throughout?” A good clinic will answer that question directly. A clinic that dodges it is telling you something.

This is not a knock on any other model. Many MD-led, psychiatrist-led, and DNP-led clinics deliver excellent care. The point is that “CRNA-led” means something specific—that the person trained in anesthesia is the person delivering the anesthetic—and patients are entitled to know that distinction so they can make an informed choice.

What this looks like at Music City Ketamine

At Music City Ketamine, Marla Peterson is the CRNA who oversees every infusion. She sets the IV, calculates the dose, runs the pump, watches the monitor, and is available throughout the session. Continuous pulse oximetry, blood pressure, and heart rate tracking are standard. Resuscitation equipment and emergency medications are on site. The clinic operates within the AANA office-based anesthesia framework and Tennessee’s scope-of-practice rules for CRNAs.

That is the “CRNA-led” model in practice: anesthesia-level monitoring delivered by an anesthesia-trained clinician, in a setting designed for it. Marla’s role during your session is the clinical anchor of the whole experience.

We coordinate with your prescribing psychiatrist or primary care provider for diagnostic and medication-management questions, because that is their training and their relationship with you. We do not try to be your psychiatrist; we try to be the safest place to receive an IV ketamine infusion in middle Tennessee. Sessions at Music City Ketamine are $475 each, and we are transparent about cost from the first conversation.

If you are comparing clinics—and you should—ask each of them the same question: who is in the room, what is their training, and what is the plan if something deviates? You will learn a lot from the answers. For our overview of the clinic landscape in the region, see our guide to the best ketamine clinics in Nashville.