I doubt you want to go custom made. A standard point collar works well with a pin. See if www.tiebar.com has any. If the spread on the collar is too wide, it will not hold together. Also, I question the use of this accessory--something of an affectation, IMO, especially without a dressy suit. But since most doctors dress like shit, with hideous ties and "comfortable shoes" (plus chinos), you'll stand out for sure! Good luck with it.