Dental anesthesia practice

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Wondering if anyone has had success either with mobile dental anesthesia or setting up a dental anesthesia clinic and having dentists come in and providing the anesthetic for procedures.

 

[CopaceticOne]

Yes, people have had success with mobile dental anesthesia.

 

[pgg]

Yeah, it's a great gig if you like working in substandard, dangerous environments, surrounded by unqualified people, a lack of proper equipment, production pressure that leaves little room for appropriate PACU care (not that there's even a PACU or anyone qualified to work in a PACU), a complete absence of any kind of medical screening or exclusion criteria (beyond ability to pay cash), where the second most qualified person in the building is a guy (or girl) who thinks an "airway" is something that's there to hold the teeth.

One can have great success getting paid a couple hundred $ per hour by said airway non-expert who's charging a $1000 cash fee for dental sedation.

Much success.

Not all dental sedation jobs are like this, but enough of them are that you should assume any recruitment pitch is a bundle of cluelessness and lies to exploit you.


Setting up an anesthesia clinic wherethe dentists come to you? Why would they do that and miss the chance to skim cash for dental sedation off the top? Never heard of it.

The sane ones who aren't running that scheme take their patients to regular ASCs.

 

[SuxDrugs&Rocuronium]

Dental anesthesiology resident here. It can be a great gig but you have to travel with all the equipment (anesthesia machine, cart, emergency supplies etc). You can get a full setup for $30-$50k depending on how fancy.

There’s a huge need for it and it pays well but like the above poster said, you’re basically on your own. A lot of DAs will travel with a recovery nurse to assist them with all aspects of the case but some people are truly solo.

The nice thing is that since there is a huge need you can be very strict with your preop criteria and don’t have to feel that bad about cancelling cases.

My opinion, if you do end up doing dental anesthesia, nasally intubate. Don’t do open airway even though some will push you to do so

 

[SuxDrugs&Rocuronium]

Yeah, it's a great gig if you like working in substandard, dangerous environments, surrounded by unqualified people, a lack of proper equipment, production pressure that leaves little room for appropriate PACU care (not that there's even a PACU or anyone qualified to work in a PACU), a complete absence of any kind of medical screening or exclusion criteria (beyond ability to pay cash), where the second most qualified person in the building is a guy (or girl) who thinks an "airway" is something that's there to hold the teeth.

One can have great success getting paid a couple hundred $ per hour by said airway non-expert who's charging a $1000 cash fee for dental sedation.

Much success.

Not all dental sedation jobs are like this, but enough of them are that you should assume any recruitment pitch is a bundle of cluelessness and lies to exploit you.


Setting up an anesthesia clinic wherethe dentists come to you? Why would they do that and miss the chance to skim cash for dental sedation off the top? Never heard of it.

The sane ones who aren't running that scheme take their patients to regular ASCs.

Why wouldn’t you bill directly? Why wouldn’t you travel with your own recovery nurse to help recover? Why wouldn’t you require a proper medical screening? Why wouldn’t your make sure the proper equipment is there before doing a case? If you’re an anesthesiologist traveling to a dental office, it is on you to make sure all of these things are up to standard.

 

[cchoukal]

maybe 10 years ago, I was interviewing a candidate for an Anesthesia Tech position. She had a HS degree and her current job at the time was in a dental surgery clinic doing book-keeping and recovery "nursing."

 

[Maz777]

Why wouldn’t you bill directly? Why wouldn’t you travel with your own recovery nurse to help recover? Why wouldn’t you require a proper medical screening? Why wouldn’t your make sure the proper equipment is there before doing a case? If you’re an anesthesiologist traveling to a dental office, it is on you to make sure all of these things are up to standard.

Anesthesiologists have different standards than dentists pretending to be anesthesiologists.

Sorry to be blunt.

And we don't need advice on how to perform anesthesia.

 

[SuxDrugs&Rocuronium]

Ignorance at its finest. Someone asks for advice on doing dental anesthesia and when someone who does dental anesthesia more frequently than anyone else gives advice, you turn your nose down on it. Keep letting CRNAs sit your cases while you bitch about someone who went through a 3 year residency doing the same cases as you doing healthy outpatient dental.

 

[SuxDrugs&Rocuronium]

Anesthesiologists have different standards than dentists pretending to be anesthesiologists.

Sorry to be blunt.

And we don't need advice on how to perform anesthesia.

So keep those standards when you do dental cases. Problem is that you guys are the ones we hear about doing cowboy **** in dental offices. I know an MD who had a case of MH in a dental office and then later told the dentist they could reschedule and he’d just run TIVA. Wtf?

 

[SuxDrugs&Rocuronium]

maybe 10 years ago, I was interviewing a candidate for an Anesthesia Tech position. She had a HS degree and her current job at the time was in a dental surgery clinic doing book-keeping and recovery "nursing."

I’m talking about actual recovery nurses, not high school graduate “assistants”

 

[Gator7]

Do you inform your patients and/or parents (for Peds) that you are in fact not an anesthesiologist in the manner that the general public assumes?

Yes you can play with words, degrees, certificates, etc. I am well aware. Genuinely curious.

 

[SuxDrugs&Rocuronium]

Do you inform your patients and/or parents (for Peds) that you are in fact not an anesthesiologist in the manner that the general public assumes?

Yes you can play with words, degrees, certificates, etc. I am well aware. Genuinely curious.

I present myself as a “dentist anesthesiologist” since that is the official title.

Becoming a Dentist Anesthesiologist - ASDA

[...]Read More... from Becoming a Dentist Anesthesiologist

www.asda.org

 

[Gator7]

I present myself as a “dentist anesthesiologist” since that is the official title.

Becoming a Dentist Anesthesiologist - ASDA

[...]Read More... from Becoming a Dentist Anesthesiologist

www.asda.org

So no, you don’t.

 

[SuxDrugs&Rocuronium]

So no, you don’t.

How would you like that I present? I’m very transparent about being a dentist who completed a 3-year hospital based residency in anesthesia.

 

[Gator7]

Hi I’m suxdrugs&roc,

I will be in charge of giving anesthesia to your child and keeping them alive today. However, I am not an anesthesiologist, nor a physician. Do you understand and consent?

 

[SuxDrugs&Rocuronium]

Hi I’m suxdrugs&roc,

I will be in charge of giving anesthesia to your child and keeping them alive today. However, I am not an anesthesiologist, nor a physician. Do you understand and consent?

So basically the same thing as saying “I’m a DENTIST anesthesiologist that will be in charge of giving your child anesthesia today”

So can you explain to me what you know about our training? It seems like many of you don’t have a true understanding of how we are trained.

Also food for thought, it seems as though the ASA has no issue with calling us “dentist anesthesiologists” in the joint statement they put out

Joint Statement on Pediatric Dental Sedation

www.asahq.org

 

[pgg]

Why wouldn’t you bill directly? Why wouldn’t you travel with your own recovery nurse to help recover? Why wouldn’t you require a proper medical screening? Why wouldn’t your make sure the proper equipment is there before doing a case? If you’re an anesthesiologist traveling to a dental office, it is on you to make sure all of these things are up to standard.

I suppose one could do all those things, if one could find a dentist agreeable to the arrangement. That's ... uncommon.

I have a very negative opinion of "dental anesthesia" gigs in general because every single one of them that I've been exposed to has been some fly-by-night clown running a fabulously unsafe clinic, charging patients high fees for anesthesia, and looking for some desperate anesthesiologist to come work for them.

And every few months we have yet another thread here about yet another dental sedation death that fits that scenario exactly.

I get my own dental care done at a very nice clinic. They have an anesthesiologist come in regularly (weekly?) to do sedations. It's some independent guy ... older guy, near end of his career. (My group doesn't do that work and isn't interested.) I don't know what his arrangement there is, but I know they don't have a PACU and I know he doesn't bring anyone with him. I'm a little dubious about the whole thing, based on the little I've observed and been told.

The responsible dentists I've known take their patients to hospitals or ordinary ASCs for dental restorations under anesthesia. We do a bunch of them here in our hospital-attached surgicenter. A lot of them are special needs kids. That is fine.

As you well know, there are very, very few people like you (dentist anesthesiologists) out there. You'll be qualified, well trained, and safe once you finish training. But you're not the norm. I don't know what % of dental sedations or general anesthetics in the USA are provided by dentist anesthesiologists (maybe you have numbers) but it isn't most of them.

Google tells me "The American Society of Dentist Anesthesiologists (ASDA) has approximately 500 members in the U.S. and Canada." That's not a lot.

The point of my post above is that dental sedation/anesthesia in the USA, when done outside of hospitals/ASCs, is often a very shady, very dangerous business. You're not part of that problem, and good for you. I'd still caution any anesthesiologist to be very, very wary of any dentist trying to recruit them to do in-office cases.

 

[AdmiralChz]

Changing gears a little bit, I have experience doing some of these cases at a local ASC. They aren't great cases, and the reimbursement is abysmal for pediatric medicaid universally (in some states, the bills just go unpaid indefinitely). We used to joke that the cases don't even keep the lights on (why the ASC kept doing them is beyond me).

The key if you want to do this is to get access to the dental sedation / anesthesia codes which are different than the AMA codes. They pay much more appropriately. There was an article in this month's or last month's ASA Monitor about this, a few states are now opening them up to physicians but it is hardly widespread. To get around this, and get access to real reimbursement, several departments employ dental anesthesia folks to get access to this and then plug them into an established ASC/hospital environment. I have no clue how many dental anesthesia people there are out there, but doesn't seem like a ton.

 

[Dantrolene FC]

People on here are being inappropriately disrespectful to the dental anesthesia resident. They take a lot of the same classes along side us in our fist 2 years of med school. Then they do a 3 year anesthesia residency.

Would I trust them to do my thoracotomy? No. But they are much better trained than the OMFS guys who do 6 months with us then do all their own sedations.

I would trust a dental anesthesiologist to do my dental case more than an OMFS, CRNA, or independent AA. And if I had to choose between a random dental anesthesiologist I don’t know vs some anesthesiologists I know, I’ll take the dentist everytime.

This guy will probably do more dental cases in one year than we’ll do in our whole careers. I would suspect they do a good job weeding out the sick patients.

 

[ambiturner]

Changing gears a little bit, I have experience doing some of these cases at a local ASC. They aren't great cases, and the reimbursement is abysmal for pediatric medicaid universally (in some states, the bills just go unpaid indefinitely). We used to joke that the cases don't even keep the lights on (why the ASC kept doing them is beyond me).

The key if you want to do this is to get access to the dental sedation / anesthesia codes which are different than the AMA codes. They pay much more appropriately. There was an article in this month's or last month's ASA Monitor about this, a few states are now opening them up to physicians but it is hardly widespread. To get around this, and get access to real reimbursement, several departments employ dental anesthesia folks to get access to this and then plug them into an established ASC/hospital environment. I have no clue how many dental anesthesia people there are out there, but doesn't seem like a ton.

Timely article: Dental Anesthesia and Medicaid: Evolving Policies,... : ASA Monitor

 

[Gator7]

People on here are being inappropriately disrespectful to the dental anesthesia resident. They take a lot of the same classes along side us in our fist 2 years of med school. Then they do a 3 year anesthesia residency.

Would I trust them to do my thoracotomy? No. But they are much better trained than the OMFS guys who do 6 months with us then do all their own sedations.

I would trust a dental anesthesiologist to do my dental case more than an OMFS, CRNA, or independent AA. And if I had to choose between a random dental anesthesiologist I don’t know vs some anesthesiologists I know, I’ll take the dentist everytime.

This guy will probably do more dental cases in one year than we’ll do in our whole careers. I would suspect they do a good job weeding out the sick patients.

This is the same argument CRNAs use.

As has been stated by others before, if you want to be an anesthesiologist go to medical school.

 

[unkemptmiso]

It's important to be respectful of all trainings, and but this is unfortunately the mindset that got the ASA and our specialty in the mess it's in right now. Just to set a few facts straight-

DA's do not sit the same cases as physicians. Most training programs exclude DAs from cardiac, OB, neuro, trauma, regional cases. There is also no DA program that has ICU training included. These are huge gaps in knowledge, and factually you cannot argue the training is the same.

Most hospitals will not credential a graduated DA to do any cases besides a head and neck case. There are very good reasons for this, many of which come from risk management and insurance companies unwilling to underwrite their policies. What the DA's are able to do in the office is another story.

Out of respect, the ASA has let DA's join the organization. This is weird to me, as ASDA does not let physicians join. Go figure lol.

I am not advocating for or against DA's. Statistically, there are so few of them that I could care less about what they do and how they do it. But, I am really fed up with everyone claiming they have physician level training, when in fact no one besides an MD/DO can match that.

 

[SuxDrugs&Rocuronium]

This is the same argument CRNAs use.

As has been stated by others before, if you want to be an anesthesiologist go to medical school.

The difference is training. Our training is not equivalent to CRNAs so that’s a pretty big point to gloss over.

Anyway, I don’t give a **** about titles and you can call me whatever you’d like. All I know is that we are more than adequately trained to safely provide anesthesia for dental cases. We do the same craniotomies, traumas, ACS, vascular, BMI 60 egds, and other surgeries in residency that you guys do. At my program we’re treated the same and take the same call as you guys. I’ve been in multiple traumas requiring invasive monitoring and MTPs, I’ve been in countless codes and dealt with all sorts of emergencies in cases.

Also if you have such an issue with the ~500 of us, why don’t you lobby for the hospitals to do more of these cases? Because most MDs don’t want to do them and hospitals don’t either because of poor reimbursement. But these patients (many who are kids or special needs) with bombed out mouths don’t cooperate with a drill spinning at 300,000 rpms in their mouth. So if you don’t want us putting them to sleep, they can’t safely get their mouths fixed and then they’ll end up in your ED with facial abscesses or dead.

 

[SuxDrugs&Rocuronium]

It's important to be respectful of all trainings, and but this is unfortunately the mindset that got the ASA and our specialty in the mess it's in right now. Just to set a few facts straight-

DA's do not sit the same cases as physicians. Most training programs exclude DAs from cardiac, OB, neuro, trauma, regional cases. There is also no DA program that has ICU training included. These are huge gaps in knowledge, and factually you cannot argue the training is the same.

Most hospitals will not credential a graduated DA to do any cases besides a head and neck case. There are very good reasons for this, many of which come from risk management and insurance companies unwilling to underwrite their policies. What the DA's are able to do in the office is another story.

Out of respect, the ASA has let DA's join the organization. This is weird to me, as ASDA does not let physicians join. Go figure lol.

I am not advocating for or against DA's. Statistically, there are so few of them that I could care less about what they do and how they do it. But, I am really fed up with everyone claiming they have physician level training, when in fact no one besides an MD/DO can match that.

See the comment I just posted, but we do actually do a lot of the same cases, at least at my program. (We are in traumas, neurosurgery, and regional and we do get icu training our third year). I’m not saying the training is identical, but to try and discount our training is disingenuous.

 

[Mman]

The difference is training. Our training is not equivalent to CRNAs so that’s a pretty big point to gloss over.

not equivalent to CRNAs, not equivalent to anesthesiologists.



As for the job of providing services in these clinics, for me the pay is crappy and the job is too dangerous for the crappy pay so I will leave it to those more desperate for work.

 

[Dantrolene FC]

See the comment I just posted, but we do actually do a lot of the same cases, at least at my program. (We are in traumas, neurosurgery, and regional and we do get icu training our third year). I’m not saying the training is identical, but to try and discount our training is disingenuous.

I have to ask because I/we are making assumptions.

Are you doing the anesthesia and another dentist is doing the surgery? Or are you doing both simultaneously?