For starters, please consider I am biased source. I am applying to DA residency now and in no way do I want to start any kind of argument, but here is how I see it.
Scope of DA practice.
This is very broad and ranges across the board. From hospital base, to surgery centers, to academia, to private practice. I personally know a resident who just finished his program and was hired as the lead anesthesiologist of a surgery center. His job is to manage and hire the other staff for this surgery center. Obviously, he came from an outstanding program and is a very impressive individual but this is what he is now doing. I have heard of other DA's who practice solely in hospital setting providing anesthesia for the full range of cases (not just dental). I also believe another resident who just finished his program was hired to build a new DA program, but I can not verify this (I only heard this through second hand information). But you are correct, a majority of DA's do private practice and travel from office to office providing different levels of sedation for patients.
.
As far as your question about what makes a DA different then a CRNA or MD Anesth, there are in fact numerous differences.
#1. Medicine knows very little about the profession of dentistry. A DA is a Dentist who is also an anesthesiologist. Their knowledge of what the dental surgeon is trying to accomplish is a thousand fold that of any medical provider.
#2. All anesthesiologists training MD/DO or DDS/DMD is thoroughly rigorous and all are capable of providing general anesthesia in a clinic setting. However, this is the focus of DA training. There is huge difference between providing general anesthesia in a hospital and then turning the patient over to a nurse in the PACU for who knows how long to providing this service in private clinic where turnover is key.
#3. Many dentists find it very difficult to get a MD anesthesiologist to agree to come to a clinic and provide all of the necessary equipment to provide general anesthesia. Think about it, if you had a great job at a large hospital where everything is provide for you, not to mention the help of CRNAs, PACU nurses, etc why would you consider leaving to practice in a clinic where you would be responsible for everything including equipment?
#4. Many states are now passing sedation laws where the there must be a doctor in the clinic who has general anesthesia (MD or DA) training in order for that clinic to be licensed for deep sedation/general anesthesia. Thus, if you were to use a CRNA the practicing dentist must have this training. This guideline is becoming more and more common.
Why DA as a recognized specialty?
#1. Most of us can agree that the field of dentistry believes it should be in charge of its own guidelines for sedation, general anestesia, etc. Recently, this has come under attack. In fact just recently the ASA (American Society of Anesthesiology) passed a guideline that all moderate sedations now require Endtital CO2 readings. There is an excellent article in Anesthesia Progress (dentistry's anesthesia magazine) about why guidelines for hospital-based anesthesia do not apply directly to clinical dentistry. Furthermore, OMFS has come under scrutiny for practicing in the single sedation/operator model as opposed to medical model where this role is done by two distinct doctors. This despite OMFS superior track record of safety. If dentistry wants to be able to govern their own guidelines for anesthesia/sedation then there must be specialists within the field to lead the way. Having dental anesthesiology as a recognized specialty will protect all dentists who provide sedation whether it is minimal, moderate, or deep. Please remember in some parts of the world no dentists can provide any sedation. American dentistry created anesthesia and we need to be sovereign in our ability to regulate it.
Finally you may ask why not just go to the hospital for people who require deep/general anesthesia?
#1. Cost. The cost difference between providing this service in a clinic and hospital environment is substantial. You are saving your patients an immense amount of money by doing this in a clinic setting. And if the patient insurance is covered by the state you are saving the state the money. You may ask who cares if I save the state money? With some Medicaid reimbursements being so low, I feel if dentistry can show we are saving the state thousands of dollars per case this can be used as rationale to raise reimbursement rates for clinical work provided. This maybe foolish thinking, but why should we waste limited resources when another option with just as safe track record is available?
#2. Patients/Parents of patients do not want to go to the hospital/surgery center. To most people it is scary taking your child to the hospital for surgery. Parents feel comfortable at the dental office and despite the fact that the same procedure is being provided they feel much more comfortable with the dental surgery taking place at the office. Simply, it is a huge practice builder. Not to mention generally it can be months before you can get a patient into a hospital for their dental surgery (greatly improves access to care).
#3. Turnover time. I am not sure about your hospital experience. But the hospital is the most unproductive, beurocratic place there can be. Our profession is about efficiency and no one can turn over a patient like a DA can in your office. I am currently in a dental residency program and the average wait is upwards of 90 minutes once I am done with the procedure before I can began my next patient. The hospital is the definition of inefficacy. Surgery centers are improved from the hospital. However, you cannot imagine the efficiency of this process in your clinic done by a DA.
Like I said at that start I hope this post is informative and in no way do I want to start any kind of argument with any one. Bottom line, I am for anesthesia in dentistry and not just by DAs but by all interested and knowledgeable dentists. It requires different training to provide different levels of anesthesia, but our patients deserve this. Dentistry must remain in charge of their own guidelines for anesthesia..
