Anesthesia for pediatric dental offices

[deleted547631]

This is very lucrative based on personal experience observing dental anesthesiologists (dentists trained at dental anesthesiology residencies) working at pediatric dental offices. Like $600/hr cash after overhead lucrative for a full eight hour day. I'm hardly hearing of MD groups expanding into this market. Why?

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[caligas]

It’s a complex situation, involving market forces, multiple types of “providers,” and politics. I’d explain more, but I don’t really know what I’m talking about.

 

[atomheart]

https://thedoctorweighsin.com/why-have-low-safety-standards-for-dental-anesthesia/

This article outlines some of the history between anesthesiology and dental anesthesia. There is a society for dental anesthesiology that mirrors the ASA and requires that members take the USMLE to obtain medical licensure. You can see some of the same age-old arguments made by nurses echoed in the dental community in that they believe their practice is different from that of medicine. I simply read this as code for dentists protecting their territory since the argument makes no sense to anyone. There is a conflict of interest between job security (greed) and patient safety in anesthesia (and by extension all of medicine, since all fields now have midlevels).

 

[Sublimazing]

Office based anesthesia is its own beast. Going to a dentist’s office is nothing like the OR and not like the majority of surgery centers where outpatient anesthesia residency training is typically done. And starting a business that involves selling yourself to dentists and buying mobile medical equipment is also drastically different than nearly all anesthesia positions out there.

Having said that, if an MD provider can offer the dentist the same speed and safety they would get from other providers they could very easily develop a thriving practice. I think dentists and parents all feel much safer when the person sleeping a 3yo airway case has an MD.

There are a handful of MDs who do this in SoCal, NW, and Texas...you should look them up and contact them. I also know of a few DAs who hire MDs, which may be a good way to gateway into the field. It’s definitely feasible, it just requires some leg work. It is very very lucrative if you can figure it out...Good luck!

 

[AdmiralChz]

This is very lucrative based on personal experience observing dental anesthesiologists (dentists trained at dental anesthesiology residencies) working at pediatric dental offices. Like $600/hr cash after overhead lucrative for a full eight hour day. I'm hardly hearing of MD groups expanding into this market. Why?

We looked into/were asked to cover it locally, and we wouldn’t even recoup overhead costs so politely declined. Not sure how you got that number but a lot of the groups around here rely on gov’t insurance...

 

[DirtDocMD]

Doing a 15 min case on a middle class pt whose parents are ok to pay $400-$600 is ok. Spending 1-1/2 or 2 hours doing a full mouth rehab on a medicaid kiddo for $200-$250 is another thing.

I’m amazed that the govt hasn’t started cracking down more on some of these pedi dental “mills”. Tons of kids (look at the stats on increased medicaid spending on pedi dental care) getting all this work on teeth that are going to fall out in a few years, anyway. All this money and risk because parents won’t get their kids to brush and some pedi dentists wanna make $$$.

 

[anbuitachi]

what do they usually give to these kids in the office anyway? ketamine ?(at least thats what i think i got when i was a kid getting dental procedure)

 

[Sublimazing]

what do they usually give to these kids in the office anyway? ketamine ?(at least thats what i think i got when i was a kid getting dental procedure)

If they have a portable gas machine it’s a simple mask down, IV, nasal tube and sevo...but usually it’s IM Ketamine, IV, nasal tube then Remi/Prop.

 

[anbuitachi]

If they have a portable gas machine it’s a simple mask down, IV, nasal tube and sevo...but usually it’s IM Ketamine, IV, nasal tube then Remi/Prop.

those sound like for long cases.

 

[Sublimazing]

those sound like for long cases.

They can run them with Remi/Prop and nasal trumpets if they don’t plan to tube. I’m describing dental anesthesiologists (their terminology)...anything less trained than them is a virtual crapshoot of techniques and sentinel events.

 

[coffeebythelake]

it's all about the money. dental offices want to keep their sedations in the office where they can bill for extra services but they don't want a specialized person conducting the anesthetic and able to handle emergencies. like most things in anesthesia and medicine, bad things happen rarely but when they do it can be disastrous. unfortunately patients and their families are none the wiser.

 

[aneftp]

6 hour guarantee. Min $400/hr. Meds/equipment are negotiable. The key is the 6 hour guarantee. Not worth ur trouble or time to come for 2 hours.

It’s a very lucrative practice.

Issue is many of the peds patients can be Medicaid and it becomes a puppy mill lucky getting $100/hr on obese peds patients.

 

[caligas]

We would be remiss not to mention these guys in the discussion:

American Society of Dentist Anesthesiologists

 

[Mr.S]

Ask yourself this question?

Do you want to be putting Peds dental kids to sleep at a dental office where you and only you know anything about rescue or hypoxia or anything?

Any complication.. gets reviewed at the state medical board level...

Most of us dont need that kinda stress.

so 600 bucks an hour is underpaid if you ask me

 

[propadope]

https://thedoctorweighsin.com/why-have-low-safety-standards-for-dental-anesthesia/

This article outlines some of the history between anesthesiology and dental anesthesia. There is a society for dental anesthesiology that mirrors the ASA and requires that members take the USMLE to obtain medical licensure. You can see some of the same age-old arguments made by nurses echoed in the dental community in that they believe their practice is different from that of medicine. I simply read this as code for dentists protecting their territory since the argument makes no sense to anyone. There is a conflict of interest between job security (greed) and patient safety in anesthesia (and by extension all of medicine, since all fields now have midlevels).

Please note that this article is specific to an incident that occured in California. Anesthesia guidelines vary state to state (and province to province in Canada) with regards to dentistry.

 

[propadope]

Doing a 15 min case on a middle class pt whose parents are ok to pay $400-$600 is ok. Spending 1-1/2 or 2 hours doing a full mouth rehab on a medicaid kiddo for $200-$250 is another thing.

I’m amazed that the govt hasn’t started cracking down more on some of these pedi dental “mills”. Tons of kids (look at the stats on increased medicaid spending on pedi dental care) getting all this work on teeth that are going to fall out in a few years, anyway. All this money and risk because parents won’t get their kids to brush and some pedi dentists wanna make $$$.

Its not necessarily the dentists’ fault. Once the damage is done you are left with a choice to fix the teeth/pull them out/ or let them rot and cause pain and infection. Of course this is a preventable situation. More has to be done to educate parents. A big problem is the parents are putting kids to sleep with a baby bottle. Its a systemic issue involving pediatricians, dentists, public health, etc... BUT ultimately its the parents responsibility.

Its no different than the effects of obesity, smoking, alcohol etc... on the healthcare system.

 

[anbuitachi]

Ask yourself this question?

Do you want to be putting Peds dental kids to sleep at a dental office where you and only you know anything about rescue or hypoxia or anything?

Any complication.. gets reviewed at the state medical board level...

Most of us dont need that kinda stress.

so 600 bucks an hour is underpaid if you ask me

but on the other side, the same applies to the dental anesthesiologists doing these cases. if they can do these cases with minimal complications, why cant we?

 

[deleted547631]

but on the other side, the same applies to the dental anesthesiologists doing these cases. if they can do these cases with minimal complications, why cant we?

The dental anesthesiologists I shadowed (combined 30 years experience) were very proficient. They have a great gig going on if you ask me and aren’t under the thumb of a medical board / medical billing rules (vs. dental billing rules).